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New Thyroid labs...opinions?
New Labs-February 2018
TSH- 1.9 Ref Range .5-3
Free T3 2.8 Ref Range 2.4-4.2
Free T4 1.0 Ref Rang .7-2.5
TPOab 20 Ref Range <70
Prior post with labs/issues for reference:
Hi everyone, feeling under the weather for a while. ZERO energy, cold all the time, weight gain, brain fog. Honestly just kinda attributed weight gain (+10-15 lbs over the last year) to the energy issues. However because I constantly use a heater at work, or have my blanket/throw, a coworker recommended getting my thyroid checked. I don't have insurance so went the Everlywell home test route. I am 37 years old, white, female.
Labs November 2017:
TSH- 3.1 High Ref Range .5-3
Free T3 3.2 Ref Range 2.4-4.2
Free T4 1.3 Ref Rang .7-2.5
TPOab 19 Ref Range <70
I understand from research and etc that there are many different ranges for results, therefore just looking for opinions from others who actually have thyroid issues to help understand these ranges and if I need to visit my primary with these results, as I also understand sometimes its hard to get them to listen to concerns regarding thyroid issues when your levels are mostly normal.
Thank you all so much!
TSH- 1.9 Ref Range .5-3
Free T3 2.8 Ref Range 2.4-4.2
Free T4 1.0 Ref Rang .7-2.5
TPOab 20 Ref Range <70
Prior post with labs/issues for reference:
Hi everyone, feeling under the weather for a while. ZERO energy, cold all the time, weight gain, brain fog. Honestly just kinda attributed weight gain (+10-15 lbs over the last year) to the energy issues. However because I constantly use a heater at work, or have my blanket/throw, a coworker recommended getting my thyroid checked. I don't have insurance so went the Everlywell home test route. I am 37 years old, white, female.
Labs November 2017:
TSH- 3.1 High Ref Range .5-3
Free T3 3.2 Ref Range 2.4-4.2
Free T4 1.3 Ref Rang .7-2.5
TPOab 19 Ref Range <70
I understand from research and etc that there are many different ranges for results, therefore just looking for opinions from others who actually have thyroid issues to help understand these ranges and if I need to visit my primary with these results, as I also understand sometimes its hard to get them to listen to concerns regarding thyroid issues when your levels are mostly normal.
Thank you all so much!
That 15 mg (1/4 grain) of NP Thyroid is going to do nothing for you. Even for a starting dose that is very little. Understand that when starting on thyroid med, the TSH will go down, resulting in less stimulation of the thyroid gland and less output of thyroid hormone. Since your serum levels are the sum of both natural thyroid hormone and thyroid med, the net effect is essentially nothing. Only after the dose is high enough that TSH is suppressed enough to no longer stimulate natural thyroid hormone production will serum thyroid levels reflect further increases in thyroid medication. By starting you on 1/4 grain of NP Thyroid, if you only get an increase of 1/4 grain every 6 weeks, it will take forever to get to the dosage needed to relieve symptoms. Many of us have found that to get symptom relief when taking desiccated thyroid med like NP Thyroid, we needed FT4 at least mid-range, and FT3 in the upper part of the range.
Just keep in mind that a good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T# levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels. I say that about TSH because when taking thyroid med adequate to relieve hypo symptoms, TSH is usually suppressed below range. If the doctor does not understand that this does not mean hyperthyroidism, then the response would normally be to reduce your med dosage. That is very wrong. A suppressed TSH does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.
Also, if not done already you need to be tested for Vitamin D, B12 and ferritin. All are very important for you and they are frequently deficient for a hypothyroid patient. D needs to be at least 50 ng/mL. B12 in the upper end of its range, and ferritin should be at least 100.
Just keep in mind that a good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T# levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels. I say that about TSH because when taking thyroid med adequate to relieve hypo symptoms, TSH is usually suppressed below range. If the doctor does not understand that this does not mean hyperthyroidism, then the response would normally be to reduce your med dosage. That is very wrong. A suppressed TSH does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.
Also, if not done already you need to be tested for Vitamin D, B12 and ferritin. All are very important for you and they are frequently deficient for a hypothyroid patient. D needs to be at least 50 ng/mL. B12 in the upper end of its range, and ferritin should be at least 100.
Your new results for Free T4 and Free T3 are worse than prior. FT4 went down from 33% of its range to 17%. Free T3 went from 44% of its range down to 22%. And those are compared to ranges that are far too broad, due to the erroneous assumptions used to establish ranges. Also, just being in the range does not mean results are optimal for you. Even more important is the symptoms you have that are so often related to being hypothyroid.
You also might like to know of this quote from an excellent thyroid doctor. Note that the ranges are different but the message is clear. "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."
You definitely need a good thyroid doctor that will treat clinically, as previously recommended in my answer to your original post last Nov.. I have copied and pasted my prior answer below.
gimel
I would say that you definitely need to see a doctor. Not necessarily your PCP, but a good thyroid doctor. Before explaining why I say that I think it is important to identify the correct definition of hypothyroidism, which is "inadequate supply of, or response to, thyroid hormones in some or all tissues of the body". This is commonly referred to as "tissue thyroid effect". So there are two main elements here: supply of thyroid hormone and response to the thyroid hormone.
