# Question About Blood Tests



## jm2629 (Jan 5, 2018)

Hi everyone! Happy New Year!

I'm a 32-year-old male and I have Hypothyroidism and it's been going on for some years now. I was Hyper before and ended up taking a Radioactive Iodine to kill my thyroid.

Fast forward to today, I'm now taking Levothyroxine at 50 mcg.

Everything was just fine and dandy until recently, when my TSH shot from 1.80 mcIU/mL to 11.33 mcIU/mL in about 9 months time.

I finally got the balls to Google what my condition is all about and got blasted with a truckload of information with regards as to how to get proper diagnosis.

Presently, I'm in the middle of switching doctors (I have Kaiser). The physician that I'm seeing currently seems to be going off of TSH solely and refuses to do further blood tests. As a result of the recent jump in my TSH levels, she has now increased my Levothyroxin dosage to 75 mcg.

Other tests that she orders for me along with TSH are: Free Thyroxine (T4), which is at 1.3 ng/dL. That's it.

Now, to my issue at hand. I simply just want to get it right, or at least be on the right track. I understand that it will take a long time to find stability (correct dosage, blood test levels, etc.).

I have an upcoming appointment with a new doctor, but I'm at a loss as to which blood tests I should request and how broad.

What would be a good starting point as far as requesting blood test goes? To get a good visual of how severe my condition is or to figure out if other factors are at play.

If it helps, my symptoms tend to hover on mild depression, "runny" thoughts, difficulty losing weight and sleeping through the night. The symptoms come and go, but recently the intensity and frequency have picked up. I also wouldn't chalk it up completely to Hypothyroidism, for I am under above average stress lately.

Thanks much for your input!

Jay


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## joplin1975 (Jul 21, 2011)

Do you have the reference range for the free t4 test?

Your best bet would be to have TSH, free t4 and free t3. Don't take your meds before you have your blood drawn.

All those symptoms sound awfully like hypothyroid.


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## jm2629 (Jan 5, 2018)

Hi. Thanks for the fast reply!

This might come across as annoying, but I don't know what the range is. I've never really paid attention and simply said yes to what my previous doctor told me. But believe me, that changes now.

I might have to contact my doctor about the range she used for my lab results.

However, I attached a photo of my lab results below. Maybe you might be able to discern as to what the range is? :mellow:


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## jm2629 (Jan 5, 2018)

So, I was able to get the range used for my TSH and T4 Free and they are:


TSH = 0.35 - 4.00 mcIU/mL (I have a current value of 11.33 mcIU/mL)
T4 Free = 0.8 - 1.5 ng/dL (I have a current value of 1.3 ng/dL)


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## joplin1975 (Jul 21, 2011)

So you're free t4 is pretty darn high.

T4 is kind of a "storage" molecule. In other to use thyroid hormone, your body converts t4 into t3. A lot of people with thyroid disorders don't convert t4 to t3. No one knows why...it just happens.

A lot of times when people have symptoms like you are describing, their t4 is high and their t3 is low...it makes one feel hypo and a bit hyper at the same time.

Which is a long way of saying that you should really push for that free t3 test!


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## jm2629 (Jan 5, 2018)

So, my T4 Free is high even though it's within range?

I know my TSH is on the high side,

I guess I've got a lot reading to do..

You're really very helpful. Many many thanks to you!


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## joplin1975 (Jul 21, 2011)

Ok, sorry! I was in a rush and did my math a bit wrong.

Your target range for free t4 and free t3 should be between 50% -75% of the range.

For the t4 range you've given, that would be 1.15-1.325.

So technically your free t4 isn't high, but its creeping in that direction. You don't want it to go much higher. It still means the free t3 test is really important.


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## jm2629 (Jan 5, 2018)

Oh alrighty! No big deal! Lots of thanks once again. =)

I'll maybe update this thread after I see a brand new doctor next week.


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## Lovlkn (Dec 20, 2009)

jm2629 said:


> So, I was able to get the range used for my TSH and T4 Free and they are:
> 
> 
> TSH = 0.35 - 4.00 mcIU/mL (I have a current value of 11.33 mcIU/mL)
> T4 Free = 0.8 - 1.5 ng/dL (I have a current value of 1.3 ng/dL)


TSH can lag up to 6 weeks so while it shows high and your FT-4 is high it might just need to be repeated.

Insist on the FT-3 test as many thyroid patients do not convert FT-4 to FT-3. Having both pushing 3/4 range will make you feel better.

Also consider testing Vit D , B-12 levels as if low can cause fatigue.


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## jm2629 (Jan 5, 2018)

Lovlkn said:


> TSH can lag up to 6 weeks so while it shows high and your FT-4 is high it might just need to be repeated.
> 
> Insist on the FT-3 test as many thyroid patients do not convert FT-4 to FT-3. Having both pushing 3/4 range will make you feel better.
> 
> Also consider testing Vit D , B-12 levels as if low can cause fatigue.


One big fat yes to further and broader testing! Hopefully, my new doctor is a good one and wouldn't give a difficult time.

