Interpreting Thyroid Labs

[Vettester Chris]

OK, here's the scoop ... The variance of your FT4 & FT3 is concerning!
FT4 is at 31% of the reference range
FT3 is at 79% of the reference range

When sufficient levels of thyroid hormone are reaching the cells of the body, with optimal ATP activity is optimal, T4 (Reserves) will more times than not be relatively close in reference range values to respond adequately to T3 demand. If they're off/apart 10%, so be it, they're off by almost 50%, NOPE, that's "usually" a marker for other issues.

More times than not you will find FT3 is POOLING and not getting into the cells. When FT3 pools, the body takes a different path and T4 takes a downstream course to Reverse T3. What needs to take place is obtaining a Reverse T3 lab, then review the FT3/RT3 ratio. 20 or higher is what you're looking for, but I'll put some coin on it that it's in the mid to low teens.

This is one of the more frequent problems that show up with people having thyroid problems. 8 out of 10 times, it's actually/usually not the thyroid itself, but areas that effect the transport of T3 to the cells, such as cortisol (glucose), iron/ferritin, D3, and some of the electrolytes. When T3 'Can't' get into the cells, it stops, builds-up (Pool), the body shifts course until it can tell the pathway is functioning properly. The body will also take these steps when you're sick, majorly hurt, recovering, etc., where it's the body's method to conserve energy.

One test is needed to remove the speculation: Reverse T3. If your ratio is low, then that's when the 'transport' areas get reviewed. More times than not, Cortisol or the Iron/Ferritin subject will be the culprit.

 

[gallan]

Thanks Chris...very concerning that the test I took seemed all inclusive but left out the reverse T3. Will get that done and thanks

 

[John O'Connor]

Chris - great info. Can you recommend any articles to read up on this?

I found a little:
http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9405
https://labtestsonline.org/understanding/analytes/t3/tab/faq
https://labtestsonline.org/understanding/analytes/t4/tab/test
https://en.wikipedia.org/wiki/Triiodothyronine

Would Reverse T3 & Free T3 normally be elevated together? Or would they typically run opposite of each other? I would think if one was high, the other would be low.

Also - with Free T3 high, what mechanism is triggering the production of more TSH?

My understanding = Free T4 is slightly low, so my interpretation is that it was converted to Free T3 as it should, thus causing the low state. The hypothalmus/pituitary see that Free T4 is now low, and therefore kicks TSH up, to signal the thyroid to make more.

Low T3 Syndrome: (This seems to be the opposite of what his labs show).
http://chriskresser.com/low-t3-syndrome-i-its-not-about-the-thyroid/

Note - I had a pretty solid understanding of this from 2006-2010 as I was originally diagnosed w/ Hashimoto's in 2006, but the Reverse T3 stuff is new for me - so I appreciate all the information you can provide.

 

[Vettester Chris]

Yeah, here's a few items ...

http://health.howstuffworks.com/human-body/systems/endocrine/understanding-thyroid-metabolism.htm

http://denvernaturopathic.com/thyroidprotocol_000.htm

I'm always amazed with STTM ... http://www.stopthethyroidmadness.com/reverse-t3/
http://www.stopthethyroidmadness.com/rt3-ratio/

Although, Dr. Bruce Rind doesn't get too deep into the pooling subject, there's some great information on his site ..
http://www.drrind.com/therapies/thyroid-scale

John, on the "Low Free T4" subject ... Just at a glance, usually (not always) when I see someone post low T4 (like the 20% to 30% range) and Free T3 is over 75%, it can mean that excess RT3 is being converted from the thyroid reserves (T4).

Yes, correct, the pituitary is picking up on the lowered T4 signal, producing a semi-higher amount of TSH, but it's not excessive. In estrogen dominance cases, this scenario will take place for years until eventually the pituitary gland gives up and stops producing TSH all together (all due to pooling because of adrenals) If he's pooling, there's still some FT3 conversion taking place, but at a slower rate, and RT3 is taking the bulk of the reserves.

Hopefully some of the items posted will at least articulate it a bit for you and anyone reading here. Again, it's just speculation at this point, but I'm just basing my theory on the multitude of people (men and women) that I've been in the loop with over the years.

 

[John O'Connor]

Chris, thanks! Learning a lot here. Looking forward to seeing what gallan's Reverse T3 shows.

 

[OMI100]

Here is another great site to look around with a lot of good info:
http://www.tiredthyroid.com/what-labs.html

And one more:
http://hypothyroidmom.com/about-dana-trentini/

 

[Vettester Chris]

Yeah, the Tired Thyroid community is a great place too!! Good call Orrin!!

 

[Vettester Chris]

Chris, thanks! Learning a lot here. Looking forward to seeing what gallan's Reverse T3 shows.

You and me both! I will be stymied if his ratio > 20!

Not to hijack this awesome thread, but John, would enjoy knowing more about your Hashis diagnosis, if it was at the enzymes are protein (TPO or TgAb), and how you and your medical team treated it? If you have a thread on it, I'll read it for sure, just point me in the direction? If not and you have time, feel free to make a thread here in the thyroid section about your condition. There are other members here that have autoimmune issues, so I'm sure plenty of folks would benefit, even if initially your doctor(s) didn't treat it correctly. Thanks

 

[John O'Connor]

Here you go Chris - as requested:
https://www.excelmale.com/forum/sho...-levothyroxine-Any-reason-to-check-Reverse-T3

 

[gallan]

Thanks everyone. I have tests ordered including the full thyroid panel with reverse T3 this time and included ferritin and Vitamin D as well. Will bump this thread next week when I get results.

