Morning all,
Just after people's thoughts on my husband's results please.
TSH. 0.03 (0.35-4.94)
Free T4 14.0 (9.0-19.0)
T3 is now being tested in the back of the above results.
The results that we do have are similar to mine but I take Levo and T3. He takes nothing, never diagnosed.
Thanks 😊
What was the reason your husband was tested? Symptoms?
His labs are a bit strange if not on any treatment. His FT4 levels are only about 50% through range which is indicative of hypo, but his TSH is suppressed which is indicative of hyper.
I was thinking a "Hashi swing" in case he has undiagnosed Hashimoto's disease, but then you'd expect the FT4 levels to be high as well I think.
I hope someone can offer more of an explanation as I've never seen results like this in a person not on thyroid meds!
He is post treatment/surgery for stage 4 cancer and suffers from all over pain, especially nerve pain, and exhaustion so our GP just ran all sorts of tests. His red blood count was high so the retest is including checks for anaemia/b12 deficiency
What time of day was the blood draw? His FT4 is mid-range, so that's good. Does he have hypos symptoms? Be interesting to see his FT3.
Hi greygoose, bloods were taken around midday. He's got such a lot of symptoms, some of which no doubt are from the chemo and radiotherapy, but I believe there's certainly a b12 issue. It certainly will be interesting to see the T3 levels
OK, so the TSH would have been lower at midday that at 8 am. But probably not too high at 8 am, either. Difficult to say. But, judging by those two results alone, he doesn't appear to have a thyroid problem.
Low B12 can cause hypo-like symptoms. Has he had it tested?
How can he NOT have a thyroid problem with a suppressed TSH and only midrange FT4 levels? In people without thyroid disease nor subclinical hypothyroidism, would you not expect TSH in range (preferably not above 2) and FT4 levels at least 75% through range, to ensure enough T4 to T3 conversion? I don't know, something about these results just doesn't seem right to me...suppressed TSH, FT4 halfway through range, when not on any thyroid meds.
The TSH is a little low, but perhaps his pituitary is failing. But, his FT4 is fine. Need to wait and see what the FT3 says.
I read recently that the healthy thyroid person had a lower T4 and higher T3 as compared to thyroid patients treated with levo, who have higher T4 and lower T3.
Yes, makes sense to me if the conversion works the way it should...it's a shame so few of us are tested while we are still healthy. It seems most only end up having tests once symptoms of hypothyroidism appear, and by then we've most likely been hypo for years (in case of Hashimoto's).
I sometimes wish I'd gone for a blood test when I was well, but yes, goodness knows what it was back then. Though even if I had, they'd only have done the TSH.
True...which in itself would not have told us much.
If I knew then what I know now, I'd have insisted on a full panel and paid for it. Though, probably it was total t3 and total t4 in those days, so maybe it wouldn't have told me anything anyway. BUT, if I could time travel Sewinmin from 25 years ago to now, I'd march her in and get a full panel with today's testing. 
Me too! If nothing else, it would have been interesting to know what my labs looked like back when my thyroid gland was functioning normally.
GG,
Are midrange FT4 levels really good in someone not on thyroid hormone replacement? I would have thought they needed to be higher as most of the T3 would need to come from T4 as well.
No, the thyroid itself makes quite a bit of T3 - more than people give is credit for. So, yes, mid-range FT4 is euthyroid.
Really? I have always read that the thyroid output is roughly...98-2%...plus, 0.03 does not seem slightly suppressed to me, it's very low.
Remember his TSH wasn't tested at 8 am, as - I presume - yours usually is. But, even if it's suppressed, that doesn't mean anything on its own.
I have always read that the thyroid output is roughly...98-2%..
No idea what you're saying, there. 98.2%? Of what?
98% T4 2% T3 from the body's needs coming from the thyroid itself (in healthy people). All the remaining T3 the body needs is supposedly coming from the conversion of T4 (source: Dr. K. Blanchard).
I'm pretty sure a healthy thyroid makes more T3 than that.
So, if you think those results indicate a thyroid problem, what is it? Hypothyroidism? Unlikely with a TSH that low - and if it were Central hypo, the FT4 would be lower. We'd just have to wait and see how things evolved. But, at the moment, he isn't hypo - according to those results. Of course, the FT3 could be low due to a conversion problem - non-thyroidal hypothyroidism - or due to the TSH being low, but that brings us back to the pituitary, and why isn't the FT4 lower?
Or, Hyperthyroidism? Hardly with an FT4 only mid-range. So, what sort of thyroid problem do you think he has?
If you look at my first post, you will see that I said that the results were confusing and that I could not think of a condition that would match a suppressed TSH along with midrange FT4. In the early stages of hypoT, it's often the other way around - a higher than optimal but still in range TSH and normal FT4. But, if a doctor had only tested his TSH (which many doctors do, unfortunately), and seen his TSH (0.03), which conclusions do you think that doctor would have drawn?
I have never heard of the TSH in a healthy person dropping to such low levels at any time during the day, but maybe I've missed something...I know it fluctuates which is why we are always told to go to the lab in the morning, but does it really fluctuate that much? What would be the cause of a TSH of 0.03...a temporary drop in TSH due to the release of hormones from the thyroid...? If so, why do most articles on thyroid testing only mention one reference range for the TSH, not several, depending on the time of day you have your blood drawn (much like the reference ranges for cortisol)?
But, then again, I never had my thyroid tested until it was obvious I was already hypothyroid so I've never had the pleasure of having labs done while it was still healthy...!
I know exactly what conclusions would be drawn. The GP would start screaming 'hyper', put him on anti-thyroid drugs, send him to an endo who would start talking about RAI. I know.
