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Help with thyroid test results
Can anyone help interpret my Thyroid test results? Over the years my TSH has been steadily decreasing - TSH 9/20/12 - 2.05 Ref range 0.27-4.20 uIU/mL. Free T4 - 1.04 ref range 0.93 - 1.70 ng/dL
TSH 2/15/13 - 1.53 Ref range 0.27-4.20 uIU/mL.
TSH 10/25/13 - 1.46 Ref range 0.27-4.20 uIU/mL.
TSH 6/20/14 - 1.98 Ref range 0.27-4.20 uIU/mL.
TSH 8/18/14 - 1.53 Ref range 0.27-4.20 uIU/mL.
TSH 7/16/15 - 0.72 Ref range 0.27-4.20 uIU/mL. Free T4 1.29 ref range 0.93 - 1.70 ng/dL
TSH 9/13/16 - 1.13 Ref range 0.27-4.20 uIU/mL.
TSH 1/5/2018 - 0.57 ref range 0.35 - 4.00 mcIU. Free T4 1.0 ng/dL ref range 0.8 - 1.5 ng/dL. T3 85 ng/dL ref range 58 - 159 ng/dL
Because my TSH numbers have been dropping looking like I’m moving toward being Hyperthyroid and kept being told my TSH was normal despite the fact that no one had performed Free T4 (with the exception of 2012 & 2015) or any type of T3 test this time and Free T3 be done at the same time as TSH (results say regular T3 was done). I have NO hyper symptoms but plenty of hypo - dry brittle hair that falls out by the handful, dry, scaly skin, major fatigue, brittle nails, depression and major abdominal weight gain despite healthy eating and daily exercise. My doctor sent my latest results with just a note saying “all Thyroid results are normal”. Prior to 2011 I was seeing a different doctor (which my insurance does not cover and I can’t afford to pay out of pocket) who said my results showed while my results were “in range” they were not “optimal” and treated me as Hypothyroid with Armour Thyroid replacement where I felt and functioned great. It was when my insurance switched to an HMO that my new doctor had me stop the Armour for a month and then tested my TSH and said my thyroid was normal and therefore I did not need medication. Yet my symptoms returned and although my doctor does order a TSH every year to monitor it she says it’s normal and doesn’t have any concerns about it continuing to drop.
TSH 2/15/13 - 1.53 Ref range 0.27-4.20 uIU/mL.
TSH 10/25/13 - 1.46 Ref range 0.27-4.20 uIU/mL.
TSH 6/20/14 - 1.98 Ref range 0.27-4.20 uIU/mL.
TSH 8/18/14 - 1.53 Ref range 0.27-4.20 uIU/mL.
TSH 7/16/15 - 0.72 Ref range 0.27-4.20 uIU/mL. Free T4 1.29 ref range 0.93 - 1.70 ng/dL
TSH 9/13/16 - 1.13 Ref range 0.27-4.20 uIU/mL.
TSH 1/5/2018 - 0.57 ref range 0.35 - 4.00 mcIU. Free T4 1.0 ng/dL ref range 0.8 - 1.5 ng/dL. T3 85 ng/dL ref range 58 - 159 ng/dL
Because my TSH numbers have been dropping looking like I’m moving toward being Hyperthyroid and kept being told my TSH was normal despite the fact that no one had performed Free T4 (with the exception of 2012 & 2015) or any type of T3 test this time and Free T3 be done at the same time as TSH (results say regular T3 was done). I have NO hyper symptoms but plenty of hypo - dry brittle hair that falls out by the handful, dry, scaly skin, major fatigue, brittle nails, depression and major abdominal weight gain despite healthy eating and daily exercise. My doctor sent my latest results with just a note saying “all Thyroid results are normal”. Prior to 2011 I was seeing a different doctor (which my insurance does not cover and I can’t afford to pay out of pocket) who said my results showed while my results were “in range” they were not “optimal” and treated me as Hypothyroid with Armour Thyroid replacement where I felt and functioned great. It was when my insurance switched to an HMO that my new doctor had me stop the Armour for a month and then tested my TSH and said my thyroid was normal and therefore I did not need medication. Yet my symptoms returned and although my doctor does order a TSH every year to monitor it she says it’s normal and doesn’t have any concerns about it continuing to drop.
