In the years when I had health insurance, I had several thyroid panels done because I presented clinically with hypothyroidism but the TSH test was always "normal." Basically I was told I would feel better on antidepressants or I should diet and exercise even more to the lose the weight I was steadily gaining. Last year, feeling like death warmed over, I made a very expensive appointment with a functional medicine MD hoping to get some help. Unfortunately, unbeknownst to me, she was also a homeopath and decided homeopathy was the was to go. She said nothing about this b/w (9/2010) which I found rather alarming.
Vit D 34.2ng/ml
Cholesterol, Total 240 mg/dl
LDL Chol Calc 143
VLDL Chol Calc 36
TSH 1.970 uIU/ml (0.450-4.5)
Thyroxine (Free T4) 1.22 ng/dl (0.82-1.77)
T3 122 ng/dl (71-180)
Reverse T3 289 pg/ml (90-350)
free serum 3.0 pg/ml (2.0-4.4)
I went to another Dr. who actually physically examined me and was prescribed Nature Throid (similar to Armour). I also adopted a lowish carb Paleo diet (have since added occasional heavy cream, butter, ghee), added supplements, began walking again (at least 30 miles a week) and doing CrossFit 3x a week. The difference is practically miraculous! My b/w six months later looked like this:
Cholesterol, Total 230 mg/dl
LDL Chol Calc 147
VLDL Chol Calc 12
TSH <0.006 uIU/ml (0.450-4.5)
Thyroxine (Free T4) .92 ng/dl (0.45-1.2)
T3 192 ng/dl (71-180)
T3 Uptake 37% (24-39)
Free Thyroxine Index 3.4 (1.2-4.9)
Now the brain fog and lethargy have dissipated, I'm not satisfied because I think I can feel better. The miraculous is not optimal! So as I prepare for my appointment next month, which blood tests should I request (please bear in mind I pay for everything out of pocket and bloodwork is very expensive) in addition to the above? I'll get the standard CBC, CMP, and fasting glucose.
Also if anyone can explain the thyroid panels actually mean, please do. Now the TSH indicates hyperthyroidism.
Additional information, female, post menopausal, still at least 30lb of extra fat. I did lose about 40lbs (approximately 1 lbs/wk) over the first 7 months but I've been stalled since March. In an effort to get back on the weight loss train I've upped carbs, lowered carbs, increased training, stopped training, fasted, blacked out my bedroom windows, and increased my deadlift to 180lbs.
asked bychnola (410)
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on August 28, 2011
at 10:54 PM
First, the TSH doesn't necessarily indicate clinical hyperthyroidism, just that you have an excess of T3. Try reducing your Nature Thyroid dose a bit, aim for TSH around 0.5.
I would also try supplementing selenium and iodine at a low level.
You want to fix the underlying cause and wean yourself of the thyroid extract.
on August 29, 2011
at 03:20 AM
Respectfully, I must correct some information from Paul Jaminet. I'm not a doctor, just a very well informed thyroid patient.
Yes, the low TSH in this instance does not necessarily indicated a hyperthyroid state (see below), however the TSH does not indicate an excess of FT3 for the following reasons:
If a person is taking thyroid medication, the pituitary gland effectively slows down its stimulation of the thyroid gland (as indicated by the TSH level) as it can detect the thyroid hormones being supplied orally. Hence it has no need to stimulate the thyroid gland, leading to a lower TSH level.
So, in this instance, the TSH should be suppressed as expected when medication is taken. It is not directly linked to FT3 in this case - the FT3 is a measure of the effects of thyroid medication itself (ie. is measures the free/available hormone that has resulted from the actual T3 in the medication plus any the T4 that has converted to T3 and is free/available).
The original post should be edited to include the lab ranges and dosage of medication. Any time RT3 is performed, the T3 measure MUST be FT3 not T3. T3 is a pretty useless measure. Your RT3 does look on the high side, but it's best compared with FT3 not T3 to give a definitive answer.
Additionally, selenium supplementation recommendations should always carry a caveat that it is toxic above 200mcg per day. I have done really well taking selenium - it effectively stopped the intense thyroid inflammation I felt which returned when I stopped selenium.But it should be taken in the right careful dose.
Regarding iodine, many patients are sensitive to iodine supplementation. Not me, personally, but many on the realthyroidhelp.com forum have reported this. Usually this is in the case of Hashimoto's disease, rather than non-autoimmune thyroid conditions.
My recommendation is to get these tests:
FT3 FT4 TSH RT3 All thyroid antibodies (you should try to find out if there's an autoimmune component to this or not - though bear in mind that blood tests are fallible and not to be relied on as the best indicator. A lot of people show either 0 or very low levels of antibodies when in fact they do have autoimmune thyroid disease).
Also your vitamin D level doesn't look optimal, can you post the lab range please. If you run the Vit D again, don't take any Vit D for 5 days before the test.