Your thoughts on lab results, why persistent high TSH

[vmri2011]

I have a 21 yo daughter w. Hashimotos with no symptoms.

Dec 2017:

TSH 9.9,

fT4: 1.48 (0.8-1.73),

fT3: 3.1 (2.0-4.7),

reverse T3 16.9 (7.5-19) and

TPO Abs > 1000 (reported like this)

Thyroglobulin about 150

Low ferritin, iron, Vit D , folate and B12: she was/is a vegetarian. Supplementing all of these. And she was given low dose naltrexone (LDN 4.5 mg). Not on any thyroid medication as she did not have any symptoms.

3/2018, Repeat labs

Vit D 90

thyroglobulin < 3.0

TT4 8.3 (5-10.8)

FT4 1.4 (0.7-2.5)

FT3 4.0 (2.4-4.2)

TSH 8.3 (0.5-3.0)

TPO Ab 539

We have not yet repeated the other lab tests. Will do next month. I

What are your thoughts on these lab results? Why is the TSH still high? It seems the antibodies have both decreased, the FT3 has increased.

thanks

[greygoose]

I would not guarantee that she doesn't have any symptoms. There are over 300 of them, and some you wouldn't attribute to thyroid at first sight. But, where she has symptoms or not, she ought to be taking some thyroid hormone replacement.

Results do tend to jump around with Hashi's - did she have both these tests early morning and fasting? But the high TSH testifies to considerable damage already done to the thyroid. So, although the LDN might lower her antibodies and make her feel good, she will always be hypo. She needs to keep a close eye on her levels, testing regularly.

Really not much point in repeating the rT3 test, it's just throwing money out of the window.

[vmri2011 in reply to greygoose]

Thanks. Yes both tests fasting and early AM. Thinking out loud: the reason to take LDN was to reverse the autoimmune (hashimotos) before it had a significant effect on thyroid. Her latest results seem to show that she is able to make enough T3 . We thought we had caught the disease process early on to perhaps halt the damage to the thyroid so that perhaps the thyroid could heal itself. Has this shown to happen- the thyroid healing itself and perhaps reversing the damage? Still curious why the TSH is high with normal FT3.

[greygoose in reply to vmri2011]

I think the only reason the FT3 is 'normal' is because of the high TSH driving the conversion. But, if her FT4 continues to drop, then that can't last.

I'm not certain that LDN does actually reverse Hashi's, although it does help. But thyroids don't heal. I've certainly never heard of one doing so.

This is a list of hypo symptoms - although I don't think it's complete :

thyroiduk.org/tuk/about_the...

[Adam1805 in reply to greygoose]

What is LDN?

Supplement?

[vmri2011 in reply to Adam1805]

LDN- immune modulator. Read more here: ldnresearchtrust.org/what-i...

[Adam1805 in reply to vmri2011]

Thank u

[jimh111]

She is fine at the moment so no need to worry. Statistically she is much more likely to develop hypothyroidism at some stage in the future although there is a chance she will be fine.

One word of caution, if she becomes pregnant or plans to, I would ask for levothyroxine treatement sufficient to bring her TSH down below 2.5. The recommendation for a TSH below 2.5 is based on studies of patients who have been diagnosed as hypothyroid so strictly speaking the evidence only applies to this group. However, just because there hasn't been a study of subjects who have a highish TSH without symptoms doesn't guarantee the requirement for a low TSH isn't applicable to them. Therefore, since levothyroxine is cheap and safe I would insist on levothyroxine treatment if I were pregnant (which is not likely!!!).

[vmri2011 in reply to jimh111]

Thanks. Will be checking her levels often, at least yearly when she stabilizes. And thanks for the caution re. pregnancy.

We are hoping that the TSH will come down soon. Is there a lag between FT3 and TSH response? I am thinking that the feedback loop to the pituitary should be lowering the TSH?

[jimh111 in reply to vmri2011]

TSH responds to the combined effects of fT3 and fT4. I've just noticed that her TSH is rather high given both her fT3 and fT4 are normal and in balance. Sometimes the TSH assay can give a false high reading due to interference from patients' antibodies. It would be a good idea to ask her doctor to arrange another blood test using a different assay. They should consult an endocrinologist or biochemist for advice.

The rT3 assay is a waste of money.

There is no need to fast for a thyroid blood test, it makes no difference.

Also TSH increases during the middle part of the menstrual cycle, so expect some variance in blood test results.

[Greybeard]

Hi, you say your daughter has no symptoms. I wonder what prompted you to get all these tests done in the first instance?

[vmri2011 in reply to Greybeard]

When she left home for college I thought she lost some weight which she denied but I mentioned the weight loss to her doctor who did a lot of blood tests looking for why she may be losing weight. Her TSH was high at that time, at about 10 (not low) but her doctor decided not to do anything and since she was feeling fine we ignored it. We repeated the tests including TPO Antibodies about 2 years later and found it to be high and started treatment in Dec 2017.

[JAMuir]

There have been some suggestion that taking selenium reduces antibodies and could be as good as LDN 200ug/day.

[vmri2011 in reply to JAMuir]

She is also on Selenium. Her TPO antibodies have come down nicely in 2 months but not completely and still has the high TSH. We may try some natural treatments as was suggested by some friends

[whispers in reply to vmri2011]

Your daughter has hashimotos auto immune thyroditis, she has hypothyroidism, the damage is already done, she needs thyroid replacement hormones to bring down her tsh level to try prevent other damage, untreated hypo can cause many problems. I don't understand why she has not been given replacement hormones as reducing antibodies doesn't usually reduce a high tsh

[vmri2011 in reply to whispers]

Yes It's because she is 21 years old, claims she has no symptoms and wanted to try alternative methods and could not convince her that she needed medications