# Sisters result



## iroczinoz (Aug 15, 2011)

I am posting this on behalf of my sister and would like to hear your opinions.

TSH - 3.21
Ft3 - 5.5 pmol (3.5 - 6.5)
Ft4 - 15 pmol (10 - 19)

Anti TPO - 69 (<60)
Anti TgA - 40 (<60)

Cortisol 692 (119-618)

Long story short sister has been having symptoms for a long time now. Titedness, not feeling refreshed after sleeping, dry skin, especially eyes, waking up during the night.

I suggest some tests to get done, doctor did not like this saying it will not show anything.

I had a feeling she is having adrenal fatigue so asked her to get cortisol checked. No surprises there as it does indicate some adrenal issues. Also told her to get thyroid tests.

about a year ago her TSH was 1.2 now it is above 3 which I think is an issue considering her symptoms. Since I have hashi's she asked for that doctor said slim chance of her having it even if I have it haha...

I think her having TPO elevated above range is a early sign of things to come.

Doctor said she is in range in TSH and normal. The above range TPO he said healthy people have it sometimes too and it is ok. Said it took him 10 years of study to get to where he is, and that I am reading too much on the internet.

Anyway he said under no circumstance will he prescribe any thyroid meds. Told her she has chronic fatigue and for her higher cortisol sent her to another doctor.

So another classic doctor who treats by numbers and not symptoms.

Do you think I should just give her 50mcg of T4 to take and see how she goes after a couple of months?

Will probably tell her to see my doctor who is a little more switched on.

BTW, for the last half year she has had an elevated temperature 37.3.


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## Negative101 (May 23, 2011)

TSH is too high
She has hashis. The doctor has studied for 10 years, and still doesn't know the basics because modern approaches say she needs to be medicated. Due to her free Ts being decent, she needs to start on a small dose to get her TSH to 2 and below. Also needs an ultrasound and a new doctor who's studied for less years but understands modern concepts.


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## Andros (Aug 26, 2009)

iroczinoz said:


> I am posting this on behalf of my sister and would like to hear your opinions.
> 
> TSH - 3.21
> Ft3 - 5.5 pmol (3.5 - 6.5)
> ...


This guy may have cut some classes here and there. The normal healthy person should have NO TPO Ab and NO Thyroglobulin Ab.

They do have very low amounts of TPO and Thyroglobulin.

TPO Ab should be negative, 0
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

(The normal thyroid has TPO but should not have antibodies to TPO)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Here in the U.S., AACE recommends TSH range to be 0.3 to 3.0 
Most of us feel best w/TSH @ 1.0 or lower with the FREES @ about 75% of the range given by the lab.

Is Sis in Australia also? Can she find a better doctor?


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## iroczinoz (Aug 15, 2011)

Thanks for the replies thought it would be the case. Yeah she will try a new doctor the one I am seeing maybe. Yes she is also in Australia. Was just going to give her my meds and tell her to take 25mcg T4 and see how she feels in 2 months.

If the next doctor does not help her out might just do that, but he should be better with her case I think.


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## Andros (Aug 26, 2009)

iroczinoz said:


> Thanks for the replies thought it would be the case. Yeah she will try a new doctor the one I am seeing maybe. Yes she is also in Australia. Was just going to give her my meds and tell her to take 25mcg T4 and see how she feels in 2 months.
> 
> If the next doctor does not help her out might just do that, but he should be better with her case I think.


Please let us know; something is definitely afoot w/sis!! You are a good brother to care for her.


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## lainey (Aug 26, 2010)

> TSH - 3.21
> Ft3 - 5.5 pmol (3.5 - 6.5)
> Ft4 - 15 pmol (10 - 19)
> 
> ...


Antibodies or not--if you read on the internet, yes, normal people can have TPO antibodies and do not necessarily have thyroid disease and they can be seen in people with other inflammatory conditions.

However, we are worshipping the TSH in a different way here.

Her free T3 is in the upper third of the range, and the free T4 is in the upper half. This would be considered almost ideal for someone on replacement. How would medication improve these?

Yes, cortisol is high--what has testing for iron, vitamins D and B shown? How about female hormone testing--is she estrogen dominant? Insulin resistant? Issues in any one or a number of these areas mimic the symptoms of hypothyroidism.


