Thyroid Lab Interpretation

[out2lunch]

If there were problems with T4 to T3 conversion, I'd expect to see an elevated T4/T3 ratio, which I don't see.

That's malarky. Elevated T4/T3 ratios aren't always a reliable indicator in hypothyroidism. I had a conversion problem with T4 to T3 as evidenced by very high levels of Reverse T3. And it took several months of Cytomel only therapy to bring the Reverse T3 back down to normal levels.

I have Hashi's but do very well on Acella desiccated thyroid. And my conversion problem went away once I treated my iron deficiency, which was being exacerbated by a riboflavin deficiency.

Normalizing my riboflavin improved my serum iron and ferritin, which in turn, stopped my burning mouth syndrome. It also significantly improved my hypothyroidism, which became easier to treat with the desiccated thyroid. My Reverse T3 elevations are now a thing of the past.

There are many different abnormalities like iron deficiency which can wreck havoc on anyone's thyroid health. And seeing healthcare professionals who understand these conditions and how they interplay with the thyroid is necessary in finding the proper treatment. Knowing about T4 and T3 isn't enough. Other factors will always be just as important.

 

[Ema]

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.

A higher FT3:FT4 ratio is associated with better conversion. Her ratio is slightly very slightly elevated from optimal...but that is all meaningless if the levels are too low to begin with or she has inadequate cortisol. You'd really need to see RT3 to make any judgments about conversion.

http://www.thyromend.com/thyroid_lab_tests.html

 

[ahmo]

https://www.youtube.com/user/TheRLCLabs Several Hypothyroid vids, incl Dragone

http://thyroidbook.com/blog/iodine-and-hashimotos/

http://www.amymyersmd.com/2015/08/thyroid-health-part-vi-the-iodine-thyroid-connection/

https://advancingthyroidcare.wordpress.com/2010/03/21/three-phases-of-treating-hashimotos/

5 Lies About Your Thyroid Disease That You’re Likely to Hear

http://thyroid.about.com/od/thyroidbasicsthyroid101/a/5lies.htm

Izabella Wentz, Pharmacologist http://www.thyroidpharmacist.com/

Here’s an interesting and unique thyroid protocol.
http://recoveringwitht3.com/blog/what-circadian-t3-method

 

[olivia94]

Hi All

These were previous to me starting medication.


I have seen endos, naturopaths, thyroid specialist, Cfs specialists and all say I'm normal.


The following symptoms began after a long period of stress:
- immediate and rapid weight gain (10kg) with no change in diet
- extremes fatigue
- inability to concentrate
- memory loss
- dry skin
- hair falling out
- sore joints

My cycles are fine however... all of these symptoms occurred when I came off the pill...

Other results I have are:
- heterozygous for c776 mutation of mtfhr
- pyrroles (low zinc and b6)
- low cortisol
- low progesterone
- low ferritin

I have tried treating methylation and pyrroles yet did not loose any of the 10kg. I can simply not fault my diet, also never feeling hungry or eating more than 1200 calories.

Other info:
I had glandular fever in 2002
I had parasites in 2013
I have lots of food sensitivities.


I have seen so many doctors and have no idea where else to turn to. I have lost all hope. I never weighed anymore than 57kg for 10years so this is so odd for me. Sleep well too.

Anybody got any hypothesises? Or other tests I should have done?

Weird that all my symptoms scream thyroid but don't reflect that.

I do eat gluten / grain / dairy / soy / nuts free

Thanks

 

[olivia94]

I have not responded that well to NDT. No drop in weight. Antibodies came down tho. My tsh is now .22.

Not sure what this all means. Not sure where else to turn now.

 

[poppythecat]

. Overdosage can also be dangerous, including problems such as atrial fibrillation complicated by stroke.

My atrial fibrillation, which I'd had for around 35 years, disappeared completely when I started treating my thyroid. My TSH is suppressed now at below 0.5 and my FT4 is around 20.

Cardiac symptoms are a classic sign of under medication or non medication. Yes, if you do become over medicated you will notice your heart start racing and you can cut back, but you will know - don't let any doctor freak you by keeping you undermedicated because symptoms that haven't happened "might" happen.

Olivia94 - have you had your iron, ferritin, folate, b12 and Vit D levels measured? All need to be well in range, not just bottom, for your NDT to work effectively. You are still undermedicated - your FT4 should be at least 3/4 range. I suggest you join a thyroid forum, such as tpauk.com or https://healthunlocked.com/thyroiduk

Also, have you had your adrenals tested using the saliva cortisol test? Hypoadrenalism goes hand in hand with hypothyroidism for many people. GenovaUK or Blue Horizon do the test in the UK. Not sure about other countries. For me, treating my adrenals was a big part of the puzzle.

Finally - consider getting properly tested for Lyme Disease. Not the NHS test, you will have to go to IgeneX in the States or Infectolab or Armin in Germany. I now believe that Lyme and its co-infections are the root cause of the majority of cases of ME/CFS.