Getting that kind of response from a doctor is terribly frustrating. The typical response of "it can't be your thyroid because test results are within range", overlooks the fact that their Standard of Care for Hypothyroidism (SOCH) is wrong. For weight issues,they just say, "eat less and move more". They don't realize the impact of hypothyroidism on metabolism and weight gain and difficulty with weight loss.
Interestingly, even the AACE/ATA Guidelines for Hypothyroidism, which is the main source for the typical SOCH does at least realize the value of tendon reflex time as a sign of the thyroid status. Unfortunately for it to be of real value it must be measured objectively in milliseconds, rather than subjectively with just the little rubber hammer on your tendon. Since tendon reflex time is only about 1/4 second you can understand why the hammer test is a waste of time. Although not recognized and accepted for use as a diagnostic, there is a company that has developed a good test for tendon reflex time in milliseconds. The reason I mention all this is that they have evaluated hypo patients with this test both before and after treatment, and according to their information the difference in Resting Metabolic Rate from hypothyroidism to euthyroidism can be up to approx. 400 calories per day.
If you look at a formula for estimating a woman's Basal Metabolic Rate, it looks something like this: BMR = 655 +(4.35 times Wt. in pounds) + (4.7 times height in inches) minus (4.7 times age in years). The constant that is multiplied by the weight in pounds, is 4.35. This means that for every pound you gain your metabolism goes up approx. 4.35 calories per day. So my interpretation is that for a given diet and exercise level if hypothyroidism has caused a person's BMR to be lower than normal by say 200 calories per day, then the person would eventually gain almost 46 pounds (200 divided by 4.35), before the increase in metabolism from the weight gain would offset the lower than normal metabolism for that person. I think this explains why so many hypothyroid patients have such issues with weight gain and loss. Their BMR is much lower than it should normally be.
If all this is confusing, let me just give you a quote from a previous UK member about her actual experience.
"I was having some major problems with my metabolism. I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library. I, too was going to see doctors who would not help me. Fortunately, I found a doctor who gave me armour thyroid despite "normal" levels. I brought him a RMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body. I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms. I documented all the thyroid lab work before and after treatment. I went and had metabolic testing to test my BMR and it measured normal for my age and weight and I was symptom free. I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face. The human body is not black and white."
Interestingly, even the AACE/ATA Guidelines for Hypothyroidism, which is the main source for the typical SOCH does at least realize the value of tendon reflex time as a sign of the thyroid status. Unfortunately for it to be of real value it must be measured objectively in milliseconds, rather than subjectively with just the little rubber hammer on your tendon. Since tendon reflex time is only about 1/4 second you can understand why the hammer test is a waste of time. Although not recognized and accepted for use as a diagnostic, there is a company that has developed a good test for tendon reflex time in milliseconds. The reason I mention all this is that they have evaluated hypo patients with this test both before and after treatment, and according to their information the difference in Resting Metabolic Rate from hypothyroidism to euthyroidism can be up to approx. 400 calories per day.
If you look at a formula for estimating a woman's Basal Metabolic Rate, it looks something like this: BMR = 655 +(4.35 times Wt. in pounds) + (4.7 times height in inches) minus (4.7 times age in years). The constant that is multiplied by the weight in pounds, is 4.35. This means that for every pound you gain your metabolism goes up approx. 4.35 calories per day. So my interpretation is that for a given diet and exercise level if hypothyroidism has caused a person's BMR to be lower than normal by say 200 calories per day, then the person would eventually gain almost 46 pounds (200 divided by 4.35), before the increase in metabolism from the weight gain would offset the lower than normal metabolism for that person. I think this explains why so many hypothyroid patients have such issues with weight gain and loss. Their BMR is much lower than it should normally be.
If all this is confusing, let me just give you a quote from a previous UK member about her actual experience.
"I was having some major problems with my metabolism. I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library. I, too was going to see doctors who would not help me. Fortunately, I found a doctor who gave me armour thyroid despite "normal" levels. I brought him a RMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body. I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms. I documented all the thyroid lab work before and after treatment. I went and had metabolic testing to test my BMR and it measured normal for my age and weight and I was symptom free. I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face. The human body is not black and white."