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## Negative101 (May 23, 2011)

> Hashimoto's Thyroiditis is a familial autoimmune disease. It can occur as early as 6-7 years old, and late as 90. It can go undiagnosed for 20 years before the patient becomes sick enough to see a physician for hypothyroidism. During that period the thyroid is growing bigger and developing nodules. When the TSH goes above 2.0 there also is an increased risk of stimulating an occult thyroid cancer to grow. Thyroiditis is the number one cause of hypothyroidism. However, because of a problem with the TSH assay, many with the disease are told they are normal. The TSH test in most labs has a normal range up to 5-6. When the TSH is above 10 the patient is clinically hypothyroid. When patients with early thyroiditis are removed from the normal range TSH falls to 2.0. The physician looks only at the abnormal tests on the panel, and until the TSH is above 5, the patient is told they are normal. There is an increased risk of thyroid cancer if the TSH is above 2.0 during the period of years it takes to go from 2 to 5-6.
> 
> An example is a family with several members with hypothyroid Hashimoto's thyroiditis, but the 17 Y/O daughter when screened had Hashimoto's thyroiditis, and on ultrasound had a suspicious nodule.
> 
> ...


thyroid.com


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## lainey (Aug 26, 2010)

> TPO antibodies are found in the majority of patients with Hashimoto's and Grave's disease, in myxodema and in pernicious anemia without overt thyroid disease. Low titers of TPO antibody may be found in apparently healthy individuals. The clinical significance of these results is undetermined. Coexisting antibodies to thyroglobulin (Tg) are common.
> Although the presence of high titers of antibodies to thyroid peroxidase is indicative of thyroid autoimmune disease, the data must be considered in light of other clinical and laboratory findings. Some individuals may have high levels of TPO antibodies with little or no evidence of clinical disease. Moderate levels of TPO antibody may be found in patients with non-thyroid autoimmune disease such as pernicious anemia, type I diabetes mellitus, or other disorders which activate the immune system. By contrast some clinically defined patients may have undetectable levels of this antibody.


http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/THYROD_e_met_Thyroid_Peroxidase_Antibodies.pdf

Nodules are not limited to persons with thyroid disease either, they occur at a rate of about 20 -40% in the normal population, with almost 95% of these being of benign nature. Blood work is not diagnostic of cancer, adenomas revealed in a thyroid scan can be evaluated if they are of an appropriate size.

As for Richard Guttler, not the best authority IMHO--read what his patients say:

http://www.vitals.com/doctors/Dr_Richard_Guttler

The thyroid.com website is his and designed to promote his practice.


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## iroczinoz (Aug 15, 2011)

lainey said:


> Antibodies or not--if you read on the internet, yes, normal people can have TPO antibodies and do not necessarily have thyroid disease and they can be seen in people with other inflammatory conditions.
> 
> However, we are worshipping the TSH in a different way here.
> 
> ...


I can see how her results can look good regarding ft3 and ft4. But considering her symptoms and a higher TSH I would have thought the doctor should treat symptoms and not just look at numbers.

I am a classic example very good ft4 and ft3 (better than sisters) with a higher TSH.


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## lainey (Aug 26, 2010)

> I am a classic example very good ft4 and ft3 (better than sisters) with a higher TSH.


So then you tell me. If we spend all of our time saying that the frees are what matter, that doctors shouldn't go by TSH alone, then how is this different?

What is changing the TSH supposed to achieve if the frees are already very good? Aren't those the active hormones?


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## iroczinoz (Aug 15, 2011)

lainey said:


> So then you tell me. If we spend all of our time saying that the frees are what matter, that doctors shouldn't go by TSH alone, then how is this different?
> 
> What is changing the TSH supposed to achieve if the frees are already very good? Aren't those the active hormones?


I guess the only variable is the pituitary. Is it working/responding correctly..

I guess the other question is then why is the body wanting more output (higher tsh) when ft3 and ft4 levels are fine.

I guess numbers are meaningless and probably best to treat by symptoms first.


