Thyroid Panel Question

[Jeff]

TSH 4.74 H range 0.40-4.50 mIU/L
T4 1.4 range 0.8-1.8 ng/dL
T3 3.0 range 2.3-4.2 pg/mL
THYROGLOBULIN ANTIBODIES <1 range < or = 1 IU/mL
THYROID PEROXIDASE ANTIBODIES <1 range <9 IU/mL

my TSH says that I am hypothyroidal but all of the other thryoid test appear to be normal, any idea what that means? I use to be on armour thyroid, based on my TSH, been off for a little over a year but now i have a new doc that ran labs and these don't look that bad to me.


Does this look right, or did he order the wrong estrogen test?
ESTROGEN, TOTAL, SERUM 146.1 range 60-190 pg/mL

 

[GreenMachineX]

I don’t have any insight, but did you make the call to come off Armour or did your doctor?

 

[Jeff]

I don’t have any insight, but did you make the call to come off Armour or did your doctor?

I moved and had trouble getting a new primary care doc for a while, i wasn't on a high dose, 1.5 grains.

 

[GreenMachineX]

I moved and had trouble getting a new primary care doc for a while, i wasn't on a high dose, 1.5 grains.

I’ve been considering either making the switch to Armour from synthroid or just coming off. I’m on 125mcg t4, and the new Armour thyroid is 1.25 or 1.5g. I tested the Armour once at a quarter of a pill and my senses were so stimulated I was seeing through walls lol. Wasn’t ready at that time to keep going but after this upcoming vacation I may try again.

 

[Charger69]

I am by no means an expert, but I have learned a great deal since they removed my thyroid.
I am still in the process of dialing in my T3/T4 . I think that we may have it dialed in, but the DR does not even check T3/T4 levels- just TSH.
According to my Dr (endo), the T3 and T4 levels are not very reliable because the conversions occur intracellular and aren’t accurate.
The TSH is a signal from the pituitary to the thyroid to produce T3/T4. . Your feedback loop is telling your thyroid to produce more with your high TSH. I would also like to state that the TSH scale is logrythmic so don’t think that it is linear. I had readings in the 12’s.
I really believe that more testing needs to be accomplished to see if there is an issue or not.
Based on my experience, I would go with the TSH readings, however I am not a Dr.

 

[HIT4ME]

Basically it looks like your pituitary gland is releasing TSH and your Thyroid isn't responding exactly appropriately. However, these results make me agree that more testing is needed. You are barely out of range and your T4 and T3 are in a good spot. You may get tested again and everything is normal.

If you had a pituitary issue causing it to release too much TSH and your thyroid was responding, you would have elevated T4 and/or T3 to go along with this.

If you had a thyroid that wasn't responding to TSH you would generally expect some drop in T4/T3 levels.

You don't really fit either of those situations. It could be an early sign that one of those situations is occuring...more testing will reveal it.

Why were you put on thyroid medication to begin with before?

I am no expert...those are just the basics.

 

[jswain34]

Subclinical hypothyroidism most likely, could also be post-illness transient hypothyroid if you’ve recently been ill. There are other things that could cause an elevated tsh w/o abnormalities in the other tests you’ve had done, but they’re rare and something I’d rather leave for your endo to discuss w/ you if need be. At least you know you don’t have hashimotis ( anti-tpo) hypothyroid or Grave’s (anti-thyroglobulin) hyperthyroid.

You probably don’t require treatment with that minimal of a tsh elevation. When it gets >10 or so that’s when there can be increased risk for a variety of things including coronary heart disease, heart failure, maybe stroke depending on your age, elevated cholesterol.

Bottom line: with how minimally elevated your tsh is, as long as you’re asymptomatic, i imagine they’ll just monitor it every 6 mo to a year and nothing more.

Also not a doctor.

 

[Charger69]

Please keep us informed. I am really curious that my Dr only goes by TSH and not T3/T4, but that may be because I don’t have a thyroid.

 

[HIT4ME]

Please keep us informed. I am really curious that my Dr only goes by TSH and not T3/T4, but that may be because I don’t have a thyroid.

