I need help reading my labs please. What do they mean?

[lady04bug]

T4 Free
Standard Range: 0.80 - 1.50 ng/dL

6/29/18      0.81

T4, Total
Standard Range: 5.5 - 11.0 mcg/ dL

6/29/18      7.6

TSH
Standard Range: 0.30 - 4.00 uIU/mL

6/29/18      2.55 uIU/mL

Thyroid Peroxidase (TPO) AB
Standard Range: 15 - 60 IU/ML

6/29/18      <28 IU/ML

[gimel]

You might be able to get your doctor's attention by clicking on my name and then scrolling down to my Journal and reading the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective, and then giving a copy to your doctor.    The doctor will have a hard time refuting anything said in the papers since everything it supported with extensive scientific evidence.    All you want from the doctor is diagnosis and treatment based on symptoms, rather than just test results.  It is worth trying with your doctor.  

[gimel]

Your TSH and tests for TPO and TG  antibodies do not indicate Hashimoto's.  Your Free T4 being at rock bottom of the range and your Free T3 of  2.7 being only at 27% of its range, fits the example used in the following quote from an excellent thyroid doctor.  "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

Instead of Hashimoto's Thyroiditis, your symptoms and test results are indicative of central hypothyroidism.  with central there is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce needed hormone.   So you need to be started on replacement thyroid hormone.   Unless there are other health issues , it is good to start with a dosage as close to the final daily requirement as possible.  So for you I would ask the doctor to consider 100 mcg of T4 med or 90 mcg of a desiccated type like Armour Thyroid or NatureThroid.   Then the dosage will need to be adjusted as required to relieve hypo symptoms.    Following is a good description of what that might entail, as described in a recent, excellent scientific paper.  

" Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range"

In addition there are a number of variables that affect response to thyroid hormone at the cellular level.  Hypo patients are frequently deficient in the following:  cortisol, Vitamin D, B12 and ferritin.   You know your Vitamin D is low.  You also need to test and supplement B12 and ferritin.  B12 should be in the upper part of its range, and ferritin should be at least 100.

Do you think you can get your doctor to do these things?

[lady04bug]

I will most certainly try to get my doctor to listen! Can you just be my doctor?! lol

Thank you for all the help you have given me. I greatly appreciate it.

[gimel]

Your Vitamin D is much too low.  It should be at least 50 ng/mL.    You can find that in Recommendation no. 14  on page 14 of the full paper on Diagnosis and Treatment of Hypothyroidism.  

So I expect that you will need to supplement with about 2000 IU of D3 to adequately bring up. your Vitamin D level.   I am sure you will also like knowing that in addition to its effect on conversion of T4 to T3, ferritin is very important for hair growth.  Of course you  need to get the other tests done and then we can further advise you.  

[lady04bug]

Ok. Thank you so much for your help. I have messaged my physician and requested to come in for additional tests.

[lady04bug]

Ok I finally got my results back from my Total T3, Free T3, and Thyroglobulin Antibody labs.

Total T3: Standard Range 0.06 - 1.81 ng/ml

          Mine: 0.98 ng/ml

Free T3: Standard Range 2.2 - 4.0 pg/mL

          Mine: 2.7 pg/mL

Thyroglobulin Antibody (Ab): Standard Range 10 - 60 IU/ML

          Mine: <15 IU/ML


My OB/GYN thinks I may have Hoshimoto's?? I saw her a week ago and she advised me to view these results and possibly get more testing but if the pcp will not listen, I can go back to her for further testing. I have no idea what is going on.

[gimel]

You have many symptoms that are frequently associated with hypothyroidism.  Next consideration should be Free T4 and Free T3 compared to their reference ranges.  Your Free T4 is way too low.  You need to be tested for Free T3 also. and make sure they always test for both any time you go in for thyroid tests.    Your Total T4  being at 38% of its range, but Free T4 being so low makes me wonder if your body is converting extra T4 to T3 to try and maintain thyroid function as best possible, or if for some reason your Thyroxine Binding Globulin (TBG) level is high and is binding excess T4 and T3 and causing your Free T4 and Free T3 to be too low.   So you really need to go back and ask for a Free T3 test, along with TBG.

I addition, hypothyroidism is not just inadequate thyroid hormone,.  The correct definition for hypothyroidism is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. "  The response to thyroid hormone is affected by a number of variables including Reverse T3, cortisol, Vitamin D,  B12 and ferritin.  So you also need to test for those, along with the Free T3 and TBG, in order to better understand everything that may need to be done before considering starting on replacement thyroid med to relieve symptoms.    

If you can get those done and then post test results and reference ranges shown on the lab report we will be happy to help interpret and advise further.  

If you want to confirm what is recommended, please click on my name and then scroll down to my Journal and read at least the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  

[lady04bug]

Thank you so much for your help. Your explanation makes a lot more sense to me than the doctor simply saying "your tests are normal". Ugh!

They did check my Vitamin D and the result was 31 ng/mL on 8/10/17 and 36 ng/mL on 6/29/18 with their range being 30.0 - 100.0 ng/mL.

[gimel]

Taken together your TSH and TPO ab tests show no indication of primary hypothyroidism (Hashimoto's Thyroiditis).  Your Total T4 of 7.6 is about 38% of its range, which is not bad.  Your Free T4 though is at rock bottom of its range, which is somewhat inconsistent with your Total T4.   You were not tested for Free T3, which should always be tested along with Free T4.    

Even more important than biochemical tests, is an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise.   So please tell us about any symptoms you have.  

[gimel]

Taken together your TSH and TPO ab tests show no indication of primary hypothyroidism (Hashimoto's Thyroiditis).  Your Total T4 of 7.6 is about 38% of its range, which is not bad.  Your Free T4 though is at rock bottom of its range, which is somewhat inconsistent with your Total T4.   You were not tested for Free T3, which should always be tested along with Free T4.    

Even more important than biochemical tests, is an evaluation for symptoms that occur more frequently with hypothyroidism than otherwise.   So please tell us about any symptoms you have.  

[lady04bug]

My Free T4 has been tested twice before but never Free T3. On 11/16/12 my Free T4 was 0.85 and on 8/10/17 it was 0.82 (both same standard range as the test on 6/29/18).

My symptoms (which have been steady and/or increasing over the past two years) include: extreme sensitivity to cold (get painfully cold); hair is falling out more than ever before (hair dresser made mention of the amount of hair that falls out during washes); hair is more dry and coarse; mood changes - more irritable, anxious, stressed; more tired than usual with mid-day crashes; night sweats; weight gain and unable to lose any weight even with steady exercise and dieting; headaches (more like a pressure or tension headache); no energy or motivation; forgetful...

This is all I can think of at the moment. The doctor made mention to PCOS but I am not sure why. My cycles are VERY regular... as in I could set a watch to them.


A little info on me: I am 32 years old, 5' 2", 170 lbs ( weight is very evenly distributed and I do NOT look as though I am at that weight which is also weird to me), I have had 2 live/ natural deliveries, BP runs around 130/70