Thyroid tests are normal?? Are you sure?

[dooy]

Hi Pam,
Latest thyroid numbers:
TSH 2.32 range: .35 - 5.5
Free T3 .85 range: .87 - 1.78
Free T4 .74 range: .58 - 1.64

Testosterone 54 range: 10-75
thyroid peroxidase (TPO) <10 range 0 -34
Antithyroidglobulin Ab <20 range 0 - 40
sex horm binding Glob 72 range 18 - 114

I know my T3 is low...doctor wrote that everything looks "great" but I have not met with her yet...what do you think I should do? Any suggestions? I'm still lethargic, dry skin, NO weight loss, still a bit moody, still some achy joints...can't remember any other symptoms right now...

I'm on bio-identical progesterone cream 20/200 and she says my estradiol looks good at 241 with the range of 19-528

I still have the vit D deficiency but I must admit I was less than diligent about taking it in March. 26 with a range of 32 - 100.

Thanks Pam! Hope you're doing ok!!!

[nonstickpam107]

I would still be feeling pretty sick with those labs. Your TSH should be close to/under a 1, and your FT4 should be about 1/3 of range now, and your FT3 should be above midway or close to top of range. My doctor would NOT say your numbers 'look good'. Goodness...don't you wonder how the doctor would be functioning if HER/HIS labs looked like that??!! EEEKKKK!!

Women need Free Testosterone, not total. The progesterone cream you are taking is also binding your thyroid hormone (sex hormones do that...you have to adjust the thyroid hormone to it) so that's another reason it's so low. You are still exhibiting hypothyroid labs. If your doctor doesn't 'get it' I don't know what to tell you...except maybe just tell her you are STILL having all the thyroid symptoms and ask her why you are being made to suffer with such low labs.

I'd be upset with a doctor who wrote that everything 'looks ok' when she's just seen the LABS! You need to tell her that you still feel symptoms and that you 'expect' some treatment that leaves you feeling better.

Pam

[dooy]

Pam thank you soo much!

I have an appointment next week. I know this might be over the line to ask you, but I would like to go in there with a plan for treatment and was wondering what you would suggest. I would like her to, at least, try me out on a trial of meds and see what happens. What would you suggest to start in terms of meds? Even a small amount may help, right? She did mention she may reduce the progesterone cream...

Also, is there a "doctor friendly" overview I could print out somewhere on line that I could bring in and show her? SHe has impressed me with her openness to talk about issues so I'm hoping if I go in armed (but humble and polite) she will be amenable to at least try something and see what happens? Is there a downside she would be concerned about by starting me on a little armour?

I am so sick of the doctor hunt. We've talked about this before...I'm in VA.

[nonstickpam107]

Yanno what? If a doctor thinks your thyroid values are 'looking great' than no amount of literature is going to sway her. There are a billion and one doctors treating thyroid going by JUST TSH alone, and most will do FT's but won't know how to interpret them (remember what I've said about that? You can GET a doctor to DO FT's but if they worship at the altar of TSH...then you are doomed). Actually, does this doctor even DO thyroid? Cuz most thyroid docs would treat you based on that lab panel.

You can go to Thyroid Disease Information - Hypothyroidism - Hyperthyroidism - Thyroid Cancer - Autoimmune Disease - Hashimoto's - Graves' - Goiter - Nodules and search there for studies and they have MANY great thyroid doctors who've written pieces on the importance of FT's and treating using those, not TSH. Stop The Thyroid Madness Index Page also has some compelling articles, etc.

I went through seven doctors. EVERY ONE of them was supposedly 'great at thyroid' and not a one helped me at all. They wanted to ignore my FT's in light of my TSH and FOUR of the seven said they'd treat me when 'your TSH is above a 10...that's what I go by'. There are lists of great thyroid docs who will treat using FT's and going by symptoms. I think you need to talk to this doctor and tell her that you feel like crap, take in some literature about 'normal may not be so normal' and ask her WHY she is allowing your thyroid hormones to be at the 'bottom of the range' and perhaps ask "Why can't we get my FT's up in the midway of range?" and see what her answer is to that.

