Help me understand my lab work ~please

[zoe114]

Two years ago I discovered that gluten was hurting my thyroid, so I got off of it completely and my TSH went from 4.59 to 1.7.. ( I was no longer sleeping all of the time, my feet and hands warmed up, the rash on my shins went away).I still have not felt like I could get any energy, so I decided to get some lab work done because my doctor would not run it without just cause, so I did it at a lab at the hospital close by. Here is what I got today.

TSH                                          3.12                          (Ref. .450-4.5)
Thyroxine ( T4)                           7.2                           (Ref. 4.5-12.0)
T3 Uptake                                  29                            ( ref. 24-39)
Free Thyroxine                            2.1                           ( ref.  1.2-4.9)
T4, Free ( Direct)                        1.18                          ( ref. .82-1.77)
Thyroglobin Antibodiy                 <1.0                          ( ref range 0-0.9)
Reverse T3, serum                      16.7                         ( ref. 9.2-24.1)
Triiodthyronine ( T3)                      94                          ( ref. 71-180)
Thyroid Peroxidase ( TPO) Ab       8                            ( ref. 0-34)
Triiodthyronine, free, serum           2.8                         ( ref. 2.0-4.4)

[gimel]

The best source to raise your ferritin would be one of the good supplements like ferrous fumarate, ferrous sulfate,  ferrous glutamate or ferrous bisglycinate.  From what I have read, the last is the one least likely to cause stomach issues.  I would suggest starting with about 25 mg and build up to about 75 mg daily.  And be sure to get your ferritin re-tested afterward.  

[zoe114]

http://www.ncbi.nlm.nih.gov/pubmed/15244201

I wanted to post this since my TPO is low, but I did get tested for gluten ( Anti-gliadin IGA) and that was high, so getting off of gluten helped. Now, I will say I am following what gimel  

[zoe114]

Next time I can get the results I will post. Thank you so much !!!

I have been taking a calcium pill  ( pre osto) with vit D, and I started back this week on a good multi and a B complex.

I picked up some prunes and raisins today and will use these for snacks as well as finding sources to increase the Ferritin.

I will post back here in a month or so and let you and others know if my energy levels have gotten better.  I am going to hold off going to a endo doc to see if this is all I need to do.    

Thank you for your help.

[gimel]

Your B12 is much too low.  Should be up around 850 or so.  We need to know Vitamin D level.  Ferritin of 14 is terribly low.  Low ferritin can cause symptoms such as the following.

    Minor aches
    Fatigue
    Weakness
    Heart palpitations
    Increased pulse
    Loss of energy
    Loss of libido
    Confusion
    Irritability
    Shortness of breath

Your tests for antibodies did not exceed their ranges, so no indication of autoimmune hypothyroid.  You might want to supplement B12 and iron to optimize and D also if below 55, and see how you feel after that.  .

[zoe114]

I Forgot to mention I did get the B12 tested, it was 482  ( ref. 211-946)

And the last test I had done in Feb.

Vit D , I had it done but I don't have the results here.
Ferritin was last at 14.0, on a scale  11-307

I thought that by having antibodies showing up that this was  Autoimmune hypothyroid .

I don't want to be on meds if I don't need to be, just trying to feel better.

Thanks

[gimel]

I'm well aware of the info about gluten and antibodies ; however, your TSH and your TG ab and TPO ab don't show Hashi's.  Your current Free T4 is only at 38% of its range and your Free T3 is only at 33% of its range, both of which are lower than most of us seem to need to relieve hypo symptoms.  So you may well achieve symptom relief from a therapeutic trial of thyroid med.  Before doing that I would be sure to test for Vitamin D, B12 and ferritin.  D needs to be about 55-60, B12 in the very upper part of its range, and ferritin should be about 70 minimum.  A deficiency in either can cause symptoms, and low D and ferritin can adversely affect metabolism of thyroid hormone.  

[zoe114]

Thank you, I had all the symptoms of Autoimmune hypothyroid but my regular doctor said everything was normal.
I will be looking for a good Thyroid doctor now. The test I ran was more then my doctor would ever run on me...so it was a guess on my part, but still very glad I ran this.

You asked about the gluten and thyroid.  I got off Gluten for diet wise, and right before I did my doc had tested my TSH...it was at 4.59 ( on a 5.5) scale. It was awful how bad I felt.   When I got off the gluten it was odd, my hands started warming up, and all the other issues went away. Months later I got tested for my TSH level and it  at 1.7 then.

My energy level has still seemed a bit low and it seems hard for me to want to do much of anything, so since I could not get my doc to pay any attention to what I felt was going on, I bought my own test just to see if anything seemed off...or if it was just all in my head  ( sigh).  
I did learn that there is a connection to thyroid and gluten, all I can say is google it as there is so much out there on it. I like Chris's website the best for explaining it. Search Gluten thyroid connection.

[gimel]

On what basis was it determined that gluten was hurting your thyroid?  

Just looking at your current tests, there are many that are outdated and not very useful.  The tests you always want to have done each time you go in for tests are Free T4 and Free T3.  Those are the biologically active thyroid hormones.  Scientific studies have also shown that Free T3 correlated best with hypothyroid symptoms, while Free T4 and TSH did not correlate.  

I am not quite sure what the test listed as Free Thyroxine is.  There are basically two tests for T4, Total T4 and Free T4 (direct). If you consider these words from a good thyroid doctor, I think you will see that your Free T4 and Free T3 are too low in the range, consistent with having hypothyroid symptoms.

"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."

Your doctor should be wiling to test you for no other reason than having symptoms which need to diagnosed and relieved.  So you should insist on testing for Free T4 and Free T3 each time you go in for tests.  Also since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, those should be tested also.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  If your doctor is not willing to test and treat clinically, then you will need to find a good thyroid doctor that will do so.