Full Thyroid Profile results...confused.

[AnthonyMs]

I've just received my thyroid profile test results from Genova. I don't know what to make of them. Any help much appreciated!

TT4 - 91.2 (58-154)

TSH - 2.77 (0.4-4.0) Previous 3.92 (0.27-4.2) (15/04/13)

FT4 - 15.8 (10-22) Previous 16.8 (12.0-22.0) (15/04/13)

FT3 - 6.13 (2.8-6.5)

FT4:Ft3 - 2.6 (2.5-4.0)

RT3 - 0.38 (0.14-0.52)

TG - 20 (0-40)

TPO - 10 (0-35)

Commentary:

"Higher than optimal TSH level. Suspect: Possible low grade/sub clincal hypothyroid state in absence of any other causes, since the TSH level is the most sensitive indicator of thyroid function."

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i1273.photobucket.com/album...

Other results I've had...

- TSH 3.92 (high/normal) 0.27 - 4.2

- FT4 16.8 (normal/optimal?) 12.0 - 22.0

- Vitamin D 37.2 (low/normal/sub-optimal)

- Active B12 108.5 (normal/optimal?) 25.1 - 165.0

- Iron 18.1 (normal/optimal?) 10.6 - 28.3 (previous - 12.5)

- TIBC 52 (normal/optimal?) 41 - 77 (previous - 54)

- Transferrin Saturation 35% (normal/optimal?) 20 - 55 (previous - 23%)

- Ferritin 180 (normal/optimal?) 30 - 400

- Red Cell Folate 645 (normal/optimal?) 158 - 1099

- Total Testosterone 16.2 (low?) 7.6 - 31.4

- Haemoglobin 13.8 (low/normal) 13.0 - 17.0 (previous - 13.2)

- HTC 0.404 (low/normal) 0.37 - 0.5 (previous - 0.389 (low!) (0.4 - 0.54))

- Red Cell Count 4.58 (low/normal) 4.4 - 5.8 (previous - 4.39 (low!) (4.5 - 6.5))

- MCV 88.2 (normal) 80 - 99 (previous - 88.6 (79 - 100))

- MCH 30.1(normal) 26.0 - 33.5 (previous - 30.1 (27.0 - 32.0))

- MCHC 34.2 (normal/high) 30.0 - 35.0 (previous - 33.9 (32.0 - 36.0))

- RDW 12.9 (normal) 11.5 - 15.0 (previous - 12.7 (11.8 - 14.8))

- Platelet Count 209 (normal) 150 - 400 (previous - 222 (150 - 400))

- White Cell Count 5.31 (normal) 3.0 - 10.0 (previous - 6.9 (4.0 - 11.0))

- Reticulocyte Count (immature red cells) % 0.84 (normal/sub-optimal?) 0.38 - 2.64

- ESR 2 (normal) 1 - 10

- Cholesterol 5.4 (high!) <5.0

- LDL Cholesterol 3.4 (high!) <3.0

- HDL Cholesterol 1.4 (normal/optimal?) 0.9 - 1.5

- Triglycerides 1.3 (normal/sub-optimal?) <2.3

[poing]

Were the bloods for the more recent test taken later in the day? That would explain why both the TSH and FT4 came down.

I don't think you have any antibodies. Those numbers look like the minimum detection limits in the test - the test can't measure anything lower.

Your TSH is a little bit on the high side. Puzzlingly, however, your FT3 looks quite good to me.

You are a bit of a mystery.

What are your symptoms?

[AnthonyMs]

So you're saying that these results look unusual i.e. not the typical hypothyroid case? The test was taken around the same time 9-10am. You'd expect TSH to be near it's peak therefore. One thing is clear, based on TSH levels alone the system is amiss, shouldn't a healthy state warrant a TSH of 1-2? My Total thyroid output looks normal but possibly a bit sluggish? If my FT3 is high/optimal then that means i'm converting well - perhaps this is due to lower than normal (for me) TT4 output, resulting in this compensatory mechanism?

Another thing, how does RT3 factor into this if at all? Levels appear normal and my understanding is that RT3 is only useful to know if there are conversion problems and there don't appear to be any

Yes clearly I don't have Hashimoto's or any other autoimmune process.

Do you know how adrenal fatigue affects TSH? If one is hypothetically suffering from it would that reduce thyroid production and thereby raise TSH? A higher than normal FT3 could then be a compensatory mechanism as mentioned. All of this is just my supposition.

I have several symptoms of hypothyroidism but also of low adrenal reserve (Dr. Peatfield's book).

My symptoms are:

depression

anxiety

poor sleep

brain fog

ankle swelling/ankle joint pain

loss of libido

fatigue

muscle weakness

cold hands/feet

eczema/skin breaks in hands

low temperature (~36C in morning)

low blood pressure (adrenal problem)

weight loss in times of stress

high cholesterol (high LDL, normal HDL)

low red blood cell count

salt craving

difficulty getting up in the morning

lethargy worse in morning

palpitations

[nostoneunturned in reply to AnthonyMs]

If the RT3 and FT3 were measured in the same units then the ratio (FT3 divided by RT3) is 16.13.

