WTF Thyroid
April 27, 2017 8:20 PM Subscribe
Based on answers to a previous question, I went and got my thyroid tested. Something's not right, but my primary care doctor isn't being very collaborative/problem-solvey and just blankly referred to me an endo, whose next appointment isn't for more than eight weeks. If you have results like mine, what did it mean for you? I'd like to get prepared and walk into the endo appointment knowing what I'm talking about.
Got my blood tested. Results are... mixed.
Free T3 is 2.8, normal.
Free T4 is 1.0, normal.
T4 (non-free?) is 14.4, high.
TSH is 2.748, normal.
So what is the difference between "free" T4 and "non-free" T4, and why would one be high and the other one normal? This seems to be an un-googleable problem, so hoping someone with their own thyroid issues can share their experience here. YANMD, but so many people jumped on the Thyroid Issues train in my last question that y'all must have some experience to share. Have at it, I'm listening and learning.
Got my blood tested. Results are... mixed.
Free T3 is 2.8, normal.
Free T4 is 1.0, normal.
T4 (non-free?) is 14.4, high.
TSH is 2.748, normal.
So what is the difference between "free" T4 and "non-free" T4, and why would one be high and the other one normal? This seems to be an un-googleable problem, so hoping someone with their own thyroid issues can share their experience here. YANMD, but so many people jumped on the Thyroid Issues train in my last question that y'all must have some experience to share. Have at it, I'm listening and learning.
Try the British Thyroid Foundation's site . There is so much crazy on the internet about thyroid disorders: most of the US sites fall somewhere between Bigfoot hunters and Infowars on the sanity spectrum so I'd stick to reputable organizations like this one for basic info and look for published articles for specifics.
posted by fshgrl at 8:57 PM on April 27, 2017 [8 favorites]
posted by fshgrl at 8:57 PM on April 27, 2017 [8 favorites]
Have you got any thyroid nodules? Sometimes they're visible at the base of someone's neck, as a very slight swelling.
Your results are not a million miles from mine, and I'm going through exploratory work for thyroid cancer. So far, biopsy results for half my nodules are benign (yaaassss!) and I get the rest of the results middle of next week. Benign or not, thyroid problems are super treatable. But the wait between endocrinologist visits must be hard for you. Personally, I was a wreck until the first results came through.
posted by scruss at 9:05 PM on April 27, 2017
Your results are not a million miles from mine, and I'm going through exploratory work for thyroid cancer. So far, biopsy results for half my nodules are benign (yaaassss!) and I get the rest of the results middle of next week. Benign or not, thyroid problems are super treatable. But the wait between endocrinologist visits must be hard for you. Personally, I was a wreck until the first results came through.
posted by scruss at 9:05 PM on April 27, 2017
Only commenting on the TSH value: while it's within normal range, some people (including me) show quite some symptoms around that value and feel better with a lower TSH value, more toward 1. Caveat, ranges vary between labs, so don't take this as hard and fast numbers.
posted by meijusa at 11:23 PM on April 27, 2017 [4 favorites]
posted by meijusa at 11:23 PM on April 27, 2017 [4 favorites]
1. Did your doctor do an ultrasound?
2. Was there no test for anti-bodies? (Hashimoto's, Graves' disease)
3. Did you get a lab range for your results? Like, for your ft4, is it 1,0 (0,8-2,4) or something similar? Then that is pretty low and many people feel better with higher ft4 and lower TSH, as meijusa said above.
posted by LoonyLovegood at 4:20 AM on April 28, 2017 [1 favorite]
2. Was there no test for anti-bodies? (Hashimoto's, Graves' disease)
3. Did you get a lab range for your results? Like, for your ft4, is it 1,0 (0,8-2,4) or something similar? Then that is pretty low and many people feel better with higher ft4 and lower TSH, as meijusa said above.
posted by LoonyLovegood at 4:20 AM on April 28, 2017 [1 favorite]
I know it is hard to wait to see the specialist to get answers, especially when you just want to feel better, but I wanted to let you know that I think in the long run it's better that your primary care doctor isn't trying to solve this one. Thyroid issues have a lot of nuance - too many people suffer for years because a generalist writes them a script based solely on the numbers. Or doesn't write one because the numbers say "in range" but the patient is clearly suffering. A good endocrinologist can be truly life changing. Thyroid issues often manifest in symptoms that are non-descript and can be written off as stress or aging related but the symptoms can absolutely be managed under the right care. Keep trying until you find what works for you. You deserve to be well.
