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What Do My Lab Test Reports Indicate?
Question: Dear Doctor,
I was diagnosed for depression and anxiety since 2011 and took all kinds of SSRI's and SNRI's till May 15th 2016 then stopped everything as I haven't noticed any huge improvement. Every 6 months since 2011, I perform regular blood tests, including TSH test and T3 + Free T4 test (TSH always 4.2-4.3-3.9 bur the rest are normal).
1 week ago, I went to an endoctrinologist who said i have no apparent goiter at all, but asked me to perform Anti-TPO test, which result was 469 [normal range being 0-34]. He said nothing to do, just a test every 6 months (this dr is a big professor at hotel-dieu hospital in Beirut-french medicine).
I went to another endoctrinologist (a big professor at the XXXXXXX University Hospital in Beirut-American School), who said you have Hashimoto's Disease and asked me to begin taking Euthyrox 50 and follow-up in 3 months, saying soonee or later you WILL have hypothyroïdism. None of them asked me for a radiography of the Thyroïd or something like this.
What is the best advice you can give me? Should I begin the treatement or not?
All my blood results and liver tests and doppler echo-cardiography and EKG and creatinine and urea and stuff like that in the blood are normal, but I have chronic tinnitus in my ears and my heas since november and chronic insomnia since december 2014. I stopped antidepressants 2 months ago and withdrawal symptoms have nearly ended i guess.. i just take half a Xanax when needed, usually at bedtime to be able to sleep 3 hours at night or 4 hours maximum!
I also have tachicardia most of the time and i'm afraid it's not a symptom of hypothyroïdism...
I'm afraid of beginning a treatement, knowing that i'm very sensitive to meds and I get a lot of side effects from them.
My arterial tension is 12/8 To 13/9 most of the time, while my father (since he was 60 years-old) was treated for hypertension. [just info for you to tell me if the med suits me or not].
Thank you for your prompt and clear answer!
I was diagnosed for depression and anxiety since 2011 and took all kinds of SSRI's and SNRI's till May 15th 2016 then stopped everything as I haven't noticed any huge improvement. Every 6 months since 2011, I perform regular blood tests, including TSH test and T3 + Free T4 test (TSH always 4.2-4.3-3.9 bur the rest are normal).
1 week ago, I went to an endoctrinologist who said i have no apparent goiter at all, but asked me to perform Anti-TPO test, which result was 469 [normal range being 0-34]. He said nothing to do, just a test every 6 months (this dr is a big professor at hotel-dieu hospital in Beirut-french medicine).
I went to another endoctrinologist (a big professor at the XXXXXXX University Hospital in Beirut-American School), who said you have Hashimoto's Disease and asked me to begin taking Euthyrox 50 and follow-up in 3 months, saying soonee or later you WILL have hypothyroïdism. None of them asked me for a radiography of the Thyroïd or something like this.
What is the best advice you can give me? Should I begin the treatement or not?
All my blood results and liver tests and doppler echo-cardiography and EKG and creatinine and urea and stuff like that in the blood are normal, but I have chronic tinnitus in my ears and my heas since november and chronic insomnia since december 2014. I stopped antidepressants 2 months ago and withdrawal symptoms have nearly ended i guess.. i just take half a Xanax when needed, usually at bedtime to be able to sleep 3 hours at night or 4 hours maximum!
I also have tachicardia most of the time and i'm afraid it's not a symptom of hypothyroïdism...
I'm afraid of beginning a treatement, knowing that i'm very sensitive to meds and I get a lot of side effects from them.
My arterial tension is 12/8 To 13/9 most of the time, while my father (since he was 60 years-old) was treated for hypertension. [just info for you to tell me if the med suits me or not].
Thank you for your prompt and clear answer!
Brief Answer:
Thyroid
Detailed Answer:
I see your TSH is hovering near the upper end of normal while the total thyroid hormone levels are normal although the Total T3 is at lower end of normal.
I have noted the positive thyroid antibody test result. Indeed it is indicative of Hashimoto's thyroiditis.
When I see someone like you in my practice, I generally wait 6 months and check TSH along with Free T4, to see if that person needs thyroid medication.
If the TSH is above 4.2 or above the upper limit of the laboratory reference range, especially with a low Free T4, then one can make a case for considering thyroid medication like thyroxine.
Typically most endocrinologists do not start thyroxine until TSH exceeds 10, unless there are unique circumstances like pregnancy which obviously is not applicable to you.But each decision needs to be made on a case-by-case basis after a thorough in-person physical examination
Thyroid
Detailed Answer:
I see your TSH is hovering near the upper end of normal while the total thyroid hormone levels are normal although the Total T3 is at lower end of normal.
I have noted the positive thyroid antibody test result. Indeed it is indicative of Hashimoto's thyroiditis.
When I see someone like you in my practice, I generally wait 6 months and check TSH along with Free T4, to see if that person needs thyroid medication.
If the TSH is above 4.2 or above the upper limit of the laboratory reference range, especially with a low Free T4, then one can make a case for considering thyroid medication like thyroxine.
Typically most endocrinologists do not start thyroxine until TSH exceeds 10, unless there are unique circumstances like pregnancy which obviously is not applicable to you.But each decision needs to be made on a case-by-case basis after a thorough in-person physical examination
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply Dr.
These are my previous results (the dates of the exams are on the top right of each page).
What do you think? I wait 3 months and do the tests again or I begin Eurthyrox 50 now? Will i need a radiography of my Thyroid? Will keeping TPO antibodies that high with normal TSH and T3 and free T4 is still Hashimoto and is needed to be treated?
