No symptoms except weight gain TSH 3.87?

[sweetbee2]

My TSH is high. I tested negative for the TPO antibodies test by my endo. I tested while fasting at 9am and the TSH at 8am while fasting. He suggests monitoring my levels if it increases. Now, I have no history of thyroid disease in my family but I have been eating poorly and not taking a multivitamin. I am also low on iron but I have been low on iron almost my entire life. I have been constipated since 5 yrs ago but had no issues losing weight then. It's just been in the past 1.5 yrs that I have been having trouble with my weight but this could be because of low physical activity and poor dieting? My gen doctor suggested I eat vegan which I have been trying to do. I also had a poor sleeping pattern due to being long distance and calling long distance friends later at night. Could this resolve my TSH to a normal level or should I say that it's ok to be tested and monitored? I worry that my TSH could get any higher. My dog had hypothyroidism and he eventually passed away.

TPO AB 3.00 IU

COMPONENT YOUR VALUE STANDARD RANGE
TSH,BLD,QN 3.870 uIU/mL 0.300 - 4.200 uIU/mL

[gimel]

As I mentioned previously TSH is totally inadequate for diagnosis of thyroid issues unless it is at extreme levels, either high or low.  Otherwise the most important indicators of your thyroid status are symptoms that occur more frequently with hypothyroidism and then biochemical tests, mainly for Free T4 and Free T3 (not the same as Total T4 and Total T3).   Also as mentioned, it is important to initially test for Reverse T3 and cortisol.  Also, due to their effect on the response to thyroid hormone, Vitamin D, B12 and ferritin 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.

If you cannot get your doctor to even consider the possibility of central hypothyroidism and do these tests, then you are wasting your time there and need to find a good thyroid doctor, instead of waiting around for months with the likelihood of  the same response.

[gimel]

You should mention to your doctor that central hypothyroidism does not manifest a high TSH, and that central hypothyroidism is not a rarity, just that it is rarely diagnosed due to inordinate attention to TSH only.    You can also tell him that TSH has only a weak correlation with the biologically active thyroid hormones, Free T4 and Free T3 and it has a negligible correlation with Tissue T3 Effect, which determines a person's thyroid status.   So TSH is useful as a diagnostic only when it is at extreme levels.  An evaluation for symptoms that occur more frequently with hypothyroidism is the most important consideration in diagnosing a person.   Next is testing for Free T4 and Free T3.   Also as mentioned it is important to initially test for Reverse T3 and cortisol.  Also due to their effect on the response to thyroid hormone, Vitamin D, B12 and ferritin 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.

You can find all this info in the paper linked in my Journal.

[sweetbee2]

I feel fine besides the weight gain but I noticed I lost about 7 pounds since I had my blood drawn 2 weeks ago with exercise and eliminating dairy, eggs, and most meats. And eliminating sugary foods and drinks and upping veggies and fruits. My endo said my test a few days ago was a lowered TSH . I fasted and tested at 9am for a more accurate result. He wants to recheck in 2-3 months but I feel that's too far away.
COMPONENT YOUR VALUE STANDARD RANGE
TSH,BLD,QN 2.690 uIU/mL 0.300 - 4.200 uIU/mL

[Red_Star]

My lab reference range for TSH is a max of 3.5 mU/L. I gained weight from hypo when my TSH was in the mid 3's.

[sweetbee2]

Yes I think that is what happened to me? Although on May 2017 I was a 1.7 TSH then in July 2017 I noticed the pounds creeping up and that is when I saw my endo at first who looked at my 1.7 TSH from May and said I was normal. Did you lower your TSH? I have no family history of hypothyroidism and wondering if all this is just my eating and exercise habits of which was none.

[Red_Star]

I have Hashimoto's thyroiditis. My TSH went back down with thyroid medication. Diet wise, causes of hypothyroidism are deficiencies of iodine or selenium or eating too many goitrogens.

[Red_Star]

My lab reference range for TSH is a max of 3.5 mU/L.

[Jenn1302]

Some doctors consider a TSH of 3.87 hypo enough to go on medication if you have symptoms and have tested positive for Hashimoto's or Graves. Has your doctor checked your Thyroglobulin (Tg) levels? Tg is basically another antibody that has been associated with Hashimoto's. Have they checked your FT3 and FT4 levels?

[sweetbee2]

No, he says the t3 and t4 isn't necessary unless I remain with a high TSH or it elevates more and that the TG test isn't as reliable.

[Jenn1302]

I would seek a second opinion. It's important that you get your Tg checked out because if it could explain your high TSH. If it comes back positive it means that you have Hashimoto's. My TPO doesn't seem to affect my thyroid nearly as much as my Tg levels. Every time my Tg goes out of range my thyroid hormones go out of whack. My TPO levels are always high, even when my thyroid hormones are stable.

