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Help in Understanding Thyroid Tests

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Hi.  I am hoping that someone out there can help me understand these tests. My most recent tests and levels are as follows.  Note:  These levels are with medication.  I take 150mcg of Levothyroxine daily and have been taking this medication for several years now.     


TSH = 0.64 mciu/ml

T3 = 891 ng/dl

Free T4 = 1.3 ng/dl


I have not had the reverse T3 test done.  Is it possible to have a bad T3 to reverse T3 ratio even though these tests are at a good level? 


I have also been told by my doctor that because I am Hypothyroid, I most likely have Hashimoto's although I have not been tested.  What tests need to be done to determine this diagnosis?


Any help would be appreciated.



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I tend to rely on Mary Shomon's information on About.com, Facebook, and elsewhere to help me understand tests - I tend to forget everything between testing periods.  :lol:   If you google Mary J. Shomon you'll come up with a BLINDING array of useful information.  She also has books out that you can buy/get from the library.


Regarding testing for Hashimoto's, I have to say that it doesn't make much sense to me that your doc wouldn't have tested you for it.  You just add it to the stuff they're testing for on the lab slip when you go for your blood work.  I'm a little :blink: that your doc is willing to presume but not willing to add a few words/syllables to your lab slip for a blood draw.  That said, I believe about 90% of hypothyroid is caused by Hashimoto's, so your doc is probably right.  But really, it's not a big deal to test for it.  I kinda can't believe your doc hasn't done that. :ph34r:


The thing about Hashimoto's vs. idiopathic hypothyroid is that Hashimoto's is an autoimmune condition/disease, and some Hashimoto's folks do much better on the Paleo AIP (auto-immune protocol).  I find that a regular Whole30 seems to be sufficient for me, my thyroid tests (whether minimal from an MD or extensive from my new and beloved naturopathic physician) and my symptoms seem fine when I am eating Whole30 pretty much all of the time except for special occasions.


I'm sorry I can't address your specific results (other than continuing to roll my eyes at your doc for not testing you for Hashimoto's), but I do know that you can get very helpful results from Mary Shomon's work.  I'll warn you, after I started reading her in depth, I switched not only my doctor but the kind of medical professional I pursue/respect for thyroid treatment. She gets you thinking for yourself. :o:lol:

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Yeah, I couldnt understand why he didnt test for that when I specifically asked to be tested for that.  I no longer go to that doctor for that reason.  My cholesterol was a little high as well and in the same breath that he told me that I probably had Hashimoto's he told me to go on a whole grain/low fat diet, eat less and workout more.  I was so upset by that I told him that he was not a good doctor and that he knew nothing about Hashimoto's at all if he was going to prescribe me that type of diet!! I then told him he was fired! I will be seeking a new specialist too.  Very frustrating!


I have a terrible time losing weight and have done a couple Whole30's and also the last Whole30 I did was AI.  I did feel better on AI, I didn't feel as tired, had more energy.  Although I lost a few pounds in that 30 days, I still have quite a bit to lose and just can't seem to.  I know it isn't about the scale so I don't rely too much on that but when you have 60 or more pounds to lose, I think there is something else going on.   


I am hoping someone else out there can give a me a little insight on these tests. 

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ok. I re-read your post and I think I'm a little out of my depth here. If you have been taking 150mcg of Levothyroxine daily for several years, this medication is keeping your thyroid at these levels. It doesn't mean your thyroid is healthy. A different doctor and a more complete blood workup is definitely in order. Whole30-style eating is good for many people with thyroid issues (including me, although I don't have Hashimotos)--I would recommend eating this way and monitoring blood levels on a regular basis, adjusting medication as needed.

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I'm just starting similar testing myself, so don't know the numbers yet.


One thing I've been made aware of already though. If your Reverse T3 is higher than your T3, this can break the internal mechanism that converts T3 to T4. Supplementing T3 or T4 isn't a real solution, as it doesn't bring you back to "normal", normal is when the conversion occurs naturally.


I'm not sure I understand this part completely, but my understanding is some thyroid disruptions are actually not the Thyroid itself, but can interfere with the thyroid. Super high Reverse T3 interferes with it, but isn't caused by it.

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Regarding reverse T3: it's something worth testing, though a lot of doctors won't. I have a friend in pre-med and she was taught that rT3 is pretty much harmless and can be ignored pretty much...

Your body has t4 circulating around your body, and your pituitary gland senses when it needs more t3 (that's your tsh level), so it essentially 'orders' a conversion from t4 to t3 to support your body to function properly. However, if your body senses it has too much t4 in the system, the body will try to dump it, so it instead converts it to rt3. The problem with that is that rt3 attaches to your t3 receptors, blocking t3 from attaching, thereby reducing your levels of t3. It's a way for the body to keep things balanced. It's also why some people feel worse when on t4 treatment only.