 

[gallan]

Still waiting on Reverse T3 and Vitamin D but here are some preliminaries and even more confused. Thyroid seems better this test as TSH is lower than previous so it really does fluctuate.
What's the deal with iron? Ferritin is low but the 2 iron labs below it are high. Could the iron supplement I took a couple hours before the test have done that or I'm I just not understanding the difference between iron and ferritin?


Iron
% SATURATION 49 15-60 % (calc)
FERRITIN 35 20-380 ng/mL
IRON BINDING CAPACITY 472 Above Normal 250-425 mcg/dL
IRON, TOTAL 229 Above Normal 50-180 mcg/dL






Thyroid
T3, FREE 3.4 2.3-4.2 pg/mL Previous Lab 3.9
T4, FREE 1.2 0.8-1.8 ng/dL Previous Lab 1.11
TSH 1.60 0.40-4.50 mIU/L Previous Lab 3.21

 

[John O'Connor]

So I was right - nice!

I'm guessing taking an iron supplement 2 hours before having blood drawn might have everything to do with it. LOL

You mentioned getting lots of sun, so it will be interesting to see where Vitamin D is. It would explain absorption issues. I'm still guessing you are below 50.

Also - be careful taking iron supplement. High iron can cause ED. There is a good reason female multivitamins have more than men's. Just take a regular men's multivitamin. That should be all the iron you need. A good friend of mine started taking his girlfriends multivitamin and started having ED issues. He had to donate blood 3-4 times to get the iron levels back down. Women need the extra iron because of their menstrual cycle.

 

[gallan]

Ya..strange lab as results for each individual test come in 1 at a time with first email at 3 am last night and looks like Reverse T3 and Vitamin D tests are being evaluated at a different lab location..anyway.

You did see where ferritin is low? I've heard that is more a concern than actual higher iron levels which is why I supplement. I give blood regularly every 2 months due to high hematocrit.
Perhaps I'll just go off the iron supplement and eat more red meat. Trying to balance all this out.

 

[John O'Connor]

Absolutely - I'm learning a lot too. Giving blood every 2 months could explain it. Maybe you would need it.

How much iron do you take, and how often?

 

[gallan]

http://www.amazon.com/Now-Foods-Ferrochel-Veg-capsules-120-Count/dp/B000WQDD2O

One of these every other day in the morning on an empty stomach with Vitamin C. Dr. Michael Scally posted a study that said taking an iron supplement EVERY OTHER DAY leads to better absorption if one has low ferritin.

 

[John O'Connor]

Ok, same as 18mg dose in ON OPTI-WOMEN multivitamin. Donating blood every 2 months probably removes more iron than typical menstrual cycle over same time. So you may even need more than every-other-day. Just guessing though. Paying attention to blood work will be only way to tell.

But I would recommend not taking anything right before blood draw. I take levothyroxine every morning, and have been told not to take it on the morning of blood draw as it can cause artificially low number. Especially when its the only thing you take with fasting blood draws.

 

[gallan]

Ya..at this point I'm trying to figure out if those high iron readings are a cause of concern or if they highly fluctuate depending on diet and/or supplementation and might even be ok now a day or 2 after not supplementing. Ferritin , I believe is the factor that takes weeks to change. Will post Vitamin D and reverse T3 as soon as they come in...maybe not till Monday now. No idea.

 

[gallan]

Found this so should be good on the iron issue.


"Your iron levels were high because you were taking iron supplements when you got tested. The only danger in iron overload is when your iron level is high AND your Ferritin is high. See link for another explanation:

http://www.medicinenet.com/iron_overload/page3.htm

"Since serum iron can be elevated by eating and can fluctuate during the day, serum iron measurements should be done fasting, usually in the morning before breakfast."

 

[Jackie Treehorn]

Great discussion here guys. When I get home tonight, I'm going to post up my latest labs. I should have gotten the full thyroid panel, but I did get TSH, Free T3, and Reverse T3. As I remember, my TSH was 3.03, Free T3 was 4.0, and reverse T3 was 10.6...same Lab Corp ranges. I wasn't very happy with the TSH number, because it was up from 2.7 (pre-TRT).

Chris, you said that the FT3/RT3 ratio should be around 20...is that correct? I must be screwed up because mine is nowhere near that number. I guess I'm getting a full thyroid panel next week!

I also have a follow up consult with Dr. Crisler in about 2 weeks, so I'll be sure to get his input as well.

 

[John O'Connor]

Jackie - the anti-TPO will give you the definitive answer. Be sure to ask for Vitamin D too, as just getting that above 50 could improve your TSH, at least that's seems to be what the studies are saying. Vitamin D seems to impact everything. I posted this yesterday. https://www.excelmale.com/forum/sho...y-Low-Vitamin-D-linked-to-Low-HDL-Cholesterol