Only problem is: FIVE of the seven 'supposedly great' docs I saw actually DID give me a little thyroid hormone, and in six weeks when they got labs and saw my FT's go up a LITTLE teensy bit, they said "Oh...there ya go, you can stop taking that now"!! EEEK!! That would be tantamount to giving a diabetic insulin, and when the glucose is lower telling them to stop taking the insulin!

ETA: I also think that's too much progesterone...sorry. About double to bring you up to speed...maybe you'd want to cut that and see what next labs look like. Perhaps that's what's really driving your FT's down too (binding).

Have you joined your state thyroid support group at Yahoo? Lots of people there are seeing family practitioners and getting really good care too in your state.

Pam

[nonstickpam107]

Here's the link for the Virginia group:

thyroidsupportofva : Thyroid Support of VA

And get right to the point: when joining, then posting, post: Need Armour doc who treats subclinical labs.

Pam

[dooy]

Pam,
Thank you so much for the links and I will be on a mission to research this and go in to my next appointment equipped. I'll also join the VA group.

My doc is a family practitioner and I'm hoping that she will take the literature and get up to speed so I won't have to see someone else but if not, I will find someone who will. My last labs before I started the progesterone cream were low on my FTs too. My doc did just lower the progesterone cream b/c of break through bleeding...

The work continues! I'll keep you posted.

[nonstickpam107]

Ok, personally I would (and I have) go there:

"Doctor, I'm really happy we can be partners in my health care" "I'm still not feeling very well, and I hear and read that many people feel better with a TSH of closer to 1, and many doctors use natural thyroid to do that. I have a lot of symptoms of thyroid: list symptoms"

Ok. Oh, and pssss...go to Thyroid Disease Information - Hypothyroidism - Hyperthyroidism - Thyroid Cancer - Autoimmune Disease - Hashimoto's - Graves' - Goiter - Nodules and do a search for 'letter to my doctor' I do believe it might still be there and can 'guide' you.

Pam

[dooy]

Thanks a million!!!

I'll let you know how it goes!

[dooy]

Just talked to my doctor on the phone. She said she won't treat me with meds - just glandular thyroid support which I hear is useless. SHe said 2.3 THS and low range Free T3 and T4 is not a problem since my antibodies are really low. I just don't get it. I still feel really fatigued, foggy, cold hands and feet, dry, dry skin and joint pain. Sleep is a little better but still inconsistent and I have NO energy. I know I MUST exercise but I'm dragging to get the basics done. AND I start work full time in May.

I dont' even know if I have the energy to keep trying to find another doctor. I am doing more research and will get Mary's book to make my case. It's just so frustrating. They are really quick to rx an antidepressant but won't even talk about armour...doesn't make sense.

She did reduce my progesterone cream.

Just needed to vent.

[nonstickpam107]

Um, if you have antibodies over the range, you have autoimmune hypothyroidism. Period.

That is tantamount to telling a pregnant woman that, since she's only a little pregnant, she's not going to allowed to deliver. ???? I'd be upset too. See if the state group you are joining has a list of docs who treat subclinical numbers with evidence of autoimmune antibodies.

Sorry...and you are right, treating with glandulars doesn't help (and might even 'hurt'...so many of them are bovine glandulars coming from other countries...).

Pam

[nonstickpam107]

Here's the Virginia list (remember, Mary Shomon's doctor is IN Virginia and listed here). I know you won't be 'duped' into seeing a doctor who's been patient recommended for 'listening to me', sigh. Too many doctors are recommended for having 'listened' to the patient..later I actually talk to the recommending patient and hear that the patient got NO thyroid hormone...but just listened. ACK!!

Virginia Top Doctors -- Best Thyroid Doctors in the World as Nominated by Patients, from Mary Shomon

Pam

[n.texasgirl]

Pam,

A quick question. My sister has had the exact same sypmtoms that I had before being treated for hypothoidism last year. She miscarried twice last year. She found out she was pg again last month and is very afraid of losing yet another baby. I had her go to health check and do the thyroid panel.

Here are her test results. I am too brain dead right now to think (long story)
What do you think?

TSH= .883 uIU/mL .350 - 5.5
T4FreeDirect= 1.02 ng/dL .61 - 1.76
Triiodothyronine Free =3.1 pg/mL 2.3 - 4.2

What tests do should she do next?

Thanks so much Pam.

