I would be hugely grateful if you could help interpret the following test results. I should explain that they are my Aunties results from a private lab in Spain (where she lives) She was diagnosed with hypothyroidism a couple of years ago and takes 75mg of levothyroxine
i've translated the results as best as I can:
Free T3: 3.63 Pg/ml 2.00-4.40 Pg/ml
free T4: 1.41 Ng/di. 0.80-1.80 ng/di
TSH 3.49 mcui/ml 0.23-5.50 mcui/ml
Immunology
microsomal antibody: 146.4 u/ml. <35uml
Thyroglobulin:430.0 <115.0 uf/ml
Are these results of any concern?Is there anything she can do to lower the antibodies?
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ctw0410
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She's very under-medicated. The TSH should come down to 1 or under when on levo. Over 3 means she's still hypo. How does she feel? How long has she been on that dose?
Her antibodies are high because she has Autoimmune Thyroiditis - aka Hashi's. People talk about ways of reducing antibodies, but even if she managed to get them down to zero - hardly likely - she would still have Hashi's because the antibodies are not the disease, they are the result of the disease. Does she know about Hashi's and what it does?
Thanks for coming back to me. She has been on 75mg since she was diagnosed 2 years ago. Interestingly she has never had the typical symptoms of hypothyroidism even when her TSH was over 60. Her worst symptoms have been very dry hair, weak nails and missing eyebrows. However my Auntie is very proactive with looking after her health and is concerned her TSH is too high. Could it be doing her damage that she is not fully aware of? For example her 'bad' cholesterol is too high - is there a link btwn this and high TSH?
Regarding the antibodies, my auntie was under the impression that if you could get these down you could slow down the destruction of the thyroid gland. Is this not correct?
She saw her Dr today who refused to up her levothyroxine as it was 'within range'
Also should she have asked the private lab to check her reverse T3?
Her doctor has been extremely negligent to have left her on such a low dose for so long. She should have been retested six weeks after starting it, and her dose increased by 25 mcg.
TSH is not the thing she should be concerned about, not in itself. The TSH level just roughly reflects the levels of her FT4 and FT3. It is too high because these are too low.
TSH is a pituitary hormone. It has two jobs: it stimulates the thyroid to make more hormone when the pituitary senses that there is not enough thyroid hormone in the blood. And it stimulates conversion of T4 to T3. TSH does not do damage to anything. It doesn't make you feel anything or cause symptoms.
The most important number is the FT3. T3 is the active thyroid hormone, needed by every single cell in the body. It's T3 that causes symptoms when it is too high or too low.
There are over 300 known hypo symptoms, and everybody has their own individual symptom list.
For example her 'bad' cholesterol is too high - is there a link btwn this and high TSH?
Well, for a start, there's no such thing as good and bad cholesterol. There's just cholesterol. But, when you have a cholesterol blood test, it's not the actual cholesterol that is tested. It's the protein carries: HDL and LDL. Neither of them are good or bad. They each have a job to do transporting cholesterol round the body to where it's needed. However, when thyroid hormone T3 is too low, they cannot do that job correctly, and they tend to build up in the blood. But, high cholesterol is not the problem doctors make it out to be. It doesn't cause heart attacks or strokes. Just as with antibodies, high levels are a symptom, not a disease.
Regarding the antibodies, my auntie was under the impression that if you could get these down you could slow down the destruction of the thyroid gland. Is this not correct?
No, it's not correct. The antibodies do not destroy the thyroid themselves, nor do they cause the destruction.
What happens is that the immune system attacks the thyroid, mistaking it for the enemy, and during the attack, the dying cells release their stock of thyroid hormone into the blood - which is why FT4/3 levels rise sharply. But, at the same time, traces of the proteins Thyroid Peroxidase and Thyroglobulin contained in the cells, also leaks into the blood, where it shouldn't be. So, the Thyroid Peroxidase antibodies and the Thyroglobulin antibodies come along to clean it up - roughly speaking. As I said, they have a job to do, and they do it. But, they don't attack the thyroid.
She saw her Dr today who refused to up her levothyroxine as it was 'within range'
Then she needs a new doctor, because this one has no idea what they're doing.
Also should she have asked the private lab to check her reverse T3?
No point. rT3 is a red herring. It can be caused by many, many things, and only one of them has anything to do with thyroid. And, that is when the FT4 is too high. Her FT4 is not too high. So, if the result came back with high rT3, she would know it was high, but she wouldn't know why.
In any case, rT3 doesn't do any harm. It is inert, only stays in the body for a couple of hours, and is then converted to T2. So, nothing to worry about.
It's not just about those numbers. You have to consider other blood tests at the same time. Her TSH is saying that her pituitary doesn't think she has enough thyroid hormone in the blood - but the pituitary doesn't distinguish between the T4 and the T3. Her cholesterol is saying that her FT3 is too low, even though it looks good on paper.
What time did she take her last dose of levo before the test? That's very important to know because it affects her FT4 level. And what time of day was the blood draw? Because that affects the TSH. We have to take all these things into consideration when interpreting results. And, doctors just don't do that. All they do is look at the TSH to see if it's in-range. Anywhere in range will do as far as they're concerned.
Another thing to consider is her conversion of T4 to T3. But, you have to bring the TSH down to one to see that. At the moment, the TSH is still stimulating her thyroid to make hormone, so the FT3 level we see there is not just conversion. It's all very complicated, which is why we ask all these questions and can't just make a snap judgement based on the FT4/3 levels.
Thanks so much for your detailed replies. I have passed the info onto my auntie. I take it as a first step she should ask for an increase in Levothyroxine to 100mg? Is it worth her having a full panel of blood tests as well (Inc vitamins/folate/B12) etc? Or wait until new dosage has taken effect?
Might be a good idea if she could get her doctor to test vit D, vit B12, folate and ferritin now. If he won't, wait until six weeks on a new dose and then do a full thyroid panel.
Thanks Slow Dragon... She was actually unaware she had to stop levothyroxine 24 hrs before. She will also check to see if she's had folate etc tested recently.
She's actually already following a gluten free diet
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