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Hashimoto's Lab Results
I have recently been diagnosed with Hashimoto's, but my endro is not the greatest at explaining anything. My thyroid was originally tested by my OB because of fatigue, depression, constipation, insomnia, anxiety, irritability etc. She noticed my thyroid results were abnormal and sent me to my endro. When he first met with me he was confused as to why I was even there. After asking me some questions and giving me a physical he said "You seem perfectly healthy to me, your thyroid values are fine, I think you're suffering from postpartum depression." I just had my baby 7 months ago so I thought maybe it's possible? He decided to do some more blood work to be sure, but he thought it was nothing. He then calls me 2 weeks later and says you have Hashimoto's and I want to see you. He did not really explain to me what it was or how to take the medication that he handed me. He just handed me my labs, synthroid, and said see you in 6 weeks. I don't understand how my blood work results changed so dramatically in the matter of 6 weeks (from the time my OB had me tested and my endro). Has that happened to anyone else? Is that normal? Is there a possibility that they confused my lab work with someone else? Can someone also please help me understand my lab work results? I'm so confused. I called my doctor with these questions and he hung up on me.. In the mean time I have scheduled an appt with a new endro, I just want to understand my diagnosis.
T4, FREE, NON-DIALYSIS 0.9ng/ dL 0.8-1.8
T4, TOTAL 5.6 ug/dL 4.5-12.0
TSH 5.70 mlU/L 0.40-4.50
TPO ANTIBODIES 394 IU/mL <9
THYROGLUBULIN ANTIBODIES 46 IU/mL < or =1
Also, when am i supposed to take synthroid? He gave me some samples do build me up to the proper dose, but did not provide me with any instructions. Also should I take Synthroid? I read that some people hated it and I heard some people have taken a more natural approach to treating their Hashimoto's symptoms. Opinions? Also, I am currently on Lo loestrin fe (birth control), will that interfere?
Thanks in advance for any help understanding all of this!
T4, FREE, NON-DIALYSIS 0.9ng/ dL 0.8-1.8
T4, TOTAL 5.6 ug/dL 4.5-12.0
TSH 5.70 mlU/L 0.40-4.50
TPO ANTIBODIES 394 IU/mL <9
THYROGLUBULIN ANTIBODIES 46 IU/mL < or =1
Also, when am i supposed to take synthroid? He gave me some samples do build me up to the proper dose, but did not provide me with any instructions. Also should I take Synthroid? I read that some people hated it and I heard some people have taken a more natural approach to treating their Hashimoto's symptoms. Opinions? Also, I am currently on Lo loestrin fe (birth control), will that interfere?
Thanks in advance for any help understanding all of this!
COMMUNITY LEADER
You're very welcome. I hope this puts your mind at ease a little bit. It might be helpful to make a list of questions for next time you see your endo, so you can make sure you get to ask them all and don't forget any.
Don't be afraid to come back and ask whatever questions you have, in the meantime.
Don't be afraid to come back and ask whatever questions you have, in the meantime.
I was not on any thyroid medication for either of these tests. And thank you so much all of this information has been so helpful!
COMMUNITY LEADER
Were you on thyroid medication when your OB did the tests in July? If so, what med and what dosage?
It's very possible that your labs changed that much in just 6 weeks. It's unlikely that your blood was confused with someone else's.
While Hashimoto's is, most often, associated with hypothyroidism, it's often characterized in the early stages with periods of hyperthyroidism, which can alternate with hypo and even periods of normal, before finally settling into permanent hypo. The periods of hyper can last for months, weeks or even days and the swings can go quickly or take their time.
It looks like you might have been in a period of hyper in July, when your OB ran the tests and by the time your endocrinologist tested your blood, you'd swung over to hypo.
Many of the symptoms can apply to either/both hyper or hypo, such as the fatigue, depression, anxiety, insomnia and irritability.
It's very possible that your labs changed that much in just 6 weeks. It's unlikely that your blood was confused with someone else's.
While Hashimoto's is, most often, associated with hypothyroidism, it's often characterized in the early stages with periods of hyperthyroidism, which can alternate with hypo and even periods of normal, before finally settling into permanent hypo. The periods of hyper can last for months, weeks or even days and the swings can go quickly or take their time.