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## Andros (Aug 26, 2009)

lainey said:


> http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/THYROD_e_met_Thyroid_Peroxidase_Antibodies.pdf
> 
> Nodules are not limited to persons with thyroid disease either, they occur at a rate of about 20 -40% in the normal population, with almost 95% of these being of benign nature. Blood work is not diagnostic of cancer, adenomas revealed in a thyroid scan can be evaluated if they are of an appropriate size.
> 
> ...


Agreed on Guttler.


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## Negative101 (May 23, 2011)

While Guttler does not have the greatest rep, it does not mean the info he stated is incorrect. I recently saw a thyroidologist who was on par with the latest research and he confirmed that TSH needs to be kept relatively low-normal, regardless of free Ts. Why is the pituitary demanding more? Is this demand causing an inflammation of sorts, or other effects which are resulting in higher cancer rates in hashis patients? I think some of us can confirm that keeping TSH down may lower the antibodies themselves... This may have some value to it.

Why are cancer patients told to suppress TSH?


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## lainey (Aug 26, 2010)

> While Guttler does not have the greatest rep, it does not mean the info he stated is incorrect.


Yes, and in all things, the interpretation of the data is always subject to the perspectives the reader brings to the table.

With this issue the reasoning really becomes rather circular, thyroid disease patients have more nodules, more nodules increases the likelihood of cancer. Basic probability.

Whether suppressive therapy is effective at reducing nodules is debatable. However, the general consensus is that it is largely ineffective. The idea that suppressing the TSH will reduce the formation of cancerous nodules can fall under this argument.

Yes, in patients on replacement, the risk does seem to be slightly higher at TSH values that are slightly higher in the normal range. The studies I have read, however, are retrospective and simply indicate that further study is needed as to the relationship between TSH and formation of cancerous nodules. If you have found something more specific, please post a link. Once again, we fall into the circular pattern of the patients themselves have underlying thyroid disfunction, which itself is the primary risk factor.



> Why are cancer patients told to suppress TSH?


This is simply because thyroid tissue can regrow after the thyroid has been removed, and it can regrow pretty much anywhere in the body. Right now the role of suppressive therapy is being questioned--it's usefulness varies with the type of cancer, and it's necessity beyond a period of 5 years post-surgery is under review.


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## Negative101 (May 23, 2011)

I have personally not found any studies, but if you've seen retrospective studies, they should be given, at least, some weight imo.

If TSH suppression is used to limit thyroid tissue, then that alone may be beneficial (if true, of course).

It does not appear that there are any major adverse effects of keeping TSH in the low-normal ranges (below 2).

Im a hashi's patient with normal Free T's (50% and above) but constantly have a TSH of over 3 and 4. My pituitary seems not to be satisfied with my Free T's... I dont expect science to be absolutely sure of why this is, but perhaps the retrospective studies can shed some light. My simple opinion is that my "normal" is to have higher free Ts -- 50% of the range is not enough.

Again, keeping TSH down seems to lower antibodies... this may have some value also (I dont propose to know the answer)


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## Andros (Aug 26, 2009)

Negative101 said:


> While Guttler does not have the greatest rep, it does not mean the info he stated is incorrect. I recently saw a thyroidologist who was on par with the latest research and he confirmed that TSH needs to be kept relatively low-normal, regardless of free Ts. Why is the pituitary demanding more? Is this demand causing an inflammation of sorts, or other effects which are resulting in higher cancer rates in hashis patients? I think some of us can confirm that keeping TSH down may lower the antibodies themselves... This may have some value to it.
> 
> Why are cancer patients told to suppress TSH?


I am stepping up to the plate. Absolutely. By keeping my TSH suppressed, my doctor and I are keeping my Anti-DNA and ANA mostly undetectable if not totally undetectable. At one time, they both were through the roof.

The only med I take is Armour. I have Lupus, discoid and systemic, Sjogren's and of course Graves'.

I think "everything" counts on the road to wellness. We must look at the whole picture, not half of it.

You are right!


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## iroczinoz (Aug 15, 2011)

Thought I would update this thread a little since my sister is still fighting to feel right. I have started moving away from blaming the thyroid and looking at something else.

She was on the pill but after she decided to stop taking it to see if her results would improve.

