Interpreting Results

[AvielaAvielle]

Hi,
I was just tested with these levels - no meds, have not yet seen and endo.
TSH 13.07 (last month it was 16.09)
T4 9.4 (4.5-12)
T3 132 (71-180)
FT4 1.05 (.82 -1.77)
FT3 2.9 (2.0-4.4)
High LDL Cholesterol
Low Vitamin D

I looks like I am low...should I request testing for antibodies so I can confirm or rule out Hashimotos??
Should I bother with an Iodine deficiency test???
Any other tests you recommend....maybe RT3????
I want to know as much as possible before going on medication.
Have heard that leaky gut might cause thyroid problems.

I feel okay...I sleep a lot, but have been like that my whole life.
am 51 yrs old and started menopause 14 months ago.
Have had some hives & rashes here & there for the past 3-4 years.

Thanks so much for your help.

[goolarra]

Those antibodies are destroying more and more of your thyroid function every day.  So, your thyroid is putting out less and less natural hormone.  You have to increase your meds as that happens to compensate.  Once your thyroid is effectively "dead", you will stabilize at a dose.

"will eventually need to find a more comprehensive doctor who is willing to to take more tests to analyze what's going on as most endo's will simply raise the dosage or maybe give t3......"

Which tests do you want to have run?
.

[AvielaAvielle]

It looks like I am doubling my dosage from 25 to 50mcg because I suddenly started getting exhausted for no reason again.
But, I am wondering why??? since i was feeling really good for 3 months and then BAM!
Doctor wanted to increase based on the lab results...at first I said no, but now....
yes, wondering why t3 is not increasing....
I don't think all the pieces of the puzzle are known regarding thyroid hormones & antibodies......
but I guess we can only do the best we can  :)
will eventually need to find a more comprehensive doctor who is willing to to take more tests to analyze what's going on as most endo's will simply raise the dosage or maybe give t3......

[flyingfool]

You seemed a bit confused about why the TSH keeps coming down.

Well it is supposed to or is expected to come down when everything is in balance.  TSH is counter intuitive.  Meaning that TSH will rise when your pituitary senses the need more thyroid.  Think of TSH as a thermostat signal in your house.  When the thermostat (the pituitary) senses the need to turn up the heat (in the winter) it will send a signal to the furnace to turn on.  If the thermostat had the ability to sense more and more urgency with the room getting colder and colder it would send a stronger and stronger signal to the furnace to hurry up and turn on.

The same is true with the Pituitary and TSH (Thyroid Stimulating Hormone).  When the pituitary senses that the body is low on thyroid, it produces TSH to tell the thyroid gland to produce hormone.  As the pituitary senses an ever increaseing shortage of thyroid it produces more and more quantity of TSH in every more desparate attempts to jump start the thyroid gland to procude more thyroid hormone.

So the lower the thyroid state the higher the TSH, as the pituitary is comfortable (the thermostat has reached the temperature you set it at for comfortable room temp) then it produces less TSH so that the thyroid gland slows production.

in an ideal world this all works just like your home thermostat. And the TSH level is at a "normal" number and keeps the body happy with sufficient thyroid.

however we all know that we don't live in a perfect world. And just like your home temperature, both the thermostat can fail and so can the furnace and different  parts of the furnace.  

So why TSH is such a poor indicator of your overall thyroid condition is that if your furnace isn't kicking on, and the Dr ONLY tests or looks at the TSH. This would be analogous to a furnace repair man you call in because you are freezing in your home if he were to ONLY look at the thermostat. And when he checks the thermostat and tells you that it is "normal".  That everything is fine, and being cold is all in your head.... here take some antidepressants to help with that and go on your way!

You would FIRE immediately any furnace repair man that was so completely and utterly negligent and uncaring and oblivious!

yet this is the "standard of care" and is exactly what the medical shcools are teaching about thyroid. That checking the thermostat only (TSH) is fine!

If you would fire a repair man for such incopetence, why won't we stand up and do that to our Dr?

Just ranting.....

rant over!

[goolarra]

No, FT3 isn't changing much, is it?

I've lost track.  Where are you at meds-wise?  Any changes in dose between any of those labs?

If you feel good, why do you want to increase more, or is it your doctor who's pushing you to increase?  The guidelines for where FT3 and FT4 should be are just that...something to shoot for until you find where you feel the best.  

As far as we know right now, antibodies have nothing to do with conversion.  The antibodies attack the thyroid, which makes T4.  Conversion to T3 happens elsewhere in the body and is a separate metabolic process.  