 

[Eeyore]

Olivia - I hate to say this, but you just sound like you have ME. I'm not sure there is a compelling need for thyroid meds. Even your ME doc thinks your thyroid is normal, and you don't have to worry about their bias against ME patients. Thyroid meds don't fix ME, and in fact do not help with weight loss except in people who are hypothyroid to start with (i.e. if you give thyroid hormone to healthy, but overweight, people, they don't lose weight.)

I disagree with the above poster - seriously listen to your doctors if they have warnings about potential dangers of meds.

I would suggest seeking out some of the ME experts in the world and seeing if what they have to offer can help. Unfortunately, even the best and most supportive docs will acknowledge they don't have a magic pill for it. Any new symptoms should be worked up to exclude anything else.

The question with ME is often whether it is ME or not - but ME docs are usually good at figuring this out. However, make sure the workup is thorough and that anything new is investigated.

If cortisol is continuously outside normal range I would think that an endo would treat this. It might be reasonable in these cases to consider this a form of addison's disease / adrenal insufficiency and to treat with some dose of hydrocortisone. If you have true adrenal insufficiency (verifiable by abnormal cortisol on lab work), it shouldn't be too hard to get treatment. Anecdotally, many patients with ME respond positively to corticosteroids. They are not benign medications, and do have risks, but there are serious risks to being undertreated and deficient as well. Exact dosing would need to be determined by your doc while checking labs. Unfortunately, cortisol supplementation is unlkely to help you lose weight - it tends to stimulate appetite. It is more likely to improve energy though. President Kennedy had Addison's Disease and had to take cortisol supplementation - it's a mainstream treatment if your cortisol really is abnormally low.

 

[Ema]

If you have true adrenal insufficiency (verifiable by abnormal cortisol on lab work), it shouldn't be too hard to get treatment.

It's actually near to impossible (in the USA and UK at least) to get properly tested for and treated for adrenal insufficiency.

I know this because I've been through it personally and helped countless other people through the process as well. For some unknown reason, endocrinologists seem to have slept through the day they talked about AI on their way to learning about diabetes and thus perform all the testing wrong (ie not fasting, not first thing in the morning, without taking baseline measurements, etc etc). The state of testing for adrenal insufficiency is shameful and dreadful and will require you to be your own best advocate even more so than for thyroid problems.

If you think adrenal issues are a problem, I suggest you read the attached article by Arlt to familiarize yourself with the testing. You may also wish to join a support group where members can help guide you through the testing like addisonssupport.com. They have members from both the US and UK.

FWIW, my thyroid numbers looked much like yours before I was finally diagnosed and treated for AI. I had a TSH below 1 and low normal FT3 and FT4. This is very typical. It's crucial to treat adrenal issues before attempting to treat thyroid issues so I encourage you to follow up on this.

If you thyroid numbers remain low normal after ruling out adrenal problems, you might want to look at Low T3 syndrome.

http://chriskresser.com/low-t3-syndrome-i-its-not-about-the-thyroid/

Did you have your FT4/FT3 measured since you have been on meds when you got the TSH .22?

Testing for Lyme disease through IgeneX might be something to think about as well since Lyme is well known to cause all sorts of endocrine problems.

Good luck!

 

[Ema]

Exact dosing would need to be determined by your doc while checking labs.

There are no labs that will tell you the appropriate dose of cortisol replacement. Run very fast away from any doctor that tries to adjust your dose by cortisol or ACTH labs once you are already on steroid replacement. Electrolyte labs can be useful though.

Unfortunately, cortisol supplementation is unlkely to help you lose weight - it tends to stimulate appetite.

This is true of pharmacological doses of cortisol, not the physiological replacement doses used to treat AI.

 

[digital dog]

Eeyore, sorry about getting your name wrong and calling you eyesore! How mean of me.

I've read that a lot of people exhibit hype symptoms for years prior to their lab tests showing any abnormality. Perhaps this is why so many of us with raised antibodies have symptoms but our T levels are normal.

Wouldn't anyone suggest gluten free and selenium to lower antibodies? Also LDN is meant to lower antibodies in hashimotos. Could that be worth a try for Olivia?

Im not an expert, just sick, and I have no idea if these suggestions will help.

 

[Ema]

Wouldn't anyone suggest gluten free and selenium to lower antibodies?

Yes, those are both good suggestions along with a trial of LDN.

PRP spray may also be useful.

https://www.numedica.com/Product_detail.cfm?Fname=NM173

 

[bertiedog]

t 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.

It's probably as well then that your doctor isn't my doctor because T4 makes me very toxic indeed whereas 2 grains dessicated thyroid (I have tried many different brands without problems) suits me fine. This goes to show we are not all the same and what suits one patient might not suit another despite similar blood test results.

Pam

 

[bertiedog]

I have listened to many webinars presented by qualified docs from the US who deal with thyroid and adrenal issues and I remember one of them saying that only about 25% of his patients did well on thyroxine as their thyroid replacement. These patients tended to be the ones who had not been ill for very long and did not have other complicated health issues.