I hope you've found a good one and will be feeling better soon.
posted by cessair at 4:29 AM on April 28, 2017 [4 favorites]
I hope you've found a good one and will be feeling better soon.
posted by cessair at 4:29 AM on April 28, 2017 [4 favorites]
Your results are not a million miles from mine, and I'm going through exploratory work for thyroid cancer.
FYI, most thyroid cancers do not affect thyroid function in early stages. American Thyroid Association: The important points to remember are that cancers arising in thyroid nodules generally do not cause symptoms [and] thyroid function tests are typically normal even when cancer is present.
So OP, you probably do not have thyroid cancer, or at the very least, you couldn't tell if you did from your labs (but obviously, if you have palpable nodules, do get them checked out.)
posted by damayanti at 4:35 AM on April 28, 2017
FYI, most thyroid cancers do not affect thyroid function in early stages. American Thyroid Association: The important points to remember are that cancers arising in thyroid nodules generally do not cause symptoms [and] thyroid function tests are typically normal even when cancer is present.
So OP, you probably do not have thyroid cancer, or at the very least, you couldn't tell if you did from your labs (but obviously, if you have palpable nodules, do get them checked out.)
posted by damayanti at 4:35 AM on April 28, 2017
Just call the endo's office every morning and every afternoon asking if there is a cancellation. By the fourth day they will be expecting your phone call, and by the second business week they will be calling you if they have one. It's worth it to see an endo rather than a GP.
posted by PorcineWithMe at 4:40 AM on April 28, 2017 [7 favorites]
posted by PorcineWithMe at 4:40 AM on April 28, 2017 [7 favorites]
This is hard to Google because it requires an understanding of thyroid physiology as well as your overall clinical picture to interpret (hence why it's much better to have results interpreted by a physician). IANAD and IANYD.
In summary, the majority of the T3 and T4 in your blood are circulating bound to other proteins, like thyroxine-binding globulin (TBG) and albumin. It's only when the T3 or T4 are unbound that they do their work in the body, which is why the "free T3" and "free T4" measurements are performed.
An analogy: Imagine that your body is a public library: if you want to get a sense of how much people in the town are reading, you could count all of the books that the library has (total T3 or total T4), but a much better approach would be to count all of the books that are currently checked out to patrons (free T3 or free T4).
Since bound T3 and T4 don't perform functions in the body, they don't cause clinically significant thyroid disease. However, having elevated total T4 can reflect having more of the binding proteins (like TBG) in your blood. In our library analogy, this would be like building an extra wing on the library and filling it with books, but not changing how many books are checked out. There are more books in the library system (elevated total T4), but the amount of reading in the community remains the same (normal free T4).
A very common cause of elevated TBG is exogenous estrogens, e.g. oral contraceptive pills or hormone replacement. Some other medicines can also causes increased TBG levels (e.g. amiodarone, high dose beta blockers, etc).
It's good to see the endocrinologist eventually but what you have in your hands is an essentially normal thyroid function panel. If you are experiencing symptoms that are impacting your quality of life, you might want to explore other possible causes while you wait for your endo appointment.
posted by telegraph at 5:43 AM on April 28, 2017 [7 favorites]
In summary, the majority of the T3 and T4 in your blood are circulating bound to other proteins, like thyroxine-binding globulin (TBG) and albumin. It's only when the T3 or T4 are unbound that they do their work in the body, which is why the "free T3" and "free T4" measurements are performed.
An analogy: Imagine that your body is a public library: if you want to get a sense of how much people in the town are reading, you could count all of the books that the library has (total T3 or total T4), but a much better approach would be to count all of the books that are currently checked out to patrons (free T3 or free T4).
Since bound T3 and T4 don't perform functions in the body, they don't cause clinically significant thyroid disease. However, having elevated total T4 can reflect having more of the binding proteins (like TBG) in your blood. In our library analogy, this would be like building an extra wing on the library and filling it with books, but not changing how many books are checked out. There are more books in the library system (elevated total T4), but the amount of reading in the community remains the same (normal free T4).
A very common cause of elevated TBG is exogenous estrogens, e.g. oral contraceptive pills or hormone replacement. Some other medicines can also causes increased TBG levels (e.g. amiodarone, high dose beta blockers, etc).
