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Help with these Lab results please, hyperthyroid?

Hello, I am a 26 year old female, 5'7 138 pounds. For several years now I've had chronic anxiety and depression. I  also have thinning hair, sensitivity to light,heart palpitations, brain fog, no motivation, lethargic. I'm still looking for a good doctor to help me with this. Thank you gor any help! Here are my recent lab results:

 

Thyroxine, Free T4 (Direct):  1.90 ng/dL (0.82-1.77)

 

TSH:  0.726 uIU/mL (0.450-4.500)

 

Reverse T3: 35.3 ng/dL (9.2-24.1)

 

Thyroglobulin Antibody:  <1.0  IU/mL  (0.0-0.9)

 

Thyroid Peroxidase (TPO) Ab:  6 IU/mL  (0-34)

 

Triiodothyronine (T3), Free: 3.1 pg/mL  (2.0-4.4)

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Avatar universal
Agreed.  I'm not ignoring you, I just have your post on a back burner.  LOL

Yes, there is a bit of chicken and egg going on, but with TSH relatively high and FT4 over range, I'm tending to focus on that.  FT3 is at 46% of range, not terrible for someone not on meds.  FT3 appears to be being kept in check; that's why RT3 is high  It seems conversion is working beautifully.  Peripheral conversion to T3 is accomplished by a different deiodinase than pituitary conversion is, and the pituitary's deiodinase is much more efficient.  So, one might expect that a properly functioning pituitary would be lowering TSH due to its own higher levels of T3.  

As I said, I think the probability of a toxic nodule or Graves' is very low, but I feel they have to be eliminated.  The vitamin and mineral tests might be required if no other cause is found for the high FT4, but right now, we have a red flag on the thyroid...over range FT4 and unsuppressed TSH.  A little further thyroid testing and perhaps treatment to lower FT4 somehow seems less daunting than testing for a whole list of possible causes of high RT3, when we already have one staring at us.

Either of our approaches is valid.  I'd just follow the red flag we already have before looking for more.  Interesting discussion...    
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Avatar universal
Okay, so both of you are ignoring my alternate theory.  LOL  I see it as being like the old question of which came first, the chicken or the egg:  a toxic nodule causing high T4, resulting in excess RT3 as a protective reaction, or excess RT3 due to one or more of the potential causes I listed, resulting in excess T4 due to inhibited conversion to T3.  So, if the recommended ultrasound and TSI tests show nothing, then she will need to go further and test for likely contributors to high RT3, such as low iron, selenium, zinc, chromium, Vit B6 and B12, Vit D, iodine, and Low testosterone to see if any of those are deficient.

In either case I agree that she is going to need a good thyroid doctor because those test results are atypical.
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Avatar universal
My personal opinion is that your RT3 is high because your FT4 is so high, and I'd be trying to identify the cause of that.  The body only has two ways to get rid of excess FT4:  It can convert it to FT3, or it can convert it to RT3.  Converting more to RT3 protects against too high levels of FT3.    

Typically, the first thing we suspect if FT4 is high is Graves' Disease, which is autoimmune hyperthyroidism.  However, I think your TSH is too high for it to be Graves', typically TSH is zero or close to it with Graves'.  The definitive test for Graves' is TSI (thyroid stimulating immunoglobulin).  Even though it's unlikely, having your doctor order TSI would rule it out.

Have you had a thyroid ultrasound?  Another possibility would be a toxic (autonomous) nodule.  A toxic nodule is kind of like a mini-thyroid within the thyroid, but it just keeps producing hormone.  It's not under the control of TSH like the rest of the thyroid is.  Once again, I think this is a low probability due to your TSH, but it's another elimination.

Another possibility is PRTH (pituitary resistance to thyroid hormone).  A disclaimer here:  I have PRTH, and it's rare, and I'm sure it influences my thoughts.  The pituitary converts T4 to T3 for itself separately from the rest of the body.  As a result, it can misinterpret thyroid hormone levels.  It's starved for T3, so it thinks the rest of the body is as well and sends out excessive amounts of TSH.  (With your high FT4, we'd expect your TSH to be zero.)  If your thyroid is functioning properly, this will result in high FT4.

My guess is that if you could lower your FT4 a bit, FT3 and RT3 might fall back into place.  FT4 should be closer to midrange.  I think you are going to need a good doctor to help you with this.  Your labs don't indicate a typical thyroid disorder.  I think you're looking at something more esoteric.  
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Avatar universal
I don't have insomnia or tremors, but I do have heart palpitations and high anxiety. I feel like I have both hyper and hypo symptoms. I feel anxious and restless but exhausted at the same time.

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Avatar universal
Your test results are a bit unusual so I would be surprised if your doctor given you a diagnosis.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  Your Free T4 is above range, yet your Free T3 lags far behind, at only 46% of its range.  Along with that your Reverse T3 is way over the range.  

I expect that the reason for those results and your symptoms lies with the Reverse T3.  Reverse T3 is a normal byproduct of conversion of T4 to T3.  Excess Reverse T3 can be the result of: leptin resistance, inflammation (NF kappa-B), dieting, nutrient difficiencies such as low iron, selenium, zinc, chromium, Vit B6 and B12, Vit D and iodine, Low testosterone, low human growth hormone, Insulin dependent Diabetes, Pain, Stress, environmental toxins, Free radical load, Hemorrhagic shock, Liver disease, Kidney disease, Severe or systemic illness, severe injury, Surgery, Toxic metal exposure.

In a scientific study Reverse T3 was shown to be a potent inhibitor to conversion of T4 to T3.

http://press.endocrine.org/doi/abs/10.1210/endo-101-2-453?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Many members say that relief from hypo symptoms such as yours required Free T4 at the middle of its range, at minimum, and Free T3 in the upper part of its range.  Your Free T3 is too low.  In addition, the Reverse T3 acts to somewhat block the effect of Free T3 at the cellular level.  It is recommended that the ratio of Free T3 to Reverse T3 should be at least 1.8.  Yours would calculate to be only .9  (( FT3 divided by RT3) times 10), which is a long way from optimal.

So the best thing to do it seems to me would be to try to identify what is causing your excessive Reverse T3 levels and correct that.  Is there anything in the list that might be a contributor?  If not, then I think I would start by testing the most likely ones, such as low iron, selenium, zinc, chromium, Vit B6 and B12, Vit D, iodine, and Low testosterone to see if any of those are deficient.
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Avatar universal
Your FT4 is high, in fact, it's over range.  FT3 is at 46% of range, just a little low of the upper half of range recommendation.  FT3:RT3 ratio is low at 9; it should be above 15.  However, that's probably because your FT4 is high; your body is trying to neutralize some of the excess FT4 by converting some of it to RT3 rather than FT3.

Do you have any hyper symptoms?  Elevated HR or BP?  Diarrhea?  Insomnia?  Hand tremors?  
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Avatar universal
I should also note that I am on NO medications right now thyroid or otherwise.
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