Is this hyperthyroidism?

[Tansia]

Hi All,

I've got a question regarding blood tests that may show hyperthyroidism. I would really appreciate your opinion on my mum's blood results.
These results are of 58yr female, who takes 0,5 grain thyroid and Progest-e. Diet is not very Peaty and may include some PUFA and bread on a daily basis.
TSH- 0.178 ulU/mL
fT3-4.18 pg/ml
fT4- 1.22 ng/dl

Temp and pulse:
morning : temp: 35,6 C pulse 73
after breakfast: 35,9 C pulse 82
afternoon: 35,9 C pulse 75

Before implementing NDT 0,5 grain blood results were:
TSH- 0.25 ulU/mL
fT3- 3.86 pg/ml
fT4- 1.21 ng/dl

So the main question do these results show hyperthyroidism? Based on temps it looks more like hypothyroidism. I know that dr Peat commented on this scenario in one of his interviews, but can't find it what to do in this case? One should take thyroid or not? Is progesterone helping in this case?

For those members that may have decent experience with thyroid results interpretation I wonder if you guys are familiar with the ft3/ft4 ratio and what does it mean clinically? I've found this source:

Free T3 : Free T4 ratio

Looks like normal ratio is up to 2,7, but with presented above blood results the ratio is 3,4. They say that higher ratio is associated with metabolic syndrome, vascular inflammation and cardiovascular disease or hyperthyroidism. Do you guys think that there is something to it or these ratios represent nothing but a total bull****?

 

[eeeeeeeeeeee]

Sounds normal for a 58 year old female, thyroid ratios are probably off because you supplement thyroid, they do not have the same t3:t4 ratios as your body produces. Unless you are currently having health problems I would not worry.

 

[gaze]

no, it's hypothyroidism. real hyperthyroidism is a steady pulse of 95 BPM or above, and high temperature. I would work on increasing temperature through foods like milk cheese fruit maybe coffee, and maybe increasing the thyroid dosage if dietary measures don't bring up the temp. They may just need to be eating more protein and salt. have you checked vitamin D?

 

[Tansia]

Many thanks for your comments @commas. Her vit D is in a lower normal range. I just wonder what causes such low TSH and higher fT3/T4 ratio if all symptoms suggest hypothyroidism.

 

[Tansia]

Sounds normal for a 58 year old female, thyroid ratios are probably off because you supplement thyroid, they do not have the same t3:t4 ratios as your body produces. Unless you are currently having health problems I would not worry.

That's kind of make sense although the t4/t3 ratio was also too high before supplementing thyroid - it was 3,2 at that time, where it should be below 2,7 according to the literature.

 

[gaze]

Many thanks for your comments @commas. Her vit D is in a lower normal range. I just wonder what causes such low TSH and higher fT3/T4 ratio if all symptoms suggest hypothyroidism.

there's plenty of things that can lower TSH that's unrelated to good thyorid.

Ray Peat, PhD on Thyroid, Temperature, Pulse, and TSH – Functional Performance Systems (FPS)

this site provides good RP quotes on the subject that's helpful. getting her vitamin D up will help a lot though i think, especially as people age synthesizing it from the sun becomes harder, so supplements can be helpful

 

[Tansia]

there's plenty of things that can lower TSH that's unrelated to good thyorid.

Ray Peat, PhD on Thyroid, Temperature, Pulse, and TSH – Functional Performance Systems (FPS)

this site provides good RP quotes on the subject that's helpful. getting her vitamin D up will help a lot though i think, especially as people age synthesizing it from the sun becomes harder, so supplements can be helpful

Indeed good references there especially that one:
Aging, infection, trauma, prolonged cortisol excess, somatostatin, dopamine or L-dopa, adrenaline (sometimes; Mannisto, et al., 1979), amphetamine, caffeine and fever can lower TSH, apart from the effect of feedback by the thyroid hormones, creating a situation in which TSH can appear normal or low, at the same time that there is a real hypothyroidism.4

Thank you @commas

 

[MitchMitchell]

The real questions are:

- why even start with the thyroid therapy considering that her pre-grain bloods were perfect

- if she had symptoms in spite of this perfect bloodwork, why take such a low dose that visibly changes next to nothing. Was there a symptom resolution?

hyperthyroidism is associated with specific symptoms and absolutely massive free t3 numbers. The normal range for a young adult goes to 6 if not 7 pg/mL so don’t pay too much attention to stupid endocrine societies that only vouch for stupid Synthroid.

 

[Tansia]

The real questions are:

- why even start with the thyroid therapy considering that her pre-grain bloods were perfect

- if she had symptoms in spite of this perfect bloodwork, why take such a low dose that visibly changes next to nothing. Was there a symptom resolution?

hyperthyroidism is associated with specific symptoms and absolutely massive free t3 numbers. The normal range for a young adult goes to 6 if not 7 pg/mL so don’t pay too much attention to stupid endocrine societies that only vouch for stupid Synthroid.

