Accuracy of Thyroid Tests

[jarm4]

Hi I am new to this board but wanted to ask how much can I rely on the snapshot Thyroid Tests?  I have been dealing with the following symptoms since I was in my teens: severe fatigue, menstrual problems, chronic anemia, depression, pain for no apparent reason, brittle skin and hair, plantar fasciitis , depression, anxiety and sleep problems.  i have been to see general practitioners who diagnosed me with depression and put me on antidepressants which have not helped.  I have seen gynecologists who have diagnosed me with PMS, Post- Partum Depression, Pre-Menstrual Dysphoric Disorder, Uterine Tumors, Early Menopause and one simply said I was lazy.  Every doctor has had the same theme though by listening to my story and symptoms and immediately ordering thyroid testing.  Every time my tests come back with my results in the middle of the normal range.  Therefore the doctors all tell me since my tests are normal, there is nothing wrong with me and then give me an antidepressant prescription.  I know something is wrong but how can I prove it if my tests results won't show the doctors?

[Barb135]

I agree with gimel that we don't let people just walk away without trying to help them, all we can.

I don't see any mention of antibody tests anywhere, so I'd have to ask if you've had any to test for Hashimoto's Thyroiditis, which is an autoimmune thyroid disease in which the body sees the thyroid as foreign and produces antibodies to destroy it.  With Hashimoto's, it's not the least bit unusual for symptoms to show up long before thyroid production is diminished enough to show up on blood work.

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyrogobulin Antibodies (TGab).  If antibodies are present, some doctors are willing to begin treatment in an effort to alleviate symptoms.

Additionally, vitamin B12 really does need to be tested, as it can cause the most horrible fatigue imaginable. It can also cause some depression-like symptoms; mostly because the person is so tired, they can't enjoy life.

As for the weight issue, you might look into insulin resistance and metabolic syndrome.  Metabolic syndrome is at least three of a set of metabolic risk factors, which are high blood pressure, high triglycerides, low HDL cholesterol, obesity (large waistline), high fasting blood sugars.  Even if you are on medications to treat these conditions, you still fall in the category.  Mildly high fasting blood sugar is a risk factor for developing full blown Type II diabetes.

Insulin resistance/metabolic syndrome is first treated via lifestyles that are conducive to weight loss, including a low glycemic diet and moderate exercise.  Occasionally, it's treated with a medication called metformin, which is also used to treat type II diabetes.

[gimel]

We don't let anyone walk away without trying to help in every way possible.  For example I had noted a doctor in your general area that seemed to be a good thyroid doctor, in that he paid attention to symptoms and would prescribe Armour thyroid, when necessary.  When I read you last post I contacted his office and learned that he now has a "concierge"  type practice, which I said would not work for my friend that I was inquiring for.  The lady then said that you would be interested to know that he has a Physician's Assistant that has been working with him for over 10 years and is fully familiar with treatment of thyroid patients, like the doctor would do.  I think this might be worth an appointment.  If you are interested, I will send PM with info.

[jarm4]

So I had my appointment with the new doc today and I am so disappointed.   He looked at all of my old labs and said he completely agreed with my previous docs that there was nothing wrong with my thyroid.  I have been so determined to get this mystery of my health solved that I did a lot of homework into my previous doctor visits.  I showed him when all of this started with my first diagnosis of "severe PMS" in my early 20s through the depression diagnoses and where I am today at age 39.  I have keep a spreadsheet of how I have been feeling for the last 3 months, time stamping my symptoms and giving each day a grade on 1-10 with 1 being I feel great and 10 being I can't get out of bed because I feel so terrible.  He looked at all of my stuff for about 10 seconds and then proceeded to explain to me that some people just feel fatigue and since I have 4 kids I should expect to be a little tired.  He then told me that I feel joint and muscle pain because I am overweight and if I lost 50 pounds I would be better off.  He had his lab draw some blood at my insistence that he check my pituitary, vitamin D and a couple others.  He said he would check but he does not expect to find anything and that I should learn to just push through this.  When he left the room I though I might lose it because his last words were "your labs look completely normal so your going to be fine."  How is it hearing those words from a doctor made me break down and burst into tears.  Typically most people would be happy with that answer from a physician.  I feel so patronized and I know that I should not let this one person dictate my health but if he is just another in a long line of doctors who think my problem really is all in my head, then maybe I should just give up and accept that this is my life and it is never going to get better.  Maybe I am just depressed and I just don't really understand what depression is.  I always thought depression meant no lust for life and just total sadness which is not my typical personality but maybe I am wrong.  
Oh well, I just want to say thank you for your advice and kind words.  While there may be no help for me, this board is wonderful and I know there are a lot of people who really benefit from all of you.

[Red_Star]

I just was reading a very interesting article about cellular resistance (posted below). I had my sex hormone binding globulin (SHBG) tested and my result was 18 nmol/L (18 - 114). I had this test done maybe 4 to 6 weeks after i started thyroid medication.  