So when you were originally started on thyroid med was it because of symptoms, or low FT4/FT3, or high TSH? And why in the world did the HMO say to stop the thyroid med to "clear the Armour out"? That is ridiculous. Your HMO doctor is just blindly following the typical Standard of Care for Hypothyroidism, which relies only on TSH, and at most a Free T4 test, compared to reference ranges which are too broad, due to the assumptions behind how they are established. Patients with central hypothyroidism, which is likely your case, are completely overlooked because of the fixation on TSH, which is demonstrably wrong.
Doctors like to believe that hypothyroidism is "inadequate thyroid hormone" correctly sensed by the pituitary gland, which then secretes TSH. So they test TSH as a surrogate for the thyroid hormones. This is totally inadequate because TSH doesn't even correlate well with FT4 /FT3, and has negligible correlation with the all important: Tissue T3 effects, and resultant symptoms, which define the patient's thyroid status. The correct definition of hypothyroidism is "insufficient T3 effect in tissues throughout the body, due to inadequate supply of, or response to, thyroid hormone". So a TSH test, even with a FT4 test, is inadequate to diagnose a person's thyroid status due to the additional processes and variables that affect Tissue T3 effects. I am going to send you a PM with info to show this. To access, just click on your name and then from your personal page, click on messages.
A good thyroid doctor will take an integrated approach by doing a full medical history, evaluation for symptoms that occur more frequently with hypothyroidism, and extended biochemical testing. Those symptoms are the most important indicator, followed by Free T4 and Free T3 levels. You having all those hypo symptoms along with a FT4 that is only at 28% of its range, and a Total T3 that is only at 27 % of its range, is indicative of hypothyroidism. And that doesn't even consider other variables that may also reduce the tissue T3 effect.
From your experience with the HMO, I doubt seriously that you can get what you need there. Of course you can try, by using the info in my PM and push them to reconsider, but very unlikely they will change. And if you go to another doctor without knowing in advance whether your diagnosis and treatment will be as described rather than just TSH, then that would be a waste of time and money. So I will also give you a recommendation for a doctor that has been recommended by other thyroid patients in your area.
Doctors like to believe that hypothyroidism is "inadequate thyroid hormone" correctly sensed by the pituitary gland, which then secretes TSH. So they test TSH as a surrogate for the thyroid hormones. This is totally inadequate because TSH doesn't even correlate well with FT4 /FT3, and has negligible correlation with the all important: Tissue T3 effects, and resultant symptoms, which define the patient's thyroid status. The correct definition of hypothyroidism is "insufficient T3 effect in tissues throughout the body, due to inadequate supply of, or response to, thyroid hormone". So a TSH test, even with a FT4 test, is inadequate to diagnose a person's thyroid status due to the additional processes and variables that affect Tissue T3 effects. I am going to send you a PM with info to show this. To access, just click on your name and then from your personal page, click on messages.
A good thyroid doctor will take an integrated approach by doing a full medical history, evaluation for symptoms that occur more frequently with hypothyroidism, and extended biochemical testing. Those symptoms are the most important indicator, followed by Free T4 and Free T3 levels. You having all those hypo symptoms along with a FT4 that is only at 28% of its range, and a Total T3 that is only at 27 % of its range, is indicative of hypothyroidism. And that doesn't even consider other variables that may also reduce the tissue T3 effect.
From your experience with the HMO, I doubt seriously that you can get what you need there. Of course you can try, by using the info in my PM and push them to reconsider, but very unlikely they will change. And if you go to another doctor without knowing in advance whether your diagnosis and treatment will be as described rather than just TSH, then that would be a waste of time and money. So I will also give you a recommendation for a doctor that has been recommended by other thyroid patients in your area.
