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Thyroid Lab Interpretation

Discussion in 'General ME/CFS Discussion' started by olivia94, Aug 30, 2015.

  1. olivia94

    olivia94

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    Of course I'm considered normal, but have just about every debilitating thyroid symptom.

    I'm struggling with the dosage of my NDT and can't find a doctor that will prescribe the right dose or even believe I have a thyroid problem :( I've gone blue and red in the face and can't convince a doctor that the thyroid is causing my problems.

    My last labs looked like this:
    Free T4: 10.7 (9-19)
    Free T3: 4.1 (2.6-6)
    TSH: 0.4 (.3-3.5)
    Thyroglobulin Ab: 91
    Peroxidase Ab: <1

    I've been told I have hashiomotos, and although my antibodies are low, they are getting higher each time

    Any help on dosages of Natural Desiccated Thryoid would be helpful :)
     
  2. Eeyore

    Eeyore Senior Member

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    I can sympathize with your problem as I am hypothyroid (idiopathic / non-hashimoto in my case).

    Based on your lab results, you do not appear to be hypothyroid. The most important number is TSH, which is low in hyPERthyroid patients, and high in hyPOthyroid patients. You're on the low end of normal, which would imply that if anything you're hyperthyroid, which is not caused by hashimotos.

    That said, if you are on medication, you might be naturally hypothyroid, but the medication is restoring you to the nearly-hyper end of normal.

    Lab tests are not everything here, as there is evidence for variable receptor sensitivity to thyroid hormone as well as differences in how the HPA regulates thyroid in different people.

    What meds do you take and in what dose? Do you have any results from off meds?

    What symptoms are you experiencing that suggest a thyroid problem - i.e. why do you believe you have one?
     
    helen1 likes this.
  3. Ema

    Ema Senior Member

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    If those are typical SI units, I would say that you are still under medicated. Typically people report feeling best when FT4 is approx 15 and FT3 around 5.

    It's normal to have a low TSH when on meds. Slightly below range is typically considered fine and not indicative of hyperthyroidism.

    Your antibodies should be low when the attack on your thyroid ceases.

    If I were you, I'd look for a doctor that will help you increase your dose until you no longer have hypo symptoms. It's better to treat the patient and use the labs as a guide.

    Don't forget about adrenals as well!

    Stopthethyroidmadness.com is a good place to start as well.
     
    Tammy likes this.
  4. Eeyore

    Eeyore Senior Member

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    Ema, I agree with a lot of what you're saying. It would be helpful to understand what symptoms the OP has that would suggest hypothyroidism.

    I don't think you can treat only on the labs - but the labs do not suggest inadequate treatment in and of themselves.
     
  5. Ema

    Ema Senior Member

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    I would disagree based on my experience and that of the many other thyroid patients I know.

    But hopefully this will provide an impetus for the OP to find a doctor that will treat her symptoms rather than her labs.
     
  6. Eeyore

    Eeyore Senior Member

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    @Ema - In this case, we are dealing with Hashimoto's, which is a primary hypothyroidism (i.e. dysfunction in the thyroid gland itself reducing its ability to make thyroid hormone). This would imply that unless she also has problems with the HPA axis, her body has a normal ability to produce and secrete TSH.

    The levels of T4 and T3 in her blood seem to be sufficient for the HPA to produce relatively little TSH. If she had inadequate levels of T4 and T3, and isolated primary hypothyroidism, TSH would be increased as the body would be trying increase production of T4 and T3.

    Patients with T3 and T4 levels in the range she lists do not generally have health complaints - these are commonly found in the healthy population.

    It's possible that she also has some degree of 2ndary or tertiary hypothyroidism, but this is less likely with diagnosed primary hashimotos. She could also have receptor insensitivity, but this would more likely have been lifelong.

    I agree with you it's possible that there is still a clinically hypothyroid state and that she is experiencing symptoms as a result - but those lab numbers do not indicate it. They are are lab results commonly found in healthy people without thyroid related complaints.

