Question about Current Lab Results - ref ranges included

[wkingmom]

It’s been about five months since I finally found a decent doctor to treat my hypothyroidism.  He started me on synthroid.  They also did a scan on my pituitary gland.  They found a Rathkes cleft cyst, 4mm large.  My doctor says they’ll have to monitor it.

But I’m kind of wondering about my recent labs.  I’ve been on synthroid for five months now and have noticed about 50% improvement in my symptoms.  The doctor has been increasing my dosage according to my symptoms and he currently has me on 100 mg.  

TSH  0.05  Ref range  0.34-5.6
T4    1.04   Ref range  0.58-1.64
T3     3.6    ref range   2.5-3.9        

My T3 is looking good, but my TSH went down.  
6/1/2016 my TSH was 0.938 ref range  0.34-5.6

Any idea what’s happening?  My doctor didn’t say anything about it.  

[wkingmom]

I'm taking synthroid 100 mcg.
I found a B12 test taken 1/27/2016
my score was 538 ref range 180-914

I will see if the doctor does anything about my high cortisol levels.  Thanks again for all your help!

[gimel]

Looks like a good assessment of your GH status.  

I meant to ask about your current thyroid med and dosage.  

So you are going to need to test your Free T4 and Free T3 without taking your thyroid med until after blood draw.  You are working on getting your Vitamin D optimal.  Need to check B12 and optimize to upper end of range.  Need to test ferritin after the end of iron infusion and then optimize to 70-100.  I did some reading about potential causes for high cortisol.  

"High cortisol in women can cause excess hair growth on their face, neck, chest, abdomen, and thighs.  Their menstrual periods may become irregular or stop.  
Other common signs and symptoms include

    severe fatigue
    weak muscles
    high blood pressure
    high blood glucose
    increased thirst and urination
    irritability, anxiety, or depression
    a fatty hump between the shoulders"

So it would be a good idea to talk to the doctor about the high cortisol level, since the last couple were significantly over the range.  Worth asking if it could be related to the cyst on the pituitary gland.  In addition to potential symptoms from the high cortisol, it also offsets the effect of thyroid hormone, requiring higher levels of thyroid to attain the required effect.  If nothing is suggested to lower cortisol levels, I have read that Rhodiola will do that.   Another thing to keep in mind and test is that DHEA-S needs to be in the right proportion to cortisol to offset the bad effects from the cortisol.  Worth testing for DHEA-S also.  

[wkingmom]

"Was the Reverse T3 result from the same blood draw for your recent tests?"   Yes.

"Were the ranges shown for the cortisol tests reflective of the time of day when blood was drawn?"  Yes.

"What did the doctor say about your cortisol being over the ranges in the last two test results."   Nothing.

No, I have not had my B12 tested lately.  I am supplementing for that as well.

Yes, I suspect my cyst is affecting my pituitary gland.  
The signs and symptoms of GHD and/or hypopituitarism, are:
• Decreased bone density - I have this
• Fatigue - I have this
• Adverse lipid changes, such as high cholesterol – I have this
• Reduced exercise tolerance - I have this

However, I read the link you referenced and it says "Growth hormone stimulates the production of insulin-like growth factor-1 (IGF-1). IGF-1 is a hormone that mediates the effects of GH and helps promote normal bone and tissue growth and development. However, unlike GH, its level is stable in the blood throughout the day. This makes IGF-1 a useful indicator of average GH levels and the IGF-1 test is often used to help evaluate GH deficiency or GH excess."

Even though my actual GH was seriously low, my IGF-1 score was fairly normal.

I noted it also says: hypothryoidism must be treated prior to testing for GH deficiency in children; otherwise, a falsely low GH result may be seen.

So my GH may be a false low because my hypothryodism is not fully treated yet.  I may have to wait until my hypothryodism is under control before I can start worrying about growth hormone deficiency.

[gimel]

Was the Reverse T3 result from the same blood draw for your recent tests?   Were the ranges shown for the cortisol tests reflective of the time of day when blood was drawn?  What did the doctor say about your cortisol being over the ranges in the last two test results.  

So you had symptoms from low thyroid hormone levels.  You are taking thyroid med, which it appears needs to be increased a bit.  To avoid false high results, you need to make sure to defer your thyroid med until after the blood draw in the future.  Your Vitamin D was low and you are supplementing for that.  Optimal is at least 50.  I don't see any info on B12.  Your ferritin was low and you got infusions for that.  You will need to re-test for that to see how much you will need to supplement with iron pills daily.  

We need to understand your cortisol results. Since you were found with a cyst on your pituitary gland, I expect that it would be affecting output from the gland.   And since I know nothing about human growth hormone, I did some looking around for info.  What I found raised a question about the need for additional testing to diagnose adequately.  Note the following link.

https://labtestsonline.org/understanding/analytes/growth-hormone/tab/test/

[wkingmom]

Thanks for the tip on holding off on taking anything before the blood tests.  

Regarding my lab results, I recently received iron infusions which greatly increased my ferritin levels.  I forget the exact numbers but they are above the reference range high limit.

