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.

[gimel]

Your symptoms, coupled with blood test results indicate hypothyroidism.  For the future, you should always insist on being tested for both Free T4 and Free T3.  Free T3 is the thyroid hormone that correlates best with hypo symptoms.  I expect that you will find it in the low end of the range as well.

Your TPO ab test is indicative of Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign and produces antibodies to attack and eventually destroy the gland.  As this proceeds, levels of the thyroid hormones gradually fall, and the TSH increases as the pituitary signals for more thyroid hormone.  Your TSH tested as lower than expected so you should ask the doctor if he has an explanation for the TPO test result, in consideration of the normal TSH.  I think the first thing would be to re-test the TSH and Free T4, and add in the Free T3 test.   Regardless of that open question, your Free T4 is very low in the range, and with your symptoms, point directly to hypothyroidism.  

The doctor probably ran Vitamin D because a deficiency can cause symptoms that mimic some hypothyroid  symptoms.  Also, D is important to metabolizing thyroid hormone, as is ferritin, which is another test I recommend for you, along with B12.  When you get these additional tests done, please post results and reference ranges and members will be glad to help interpret and advise further.  

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 TSH levels.  Symptom relief should be the main concern, not just test results.  

So you should request your doctor to prescribe a starter dose of thyroid med and re-test and adjust about every 4 weeks to get your Free T3 and free T4 levels high enough to relieve symptoms.  You can supplement your Vitamin D as necessary to get to about 55-60.  When you find out your ferritin and B12, you will likely need to supplement those as well to raise your ferritin to about 60 minimum and B12 in the upper part of its range.  If your doctor is not willing to treat clinically as described, then you will need to find a good thyroid doctor that will do so.