Hashimoto's?

[karib574]

Might I have Hashimoto's?  Here are my test results from yesterday:

TSH:  1.35 uIU/mL  (Ref:  0.47 - 5.01 uIU/mL)
Free T4:  0.77 ng/dL  (Ref:  0.70 - 1.50 ng/dL)

I also had TPO tested but have not received results yet.

My symptoms include fatigue, tingling hands, occasional muscle cramps, depression/anxiety, sensitive to cold, high cholesterol, poor memory/brain fog.

I have not experienced weight gain and am in pretty good shape.  I do not believe I have an enlarged thyroid.  Would these factors rule out a Hashimoto's diagnosis?

[gimel]

Tirosint is a hypoallergenic version of T4.  Users like it, but it is more expensive than generic T4 med.  The 25 mcg dose is a small starting dose that is unlikely to do anything for your Free T4 and Free T3 levels and symptoms.  I say that because serum thyroid hormone is a sum of both natural thyroid hormone and thyroid med.  As you start on the med, your TSH will go down and reduce the flow of natural thyroid hormone.  Your levels will rise significantly only after TSH is basically suppressed and no longer part of the picture.  At that point further your Free T4 and Free T3 will rise consistent with your med dosage increases.  

So, two things to guard against.  One is that your doctor may mistakenly believe that a suppressed TSH indicates hyperthyroidism and will want to reduce your med dosage, even though it likely would not even be enough to relieve hypo symptoms.  This is wrong.  TSH is typically suppressed when taking significant doses of thyroid med.  That does not mean hyperthyroidism unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, which won't be the case.  

Two is that Your doctor won't be aware of the need to treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, rather than by test results.  Symptom relief should be all important.  

I also don't understand why your doctor ran a TSH Receptor Ab test.

I am not sure of the value of seeing a Naturopath if you can assure that your current doctor is willing to treat for symptoms as described, rather than by test results.  Also would ask if that doctor is wiling to prescribe T3 meds like Armour Thyroid and Cytomel, if it becomes necessary to get your Free T3 high enough to relieve symptoms.  And don't forget to push for tests for Vitamin D, B12 and ferritin and then supplement as needed to optimize.  

Last, from your TSH and FT4/FT3 levels I expect that you have central hypothyroidism, which is a dysfunction of the hypothalamus/pituitary system that results in relatively low TSH that does not adequately stimulate the thyroid gland to produce hormone.   In view of that I also suggest testing for cortisol.  

[karib574]

Thank you so much for the information.  I received my Free T3 results today, which I didn't realize was tested for.  Here are the results:

T3, Free: 2.7 pg/mL  Ref:  2.4 - 6.8 pg/mL

I had ferritin tested a couple years ago and it was:

FERRITIN:  28.60 ng/mL Ref:  11.00 - 307.0 ng/mL

Also had the following iron tests at the same time:

TIBC:  504 ug/dL  Ref:  260 - 490 ug/dL
% SATURATION:  15.5 %  Ref:  20.0 - 50.0 %
IRON:  78 ug/dL  Ref:  28 - 170 ug/dL

The ferritin was some time ago.  I will ask for a retest, as well as the other tests you recommended.  Still awaiting TPO results.  Thank you again.

[gimel]

Apparently your doctor recognizes that you have hypo symptoms and that just being in the low end of the range for Free T4 and Free T3 does not mean that all is well.  The ranges are far too broad, due to the erroneous assumptions used in establishing the ranges.  So it is a good step that your doctor has prescribed thyroid med.  Now you will need to continue to make sure they test for Free T4 and Free T3 each time you go in and keep pushing for increases until your symptoms are relieved.  

Also don't overlook the importance of Vitamin D, B12 and ferritin.  Your ferritin is way too low, so you need to supplement with a good iron supplement.  Once you get your D and B12 tested you can supplement s needed to optimize.  D should be 50 min., B12 in the upper end of its range, and ferritin should be 70 min.

When you find out your medication and dosage, please let us know.

[karib574]

Here is my prescription.  Thoughts?  Thinking of not picking it up just yet and seeing a naturopath first.

TIROSINT 25 MCG CAPSULE

Supposed to take it once per day.

[gimel]

Both your Free T4 and your Free T3 are extremely low in their ranges, consistent with having hypothyroid symptoms.  Typically we recommend Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, adjusted as needed to relieve symptoms.  Your ferritin test was also much too low,  Optimal is at least 70.  

So you have much to discuss with your doctor:  tests for Vitamin D, B12 and ferritin again.  You also should ask for a prescription for thyroid med.  And most important is to find out if the doctor is going to be willing to treat clinically as described.  If you need help convincing the doctor to treat clinicaly, I have sent you a PM with some info.  

[karib574]

Thank you again.  Here is one more test result.  It looks normal, I think.

TSH Receptor Ab:  <0.80 IU/L  (Ref:  <1.76 IU/L)

[karib574]

I'm not sure why she ordered this test.  Seems to be a test for HYPERthyroidism...?

[karib574]

Doctor's office called this morning and said all TSH, F4, and F3 were all normal and antibody test was negative.  But she sent in a prescription for me to start low lose.  Not sure what it is, have to go pick it up.  I'm confused why she gave me a prescription if, according to her, everything is normal.  But glad she's listening to me.

[gimel]

To access the PM, just click on your name and then from your personal page, click on messages.  

[gimel]

Nothing so far that you have posted rules out or in the possibility of Hashi's; however, with Hashi's we most often see an elevated TSH.  Even if the TPO ab test is negative, they should also test for Thyroglobulin antibodies (TG ab).  If that is also negative there is the possibility of central hypothyroidism, which is a dysfunction of the hypothalamus/pituitary system that results in TSH levels too low to adequately stimulate the thyroid gland to produce needed thyroid hormone.  

You have many hypothyroid symptoms, consistent with your low Free T4; however, you should make sure they always test for both Free T4 and Free T3 every time you go for tests.  Studies have shown that Free T3 correlates best with hypo symptoms.  

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

Since hypo patients are so frequently too low in the ranges for Vitamin D, B12 and ferritin, I also suggest getting those tested as well.  Then you can supplement as needed to optimize.  D should be about 50 min., B12 in the upper end of its range, and ferritin should be about 70 min.  

When you have contact with your doctor next you should ask about the additional testing and also if he is going to be willing to treat clinically as described, rather than just based on test results.   If not then you will ultimately need to find a good thyroid doctor that will do so.  

Assuming that you are able to get the additional tests done, then please post results and reference ranges shown on the lab report and we will be glad to help interpret and advise further.