However, if your tsh is telling your body it has too much t4 even when it doesn't, well, it's not fun. It can be caused by a defect in the pituitary gland, deficiency in the nutrients that help convert t4 to t3, etc. In those situations, it's sometimes necessary to only treat with t3 and leave t4 out if treatment. This is what I have to do.

I'm not implying that's what's going on with you, but hope it helps you understand rt3. I'd suggest getting the thyroid antibodies test to help determine where the issue begins. I'd also suggest getting rt3. Also, I don't recall what the range for t3 is, but I've read people typically feel well even their t3 is within the upper third or even a bit higher of the range, and some find supplementing their synthroid with a small dose of t3 helps considerably.

If you're still not feeling great and are holding onto weight, it makes me think you're not at the optimal level and it'd be worth digging into it more. It's worth noting that once you start thyroid medication, the tsh level has little value; your t4, t3, and rt3 tell a much better story.

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Thanks for the info.  The reason I am digging more into these tests is because although my most recent tests are in the "normal" range, I am having some of the same symptoms as before.  Sluggish, joint pain, irritable and a very hard time losing weight even though I have been strict in my eating and exercise.  I have to get labs done soon and have asked my doctor to check my reverse T3, leptin and cortisol level but he has told me that he wants to see me first before he will order these tests.  He is my new doctor so hopefully he will listen to me.  My last doctor had no clue.  I am also watching my food intake more closely. I know there are some foods my body just cannot tollerate. I just hope I dont have a huge fight on my hands with my new doctor.  If so, I am prepared to change health care plans and find a doctor who will listen.  Fingers crossed.....


Thanks everyone for the info! 

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Chris Kresser has a free eBook that goes VERY in depth about thyroid issues, common problems with drugs, and what exactly to do, dietary-wise. Here is a link: http://my.chriskresser.com/ebook/thyroid-disorders/ You will have to enter your e-mail address, but it is a great read, and you can figure out a ton of things that you will need to know, in order to deal with this.


Yes, your doctor is right in that it is likely Hashimoto's. You will need to do an AIP for the rest of your life, if you truly want this to subside. I know, it sounds rough, but that's the way it is. Here is Mat Lalonde (Harvard organic chemist Ph.D.) explaining the situation:


Yeah. So if you look at the comments, there are some people that made some good recommendations here. And I know that Robb has a section on his site about the, like the autoimmune protocol. I unfortunately didn't get the chance to read that. I'm sure my – there's going to be some overlap with the recommendations I give here.
But gluten-free or 100% Paleo is not enough, and she's not even 100% Paleo. She's like 85% Paleo. If you have an autoimmune disease, you need a pretty rough buy-in here. So here are the recommendations I'm going to make.
I think you should follow a low-ish carbohydrate diet. Keep in mind that might increase TSH levels, but that doesn't – that doesn't mean it's pathological.
I want the carbohydrate that you consume to be mostly glucose and a little bit less fructose. So, you know, go for vegetables, roots, tubers, and bulbs, but limit fruits. Peel your vegetables whenever possible just because a lot of the protective chemicals are found in the peel.
And then the following foods or substances have to be eliminated from your diet or life: cereal grains, including – and I'm going to be comprehensive here. All varieties of wheat whether it's spelt, einkorn, emmer, or durum, barley, rye, oats, triticale, corn, maize, rice including wild rice, sorghum, millet, fonio, and teff, they have to be gone. All grain-like substances or pseudocereals whether it's amaranth, red nut, buckwheat, cattail, chia, cockscomb, kaniwa, pitseed goosefoot, quinoa, and wattleseed, which is also known as acacia seed, has to be gone.
Eggs of any kind, dairy of any kind, nuts and seeds of any kind, nightshades which includes tomatoes, potatoes, eggplants and peppers, especially hot peppers that contain capsaicin are gone; alcohol gone, NSAIDs of any kinds including aspirin, none. Antacids that contain aluminum hydroxide none, those that contain calcium carbonate are fine.
Oral contraceptives you might want to consider eliminating. And then if you have Hashimoto's, you should avoid supplementing with iodine because it's going to up regulate the heart function and make things worse.
There are some people that I've worked with that have like all kinds of funky autoimmune things going on, and I had this one person that just reacted to any kind of plant matter. I thought it was insane, but I eventually recommended an all meat and fat diet for her, and I just made sure that she got some – she didn't have Hashimoto's, so I made sure that she got some iodine in there, and that she was getting quality meat from grass-fed animals.
So she got plenty of CLA, carotenoids, conjugated linoleic acid like xenic acid and omega-3s and all that stuff. And she actually did fine, like, for the first time her liver enzymes came back positive, and she's improving. But then, you know, if she breaks down and has a sweet potato or a pear like she wakes up the next morning and she's completely swollen. So – I know it's a rough buy-in but this is it.


Here is a free article on Chris's site that will show you some common misdiagnoses related to thyroid issues:
Hopefully this helps you. Let me know if you have further questions :)
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