I've had hypothyroid symptoms for decades due to cellular issues and the only reason my TSH changed was due to Hashimoto's thyroiditis affecting my thyroid gland.  The pain in my hands that i thought was arthritic pain was due to vitamin D deficiency.  One study found 92% with Hashimoto's thyroiditis have vitamin D deficiency.

About Guide - Long Term Weight Loss for Thyroid Patients: Hormonal Factors That Affect Diets...

"Another important lab to get is sex hormone binding globulin (SHBG). It is stimulated in the liver in response to thyroid hormone and estrogen, so it can be a useful marker for tissue level of thyroid.

In a premenopausal woman, the level should be above 70. If not, it is a good indication that there are low tissue levels of thyroid. This is especially true if the woman is on oral thyroid replacement, because -- due to first pass metabolism – her liver will have much higher thyroid levels than the rest of the tissues. Thus, if SHBG is low, the rest of the body is low thyroid.

(Note: This test is not useful if a woman is on oral estrogen replacement, because that will artificially elevate SHBG due to high estrogen level in the liver. The test is accurate for women who are using transdermal estrogen preparations, however.)

Diabetes and polycystic ovary syndrome (PCOS) also suppress SHBG, due to the suppressed intracellular T3 levels seen in these conditions. Also, if you check your SHBG before going on thyroid replacement and see little change with treatment, it is an indication that you have thyroid resistance."

[jarm4]

Wow kevib I had no idea a low vit D could cause that. I am seeing a new Doc a week from Monday. I am hoping he will help. He is an endocrinologist who also has a pharmocology degree. I am hoping he will place more stock in symptoms as both of you have said. I had to apply for him to see me about a month ago. Apparently he only accepts new patients that are for cases he finds to be interesting. I am in the Northwest Atlanta area in Georgia. I have been researching docs online and what I am finding is a large focus in our area on endocrinologist who specialize in diabetes treatment.  I understand they are still trained understand the entire endocrine system but it seems like docs who focus on one specialized area of their area of expertise don't know what to do with patients who don't fit the mold so to speak.
Gomel - thanks for the advice. I have never heard of Central Hypothyroid but I can definitely see a connection to the pituitary and hypothalamus would be logical. I will definitely talk to my new doc about it.   I am also going to ask him about my joint and muscle pain. I know this is weird but ever since my Gyn told me to stop taking my anti depressants my pain has been gradually increasing.  She suggested the anti depressants were causing my fatigue but that has not changed with stopping them and it has been 2 months since they weened me off the Celexa. Actually the only change I have had has been the increase in pain. That I did not expect.

Thank you both for your commentary. Just hearing someone else say they have similar issues makes me feel less like this is all me being "melodramatic" as my husband thinks. He keeps telling me to just get over it but I just don't think I can on my own.

[kevieb]

I'm with gimel--you need to see if you have a pituitary problem going on.  If you do---it could explain all of your symptoms---and the TSH would be totally useless.  My doc doesn't believe in "lab ranges" he believes in treating according to symptoms.

so many of your symptoms sound like what I have been dealing with for years,   i have central adrenal insufficiency and hypothyroidism.  My DHEA and testosterone levels fall too low if i do not supplement them.  I have to take hydrocortisone daily---and only have just realized that I seem to need a slightly higher dose than many people take.

I am just barely starting to feel like there is a chance I could get somewhat of a normal life back!

I was also low in a number of vitamins and minerals---Vit D was so low I felt like I had shin splints.

[gimel]

With those lab results I can see that many doctors would not consider the possibility of a thyroid issue; however, they are quick to jump to depression as a cause.  If that were true, how does that explain all those other symptoms??????     Of course they don't get into that.    

Well, maybe you should ask them about the possibility of central hypothyroidism, related to the hypothalamus/pituitary system.  With that, the TSH output is lower than normal and results in Free T3 that is too low in the range to relieve symptoms.  The Free T3 range is far too broad due to the erroneous way it was established.  Many of our members say that symptom relief for them required Free T3 in the upper third of its range and Free T4 around the middle of its range.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

I think you are going to need to find a good thyroid doctor.  By that I mean one that will treat clinically, by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  So, if you will tell us your location, perhaps we can help locate a good thyroid doctor for you.  In the interim, I also suggest that you should request to be tested for Vitamin D, B12, ferritin, and a full  iron test panel.  Sometimes these are too low in the range and can mimic hypo sympotms.

[jarm4]

Sure.  My labs were as follows:

TSH reading 1.44; reference range of 0.40 to 4.5 mIU/L
Free T4 reading 1.2; reference range of 0.8 to 1.8 ng/dL
Free T3 reading 3.0; reference range of 2.3 to 4.2 pg/mL.

My doctor told me that with lab results like these there is no way something could be wrong with my thyroid.  She just doesn't ave any clue what is wrong.

[gimel]

There are several possibilities I can think of.  but before getting into those, please post some of your thyroid test results and their reference ranges shown on the lab reports, so that members can assess.