What do you make of these labs

[blade3]

August
TSH 1.0
Free T4: 17 (10-20)
Free T3: 6.8(3.8-6.8)
Total Testosterone 11(10-33)

November
TSH 1.0
Free T4: 17(10-20)
Free T3: 6.5(3.6-6.5)
TRAB 0.5(<1)

Symptoms:
Chronic Fatigue
Hypertension
Uncontrollable weight gain
No libido
Cracking joints
Head Fog
Anxiety
Low body temperature readings

So I seem to have a mix of hyper and hypo symptoms, but my labs would suggest more towards hyper? Or should I entirely forget trying to associate my health problems with thyroid? Any chance a pituitary tumor could produce these results?

I have noticed in the past occasionaly my throat area feels a bit strained Sometimes the tone of my voice changes from assertive and strong, to feeling a bit weak. For someone whos has progressively, uncontrollably gained 15kg in a year, my body function doesnt seem to match the thyroid lab readings.

[goolarra]

Which antibody was that...TPOab or TGab?

RT3 is a controversial subject.  Most of mainstream medicine denies any importance; "it's nothing but neutralized T4".  However, some in alternative medicine believe that the ratio of FT3 to RT3 is the best measure we have of tissue thyroid levels (there's no way to measure those).  So, many doctors don't order it and won't upon request.

FT4 is converted to both FT3 and RT3; that's normal.  RT3 is inert, so when FT3 levels (or FT4 levels) get too high, more conversion is shunted toward RT3.  This is typically a survival mechanism.  RT3 levels go up during some illnesses, trauma, starvation (even crash dieting), etc.  However, sometimes the production of too much RT3 seems to outlive the stimulus that caused it to begin with.  That's when it becomes problematic.

Since your FT3 and FT4 levels are actually on the hyper side, if FT3 isn't getting into cells and your tissue levels are low, you are going to feel hypo.  The final step, beyond the serum testing we do, is the actual transport into cells.

If you want to do some reading, check out RT3 dominance.

  

[Red_Star]

Dr Kaslow has an article on Pyroluria which is interesting to read.

"Pyroluria is managed in part by restoring vitamin B6 and zinc.  The type of replacement therapy is very important as zinc must be provided in an efficiently absorbed form. Vitamin B6 is also available in several forms. Both zinc and B6 supplementation need to be directed by the doctor as too much can be toxic, use of the wrong form will be ineffective, and avoiding competing minerals and supplements may be necessary. Other nutrients may assist in pyroluria include niacinamide, pantothenic acid, manganese, vitamins C and E, omega-6 fatty acids and cysteine. Food sources and nutritional supplements containing copper and red/yellow food dyes should be avoided."

[blade3]

Well I have taken zinc in the past, sometimes I feel nothing and sometimes I feel better followed by feeling worse. I have been tested for a "condition" called pyroluria. I use quotations because I'm not entirely convinced its a real conditon. It came back positive(something like 24(>15)). And a red cell zinc showed low end. I believe it was something like 63(60-80), i'll have to dig it up.

I've tried zinc numerous times but always end up feeling worse. Even in combination with copper, magnesium & manganese.

[Red_Star]

Well that was my experience anyway. :)  Are you taking zinc? Copper can be depleted when taking zinc supplements. An interesting test you might want to try out is the myxedema skin pinch test. There is a demo on youtube: Hypothyroidism Type 2: Myxedema Symptoms.

[blade3]

thanks for the feedback. I have supplemented with Vit D and B12 in the past, along with many other vitamins and minerals but my blood pressure had been progressively getting worse so I stopped(even when adding magnesnium). Now that I am on BP meds I can try again.

For some reason I find copper stops panic attacks and severe anxiety, although it comes with its own set of symptoms, like a low level depression. I was thinking maybe the copper, while not necessarily being deficient in it, was helping to slow down my thyroid. But thats just taking a stab. I dont know if im hypo or hyper or if any of my symptoms or reactions have anything to do with thyroid.

[Red_Star]

My cellular hypothyroid symptoms worsened when I wasn't taking enough sublingual B12 spray. I increased my B12 dosage (was using my B12 very sparingly for a week as I had almost run out) and my B12 deficiency symptoms vanished and my cellular hypothyroid symptoms improved.  My cellular hypothyroid symptoms disappear when I'm very hyperthyroid.  Correcting my vitamin D deficiency had no notable affect with thyroid symptoms.

[blade3]

Antibody test have come back mid range twice, 33(<60) etc.

Yeah I know my total T is low. My total T in the past has usually been mid range or a bit higher. This is the lowest result I have had so far. I want to rule out thyroid issue before I address testosterone, as from what I understand thyroid can effect T levels but not vice versa. And my TSH has slightly crept up from a usual of 1.3-1.5 to 1.0 last two tests.

I have never had a reverse T3 suggested by a doc or my endo. How important is it? Could I have "normal" standard tests like tsh, FT3 and FT4 yet RT3 out of whack?

[goolarra]

B12 can mimic hypo symptoms.  It has to be well up into the range.  The lower limit of the range in this country is basically ridiculous.  However, B-12 doesn't help with the metabolism of thyroid hormones at the cellular level.  

Both vitamin D and iron (ferritin specifically) have to be present in sufficient quantity or thyroid hormones can't get into cells where they have to be to do their work.  Once again, just being low in range isn't enough.  

In addition, your testosterone is on the low side, and the whole endocrine system is interdependent.  So, a disturbance in one portion of it can cause other parts to try to compensate.

What about thyroid antibody tests?  Have you had any of those?

Was RT3 ever tested?

[blade3]

I've had copper, zinc, B12, Vit D, RCF and a few others. What vitamins and minerals specifically are you talking about to help metabolize?

[goolarra]

You're right; your labs lean toward the hyper side.  FT4 is at 70% of range, and FT3 is at 100%.  TSH is fairly consistent with FT4, I think, so I don't really see a pituitary issue indicated.  

Have you had any vitamin and mineral testing?  Even with adequate serum FT3 and FT4 levels, we can be hypo at the cellular level if the vitamins and minerals necessary to metabolize thyroid hormones aren't available.