# Lab results.. confused.



## Travis

Got my lab results in..

TSH- 4.250 uIU/mL (.450 - 4.500)
T4 (free/direct)- 1.25 ng/dL (.82 - 1.77)
Triiodothyronine (free/serum) 3.7 pg/mL (2.0 - 4.4)

What does this mean? How can my TSH be at 4.25, with normal T4 and T3 that's towards the upper end of normal?

I've been feeling like crap for months, and I've struggled with anxiety, depression, weight loss, hearing loss/ringing, and just a foggy feeling.

My TSH has been around the 4.2 - 4.8 range over the past 3 months, but this is the first time I had my free T3 and T4 checked.

Travis


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## lainey

Your results are not that unusual. Keep in mind TSH is produced by the pituitary based on thyroid hormones in the blood. Your actual thyroid hormones are present at a good level. There is a lag in the response of TSH levels to these. The thyroid results can also be affected by other hormones, general health and other medications.

TSH is not a normal distribution--about 50% of the population clusters between TSH 1 and 2 with about 15% lower than that and 35% above that. The lab ranges reflect that.

There is a position held by ACCE that in the presence of antibodies, people with TSH in the upper limits of normal (above 3) may begin to show signs of thyroid dysfunction.

You many want to have your antibodies tested--Thyroid peroxidase--to see if you have anything of that nature going on.

Many other conditions, such as low testosterone, low vitamin D and B and low iron have symptoms that closely match those of thyroid disorder. Your doctor should be fully investigating those as well.


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## Travis

He just told me that everything is in the "normal" range, so it's nothing to worry about. But, I don't understand why I feel so bad all of a sudden. Nothing else looks abnormal from my blood work. Keep in mind that my TSH has been elevated in the 4+ range for several months. I'm not sure how long it takes to catch up, though.

I do take a beta blocker, and a diuretic for HBP, and I also take Klonopin. I quit drinking alcohol back when all of this started. I've also started doing some cardio and working out. There were a lot of changes made with my diet and such, as I'm trying to get in shape.. but, I don't see how that could make me feel bad.

Is there anything other than Thyroid Peroxidase that I should have checked? I'm not too familiar with this stuff, and at this point, I'm pretty much doing it on my own, since my doc thinks I'm fine. I'm not a worry-wart.. But, I know when something doesn't feel right, and I haven't felt "good" in months. So, I really want to get to the bottom of it, and this thyroid thing is all I had to go on.

Travis


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## daisydaisy

I would suggest you get a referral to an endochronologist just to get the ball rolling as you dont feel well and it takes a while to get in. it won't hurt to try and this is your health or try another doctor


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## Andros

Travis said:


> Got my lab results in..
> 
> TSH- 4.250 uIU/mL (.450 - 4.500)
> T4 (free/direct)- 1.25 ng/dL (.82 - 1.77)
> Triiodothyronine (free/serum) 3.7 pg/mL (2.0 - 4.4)
> 
> What does this mean? How can my TSH be at 4.25, with normal T4 and T3 that's towards the upper end of normal?
> 
> I've been feeling like crap for months, and I've struggled with anxiety, depression, weight loss, hearing loss/ringing, and just a foggy feeling.
> 
> My TSH has been around the 4.2 - 4.8 range over the past 3 months, but this is the first time I had my free T3 and T4 checked.
> 
> Travis


Antibodies Travis. They are attempting to set the body to rights. They are opposing one another.

There are blocking, stimulating and binding antibodies and immunoglobulins.

Have you had any of these tests?

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

Also, just for your edification, you had the FT4 and FT3 (FREE) labs done, not the T4 and T3 (Total) which is a very good thing but you put T4 and T3.

I suspect antibodies are very active and I know that you do not feel well at all.


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## Travis

So, let me see if I have this straight..

There are antibodies at work, that could be preventing the thryoid from stopping production of hormones? Or, do the antibodies prevent the hormone that's in place from being used/detected?

Obviously, the hormone levels are pretty much right where they need to be, but antibodies are preventing the brain from stopping the release of TSH?

I will have to get those tests run.. They are a bit more expensive, and I'm having to pay for this stuff out of pocket. So, I will have to wait a few weeks. I've spent thousands of dollars over the past few months on ENT's, GP's, tests, MRI's, etc.. 

Travis


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## lainey

Some antibodies stimulate the thyroid to produce more (TSI). Some antibodies block the thyroid (TPO). Depending on which you have, and to what level, they can interfere with production to varying degrees.

