What is the Relative Priority of the Different Thyroid Tests?

[Scotty81]

Hi,

My 21-year old daughter, who has ME/CFS, FM, IBS, adrenal dysfunction and POTS, among other issues, is going to get some thyroid blood work done, just so her doctor can continue to rule out any thyroid issues. Giving a lot of blood at one time tends to wipe my daughter out, so she would like to get the most relevant testing done first.

I asked for a prioritization of the list below from her doctor, but her doc just said to "get as many as you can done". I was hoping for something more prescriptive than that. Here's what she's had so far and general results.

Test Date Result _____________
Free T4 2012 Within reference range
Total T4 2012 Toward High End of Ref Range
Free T3 Never Had
Total T3 2012 Within Ref Range
Reverse T3 Never Had
T3 Uptake 2012 Within Ref Range
TSH 2004 Below during initial, mono-like illness
2012 Within Ref Range
PTH 2012 Toward Low End of Ref Range
Anti-TPO Antibodies Never Had
Anti-TG Antibodies Never Had

Given the above general results, can someone prioritize what might be most important? I realize that my daughter has never had some of the tests, such as the Antibodies tests. But, I've also read that it only makes sense to get those tests done when other thyroid test results come back abnormal.

Can anyone provide some general guidance on the order of such tests? If certain tests won't be required (unless some baseline testing comes back abnormal), then it would be good to know that too!

I realize that there may be different opinions on this, but I'd appreciate what this forum might have to say.

Thanks in advance for your help.

Scotty81

 

[August59]

My opinion is that the Anti-TPO & TG should be tested at the first signs of abnormal thyroid function. Whether it is a high TSH (in the US I think the general consensus is that it should be at 2.0 or below and this still may not give a good indication), low basal body temperature & etc.....(long list). 2nd priority would be Free T4 and Free T3 (which my endo will check at my next appt. or he will be my ex endo!). If Free T4 is normal or high end of normal and if Free T3 is low (conversion problems) or if Free T3 is elevated above normal range (pooling problems, this is probably not the right terminology). Either case would justify T3 Uptake and Reverse T3 (which a lot of endo's will not do because they don't know how to treat if abnormal).

Integrative doctors are much more apt to test the thyroid correctly, but they are scare in my area plus many of them will not take insurance.

This is just my experience and please don't take it as advice. There are many others on PR that are much more capable in guiding you in a good direction to get the test that are required. I have paid out of pocket and ordered some of my test through "Private MD Labs(???)"

 

[WillowJ]

To be honest, I am not sure what all of those are. I feel that I am being screened adequately if I get TSH, T3, and T4 (mine is usually ordered "free" or without any descriptor; I read most docs think reverse tests unnecessary).

Repeating the parathyroid which was near the edge of range seems sensible.

Then seeing those results you and your doc could discuss what would come next.

Of course I am not a doctor, much less an endocrinologist.

You may know this already, but bringing a good electrolyte drink and something safe to eat afterwards may help with recovery. But I find the problem is sometimes the lights or antiseptic in the clinic, or the draw process stimulates the vagus nerve (a phlebotomist told me this). I can change clinics for the first problem, but not sure what to do for the second.

Ps, I had a few docs who thought it necessary to have an antibody test as part of the screening test. I used to remember reading about Hashimotos as something that fluctuated thyroid readings, and presumably the thyroid function tests at a single point in time could be in the middle at the time of the test if it were varying from low to high. However I now do not read this most places (though I just did again on about.com).