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Hypothyroidism? Questions on some lab work

28 y/o male
6'4 200lbs

I've been in fairly good shape throughout my life without any major issues. I had surgery in January of 2014, hip labral repair, so I've been sidelined because of the recovery. In the meantime, for about a year or so, I've been exposed to some fatigue here and there. I have some heart palpitations from time to time, but I thought it could be from stress. Nothing major to be honest and I always associated the fatigue to maybe lack of sleep. I decided to get some blood work done and go from there. I asked my PCP to run some tests for TSH level, Vitamin D, and testosterone.

1/5 test results
TSH
Result      Ref. Range
6.640 0.450-4.500 UIU/ML
TESTOSTERONE, TOTAL, LC/MS
590.1 348.0-1197.0 NG/DL
FREE TESTOSTERONE(DIRECT)
9.8 9.3-26.5 PG/ML
VITAMIN D, 25-HYDROXY
15.1 30.0-100.0 NG/ML

The rest of the tests were mainly withing all of the ranges (slight elevation in Bilirubin). PCP wanted to put me on 50,000 Vitamin D2 supplement, once a week. He also prescribed the thyroid supplement. I did some research and noticed that there might be correlation between Vitamin D and Thyroid. Also, I didn't want to be on thyroid meds without finding a cause. So I took the D3 Vitamin, changed my diet (cut out some sugar even though my glucose was 97-98, I think range was until 102).

3/6 Test Results
VITAMIN D,25-OH,TOTAL
42 30-100 ng/mL
VITAMIN D 25-OH, D3
42 ng/mL
VITAMIN D, 25-OH, D2
<4 ng/mL

TSH
6.12 0.40-4.50
T4, FREE, NON-DIALYSIS
1.1 0.8-1.8
T3, FREE
3.5 2.3-4.2 pg/mL
T3, REVERSE
15 8-25 ng/dL
THYROID PEROXIDASE ANTIBODIES
2 <9

Now, I think Vitamin D helped a little. I'm not tired at work, just when I get at home at night. I also feel the fatigue throughout the day on weekend. I feel lazy. I still get a heart palpitation here and there. So now, I'm not sure what's the next step? Thyroid meds? Other tests? Should I just let this be and get back in shape, sleep well etc.? Thanks.
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Avatar universal
Do you have FT3 and FT4 from January?

D is definitely looking better, but your TSH is virtually unchanged.  Just wondering if your FT3 and FT4 are equally unchanged.

Did they test thyroglobulin antibodies (TGab), too?  Some of us with Hashi's are positive for TPOab, some TGab and some both.  So, you really have to test both to rule it out.
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Avatar universal
No.
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Avatar universal
Sorry, I meant to say no, my doc didnt test TPOab. Hell, first time he only tested TSH and recommended meds without any other baseline numbers. He assumed I has Hashis.

Should I get mode bloodwork or just get on meds now? Most of the time I feel great. But, I would want to find the cause of elevated TSH without medication. Treat the cause after you find it. It just aucks going back and forth with doctor/lab. Should be done once and get the results needed. Any recommendations?
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Avatar universal
That was meant "no Tgab". TPOab seemed normal as you can see.
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Avatar universal
With a negative TPOab, I don't know why he'd assume you have Hashi's.  Testing positive for either TPOab or TGab will confirm Hashi's, but you have to test both to eliminate the possibility.

If he only tested TSH and recommended meds when you don't have symptoms, by and large, he's obviously not a good thyroid doctor.

I'd want to see where this is going before starting meds.  Your numbers aren't so off that it would hurt to retest in a couple of months and see where you are then.  Also, you're feeling well.  At that time, you might request TGab as well.

My first recommendation would be to forget about TSH and concentrate on FT3 and FT4.  TSH is a pituitary hormone, and it can be affected by any disturbances in the thyroid/hypothalamus/pituitary feedback cycle.  TSH, high or low, causes no symptoms, and TSH is seldom directly treatable.  TSH is nothing but a messenger hormone from the pituitary to tell the thyroid that FT3 and FT4 levels are getting low.  So, we lower TSH by increasing FT3 and FT4 levels, and we raise it my decreasing them.
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Avatar universal
Thank you for your reply. I will test the ferattin and TGab next. If those are ok, I dont know what else to test for?

My t3 and t4 look within the ranges. If everything else is normal, why is my tsh elevated? Could something else be causing it? Should i increase my t3 and t4 levks from their current ones to lower TSH?
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Avatar universal
If ferritin and TGab are both okay, but your TSH remains high and FT3 and FT4 stay where they are, you could be looking for a pituitary issue.

Anything in the thyroid/hypothalamus/pituitary axis can throw TSH off.  Free testosterone is a little on the low side, which could also indicate a pituitary issue.  

I don't understand "Should i increase my t3 and t4 levks from their current ones to lower TSH?".  Sorry, I know there's a typo in there, but I can't fathom what it should be.
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Avatar universal
That should have read "should I increase my current t3 and t4 levels"

Could the TSH level be due to stress or some weird cycle in my body that gets corrected on its own in due time? How would I even test if its pituitary? Any recommendations at this time. Stay as is and retest all levels in summer?

Could the TSH levels be indicative of any other problems like tumors or something else extreme?
Helpful - 0
Avatar universal
Your FT4 is currently at 30% of range, which is a little low of the 50% target.  However, at the same time, your FT3 is at 63% of range, which is pretty much as it should be.  The only "problem" I have with those is relative to one another.  It could be an indication that things are starting to happen, i.e. your thyroid isn't producing as much FT4 as it should, and your body is trying to make up for that with extra conversion to T3.  

Yes, all kinds of thing might be raising your TSH.  TSH is very volatile; it can change as much as 70% intraday, just depending on the time of day the blood was drawn.  

The pituitary is the master adrenal gland, and it controls all the others.  It does this by sending out messenger hormones, TSH in the case of thyroid, FSH in the case of sex hormones, etc.  Several pituitary hormones are usually tested to see if the pituitary seems generally "off".

Recommendations really depend a lot on how you feel.  You have some mild symptoms.  If you started meds, your FT4 could rise a bit, and that might readjust the balance of FT4 to FT3.  It depends on whether you'd prefer to take a wait and see approach or if your symptoms are bothering you enough to start meds now.  Your TPOab is negative, so it seems you don't have Hashi's (although TGab is still up in the air).

The TSH level could be indicative of a pituitary tumor, but it's highly unlikely.  They're rare.  I think it's much more likely that your slightly low FT4 is kicking it up.  But, as I said, we don't want to spend too much time worrying about TSH.  My real concern is your somewhat low FT4 level.

If I were you, I think I'd wait a few months, unless of course symptoms increase or change, and retest.  This could be just a blip on the screen.  You're working on your vitamin D, but it's still not optimal in terms of thyroid.  You seem to think some lifestyle changes might be in order ("Should I just let this be and get back in shape, sleep well etc.?").  Why not try that?  Your numbers are not so off, and your symptoms are mild and perhaps attributable to other things.  
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Avatar universal
Thank you so much for taking time and responding. Do you have a medical background or do you have similar situation like the majority of us
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Avatar universal
No medical background whatsoever.  I just struggled through a bad doctor for a year as many of us have, got on this forum and got a lot of good advice from people and learned a lot in the process.  

Best of luck, and let me know how it all turns out.
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