You are probably right - since you don't have a thyroid, he is going by the feedback that your exogenous use is creating. Plus, I think TSH is cheap and for most of the time it is a pretty reliable approach, even if it lacks the resolution of knowing every hormone and what it is doing. If your TSH is normal, then it is telling you that your pituitary gland is most likely sensing appropriate levels of T3 in your system.

 

[Jeff]

Basically it looks like your pituitary gland is releasing TSH and your Thyroid isn't responding exactly appropriately. However, these results make me agree that more testing is needed. You are barely out of range and your T4 and T3 are in a good spot. You may get tested again and everything is normal.

If you had a pituitary issue causing it to release too much TSH and your thyroid was responding, you would have elevated T4 and/or T3 to go along with this.

If you had a thyroid that wasn't responding to TSH you would generally expect some drop in T4/T3 levels.

You don't really fit either of those situations. It could be an early sign that one of those situations is occuring...more testing will reveal it.

Why were you put on thyroid medication to begin with before?

I am no expert...those are just the basics.

Thanks for the info! The last doc put me on based of tsh level only, hopefully the new one knows what they are doing

 

[GreenMachineX]

You are probably right - since you don't have a thyroid, he is going by the feedback that your exogenous use is creating. Plus, I think TSH is cheap and for most of the time it is a pretty reliable approach, even if it lacks the resolution of knowing every hormone and what it is doing. If your TSH is normal, then it is telling you that your pituitary gland is most likely sensing appropriate levels of T3 in your system.

I find it weird the medical community uses a negative feedback loop for testing of the thyroid but directly measures hormones for everything else.

 

[HIT4ME]

I find it weird the medical community uses a negative feedback loop for testing of the thyroid but directly measures hormones for everything else.

Well, they both have their pluses. I mean,, I don't really know what I am talking about but my take is that, obviously, actual data can be enlightening - but on some level you also care about a person's response as much as their actual levels...so the feedback loop does make some sense.

And Thyroid is pretty simple and reliable. For the most part it seems like TSH is released and the thyroid releases T4 and that converts to T3 and T3 inhibits TSH release. Of course there are metabolites and rT3 and antibodies as well...but the picture for the most part is simple among the relationship of those 3 substances.

Something like Test is more complicated. PREG turns to DHEA to prohormones to Test which aromatizes to estrogen or converts to other compounds...all of which play different roles...but to me I think most doctors still take a simplistic view unless there is a reason to dig in.

I mean, you could spend thousands on testing if you tested everything ...and just find out most of it was a waste. So most doctors build evidence to support their testing. If total test is low, they will dig deeper. If TSH is way off, they will dig deeper.

But if you don't have a thyroid and you are taking T3 and T4 exogenously, then the response is 95% of the battle. The only thing testing T4/T3 will tell you in that situation is mostly academic - how much of the T3 is being absorbed, etc. If your dose is too low, your TSH will be elevated and tell you the same thing reliably with minimal testing.

Keep in mind doctors are process oriented and have to explain their actions to their hospitals and insurance, etc. And the last thing most patients want is a bill for a blood test that the insurance didn't cover because it was unnecessary. Maybe not you or I - but most people are adverse to paying for something they don't even understand...

 

[HIT4ME]

Thanks for the info! The last doc put me on based of tsh level only, hopefully the new one knows what they are doing

Interesting. Strange to me that you had high TSH at one point and were put on medication, came off for a year and it is now almost within range. Are you generally healthy? How is your diet? Any chance of nutrient deficiencies.

Also, JSWain is probably more precise in his wording than I...he probably knows more about this than I do tbh...even though he isn't a doctor either.

 

[Jeff]

Interesting. Strange to me that you had high TSH at one point and were put on medication, came off for a year and it is now almost within range. Are you generally healthy? How is your diet? Any chance of nutrient deficiencies.

Also, JSWain is probably more precise in his wording than I...he probably knows more about this than I do tbh...even though he isn't a doctor either.

Yeah, it seems odd to me also, i was on armour for 4-5 years before i moved. My TSH before the last doc put me on it was around the same, over the limit but not off the charts, just told me I had a "slow" thyroid. Since i ran out of the prescription, i have probably put on 30 lbs, tired no motivation, etc.