    Additionally, some patients do not efficiently convert T4 to T3 (T3 is far more active), but her T3 is right near the middle of normal range, so she is doing that - or is being supplemented with T3.

    We both agree that you do need to treat symptoms/patients and not just lab results, but the lab results alone would not convince any doctor anywhere to treat. Add in the symptoms and other findings, and maybe - the lab numbers themselves do not indicate a problem.
     
  7. Ema

    Ema Senior Member

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    @Eeyore, she's already on meds. What you say about the labs would only apply if she were unmedicated. There's a different standard involved when on replacement.
     
  8. Eeyore

    Eeyore Senior Member

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    Not true - since medication is via T4 generally (synthroid, levoxyl, tirosint, etc.), this causes a feedback inhibition in the HPA which reduces production/secretion of TSH, so TSH goes down. People with hashimoto's do not as a rule need more T4 or T3 than other people - they just can't make enough of it. So if you can supplement it to normal levels, they should not be more symptomatic than everyone else.

    So if she is still symptomatic and the cause is thyroid, she would have to have something in addition to hashimotos, either involving sensitivity to thyroid hormones or secondary and/or tertiary hypothyroidism.

    With primary hypo, TSH is used to determine when the HPA "thinks" the body has enough thyroid. Her HPA seems to think she has enough with a TSH of 0.4, which is bottom of normal range (suggesting relatively high levels of thyroid hormones).
     
  9. Ema

    Ema Senior Member

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    Actually this isn't true...but it's a mistake many conventional doctors also make with regards to thyroid treatment. And it's why thousands of patients continue to suffer from hypothyroid symptoms. It's totally normal to have a suppressed TSH when on replacement. It doesn't offer any insights into the thyroid hormone status at the cellular level to measure a pituitary hormone. May as well knock on the mailbox instead of ringing the doorbell.

    You might want to take a look at Stop the Thyroid Madness as well as the thyroid book written by Dr Datis Kharrazian for a more up to date view on Hashi's treatment.
     
    Tammy and Gondwanaland like this.
  10. Eeyore

    Eeyore Senior Member

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    My thyroid doc is anything but conventional - he's about as cutting edge as you can get, and he treats based on symptoms, but he does test TSH and considers it by far the most useful indicator.

    Yes, treatment with T4 will suppress elevated TSH, but when TSH is suppressed down to normal, the body is no longer signalling a need for more thyroid from the HPA. The HPA can be wrong sometimes - but it responds the same way to T4 in primary hypo patients as it does in healthy controls. This is also why TSH is elevated in primary hypo - the body knows it needs more thyroid hormone, but the thyroid isn't making it.

    To be clear, I'm not saying the tests prove she doesn't need more thyroid. I'm saying they do not suggest that she DOES need it. Signs and symptoms may say otherwise, and there is huge variation between individuals, which is why you can't just treat by TSH or even TSH/T3/T4. We all respond differently even to the same levels of thyroid hormone for a wide variety of reasons we do not understand.

    Currently, my TSH with treatment is generally around .7 to 1.1. This seems to work well for me. That doesn't mean it works for everyone, and I'm not suggesting that. What it is saying is that my HPA seems content with that level of thyroid. I don't have hashimoto's though - or at least, I have no measurable antibodies - so mine is classed as idiopathic, and may be 2ndary or tertiary. My doc would be the first to say though that he treats based on symptoms. Some patients he'll treat to a TSH of 0.01. Some he'll treat to a TSH of 10 or higher. It depends on the signs and symptoms.

    The problem is when docs get fixated on TSH alone and ignore symptoms. A normal TSH doesn't rule out thyroid dysfunction, but it doesn't suggest it is there either.
     
  11. Ema

    Ema Senior Member

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    Do we know this for sure? That sounds like a study worth reading. Love to see a link...