-Andrea

[Beth1121]

Originally Posted by nonstickpam107

Um, if you have antibodies over the range, you have autoimmune hypothyroidism. Period.

I think we should all print that out and give it to any doctor who just can't seem to get it!

[nonstickpam107]

Originally Posted by n.texasgirl

Pam,

A quick question. My sister has had the exact same sypmtoms that I had before being treated for hypothoidism last year. She miscarried twice last year. She found out she was pg again last month and is very afraid of losing yet another baby. I had her go to health check and do the thyroid panel.

Here are her test results. I am too brain dead right now to think (long story)
What do you think?

TSH= .883 uIU/mL .350 - 5.5
T4FreeDirect= 1.02 ng/dL .61 - 1.76
Triiodothyronine Free =3.1 pg/mL 2.3 - 4.2

What tests do should she do next?

Thanks so much Pam.

-Andrea

I don't think it's her thyroid that is causing the miscarriages..and if I, myself, had those numbers, I wouldn't be looking for more 'proof' unless there were a lot of women with Hashimoto's or Graves' disease in family.

Those are test results WHILE she is pregnant? If she wants further testing, about all she can do is get a TPO antibodies and possibly a TSI too (Graves hyperthyroid) but I would be looking elsewhere for the answer to her miscarriages at this point. Sorry she's not been able to carry to term, and a big and that this time will be different.

Pam

[n.texasgirl]

Pam,

Thank you as always.

-Andrea

[Lee-Anne65]

Pam I had these labs done last year and was wondering if you could give me your opinion. To me they all fall in the low end of the ranges...doc of course said I am fine but I have not felt well for quite sometime and have quite a few symptoms that present with thyroid issues.

My labs were as follows:

T-4 free 1.1 range 0.8-1.8
T-3 free 274 range 230-420
TSH, 3rd generation 1.58 range .40-4.50
T3 reverse (what is this) 22 range 11-32

Thanks for any input you can give me.

Lee-Anne

[nonstickpam107]

Lee-Anne, your FT3 is a bit low, the rest is pretty good. Low T3 isn't from it changing to Reverse T3 either, so that's not a 'reason'. Here are some reasons for low FT3:

Taking hormones (including birth control)
Not getting enough calories AND carbs (or being on a very low carb diet when the tests were taken)
Eating soy protein

If I were YOU..I would want my: iron, ferritin checked NEXT (low iron and ferritin can mimic hypothyroid symptoms. Since iron lab range are generally from 10-210 (or something similar) if yours is below 70, you could still have symptoms. Same with ferritin (which is storage iron).

ETA: These were LAST year? Then they don't apply whatsoever to today/now. They could have changed drastically by now. Thyroid labs should be done every year (unless you are on thyroid replacement, and then they should be done every eight weeks until labs lood good, and then every three to six months).

Pam

[Lee-Anne65]

Thanks Pam. These labs were done last August. As far as the reasons you gave for the low FT3 none of those apply to me and didnt apply at the time the labs were done. At my next physical I will ask him to check my iron and ferritin and also rerun the same labs he did last August. Thanks for the input.

Lee-Anne

[nonstickpam107]

Yeah, last August doesn't apply to now...with the dropping FT3 (can also be a 'sign'). And this time...have doc do an TPO antibodies test just to rule out Hashimoto's if he/she will. OH, and..I don't know your age...but if in perimeno or meno, low FT3 can ALSO point to hormone imbalance, in particular low progesterone. So if iron and ferritin and TPO's look good, you might then have estradiol, progesterone done. But overall...it's a good panel.

Pam

[Dblyn]

Hi Pam, I dont even know if i have enough information to share with you for you to even comment on, but here goes.
I had my annual gyno appt april 4th. My doctor got called out on a emergency so i had a nurse practioner see me.She didnt even run a FHS?? But i insisted she run a thyroid which she poo pooed and made me feel dumb about, did it. Ive still not heard from doctor but got these results in the mail yesterday.
TSH 1.86
CHOL/HDL ratio 3.3

Im cold all the time, my hair is falling out, im tired. And she laughed off all these symtoms and said i was fine? Last year they said i was in menopause and put me on HRT which really messed me up so she took me back off and put me on Loestrin. I dont even know whats going on with the menopause issue. Any recommendations besides the obvious" GET a new doctor!" haha she is so busy i feel like i get left to the wayside with to many unanswered questions.