[AvielaAvielle]

Hi,
So I know that TSH doesn't mean anything on it's own, but
mine keeps going down...
it started at 16
TSH 7.3 (.45-4.5)  prior10.16   prior test 13.07  Prior 16.09  
T4  ????   ???   prior 9.4 (4.5-12)      prior 8.9
T3 ???    ??      prior 132 (71-180)    prior ???
FT4  didn't tell me 1.20 (.82-1.77)   prior1.05  
FT3 2.6 (2.0-4.4)   prior2.6     Prior 2.9

FT3 is not changing though.
I told the Doctor I wanted to wait longer before increasing meds as I feel good and am currently doing the AIP detox diet...gluten free, dairy free, etc...
How do I know if it's because of antibodies or slow thyroid or missing nutrient to convert to T3 or some other T3 problem.
Doctor pretty much only looks at TSH
I am taking all recommended supplements.
Any ideas on what else I can do???
Thank you in advance :)

[goolarra]

At one time or another, I have been on Levoxyl, Synthroid and generics.  In fact, at times, I was combing tablets for an interim dose and was taking more than one brand at the same time.  To me, there is absolutely no difference among them.  However, some people are sensitive to the fillers in the tablets (all the manufacturers use different ones) and have to stick with the same ones.  When you're prescribed generics, your pharmacy can change who they buy their meds from at any time and without even telling you.  So, the recommendation has always been that if you find something that works, stick with it.

Active ingredients in all are exactly the same.  

[AvielaAvielle]

Hi Goolarra,
Just wondering what the difference were from generic synthroid to Levoxyl....
thank you :)

[goolarra]

I see my endo only once a year, but I have labs every six months.  If either of us has a problem, we talk on the phone when I'm not scheduled for my annual visit.

I just switched back to Levoxyl now that it's back on the market, and I paid $17 for my script the other day.  I was on generic when Levoxyl wasn't available, and I just did my tax return and tossed all last year's receipts, so I don't remember what that was costing me.  

I've never been on Armour, but I hear people complaining about the price.  I can't imagine anyone complaining about $7.11 per month.    

[AvielaAvielle]

I agree....I think I would want to know lab results too....but maybe just once a year once you felt it all to be in balance??? not sure ...

I think that is her price with HMO???  depends on her plan I suppose...and maybe it's generic...
My meds only cost me $5 per prescription for generic....

[goolarra]

I agree with a good part of what this article has to say.

However, if "Michelle" is getting a month's supply of 90 mg per day tablets of Armour for $7.11, I think there are a lot of people who'd like to know WHERE she gets them for that.  The article appears to be currently updated, but I don't believe that price for a second, unless her husband is the pharmacist...LOL

Also, I don't agree that you should ignore blood work completely.  While it's true that being in population range does not speak to the individual, once each of us finds out where we feel best, we can use our own prior labs to guide us.  Many symptoms can cross over and be symptoms of both hypo and hyper (overmedication).  Labs can really help in that instance.

While treatment should be symptom driven as much as possible, I don't think it's necessary to throw the baby out with the bath water...    

[AvielaAvielle]

just sharing an article I thought was interesting regarding Hypo with antibodies

http://www.thyroid-info.com/articles/woliner.htm

[AvielaAvielle]

thank you both for your comments....
it's kind of strange how the autoimmune thing just starts up at a certain point in your life......or maybe it's been somewhat dormant & then wakes up.....who knows....my 1/2 sister has the antibodies as well & she found out when she was pregnant & had no choice but to go on meds because her hair was falling out & she was exhausted all the time.....I understand there is no cure, but I'm hoping it can just go back to dormancy.....and I guess I'm will to try whatever to get that happen....

yes, I'm sure we are all different......

Gin52 - that's strange that you have symptoms & you have antibodies but it hasn't affected your thyroid labs.....

I have to say I have so much more energy even with just 12.5 mcg.....and I'm not hyper at all....and I can still sleep a full 8+ hrs.  

[Gin52]

I just wanted to add that I have the Hashi's antiboidies and did do gluten-free for 6 months.
Although my antibody test while g/f was lower , It did nothing to help my symptoms or feel better in general.
And I went back on gluten, had another antiboidy test and they were even lower.  My symptoms continue also.
So it didn't help me. But everybody is different so If it helps, I'm happy for you.
Personally, I wish mine would hurry up and just put me into the official Hypo range so I  get treated.
Good luck

[goolarra]

There are those who purport that a gluten free diet will "lower" your antibody count.  Even the proponents won't say that a g/f diet will "cure" you.  I've done some pretty extensive reading on the subject, and I see no proof of this whatsoever.  The theory is based on testimonials with science barely even mentioned.  If you feel better g/f, by all means do it.  If you're doing it in hopes of improving your thyroid condition, I fear you will be disappointed.  Selenium is also claimed to lower antibodies, but this is yet to be proven with a large scale study of a heterogeneous population.  

"I'm hoping not too much thyroid gland damage has been done yet...... "  Damage will continue despite being on meds.  Unfortunately, damage continues until there is no thyroid function left.  Once you're dependent on meds to feel well, it really doesn't matter if you take full replacement or only half replacement.  In fact, many people, and this was my experience as well) feel better once the thyroid is "dead"...meds become more stable since you're not increasing periodically to compensate for more loss of function.

Hopefully, some day, the cause can be treated directly.  Most of the work right now in attacking autoimmune diseases is going toward type 1 diabetes research.  Neither Hashi's nor Graves' is even on the short list after that.  However, if they find a "cure" for one, the others will probably fall rapidly.

