T Nation

Thyroid Lab Review and Recommendations

T Replacement
#1

A friend had some recent lab work and is hearing / reading a lot of contradictory treatments. She is trying to research to educate herself prior to Dr follow up. There is obviously a problem w/ TPO antibodies, possibly Hashimotos. The Dr is unlikely to recommend iodine or selenium treatment. KSman Thoughts?

You have not been using iodized salt? No
Do you eat much seafood? No
Do you take selenium? No
Is your thyroid enlarged, asymmetric or lumpy? No
Are your outer eyebrows sparse? Yes, extremely sparse has to draw them on with makeup
Body Temps? Temp always below normal, cold all the time, gets chills often
Fatigue? Fatigue and tiredness previously treated for years w/ ADD meds (stimulant to stay awake during the day)
Family history of thyroid issues although her Dr only addressed fatigue with ADD stimulant.
Gains weight easily, has to drop to 900 cals a day to lose any weight

TPO antibody 658 <9.0
fT4 free 1.1
TSH 3.28
fT3 3.3
IgG, IgM antibodies Negative <0.2, I believe this test rules out some auto immune disorders but not all?

KSman is Here
#2

These labs should point any competent doctor to looking further into autoimmune thyroiditis. Clearly hypothyroid ism is at play. With that said TPO at that level risks serious concern for adrenal insufficiency and type 1 diabetes. Dont take my word for it though, I’m just a random person on the internet. But I would take the word of the Mayo Clinic, they are known to be smart folks:

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81765

#3

I agree her TPO is off the chart but her TSH, fT4 &fT3 are all “within range”. My understanding is Hashimoto’s is not treated preventativiely by mainstream medicine while the thyroid is still functioning.

#4

Ranges are for “reference” as they are to assist in diagnoses with symptoms of disease. While under AAFP guidelines the numbers suggest “sub-clinical hypothyroidism” when viewing the “at risk” level of TSH (TSH > 3.0) under most guidelines and out of some of the narrow reference ranges. So there you have it. If we only look at the reference range of the TSH and FT4 there is sub-clinical hypothyroidism. However, persistent symptom of hypothyroidism in sub-clinical, or normal ranges is caused primarily by Anemia, kidney disease, psychiatric conditions, liver disease, sleep apnea, certain viral infections or vitamin D deficiency. Also in rare cases adrenal insufficiency. Now with the TPO antibodies off the chart we have inference of adrenal insufficiency so we have a place to start for a root cause. To confirm Addision’s Disease (adrenal insufficiency) blood testing of ACTH, sodium, cortisol and potassium will be drawn. The treatment is often corticosteroids taken orally or via injection. Remember health is not the doctors, it is the patients. If they do not want to order the tests make them, its the patients health and the doctor is a service provider. Also you can always order lab tests online have them performed at your local LabCorp or Quest. I pray the information provided assists and I wish you the best of luck.

References:

http://www.aafp.org/afp/2012/0801/p244.html

https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296

#5

fT3 looks perfect and body temperatures are low. This looks like adrenal fatigue with elevated rT3 the result, blocking some of the fT3 action, lowering body temperatures and increasing TSH that is partly driving the thyroid autoimmune state. Selenium may help. She probably needs thyroid hormones. If rT3 is elevated, T4 hormone increases T4–>rT3 and makes things worse. Most doctors would fuck that up. T3 only meds are needed, and time release the best and only a compounded product in USA.

ADD meds may have been needed because of thyroid and/or cortisol.

Is this women menopausal or Peri-menopausal?

When women have a history of plucking eyebrows, this makes reading eyebrows a problem.

Labs:
rT3
AM cortisol - do at 8AM or 1 hour after waking up
DHEA-S - another adrenal hormone
CRP
homocysteine
fasting glucose
A1C
CBC

  • perhaps a female hormone panel [including TT, FT] on day 18 of her cycle

Do we care if doctor recommends or understands iodine+selenium?

See the thyroid basics sticky noting references to:
stress
illnesses, infections, inflammation, chronic
adrenal fatigue
Wilson’s book