[bmoyer1]

This has been a very interesting discussion, I have also been diagnosed normal by both my gp and gyno, although with dieting and excersizing I have gained 10 lbs since september last year. And that has been after fighting to maintain up till that point. I am menopausal, so probably that has something to do with it. But I am really getting fed up. Someone mentioned to me that L-tyrosine has some kind of effect on the thyroid, to get it going. I know some say the coconut oil has some effect on it too. Any suggestions for something like this since the Drs. are dragging their feet in this area?

[Dblyn]

Originally Posted by bmoyer1

This has been a very interesting discussion, I have also been diagnosed normal by both my gp and gyno, although with dieting and excersizing I have gained 10 lbs since september last year. And that has been after fighting to maintain up till that point. I am menopausal, so probably that has something to do with it. But I am really getting fed up. Someone mentioned to me that L-tyrosine has some kind of effect on the thyroid, to get it going. I know some say the coconut oil has some effect on it too. Any suggestions for something like this since the Drs. are dragging their feet in this area?

I hear ya, ive gained back 20

[nonstickpam107]

Originally Posted by Dblyn

Hi Pam, I dont even know if i have enough information to share with you for you to even comment on, but here goes.
I had my annual gyno appt april 4th. My doctor got called out on a emergency so i had a nurse practioner see me.She didnt even run a FHS?? But i insisted she run a thyroid which she poo pooed and made me feel dumb about, did it. Ive still not heard from doctor but got these results in the mail yesterday.
TSH 1.86
CHOL/HDL ratio 3.3

Im cold all the time, my hair is falling out, im tired. And she laughed off all these symtoms and said i was fine? Last year they said i was in menopause and put me on HRT which really messed me up so she took me back off and put me on Loestrin. I dont even know whats going on with the menopause issue. Any recommendations besides the obvious" GET a new doctor!" haha she is so busy i feel like i get left to the wayside with to many unanswered questions.

Nope, you don't know if you have thyroid disease, and neither does the doctor/nurse. Just a TSH just tests the pituitary (congrats, you have one!). The FSH is just as senseless/useless as the TSH too.

Free T4, Free T3 and TPO antibodies for thyroid, and for testing sex hormones, it should be a Estradiol, estriol, progesterone and Free Testosterone.

Did they put you on the HRT that causes cancer? (Premarin/Prempro)?? That's not good. Neither is Loestrin (synthetic, made in testtube). Most of us are using bio identical HRT. You can call around to the pharmacies in the area, ask if they do compounding hormones and ask which docs send their patients there for bioidentical HRT. And...you can get a TSH, FT4, FT3 at Online Lab Tests: blood work, blood testing and laboratory tests you order, pay, they send you to a lab near you and report results back to you (under 90 dollars).

I wouldn't want synthetics and I wouldn't want JUST a TSH (I'm about ready to request Hallmark cards make up one for GYN's and other docs that says: 'Testing only TSH is a new way to say 'I don't care about you, now pay up front, buh buy')

Pam

Pam

[nonstickpam107]

L tyrosine contains no thyroid hormones. So, no, it doesn't 'get it going'. TWO out of every ten women have Hashimoto's autoimmune hypothyroidism. Taking a supplement doesn't 'cure it'. Or stop it.

If you were pronounced 'normal thyroid', get a copy of those tests. If there isn't a TSH, Free T4, Free T3 and anti TPO antibodies...no one knows what your thyroid is doing, not even the doc who ordered the testing.

The thyroid is triggered in menopause by not having enough progesterone...progesterone is the thyroid's buddy, and once it goes low in perimeno, the thyroid tries to do it's job...and that's how it's triggered, and finally just gives up.

I have lists of good thyroid docs (patient recommended), but go to ArmourThyroid first and use the docfinder feature for your state (and any state lines that are close, those of us that are receiving the BEST of care for thyroid usually are travelling up to two hours driving time ONE way...so put in zip codes for a radius of one to two hours driving time..if you find a doc...call FIRST and make SURE the doc is actually using Armour Thyroid..some have put their names in there just to get patients, sigh).

