Background Case Information:
Male patient, age 65, on Eutroxsig 50mcg 5/7 since October 2017.
TSH:
9/21/19 = 2.79mIU/L,
2/1/20 = 1.93,
11/10/20 = 3.07.
fT4:
9/21/19 = 14.0 pmol/L.
2/1/20 = 16.9.
11/10/20 = Not tested 11/10/20
Questions:
A) what impact can thyroid hormone have on lab test results?
B) why is thyroid showing up as an issue on the OptimalDX report?
Does this result mean that I need to look deeper into the thyroid issue and request the MD run the additional tests recommended by Optimal DX. (FYI - the MD thinks everything is OK).
Answer
I have had a chance to review the info you sent through and there are a few points that I want to go over before diving into the case itself.
With body systems like the adrenal and thyroid, there are 2 counteracting states of dysfunction that can exist: a hyperactive state and a hypo-active state. In calculating the probability of dysfunction in these systems we have to take into consideration the movement of all biomarker values, also often counteracting, that have implications for that particular system. The Functional Body Systems give you a sense of dysfunction within the system itself and you must go to the conditions report to get a sense of WHAT is causing the dysfunction in that system.
Now, in your patient's case, there are only a couple of thyroid biomarkers. The TSH is above Optimal and above standard and thus gets a high score towards dysfunction. It is elevated and therefore implicated in hypothyroidism. The Free t4, on the other hand, is elevated (not surprising given he is on thyroid hormone), which is indicative of a hyperactive thyroid. With these 2 biomarker values, we have that counteracting state hypo and hyper on the same blood test but the output is that there's dysfunction in the thyroid, which should be looked into
if you read the language under the "Thyroid Function" section, you'll see the following:
"Consider that the dysfunction might be a hyperactive thyroid (hyperthyroid) or a hypothyroid situation. Please refer to the "Clinical Dysfunctions" report to get a sense of the probability of dysfunction in these "conditions": Hyperactive Thyroid, Hypothyroidism - Primary (a dysfunction in the thyroid itself), Hypothyroidism - Secondary (dysfunction in the anterior pituitary), or Thyroid Conversion Syndrome. You may also want to check the scores for Selenium Need and Iodine Need."
If you review the Clinical Conditions report you'll see that "Hypothyroidism - Primary" scores high, which is due to the TSH level being above standard. The patient is taking a thyroid hormone, presumably because he's been diagnosed with hypothyroidism, so this finding isn't out of the ordinary. The fact that the TSH is only slightly elevated in a patient on thyroid hormone is a good sign. The thyroid hormone is regulating his hypothyroidism. The fact that the free t4 is also elevated is a finding consistent with this picture of a medically regulated patient with hypothyroidism. It's not super elevated so I think he's probably quite well regulated on his current dose.
I am always in favor of ordering more tests but in this case, I don't think that there's a need for more thyroid testing right now. However, at some point, if you continue to work with him, I'd suggest you run a bigger battery of tests on him including TSH, Free, and Total T4 and T3, and reverse T3. I'd also be interested to learn more about why he's on thyroid medication in the first place. Does he have Hashimotos?
I hope this helps.