Need help interpreting thyroid labs

[ta406]

I"ve been on TRT for a couple of years now. My TT has generally been around 900, FT around 20 and E2 around 30(labcorp). My libido and erections are so so and occasionally use generic cialis with good results unless my E2 is out of whack. Lately I have been dealing with anxiety, fatigue, sleep issues, sweating, to name a few. My doc agreed to do a thyroid panel. He thought all my levels were good but after some research it appears that my TSH is low and that may be a sign of hyperthyroidism. I was wondering if you thyroid gurus wouldn't mind looking at my labs and letting me know what you think. My doc thinks its more of an anxiety issue than anything and I have scheduled a follow up appointment with him in a few weeks to discuss the results.

Thanks

Free T4 1.34 Range .82-1.77 ng/dl
TSH .981 Range .450-4.500 uIU/ml
TPO 11 Range 0-34 IU/ml
T3 Free 3.3 Range 2.0-4.4 pg/ml
Reverse T3 16.7 Range 9.2-24.1 ng/dl

 

[Vettester Chris]

Both your Free T3 and Free T4 are sitting at 54% of their reference ranges. You would normally aim to see both of these somewhere between 50% and 80%, so with that talking point you're in the zone, or call it towards the low end of the zone. With what's provided, nothing even close to "hyper", and for some might be borderline "hypo", depending on what free serum levels work best for you?

The other factor with the Free T3 & T4 zone is Reverse T3 and its ratio. Ideally, a FT3/RT3 ratio that is > 20 will be ideal, and that's usually a good marker to know that FT3 isn't pooling, or call it not getting to the cells. When pooling you will "usually" see FT3 at a higher level in the reference range than FT4, sometimes substantially, e.g., FT3 at 75% and FT4 at 20% ... Again, both of yours are equal in the reference range, which is ideally a good thing.

The only thing missing is a TgAb antibody lab. TPO only checks enzyme autoimmune, TgAb will check the protein side of it. You will want to know this going forward, especially if some form of treatment is ever in play.

Also, your labs are one reason why it's not good to just rely on TSH lab alone. Some guys with the same FT3 and FT4 might be at 2.0 or 3.0uIU/ml on TSH, or higher or lower, it can be all over the place. Sometimes thyroid hormone levels can be fairly normal, but one might see their TSH elevated (a la sub-clinical of sorts) ... It's good to have, it's good to compare, but the real truth is with the other labs you posted (plus the TgAb when you can).

Also, just for grins, talk with your physician about a 24 hour cortisol w/DHEA correlation kit.

 

[ta406]

Thank you very much for the informative reply. I basically know nothing about the thyroid (and it shows). I have started to read more about it from some of the stickies that Nelson has on this forum. For some reason I'm having a hard time getting my head around some of it, but its slowly making more sense. My doc did mention a retesting my cortisol. I had it tested in 2015 and my cortisol levels were high. Sounds like that should be my next avenue to pursue.

6am 12.7 ng/ml
11am 7.4ng/ml
4pm 5.4ng/ml
8pm 7.9ng/ml

Thanks again.

 

[Vettester Chris]

Need the reference ranges on that cortisol?

 

[ta406]

Need the reference ranges on that cortisol?

Sorry about that. The test was done by Pharmasan Labs and they state the reference range as the following:

Morning 7.0-10.0
Midday 3.0-7.0
Afternoon 2.0-4.0
Evening <1.5