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Inconsistent TSH results
My most recent test shows my TSH levels at normal (2.760), while the test from less than a week prior shows 4.020. I know that the best indicator is FT4, which seems to be right in the middle on the latest test, but is the fluctuation in TSH levels within such a short time frame normal?
Date collected: 07/19/2018
TSH 4.020 uIU/mL 0.450 - 4.500
Date collected: 07/24/2018
TSH 2.760 uIU/mL 0.450 - 4.500 uIU/mL
THYROXINE,FREE 1.20 ng/dL 0.82 - 1.77 ng/dL
Date collected: 07/19/2018
TSH 4.020 uIU/mL 0.450 - 4.500
Date collected: 07/24/2018
TSH 2.760 uIU/mL 0.450 - 4.500 uIU/mL
THYROXINE,FREE 1.20 ng/dL 0.82 - 1.77 ng/dL
You have a number of symptoms that frequently occur with hypothyroidism. So you need to get those tests done that I listed above. Also, to check for Hashimoto's you should request tests for TPO ab and TG ab. When you have more test results please post them here along with reference ranges shown on the lab report and we will be happy to help interpret and advise further.
Many of your symptoms are similar to mine (dry skin, weight gain for the first time, severe memory problems, dry skin, etc). Have you been tested for Hashimoto's and Graves?
Thank you both for your responses.
My symptoms include:
-increased cold sensitivity over the last ~9-12 months. This is especially problematic in my right arm (and even more so in my right hand), where even standard air conditioning (below 74° F.) that I used to find comfortable, now makes me chilly even through a sweater over the course of an hour or two. Once my hand gets cold, it takes at least 20-30 minutes of being somewhere warm to feel somewhat comfortable again. This is the most significant symptom, and the only one that I've never had any problem with until recently.
-memory loss / difficulty remembering things - my memory hasn't ever been stellar, but it really feels like it's been slowly getting worse over the past year or so
-weight gain - I seem to have gained a muffin top for the first time in my life over the past year
-depression and fatigue - I'm lumping these together because I believe depression will probably cause fatigue. I've dealt with moderate anxiety and depression most of my adult life (I'm 35 now). I've only recently (6 months) been able to get the anxiety to a very manageable level via meditation and frequent cardio exercise. It was around that time that I started to notice depression symptoms (and lethargy), but I figured that it was just previously masked by the more intense anxiety.
-dry skin - but I'm taking accutane so this one doesn't really count
My symptoms include:
-increased cold sensitivity over the last ~9-12 months. This is especially problematic in my right arm (and even more so in my right hand), where even standard air conditioning (below 74° F.) that I used to find comfortable, now makes me chilly even through a sweater over the course of an hour or two. Once my hand gets cold, it takes at least 20-30 minutes of being somewhere warm to feel somewhat comfortable again. This is the most significant symptom, and the only one that I've never had any problem with until recently.
-memory loss / difficulty remembering things - my memory hasn't ever been stellar, but it really feels like it's been slowly getting worse over the past year or so
-weight gain - I seem to have gained a muffin top for the first time in my life over the past year
-depression and fatigue - I'm lumping these together because I believe depression will probably cause fatigue. I've dealt with moderate anxiety and depression most of my adult life (I'm 35 now). I've only recently (6 months) been able to get the anxiety to a very manageable level via meditation and frequent cardio exercise. It was around that time that I started to notice depression symptoms (and lethargy), but I figured that it was just previously masked by the more intense anxiety.
-dry skin - but I'm taking accutane so this one doesn't really count
My thyroid does this too sometimes. I don't know why but I have Hashimoto's so it's probably related somehow.
TSH is affected by so many things, including the time of day when blood is drawn, that it has value as a diagnostic for thyroid status only when at extreme values. No conclusion can be drawn from your TSH results.
In trying to assess a person's thyroid status most important is an evaluation for symptoms that occur more frequently with hypothyroidism. So please tell us about any and all symptoms you have. Next in importance is biochemical tests for Free T4 and Free T3, along with Reverse T3. Your Free T4 of 1.20 is at 40% of its range, which is borderline for most people without hypothyroidism. You really need to also test for Free T3 and Reverse T3. Cortisol is also important to know since it directly affects thyroid metabolism. Hypo patients are frequently deficient in Vitamin d, B12 and ferritin also so those should be tested and supplemented as needed to optimize. D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.
When you have Free T4 and Free T3 results, the following quote from an excellent thyroid doctor is a good way to evaluate results.
"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."
In the absence of needed test info, let's at least review any symptoms you have.
In trying to assess a person's thyroid status most important is an evaluation for symptoms that occur more frequently with hypothyroidism. So please tell us about any and all symptoms you have. Next in importance is biochemical tests for Free T4 and Free T3, along with Reverse T3. Your Free T4 of 1.20 is at 40% of its range, which is borderline for most people without hypothyroidism. You really need to also test for Free T3 and Reverse T3. Cortisol is also important to know since it directly affects thyroid metabolism. Hypo patients are frequently deficient in Vitamin d, B12 and ferritin also so those should be tested and supplemented as needed to optimize. D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.
When you have Free T4 and Free T3 results, the following quote from an excellent thyroid doctor is a good way to evaluate results.
"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."
In the absence of needed test info, let's at least review any symptoms you have.
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