RE: Help please with TFT interpretation - rT3 issue ??

[Guest guest]

have you considered the adrenal side of things, espeically given she has bowel

problems? in the stress effect book, the author talks about bowel problems

needing cortisol to suppress inflammation i believe? has she had any adrenal

tests?

>

>

> Levo) – Over the past 18 months she has lost 2 of her beloved dogs

> and had been hospitalized on a couple of occasions with bouts of severe

> diverticulitis – she had been ill to such an extent that she is now

> scheduled for a bowel operation next month. I believe that she has lost

> all reference to `feeling normal' and that `normal' for

> her now means not lying in bed doubled up in pain – physically as

> well as mentally....

[Guest guest]

Did she take her thyroid med before having her labs drawn that day? That could be a reason for the Free T3 being higher.

From: <christina@...>thyroid treatment Sent: Thu, October 7, 2010 12:45:40 PMSubject: Help please with TFT interpretation - rT3 issue ??

Hi all,

I am hoping someone might be able to help me make sense of the thyroid results of a close friend. She suffers from Hashimoto's, started on Armour 3 years ago, and all was well back then. After a year on Armour her wretched endo persuaded her to switch to Levothyroxine... she did, and for about a year she seemed ok-ish on it – then the hypo symptoms (mainly fibromyalgia) kept creeping back and now she has put her foot down and told her endo she was going back on NDT – because of the Armour reformulation she switched to Thiroyd in August this year and she tells me she feels ok, certainly better than on Levo.... only I have reason to believe she has forgotten what it means to feel ok. She's had an awful lot of stress and ill health over the past couple of years (which incidentally coincided with her switching from Armour to Levo) – Over

the past 18 months she has lost 2 of her beloved dogs and had been hospitalized on a couple of occasions with bouts of severe diverticulitis – she had been ill to such an extent that she is now scheduled for a bowel operation next month. I believe that she has lost all reference to `feeling normal' and that `normal' for her now means not lying in bed doubled up in pain – physically as well as mentally....

So, those below are her thyroid results.... I can understand why her FT4 has dropped – she has switched to NDT, so that would explain it. But how can the FT3 be at the upper norm range when at the same time her TSH has rocketed to 4.42 ??? It is not on this chart, but previously (when she was first on Armour) her TSH was down to 0.something and she had good FT4 and FT3 readings. During her almost 2 years on Levo the TSH had either not been checked or she hasn't got the numbers, just her FT4 and on one occasion her FT3 as well.

Ranges

March

April

July

Sept 20th

FT4

10 - 22

21.8

34.4

21.8

8.9

TSH

0.3 – 3.82

4.42

FT3

3.95 – 6.8

4.7

6.8

Levothyroxine

125mcgs

150mcgs

125mcgs

Thiroyd

1 1/2 grain

What comes to my mind (rightly or wrongly) is rT3 ..... Nick, if you are about ? – what do you make of the above? Could such results be brought on by too much rT3 ?? Does anybody have any bright ideas of what might be going on here? I'd be grateful for suggestions.

Other than 1 1/12 grains NDT she takes 1 NAX (she should take more, I know), extra calcium (away from thyroid) and Vit C – nothing else.

Many thanks,

[Guest guest]

Hi and - many thanks for your input.

- no, she would not have taken her thyroid meds on the morning of the blood draw. She knows the score....

- yes, low adrenal reserve and lack of cortisol might well be present and play a role here, but what I am trying to figure out is the relationship between her high TSH and her high FT3. That does not make sense when you look at the overall picture.

If there were enough T3 in her cells, the hypothalamus would not have received signals of low thyroid and would not have instructed the pituitary gland to produce more TSH – a TSH of 4.42 indicates that the cells are apparently lacking thyroid hormones. Her high FT3 however indicates that there is plenty of T3 available ... therefore there must be an error of communication somewhere. I just can't work out where ....

My friend says she feels fine – although that feeling is subjective (I know she is under an awful lot of stress and has been for some time), she does not appear to be severely hypothyroid at the moment. She can function normally and is not in any physical pain at present ... all of which indicates to me that there must be at least a reasonable amount of thyroid hormones inside her cells .... so why has her TSH shot up ??

The only explanation I can think of – and I may well be wrong – is that instead of FT3, her body might have produced too much rT3. rT3 would prevent sufficient FT3 from getting into the cells, but all would show up as FT3 in the blood results because rT3 and FT3 have the same molecular structure as I understand it (unless you specifically check for rT3 you won't know how much of each is present) ... - but if this were the case – why is she feeling "well" ???

Another possibility might be that her pituitary gland is malfunctioning for some reason ... but if so – WHY – and why NOW ? - it was apparently working normally a year ago or whenever she had her last TSH check, which had been in accordance with her thyroid figures and reflected accurately the level of her medication.

Obviously, there must be an error of thinking on my part somewhere, I just wish I knew where I am going wrong.

Has anybody else some thoughts on the matter?