The majority of these doctors found that their patients with illnesses like ME/CFS or Fibromyalgia did not do well at all on thyroxine but were feeling better on dessicated thyroid or in some patients T3 only therapy.

Pam

 

[Eeyore]

Actually, my endo wouldn't keep using T4 if it were making you sick. I don't know if he always starts with T4, although I think he usually does. He'll use all the options and tailor treatment to the patient.

I have never used armour thyroid, but have done well on T4. I don't have hashimotos - no antibodies detectable - so my thyroid issues are idiopathic.

By all means, if your endo thinks dessicated thyroid is appropriate for you, and you discuss it and decide together it's the right choice, go for it. I think the concerns on this thread were mostly that one shouldn't do it w/o an endo (or other qualified health practitioner) to guide you and make sure you aren't overdoing it (or under). It's a potentially dangerous medication - which doesn't mean it shouldn't be used, just that one should be careful and work with a doc.

I know for a fact that my doctor does, with at least some patients, recommend some kind of dessicated thyroid, or at least he did at one time when we talked about it (probably still does). With me, he went right to T4, and it worked well.

I also have a habit of responding well to meds that bother other patients sometimes. I take florinef, which is extremely helpful, and have been on it for decades. My ME doc says most of his patients on florinef get really sick and get bad headaches, but I never had any of that. He did say those who are younger do better, and I was a teen when I started on it, so maybe that is part of why.

 

[Eeyore]

Wouldn't anyone suggest gluten free and selenium to lower antibodies?

Selenium deficiency can certainly cause thyroid symptoms, as it's a necessary cofactor for the production of thyroid hormones. However, I don't see why it would affect TPO antibodies. It's still probably beneficial in normal doses for thyroid function though, at least if you have any residual thyroid function. It might mean not needing meds or needing less, although I think this wouldn't often be the case.

I don't see how gluten relates to thyroid function. Does it affect thyroid function even in diagnosed celiac patients? I've never heard of this but I don't know.

 

[Ema]

However, I don't see why it would affect TPO antibodies.

http://jeffreydachmd.com/hashimotos-selenium-and-iodine-part-two/

Three Selenium Studies Showing Selenium Beneficial

The first study by Dr. Mazokopakis from Crete was published in the 2007 Thyroid Journal.(1) This studyreported a 21 % reduction in the anti-thyroid antibody called thyroid peroxidase (TPO) antibodies after one year of selenomethionine supplementation at a dosage of 200 mcg per day.

A second study from Germany by Dr. Gärtner in the 2002 Journal of Clinical Endocrinology and Metabolism showed a 40 % reduction in antibody levels after selenium supplementation. Twenty Five percent (9 of 36 patients) completely normalizing their antibody levels.

Left images: selenium diagrams courtesy of wikimedia commons.

A third study done in Turkey by Omer Turker et al. was published in the 2006 Journal of Endocrinology.(5) They showed a 30% decrease in anti-thyroid antibodies after three months of L-selenomethionine supplementation at 200 mcg per day in women with Hashimotos thyroiditis. The starting average TPO antibodies of 803 and after three months the average was 572. The below bar chart shows the data from Omer Turker et al.

 

[Ema]

I don't see how gluten relates to thyroid function. Does it affect thyroid function even in diagnosed celiac patients? I've never heard of this but I don't know.

A 2008 study by Naiyer et al explored the connection between autoimmune hypothyroidism and celiac disease and hypothesized a mechanism via serum antitissue transglutaminase (tTG) antibodies. It is well established that anti-tTG antibodies are present in patients with active celiac disease and that they decrease and eventually disappear on a gluten-free diet. The study demonstrated that these anti-tTG antibodies bind and react to thyroid tissue as well, which may contribute to ATD development. Antithyroid antibodies were observed more often in patients with celiac disease than in either controls or patients with another autoimmune condition (eg, Crohn’s disease).10,11

Impact of a Gluten-Free Diet
As previously discussed, when individuals with celiac disease follow a gluten-free diet, their anti-tTG levels return to normal. A growing amount of research suggests that when people with celiac disease and ATD adopt a gluten-free diet, not only do their celiac-related antibody levels improve, but their thyroid antibody levels also decrease.12

 

[Eeyore]

That's very interesting about the selenium! I would never have guessed it would lower TPO antibodies. I guess I never looked into it too much as I don't have anti-thyroid antibodies.

I'll have to mention this to my endo - although he probably knows already since he's pretty on top of that stuff - just never bothered to tell me since I don't have the antibodies.

 

[Eeyore]

Re: gluten, it does sound like if you have celiac, then gluten might affect thyroid function (but presumably not if you do not). Everyone with ME should probably get a celiac test to know one way or the other. (I have - I don't have celiac - but it seems that many ME patients may have it.)

 

[Rlman]

@olivia94 check out the stop the thyroid madness facebook forums