A bit more about me:

I was actually feeling normal for the longest time right after I received the Radioactive Iodine pill (blood work coming out within range). I received it in 2011 and I just started hormone replacement medicine last year. They put me on Levothyroxin.

Additionally, when I started Levothyroxin at 50 mcg, that did the trick. My TSH fell within range and everything was good and dandy.

BUT! I'm a heavy coffee drinker... Sometimes I would drink coffee just half an hour after I had Levothyroxin in the morning. I feel like that's what caused the recent jump in my TSH levels. I might have to drop caffeine altogether and really get a grip on my diet. o think that this is going to be forever...


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## joplin1975 (Jul 21, 2011)

Usually waiting 30 mins it ok. Especially if you aren't eating anything right away.

It's unusual (but not unheard of!) to "just" have hyperthyroid issues or "just" have hypothyroid issues, although things may start off that way.

You have thyroid tissue remain with RAI. I'd bet that originally your remaining thyroid cells were kicking out enough hormone so that you felt normal. And now your antibodies are probably attacking the remaining tissue so that it can't do the job properly (that is, things are acting hypothyroid).

Either way, if you can wait 30 mins and you like coffee, keep up with that routine. You just might need a higher dose.


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## Lovlkn (Dec 20, 2009)

I drink coffee everyday - it does not have an effect.

Consistency of taking dose is the key.

RAI sometimes does not completely kill of thyroid function. You may just be having thyroid tissue kicking in some activity.


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## jm2629 (Jan 5, 2018)

joplin1975 said:


> Usually waiting 30 mins it ok. Especially if you aren't eating anything right away.
> 
> It's unusual (but not unheard of!) to "just" have hyperthyroid issues or "just" have hypothyroid issues, although things may start off that way.
> 
> ...


I've always felt that my Hyperthyroidism (my original diagnosis/the beginning of everything) came out of nowhere!! All of a sudden I started losing weight fast and was super duper anxious. Then the goiter came and I was all bones. Then it was radioactive iodine time.

I find it extremely interesting when you say that it's unusual to "just" have thyroid issues. I feel like I could have prevented destroying my thyroid.


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## joplin1975 (Jul 21, 2011)

jm2629 said:


> I find it extremely interesting when you say that it's unusual to "just" have thyroid issues. I feel like I could have prevented destroying my thyroid.


Eh. If you are hyper, you need to do something. It's either RAI or surgery. Surgery tends to be more "precise" but RAI can be simpler (at the time).

You did what you had to do at the time.


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## jm2629 (Jan 5, 2018)

joplin1975 said:


> Eh. If you are hyper, you need to do something. It's either RAI or surgery. Surgery tends to be more "precise" but RAI can be simpler (at the time).
> 
> You did what you had to do at the time.


Right on. I'm over it. Lol. =D


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## jm2629 (Jan 5, 2018)

Lovlkn said:


> I drink coffee everyday - it does not have an effect.
> 
> Consistency of taking dose is the key.
> 
> RAI sometimes does not completely kill of thyroid function. You may just be having thyroid tissue kicking in some activity.


This tends to be my problem half the time. The time I take my thyroid medicine tend to vary between 3:00 - 5:00 AM.

Does it matter if it varies wildly within that two-hour window? Thanks!


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## Lovlkn (Dec 20, 2009)

jm2629 said:


> This tends to be my problem half the time. The time I take my thyroid medicine tend to vary between 3:00 - 5:00 AM.
> 
> Does it matter if it varies wildly within that two-hour window? Thanks!


You should never take your thyroid hormone prior to the lab draw.


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## jm2629 (Jan 5, 2018)

Hi everyone,

So, I decided to get my lab tests from an online company, which was a week ago and the results just came back right now.

I was wondering if anyone would be able to look it over for me and provide any meaningful input? I would appreciate it very much.

Also, this is the first time I've ever had a full panel taken, so, this is pretty much the first time I'm seeing these numbers and it's a little overwhelming.

A bit of a context: I was hyper, then had RAI. Five years later (2016), I started showing symptoms of hypo so they put me on Levothyroxine. It's been a roller coaster of symptoms since then.

Without further adieu.

**EDIT**

Thyroxine binding Globulin 001735: (Result: 17) (Range: 13 - 39) (Units: ug/mL)

Thyroid Peroxidase (TPO) Ab 006676: (Result: 193) (Range: 0 - 34) (Units: IU/mL)

Thyroglobulin Antibody 006706: (Result: 6.4) (Range: 0.0 - 0.9) (Units: IU/mL)

Reverse T3, Serum 070105: (Result: 17.6) (Range: 9.2 - 24.1) (Units: ng/dL)

Thyroid Stim Immunoglobulin 140747: (Result: 140) (Range: 0 - 139) (Units: %)

TSH 004264: (Result: 7.64) (Range: 0.450 - 4.500) (Units: uIU/mL)

Triiodothyronine,Free,Serum 010389: (Result: 3.3) (Range: 2.0 - 4.4) (Units: pg/mL)

T4,Free(Direct) 019745: (Result: 1.46) (Range: 0.82 - 1.77) (Units: ng/dL)


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## jenny v (May 6, 2012)

Well, you've got a boatload of antibodies going on, which isn't great and explains your symptoms. You're similar to my old situation in that you've got both TSI (hyper) and TPOAb (hypo) antibodies, which means your system is pushing and pulling against itself. You've also got a high TgAb (thyroglobulin antibody), which doesn't necessarily indicate cancerous cells, but warrants an ultrasound. When is the last time you've had one? I believe you've had RAI, but it's not unheard of for thyroid tissue to regenerate and "kick back on", so to speak. An iodine uptake test might be in order to see if your thyroid bed lights up (meaning it's working again).