    But even if the HPA does respond the same as healthy controls to T4, that doesn't mean that the thyroid hormone at the cellular level is sufficient.

    Most non-medicated people I know have a TSH between 1 and 2 when euthyroid. Most medicated people have a TSH at the bottom or below range. There are just differences all around when on meds vs when not on meds. Lower FT3 and FT4 are also common for euthyroid people. It seems that most hypo people have some level of thyroid resistance too no matter what the cause and thus require higher numbers on labs than those without hypo.

    But the key here is that the OP is on NDT and still has hypo symptoms and antibodies with labs lower than what most women report as optimal thyroid lab numbers. This bears further investigation by someone not obsessed with the TSH.

    https://www.nahypothyroidism.org/how-accurate-is-tsh-testing/

     
  12. digital dog

    digital dog Senior Member

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    Olivia, Im just interested in what you have tried to do to lower your antibodies. Have you tried gluten free and selenium. Have you considered LDN?
    The more I read about thyroid issues (I have hashimotos) the more I believe it is the antibodies we need to stop the attack.
    Please forgive me if you know all this!
     
    Ema likes this.
  13. Eeyore

    Eeyore Senior Member

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    @Ema - what your quote describes is pituitary / hypothalamic thyroid dysfunction (secondary and tertiary hypothyroidism). This is closer to what I have. Hashimotos is always primary. It's possible someone can have both, but having one is not a reason to suspect another. They would not be expected to co-occur more than randomly.

    Also, nothing there suggests that her tests by themselves prove inadequate thyroid treatment. They don't rule it out either - which I never claimed. I just don't think they are really very useful at all in deciding what to do. You have to look at symptoms, but the OP hasn't listed or described any symptoms, so it's very hard to understand whether they are likely to be caused by thyroid issues. To help her we'd have to see some symptoms described.

    Yes we do - it is true by definition. Primary hypothyroidism by definition requires that the HPA is functioning normally but that the thyroid is still not producing enough thyroid hormone. If this were not the case, then it would not be primary hypothyroidism, it would be secondary, tertiary, or complex/combination hypothyroidism.

    So we do know that in primary patients the HPA is normal, but we don't know if the OP is a primary only patient - she could have some degree of secondary or tertiary dysfunction too. The test don't show it, but they don't rule it out either. The tests are essentially useless here as they do not show a problem and they do not rule out a problem (although they do rule out certain specific types of problems).

    @digital dog - Is there any proven method for altering the body's autoimmune response against the thyroid? I don't know of one other than broad immunosuppression (e.g. probably high dose corticosteroids or even calcineurin inhibitors would work (hypothesizing - I know of no proof on that), but docs likely would prefer supplementation of T4 or T4/T3 as it would be safer).
     
  14. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    Your results look normal.
    You must absolutely not take any advice from members here on thyroid medication. This has to come from your doctor and I would personally strongly advise against looking for a doctor who will give a aparticular sort of advice you are hoping for.
    Underdosage with thyroxine can lead to significant medical problems over time. Overdosage can also be dangerous, including problems such as atrial fibrillation complicated by stroke. This is something you have to rely on qualified medical advice for.
     
    Valentijn, 2Cor.12:9, Mij and 2 others like this.
  15. Ema

    Ema Senior Member

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    Again, that's not something that you can just say without having some proof beyond an opinion.

    Some 20% of AI thyroid patients also have antibodies to the pituitary. These deficiencies could easily cause a further dysregulation beyond what would occur by random chance. Cortisol, for example, has a strong influence on thyroid function and how well it is used on a cellular level.

    We simply don't know enough about the disease process (or the OP) to make the kind of definitive statements that you are making.

    I still don't think you can assume this simply by definition. Maybe if primary hypo was the only thing wrong, maybe...but that is so rarely ever the case.