Thanks @MitchMitchell for your input! The 0,5 grain was added based on symptoms. I wasn't aware of the old results till recently. As per B. Broda book it's good to start slowly so that's why only 0,5 grain. It was coincidence that the blood test were done now and showed the presented result. My main concern was weather adding thyroid may hurt in this case as I wasn't sure how to interpret those results and seem like some doctors that my mum have seen are also unsure what these results mean.. So thanks for sharing your opinion :)

 

[mrchibbs]

Thanks @MitchMitchell for your input! The 0,5 grain was added based on symptoms. I wasn't aware of the old results till recently. As per B. Broda book it's good to start slowly so that's why only 0,5 grain. It was coincidence that the blood test were done now and showed the presented result. My main concern was weather adding thyroid may hurt in this case as I wasn't sure how to interpret those results and seem like some doctors that my mum have seen are also unsure what these results mean.. So thanks for sharing your opinion :)

At the very least, taking a small amount of extra thyroid like you're doing, mimics the diet of our ancestors who would get a few grains a week from foods (sausages, fishhead soups, chicken necks etc.) So it can only help make you feel better.

 

[Peater Pan]

Low temp and not too high pulse = not hyper IMHO

 

[Tansia]

At the very least, taking a small amount of extra thyroid like you're doing, mimics the diet of our ancestors who would get a few grains a week from foods (sausages, fishhead soups, chicken necks etc.) So it can only help make you feel better.

That's right I haven't thought about it in this way, but it totally make sense. The plan for my mum was to slowly increase the dose but I was put off by her blood results.

 

[MitchMitchell]

Thanks @MitchMitchell for your input! The 0,5 grain was added based on symptoms. I wasn't aware of the old results till recently. As per B. Broda book it's good to start slowly so that's why only 0,5 grain. It was coincidence that the blood test were done now and showed the presented result. My main concern was weather adding thyroid may hurt in this case as I wasn't sure how to interpret those results and seem like some doctors that my mum have seen are also unsure what these results mean.. So thanks for sharing your opinion :)

alright I had missed the part where you didn’t have pre treatment results on hand.

If you want to listen to to a capable endocrinologist Neal Rouzier is on point.

Going by symptoms you can safely bump to 1 grain daily.

 

[Tansia]

alright I had missed the part where you didn’t have pre treatment results on hand.

If you want to listen to to a capable endocrinologist Neal Rouzier is on point.

Going by symptoms you can safely bump to 1 grain daily.

Cool, thanks a lot I will google him! :)

 

[Tansia]

Low temp and not too high pulse = not hyper IMHO

IMHO?

 

[Tansia]

alright I had missed the part where you didn’t have pre treatment results on hand.

If you want to listen to to a capable endocrinologist Neal Rouzier is on point.

Going by symptoms you can safely bump to 1 grain daily.

This Neal Rouzier seem to like estradiol, I guess that's opposite to what dr. Ray says

 

[Peater Pan]

IMHO?

in my humble opinion

 

[Tansia]

in my humble opinion

Thanks :)

 

[boris]

Waking temperature below 36.5C is hypothyroidism. Waking temperature should be about 36.5 rising to 37C after a meal. Those were Broda Barnes' findings, Peat added that you should diagnose based on both temperature and pulse rate (should be in the 80s), because warm weather could influence your body temperature.

PUFA directly inhibits thyroid through various mechanisms (directly in the gland, blood, cells, by activating aromatase, by damaging the liver, etc) it would be best to limit high PUFA foods.


About "free hormone" tests:

Ray Peat:
"The idea of measuring the "free hormone" is that it supposedly represents the biologically active hormone, but in fact it is easier to measure the biological effects than it is to measure this hypothetical entity. Who cares how many angels might be dancing on the head of a pin, if the pin is effective in keeping your shirt closed?"

"Because the actions of T3 can be inhibited by many factors, including polyunsaturated fatty acids, reverse T3, and excess thyroxine, the absolute level of T3 can't be used by itself for diagnosis. “Free T3” or “free T4” is a laboratory concept, and the biological activity of T3 doesn't necessarily correspond to its “freedom” in the test."

"the idea of free and bound hormones, it's purely a laboratory construction and in the case of thyroid it usually has some relation to symptoms, but it's a little bit analogous to reading tea leaves, because actually, when thyroid hormone is stuck to the albumin protein - which is the main protein in the blood - it has no trouble at all getting into cells, taking the thyroid into the mitochondrion and nucleus and so on. So the free thyroid test does correspond for a variety of indirect reasons to the real available activity of the thyroid, but it's really just a laboratory construction that should be minimized."


Good summary of how to supplement thyroid:
Danny Roddy | Demystifying Thyroid Supplementation

 

[MitchMitchell]

This Neal Rouzier seem to like estradiol, I guess that's opposite to what dr. Ray says

Only in the context of high testosterone in men and progesterone in women. Plus ray is wrong about estradiol anyway. Plus it’s thyroid we are talking about.