While your FT3 is good-ish, you've got a high reverse T3 which means your body isn't using the T3 properly. rT3 is ideal when it's closer to 11 or so. Has your doctor said anything about next steps?


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## jm2629 (Jan 5, 2018)

jenny v said:


> Well, you've got a boatload of antibodies going on, which isn't great and explains your symptoms. You're similar to my old situation in that you've got both TSI (hyper) and TPOAb (hypo) antibodies, which means your system is pushing and pulling against itself. You've also got a high TgAb (thyroglobulin antibody), which doesn't necessarily indicate cancerous cells, but warrants an ultrasound. When is the last time you've had one? I believe you've had RAI, but it's not unheard of for thyroid tissue to regenerate and "kick back on", so to speak. An iodine uptake test might be in order to see if your thyroid bed lights up (meaning it's working again).
> 
> While your FT3 is good-ish, you've got a high reverse T3 which means your body isn't using the T3 properly. rT3 is ideal when it's closer to 11 or so. Has your doctor said anything about next steps?


Thanks for your reply.

I haven't had an ultrasound since I had RAI. My appointment is tomorrow with a brand new doctor. I hope to have a productive conversation with her.

So, how do one fix their high antibodies? And why is mine going haywire like this?

Also, does that mean that I need additional meds on top of the levothyroxine that I'm already taking?

Such a headache this is..


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## joplin1975 (Jul 21, 2011)

At the risk of being a total downer...

At this point, sometimes surgery to remove any thyroid tissue might be your best option. Once you have competing antibodies, there isn't a really good solution. Some people use block and replace, meaning they use anti-thyroid meds and levothyroxine/cytomel/dessicated meds. Its a really tricky dance - and I admit I don't know much about it - but some posters, on occasion, have reported success.


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## jm2629 (Jan 5, 2018)

joplin1975 said:


> At the risk of being a total downer...
> 
> At this point, sometimes surgery to remove any thyroid tissue might be your best option. Once you have competing antibodies, there isn't a really good solution. Some people use block and replace, meaning they use anti-thyroid meds and levothyroxine/cytomel/dessicated meds. Its a really tricky dance - and I admit I don't know much about it - but some posters, on occasion, have reported success.


What you're saying makes a tremendous amount of sense.

But man.. this makes me cry....

I have an appointment today..


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## jenny v (May 6, 2012)

It sucks, I know. Some people do the block and replace or sugery, like joplin said, and some do another round of RAI. I think it will all depend on what the ultrasound and uptake exam show. How did your appointment go?


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## jm2629 (Jan 5, 2018)

My appointment did not go well. The brand new doctor that I saw was scratching her head at my lab results that I brought (the one I got from an online company). She was really nice, however; a very pleasant lady.

She wanted me to explore talking to a therapist/psychotherapist. I was emotionally drained, so, I just told her "sure."

She did order new labs for me, which includes cholesterol panel, testosterone, sex hormone and various other stuff. As for my thyroid, she only ordered the TSH and Thyroperoxidase Antibody.

So, now my TSH is at 3.76 mcIU/mL (range: 0.35 - 4.00 mcIU/mL), while my TPO AB is at 233.4 IU/mL (range: <= 5.5 IU/mL). My levothyroxine was upped from 50 to 75 mcg 3 - 4 weeks ago (she would probably conclude that my new dosage is starting to work and that I should be ok now).

She won't do an ultrasound until I find out a bit of info about the one RAI I went through back in 2011 and she would then decide whether I need to get an ultrasound or uptake exam.

I now have an appointment with an endocrinologist whom I found through www.thyroidchange.org. He is, unfortunately, not with Kaiser (my insurance) and I will be paying him out of pocket.

My current symptoms consists of:


anxiety/depression (they come and go)
weight/fat gain (the most annoying currently. I want to post a picture of myself from 2016 and today)
lack of energy/motivation (they come and go)
dry skin (improved a little bit since last week)
brain fog/memory lapse (very annoying when they happen. I've been having a lot of these lately)

Any tips on diet? I tend to follow a low-carb lifestyle. I have no problem changing that to whatever.

Also, based on what I've read, I shouldn't really be on a T4-only medication. I wonder how I'll do on NDT thyroid meds... :confused0006:

That's pretty much my update. Thank you very much for reading! =)


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## jenny v (May 6, 2012)

Before you pay out of pocket, it might be a good idea to call his office and verify that he tests and takes into consideration all of the right tests (Free T3, Free T4, etc.). Better to know ahead of time and not waste your money!


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