1 Comments
I was originally started on thyroid replacement due to low/normal TSH along with low/normal Free T4 and low Free T3. But at the the my TSH was never as low as it currently is. Since stopping the replacement my TSH has steadily dropped lower and lower ever time it’s tested which if going by the “standards” I should be experiencing Hyperthyroid symptoms not Hypothyroid ones. I’m someone who would run so much (a passion of mine) that I developed a stress fracture where my knee meets my femur and have ruptured tendons in my ankle and foot. Yet despite that I continued to gain extreme amounts of weight to the point where I took the drastic route and had Gastric Sleeve surgery to help me lose weight. Initially I lost 60+ lbs. but while continuing to eat small healthy meals, continuing to run long distances, mixed with interval training and weights I started regaining the weight. Currently I have regained 27 lbs! all situated in my abdomen. Because of this in conjunction with my hair starting to fall out more and more, along with my eyebrows, the overwhelming fatigue (I could sleep all day and night and it wouldn’t help), headaches, dry, peeling skin on my feet that no amount of buffing or moisturizing helps, lack of a once robust libido, depression and just plain apathy is the reason I suspected my thyroid isn’t working properly and made the request to my doctor to perform more just a TSH. After seeing my results that showed my TSH had gone even lower than the last test, Free T4 was towards the low end and even though she ordered T3 and not the Free T3 I requested, the fact that it too was at the low end I was shocked and dismayed to see her note stating all testing was “normal and show no evidence of thyroid dysfunction”. When I explained to her about my weight gain and how healthy I eat along with my exercise routine her response was that the weight gain might be because I might be eating more than I realized and that I should start a food journal as well as an exercise journal and think about joining one of their weight management programs. I’m so beyond frustrated that she can’t think out of the box when it comes to so called “normal” laboratory reference ranges. I may go broke but I need answers so I’m going to try and get an appointment with the doctor you recommended; luckily she’s located less miles away. Thank you again for your help.
TSH is a pituitary hormone that doctors like to believe is an infallible indicator of thyroid status. In reality it is affected by so many things that it doesn't even correlate with actual thyroid hormones much less with symptoms which are the patient's concerns. Doctors also like to think that all hypothyroidism is primary (inadequate output of thyroid hormone, most frequently due to the effect of Hashimoto's Thyroiditis). This causes them to overlook central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are inadequate to stimulate the thyroid gland, resulting in inadequate levels of the thyroid hormones. Free T4 and Free T3. Interestingly you were only tested for FT4 3 times in 5 years and never tested for Free T3, only Total T3, which is not nearly as useful as a Free T3 test. .
From the beginning of testing the limited testing indicates the likelihood of inadequate output of thyroid hormone. Before further discussion, we need to know if you had symptoms at that time, or have the symptoms developed during the last 5 years?
From the beginning of testing the limited testing indicates the likelihood of inadequate output of thyroid hormone. Before further discussion, we need to know if you had symptoms at that time, or have the symptoms developed during the last 5 years?
4 Comments
The reason I only had Free T4 done a couple of times was when I insisted on having Free T4 and Free T 3 done in conjunction with my TSH and the doctor reluctantly ordered just the Free T4. The doctors kept telling me TSH is really the only test necessary and since it’s within range they would always say it’s normal and no other tests are warranted. With my latest test done last week I again insisted on having Free T4 & Free T3 done and my new doctor only agreed because I have a mineralocorticoid deficiency (Hyporeninemic hypoaldosteronism). But when I got my results back I saw that instead of Free T3 she ordered a regular T3. Since she was reluctant to order the tests I requested to begin with and her note saying my results were normal and show no evidence of Thyroid disorder I don’t feel I will be successful in having her run a Free T3. But to answer your question regarding symptoms, yes, I have had Hypo symptoms since 2008 and my previous doctor prescribed Armour Thyroid replacement which I was on from 2009-2011. While on replacement therapy I was doing well. But when my insurance changed to an HMO in 2011 and I had to change doctors that’s when they had me stop the Armour for a month to allow my system to clear the Armour out and then they retested only my TSH. Since my TSH was “in range” I was told I did not have a thyroid problem and did not need any kind of replacement therapy. Once I stopped the Armour my Hypo symptoms returned but trying to get any doctor to look beyond just the TSH is like talking to a brick wall. Before I spend money I really don’t have to see a doctor outside of my HMO that specializes in Thyroid issues and who will look at the big picture as far as my symptoms and look at my Free T4, Free T3 in conjunction with my continued lowering TSH I wanted to see if based on the latest testing I just had done if my doctor’s assertion that there is no thyroid problem is correct or is it possible that I am Hypo caused by a pituitary issue and not my thyroid. I was told my Aldosterone/Renin deficiency was likely due to a faulty signal from my pituitary to adrenals.