 

[Charger69]

Subclinical hypothyroidism most likely, could also be post-illness transient hypothyroid if you’ve recently been ill. There are other things that could cause an elevated tsh w/o abnormalities in the other tests you’ve had done, but they’re rare and something I’d rather leave for your endo to discuss w/ you if need be. At least you know you don’t have hashimotis ( anti-tpo) hypothyroid or Grave’s (anti-thyroglobulin) hyperthyroid.

You probably don’t require treatment with that minimal of a tsh elevation. When it gets >10 or so that’s when there can be increased risk for a variety of things including coronary heart disease, heart failure, maybe stroke depending on your age, elevated cholesterol.

Bottom line: with how minimally elevated your tsh is, as long as you’re asymptomatic, i imagine they’ll just monitor it every 6 mo to a year and nothing more.

Also not a doctor.

Remember the scale is not linear, it is logrhythmic .

 

[Charger69]

Well, they both have their pluses. I mean,, I don't really know what I am talking about but my take is that, obviously, actual data can be enlightening - but on some level you also care about a person's response as much as their actual levels...so the feedback loop does make some sense.

And Thyroid is pretty simple and reliable. For the most part it seems like TSH is released and the thyroid releases T4 and that converts to T3 and T3 inhibits TSH release. Of course there are metabolites and rT3 and antibodies as well...but the picture for the most part is simple among the relationship of those 3 substances.

Something like Test is more complicated. PREG turns to DHEA to prohormones to Test which aromatizes to estrogen or converts to other compounds...all of which play different roles...but to me I think most doctors still take a simplistic view unless there is a reason to dig in.

I mean, you could spend thousands on testing if you tested everything ...and just find out most of it was a waste. So most doctors build evidence to support their testing. If total test is low, they will dig deeper. If TSH is way off, they will dig deeper.

But if you don't have a thyroid and you are taking T3 and T4 exogenously, then the response is 95% of the battle. The only thing testing T4/T3 will tell you in that situation is mostly academic - how much of the T3 is being absorbed, etc. If your dose is too low, your TSH will be elevated and tell you the same thing reliably with minimal testing.

Keep in mind doctors are process oriented and have to explain their actions to their hospitals and insurance, etc. And the last thing most patients want is a bill for a blood test that the insurance didn't cover because it was unnecessary. Maybe not you or I - but most people are adverse to paying for something they don't even understand...

My Dr (Endo) came out and said that the TSH was more accurate as to the actual T3 levels. I asked where the T3 and T4 tests were. It wasn’t because of insurance reasons.

 

[HIT4ME]

Yeah, it seems odd to me also, i was on armour for 4-5 years before i moved. My TSH before the last doc put me on it was around the same, over the limit but not off the charts, just told me I had a "slow" thyroid. Since i ran out of the prescription, i have probably put on 30 lbs, tired no motivation, etc.

Interesting - have you had an A1C or testosterone test? He may have been onto something we can't see in the current test, or maybe it was slow due to something else going on - like a lack of iodine? I don't know.

My Dr (Endo) came out and said that the TSH was more accurate as to the actual T3 levels. I asked where the T3 and T4 tests were. It wasn’t because of insurance reasons.

Yeah, I agree that TSH is reliable...I wouldn't say accurate, but reliable. It may not always describe every problem, but it will often show there is a problem. And if insurance won't pay because the general rules say there isn't a need, he will just say there is no need to avoid the insurance discussion.

Which brings us to another feedback loop - medical policies/insurance companies.

 

[Charger69]

Interesting - have you had an A1C or testosterone test? He may have been onto something we can't see in the current test, or maybe it was slow due to something else going on - like a lack of iodine? I don't know.



Yeah, I agree that TSH is reliable...I wouldn't say accurate, but reliable. It may not always describe every problem, but it will often show there is a problem. And if insurance won't pay because the general rules say there isn't a need, he will just say there is no need to avoid the insurance discussion.

Which brings us to another feedback loop - medical policies/insurance companies.

Our Dr’s don’t give a crap about cost and what is covered by insurance. You sign a statement that you are responsible whether or not the insurance pays.. I need to ask questions to make sure that things are covered.
Last physical blood test, I had to pay $80 extra. Insurance didn’t cover that test.
I just had to pay $250 extra because one of the things accomplished was not covered.

