1. #1

    Post Should I get a more complete thyroid panel?

    Should I get a more complete thyroid panel?

    There doesn’t seem to be anything wrong with my thyroid. I do feel I get more tired than I used to, but I assumed that was low T. It's easy to get to sleep, but I often wake up at 2-3 AM. After an hour, I get back to sleep.

    My TSH reading has been between 1.6-1.8 for the last 20 years. These readings are from a few weeks ago. I could post the entire lab, but it's pretty normal outside of total T of 348 mg/dl, not even out of range.


    TSH 1.60 uIU/mL {0 0.450-4.500 uIU/mL}
    Ferritin, Serum 224ng/mL {30-400 ng/mL}
    Thyroxine (T4) Free, Direct, S 1.00ng/dL {0.82-1.77 ng/dL}

    Iron and TIBC
    Iron Bind.Cap.(TIBC) 357ug/dl {250-450 ug/dL}
    UIBC 249ug/dL {111-343 ug/dL}
    Iron 108 ug/dL {38-169 ug/dL}
    Iron Saturation 30% {15-55 %}

    I am not sure if I there is any reason to do a more complete thyroid panel.

    What do you all think?

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  3. #2
    Have you previously ruled out the autoimmune potential that is revealed with the antibody panels??
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  4. #3
    Quote Originally Posted by CoastWatcher View Post
    Have you previously ruled out the autoimmune potential that is revealed with the antibody panels??
    No, what you see is the more comprehensive test I have ever done. 23 years ago I did get T3 uptake, which at the time was slightly below range at 24.4% (25-35%) But 23 years ago doesn't count for spit.

  5. #4
    Moderator Vince's Avatar
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    I'm not the thyroid expert but looking at your free T4, in the low range. I would definitely get a complete thyroid panel along with reverse T3 and check your antibodies again.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  6. #5
    Quote Originally Posted by DragonBits View Post
    No, what you see is the more comprehensive test I have ever done. 23 years ago I did get T3 uptake, which at the time was slightly below range at 24.4% (25-35%) But 23 years ago doesn't count for spit.
    I'd dig a little deeper. Run both antibody panels, rt3, t3...and avoid any of those tests that have "uptake" associated with them. No value to you.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  7. #6
    I would get the following if I decide to get a full thyroid panel, I would get the following.

    BTW< I have seen some websites recommend also testing Sex hormone binding globulin, I don’t know why. I didn’t think SHBG was involved with thyroid hormones.

    Thyroid-Stimulating Hormone (TSH) - Evaluates overall thyroid function
    Total Thyroxine (T4) - Measures the total amount of T4 produced by the thyroid gland
    Free Thyroxine (T4) - Measures the amount of T4 available to the cells and tissues
    Free Tri-iodothyronine (T3) - Measures the amount of T3 (the active form of the hormone) available to the cells and tissues
    Reverse T3 - Measures the non-functioning form of the active hormone T3
    Thyroglobulin antibody (ATA) - Often measured along with TPO, these antibodies can attack proteins involved in the production of thyroid hormones rendering them dysfunctional
    Thyroid Peroxidase antibody (TPO) - Often measured along with ATA, these antibodies can attack proteins involved in the production of thyroid hormones rendering them dysfunctional

    Any thoughts on why SHBG was sometimes included?

    Another question, has anyone moved their FT4 from the lower part of the range to the upper, if so, what effect has that had on energy and metabolism? Any side effects?
    Last edited by DragonBits; 05-09-2018 at 03:12 PM. Reason: left off last sentence

  8. #7
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    Once you get the results back you can compare them to this excellent website:
    https://www.restartmed.com/normal-thyroid-levels
    Pay special attention to your RT3. Needs be less than 15. Also your FT3/RT3 ratio needs be more than 20.
    I don’t know of anyone including SHBG when testing thyroids

  9. #8
    Quote Originally Posted by 1Draw View Post
    Once you get the results back you can compare them to this excellent website:
    https://www.restartmed.com/normal-thyroid-levels
    Pay special attention to your RT3. Needs be less than 15. Also your FT3/RT3 ratio needs be more than 20.
    I don’t know of anyone including SHBG when testing thyroids

    This was my mistake. When I read a description of what affects thyroid hormones, there was something about thyroxine being bound to a protein, I thought it was SHBG, but with Thyroxin there is also TBG which is Thyroxin-binding globulin and behaves like SHBG. TBG binds thyroxin.

    TBG usually isn’t important to measure, but you can get a blood test to measure your level of TBG.

    I did get a blood test, I just haven't yet gotten the results back. For sure by the end of the week.

  10. #9
    Read here for basic thyroid panel:
    http://www.tiredthyroid.com/what-labs.html
    THEN READ HERE:
    http://www.tiredthyroid.com/optimal-labs.html
    Then spend some time looking around and reading.
    a LOT of GOOD, easy to read info on thyroid.....

  11. #10
    So just now I got in my thyroid panel results. What do you all think?

    Thyroxine (T4) Free, Direct, S 131-305-5863-0
    T4,Free(Direct) 1.06 ng/dL 0.82-1.77 CB

    TSH 131-305-5863-0
    TSH 2.000 uIU/mL 0.450-4.500 CB

    Reverse T3, Serum 131-305-5863-0
    Reverse T3, Serum 16.4 ng/dL 9.2-24.1 BN

    Thyroxine (T4) 131-305-5863-0
    Thyroxine (T4) 6.4 ug/dL 4.5-12.0 CB

    Thyroglobulin Antibody 131-305-5863-0
    Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9 CB

    Thyroglobulin Antibody measured by Beckman Coulter Methodology
    Thyroid Peroxidase (TPO) Ab 131-305-5863-0
    Thyroid Peroxidase (TPO) Ab 12 IU/mL 0-34 CB

    Triiodothyronine,Free,Serum 131-305-5863-0
    Triiodothyronine,Free,Serum 2.7 pg/mL (FT3) 2.0-4.4


    Normally for the last 20 years my TSH has been 1.6 - 1.8, last taken 4/21/2918. Maybe it's 2.0 because this is a different lab, or maybe TSH went up because I see the blood test I did 4/21 had TSH at 1.6 and Free T4 at 1.0 ng/dl, now Free T4 is at 1.06 ng/dl, a small increase and consistent with a higher TSH.

    Curious to see the next time I pull results.

    So I am guessing not optimal, but should I do anything about it? What do you all think?

  12. #11
    This is the one that really impact you, Free T3:

    Triiodothyronine,Free,Serum 2.7 pg/mL (FT3) 2.0-4.4

    You're rather low there and I know most of the discussion is going to want to treat that and may be concurrently with some T4, too, which is quite low as well, possibly contributing to the hypo symptoms you have.

  13. #12
    Looks like your thyroid is in a steady decline, it's not just a lack of FT3 but also lower FT4 and T4. Nowhere near optimal and far from average in my opinion.

  14. #13
    Quote Originally Posted by Vince Carter View Post
    This is the one that really impact you, Free T3:

    Triiodothyronine,Free,Serum 2.7 pg/mL (FT3) 2.0-4.4

    You're rather low there and I know most of the discussion is going to want to treat that and may be concurrently with some T4, too, which is quite low as well, possibly contributing to the hypo symptoms you have.
    How does one usually treat this?

  15. #14
    armour thyroid, cytomel, NDT, I'm not sure exactly what might be better for you in this case, I would think that a mono T3 replacement would alleviate any symptoms but I'm a little novice on Thyroid treatments. I *think* it would be better what ever option treats T4 and T3 together.

  16. #15
    Moderator Vince's Avatar
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    My two cents is, Synthroid and liothyronine are so inexpensive why not just use them two. You can also target the FT4 and FT3 separately. I believe you can buy both from overseas pharmacies, but they're even more inexpensive with a script.

    The hard part is finding a good thyroid doctor.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  17. #16
    Quote Originally Posted by Vince View Post
    My two cents is, Synthroid and liothyronine are so inexpensive why not just use them two. You can also target the FT4 and FT3 separately. I believe you can buy both from overseas pharmacies, but they're even more inexpensive with a script.

    The hard part is finding a good thyroid doctor.

    How expensive is something like Synthroidwith Defy, and does Defy supply a script or fax this into a local pharmacy outside of Florida?

    As far as a "good thyroid doctor" I am guessing it will be the same problem as with TRT. If you aren't outside of the ranges, they are going to consider it more like enhancing the quality of life (anti-aging) vs disease.

    I think a lot of doctors do understand that you might feel better with a higher level of testosterone or higher thyroid levels, but they are constrained by the medical industrial complex. Mostly insurance companies who don't want to pay for anything that improves your life Vs an actual disease. And most doctors do see a lot of patients who are really sick Vs people like us who want to improve what we have.

  18. #17
    Your labs aren't great, but before you start taking thyroid meds you may want to try supplementing iodine and selenium for a while. Look up Dr. David Brownstein's bookIodine: Why You Need It, Why You Can’t Live Without It


  19. #18
    Quote Originally Posted by HarryCat View Post
    Your labs aren't great, but before you start taking thyroid meds you may want to try supplementing iodine and selenium for a while. Look up Dr. David Brownstein's bookIodine: Why You Need It, Why You Can’t Live Without It

    I can give Selenium a try, I don't get a lot or any from supplements, but should't I get plenty of iodine from ionized salt? I don't make any effort to avoid salt in my diet and most of it is ionized.

  20. #19
    Your:
    FT3 = 29% of range
    FT4 = 25% of range
    RT3 = 48% of range
    Read here:
    http://www.tiredthyroid.com/optimal-labs.html
    Might get a complete iron panel:
    Full iron panel (includes serum iron, iron binding capacity, and % saturation)
    Ferritin (not included in the full iron panel and must be requested separately)
    http://www.tiredthyroid.com/cofactors.html
    Find a DR that that understands thyroid and treats to symptoms and not ranges....

  21. #20
    Moderator Vince's Avatar
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    Quote Originally Posted by DragonBits View Post
    How expensive is something like Synthroidwith Defy, and does Defy supply a script or fax this into a local pharmacy outside of Florida?

    As far as a "good thyroid doctor" I am guessing it will be the same problem as with TRT. If you aren't outside of the ranges, they are going to consider it more like enhancing the quality of life (anti-aging) vs disease.

    I think a lot of doctors do understand that you might feel better with a higher level of testosterone or higher thyroid levels, but they are constrained by the medical industrial complex. Mostly insurance companies who don't want to pay for anything that improves your life Vs an actual disease. And most doctors do see a lot of patients who are really sick Vs people like us who want to improve what we have.
    I use Advanced Lipidology in Wisconsin for my thyroid doctor and get prescription from CVS. I don't remember the exact price, my guess is about $20 dollars for each 90 day supply.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  22. #21
    Quote Originally Posted by Orrin Israel View Post
    Your:
    FT3 = 29% of range
    FT4 = 25% of range
    RT3 = 48% of range
    Read here:
    http://www.tiredthyroid.com/optimal-labs.html
    Might get a complete iron panel:
    Full iron panel (includes serum iron, iron binding capacity, and % saturation)
    Ferritin (not included in the full iron panel and must be requested separately)
    http://www.tiredthyroid.com/cofactors.html
    Find a DR that that understands thyroid and treats to symptoms and not ranges....
    I had done a full iron panel, attached is the last blood test I did with iron, CBC, CMP, etc, etc.

    But here is a copy of the full iron panel which I copied from the attached file.

    Iron and TIBC
    Iron Bind.Cap.(TIBC) 357 250-450 ug/dL 01
    UIBC 249 111-343 ug/dL 01
    Iron 108 38-169 ug/dL 01
    Iron Saturation 30 15-55 % 01

    Ferritin, Serum
    Ferritin, Serum 224 30-400 ng/mL 01
    Attached Images Attached Images

  23. #22
    Quote Originally Posted by DragonBits View Post
    I can give Selenium a try, I don't get a lot or any from supplements, but should't I get plenty of iodine from ionized salt? I don't make any effort to avoid salt in my diet and most of it is ionized.
    The doses recommended by Brownstein are far higher (12.5mg/day or more) than anything you can get from iodized salt, which has about 0.4mg/teaspoon. He has a lot of theories as to why the dose needs to be so high, if your interested get his book or search online. There's much more to it than I can get into in a forum post.

  24. #23
    Quote Originally Posted by HarryCat View Post
    The doses recommended by Brownstein are far higher (12.5mg/day or more) than anything you can get from iodized salt, which has about 0.4mg/teaspoon. He has a lot of theories as to why the dose needs to be so high, if your interested get his book or search online. There's much more to it than I can get into in a forum post.
    I would have to read the book.


    This is also interesting study on iodide supplementation. Too much iodine causes subclinical hypothyroidism.

    Conclusions: This study showed that subclinical hypothyroidism appeared in the participants who took the 400-μg I supplement, which provided a total iodine intake of ~800 μg/d. Thus, we caution against a total daily iodine intake that exceeds 800 μg/d in China and recommend further research to determine a safe daily upper limit.

    https://academic.oup.com/ajcn/article/95/2/367/4576756

    I have no idea who is right or wrong about this, 12.5 mg seems very high compared to what the RDA of 150 micrograms (mcg) is, and one should note that female hormone estrogen inhibits the absorption of iodine. So women need more iodine than men.

    I would be comfortable with 400 ug per day, it would be difficult to convince me that the Brownstein recommendation of 12.5 mg won't have negative health consequences.

    Do you or anyone you know take 12.5 mg of Iodide, and if so, do you also have hypothyroidism?.

  25. #24
    Quote Originally Posted by DragonBits View Post
    I would have to read the book.


    This is also interesting study on iodide supplementation. Too much iodine causes subclinical hypothyroidism.