    

[AvielaAvielle]

thanks so much!!!
I was hoping that "maybe" diet - gluten free or something else might minimize the antibody count so that damage to the thyroid wouldn't progress.....that's horrible!!!   I thought there might be a way to turn the gene off...I mean, I really believe that I just started having problems when menopause hit.....I'm hoping not too much thyroid gland damage has been done yet......
Oh, well....yes, I figured I would take 1/2 the pill for a week or so & then see if the full one is okay by then.....

[goolarra]

Thyroid meds (any of them) don't decrease antibodies.

Once you test positive for antibodies, further testing really adds no more information.  Once you have antibodies, you have them for life, although they can go into remission if your thyroid is removed or once it dies off completely.  Antibody counts also vary wildly, even intraday, so when they go down, it's pretty meaningless.  

It takes a little getting used to thyroid meds.  It's usually best to start out low and increase as tolerated and as needed.  Try the 12.5 for a while, and when you're comfortable (should only take a week or two), move up to 25.  A few symptoms at first are to be expected.

Good luck with your meds!

[AvielaAvielle]

Hi,
I'm curious about how often you check your antibody levels.....
did you find that taking Levo decreased them???
I don't think it would, but I wanted to be sure.....
I started the medication but it was really strong....my heart was beating really hard the next morning.....so I skipped day 2 and then took 1/2 today....seems okay for now.
thank you!

[AvielaAvielle]

actually she prescribed synthroid....
so we'll see if that does anything for the FT3 & cholesterol.
I will probably just supplement with Iron on my own & see if that changes
the next blood test.
thanks :)

[goolarra]

Your doctor most likely called in a script for 25 mcg (micrograms) of levo.

Did she indicate which "autoimmune" she thought you had?  Both your TPOab and TGab are strong positives.  Hashi's is diagnosed all the time on the basis of elevated antibodies.  I have Hashi's, and I had elevated antibodies.  I've never had a biopsy.  Biopsy may be the only way to absolutely, positively confirm Hashi's, but it's not at all necessary for a diagnosis.  If it walks like a duck and quacks like a duck, you may not have to do DNA testing on it to make absolutely sure it's a duck!  LOL

I think you should see a doctor about your iron/ferritin levels.  

  

[AvielaAvielle]

my doctor is calling in a prescription for 25mg?? of Levo.
That's all she really had anything to say about.
She says I'm auto-immune but not necessarily Hashi, the only diagnose that with a biopsy.
She didn't mention my Iron.
:)

[goolarra]

I don't know how low your D was, but some people's doctors will put them on 50,000 IU per week if they are actually below range or right at the bottom.

What you may have to avoid is a group of foods called goitrogens, which tend to inflame the thyroid.  You can google a list.  They are fine once cooked; cooking kills the goitrogenic effect.  So, continue to enjoy them that way because most of them are good for you.

[AvielaAvielle]

I'm taking 1000mg of D3 & trying to get out into the sun for 1/2 hr a day...
I didn't check it again.

I am getting used to the idea of meds....so...hopefully a low dose to start...

I heard it's not good to eat nuts, beans, & night shade vegetables when you have Hashi....and I've been eating tons of those since I found out I had high cholesterol....so now...I guess I have to change diet again...hahaha....
I'm wondering why the FT3 went down.....hmmm....

I haven't spoken to the doctor yet about the results.....see how long it takes for her to contact me.....
Guess I'll have to learn how to get more ferritin in my system now....
Thanks for your guidance Goolarra :)

[goolarra]

Your ferritin is very low; it's below range, and ferritin has to be up around 70 for the proper synthesis of thyroid hormones in the thyroid and must be present in cells for thyroid hormone to be properly metabolized there.

Don't worry about total T3 and total T4 being dropped.  They're both considered obsolete as a regular diagnostic of thyroid status, pretty much a waste of money.  The frees are much more important.

Your FT4 did come up quite a bit.  It's at 40% of range now...a little low, but not terrible by any means.  FT3 actually came down.  It's only at 25% of range now.  That's pretty low; the guideline for FT3 is 50+%.  FT3 is the test that correlates best with symptoms.  We've already talked about TPOab and TGab.

What's more important is that your HDL went up nicely.  

Are you supplementing D?  How low is your D, and how much are you taking?  Have you checked with your doctor about ferritin?

How are you feeling about thyroid meds?

[AvielaAvielle]

Hi,
Here are the results:
Iron TIBC 363 (250-450)
UIBC 296 (150-375)
Iron,Serum 67 (35-155)
Iron Saturation 18 (15-55)
Ferritin, Serum 11 (15-150)

TSH 10.16 (.45-4.5)    prior test 13.07  Prior 16.09
They didn't test regular t3 & t4 so I don't know if that changed.
T4  ???   prior 9.4 (4.5-12)      prior 8.9
T3 ??      prior 132 (71-180)    prior ???
FT4 1.20 (.82-1.77)   prior1.05  
FT3 2.6 (2.0-4.4)       Prior 2.9
TPOab 259 (0-34)    
TGab 3.0 (0.0-0.9)

Bad Cholesterol & fat went down significantly due to dietary changes:
Total 262    was  315
LDL 169      wqs 221
HDL 74        was 66
Tri glycer  93   was 140

Thanks :)