FT3 and FT4 are also important. If you have an appointment with a specialist or another doctor you can always ask them to run these tests.

[gimel]

First thing to understand is that the correct definition for hypothyroidism is not just inadequate thyroid hormone.  Instead it is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."  It is the TISSUE T3 EFFECT that determines your thyroid status.  TSH is a pituitary hormone that is affected by so many things that it has only a weak correlation with the biologically active thyroid hormones, Free T4 and Free T3, and a negligible correlation with TISSUE T3 EFFECT.  Thus TSH is useful as an indicator of thyroid status only when it is at extreme values.  Your TSH does not come anywhere near such a level.  

The best way to assess a person's thyroid status is an integrated approach including a full family history, evaluation for symptoms that occur more frequently with hypothyroidism, and finally extended biochemical testing.  Tests should include Free T4 and Free T3 (not Total T4 and Total T3) every time you go in for tests.   A TSH test with followup to TPO ab and TG ab, if TSH is high.  Reverse T3 is also useful, along with cortisol.  Since hypo patients are so frequently deficient in Vitamin D, B12 and ferritin, those should be tested and then supplemented to optimize.   D should be at least 50 ng/mL, B12 n the upper end of its range, and ferritin should be at least 100.

You have mentioned several symptoms that frequently occur with hypothyroidism.  So I suggest that you try to get the additional testing done as the next step.  Then post results and reference ranges here and we will be glad to help interpret and advise further.  

Also keep in mind that a good thyroid doctor will diagnose and treat a hypothyroid patient clinically, by adjusting Free T4 and Free T3 levels as needed to relieve symptoms, rather than based on biochemical tests, especially TSH.    As mentioned TSH is useful for diagnosis only when at extreme levels.  TSH  is useful in distinguishing between primary central hypothyroidism.  

If you want to confirm anything I have said, 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.  

[gimel]

Sorry, should read TSH is useful in distinguishing between primary and central hypothyroidism.  

[sweetbee2]

Well here is the response I received from my doc who is a top rated endo in my area. Not sure if I should push for the test still? Well the other symptoms started 5 yrs ago but last year in 2017 I had a TSH of 1.7 when I tested in the am or pm I forget.

The TPO Ab are most sensitive in detecting autoimmune thyroid disease

The TG Ab can be false positive, because about 30% of adults have these antibodies

The t3/t4 are checked if the tsh remains elevate(s)(d), if the tsh is normal, then we recommend(s) Using this test

Insulin resistance does not affect thyroid hormone production

The negative family history of thyroid disease is reassuring as autoimmune thyroid disease does run in families.

[Morning_Light]

I'm sorry to hear about your dog passing away and the was hypothyroid just like you. Did you give him thyroid medication? This endocrinologist sounds more like one who focuses on diabetes and is not familiar with thyroid. Fasting from food isn't done for testing TSH or TPO. Did he test your free thyroid hormones FT3 and FT4, or is he just going by TSH? TSH is not a reliable test for your thyroid because it's not a thyroid hormone.

The only fasting that is done before testing is fasting from thyroid medication the morning of your tests. What were your results from the TG antibody test, or did the doctor not remember that there are two? TSH isn't a thyroid hormone. It's from pituitary but it communicates with your thyroid and tells it how much thyroid hormone to produce. TSH 3.87 is too high, is hypo. You don't want it to be left that high. Your pituitary is telling your thyroid to try to make more thyroid hormones, T4 and T3. Your symptoms of weight gain, constipation, sleep problems, low physical activity are hypo signs. I'm sorry to say that your TSH will not resolve on it's own. It sounds like you've been hypo for over 5 years with constipation and other symptoms. You need a doctor to run a complete thyroid panel on you so that your thyroid can be correctly evaluated, which is impossible by TSH and one antibody. Do you also have diabetes? Diabetes can be related to being hypothyroid. I hope he tested your A1C, fasting glucose and insulin. Since he didn't test your thyroid (TSH is pituitary) this makes me concerned about his ability as an endocrinologist to diagnose health conditions.

[sweetbee2]

I don't have sleep problems. I can fall asleep easily at the hour without waking up and not feel tired at waking. I said I had been staying up late by preference. The constipation I had after an anxiety attack 5 yrs ago after which I lost weight easily while dieting and my last TSH test in 2017 that I might have taken in the am or pm forget was 1.7 TSH. I can easily and without efford do high cardio workouts and walking without huffing and puffing and sweat. No issues there. The constipation developed 5 yrs ago after anxiety issues but I also had anxiety my entire life without frequent attacks except the last few years or so. I was tested negative for diabetes. It's at 5.6% currently but I have stopped eating sugary drinks and foods.