These are my previous results (the dates of the exams are on the top right of each page).
What do you think? I wait 3 months and do the tests again or I begin Eurthyrox 50 now? Will i need a radiography of my Thyroid? Will keeping TPO antibodies that high with normal TSH and T3 and free T4 is still Hashimoto and is needed to be treated?
Brief Answer:
Follow up
Detailed Answer:
I have reviewed the attached reports.
1 When I see someone like you in my practice, I recheck TSH and Free T4 in 6 months.
What you should do, is dependent on a discussion between your endocrinologist and you.
2 Radiography of the thyroid is not required.
3 Please note that TPO antibodies can be positive in a small percentage of normal people too.
4 There is no treatment yet for positive TPO antibodies alone.
Treatment with thyroxine is begun only when Hashimoto's causes hypothyroidism (ie thyroid under activity)
Follow up
Detailed Answer:
I have reviewed the attached reports.
1 When I see someone like you in my practice, I recheck TSH and Free T4 in 6 months.
What you should do, is dependent on a discussion between your endocrinologist and you.
2 Radiography of the thyroid is not required.
3 Please note that TPO antibodies can be positive in a small percentage of normal people too.
4 There is no treatment yet for positive TPO antibodies alone.
Treatment with thyroxine is begun only when Hashimoto's causes hypothyroidism (ie thyroid under activity)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks you Dr.
Please reply to these points in the same chronologic order :
1) in my case, when you saw my reports, do you think i have a mild hypothyroidism?
2) dr said : with these eleveted anti-tpo, you WILL have hypothiroidism one day, there is no escape, so better to treat with Levothyroxine the soonest. Is he right?
3) I've been suffering from muscle weekness and insomnia (1 year and a half) and depression and frilosity for a long time now (5 years now). Don't you think taking 50 Mg of Levothyroxine daily will help solve these problems or reduce them by 50% at least, while reajusting TSH level from 4.45 to 1.5 for example? Don't you think it's time to do something?
4) Let's say I took Levothyroxine 50 Mg starting tomorrow morning. What are the risks IF i don't REALLY need it like someone who has a TSH level of 11 [what are the risks if my body don't really need it]. Will I die from it? Can't I stop it anytime if it doesn't suit me?
These were my last questions.
Thank you for your time and patience.
Please reply to these points in the same chronologic order :
1) in my case, when you saw my reports, do you think i have a mild hypothyroidism?
2) dr said : with these eleveted anti-tpo, you WILL have hypothiroidism one day, there is no escape, so better to treat with Levothyroxine the soonest. Is he right?
3) I've been suffering from muscle weekness and insomnia (1 year and a half) and depression and frilosity for a long time now (5 years now). Don't you think taking 50 Mg of Levothyroxine daily will help solve these problems or reduce them by 50% at least, while reajusting TSH level from 4.45 to 1.5 for example? Don't you think it's time to do something?
4) Let's say I took Levothyroxine 50 Mg starting tomorrow morning. What are the risks IF i don't REALLY need it like someone who has a TSH level of 11 [what are the risks if my body don't really need it]. Will I die from it? Can't I stop it anytime if it doesn't suit me?
These were my last questions.
Thank you for your time and patience.
Brief Answer:
Second follow up
Detailed Answer:
See trailing responses
1) in my case, when you saw my reports, do you think i have a mild hypothyroidism?
No
2) dr said : with these eleveted anti-tpo, you WILL have hypothiroidism one day, there is no escape, so better to treat with Levothyroxine the soonest. Is he right?
While there is a good chance you will eventually develop hypothyroidism, I personally do not believe this is inevitable
3) I've been suffering from muscle weekness and insomnia (1 year and a half) and depression and frilosity for a long time now (5 years now). Don't you think taking 50 Mg of Levothyroxine daily will help solve these problems or reduce them by 50% at least, while reajusting TSH level from 4.45 to 1.5 for example? Don't you think it's time to do something?
You can try levo thyroxine under your doctors guidancet, although in my professional opinion doing so is unlikely to help these symptoms.
4) Let's say I took Levothyroxine 50 Mg starting tomorrow morning. What are the risks IF i don't REALLY need it like someone who has a TSH level of 11 [what are the risks if my body don't really need it]. Will I die from it? Can't I stop it anytime if it doesn't suit me?
It is unlikely to harm you as long as the TSH is in the normal range. You can stop it if it does not suit. Just keep your endocrinologist in the loop at all times
Second follow up
Detailed Answer:
See trailing responses
1) in my case, when you saw my reports, do you think i have a mild hypothyroidism?
No
2) dr said : with these eleveted anti-tpo, you WILL have hypothiroidism one day, there is no escape, so better to treat with Levothyroxine the soonest. Is he right?
While there is a good chance you will eventually develop hypothyroidism, I personally do not believe this is inevitable
3) I've been suffering from muscle weekness and insomnia (1 year and a half) and depression and frilosity for a long time now (5 years now). Don't you think taking 50 Mg of Levothyroxine daily will help solve these problems or reduce them by 50% at least, while reajusting TSH level from 4.45 to 1.5 for example? Don't you think it's time to do something?
You can try levo thyroxine under your doctors guidancet, although in my professional opinion doing so is unlikely to help these symptoms.
4) Let's say I took Levothyroxine 50 Mg starting tomorrow morning. What are the risks IF i don't REALLY need it like someone who has a TSH level of 11 [what are the risks if my body don't really need it]. Will I die from it? Can't I stop it anytime if it doesn't suit me?
It is unlikely to harm you as long as the TSH is in the normal range. You can stop it if it does not suit. Just keep your endocrinologist in the loop at all times
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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