4253368 tn?1351758543

High TPO & TSH while T3 and FT4 withing range?

I have started taking Thyroid Function Lab Tests recently and test results are not going in favorable direction.

                    T3                FT4       TSH   TPO
NORM 0.69-2.02      0.8-2.2 0.3-6.2 <30
20.10-18      1.39             1.51          2.40 19.70
29.11.18     1.04                 1.21 5.00         42.40
04.03.19     0.96                 1.10         8.00 34.40

My doctor wants to put me on steroids, and I am really cautious about it. What would you recommend?
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Avatar universal
Your test results are indicative of an autoimmune disorder called Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies that thyroid gland as foreign to the body and produces antibodies (TPO ab) to attack and eventually destroy the gland.   As this proceeds the gland's output of T4 and T3 hormone gradually drops.  In response the pituitary increases output of TSH to try and stimulate the gland to produce more.  So that is what you see happening with your test results.   There is no reason to take steroids for your condition.  

The correct definition of hypothyroidism is "inadequate T3 effect in tissue throughout the body, due to insufficient supply of, or response to thyroid hormone."   Once your thyroid hormones become too low, you start having symptoms of being hypothyroid; however, due to the many variables involved that affect TSSUE T3 EFFECT, contrary to most doctors' belief, there is no blood test that can reliably  diagnose your thyroid status.   In trying to assess a person's thyroid status,  and the possible need for treatment with thyroid med, the most important indicator is always an evaluation for symptoms that occur with hypothyroidism.    So before further review of your test results,  please tell us what symptoms you have, if any.
Helpful - 0

Thanks very much for your reply.

I don't have any specific symptoms. Saying that, I had dizziness and nausea and doctors thought I might be having Meniere's syndrome. Some believe that, Meniere's syndrome is an autoimmune issue, therefore recommend to get thyroid checked. That is how I ended up checking my thyroid.

My doctor have been trying to put me in steroids since the first time I got thyroid checked, and I have been resisting, I will keep monitoring my thyroid functions (i.e. doing lab tests and ultrasound inspections) and intervene when required.
Avatar universal
Your thyroid hormones have dropped quite a bit in a short time.   Your FT4 is about 20% of its range and your Total T3 about the same in its range.    Of course everyone can be different in their thyroid hormone requirements, but those levels are too low for many people.  Are you sure you don't have any hypothyroid symptoms?  Many times symptoms are overlooked, so have a look at this link and check any of those you have.  


Even if you have no symptoms now, it is only a matter of time until you will start noticing the effect of low thyroid hormones.   When you reach that point, I suggest that you should take both T4 (the usual one prescribed) and also T3.    Hypo patients taking T4 med only usually find that their body does not adequately convert the T4 to T3, so their TISSUE T3 EFFECT is inadequate to fully relieve symptoms.    And that is the goal of treatment:  relief of hypothyroid symptoms, not just achieving test results that make your doctor happy.   Most of us have found that symptom relief required FT4 around mid-range, and fT3 in the upper half of the range, adjusted as needed to relieve symptoms.  

Hypothyroid patients are also frequently deficient in Vitamin D, B12 and ferritin.  So along with making sure to always test for both Free T4 and Free T3 every time you go for tests, you should get D B12 an ferritin tested and then supplemented as needed to optimize.   D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

Please keep in touch and let us know how you are doing and any way we can help with further information.
Helpful - 0

Thanks for detailed response.

I will start with my symptoms:
- I have gained 5 kilos in last few months, and have been struggling to loose weight for a long time now
- Low energy: I sometimes wake up in the morning very tired and think to myself "how to get through the day if I am already tired"
- I have been told that I have cold hands, people comment on this especially in summer...
- My feet swell by the end of the working day and sometimes I unzip / untie boots for some relief. I also get tingling sensation in hands and feet
- I have been having reoccurring severe headaches and most of the time doctors were saying it might be due to high blood pressure
- I have been having dizziness and vertigo recently (August 2018), doctors are not excluding Meniere's disease... I have researched online and saw many resources recommending to get thyroid functions checked for patients diagnosed with Meniere's - that is how I got into Thyroid screening. And as you mentioned above, all the symptoms that I have been having for a long time now were undermined / overlooked....

On the contrary:
- I suffer from high blood pressure and my pulse is generally around 95 bpm
- I got my cholesterol checked, no issues there
- I sweat a lot, like a lot a lot, doctors think it is some kind of an anxiety related thing

At the moment, I am not taking any hormones / or steroids... I am taking pills to enhance immune system (contains Vit E, sodium selenite, zinc oxide, Vit C, echinacea) and probiotics.

I will have another Thyroid exam in a few weeks time and will post my results here.
Avatar universal
There is a very long list of symptoms that can be related to hypothyroidism.  I can find all of your symptoms on that list, including high BP, fast pulse rate,  and dizziness/vertigo.   So you have numerous symptoms that occur more frequently with hypothyroidism than otherwise.  In addition your test results are indicating Hashimoto's Thyroiditis.  With Hashi's the antibodies are attacking your thyroid gland and will continue to  do so until, over an extended period, the gland is destroyed.   This is causing your TSH to rise in an attempt to stimulate more output of thyroid hormone.  

Both your FT4 and T3 are only around 20% of their reference ranges, which is much too low.  The ranges are far too broad, and skewed to the low end, due to the erroneous methods used to determine those ranges.    When a patient has numerous symptoms that are frequently related to hypothyroidism and FT4 and FT3 are in the lower part of the range, that is strong evidence of hypothyroidism and the need for thyroid medication.  

Another exam is not going to do anything but show more of the same.  I expect that your doctor is basically ignoring your symptoms and waiting until your FT4 and TT3 results are out of the range, before starting you on thyroid med.  That is totally wrong.  You need to get your doctor to prescribe medication to start raising your FT4 and FT3 levels as needed to relieve symptoms.  And that is Free T3, not Total T3, as tested previously.  You should always make sure they test for both Free T4 and Free T3.  Most of us have found that for symptom relief we needed Free T4 around mid-range, and Free T3 in the upper part of the range, and adjusted from there as needed to relieve symptoms.   Symptom relief should be all important, not just test results.  If the doctor is willing to treat clinically, for symptoms, then I would also ask for both T4 and T3 thyroid med, to assure adequate Free T3 levels.    If the answers are no, do you have the option to go to other doctors?

And don't forget about the importance of Vitamin D, B12 and ferritin, as previously mentioned.  Those need to be tested and supplemented to optimize, as well.

Please keep in touch with us as you proceed with getting started on all this.  There is lots more we need to relate to you as you start taking thyroid medication.  
Helpful - 0
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