My niece has these blood test results and the doctor said she was okay because all is in range, but is sending her to an endocrinologist because she has a high TPO. Any suggestions will be greatly appreciated! Thank you!
FT4
0.9 Range: (0.8 - 1.5) FT4 14.29%
FT3 107 Range: (80 - 210) FT3 20.77%
TSH 2.10 Range: (0.35 - 4.0 mclU/mL
TPO AB 27.6 Range: <= 5.5 IU/mL
She needs vitamin D, folate, B12 and ferritin tested
What are her main symptoms?
Her high antibodies confirm Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Thank you so much for the quick response. I actually don't know her symptoms, but just found out about it and asked for the blood test results. She did have the flu when she went to the doctor, and most of the time has bad acne. I mentioned to her on the phone that she should lay off the gluten and sugar, and she confirmed feeling better and has less acne when she has refrained from these in the past.
I will look at all the links you sent and suggest that she test for the D, folate, etc. when having the next blood draw.
Questions: Is her high TPO - autoimmune issue irreversible, and addressing diet the way to minimize symptoms only? And what do you think of the TSH - FT4 and FT3 results?
Thanks a million!
FT3 107 Range: (80 - 210) FT3 20.77%
I really don't think that's an FT3. It's the wrong type of range. It looks more like a Total T3, which gives you very little useful information. She needs the FT3 tested to be able to compare it to the FT4.
Her FT4 is in-range, true. But only just! It's much too low, making her hypo.
Unfortunately, her TSH does not correspond to her FT4 level - one would expect it to be much higher. But, that could just be due to her Hashi's.
Is her high TPO - autoimmune issue irreversible, and addressing diet the way to minimize symptoms only?
Yes, it's irreversible. Antibodies fluctuate but once you've had an over-range result like that, it means you have Hashi's, and Hashi's doesn't go away. And, no amount of addressing diet will make it go away. Going gluten-free may help with symptoms if she is gluten-sensitive, but the Hashi's will still be there.
I will have her ask for the Free T3 to be tested this coming week when she sees the Endo. along with the other items SlowDragon mentioned.
I am wondering if with the results so far, will the Endo suggest she start on Levo? Do you think with diet adjustments that her FT4 and TSH may revert to a more normal reading?
I just want to be more informed before I suggest anything, as I am not familiar with all the details as you are. Thanks so much!!
There's no guarantee that he will agree to order an FT3 test, or that the lab will actually do it if it is ordered. She can but try.
I rather doubt the endo will suggest she start levo, but it depends very much on the individual endo and his understanding of thyroid. Not all endos are created equal! If he is someone that goes by TSH only, he won't, because it's not that high.
But, no, I really don't think that diet adjustments will have any effect on her FT4 or TSH readings. Sorry.
Do you think it will harm her if she doesn't take levo since the results of the TSH are not so high?
Her father is involved and I think he will insist on the FT3 being tested. If not, I will suggest she see my Endo who always accommodates my requests. But again, what are your thoughts on her not being with replacement? Thank you again!!
The TSH is pretty irrelevant. It's a messenger, an indicator, it doesn't do anything much, and pretty unreliable on its own. It should only be looked at in conjunction with the other results.
The most important number is the FT3, which they rarely test! T3 is the active hormone, and it's T3 that causes symptoms if it's too high or too low.
Next best number is the FT4, and hers is pretty low. Which probably means that her FT3 is even lower. That said, I don't think that any permanent damage will be done if she's not treated for a while. But she will probably feel pretty rough. The thing is to get it sorted as soon as possible. And, the first step is to get that FT3 tested, even if she has to do it privately.
Thank you for your invaluable knowledge and assistance! We will move forward with more confidence now with what we need to do.
You're welcome. 
Let us know how you all get on.
Thank you for the open door. I'm sure I will need assistance in the future. Knowing you are there is a great comfort. Happy New Year!
Happy and healthy New Year to you, too.
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