This is lower than the 20 or higher ratio reckoned to show healthy levels of RT3.

I am not a doctor - perhaps this link will be useful to you for further pursuit of this, and its background.

stopthethyroidmadness.com/r...

Low red blood cell count? If you have had an FBC then perhaps you could post its results here for advice.

Something is truly amiss when you have all these symptoms.

Another link from which Panel 7 and associated text might be thought by you to apply is this: Into search engine search box type:

Interpretation of thyroid function tests by Colin Dayan

When the results come up, click on the Keck School of Medicine reference as others charge for access to this valuable information source.

[AnthonyMs in reply to nostoneunturned]

Great, so according to Panel 7- Normal or raised TSH, raised free T4 or T3...

Possibility 1 - antithyroid hormone antibodies

"If results of the free T4 and T3 assays are widely discordant with each other, or with the clinical status, then antithyroid hormone (anti-T4 and anti-T3) antibodies interfering with the assay should be suspected. Interference can cause considerable confusion, since it is more common in free rather than in total thyroid hormone assays, and autoantibodies develop in individuals who already have autoimmune thyroid disease and disturbed thyroid

function."

My TG and TPO are within optimal range which suggests I don't have autoimmune thyroid disease. If antithyroid hormone antibodies can be present in the absense of autoimmune thyroid disease/autoimmune thyroid antibodies i.e. TG and TPO, then this could be one possibility.

Possibility 2 - familial dysalbuminaemic hyperthyroxinaemia

"Discordant free T4 and T3 results are also seen in familial dysalbuminaemic hyperthyroxinaemia, in which the individual is euthyroid but a defect in albumin

results in increased affinity for T4. This disease causes interference with both total and analogue free T4 assays, but free T3 concentrations are usually normal."

T4 and FT4 looked normal i.e. mid-range and FT3 was to the right of both. Although my symptoms appear to be congruent with hypothyroid not euthyroid. The disturbance appears to be to the FT3 only.

Possibility 3 - TSH (or TRH?) secreting pituitary tumour/abnormality

"The two rare but important clinical conditions, in which detectable TSH is associated with raised free T4 or T3, are thyroid hormone receptor mutations that lead to resistance to thyroid hormone and a TSH secreting pituitary tumour. Features that distinguish these two conditions, and favour resistance to thyroid hormone include: family history of thyroid hormone resistance (dominant inheritence); absence of a pituitary lesion shown by computed tomography or magnetic resonance imaging; a normal -subunit/TSH molar ratio; a normal

sex-hormone-binding globulin concentration; a normal or exaggerated TSH response to TRH; and inhibition of TSH secretion following T3 suppression. The concentration of thyroid hormones or of TSH (usually in the laboratory normal range) does not differ significantly between the two conditions."

No mention of adrenal fatigue as a possible source of interference???

[AnthonyMs]

Thankyou, I'm most certainly not hyperthyroid despite my elevated FT3 and all my symptoms point towards a hyperthyroid state. Reading Dr. Peatfield's book has made it all clear:

"The blood levels depend mostly on what's happening to the thyroid hrmones. If the cellular receptors are sluggish, or resistant, or there is extra tissue fluid together with mucopolysaccharides, the thyroid won't enter the cells as it should; so that part of the hormone is unused and left behind, giving a falsely higher reading to the blood test. It is simply building up unused hormone. This may apply to both T3 and T4. Further complications exist if the T4 -> T3 conversion is not working properly, with a 5'deiodinase enzyme deficiency. There will be too much T4 and too little T3. If there is a conversion block, and a T3 receptor uptake deficiency, both T3 and T4 may be normal or even raised. The patient will be diagnosed as normal or even over-active, in spite of all other evidence to the contrary.

Adrenal insufficiency adds another dimension for error to the T4 and T3 tests. Adrenal insufficiency, of which more anon, will adversely affect thyroid production, conversion, tissue uptake and thyroid response. It may make a complete nonsense of blood tests."

So my guess is that I either have a tissue uptake (thyroid hormone resistance) or pituitary problem. Any clue as to how to test for these?

[poing in reply to AnthonyMs]

Hi there,

I've only just realised that we've corresponded before on other threads!

I would say you probably have more of a problem with adrenals and stress than with your thyroid. The two sets of problems have a huge range of overlapping symptoms. However, you've mentioned losing weight under stress ather than putting it on, and that seems to be the biggest clue, pointing to adrenals rather than thyroid.

There's a comparison here:

drrind.com/therapies/metabo...

I'm a hypoadrenal person, and probably have been my entire life. I inherited some of this from my mother, who had chronic fatigue, and I nearly died at birth... a stressful start in life kind of wrecks your adrenal function. I've been able to manage it more or less, it's just been part of who I am.