It's good to see the endocrinologist eventually but what you have in your hands is an essentially normal thyroid function panel. If you are experiencing symptoms that are impacting your quality of life, you might want to explore other possible causes while you wait for your endo appointment.
posted by telegraph at 5:43 AM on April 28, 2017 [7 favorites]
I am just chiming in to agree with cessair.
I have been both hyper and hypothyroid (the latter the result of the treatment for the former). The symptoms can be subtle, so it really took a while for family doctor to test me for hyperthyroid. And then, years later, it took a while for the same doctor to realize I had become hypothyroid, with other different subtle symptoms. Also I'm a guy so statistically less likely.
As for being prepared for your appointment (when you finally get in) I would be sure to mention (but IANAD and IANYD) things you notice with regard to heart rhythms, skin dryness or irritation, affect or mood changes, obviously temperature (my feet are still always cold), cloudy thinking, tremors, etc. Of course the doctor will be looking for specific signs, so between your self-reporting, their exam and lab/imaging tests a picture is formed.
By the way, since in your previous question you said you were science minded, so you might find the connection between the pituitary and thyroid interesting (vis TSH). Hang in there!
posted by forthright at 7:04 PM on April 28, 2017
I have been both hyper and hypothyroid (the latter the result of the treatment for the former). The symptoms can be subtle, so it really took a while for family doctor to test me for hyperthyroid. And then, years later, it took a while for the same doctor to realize I had become hypothyroid, with other different subtle symptoms. Also I'm a guy so statistically less likely.
As for being prepared for your appointment (when you finally get in) I would be sure to mention (but IANAD and IANYD) things you notice with regard to heart rhythms, skin dryness or irritation, affect or mood changes, obviously temperature (my feet are still always cold), cloudy thinking, tremors, etc. Of course the doctor will be looking for specific signs, so between your self-reporting, their exam and lab/imaging tests a picture is formed.
By the way, since in your previous question you said you were science minded, so you might find the connection between the pituitary and thyroid interesting (vis TSH). Hang in there!
posted by forthright at 7:04 PM on April 28, 2017
I would like to second and highlight again fshgrl's response.
People like taking thyroid hormone for a number of reasons. It has been debated whether thyroid hormone could be considered a performance enhancing drug. It can seem like quick fix for nonspecific symptoms that would otherwise be difficult to pin down and treat. These are some reasons why thyroid hormone is thought to be a very overprescribed/abused medication. You can read more about the American Thyroid Association's opinion on the definition of hypothyroidism and when to treat it in this clinical guideline from page 1000 to 1002.
posted by treehorn+bunny at 9:46 PM on April 28, 2017
People like taking thyroid hormone for a number of reasons. It has been debated whether thyroid hormone could be considered a performance enhancing drug. It can seem like quick fix for nonspecific symptoms that would otherwise be difficult to pin down and treat. These are some reasons why thyroid hormone is thought to be a very overprescribed/abused medication. You can read more about the American Thyroid Association's opinion on the definition of hypothyroidism and when to treat it in this clinical guideline from page 1000 to 1002.
posted by treehorn+bunny at 9:46 PM on April 28, 2017
Response by poster: Just in case anyone is further watching this thread - I did end up going to an endocrinologist, got retested, and had an elevated TSH level for the retest; I am now on thyroid-replacement hormones.
For what it's worth, the endo said there were plenty of other reasons I could be experiencing symptoms like mine that were related to endocrinology, and had my TSH test come up normal (not indicating hypothyroidism), she was planning to test for PCOS next.
posted by juniperesque at 12:47 PM on July 14, 2017 [1 favorite]
For what it's worth, the endo said there were plenty of other reasons I could be experiencing symptoms like mine that were related to endocrinology, and had my TSH test come up normal (not indicating hypothyroidism), she was planning to test for PCOS next.
posted by juniperesque at 12:47 PM on July 14, 2017 [1 favorite]
Ask them to test anyway if you are having the symptoms that correlate to PCOS. Having PCOS puts you at higher risk of cardiac issues, so you'll want to behave accordingly should you be diagnosed. Hypothyroid and PCOS are often co-diagnoses.
posted by PorcineWithMe at 12:54 PM on July 14, 2017
posted by PorcineWithMe at 12:54 PM on July 14, 2017
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