I did some digging and found my Reverse T3 scores.  15 ref  range 9.2-24.1.   My Vitamin D was 36, ref range 32-100.  the nurse was like that's normal, I said uh, I don't think so.  I'm taking vitamin D supplement with K right now.  

Here are my recent cortisol tests  March 2016 cortisol was 7.5 ref range 2.9-17.3, in June 2016 cortisol was 22, ref range 2.3-11.9.  July 2016  my score 30  ref range 3.1-22.4.

My ACTH 3/2016 was 7.1  ref range was <45
7/20/2016 was 15  ref range <45.

So if my "tissue thyroid levels are lower than indicated by my blood test result" what does that mean?  And what can I do to fix it?

Some more info:  Since taking the synthroid and getting the iron infusions, my fatigue is not as bad as it used to be.  I would say my energy levels have improved about 50%.  I still have a hard time dealing with both cold and hot weather, although I noticed in the past couple of weeks it's not as bad as it used to be.  Most nights after dinner I would sit down and watch TV, then about 30 minutes later feel a chill.  I would have to sit in front of my portable heater for a good ten minutes to warm myself back up.  This still happens about three times a week.  The main thing that's still a problem is my muscle pain.  Most of it is in my back, and it seems to get worse when I do too much work, or carry something heavy.  That was part of the reason I'm suspecting I have a human growth hormone deficiency.  I think my muscles are weak and get overworked and strained.  When muscles are strained and overworked, spasms are caused, which cause pain.  My entire back is tight with painful muscle knots all the time.  I also have poor stamina.

The doctor did run some tests.  My insulin like growth factor 155 ref rance 69-227.  My growth hormone (GH) was 0.9 ref range 0.0-10.0.  Based on some of my symptoms (muscle pain, muscle weakness) he also checked my Parathyroid Hormone (PTH) Plus Calcium.  The PTH was 36 ref range 15-65 and my calcium was 9.2 ref range 8.7-10.2.

The doctor said everything was "normal".  But I don't believe him.

[gimel]

Yes there is that possibility.  Serum thyroid hormone levels may not accurately reflect tissue thyroid levels.  The reason being that serum thyroid hormone has to be actively transported into cells (tissue).  It is not just a matter of simple diffusion into cells, there are variables that affect the transport.  Scientific studies have shown that Reverse T3 is a good indicator of reduced cellular thyroid hormone levels.  If there are deficiencies in the variables affecting thyroid hormone transport into cells, such as low ferritin, or low cortisol, then there is a reported tendency of T3 to pool in the blood, rather than getting into cells.  

Usually hypo patients taking thyroid med find that their Free T3 level is somewhat lower in its range than Free T4. The fact that your Free T3 is higher in its range than your Free T4, made me wonder about the possibility that your tissue thyroid levels are lower than indicated by your blood test result, and causing symptoms.  So that was why I recommended testing for Reverse T3 and cortisol.  

By the way, it is recommended that a hypothyroid patient defer the morning dose of thyroid med until after the blood draw for tests.  That avoids the possibility of false high results.   It is also recommended that you stop any iron supplement for several days before testing for ferritin, for the same reason.  

[wkingmom]

Sorry for the late response, Hurricane Mathew came through my area and I've been busy.  No, I have not been tested for Reverse T3.  My ferritin is good now, I recently got iron infusions, I forget the exact number, but my recent lab results showed my ferritin was over the reference range high.  My vitamin D was very low, so I've been taking a supplement for that.  

I do not understand when you say  "reverse T3 is an excellent marker for reduced cellular T4 and T3 levels not detected by TSH or serum T4 and T3 levels."  Does my high T3 level mean I'm not getting enough T4 and T3 into my cells?

[gimel]

Don't give TSH a second thought.  When already taking thyroid med, TSH is basically a wasted test because frequently it becomes suppressed when taking significant doses of thyroid med.  A suppressed TSH does not mean hyperthyroidism, unless you have hyper symptoms due to excess levels.  You can read about that in item no. 10 on page 13 of the following link.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Since you still have some symptoms, your Free T4, at 43% of its range,  is a bit lower than optimal, which is mid-range, at minimum.  Your Free t3 is at 79%, which is significantly higher in its range, than Free T4, which is a bit unusual.   Symptoms are directly related to tissue thyroid levels and effects, and serum thyroid levels do not always accurately reflect tissue thyroid levels,   There are a number of conditions that can hinder transport of Free T3, causing it to pool in the blood rather than getting into all the cells of the body.  A scientific study has shown that, "reverse T3 is an excellent marker for reduced cellular T4 and T3 levels not detected by TSH or serum T4 and T3 levels."  So have you been tested for Reverse T3, along with a Free T3 from the same blood draw?  You will find suggestions for tests on page 2 of the link above.  Along with RT3, FT3, FT4, cortisol, Vitamin D, ferritin should be done.  If fatigue is one of you symptoms, then also test for B12.  If you have been tested for any of those, please post results.