What Do These Thyroid Results Indicate?

Posted on Mon, 21 Apr 2014

Question: Hi Doctor, Patient has been diagnosed with Hypothyroidism and been on NDT (natural desiccated thyroid) for 2 years. The current dose is 1 Grain (65 mg) 38 mcg T4, 9 mcg T3. Latest blood resulst came out as follows: Test Result Reference S-TSH (ModE) 1,2 (0,3-4,2) S-T3, free (ModE) 6,3 (3,1-6,8) S-T4, free (ModE) 12 (12-22) Patient is feeling better when taking the NDT as oppose to not taking them but is still not ok and many sumptoms are still there (Fatigue, Weight Gain, Menstrual Disturbances, Myxedema etc.). When trying to raise the dose, patient is experiencing hyper symptoms. Any suggestions on how to move on with treatment? T4 is just slightly within range it seems

Answered by Dr. Shehzad Topiwala (4 hours later)

Brief Answer: Thyroid Detailed Answer: First confirm if this patient truly has hypothyroidism. There are a few ways to ascertain this. One is to find out the baseline TSH before treatment was begun. If it was abnormally high, especially above 10 then it is likely she has hypothyroidism. However this can occur as part of recovery in thyroiditis so it is not 100% certain that she has permanent hypothyroidism. There are further means to determine this. One is to check blood levels of antibodies like anti TPO (Thyroid Peroxidase) and anti Thyroglobulin. If any one or both of these are positive then it is extremely likely that she has chronic hypothyroidism requiring lifelong treatment with thyroid medication. Other indirect ways include having a goiter or a strong family history of thyroid problems, or a baseline TSH of more than 20. These are highly suggestive of permanent hypothyroidism Once the above has been settled then treatment with levo thyroxine is to be initiated. The latest expert guidelines reconfirm the fact the levo thyroxine alone suffices and NDT/other preparations are deemed unsafe. they contain varying amounts of T3 and T4. This is not necessary because the body converts t4 to as much T3 as it needs. As long as she has no major cardiac problems or sever osteoporosis, she will need enough replacement doses of levo thyroxine to keep her TSH between 0.4 to 2.5 If she gets pregnant she must increase her dose by 30 to 50 %

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar