Interpreting Thyroid Labs

[gallan]

Everything appears in normal ranges but some things I am reading say not to go by that. Some confusing info out there. Any quick thoughts on these labs? Thanks.

 

[Vince Carter]

I think your TSH is undesirably high, the other numbers look fine to me, not too low or too high in the ref ranges. In the future include Reverse T3 in your Thyroid panel, I think that's the only test I see missing.

 

[gallan]

Thanks Vince, any thoughts on how to self treat..again..I am reading a lot of conflicting info. Low ferritin appears to be a cause. I'm at the lower end of the normal range for ferritin due to donating blood often but bringing that up with supplementation. Any good sources of info out there so I don't have to keep asking questions?

 

[John O'Connor]

Slow down. This is a snapshot of one moment in time.
TSH 3.2 is high normal.
Free T4 is low/mid normal.
Free T3 is high normal = GOOD!

No antibodies - so you do not have Hashimoto's thyroiditis, but there are other forms of thyroid disease. (note I'm not suggesting you have any thyroid issues.)

Think for a second. TSH is like LH & FSH. If Total Testosterone & Free testosterone were normal, but FSH was high normal, would that indicate you need TRT??? No.

All your current test suggests is that you should keep an eye on it (annually). Don't start self-treating something that doesn't exist. What time of day did you have TSH checked? It matters. Just like T. Lots of reasons your TSH could be slightly high/normal. Emphasis on normal.

 

[Vince]

I wonder why your TSH is so high? Hopefully Chris will chime.

 

[John O'Connor]

Have you checked Vitamin D?

Ferritin = iron. Vitamin D is needed for absorption of iron, calcium, phosporus, magnesium & zinc. https://en.wikipedia.org/wiki/Vitamin_D

 

[John O'Connor]

Its not "so high" its slightly elevated but still normal. No different then FSH or LH being high normal at a moment in time. Hormones fluctuate through the day. This is one test. All it should indicate is to check Free T4 & Free T3, and Anti-TPO which was done, and those are good. He's good - recheck in 1 year.

 

[gallan]

I did all the tests recommended by that stop the thyroid madness website though looks like I missed the reverse 3 like Vince said. Had blood taken early in day as recommended also. Thanks.

 

[gallan]

Haven't had D tested in a few years. I live in South Florida and spend lots of time in sun by the pool.

 

[John O'Connor]

I'd assume D is normal, but wouldn't hurt to recheck. Note normal range is 30-100, but optimal is 50+. Do you eat red meat or other sources of iron?

Also - do you carry much excess fat? Vitamin D is stored in our fat. If you have too much fat, less Vitamin D is in circulation as the excess fat cells retain it.

I'm guessing your high/normal TSH was just a moment in time. I don't know enough about the Reverse 3 to comment on that. Here is video someone posted before on this topic. https://www.youtube.com/watch?v=ol16BZqVM48

 

[gallan]

Ferritin was low a year ago. 9. Have brought that up to 45 with supplementation and I eat lots of red meat. I do frequent labs to check and will check Vitamin D this week. Thanks. Probably around 18-20 percent body fat

 

[Vince Carter]

TSH of 3.2 isn't "high normal" or some such. Its indicative of being well on the way to having a Thyroid problem. Anything over a 2 is cause for concern. There's some reason your pituitary is drilling the Thyroid to make more hormone, the body thinks it's low and is trying to gas the Thyroid. It's not good. Is it better than a TSH of 5? Of course. But HIV is better than AIDS, in a manner of speaking.

 

[John O'Connor]

Mine was diagnosed in 2006 at age 37 with TSH of 3.8, so I agree - slightly elevated should be a concern. But it is not definitive when everything else looks good and TPO antibodies are not elevated. What would putting him on low dose synthroid accomplish? He already has good Free T3. My TPO antibodies were 800 (0 - 50).

Scroll down to look at the graphs in "RESULTS" to see what normal levels look like. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012447/

Also TSH fluctuates during the day.: Page 12 of pdf or page 999 or article:
https://www.aace.com/files/final-file-hypo-guidelines.pdf
"Pitfalls encountered when interpretingserum TSH levelsMeasurement of serum TSH is the primary screeningtest for thyroid dysfunction, for evaluation of thyroid hormonereplacement in patients with primary hypothyroidism,and for assessment of suppressive therapy in patientswith follicular cell-derived thyroid cancer. TSH levels varydiurnally by up to approximately 50% of mean values (78),with more recent reports indicating up to 40% variationon specimens performed serially during the same time ofday (79). Values tend to be lowest in the late afternoon andhighest around the hour of sleep. In light of this, variationsof serum TSH values within the normal range of upto 40%-50% do not necessarily reflect a change in thyroidstatus

 

[gallan]

Thanks Vince...what should I do now? Thanks for the feedback John as well. Like I said...it's really confusing.

 

[John O'Connor]

Also - maybe a quick re-check is warranted - only because your Free T4 was slightly low (not "subnormal"). But the same page linked above (999) mentions this in first paragraph:

"A subnormal assessment of serum free T4 serves toestablish a diagnosis of hypothyroidism, whether primary,in which serum TSH is elevated, or central, in which serumTSH is normal or low (46,47)."

Again - yours is not subnormal, and the negative anti-tpo probably indicates waiting a year for recheck is fine. Daily fluctuations could easily account for your 3.2 number - and again look at the tables in the other article, 3.2 is very close to the norm.

 

[John O'Connor]

Thanks Vince...what should I do now? Thanks for the feedback John as well. Like I said...it's really confusing.

Do you have symptoms? Weight gain, lethargy, are you always cold?
Have doctor check your patella & achilles reflex. Mine were non existent - and even with 50mcg rarely occur.
Lacking these reflexes are signs of hypothyroidism.

Vince - good conversation, I definitely do not know everything. I've learned a ton from your posts and have the utmost respect for your views too.

 

[gallan]

Hmmm. Maybe I have a toomah and should have had that checked before getting on TRT 5 years ago? Edit: Joking..hopefully. No. I seem ok..I'm in good shape. 49 years old. 6 ft. 200 pounds. Pretty lean and muscular. I do seem to get cold easily though throughout my life and seem prone to dehydration. I have to drink a ton of water daily to feel ok.

 

[gallan]

I just passed a CDL physical where they do a barrage of those reflex tests. I don't drive truck anymore but like to keep my license updated.

 

[John O'Connor]

Well assuming you had good reflexes = foot kicked out when patella was hit. Plus low body fat, and negative anti-TPO, I'm guessing you can wait to check again until next year.

As for the water - not sure. I tend to drink a lot also, but I live in Denver (high desert) so its a must anyway.

The cold intolerance seem to be your only symptom.
Assuming no lethargy or difficulty concentrating.
TSH would likely need to be much higher to see any significant symptoms.

Full list of symptoms, but pretty sure you can ignore the heavy menstrual cycle.
http://www.webmd.com/women/tc/hypothyroidism-symptoms

 

[gallan]

Thanks John. Lots of good info and conversation. Appreciate it.