    You've made a lot of assumptions about the OP...that she ONLY has Hashi's...so therefore she's ONLY primary hypo...so therefore the rest of her HPA axis must work just like a healthy control...so therefore the TSH is a good measurement of her need for thyroid hormone...so her thyroid hormone levels must be sufficient on a cellular level.

    I disagree with most all of that. Our bodies don't work in a neat vacuum.

    Hopefully the OP will be able to take something from this discussion though, and the websites I've suggested, and find some improvement in the symptoms that caused her to start this thread.
     
  16. Eeyore

    Eeyore Senior Member

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    Definitely agree with Dr. @Jonathan Edwards on the part about not self medicating with dessicated thyroid. It's all well and good to come here to talk about things like thyroid issues and to ask other patients about their experiences and what has worked or not worked for them, but treating hypothyroidism is not something you should do without a doctor's assistance. It is too dangerous. I've been hypothyroid for many years (determined initially by symptoms, signs, and lab work). I wouldn't touch dessicated thyroid unless my doctor thought it was a good idea and worked on it with me. Those preparations are also notoriously non-standard and two of the same pill from the same brand may contain really different doses of active hormone. This is one of the main reasons that docs don't usually use dessicated thyroid preparations - pharmaceutical grade prescription meds your doctor can provide you with will be much more consistent from pill to pill, and your doctor can make sure you aren't taking too little or too much, as either can be quite dangerous.

    Don't assume your problems are caused by thyroid issues. I think it can be worthwhile to get a second opinion from another qualified doc if the first seems wrong to you or if you just don't like a doctor for some reason - I've met many really bad docs over the years - but that's not the same as doctor shopping until you get the answer you want.

    You clearly have some medical issue you are suffering with. It may be thyroid, but your tests don't look abnormal. Either way, knowing what it is is critical to treatment, and you should work with an endocrinologist on this.

    Again, I emphasize that nothing I've said should imply you should take any dose of any thyroid meds at all without your doctor's involvement. Even if I were a doctor, which I am not, there is not sufficient information on this thread to give advice, and no good doctor would actually treat you without meeting you and examining you.
     
  17. Ema

    Ema Senior Member

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    I totally agree and have suggested multiple times finding a doctor that is experienced in the current theories on Hashimoto's and the proper treatment (which does not rely on the TSH).

    This is actually a myth and has been disproven time and time again.

    http://jeffreydachmd.com/why-natural-thyroid-is-better-than-synthetic/

    As you can see, thyroid replacement is a contentious subject and I urge you to do your own research and not rely on any one opinion you find on the Internet.

    http://www.stopthethyroidmadness.com/
     
  18. Eeyore

    Eeyore Senior Member

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    It may be that some forms of natural dessicated thyroid are better standardized, but considering some of the recent headlines on supplements confiscated from major pharmacies and large chain retailers, I'd remain suspicious. (Many had no active ingredients at all!)

    Even if they are standardized, it doesn't make it safe to self medicate with thyroid. Too much or too little is dangerous.

    My endo does, on occasion, use armour thyroid - but he's qualified to do this and knows how to monitor his patients looking for problems. Most often, however, he uses synthetic T4 (levoxyl/tirosint/etc.) It depends on the patient.
     
  19. Ema

    Ema Senior Member

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    Nothing I've read about this doctor so far suggests "cutting edge" unfortunately! These are all very old school, conventional views. And that is fine if it is working for you. But it's far from the only treatment option and I encourage the OP to keep searching for a doctor that will treat her as a whole patient and not a lab result.

    Most chronically ill patients (and after all the OP is on an MECFS forum) need supplemental T3 to feel well due to the reduced conversion you mentioned earlier. This is a given not some sort of rare scenario.
     
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  20. Eeyore

    Eeyore Senior Member

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    If there were problems with T4 to T3 conversion, I'd expect to see an elevated T4/T3 ratio, which I don't see. So I just don't see the logic in assuming that to be true.

    Yes, presumably the OP does have ME, which does suggest that a degree of HPA dysfunction is more likely.
     

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