And, you have a very good point there: why aren't there several ranges for TSH according to time of day? The fact is, no-one really seems to have latched on to the fact that the TSH is highest in the morning except researchers. Or why would doctors think it's ok to test the TSH at any old time? Is it all just a dastardly plot to diagnose as few people as possible?
Also, it amazes me that the lab didn't test the FT3 - I thought they were supposed to when the TSH was low. But they didn't. There's more than just the results that are confusing here. But arguing about it doesn't change anything. We'll just have to wait and see.
Morning greygoose
We only know the results and what they're planning to test next, from the print out he got at the surgery. His appointment with the GP isn't until Tuesday. Do you think we should push for the antibodies to be tested too?
Thanks
Salshep
Yes, I think you should. Might explain something.
Hopefully, it's a bit bizarre. I'll post the next results when we get them
greygoose hope you are well.
Just got my husband's results
T3 5.5 (2.6-5.7)
Peroxide antibody 1.29 (0-5.9)
TSH has increased slightly to 0.06 (0.35-4.94)
T4 13.2 (9-19)
Not sure what to make of those numbers but hopefully you will 😊
Well, his FT3 is very good, top of the range. Which - plus time of day - could account for his low TSH (which hasn't increased significantly) So, he's not hypo, and he's not hyper, because FT3 is still in-range. I'm not sure he can be diagnosed with anything at this point.
But, how long ago did he finish his cancer treatment? That, plus the original illness, would have upset his thyroid dreadfully. He probably hasn't yet recovered sufficiently for his thyroid to have resumed normal service (to quote a phrase).
I very much doubt that thyroid is responsible for any of his symptoms because his FT3 is good. I think you have to wait for him to recover and retest in a few months.
I've just read an interesting piece in Dr Tofts Pulse article. Low TSH, normal T4 and T3 in someone not taking any meds could be Graves in remission or nodular thyroid disease. His GP is referring him for an ultrasound as his thyroid was enlarged.
I agree, I think his body has been through so much in the last 15 months. He hasn't had any chemo or radiotherapy since December but he's had 3 major surgeries since and there's only so much the body can take is there 
I've never heard of nodular thyroid disease. Or maybe another name was used? Does he mean nodules that produce hormone independent of the thyroid?
I think that if he'd had Grave's it would have shown itself long before it got to the remission stage. And, surely, if he's had all those surgeries, his TSH at least was tested by the anesthetist beforehand. They don't like giving anesthetic with a suppressed TSH. So, I really don't think he's had Grave's all this time.
There is one more thing that could be tested, but the NHS are unlikely to agree: Tg antibodies. If he does have Hashi's, it could be that the TgAB is high when the TPOab is low.
Oh, and what about vit B12? Have they tested that? With all that anesthetic, could be that the B12 is low, and low B12 gives hypo-like symptoms.
I was very surprised that nothing had ever shown up in one of the 100s of blood tests he's had.
It says "endogenous subclinical hyperthyroidism usually caused by Graves disease in remission or underlying nodular thyroid disease"
TPOab was low, they didn't test tgAB.
B12 was 249 (180.0-640.0)
His B12 is much too low. It should be at least over 550. So, that will probably be causing him a lot of symptoms. And, as I said, they are symptoms that resemble hypo symptoms. I think it might be an idea if he started supplementing that. Has the doctor not said anything about it?
I'll get some B12 for him, his GP didn't mention it at all
Probably doesn't understand the importance of B12. Not many of them do - besides, it was in range and anywhere in range will do for them!
What you need is 5000 mcg sublingual methylcobalamin (B12). He also needs to take a B complex with it - one with methylfolate, not folic acid.
That's so true sadly. I only got my thyroid and vitamin issues sorted with the help of the wonderful people on this forum I've used Solgar methylcobalamin which was very good so I'll get that for him along with a B Complex
I guess it depends on the lab and health insurance of each patient - my health insurance will only cover FT3 if TSH and FT4 are out of range. Incidentally, the FT3 test is more expensive than the other two...
No, it's not. That point has been well covered on here. The FT3 costs exactly the same as the FT4 - and really can't be called expensive.
Mind you, that's in the UK. I take it you're in the US? People in the UK don't tend to have private insurance, it's all supposed to be covered by the NHS. Pretty sure the OP is in the UK.
Yes, I am in the UK greygoose so the test will be NHS
That is surprisingly low (2% from the thyroid).
Do remember that it is not exclusively de novo secretion of T3 that is relevant.
If you can, read the full paper:
The role of functional thyroid capacity in pituitary thyroid feedback regulation
Rudolf Hoermann, John E. M. Midgley, Rolf Larisch, Johannes W. Dietrich
onlinelibrary.wiley.com/doi...
Well, I guess it will vary according to source...some say the T3 output from the daily is about 10 mcg daily (6 made by the thyroid directly and the rest from conversion taking place inside the thyroid gland itself).
Yes, I've read that before, somewhere.
This suggests the thyroid makes 20% T3 (or at least, a healthy one does) endocrineweb.com/conditions...
When I was hyper with Graves my TSH was <0.03 (0.35-5.5) below reference range and my T4 was something like 28.6 (10-19) so his T4 looks ok within the range.
Your husband has obviously been very ill, between his illness and it’s treatment his system is probably totally messed up and as we all know the thyroid affects every part of our body.
Hopefully his doctor will test B12, vitamin D, folates, ferritin, and antibodies and that might give you more idea and he starts to feel well soon.
I know I’m always banging on about it but boost his vitamin C input if you can, it helps healing.
I do think a lot of what's going on has been caused by the chemo. His red blood cells are low but haemoglobin high so they're checking for macrocytic anaemia as well. He's more unwell now than ever
I’m sending good thoughts n your direction, you have both have had more than enough to deal with - hopefully things will get better soon.
Bless your heart, thank you that's very kind
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