It looks like you might have been in a period of hyper in July, when your OB ran the tests and by the time your endocrinologist tested your blood, you'd swung over to hypo.
Many of the symptoms can apply to either/both hyper or hypo, such as the fatigue, depression, anxiety, insomnia and irritability.
Ok I have the results from my OB. Originally she tested me in July and the results were:
TSH .38mlU/L .40-4.50
T4, FREE, NON-DIALYSIS 1.5ng/dL .8-1.8
These results were different 6 weeks later when my endro tested me. I have the results listed above, but just to reference them again:
TSH 5.70mlU/L. .40-4.50
T4, FREE, NON-DIALYSIS .9ng/dL .8-1.8
Is it normal for these to chane that much in 6 weeks? Or am I crazy for thinking my bw results could have been confused with someone else's?
TSH .38mlU/L .40-4.50
T4, FREE, NON-DIALYSIS 1.5ng/dL .8-1.8
These results were different 6 weeks later when my endro tested me. I have the results listed above, but just to reference them again:
TSH 5.70mlU/L. .40-4.50
T4, FREE, NON-DIALYSIS .9ng/dL .8-1.8
Is it normal for these to chane that much in 6 weeks? Or am I crazy for thinking my bw results could have been confused with someone else's?
COMMUNITY LEADER
I'm understanding that your OB ran these tests, not your endo, is that correct? And your endo expects you back in 6 weeks, right? For further testing? Hopefully, at that time, he will test the FT3, along with FT4 and TSH.
There isn't really anything you can do to stop the antibody attack and you will be on some sort of thyroid replacement hormone for life. It was nice of your endo to provide you with samples of the Synthroid, rather than making you fill a script, since it sounds like he might started you at a low dose and intends to increase you. It would, however have been nice if he'd have explained its use.
Synthroid should be taken first thing in the morning, on an empty stomach, with a cup of water. According to the instructions you should wait 30-60 minutes after taking the pill before eating or drinking anything but water. Most of us go ahead and have coffee, but refrain from eating. You should maintain at least a 4 hour distance between Synthroid (or other thyroid replacement hormones) and vitamins/minerals, particularly, calcium - usually best to thyroid hormones in the morning and vitamins/minerals at noon or bedtime. You should talk to your pharmacist about an interaction with your birth control. There shouldn't be one, but you should probably maintain separation between taking your Synthroid and other medications if possible. For instance, I take my thyroid meds first thing in the morning, then wait about an hour before I take my blood pressure and other meds.
Since your doctor didn't tell you anything else, he probably didn't tell you that it takes 4-6 weeks for the med to build in your blood, which is why he's having you come back in 6 weeks, at which time he will most likely do blood work to see how the med is working.
If he doesn't order FT3 on the next visit and isn't more forthcoming with information, then I certainly agree that you should start looking for a different doctor.
There isn't really anything you can do to stop the antibody attack and you will be on some sort of thyroid replacement hormone for life. It was nice of your endo to provide you with samples of the Synthroid, rather than making you fill a script, since it sounds like he might started you at a low dose and intends to increase you. It would, however have been nice if he'd have explained its use.
Synthroid should be taken first thing in the morning, on an empty stomach, with a cup of water. According to the instructions you should wait 30-60 minutes after taking the pill before eating or drinking anything but water. Most of us go ahead and have coffee, but refrain from eating. You should maintain at least a 4 hour distance between Synthroid (or other thyroid replacement hormones) and vitamins/minerals, particularly, calcium - usually best to thyroid hormones in the morning and vitamins/minerals at noon or bedtime. You should talk to your pharmacist about an interaction with your birth control. There shouldn't be one, but you should probably maintain separation between taking your Synthroid and other medications if possible. For instance, I take my thyroid meds first thing in the morning, then wait about an hour before I take my blood pressure and other meds.
Since your doctor didn't tell you anything else, he probably didn't tell you that it takes 4-6 weeks for the med to build in your blood, which is why he's having you come back in 6 weeks, at which time he will most likely do blood work to see how the med is working.