Thanks,

[Guest guest]

> I remember reading somewhere that a high or even normal level of T3 with Low T4> can be a result of compensation. (I wish I could remember where I read it but> unfortunately I can't.) Somehow the thyroid compensates for Low T4 by making> more T3.  I have experienced this myself. I have had a TSH of 10 and had a mid> range Free T3 but with all the symptoms of hypothyroidism.

Thanks, , that is interesting.... I have not heard that before. Were you on thyroid medication whilst having such a high TSH? - and had your TSH been suppressed before shooting up ?

My friend is on natural thyroid, and I assume her FT4 is so low because the T4:T3 ratio in NDT is much higher in T3 than the T4:T3 ratio a normal thyroid would produce. The FT3 and FT4 figures do not worry me - I would expect such a pattern when taking NDT and having a flare up of diverticulitis. What confuses me is why her TSH would shoot up from being totally suppressed by thyroid medication to a height of 4.42 all of a sudden ... and why her endo does not seem to attach any importance on that.

I remember that one of our members (was it Stevie??? ...sorry if I remember the name wrongly) had similar TSH fluctuation whilst on thyroid medication and her endo glossed over that too. I want to get to the bottom of what causes a TSH to shoot up from a suppressed status to the top of the ref range when the patient is on 'apparently' sufficient thyroid replacement.

To the best of my knowledge, non-thyroidal illnesses can cause the T4 to fall - so my friend's very low T4 might have been caused/influenced by her diverticulitis. But non-thyroidal illnesses do not, as far as I know, cause a rise in TSH. In fact, a low T4 but normal TSH it is one of the criteria for doctors dismissing thyroidal illness. So what am I missing here ?

love,

[Guest guest]

Hi, What does the funny thyroid results chart in the files say? I would not have thought 1.5 grain was a full replacment dose, and fT3 at that level should be fine, but if receptors blocked then it's going nowhere. Be interesting to see FT3 versus RT3 What is ferritin like? zinc? etc thyroid treatment From: christina@...Date: Thu, 7 Oct 2010 16:45:40 +0000Subject: Help please with TFT interpretation - rT3 issue ??

Hi all,

I am hoping someone might be able to help me make sense of the thyroid results

So, those below are her thyroid results.... I can understand why her FT4 has dropped – she has switched to NDT, so that would explain it. But how can the FT3 be at the upper norm range when at the same time her TSH has rocketed to 4.42 ??? It is not on this chart, but previously (when she was first on Armour) her TSH was down to 0.something and she had good FT4 and FT3 readings. During her almost 2 years on Levo the TSH had either not been checked or she hasn't got the numbers, just her FT4 and on one occasion her FT3 as well.

Ranges

March

April

July

Sept 20th

FT4

10 - 22

21.8

34.4

21.8

8.9

TSH

0.3 – 3.82

4.42

FT3

3.95 – 6.8

4.7

6.8

Levothyroxine

125mcgs

150mcgs

125mcgs

Thiroyd

1 1/2 grain

What comes to my mind (rightly or wrongly) is rT3 ..... Nick, if you are about ? – what do you make of the above? Could such results be brought on by too much rT3 ?? Does anybody have any bright ideas of what might be going on here? I'd be grateful for suggestions.

Other than 1 1/12 grains NDT she takes 1 NAX (she should take more, I know), extra calcium (away from thyroid) and Vit C – nothing else.

Many thanks,

[Guest guest]

> See http://www.patient.co.uk/doctor/Thyroid-Function-Tests-(TFTs).htm >

Many thanks for posting the chart, Sheila

I read through it, and although my friends 'case' is not covered, it nonetheless gives me some pointers as to what might have upset the apple cart with her. She had been on several antibiotics as well as Tramadol repeatedly and for some length of time and that might have influenced the TFT. The medication she has taken has not been listed in this article, but still, it is possible that it might have had an effect .... even if I cannot see the logic why this should elevate the TSH. However, aanother possibility is that her TPO autoantibodies might have erroneously pushed up her FT3 and the true figure might be much lower than it appears. I have seen such confusing figures in TFT's of dogs, but never in humans. I have in the past been told conflicting things about what autoantibodies can or cannot do. If you remember (no reason why you should ) - this was one of my questions to Dr. Peatfield two years ago at the Yorkshire meeting. Dr. P. said categorically that positive autoantibodies will not falsely elevate the FT's.... whereas a leading US veterinarian assured me that positive thyroid autantibodies do falsely elevate the FT's.... not sure who is right or if different meachnisms apply to the canine world, but I would not rule it out as a possibility. My friend will have a further thyroid test quite soon, and I am very curious what figures she will present with this time.

Love,

xx

[Guest guest]

>> http://www.bioscilibrary.com/resource/summerschool/2006/ss06/gur.gif

> Does this chart help ?

Wow, Sheila - that's a good one too , many thanks .... but no, in this particular instance it is still too vague. I am looking for a cause for high TSH, low FT4 and high FT3 ..... a mix that does not make sense to me.

My thoughts for a possible cause are - non-thyroidal medication ?, questionable rT3 ? . severe mineral or vitamin deficiency of some sort which might prevent the T3 from getting into the cells ? or an autoantibody attack which might have erroneously pushed up the FT3 figure ? - But all those are only guesses.

