# Seeking Advice on Lab Results



## pixie (Jan 17, 2015)

So, a little background. Back in August of 2013 I went to my doctor because I was experiencing symptoms that pointed towards Hypothyroidism - lack of energy, heavy menstrual cycles, no libido, inability to lose weight no matter how much I worked out/dieted. She tested my TSH only and it came back "normal" at 2.890. I ended up going on Mirena for the menstrual cycles because they just got worse, but had no "answers" for any of my other symptoms - just chalked them up to having a 3 year old and 18 month old.

Fast foward to Decemebr 2014 - I had my first ever panic attack which sent me to the ER (because I had no clue what was going on) and the only thing they find in my labs is that my TSH was high:

TSH w/ Free T4 reflex was 6.875
Free T4 was 1.02

Week and a half later I see my primary and request full Thyroid panel including antibodies, D3, B12, etc. She also started me on 25mcg Levothyroxine based on the TSH of 6.875, but I did not take them until after I took my labs.

Lab Results from those labs:
TSH: 2.33 (range .45-4.5)
Free T4: 1.08 (range .82-1.77)
Reverse T3: 11.1 (range 9.2-24.1)
T3: 96 (range 71-180)
TPO: 8 (range 0-34)
D3: 28.4 (range 30-100) LOW
B12: 807 (range 211-946)
White Blood Count: 2.9 (range 3.4-10.8) LOW
Cortisol-AM: 16.1 (range 6.2-19.4)

My primary says it is normal for TSH to flucuate like that and she is keeping me on the levo because I am having symptoms (this is funny to me considering that she didn't think I had a thyroid issue in 2013 when I had the symptoms and a TSH of 2.890). I'm not sure why she didn't do the TgAB. I am getting my white blood count retested when I retest my thyroid in 4 weeks.

Does anyone have any idea as to why my TSH would flucuate like that without being on medication? Should I be concerned that my reverse T3 is on the low end of normal?

My doctor is very open to my suggestions, and I want to make sure I am asking the right questions and requesting the right tests. She is also open to switching me to Armour, but wanted me to wait 4 weeks for next round of labs.

Thank you in advance for your time!


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## Lovlkn (Dec 20, 2009)

WOW! You are a very good student of online thyroid education - you go girl!

Free T-4 and Free T-3 are the 2 labs you want to be tested now that you are on thyroid replacement. TSH can lag up to 6 weeks and is not a good way to track yourself while on thyroid replacement medications. The least expensive lab I have found is http://www.healthonelabs.com/pub/tests/test/pid/167

Your FT-4 and FT-3 range goal should be 3/4 which is where most of us feel best.

This package gives you the FT-3 and FT-4 and also the TSH. The rest are not as important and my experience with some such as the T-4 do not track at all with the FT-4.

Being hypo caused heavier periods for me.

You should call the hospital and ask for copies of the lab results with ranges.


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## pixie (Jan 17, 2015)

Hi Lovlkn, 
Thanks for responding. As soon as I got home from the ER I was researching like crazy. I was off that week after for the Holiday's so that freed up a lot of time to read, read, read!

The ranges from the ER are:
TSH w/ free T4 Reflex: .35-5.5
Freet T4: .89-1.76

Aslo, my WBC from the ER was 8.7 (range 4.8-10.8) - no clue as to why is dropped so much in 11 days.

As far as the new labs, based on the 3/4 it looks like I should strive to be around 1.5325 for FT4. It looks like she didn't test my Free T3, just reverse and total.

My primary already gave me my slip for next time, but she is adding WBC, so I will also have her add the Free T3 because that slip is also just TSH, FT4, and TT3. Should I ask her to add the TgAB since it looks like she only did TPO?


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## Lovlkn (Dec 20, 2009)

> Should I ask her to add the TgAB since it looks like she only did TPO?


Yes. Absolutely.

Based on my web search - hyper thyroid can alter White blood count. I never paid much attention to this.


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## pixie (Jan 17, 2015)

That's interesting considering my TSH dropped a lot too in just 11 days. Not to the hyper range, but a lot.

She said she would add the TgAB, and FT3.

I explained that even though my TSH was "normal" I'd like to strive for my FT3 & FT4 to be in the 3/4 range. She only responded by saying my FT4 was fine. She does listen to my suggestions, but I have a feeling that if my numbers are in the "normal" range when I get retested she won't adjust my meds despite my symptoms.


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## pixie (Jan 17, 2015)

So, I emailed my dr and asked her to put the following tests on the slip for mid February:

TSH

FT4

FT3

TPO

TgAB

WBC

Vitamin D

Also, anyone know why lab ranges are so different? For example - Mayo Clinic says a TPO <9 is a positive, but my lab says <34...that is a huge difference!


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