The reason I only had Free T4 done a couple of times was when I insisted on having Free T4 and Free T 3 done in conjunction with my TSH and the doctor reluctantly ordered just the Free T4. The doctors kept telling me TSH is really the only test necessary and since it’s within range they would always say it’s normal and no other tests are warranted. With my latest test done last week I again insisted on having Free T4 & Free T3 done and my new doctor only agreed because I have a mineralocorticoid deficiency (Hyporeninemic hypoaldosteronism). But when I got my results back I saw that instead of Free T3 she ordered a regular T3. Since she was reluctant to order the tests I requested to begin with and her note saying my results were normal and show no evidence of Thyroid disorder I don’t feel I will be successful in having her run a Free T3. But to answer your question regarding symptoms, yes, I have had Hypo symptoms since 2008 and my previous doctor prescribed Armour Thyroid replacement which I was on from 2009-2011. While on replacement therapy I was doing well. But when my insurance changed to an HMO in 2011 and I had to change doctors that’s when they had me stop the Armour for a month to allow my system to clear the Armour out and then they retested only my TSH. Since my TSH was “in range” I was told I did not have a thyroid problem and did not need any kind of replacement therapy. Once I stopped the Armour my Hypo symptoms returned but trying to get any doctor to look beyond just the TSH is like talking to a brick wall. Before I spend money I really don’t have to see a doctor outside of my HMO that specializes in Thyroid issues and who will look at the big picture as far as my symptoms and look at my Free T4, Free T3 in conjunction with my continued lowering TSH I wanted to see if based on the latest testing I just had done if my doctor’s assertion that there is no thyroid problem is correct or is it possible that I am Hypo caused by a pituitary issue and not my thyroid. I was told my Aldosterone/Renin deficiency was likely due to a faulty signal from my pituitary to adrenals.
The reason I only had Free T4 done a couple of times was when I insisted on having Free T4 and Free T 3 done in conjunction with my TSH and the doctor reluctantly ordered just the Free T4. The doctors kept telling me TSH is really the only test necessary and since it’s within range they would always say it’s normal and no other tests are warranted. With my latest test done last week I again insisted on having Free T4 & Free T3 done and my new doctor only agreed because I have a mineralocorticoid deficiency (Hyporeninemic hypoaldosteronism). But when I got my results back I saw that instead of Free T3 she ordered a regular T3. Since she was reluctant to order the tests I requested to begin with and her note saying my results were normal and show no evidence of Thyroid disorder I don’t feel I will be successful in having her run a Free T3. But to answer your question regarding symptoms, yes, I have had Hypo symptoms since 2008 and my previous doctor prescribed Armour Thyroid replacement which I was on from 2009-2011. While on replacement therapy I was doing well. But when my insurance changed to an HMO in 2011 and I had to change doctors that’s when they had me stop the Armour for a month to allow my system to clear the Armour out and then they retested only my TSH. Since my TSH was “in range” I was told I did not have a thyroid problem and did not need any kind of replacement therapy. Once I stopped the Armour my Hypo symptoms returned but trying to get any doctor to look beyond just the TSH is like talking to a brick wall. Before I spend money I really don’t have to see a doctor outside of my HMO that specializes in Thyroid issues and who will look at the big picture as far as my symptoms and look at my Free T4, Free T3 in conjunction with my continued lowering TSH I wanted to see if based on the latest testing I just had done if my doctor’s assertion that there is no thyroid problem is correct or is it possible that I am Hypo caused by a pituitary issue and not my thyroid. I was told my Aldosterone/Renin deficiency was likely due to a faulty signal from my pituitary to adrenals.
Sorry for the multiple posts. My computer froze and I hit enter multiple times which resulted in the multiple responses.
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