Interesting thyroid test results (Yes, I have a call in to my doc!)

In My Humble Opinion
1

Hey all. I’m wondering if any medically-minded folks might have an answer for me about some lab results I’ve received.

Quick backstory: I suffer from panic disorder and on January 3rd I “panicked” my way into the ER with tachycardia (about 125) that wasn’t responding to Xanax (I only take Xanax when in a full-blown attack, and usually after about ten minutes things calm down; this time, it didn’t work, and in fact, my heart rate was climbing. Worried I was having a heart attack, I called 911. Anyway, as usual, all tests were fine (except for high blood pressure and the tachycardia, which resolved after about six hours and three bags of fluids – the staff said the tachy was partly caused due to dehycration) – however, for some reason the ER docs wanted to double-check my thyroid levels.

Now, backstory to the backstory: back in October I’d had a full CBC including thyroid tests (at the same hospital) for my regular doctor checkup, and everything was normal; my TSH (thyroid stimulating hormone) level was about 1.3 or so, which according to this lab falls well within the normal range (0 - 5).

Anyway, in the ER, though the t3 and t4 levels were fine, the TSH was up to 9. This was flagged as too high, natch, and the docs suspected hypothyroidism. Perhaps not surprising considering I have many of the symptoms–recent weight gain, suseptibility to cold (my fingers have been cold since like November), depression (though I’m always depressed so that’s hardly new), lack of energy, etc.

Anyway, I went for a follow-up to an endocrinologist at the same hospital this week. He looked at the lab tests both from October and January, as well as viewed my symptoms/overall health, and said he wouldn’t be surprised if the high TSH result in January was a one-off problem due to the high levels of stress which, naturally, would be the case during a panic attack. Of course he did a physical check of the thyroid (normal) and ordered another round of blood tests to see what my levels were now. He figured these tests would be the tiebreaker between the normal results in October and the abnormal ones in January. :slight_smile:

I just looked up my test results online and my TSH was back down, this time to 3.89, still within what this lab considers normal. The other results were normal too. Here’s the results:

So, according to this, it looks normal, right? However, the hospital’s medical records section also included something called a “Health Issues Report” and when I clicked on that, the result said:

So here, at long last, is my question. Does this mean they’re officially diagnosing me with hypothyroidism? Why would this be, given the lab test results above? Or am I misreading it and this isn’t an actual diagnosis but the reason for the tests (for insurance purposes I guess)?

I’ll be speaking with the doc on Monday, and it’s not really an emergency, but I’m just curious what anyone who’s experienced either hypothyroidism or is a doctor who understands codes like this might shed some light on these readings/results.

Any help would be greatly appreciated. :slight_smile: Thanks!

2

It’s the reason for the test. Insurance won’t pay for two tests so close together without a valid reason. Glad your tests look better.

3

Wow, quick service. Thank you psychobunny, both for the rapid answer and the good wishes.

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FWIW, my daughter’s endocrinologist, a thyroid expert, says TSH in someone with a normally functioning thyroid gland should not be above 2.0. The American Association of Clinical Endocrinologists has recommended a TSH reference range of 0.3 to 3.0 for close to a decade. I am not sure why so many labs still have a reference range that goes to 5.0. She also tells me that free T4 should be in the upper half of the reference interval. In my opinion, you do have hypothyroidism, especially as you have clinical signs. Of course, you are not a species I can treat, as I am a veterinarian, but that’s my opinion just the same.

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Yup. Plus insurance will no longer pay for something billed as “rule out (diagnosis name)” so they had to actually plug in the diagnosis name itself.

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Possibly differing reference ranges might depend on the particular brand of lab test.

The National Institutes of Health says:

*"Normal values (for TSH) are 0.4 - 4.0 mIU/L (milli-international units per liter).

However, those without signs or symptoms of an underactive thyroid who have a TSH value over 2.0 mIU/L but normal T4 levels may develop hypothyroidism in the future. This is called subclinical hypothyroidism (mildly underactive thyroid) or early-stage hypothyroidism. Anyone with a TSH value above this level should be followed very closely by a doctor."*

Aside from the obvious advice to follow a competent physician’s counsel on what the OP should do, I’ll note that it is not all that uncommon for a single lab test result to be out of whack for a variety of non-physiologic reasons, and even in rarer instances to give deceptive results more than once. Lab tests have to be correlated with the rest of a good clinical workup in deciding on a course of therapy (or observation instead of therapy).

Jackmannii, M.D.

I dunno, we’re all mammals ain’t we? :slight_smile:

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Ooh interesting, thanks everyone. I had read about the differing ranges of what’s considered “normal” according to various labs and the AACE. My endoc did mention that I might have “subclinical hypothyroidism.”

As FrillyNettles mentioned, I do have some symptoms of hypothyroidism, and I just remembered that something I forgot to mention to the doctor is that over the last year I have noticed that my body temp is usually in the 97s, rather than the 98s, excepting when I have a fever of course. Apparently low body temp. is another possible sign. It’s hard for me, though, because I know I am a hypochondriac and a worrier, so I hate to bring up all these things without sounding like a fruit loop.

