Confused about thyroid labs...

[sarahbeth629]

In July I was diagnosed hypothyroid by my GP, solely on my TSH of 12. He refused to test my free hormones, or prescribe NDT.

I found a DO who was willing to prescribe NDT, but who did not do any additional bloodwork. He prescribed me 1/2 grain of Naturethroid and said we would redo labs in 4 weeks.

I was only on the Naturethroid for 12 days before I stopped due to an increase in anxiety. After 9 days of being off of Naturethroid my labs were drawn again.

TSH 5.410  Range .450 - 4.50

Free T4 1.58  Range .82 - 1.77

Free T3 3.8  Range 2.0 - 4.4

TPO 10  Range 0-34

Thyroglobulin Antibody 2.1  Range 0 - 0.9

So I'm confused as to why my TSH is high, but my free hormone levels are almost hyperthyroid and I've been off the meds for 9 days at the time of the blood draw. Any input would be greatly appreciated.

[jsycz]

I misread the original post. I thought your TPO was a lot higher than it was. I would still get an Endocrinologist to manage your thyroid medication.

[jsycz]

Have them do a full thyroid workup. You need to see an Endocrinologist. Based on the information you present, it is Clearly Hypothyroidism. However, I suspect Autoimmune which warrants further investigation. That requires an immunologist.

TSH is over 5...its no question. mine was nearly 7 when they diagnosed me. NO question you need Levothyroxine. Question is..is there something else. According to my Endocrinologist: T4 converts into T3 so Naturthyroid is pointless. There are rare indications when it is needed. As initial therapy, I would start with 150=200ug Levothyroxine.

[sarahbeth629]

Thank you very much, you have helped ease my mind tremendously. Now if only I can get these doctors to listen to me.

[gimel]

Some doctors might call you biochemically or subclinically hypothyroid, but that would be based on TSH only, which is not nearly as good an indicator as symptoms and levels of the biologically active thyroid hormones, Free T4 and Free T3.  Even those doctors would test for Free T4 and if within range, they would not be inclined to treat.  I would say that at present you are clinically euthyroid and don't need to  do anything unless you began to have overt hypo symptoms due to low levels of Free T4 and Free T3.  

Taking 1/4 of a grain of NatureThroid will do nothing to your Free T4 and Free T3 levels because if it reduces your TSH level, that will result in less production of natural thyroid hormone, and the net effect will be basically zero.  Reducing your TSH level will do nothing for you except keep the doctor happy.  As I see it you have nothing to be concerned about at this point as far as your thyroid condition.  

[sarahbeth629]

So I'm still not sure what route to take from here. I'm not sure if I'm considered subclinically hypothyroid. My original TSH in July was 12, but unfortunately at the time I didn't have my free numbers. I'm assuming they couldn't be that different from what these numbers reflect considering I only took the Naturethroid for 12 days.

The DO said to just take 1/4 grain of my NatureThroid until we retest. I'm just frustrated because I feel like the doctor doesn't really know a lot about thyroid.

My health anxiety and the fact that I'm trying to wean myself off of a benzodiazapene really makes this uncertainty unbearable. I'm also on state aid insurance so finding a good Dr. is next to impossible unless I can pay out of pocket.

[gimel]

The reason I am puzzled is that in this link it states that the reference range for antithyroglobulin is less than 116 IU/ml.  

http://emedicine.medscape.com/article/2086797-overview

Then in this link it states that the range for Thyroglobulin antibodies is less that 20 IU/ml.

http://emedicine.medscape.com/article/2086819-overview

Then when I try to understand the difference I find the following somewhat different definitions.  :

Antithyroglobulin antibody is a test to measure antibodies to a protein called thyroglobulin, which is found in thyroid cells.

Thyroglobulin antibodies are proteins that the immune system uses to block the thyroglobulin compound. Thyroglobulin, used by the thyroid gland, helps to control metabolism and growth hormones.


I previously never thought there was any difference between the two.  Now I am not sure what to think; however, in looking at the two listed reference ranges, it appears that perhaps the range that goes with your result just cannot be correct.  That interpretation would be much more consistent with your Free T4 and Free T3 levels.  

If anyone has a better understanding of the difference, if any, between antithyroid antibodies and thyroglobulin antibodies I would sure like to hear it.  And if they are the same why are there two completely different ranges shown in the same measurement units?

[sarahbeth629]

It says thyroglobulin, antibody 2.1 high IU/ml range 0.0 - 0.9

Free t4 was measured in ng/dl

Free t3 was measured in pg/ml

[gimel]

Your TSH is not elevated enough to worry about a dysfunction in the hypothalamus/pituitary system.  I am a bit puzzled by the reference range shown for your TG ab test.  Please double check the results and range.  Also, what are the measurement units for that test, as shown n the lab report?

[sarahbeth629]

Sorry to be a bother but why are my antibodies high as well, is this dangerous? I appreciate your help.

[sarahbeth629]

I did have some hypothyroid symptoms such as weight gain and high cholesterol but maybe those were caused for other reasons.

[sarahbeth629]

Thank you. So should I worry that there may be something wrong with my pituitary gland if it is creating too much tsh even though my frees are normal?

[gimel]

TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones Free T4 and Free T3.  

Even though you were on the NatureThroid for 12 days and then off for 9 days, the dosage was small enough that it would not have affected your levels very much if at all.  So looking at those test results, I'd say that your Free T4 at 80% of its range, and your Free T3, at 75% of its range are good, and I would not expect hypo symptoms from those levels.  They are nowhere near hyper levels.  So even though your TSH level was on the high side that does not mean much since both Free T4 and Free T3 were good.   Many doctors have the "Immaculate TSH Belief' and only pay much attention to TSH.  Unfortunately that causes many misdiagnoses and improper treatment.  

A high TSH is insufficient reason to medicate you since your Free T4 and Free T3 were good.  We have a member whose doctor insisted on medicating her because her TSH was high, even though her Free T4 and Free T3 were within range and she had no hypo symptoms.  She went through some tough time before she got her doctor off the TSH wagon.