Pam

[Dblyn]

Originally Posted by nonstickpam107

Nope, you don't know if you have thyroid disease, and neither does the doctor/nurse. Just a TSH just tests the pituitary (congrats, you have one!). The FSH is just as senseless/useless as the TSH too.

Free T4, Free T3 and TPO antibodies for thyroid, and for testing sex hormones, it should be a Estradiol, estriol, progesterone and Free Testosterone.

Did they put you on the HRT that causes cancer? (Premarin/Prempro)?? That's not good. Neither is Loestrin (synthetic, made in testtube). Most of us are using bio identical HRT. You can call around to the pharmacies in the area, ask if they do compounding hormones and ask which docs send their patients there for bioidentical HRT. And...you can get a TSH, FT4, FT3 at Online Lab Tests: blood work, blood testing and laboratory tests you order, pay, they send you to a lab near you and report results back to you (under 90 dollars).



I wouldn't want synthetics and I wouldn't want JUST a TSH (I'm about ready to request Hallmark cards make up one for GYN's and other docs that says: 'Testing only TSH is a new way to say 'I don't care about you, now pay up front, buh buy')

Pam

Pam

Thanks Pam. I did look up your list of Thyroid doctors and we have one only 15 miles away. And we also have a compound pharmisist. The stuff she had me on last year was progestin and cenestin Im going to do your suggestion of online lab work. ITs time to take matters into my own hands Thanks for your help.
Is it the Thyroid panel II that im ordering on that page?

[nonstickpam107]

Yes, thyroid panel II and if that comes back 'suspicious' than you would also order the TPO antibodies (unless you can get that too, I know it's there also..don't know your particular budget). Oh, wow...anyone who only hands synthetics out...wouldn't be someone I'd want to go to. Wow..progeSTINS...good heavens!

Pam

[retroworx]

Hi Pam:

We haven't yet met, and I'm only on page 4 of this rather long thread so it's kind of nervy of me to jump right in here, but I have a meeting with my GP in a few days and I was wondering if you might be able to help me out with a couple of questions before then.

I've been fairly lethargic, have inexplicable weight gain, swelling, leg cramps, hair loss cold (I'm sitting here in 2 sweaters and a fleece vest -- it's 72 degrees outside) -- you know the drill. I started reading this thread to research whether I might be having thyroid issues. The thread prompted me to dig up latest blood work (from last August) and I discovered that my ferritin was only registering as a 10. Doc never mentioned this to me (or the fact that my Vit D came in low) and now I'm investigating whether I may currently have iron and/or thyroid issues.

Can you point me to a link with a list of the proper thyroid blood work I should request be drawn on my next visit, or could you list them for me here, in the medical terminology she and the lab will understand? I want to fax it over to her for a script for the bloodwork so that I can have the results in when I do see her.

Thanks from a nervy stranger!

-Susan

P.S. Here are some numbers form those August labs:

WBC: 3.5 (4.0-10.5)
RBC: 4.05 (3.8-5.10)
Hemoglobin: 12.3 (11.5 - 15)
Hematocrit: 35.7 (34-44)
MCV: 88 (80-98)
MCH: 30.5 (27-34)
RDW: 13.8 (11.7-15)
Platelets: 183 (140-415)

TIBC: 341 (250-450)
UIBC: 278 (150-375)
Iron, Serum: 63 (35-155)
Iron Saturation: 18 (15-55)

TSH: 1.92 (.35-5.5)
T4, Free: .95 (.61-1.76)
Ferritin, Serum: 10 (10-291)

Vit D: 24.8 (32-100)

[nonstickpam107]

As you can see, your FT4 is kind of low. But you still would want to get a FT3 (NOT a 'T3 Uptake'...caution...a T3 Uptake is actually a T4 binding test) and perhaps a TPO antibodies, along with TSH (again). So, the following:

TSH
Free T4
Free T3
TPO antibodies (this is a test to see if you have autoimmune hypothyroidism, otherwise known as Hashimotos).
ferritin
iron

Your iron is a little low too, but not to the point of bottoming out...and they didn't do enough thyroid testing to tell (very common also, sigh). Your Vit D is, of course, way too low, but that can be remedied by taking Vit D, and calcium (preferably with magnesium too). It doesn't appear that the iron is 'low enough' to be mimicing all those thyroid symptoms. Any other females in your family with hypothyroidism (or Graves hyperthyroidism) that you know of? Especially Mom, sisters, Grandma, etc.?