(Another thing I’ve noticed is that in the last three months I’ve been craving sweet stuff like you wouldn’t believe. Normally if I snack on stuff, my taste runs to salty/starchy things-- popcorn being my particular weakness–but lately it’s been chocolate and especially caramel that is my obsession. Seriously, if I could get an IV drip of caramel I’d be in heaven. Of course, this probably accounts for the weight gain right there! :slight_smile: But supposedly craving sugar (and caramel is like stuffing handfuls of sugar into my mouth) is another sign. I did mention this change to the doc.

But anyway when I talk to my doc on Monday (or whenever he calls back) I’ll see what he says, and will ask about the different ranges. He may say it’s a “let’s just keep an eye on these levels” thing and re-test in a couple of months, or maybe it’s a “might as well treat the mild hypothyroidism now and get you below 2 or 3” thing. Since panic attacks are considered a symptom of hypothyroidism I’d be delighted if treatment could help. I’ve been depressed all my life but the panic thing has only been an issue for about 4 years. I swear, I never thought I’d look with great nostalgia on the days when I was “only” majorly depressed.

So… yeah, as Jackmannii recommended, I’ll check with the endocrinologist and also my GP. Since it’s not a difficult illness to treat I’m not hugely worried, which is rare for me as a hypochondriac. But considering my panic issues, if getting my TSH to a lower range might help with that, I’m all for it.

Thanks again very much guys.

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Yeah, +1 on this whole post.

MANY people are still using that old-ass range and it’s terrible.

It certainly couldn’t hurt to ask the doc if you could have a low dose of Synthryoid ($10 for 3 months in most states at big-chain pharmacies) even if he doesn’t think you’re in the danger zone. My mom is also hypothryoid and jokes it’s her “happy” pill but in reality it’s our “only needs 8 hours of sleep” pill instead of “sleep for 12 hours and be unrested and sluggish pill”.

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Thank you for posting this!

I’m about to be worked up for (intermittent) palpitations. I just had labs drawn and my TSH was 3.5. (They didn’t measure any of the other stuff.). I don’t know how the hell it didn’t occur to me until this thread that maybe it’s my thyroid! I’ll definitely bounce it off my doctor.

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Great suggestion, thank you. The only concern I have re: the thyroid meds (which as far as I know are actually just natural hormones) is that there’s some “contra-indication” with my anti-depressant du jour, which is Elavil (amitryptaline). I’d hate to have to go off Elavil, which honestly is the only thing that’s let me sleep after years and years of insomnia. But this is all stuff I’ll talk to my doc about. Especially since there aren’t really negative side effects of these thyroid meds, it might be beneficial to give 'em a try if that’s what the endocrinologist suggests.

Good luck! Another thing to check on is b12 deficiency. (i’ve been beating this drum for several years.) In 2007 I started having palpitations / PVCs (extra/skipped heartbeats) and numbness/tingling around my extremeties, and I really feared I’d either had a stroke, a heart attack, or MS. Went to a cardiologist, my heart was fine; he sent me to a neurologist. My neurologist tested me and said “let’s rule out something different – b12 deficiency, because it could cause all these problems and more.” Turns out my b12 level was 150, which was crazy low. So all it took was megadoses of b12 to improve my health significantly.

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I didn’t want to get into details but there are other factors to decide whether you treat subclinical hypothyroidism. For example, I would be more likely to try to get your TSH <2 if you are symptomatic. However, there is not necessarily good data saying that there is any benefit to getting a TSH <3 and there are real risks to overtreatment. Just remember that if you truly have low thyroid or low B12 then supplementation can make you feel better but neither has been shown to be effective in those whose levels start out normal despite anecdotal evidence. (Snake oil salesman have been selling B12 shots since the 1920s and unless your B12 is truly low it’s a waste of money.

Just an FYI- I would also condsider factors such as family history of thyroid disease and your antibodies. Somebody with a borderline thyroid and positive TPO antibodies likely has Hashimoto’s thyroiditis, which means that the thyroid will probably get lower over time and it might be beneficial to start treatment earlier.

In any case-my original answer still stands; never base potential life-long treatment on one measurement and if the labs seem to be improving don’t be afraid to wait a few weeks and check a third time before committing to therapy.

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I swear, vitamin B is like a miracle drug when you’re vitamin-deficient. I had been feeling tired and sluggish for months, but the decline was so slow that I didn’t really take notice (and I’m depressed so I figured it was because of the depression). Then I drank one of those B-vitamin boosting drinks from the gas station (not to supplement, it just looked tasty) and I felt totally awesome for the next 3 days. Going from feeling half-dead after 9-10 hours of sleep to not even needing 6. Thanks for reminding me, I need to pick up a B supplement because I’m getting tired again! D: