TBG, Reverse T3 & SHBG Issues - What Does This Mean?

[ASkepticalConsumer]

Greetings and happy July all.

I have Hashi's confirmed by ultrasound and blood antibodies.

I am not being treated as my family doctor and encrinologist say my blood work does not justify it.

I have every symptom of hypo, I mean every symptom, and I also believe I have fatigued adrenals big time.

But, I just got new blood work and I am concerned about the TBG and Reverse T3, in particular.

TBG (Thyroxin Binding Globulin) - Low 240 (260-575) - What does this mean?

Reverse T3 - High Normal - 20.1 (9.2-24.1) - Steadily rising quite quickly

SHBG (Sex Hormone Binding Globulin) - 49 Low Normal (22-142)

TSH 1.0 (0.35-5.00) - A month ago it was 3.5

Free T4 - 17 (12-22)

Free T3 - 4.7 (3.4-5.9)

Thyroid Peroxidase Antibodies - 33 (above 35)

B12 - 1,475 (over 220)

Ferritin - 139 (12-280)

Sodium - 134 Low (136-145)

Potassium - 4.4 (3.7-5.4)

DHEA - 6.5 High (0.51-5.56) - Been high for a long time

PTH - 3.4 (1.6-6.9)

Zinc - 10.8 (7.7-14.9)

CRP - 2.5 (under 8)

ACTH - 3.9 (under 10) - 2 months ago this was 9, very high normal

Vitamin D - 223 (76-250)

Selenium - 2.3 (1.5-2.9)

Then there is the sex hormones which seem out of whack - related to the adrenals I believe. I am taking a small amount of bioidentical hormones in these 3 below):

Estradiol - 78 (post menopausal under 220) - so very low normal

Testosterone - 18 (post menopausal under 30)

Progesterone - 2.6 (post menopausal under 0.7) - This is higher because I am supplementing this in particular

I am exhausted all the time, my heart is always pounding and I can feel my heart beat so clearly (I used Metroprol from time to time to calm it), shallow breathing, dizzy, I have some edema on face and feet (Hashi face I look like), hair thinning, outer 1/3 of eyebrows gone, my voice is hoarse, my throat feels swollen (i can tell because my CPAP machine is less and less able to keep my airway open - my instances of obstruction can be ok for a while, then go way up and when way up it seems to coincide with me feeling worse), brain fog, tinnitus in both ears totally and on and on.

Then........ I can often be shaking and tense and my muscles are like rock. I have many muscle cramps of my calf and feet - l just want to cry and run and slam a hammer into a car.

I am mostly gluten free, caffeine free and do 2 glasses of wine per day. What I find is that even after the caffeine free coffee, my heart starts to race, the same after wine, my heart races.

I have osteoporosis, sleep apnea, high blood pressure, high choresterol, Hashi's.

Being desperate, I have taken some of my mother's Synthroid and a friends DT.

So on 12.5 mg of Synthroid and about the same of the DT - I get revved up - sweating, shaking, diarreah etc.

These meds do not seem to help - yes I know these were tiny, tiny does, but I felt worse.

Questions -

1) what does the low TBG mean?

2) what does a rising reverse T3 mean?

3) I have very low normal SHBG

4) Are my sex hormones appropriate?

5) Do I have fatigued adrenals?

Your assistance would be eternally appreciated, cause I feel about ready to die. Slow, slow and then revved up.

Thank god for each of you volunteers and the sharing of information from members.

Thanks

[greygoose]

I can't answer all your questions, but I can number 2.

Frankly, there's no knowing what your rising rT3 means. The rT3 test is one of those tests that tells you if there's a problem, but doesn't tell you what it is. There are many, many causes of high rT3, and only one has anything to do with thyroid. And that is poor conversion. You do not appear to suffer from poor conversion. Your FT4 and FT3 are both around mid-range - which is good for someone not on thyroid hormone replacement. If your FT4 were high and your FT3 were low, then your conversion to T3 would be poor, and we'd know that most of the T4 was converting to rT3. But, that isn't your case.

Apart from that, it could be low ferritin - which you don't have - or high cortisol - you'd need a 24 hour saliva cortisol test. Low calorie diets, long-term beta blockers, infections and injuries… So many things.

But, your rT3 is not yet over-range, so it's still ok at this point. And, even if it were over-range, that is not a problem in itself, just an indication that there is a problem somewhere. rT3 does not do anything bad, it just keeps FT3 from going too high, for whatever reason. So, don't worry about it, but look out for something that could be wrong.

I said your levels of FT4/3 were good. But, the problem with Hashi's is that they can jump around a bit. When did you have your last blood test before this? Were the results about the same? Because high cholesterol usually indicates low FT3 - but, maybe, your FT3 is just too low for you - or, it was lower recently.

High blood pressure can be a hypo symptom, too.

I don't know if you have adrenal fatigue, you would need your cortisol tested in the 24 hour test to find out. But, that low sodium won't be helping your adrenals, they need good levels. Your other nutrient levels look good, but I can't see a result for folate.

Mostly gluten-free won't cut it. You need to be 100%. Do you consume any kind of soy?

Have you tried magnesium for the muscle cramps? Most people are deficient, but for a hypo it would be worse. Try taking about 350 mg magnesium glycinate.

Are you supplementing B12 for it to be so high?

I don't think there's much more I can add, so I'll stop. Hoping some of this helps.

[jimh111]

Just to answer the bits I know about. You say you have 'have Hashi's confirmed by ultrasound and blood antibodies' but this blood test confirms you don't have Hashi's, your TPO and TBG are not elevated. rT3 is not much use and yours is OK, rT3 varies a lot. SHBG is a marker for thyroid hormone action in the liver but individual variation is so large that the result is not much use, this is reflected in the very wide reference interval (22-142). The lab should not have put a 'low normal' comment on the result.

Your thyroid hormone levels are fine, that doesn't mean you definitely aren't hypothyroid. Given you don't respond to thyroid hormone perhaps it is more likely your sleep apnea is a major contributor to your symptoms. I don't know if anything can be done to improve that.

[ASkepticalConsumer in reply to jimh111]

Thanks greygoose, jimh111.

Your knowledge and generosity in sharing is much appreciated.

I have significant elder caregiver stress for the past 3 years and am on high alert for the next phone call. I get no exercise.

Given your comments about my thryoid values being ok, I am moving onto the next culprit, the adrenals. I am doing a saliva test this week. I have a natropath who suspects the adrenals are fatigued and creating low sex hormone levels.

My shallow breathing, worsened sleep apnea, fatigue etc makes me wonder.

It is the loud beating of my heart - I have never had this before - it freaks me out - but my pulse is like 85.

I will check the folate level, I only get the ferritin.

Once I get the saliva test results, I will report back in.

Thanks for helping everyone!