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central hypothyroidism blood tests

I will see a family doctor to order more blood tests soon since it takes time to make an appointment to see an Endocrinologist. Are the following tests enough to diagnose central hypothyroidism?

T4, FT4, T3, FT3, Reverse T3, TSH, TPO, ATA, Cholesterol Level, IGF-1.

Please give me suggestions for blood tests for central hypothyroidism.

4 Responses
Avatar universal
In view of your symptoms and prior test results, I suggest testing for  Free T4, Free T3, Reverse T3, TSH, cortisol, Vitamin D and ferritin.  I also suggest that you have a look at the paper on Diagnosis and Treatment of Hypothyroidism that is linked in the following.  I suggest that you read at least the first two pages and consider giving a copy to your doctor to help encourage him to treat you.  

I went to see the family doctor and he only did the following tests for me. I will make an appointment with an Endocrinologist. Since my TPO is out of range, is there any possibility I have Hashimoto’s hypothyroidism? Or central hypothyroidism? Thanks.

5/23 tests: TSH:1.49 (0.40-4.00) , FT4 0.9( 0.6-1.6 ), T3 88 (70-180 ).

8/16 tests: TSH 2.32 (.5-4.3), FT4 1.0 (.8-1.8), T3 UPTAKE 29 (22-35), T3 98(76-181), TPOAb 24(<9),  TAA<1, T3 Reverse 11 (8-25)

Avatar universal
You don't necessarily need an Endo, just a good thyroid doctor.  By that I mean one that will treat clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by TSH levels.  Symptom relief should be all important, not just test results.   Because of their training Endos frequently specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief" by which they mainly pay attention to TSH and not symptoms or Free T4 and Free T3. That is very wrong.   If they go beyond TSH it is usually only Free T4 and if within range, they will tell you that is "normal" and your symptoms must be due to something else.  That is also very wrong because the ranges are far too broad due to the erroneous assumptions used to establish them.  

Before going further I would like to review whatever symptoms you have.
It is hard for me to lose weight, I'm constipated, have lots of rashes and allergies, and have low BBT.

Do I firstly need to be diagnosed with hypothyroidism by an Endo before I can take thyroid medication? Did thyroid doctors recieve special training in hypothyroidism like Endos do?

Is hypothyroidism medication harmful to the body if the person doesn't have hypothyroidism, just low but normal FT4 and T3?


Avatar universal
With those symptoms and your Free T4 level at only 20% of its range, and your Total T3 at only 21% of its range, and the TPO ab being above range, I'd say that you have Hashimoto's Thyroiditis and are hypothyroid.  For info in the future you should always make sure they test for both Free T4 and Free T3, not Total T4 and Total T3.  

As I mentioned, you do not necessarily need an Endo, just a good thyroid doctor.  Doctors do not receive as much training in hypothyroidism as Endos; however, much of what they are all taught is based on the assumption that the TSH test is a perfect diagnostic for thyroid.  That is very wrong.   Also using "Reference Range Endocrinology" does not work for many hypo patients.  

So you need to find a good thyroid doctor that will treat clinically as described above.  If you will tell us your location perhaps we can suggest a doctor in your area that has been recommended by other hypothyroid patients.  
For Hashimoto's, TSH is elevated, but my TSH is 2.32 (8/16) and 1.49 (5/23). Can I still have Hashimoto's?
Avatar universal
Yes, TSH is usually elevated; however, TSH 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, plus TPO ab when it is run.  Your TPO ab indicates Hashi's, but your TSH is lower than would be expected with Hashi's.  Really doesn't matter as far as the treatment you need.  You need a good thyroid doctor that will treat clinically, as described above.  

In addition, you also need to test for Vitamin D, B12 and ferritin and supplement as needed to optimize.  D should be 50 min., B12 in the upper end of its range, and ferritin should be at least 70, and some say 100.  
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