# need help with lab results



## BING (Jun 25, 2013)

My father has thyroid dysfunction for about 15 years. Could anyone help interpret the lab results below? Does he need to take more T4 or both T3/T4? He has medicines for either T4 or the combination of T3 and T4. I searched online and it seems it is not that common to see low T3, T4, normal free T3, T4 and TSH. Your help is greatly appreciated. Thank you....

*TSH 0.534 *uIU/mL Reference Interval 0.450-4.500
*Thyroxine (T4) 2.1 (low)* ug/dL Reference Interval 4.5-12.0
T3 Uptake >50 (high) % Reference Interval 24-39
Free Thyroxine Index >1.1 Reference Interval 1.2-4.9
*Thyroid Peroxidase (TPO) Ab 99 (high)* IU/mL Reference Interval 0-34
Antithyroglobulin Ab 38 IU/mL Reference Interval 0-40
Siemens (DPC) ICMA Methodology
*Thyroxine (T4) Free, Direct, S, 1.35* ng/dL Reference Interval 0.82-1.77
*Triiodothyronine (T3) 58 (low)* ng/dL Reference Interval 71-180
*Triiodothyronine, Free, Serum 3.1* pg/mL Reference Interval 2.0-4.4


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## Lovlkn (Dec 20, 2009)

> Thyroxine (T4) Free, Direct, S, 1.35 ng/dL Reference Interval 0.82-1.77
> Triiodothyronine (T3) 58 (low) ng/dL Reference Interval 71-180
> Triiodothyronine, Free, Serum 3.1 pg/mL Reference Interval 2.0-4.4


These are the labs you need to be looking at for dosing purpose.

1/2 to 3/4 range for each is the goal.

1.29 is 1/2 range for FT-4
3.2 is 1/2 range for FT-3

Since you have both free's its best to dose by them. What are his current medications and doses?

How does your father feel?


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## BING (Jun 25, 2013)

Lovlkn,

Thanks for the quick response. Really appreciated.
My father feels a little bit easy to get tired and it seems that he sleeps quite a lot, which may be related to jet lag because he came here in US about two weeks ago. I have to check his medicines again to be sure.

Bing


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## Lovlkn (Dec 20, 2009)

He's right at 1/2 range. If he adds more Levothyroxine he will likely drop his TSH below 0 which will concern most doctors. He may have some stimulating antibodies which would cause his TSH to fall below range with higher than 1/2 range Free's.

Maybe give him a few days to rest up and see how he feels.

If it were me I would increase my levothyroxine medication a bit to see how I felt.


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## BING (Jun 25, 2013)

Thank you again, Lovlkn.

My father is 65 years old now. He is currently taking 50ug of Levothyroxine in the morning and 1 pill (40mg) of thyroid tablet in the evening as prescribed. As you know, the thyroid tablet is made from animal thyroid glands. But according to the drug instruction, T3 and T4 concentrations in this tablet are not clearly indicated, and varies from lot to lot. I read a lot online regarding T4 transformation to T3. I am not sure if this is good time to drop the tablet and use Levothyroxine alone for more accurate dosage. For now, I'll take your advice to observe for a little bit longer.

Bing


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## Lovlkn (Dec 20, 2009)

We rarely see a patient on BOTH a Levothyroxine and a Armour type drug. Levothyroxine/Cytomel is more common.

How long has he been taking both? If he tolerates well a slight dose increase of either might help his fatigue issues.


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## Andros (Aug 26, 2009)

BING said:


> My father has thyroid dysfunction for about 15 years. Could anyone help interpret the lab results below? Does he need to take more T4 or both T3/T4? He has medicines for either T4 or the combination of T3 and T4. I searched online and it seems it is not that common to see low T3, T4, normal free T3, T4 and TSH. Your help is greatly appreciated. Thank you....
> 
> *TSH 0.534 *uIU/mL Reference Interval 0.450-4.500
> *Thyroxine (T4) 2.1 (low)* ug/dL Reference Interval 4.5-12.0
> ...


Your dad definitely needs an ultra-sound as evidenced by antibodies above also the T3 uptake indicates he may be hyper thyroid.

T3 Uptake test
http://www.drstandley.com/labvalues_thyroid.shtml (high, hyper---low, hypo)

The T3 uptake explained.
http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm

There are other antibodies that can make the TSH, T4 and T3 appear in normal range. They are binding, blocking and stimulating antibodies to the receptor sites.

It would be wise for your dad to have 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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248

How old is your father? Gender and age could suggest that an ultra-sound is mandatory.


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## BING (Jun 25, 2013)

Thank you both.

My Father is 65 years old. Right before his departure for US, which is about 20 days ago, he had thyroid ultra-sound done but did not have blood tested. Somehow, the doctor reduced Levothyroxine and added Armour type drug in prescription. So Lovlkn, the blood test done here was about 2 weeks from the date he changed medications. I'll try to see if I can find the image from the ULtrasound test.

Bing


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