Thyroid Blood Test Results and Questions

[msdanicat]

Hi Group,
Sorry for the long post. I've struggled with fatigue, joint pain, etc, almost my whole life and have sort of just chalked it up to depression and laziness.I spent many many weekends laying in bed as if I'm in a coma and then I feel guilty because I have accomplished nothing.  My life is a mess, house messy, can't concentrate (I can't multitask at work and was starting to suspect ADHD).  

I have had my thyroid tested before, about 10 years ago, at the request of my doctor after I complained of neck pain which no amount of physical therapy could alleviate. The blood results are long gone, but the ultrasound showed two 4-5mm hypoechoic nodules on the thyroid isthmus and recommended regular follow-up which I never did due to loss of health insurance.  My doctor at the time never said anything about hypothyroid, though looking back I am certain the symptoms were there.

Recently, the fatique feels worse and my hair is thinning, which freaks me out. My quality of life is in the toilet and I can barely drag myself out of bed for work. New doctor requested bloodwork, results below, and an ultrasound (results not back yet).

I go back this week to discuss the blood work and ultrasound, I feel like I don't know enough to ask the right questions or request the right treatment (if any). I would appreciate your thoughts.  It sounds awful to say, but I am hoping something is wrong so I can finally be well. And I am also angry at myself and my doctors because I suspect I've had thryoid issues for most of my adult life.

TSH: 1.41    Range 0.40-4.50 mIU/L
T4, Free: 1.0    Range 0.8-1.8 ng/dL
Thyroid Peroxidase Antibodies:  27     Range <9/IU/mL
Vitamin D, 25-OH Total: 9   Range 30-100 ng/mL

I dont know how Vitamin D fits in...

Thanks in advance for your help.

[JoJo768]

Here's my blood work so far, I am getting more blood work at the end of the week.

TSH 0.931 Range 0.358-3.74 uIU/ml
Free T3 3.0 Range 2.3-4.2 pg/ml
Free T4 Range 1.2 Range 0.8-1.8 ng/dL

[gimel]

I can see that in the eyes of most doctors we encounter, you would be told that your thyroid test results were within the "normal' range and that any symptoms you have are due to something else.  However, your Free T4 is at only 40% of the range and your Free T3 is at about 37 % of the range.  Those can be associated with being hypothyroid.

In the words of a good thyroid doctor, ""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."

Of course weight gain can be associated with a number of things, but low metabolism associated with low thyroid hormone levels is a common problem.  So, based on all that, you at least deserve a therapeutic trial to raise your Free T3 into the upper part of its range and your Free T4 to at least the middle of its range.  Free T3 has been shown to correlate best with hypo symptoms.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief is the most important consideration, not just test results.  So when you see your doctor next to discuss all this with him I also suggest you should find out if he is going to be willing to treat clinically as described.  If not then you will need to find a good thyroid doctor that will do so.  

Finally, please tell us about the additional blood work to be done.  And also are you having any other symptoms besides the ones mentioned in prior posts?

[JoJo768]

Thank you gimel for your comments. Since I just signed into this website, please understand all this is new to me. Do you have a clinical/medical background? You certainly sound very clinical and knowledgeable and I appreciate your responses. Are there specific symptoms you are referring to? Having thyroid issues i.e. Goiter is something pretty recent and new for me. Since my hysterectomy 1 year ago I was diagnosed with multinodular goiter. Being thrown into surgical menopause is a whole new world for me as well. Hot flashes, night sweats, insomnia, menopause muffin top (weight gain) has not been easy getting use to. I think the surgery had a direct effect on my thyroid, obviously, so those symptoms are either menopause related or thyroid related or both. I just feel like my body took a dive post surgery-lots of changes-hard to adjust.

[Red_Star]

If you have an iodine or selenium deficiency you will be hypothyroid. There won't any asymptomatic cases. The same doesn't apply to vitamin D which is why it seems a bit dodgy lol.

But thinking about this further, it's possible there might be something to do with reverse T3 since that is the closest test that have found to measure thyroid hormone at a cellular level. Perhaps for some people this deficiency does affect reverse T3 levels. Other things to consider is vitamin D is needed for the immune system and some of the vitamin D symptoms are the same as hypothyroidism.

[gimel]

My background is partly that I suffered with hypothyroidism for about 35 years.  At first the doctors refused to accept that I was hypo since my TSH was slightly below 5. Then I finally coerced a doctor into a trial of Synthroid.  That helped, and over the years the dose was gradually increased up to 200 mcg daily, and I still had lingering hypo symptoms.  Six years ago I found this Forum and learned from the members about the importance of Free T3.  Got mine tested for the first time and confirmed it as low in the range.  Convinced my doctor to switch me to Armour Thyroid, because I was obviously not converting the T4 to T3 adequately.  After some tweaking of meds and dosages, my Free T3 is now in the upper end of the range and my Free T4 right around the middle of the range, and I supplement Vitamin D, B12 and iron, and I feel the best that I can even remember.  

I mention all that just to acknowledge what I have learned on the Forum that has helped me so much.  Also, since I am retired, I have time for extensive research into scientific studies related to hypothyroidism.  So, I try to learn more every day from scientific studies as well as from the knowledgeable and experienced members here.  Then as a way of paying back to the Forum I try to use that info to help other members.

  
When will you have the additional blood test results?  When will you be seeing your doctor next?

[msdanicat]

Hi Everyone, I am the original poster to this thread and wanted to thank you so much for the advice. I have copius notes to take to my endo (we are meeting tomorrow morning).  I will report back.  I pray that she doesn't dismiss treatement based on the TSH levels, she sounds like a very progressive doctor who treats symptoms to optimal not "normal" so we will see.  It sounds like there is finally an explanation for why my body acts as it does and I feel relieved of the guilt I've felt because I thought I was just lazy.  

Will report back soon.  Thanks again!