Here are her results while on the pill

Total Testosterone: 0.5 nmol/L (0.5-2.6)
Dehydroepiandrosterone Sulphate: 3.1 umol/L (4.0-10.0) 
Sex Hormone Binding Globulin: 92 nmol/L (27-109)
Free Androgen Index (Total T.): 0.5 (1.0 - 5.0)

SERUM HORMONES

FSH - 6
LH - 2
E2 - 243
PROG - 0.6

Follicular Phase Reference Intervals

FSH - 1-6
LH - 1-10
E2 - 70 - 530
PROG - 1.0 - 7.0

As you can see a total mess! She stopped taking the pill and below are her results after 3 months.

Sensitive Testosterone: 1.5 nmol/L (0.6-1.7)
Androstenedione: 13.7 nmol/L (3.0-9.5) ***
Dehydroepiandrosterone Sulphate: 3.2 umol/L (2.2-7.9)
Sex Hormone Binding Globulin: 95 nmol/L (27-109)
Free Testosterone: 13 pmol/L (8-32)

SERUM HORMONES

FSH - 4
LH - 4
E2 - 948
PROG - 40.8

Luteal Phase Reference Intervals

FSH - 1-12
LH - 1-20
E2 - 205 - 790
PROG - 5.0 - 95

SERUM CORTISOL
10.00am - 451nmol/L (119 - 618)

Her cortisol was also elevated when on the pill slightly over range but can't find the figure now.

Anyway it seems like a nice improvement over the 3 months but her symptoms are still there. So looking into it a little more one can see that he E2 is over range and Progesterone is mid range.

I have yet to confirm the units with my sister but I assume progesterone is in nmol/l and E2 would be in pmol/l

So her ratio is 40800/948 = 43

Now according to http://www.yourmenopausetype.com/menopausequestionsandanswers/06112000.html she falls into the 1st quartile which can't be good.

Endo basically told her, look your values look fine there is nothing wrong, go back on the pill. What a joke, she can't be serious. It does not matter if you are within range you are fine and even when out of range you are fine. This is absurd so I suggested to her to try some progesterone cream as it can't hurt. The problem is some work some don't I have heard that KAL progesterone cream is a good one that apparently works well.

I know this is a little off topic from thyroids but figured there are a bunch of switched on people here so something might click.

We looked at PCOS but it seems that her Androstenedione is not high enough and her symptoms apparently don't really match.


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## Andros (Aug 26, 2009)

iroczinoz said:


> Thought I would update this thread a little since my sister is still fighting to feel right. I have started moving away from blaming the thyroid and looking at something else.
> 
> She was on the pill but after she decided to stop taking it to see if her results would improve.
> 
> ...


Bumping this up in case someone can comment. Not my field of expertise. I don't believe messing w/the female hormones.


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## surge (Aug 15, 2012)

fwiw: my sister also has hashis. I hate to see her struggle at all and want to fix things for her more than I want them fixed for myself. Which means, I have trouble seeing her situation clearly; I'm invested and I have a low threshold for her suffering. This makes me a good advocate for her and support, but it makes me a terrible doctor for her, as I'd be desperate to try anything that might work...you implied that you were going to start your sister on your t4 meds, as well as looking into cream for her. I think it's far more important role for you to encourage and empower her to keep looking for another doctor. Since it seems like something systemic is going on with her-- maybe early onset of hashis or that + other things-- she should consider an NP, if you has comfort with that philosophy, or a DO, who is also more interested in looking at the big- picture of the body as a system.

You're kind and supportive. I just want to encourage you to support her in finding a doctor who will help her for the long haul-- especially if she is developing hashis.


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## iroczinoz (Aug 15, 2011)

Yeah that was an option to start her on the t4 meds but we did not proceed with it. I have read the stories of people wrongly diagnosed and on thyroid meds for 20 years plus, but once off there thyroids worked normally again. So it was more of a test to see if it had any effect, but we have held off.

She went to the Endo paid about $200 out of pocket. Endo did not even run Thyroid tests, never asked her what phase in her cycle she was. All she apparently said is I quote " I feel bad that I don't think I have actually helped you" How nice, she still took the money though 

The units are correct as stated so the ratio numbers are correct. I'll see how she goes on the progesterone cream.


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