If your doctor (or the lab, some labs refuse to do a FT3 (Free T3) is the TSH is under a 5...that really chaps my...um...but I digress) will not do that panel, you can get it yourself at Online Lab Tests: blood work, blood testing and laboratory tests it will be Thyroid panel II (does not include the TPO, so you'd have to order that separate) and they send you to a lab near YOU and report back to you). HTH

Pam

[retroworx]

Wow, girl you are FAST!!

Thanks so much for your input

-Susan

[laurawd]

Originally Posted by n.texasgirl

Pam,

A quick question. My sister has had the exact same sypmtoms that I had before being treated for hypothoidism last year. She miscarried twice last year. She found out she was pg again last month and is very afraid of losing yet another baby. I had her go to health check and do the thyroid panel.

Here are her test results. I am too brain dead right now to think (long story)
What do you think?

TSH= .883 uIU/mL .350 - 5.5
T4FreeDirect= 1.02 ng/dL .61 - 1.76
Triiodothyronine Free =3.1 pg/mL 2.3 - 4.2

What tests do should she do next?

Thanks so much Pam.

-Andrea

Hi Andrea. I am currently 6 weeks pregnant and have had lots of thyroid tests in the past year because I suspect I'm hypo, but my TSH is firmly normal!

Since becoming pregnant, I have learned that low FT4 is a problem (mine is perpetually low.) There was a Swedish study that showed that FT4 needs to be above 10 mmol/l for proper psychomotor devt of the fetus.

A score of 1 ng/dl is about 13 mmol/L. Now, that doesn't mean that her FT4 could have been lower at the time. It's also possible that her levels vary throughout the day. Anyway, I think it's still worth investigating. How's she doing?

Abstract below:
> Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy*. Original Papers
>
> Clinical Endocrinology. 50(2):149-155, February 1999.
> Pop, Victor J. *; Kuijpens, Johannes L. +; van Baar, Anneloes L. ++; Verkerk, > Gerda *; van Son, Maarten M. [S]; de Vijlder, Jan J. [P]; Vulsma, Thomas [P]; > Wiersinga, Wilmar M. ** ; Drexhage, Hemmo A. ; Vader, Huib L.
> Abstract:
BACKGROUND: Maternal thyroid function during early pregnancy is an important determinant of early fetal brain development because the fetal thyroid is unable to produce any T4 before 12-14 weeks' gestation. Overt maternal hypothyroidism as seen in severe iodine-deficient areas is associated with severely impaired neurological development of the offspring. At present, it is not known whether low free T4 (fT4) levels during pregnancy in healthy women from iodine sufficient areas may affect fetal neurodevelopment.

METHODS: Neurodevelopment was assessed at 10 months of age in a cohort 220 healthy children, born after uncomplicated pregnancies and deliveries, using the Bayley Scales of Infant Development. Maternal TSH, fT4 and TPO antibody status were assessed at 12 and 32 weeks' gestation. Maternal gestational fT4 g t; concentration was defined as an independent parameter for child development.

RESULTS: Children of women with fT4 levels below the 5th (<9.8 pmol/l, n = 11) and 10th (<10.4 pmol/l, n = 22) percentiles at 12 weeks' gestation had
> significantly lower scores on the Bayley Psychomotor Developmental Index (PDI) scale at 10 months of age, compared to children of mothers with higher fT4 values (t test, mean difference: 14.1, 95% confidence interval (CI): 5.9-22 and 7.4, 95% CI: 1.1-13.9, respectively). At 32 weeks' gestation, no significant differences were found. In the group of women with the lowest 10th percentile

fT4 concentrations at 12 weeks' gestation, a positive correlation was found
between the mothers' fT4 concentration and children's PDI scores (linear
regression, R: 0.46, P = 0.03). After correction for confounding variables, a
fT4 concentration below the 10th per centile at 12 weeks' gestation was a
significant risk factor for impaired psychomotor development (RR): 5.8, 95% CI: 1.3-12.6).
>
> CONCLUSIONS: Low maternal plasma fT4 concentrations during early pregnancy may be an important risk factor for impaired infant development.
> (C) 1999 Blackwell Science Ltd.