Labs

[Asil737]

I got them!

Thyroid peroxidase antibody

100.2 (0-9)

T3 total

120 (80-200)

TSH

0.74 (0.465-4.68)

B12

822 (239-931)

T4

7.5 (5.53-11)

Free T4

0.98 (0.78-2.19)

Transforming Growth Factor Beta

403 (463-5423)

[Nanaedake]

Have you got a Free T3 result? It's free T3 rather than Total T3 you need.

[Asil737 in reply to Nanaedake]

Not with these labs. The last one of RT3 was done in October.

RT3 - 20 (9-27)

[greygoose in reply to Asil737]

FT3, not rT3.

[Asil737 in reply to greygoose]

Is Free Thyroxin Index the same as FT3? If so:

Free Thyroxin Index: 2.50 (1.65-3.89)

[helvella Administrator in reply to Asil737]

No - it is not.

it is an old and questionable approach:

Estimating the amount of circulating free thyroxine (free thyroxine index) using the total thyroxine and thyroid binding capacity (T-uptake)

mayocliniclabs.com/test-cat...

We now have Free Thyroxine (Free T4) and Free Triodothyronine (Free T3) tests which are usually better regarded.

[Asil737 in reply to Asil737]

Nm, i see that it is not

[Angel_of_the_North]

There's no free T3, which is the most important result. Your free t4 looks too low in range so and your TPO antibodies show that you have Hashis

[SlowDragon Administrator]

Presumably you are in USA.

In USA Total T3 seems to be always done, rather than FT3

As you have Hashimoto's are you on strictly gluten free diet?

You need vitamin D, ferritin and folate tested if possible

You look like you have room to increase dose slightly. What does functional doctor say?

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

Understanding Hashimoto's

hashimotoshealing.com/under...

[anonymous45]

High TPO antibodies suggests Hashimotos disease (autoimmune hypothyroidism).

Your TSH suggests you are not hypothyroid, as anything between 0.2 and 1.0 is considered good when treating with Levothyroxine/Thyroxine. However, from your previous posts I can see that you suspect or have been diagnosed with poor pituitary gland function (hypopituitarism). This means TSH is likely NOT reliable in determining thyroid gland function, because the pituitary gland is not responding properly to signals from the hypothalamus (measures thyroid function and releases TRH to signal the pituitary).

Your free T4 (fT4) is on the low side, so if you have symptoms and do not already take Thyroxine, then it would be reasonable to discuss increasing your T4 level with a low dose of Thyroxine (e.g. start at 25mcg per day). This can then be increased by 25mcg increments until your fT4 is in the upper 1/3 of the range.

I also suggest getting hypothalamus hormones tested (TRH - stimulates TSH; CRH - stimulates ACTH). If these are high, this confirms poor pituitary function and means you cannot rely on TSH to measure thyroid function.

With hypopituitarism, you should also be monitoring cortisol levels since ACTH production by the pituitary could also be low.

[Asil737 in reply to anonymous45]

I had more labs that wasn't included:

Transforming Growth Factor Beta:

403 (463-5423)

Cortisol Random:

3.6 (no reference range)

Vitamin D:

75.4 (30-100)

Iron:

107 (37-170)

Thyroid Med :

Levothroxine 50mcg

Cytomel 10 mcg

Multivitamin

[Nanaedake in reply to Asil737]

'Thyroid Med :

Levothroxine 50mcg

Cytomel 10 mcg'

I see you are taking Cytomel which I think is T3 thyroid hormone? In this case it's not surprising FT4 and TSH are low. You need FT3 test result.

We need all the information to help you make sense of your test results and at the moment it's too fragmented and disjointed to help.

Could you type up the information with results+lab ranges, dates when tests were done and amount of levothyroxine, T3 and other medications being taken at the time the test was done?

[Asil737 in reply to Nanaedake]

I dont have a FT3

[anonymous45 in reply to Asil737]

When taking T3/Liothyronine/Cytomel/Tiromel, it's always advisable to get fT3 tested (medichecks is what I use, although I don't take T3 anymore - my conversion eventually improved after a long enough period on Thyroxine/T4). When using T3, it's important you keep the fT3 level in the normal range to avoid over-replacement and symptoms of hypERthyroidism.

Your TSH could be lower due to the use of Cytomel/T3. I've seen it recommended that fT4 is optimised first, then check conversion by measuring fT3. If conversion is poor despite good free Thyroxine / fT4 levels, then additional T3 can be paired with the same or reduced dose of T4.

For thyroid function tests, especially TSH, early morning result is ideal (before 9am ideally). T3 and T4 should not be taken before the blood is drawn.

Random cortisol is not particularly useful. Serum/Blood cortisol should be taken around 8am, as this is roughly the peak cortisol level. Yours at 3.6 (assuming mcg/dL unit) would be way too low for early morning (pre 9am), but if it was 12pm or later your value would not be unusual.

8am serum cortisol, or saliva cortisol (4 times throughout the day) is more useful in identifying adrenal insufficiency. Peak morning (8am) serum cortisol should ideally be above 400 nmol/L or 14.5 mcg/dL.

[Asil737 in reply to anonymous45]

Thank you everyone for your help

[Ladybex]

I have TPO abs: 1300

T4 10.01

TSH 14

???? I don’t understand ... anyone know please ...

[greygoose in reply to Ladybex]

We cannot interpret lab results without the lab ranges. But, a TSH of 14 is very high and means you're very hypo.

However, the TSH you gave us above was 0.74 (0.465-4.68). Can you tell us when these two different TSH tests were done? If you don't give us all the details, then we can't understand, either.

[Ladybex in reply to greygoose]

Thank you greygoose ... approx 6 weeks apart ...

[greygoose in reply to Ladybex]

Yes, perhaps, but can you give us dates? How recent was the most recent one. And, which one is the most recent?

And we still need the ranges. A lab result usually looks something like this (example):

TSH 5 (0.2 - 4.5)

The range is in the brackets.

[Asil737]

They were all Dec 5