    Conclusions: This study showed that subclinical hypothyroidism appeared in the participants who took the 400-μg I supplement, which provided a total iodine intake of ~800 μg/d. Thus, we caution against a total daily iodine intake that exceeds 800 μg/d in China and recommend further research to determine a safe daily upper limit.

    https://academic.oup.com/ajcn/article/95/2/367/4576756

    I have no idea who is right or wrong about this, 12.5 mg seems very high compared to what the RDA of 150 micrograms (mcg) is, and one should note that female hormone estrogen inhibits the absorption of iodine. So women need more iodine than men.

    I would be comfortable with 400 ug per day, it would be difficult to convince me that the Brownstein recommendation of 12.5 mg won't have negative health consequences.

    Do you or anyone you know take 12.5 mg of Iodide, and if so, do you also have hypothyroidism?.
    This is definitely a case of conflicting studies. Brownstein cites several to prove his case that high dose iodine is safe.

    I've had hypothyroidism for years and did try Brownstein's protocol for a couple of years. Never noticed any benefit, but there are a lot of reports online of people who say it has helped them. Interestingly I've never been able to find reports of people who said they tried it and were harmed by it.

    Right now I still take about 2mg of iodine a day as well and 100mcg of selenium in addition to my thyroid med.

    If I had to chose I'd say that doing a trial of thyroid hormone is probably safer than high dose iodine.

  26. #25
    Quote Originally Posted by Systemlord View Post
    Looks like your thyroid is in a steady decline, it's not just a lack of FT3 but also lower FT4 and T4. Nowhere near optimal and far from average in my opinion.

    The oddest thing about this thyroid panel.


    I had done a blood test on 4/21/2018 for another purpose, not to look specifically at thyroid, but the test included included TSH which was 1.6 and FT4 which was 1.0.


    The test on 5/15/2018, which is about 3 weeks later, has TSH at 2.0 and FT4 at 1.06, a 25% and 6% gain.


    The labs that did the blood work were different, but the ranges were the same, and I have never seen a significant change in TSH no matter what the lab was that did the test.


    I have no idea about any of the other thyroid measures like rt3, ft4, ft3 also changed as I don't have any baseline.

    If could be a difference in the labs, it could be a multivitamin I intermittently take that has 20 mcg selenium 150 mcg iodine along with all the other typical in a multi, I had been trying to take it every day.

    So for now, before getting thyroid hormones I think I will wait till I have to pull blood work, I will have to sometime in the future as I will inject some TRT. Then see what is what.

  27. #26
    The problem with thyroid testing is that thyroid problems don't always show up on labs, thyroid problems can be intermittent and not linear at all. It can be fine one minute and problematic the next, there are those with a steady decline and those with an intermittent decline. It's not uncommon to see a drastic change from one week to the next where thyroid hormones do an about-face.

    I've seen guys with very low thyroid hormones with a normal TSH, caught in the act of an about-face where TSH hasn't changed yet. I really wish all labs would use the same lab ranges worldwide, I'm not holding my breath.

  28. #27
    Quote Originally Posted by Vince View Post
    I use Advanced Lipidology in Wisconsin for my thyroid doctor and get prescription from CVS. I don't remember the exact price, my guess is about $20 dollars for each 90 day supply.

    I am tempted to go to Advanced Lipidology, it's a about a 2 hour drive.

    Do you think my thyroid panel is low enough to justify hormone treatment? I know it's up to a doctor, but make a guess. The levels after all are within the normal range.

  29. #28
    Quote Originally Posted by DragonBits View Post
    I am tempted to go to Advanced Lipidology, it's a about a 2 hour drive.

    Do you think my thyroid panel is low enough to justify hormone treatment? I know it's up to a doctor, but make a guess. The levels after all are within the normal range.
    There is a world of difference between "being within range" and being "Optimal".
    One more time:
    http://www.tiredthyroid.com/optimal-labs.html
    https://stopthethyroidmadness.com/lab-values/
    Find a DR that that understands thyroid and treats to "symptoms" and not "ranges"....

  30. #29
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    [QUOTE=DragonBits;107200]How expensive is something like Synthroidwith Defy, and does Defy supply a script or fax this into a local pharmacy outside of Florida?

    Yes Defy can send a script over to your pharmacy for any medications. My RT3 was 28.1 back in March due to having a severe sinus infection/flu and they sent prescription over to Walgreens for Cytomel 5mcg. Currently taking 20 mcg divided up 2 doses, 1 in am and 1 at lunch. Thinking about adding another dose around 4 pm.

    Got labs and consult coming up so will be interesting to see how they want to treat T3 and T4. Pretty sure my RT3 is back in line by now but my T4 and T3 are still low.

    Don't know the state you live in but, pretty sure shouldn't be a problem getting Defy to send dosing to your pharmacy.


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