The Standard of Care for Hypothyroidism (SOCH) is flawed because it ignores numerous body processes and variables that affect tissue thyroid effect, and relies almost exclusively on TSH and sometimes Free T4 tests compared to reference ranges. Free T3 is usually ignored on the faulty assumption that T4 always converts to T3 as needed. The SOCH doesn't work well for patients because TSH does not correlate at all with symptoms, and Free T4 has only a weak correlation with symptoms. Since there are no direct measures of tissue thyroid effect, indirect measures are required. Among those the most important by far are symptoms, followed by Free T4 and Free T3 and sometimes Reverse T3. In addition hypo patients are frequently deficient in Vitamin D B12 and ferritin. Vitamin D and ferritin are especially important to assuring adequate tissue thyroid effect.
You can read about all this in the following link. I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended. You will also find in the paper a discussion of why test results and associated reference ranges vary from one lab to another, and are flawed due to erroneous assumptions used to establish ranges.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
So the doctor you need is one that understands all this and is willing to treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. You will also need a doctor that is willing to prescribe T3 meds, if needed. Your TSH is slightly above range, but doesn't mean much here. Your TPO ab was within range, but you were not tested for Thyroglobulin antibodies, the other type of antibodies associated with Hashimoto's thyroiditis. Your Free T4 is only at 33% of its range and your Free T3 is only at 44% of its range. In the paper you will note that when a patient has symptoms that are typical of hypothyroidism, such as yours, having FT4 and FT3 that are below the mid-point of the range is also indicative of hypothyroidism. Most doctors would ignore all this and tell you that your thyroid test results are "normal" and that your symptoms must be due to something else.
So if you are not sure that your doctor will be willing to treat clinically as described, and also prescribe T3 meds when needed, then I would suggest not wasting your money there and instead locate a good thyroid doctor that will do these things. If you need help with that we may be able to suggest a doctor that has been recommended by another thyroid patient.
Nov 14, 2017
You also might like to know of this quote from an excellent thyroid doctor. Note that the ranges are different but the message is clear. "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."
You definitely need a good thyroid doctor that will treat clinically, as previously recommended in my answer to your original post last Nov.. I have copied and pasted my prior answer below.
gimel
I would say that you definitely need to see a doctor. Not necessarily your PCP, but a good thyroid doctor. Before explaining why I say that I think it is important to identify the correct definition of hypothyroidism, which is "inadequate supply of, or response to, thyroid hormones in some or all tissues of the body". This is commonly referred to as "tissue thyroid effect". So there are two main elements here: supply of thyroid hormone and response to the thyroid hormone.
The Standard of Care for Hypothyroidism (SOCH) is flawed because it ignores numerous body processes and variables that affect tissue thyroid effect, and relies almost exclusively on TSH and sometimes Free T4 tests compared to reference ranges. Free T3 is usually ignored on the faulty assumption that T4 always converts to T3 as needed. The SOCH doesn't work well for patients because TSH does not correlate at all with symptoms, and Free T4 has only a weak correlation with symptoms. Since there are no direct measures of tissue thyroid effect, indirect measures are required. Among those the most important by far are symptoms, followed by Free T4 and Free T3 and sometimes Reverse T3. In addition hypo patients are frequently deficient in Vitamin D B12 and ferritin. Vitamin D and ferritin are especially important to assuring adequate tissue thyroid effect.
You can read about all this in the following link. I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended. You will also find in the paper a discussion of why test results and associated reference ranges vary from one lab to another, and are flawed due to erroneous assumptions used to establish ranges.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
So the doctor you need is one that understands all this and is willing to treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. You will also need a doctor that is willing to prescribe T3 meds, if needed. Your TSH is slightly above range, but doesn't mean much here. Your TPO ab was within range, but you were not tested for Thyroglobulin antibodies, the other type of antibodies associated with Hashimoto's thyroiditis. Your Free T4 is only at 33% of its range and your Free T3 is only at 44% of its range. In the paper you will note that when a patient has symptoms that are typical of hypothyroidism, such as yours, having FT4 and FT3 that are below the mid-point of the range is also indicative of hypothyroidism. Most doctors would ignore all this and tell you that your thyroid test results are "normal" and that your symptoms must be due to something else.
So if you are not sure that your doctor will be willing to treat clinically as described, and also prescribe T3 meds when needed, then I would suggest not wasting your money there and instead locate a good thyroid doctor that will do these things. If you need help with that we may be able to suggest a doctor that has been recommended by another thyroid patient.
Nov 14, 2017
1 Comments
Thank you...I did see a functional Dr this week who was also concerned about the FT3 and FT4 dropping even though my TSH went down. I was prescribed 15mg of NPThyroid to start, retest in 6 weeks. There are so many opinions from Drs on treatment when "in range" I just wanted to get opinions from actual people who see their #s go up and down, on meds and not, to help understand how I feel vs what is on the paper. Thank you again for responding!
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