In the last few years, my digestive system started to fail. There are bunch of nutritional deficiencies that cause low body temperature (iron, zinc, copper and vitamin B1), and low cortisol output seals the deal. I went seriously hypothermic from lack of iron and zinc, and still have days when I'm very cold. Cortisol output definitely still affects my body temperature. On a "public" work day, such as attending a conference, I'm mildly stressed out, but warm for a change!

Of course, I'm not saying that you are like me and have the same problem - we've never met and there are 1000s of possible underlying health conditions that you might have. However, whatever health problem you do have, adrenals usually come into things at some point.

To answer your earlier question, I don't think adrenal problems really affects TSH until they are extremely advanced and you have full blown chronic fatigue bordering on adrenal insufficiency. At that point I believe that you will start to see TT4 come down (that's total T4) and then TSH might start to go up a little. However, in some people they might produce more RT3, and the TSH will stay low.

Adrenal fatigue does involve the pituitary in the brain... but it's not broken, everything gets downregulated due to your body's reaction to stress. In chronic fatigue, those reactions become over-reactions and eventually lead to mitochondrial failure (low energy output from every cell). There are no good tests for this kind of thing. You cannot easily measure tissue uptake of thyroid hormones, and even if you could, I doubt that adding more hormones is the correct treatment.

If you have adrenal fatigue, then this is an adaptive mechanism - albeit one that makes you feel rotten. There's an interesting book called "CFS Unravelled" that looks at the nervous system response to stresses and the various physical malfunctions that tend to crop up when the adrenals are struggling. I thought it was good - although it was also free when I downloaded it. Otherwise you could read Dr Myhill's guide to CFS. Whether or not you actually have CFS, I'll bet there are parts of those books that resonate with you.

poing

[AnthonyMs in reply to poing]

Hi, funny, I can remember communicating with you before.

Even without testing I'd definately agree with the premise of adrenal fatigue interfering with thyroid function, possibly causing diminished number of receptors/less tissue uptake of thyroid hormones....this could explain why I had a high blood FT3 level. Otherwise, if cells were uptaking thyroid hormones adequately then I'd presumably have hyperthyroid symptoms which I clearly do not.

But one thing doesn't make sense, according to Dr. Rind's thyroid scale matrix

drrind.com/therapies/thyroi..., if I were to have adrenal fatigue then I'd expect low TSH, T4, T3. The most fitting category is "poorly effective thyroid hormone" which would suggest either nutrient deficiency, viral damage to mitochondria, toxic burden or diminished cell receptor sites to thyroid hormones. I may have an overlap between adrenal fatigue and hypothyroid, because I clealy have symptoms of both conditions. Like you said adrenal fatigue downregulates every process in the body and thyroid uptake could be one of the consequences. I'm expecting the results to the 24 hour adrenal test soon, this could confirm my suspicions. And i'll be seeing an endocrinologist at some point, i've requesting a referal, who knows how long that would take, but i'd imagine i'll be waiting months for an appointment.

[poing in reply to AnthonyMs]

I don't see a problem with thyroid hormones in the upper third of the reference range - that's what all the hypO people are aiming for! Mine are up at that level too. I find the comment that good hormone levels reflects poor tissue uptake totally bizarre.

I've found a bunch of things that affect my body temperature, but my thyroid hormone levels aren't one of them. My thyroid keeps getting tested because I complain that I'm cold, but my TSH has been remarkably stable over the years - it only changes a little bit according to time of day.

Llike I said, I believe that adrenal fatigue only affects thyroid output when it's turning into more advanced chronic fatigue. The effect on TSH and hormone levels may vary according to what degree of illness you have. Dr Rind has tried to simplify things, but we are individuals, and so I don't think it's possible to generalise completely and absolutely.

I have the chronic fatigue prone personality, and the inheritance. So far, I've managed to dodge that one. Fingers crossed for us both!

[AnthonyMs in reply to poing]

Well ok, I agree it might indicate good thyroid regulation, however then the question remains, why do I have hypo symptoms? I was refering to a quote from Dr. Peatfield (see above)...

"The blood levels depend mostly on what's happening to the thyroid hormones. If the cellular receptors are sluggish, or resistant, or there is extra tissue fluid together with mucopolysaccharides, the thyroid won't enter the cells as it should; so that part of the hormone is unused and left behind, giving a falsely higher reading to the blood test. It is simply building up unused hormone. This may apply to both T3 and T4."

He mentions T3 and T4 but what about FT3 and FT4?

In the two times I've tested TSH they've differed in value by >1.0, whilst being taken at approximately the same time 5 weeks apart. I don't know if this is significant or not as hormones fluctuate throughout the day? What is your typical TSH?

I think I might have full blown chronic fatigue, it's almost impossible to wake up in the morning and I routinely wake up during the night around 2-4am. Now i'd be disappointed if my 24 adrenal test came out "normal" that wouldn't explain anything. I think you must never discount genetics in any health ailment, in the end our genes only evolved to fit a particular environment that bares no resemblance to modern day lifestyles.