Contradicting Thyroid panel of my wife, is it hypo or something else? Doctor can't explain

[Zsolt]

Hi All!

Can someone shed some light on the below lab results and theory?

It's about my wife. She has some hypo symptoms(or it might actually connect to adrenals since her cortisol levels are very low during the day). Anyway her Thyroid panel is contradicting:

TSH : 2.2 (1-4)

FT4 : 10,5 (11,5-22,7) ! this is too low, outside of low range

FT3 : 6(2,8-6,5) This is almost going out of the high range

ATPO : 16 (<35)

Tireoglobulin : 52 (1,6-60)

I know she is missing RT3, TGAB, TRAB this is on the way now.

Her prolactin is 1350(40-530) !! way too high as well.

The contradiction here is that her FT4 is too low, but her FT3 is almost too high.

IF she would have hypo, shouldn't both value fell down in parallel?

Her TSH is not super high, but how i know it should be around 1 not over 2.

Thanks in advance,

Zsolt

[greygoose]

Has she had her iodine tested? If iodine is insufficient, the thyroid will sometimes make T3 rather than T4 to economise on iodine.

[Zsolt in reply to greygoose]

I suspected iodine deficiency as well, because we don't really eat that. We eat pure salt, and occasional sea foods. In case its low do you know how its should be dosed?

[greygoose in reply to Zsolt]

No, I'm afraid I don't. You will need to find an experienced doctor who knows the protocol. It's not just as simple as taking a supplement. You'd have to ask around, because that type of doctor is difficult to find. But, first of all, get the test.

[SlowDragon Administrator]

High prolactin can be due to autoimmune thyroid disease also called Hashimoto's

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pubmed/915...

Early stage Hashimoto's can easily give these sort of test results as thyroid levels hop about

her TG antibodies are only just under range

It's possible to have Hashimoto's and never have raised antibodies

Ask for ultrasound scan of thyroid

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

Plus very important to test vitamin D, folate, ferritin and B12

Low vitamins can badly affect Thyroid or thyroid can badly affect vitamins

[Angel_of_the_North]

Could be secondary/central hypothyroid as free t4 is too low but TSH is only a little higher than most healthy people, but prolactin is very high suggesting a problem with the pituitary gland. To keep you going, if it can, the thyroid will try to make as much T3 as possible until it fails (or taking a vitamin supplement with biotin can give false blood test results)

[Zsolt in reply to Angel_of_the_North]

She is taking b complex with 1/4 dose of the daily recommended serving. That is 12mcg biotin. In what sense Biotin can cause false blood test?

I have read that pituitary adenoma can cause high prolactin, but she had a negative brain CT 4 months ago. Also read that in some cases adenoma is not visible from CT, so a bit stucked now. She visited many docs but, all said she has no problem so far... i just didn't believed this, as i was experiencing how she lives and how not normal is that.

[Angel_of_the_North in reply to Zsolt]

Many thyroid blood assays use biotin as part of the test, so consuming it as a supplement can either raise or lower the test results depending on the assay type used. Many private testing companies (eg Blue Horizon) tell you to stop taking biotin supplements for a couple of days before the test. That amount probably isn't enough to alter results, but better to be on the safe side

[helenshubby]

As suggested above your wife may have a pituitary micro adenoma which may not be detectable on a scan yet. You may have to wait to see if the prolactin rises further or another scan reveals one. You could ask if a trial of Bromocriptine in a small dose makes a change. It would confirm an adenoma if your wife's her symptoms and bloods improve.

PS I used to assess people for life insurance so am aware of the cause of raised prolactin and treatment, but please research/discuss with GP as I am not medically qualified.