What worries me for her is that she is scheduled to undergo major bowel surgery next month whilst she might still be experiencing a dodgy thyroid situation.... - not the best of combinations !

Love,

xx

[Guest guest]

H i ,

What about Trab blocking antibodies?

On the other hand, the most common cause of a falsely high TSH results is assay

...... antibodies (TBAb) that block TSH binding to its receptor.

http://www.thyroidmanager.org/Chapter6a/6a-frame.htm

PS. I've been waiting for the same op (bowel resection?) and my surgeon said my

thyroid levels need to be spot on as going hypo again will defeat the purpose,

getting constipated will cause diverticular disease in another place as the

bowel

wall is already weakened. I've had Crohns for years though so maybe that makes

a difference.

Love Tess

> >

> > http://www.bioscilibrary.com/resource/summerschool/2006/ss06/gur.gif

> <http://www.bioscilibrary.com/resource/summerschool/2006/ss06/gur.gif>

>

> > Does this chart help ?

>

>

>

[Guest guest]

Hello Tess,

***What about Trab blocking antibodies?

***On the other hand, the most common cause of a falsely high TSH results is assay..... antibodies (TBAb) that block TSH binding to its receptor.

Please tell me more about this – that sounds very interesting, Tess. I have heard of Trab and TBAb, but have no proper idea of what they do..... must google them... But please tell me what you know about those antibodies and how they affect the thyroid function....

http://www.thyroidmanager.org/Chapter6a/6a-frame.htm

Many thanks for that site ..... I did start reading but that's a mammoth article and not easy to understand. I will get through it though ;o)PS. I've been waiting for the same op (bowel resection?) and my surgeon said mythyroid levels need to be spot on as going hypo again will defeat the purpose,getting constipated will cause diverticular disease in another place as thebowel wall is already weakened. I've had Crohns for years though so maybe that makesa difference.Yes, her ops will be a bowel resection too – and as you say – one needs to be as fit and healthy as possible when undergoing this operation. She hasn't got Crohn's, "just" severe diverticulitis with adhesions, so the worry here is bowel strangulation....

Love,

[Guest guest]

http://f1.grp.fs.com/v1/cCazTLWxqpgDznAtND7-lPgaKU_FVMXYDrgD2McuNu6NHewQxsZ\

IYnoFYyytd-e5oiLTSIxsc5MnexmhVCp3gLy-Js5kqNBIzIw/TESTS/'Funny' Thyroid Function

Tests.doc

[Guest guest]

Hi ,

I only know about them because when I asked for a second opinion on my Graves

diagnosis, (I was very hypo then due to carbimazole) endo retested my TRab and

that time tested for both stimulating and blocking.....I had both.

They seem to only test for stimulating ones here!

Actually I found that article because I was googling them because they're

looking

into my lack of TSH as my TRab is still elevated even though I've no thyroid.

I'm

the opposite of your friend low T4 and T3 and TSH o.o1. I know the TSH can stay

suppressed in Graves for ages.....and I'm on T3 but GP thinks there is something

else going on. Hypothalmus and Pituitary was mentioned but my brain had clouded

over at that point.

I thought they did the same as the TSI and blocked the TSH making it stay low

then came across that article

and thought about your post. Here's a link on thyroid antibodies with a bit

about

the blocking ones. I'm sure I put this files before. It explains it better than

I can lol.

http://www.suite101.com/lesson.cfm/19330/2899/4

It's repeated Diverticulitis I'm getting the op for this time too....colonoscopy

report

from a few wks ago :-( Severe narrowing/tortuosity and circular muscle

hypertrophy. Great stuff!!

Love Tess

>

>

[Guest guest]

> Actually I found that article because I was googling them because they're looking> into my lack of TSH as my TRab is still elevated even though I've no thyroid. I'm> the opposite of your friend low T4 and T3 and TSH o.o1.

Brilliant Tess - many, many thanks for that. I have never been able to get my head round Graves disease and antibodies like TRab and TSI. This last article makes it a little easier to understand. Most of it is still going over my head, but usually when I read it a few times, it slowly tends to sink in.

I will forward the website to my friend and prompt her to ask her doctor for testing all those autoantibodies too. They should really not leave any stone unturned before she has this operation.

All the best for your forthcoming operation, Tess. Those are worrying times for you too . Please keep us all posted on your progress.

love,

[Guest guest]

Glad it helped , my op won't be until Jan at least :-( my vocal chord

has

been paralysed since thyroidectomy so that needs sorting first. Good luck for

your

friend though as it's a big op....I've already had one done!

Good luck with getting TRab tested by a GP too......usually only endo's will do

that

one though God only knows why?

Love Tess

> > Actually I found that article because I was googling them because

> they're looking

> > into my lack of TSH as my TRab is still elevated even though I've no

> thyroid. I'm

> > the opposite of your friend low T4 and T3 and TSH o.o1.

>

>

>

> Brilliant Tess - many, many thanks for that. I have never been able to

>