 

[jswain34]

Remember the scale is not linear, it is logrhythmic .

Remember the scale is not linear, it is logrhythmic .

K, thanks. All of my statement still stands.

The point where I stated “as long as you are asymptomatic” shouldnt be overlooked. Knowing that he stopped the meds and is now having some symptoms of hypothyroidism in addition to his elevated tsh is very likely an indication for thyroid replacement.

- random forum bro.

 

[Jeff]

Interesting - have you had an A1C or testosterone test? He may have been onto something we can't see in the current test, or maybe it was slow due to something else going on - like a lack of iodine? I don't know.

Yeah, A1C was in the normal range

Test, Total 356 (250-1100)
SHBG 22 (10-50)
Albumin 4.6 (3.6-5.1)
Test, Free 62.2 (46-224)
Test, Bioavailable 130.7 (110-575)
Estrogen, Total Serum 146.1 (60-190)
PSA 1.1 (<= 4.0)

I am 50, not sure how much of a difference that makes with these.

 

[Jeff]

Yeah, A1C was in the normal range

Test, Total 356 (250-1100)
SHBG 22 (10-50)
Albumin 4.6 (3.6-5.1)
Test, Free 62.2 (46-224)
Test, Bioavailable 130.7 (110-575)
Estrogen, Total Serum 146.1 (60-190)
PSA 1.1 (<= 4.0)

I am 50, not sure how much of a difference that makes with these.

Followed up with the Dr this week. They want to just monitor the thyroid values for now. He felt the estrogen was out of line and I am now on .5mg anastrozole 2x a week, scheduled a retest and followup in 2 months.

 

[simpllyhuge]

What about your vitamin D? Supposedly it affects thyroid positively on a cellular level to a significant degree. Why not take 5000 iu with some fish oil or a meal that contains fat. Also maybe some selenium and a small amount of kelp. I noticed 1 kelp cap a day dropped my tsh from like 4 to 2 and improved my thyroid numbers, I would imagine from t4 collecting but not converting, however the better numbers made me feel weak and mentally slow and dying for stimulants. I attribute this to possibly not producing cortisol enough or at the correct times to handle the extra endogenous thyroid. If I were to take endogenous t3 same thing seems to happen and I feel weak and slow like it’s not making it to the cell. T4 supplementation I feel, but it makes me jittery which IMHO is either I don’t have the cortisol or took too much.

anyway try the D if you don’t already, it’s needed for many other things as in sure you know. And buy some cheap kelp caps off Amazon and reputable brand of selenium.

 

[Jeff]

What about your vitamin D? Supposedly it affects thyroid positively on a cellular level to a significant degree. Why not take 5000 iu with some fish oil or a meal that contains fat. Also maybe some selenium and a small amount of kelp. I noticed 1 kelp cap a day dropped my tsh from like 4 to 2 and improved my thyroid numbers, I would imagine from t4 collecting but not converting, however the better numbers made me feel weak and mentally slow and dying for stimulants. I attribute this to possibly not producing cortisol enough or at the correct times to handle the extra endogenous thyroid. If I were to take endogenous t3 same thing seems to happen and I feel weak and slow like it’s not making it to the cell. T4 supplementation I feel, but it makes me jittery which IMHO is either I don’t have the cortisol or took too much.

anyway try the D if you don’t already, it’s needed for many other things as in sure you know. And buy some cheap kelp caps off Amazon and reputable brand of selenium.

I will take a look and do some research into the kelp and selenium. Dr put me on a 50,000iu pill of D2 once a week, i was supplementing with 4000IU of D3 a day and my numbers were still on the lower range. Thanks for the info.

 

[Jeff]

Digging up an old thread here

So for the past 6 months the new dr has me on 50K IU (1 pill a week) of vitamin D and 1mg 2x a week of anastrozole. Latest labs:

TSH: 2.51
T: 540
T (free): 107.7
Estradiol: < 15
Vit D: 64

Don't know why it's a different test for E this time Estrogen vs Estradiol. But I am feeling pretty good, modest increase in T and free T is way up, estrogen sides are down and I am slowly taking the weight off. It could just be a placebo affect but after I take the anastrozole i do feel a difference that day in the gym.