Thyroid peroxidase and thyroglobulin antibodies are present in the general population at a rate of about 15-20%. Their presence does not necessarily indicate a problem, but the potential for one in the sense that autoimmune activity against the thyroid may occur. TSH is produced in the pituitary, but the antibodies don't work in the brain, but rather in the blood and thyroid, blocking the production of thyroid hormone. In any case, thyroid function is measured by the presence of thyroid hormones primarily, not antibodies.

You didn't mention if you have been tested for other issues, or just thyroid, as so many other problems have cross over symptoms. It is important to rule those out.


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## Travis

I've found this..

http://www.privatemdlabs.com/lab_tests.php?view=search_results&show=876&category=11&search=thyroid antibodies#876

Says that it tests for Thyroid Peroxidase Ab and Antithyroglobulin Ab.

Is there anything else?


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## Travis

lainey said:


> Some antibodies stimulate the thyroid to produce more (TSI). Some antibodies block the thyroid (TPO). Depending on which you have, and to what level, they can interfere with production to varying degrees.
> 
> Thyroid peroxidase and thyroglobulin antibodies are present in the general population at a rate of about 15-20%. Their presence does not necessarily indicate a problem, but the potential for one in the sense that autoimmune activity against the thyroid may occur. TSH is produced in the pituitary, but the antibodies don't work in the brain, but rather in the blood and thyroid, blocking the production of thyroid hormone. In any case, thyroid function is measured by the presence of thyroid hormones primarily, not antibodies.
> 
> You didn't mention if you have been tested for other issues, or just thyroid, as so many other problems have cross over symptoms. It is important to rule those out.


So, I guess, where is the disconnect in the "loop" from where I have the right amount of hormone, but the message isn't being sent to stop producing TSH? Sorry if I sound ignorant here.. I understand roughly how it works. TSH is released when low hormone levels are detected. Once hormone levels reach the correct level, something tells the pituitary to stop pumping out TSH? What I fail to understand is how/where antibodies come into play in this process.

I had no other tests run, except for comprehensive metabolic panel. Everything showed fine there, except for slightly elevated Globulin level, and my albumin/globulin ratio was low. My calcium was elevated as well.. but has since gone back down to normal levels.


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## lainey

Technically, you do not have too much TSH. You would be at best sub-clinical, and majority of doctors would call your results normal. That same majority would also not likely recommend any replacement medication primarily because your actual thyroid hormone levels are quite good.

The antibodies can affect the thyroid itself, and the body's ability to process the hormone. They can also skew the test results in the sense that all of the hormone shown in the blood may not necessarily be available for the cells to use, because it may blocked by antibodies.

Had you had your TSH tested previously, such as last year or the year before that with results that indicate a change? Just because it is "high" in the range does not necessarily mean that it is abnormal--most research calls for TSH levels over 10, for example, to define "clinical" hypothyroidism.

A comprehensive metabolic panel isn't going to asses the iron, vitamins and hormones that could also cause your symptoms. The medications you are taking can also cause the symptoms you mention as side effects. There are a lot of variables, and you need to do a little more exploration.


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## lainey

Travis said:


> I've found this..
> 
> http://www.privatemdlabs.com/lab_tests.php?view=search_results&show=876&category=11&search=thyroid antibodies#876
> 
> Says that it tests for Thyroid Peroxidase Ab and Antithyroglobulin Ab.
> 
> Is there anything else?


With the high T3, you would want the TSI.


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## Travis

3 weeks later, and I feel worse.. My ears are ringing like crazy, I get dizzy/exhausted very easily, and every time I do anything strenuous, I get the shakes. I bounce between hyperactivity, and periods where I don't want to get out of bed. My weight has been up and down.. all over the place.

I guess it's more tests.. I have the funds to do another round.


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## Travis

TPO
TSI
Antithyroglobulin Ab
TSH 
Free T4 
Free T3

Having those tests run tomorrow..


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## Andros

Travis said:


> TPO
> TSI
> Antithyroglobulin Ab
> TSH
> Free T4
> Free T3
> 
> Having those tests run tomorrow..


Good choices. And to help you understand some of this, there are binding, blocking and stimulating antibodies and immunoglobulins. There is a fierce battle going on inside your body.

In reality, it is the body's last ditch effort to right it's self.

Let us know when you get the results and the ranges.


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## Travis

Thanks Andros..  Hopefully these tests will paint a better picture of what's going on.


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