Saturday, March 06, 2010

Thyroid Update: Do Labs Mean Much?

By Diana Hsieh

I'm starting to think that thyroid lab values mean very little, at least in some cases.

I got my latest thyroid labs on Thursday:

  • TSH = 3.24 (above 2.5 is hypothyroid, goal to be 1.0)
  • Free T3 = 2.6 (normal range 2.0-4.4, goal to be high in that range)
  • Free T4 = 1.0 (normal range .82 to 1.77, goal to be in the middle of that range)
That's not what I expected! Basically, these lab values are the same, if not slightly worse, than they were when I was originally diagnosed as hypothyroid in November. Back then, I was pretty much a senile corpse, but the labs indicated only very mild hypothyroidism. Now I'm doing pretty darn well, thanks to desiccated thyroid and iodine, as I reported in this blog post. I still have some symptoms -- I'm still cold, my cholesterol is still high, my skin is terribly dry, and I'm not quite at full strength for weightlifting. Overall though, I'd have to say that I feel pretty darn fabulous. Yet... the labs are the same. So basically, I've gone from night to day on the inside, yet my lab values haven't budged. At least in my case, my thyroid lab values don't correlate with my well-being in the slightest! Why would that be? Speaking purely as a well-read layperson, I suspect that many of my worst hypothyroid symptoms were due to the inability of my body to make proper use of its own thyroid hormones, likely due to iodine deficiency. In this good article on the reliability of conventional thyroid tests, Dr. Briffa writes:
Another reason why TSH may not reflect true thyroid status relates to the fact that the brain and peripheral tissues (outside the brain) can sense thyroid hormone levels different. Imagine, for a moment, that the tissues in the periphery are somewhat resistant or 'numb' to the effects of thyroid hormones (in a way similar to the situation when tissues become resistant to insulin). But let's imagine there is no such problem in the brain. Then what can happen is the brain thinks there's enough thyroid hormone around, while the rest of the body is in fact deficient in thyroid hormone and therefore exhibiting the symptoms and signs of hypothyroidism.
That's the "type 2 hypothyroidism" that Dr. Mark Starr discussed in his book Hypothyroidism Type 2.

Of course, my labs and symptoms indicate some "type 1 hypothyroidism" too, meaning that I'm not producing enough thyroid hormone. Perhaps my thyroid will fully recover with more iodine supplementation, but I'm not holding my breath. For now, my doctor has raised my medication from 1.0 to 1.5 grains of desiccated thyroid, with another thyroid blood panel scheduled for eight weeks. Hopefully, that extra half grain will be all that I need to feel completely fabulous!

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