If he doesn't order FT3 on the next visit and isn't more forthcoming with information, then I certainly agree that you should start looking for a different doctor.
First off I would highly recommend that you find yourself another Dr.
Secondly, Hashimoto's is the #1 cause for hypothyroidism -low thyroid or simply referred to here as "hypo" in the industrialized world. It is an autoimmune condition where for whatever reason your immune system believes that your thyroid gland is actually a foreign invader. And like a good immune system is supposed to do it creates antibodies to "kill" the foreign body. Which in this case is your thyroid gland.
What this means is that your immune system is progressively attacking your thyroid gland. As a result your thyroid gland is able to produce less and less thyroid hormone over time. In some people the process to completely render your thyroid gland useless takes years. In others it takes a very short time. never the less, what you need to know is that you must be your own best advocate and you will need to keep taking thyroid medication and the dosage may have to increase over time to make up for the less and less production of hormone from your thyroid gland.
Hashimoto's is diagnossed primarily upon the two antibody tests that you list above. It is positive if one or the other or both of them have a lab result showing that they are elevated. In your case, it appears BOTH of the antibodies are elevated so it is almost assured that you in fact have Hashi's.
You really need to spend a lot of time educating yourself. You can do a gread deal of that here if you simply read enough posts.
Back to my recommendation to find a new Dr. It is due to the lab results at least as I interpret them having learned a lot here over the years. How your Dr could say initially that you were "normal" and everything is find is beyond me.
The TSH test which stands for (Thyroid Stimulating Hormone) this is a screening test at best. Dr's were taught and unfortuanatly appear to still be taught that TSH is the gold standard test for thyroid function. Nothing could be further from the truth! However even as a screening tool your TSH test showed an elevated result. This is an indication that you may likely be Hypo or low thyroid.
many have found here that in order for many who are symptomatic yet may be "within the reference range" of the lab result have found that they need to be well up into the range before they feel well and symptooms disappear. The rule of thumb is that you need to have BOTH of the following:
1) Free T4 (FT4) should be 50% of the range if not slightly more. Your test result above shows you to be low in the range at only a measly 10% of the range! The "total T4" test is an outdated test of little value but it too shows you to be very low in the range at only 14.5% of the range.
AND -This means in addition to
2) Free T3 (FT3) to be in the UPPER half and many people say up to 66.7% of the range.
Free T3 is the ONLY hormone that is actually used by your body's cells. Unfortunately you were not tested for Free T3. It is up to you to DEMAND that you be tested for FT3 in addition to FT4 every time you are tested. You may get some resistence by your Dr as they again are told in med school that everyone converts the T4 in a persons blood into usable T3 properly. And again nothing could be further from the truth. Many people have poor conversion. But there is no way to determine if that is an issue if you are not tested for FT3. And simply ask yourself this basic question:
If Free T3 hormone is the ONLY hormone that is actually ultimately used by your body at the cellular level, why would you not want to test for this???? It seems like it would be blatantly obvious but unfortunately our medical industry has not learned how to effectively and properly test and treat thyroid patients. Getting the medical industry to shift paradigms away from TSH and maybe Free T4 testing only is a challenge. The next challenge is getting them to understand that simply being in a reference range has NOTHING to do with a specific individual's optimum level.
By the way. TSH is a pituitary hormone, NOT a thyroid hormone. TSH is a hormone produced by the pituitary in your brain that is supposed to regulate; that is to increase or decrease production of the thyroid gland hormones. In other words it is only a "signal" much like the signal your thermostat on your house telling your furnace or air conditioner to kick on or off. In a perfect world this would all work great. But we do not live in a perfect world.
How would you react if your furnace was not working. But when the furnace repairman shows up he ONLY checks the signal from the thermostat and ignores that your house is freezing cold. But he tells you that "everything is fine" with your furnace because the thermostat signal was perfectly within normal limits.?
You would be rightfully outraged and woud "fire" that heating repair man! Well this is identical to what the medical industry does with TSH. You could come in with every symptom in the book for low thyroid, but as long as the TSH test was within range they tell you that it is not your thyroid and you are "fine."
Similar is pretty much true with regard to Free T4 and Free T3. Where a Dr may simply believe that as long as you are "somewhere" within the range that you are fine. That is totally a pile of male bovine manure!
Secondly, Hashimoto's is the #1 cause for hypothyroidism -low thyroid or simply referred to here as "hypo" in the industrialized world. It is an autoimmune condition where for whatever reason your immune system believes that your thyroid gland is actually a foreign invader. And like a good immune system is supposed to do it creates antibodies to "kill" the foreign body. Which in this case is your thyroid gland.
What this means is that your immune system is progressively attacking your thyroid gland. As a result your thyroid gland is able to produce less and less thyroid hormone over time. In some people the process to completely render your thyroid gland useless takes years. In others it takes a very short time. never the less, what you need to know is that you must be your own best advocate and you will need to keep taking thyroid medication and the dosage may have to increase over time to make up for the less and less production of hormone from your thyroid gland.
Hashimoto's is diagnossed primarily upon the two antibody tests that you list above. It is positive if one or the other or both of them have a lab result showing that they are elevated. In your case, it appears BOTH of the antibodies are elevated so it is almost assured that you in fact have Hashi's.
You really need to spend a lot of time educating yourself. You can do a gread deal of that here if you simply read enough posts.
Back to my recommendation to find a new Dr. It is due to the lab results at least as I interpret them having learned a lot here over the years. How your Dr could say initially that you were "normal" and everything is find is beyond me.
The TSH test which stands for (Thyroid Stimulating Hormone) this is a screening test at best. Dr's were taught and unfortuanatly appear to still be taught that TSH is the gold standard test for thyroid function. Nothing could be further from the truth! However even as a screening tool your TSH test showed an elevated result. This is an indication that you may likely be Hypo or low thyroid.
many have found here that in order for many who are symptomatic yet may be "within the reference range" of the lab result have found that they need to be well up into the range before they feel well and symptooms disappear. The rule of thumb is that you need to have BOTH of the following:
1) Free T4 (FT4) should be 50% of the range if not slightly more. Your test result above shows you to be low in the range at only a measly 10% of the range! The "total T4" test is an outdated test of little value but it too shows you to be very low in the range at only 14.5% of the range.
AND -This means in addition to
2) Free T3 (FT3) to be in the UPPER half and many people say up to 66.7% of the range.
Free T3 is the ONLY hormone that is actually used by your body's cells. Unfortunately you were not tested for Free T3. It is up to you to DEMAND that you be tested for FT3 in addition to FT4 every time you are tested. You may get some resistence by your Dr as they again are told in med school that everyone converts the T4 in a persons blood into usable T3 properly. And again nothing could be further from the truth. Many people have poor conversion. But there is no way to determine if that is an issue if you are not tested for FT3. And simply ask yourself this basic question:
If Free T3 hormone is the ONLY hormone that is actually ultimately used by your body at the cellular level, why would you not want to test for this???? It seems like it would be blatantly obvious but unfortunately our medical industry has not learned how to effectively and properly test and treat thyroid patients. Getting the medical industry to shift paradigms away from TSH and maybe Free T4 testing only is a challenge. The next challenge is getting them to understand that simply being in a reference range has NOTHING to do with a specific individual's optimum level.
By the way. TSH is a pituitary hormone, NOT a thyroid hormone. TSH is a hormone produced by the pituitary in your brain that is supposed to regulate; that is to increase or decrease production of the thyroid gland hormones. In other words it is only a "signal" much like the signal your thermostat on your house telling your furnace or air conditioner to kick on or off. In a perfect world this would all work great. But we do not live in a perfect world.
How would you react if your furnace was not working. But when the furnace repairman shows up he ONLY checks the signal from the thermostat and ignores that your house is freezing cold. But he tells you that "everything is fine" with your furnace because the thermostat signal was perfectly within normal limits.?
You would be rightfully outraged and woud "fire" that heating repair man! Well this is identical to what the medical industry does with TSH. You could come in with every symptom in the book for low thyroid, but as long as the TSH test was within range they tell you that it is not your thyroid and you are "fine."
Similar is pretty much true with regard to Free T4 and Free T3. Where a Dr may simply believe that as long as you are "somewhere" within the range that you are fine. That is totally a pile of male bovine manure!
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