Confused on lab results and I'm going insane!

[thyroid_confusion]

I have really been having a time getting my thyroid under control. At first, I thought it was because I quit smoking a year ago and (I know some of the problems did happen because of the quit) but now I am just wondering why certain things are going nuts now.

Back in June, My TSH was .03 (.40-5.50).  My Free T4 was .9 (.8-1.8) My Total T3 was 114 (60-181). At the time of this blood test I was on 90mg Armour and 50mcg Unithroid.

In August, my TSH was .10; Free T4 was .9, and my Total T3 was 168.  I was on 90mg Armour and 25 mcg Unithroid. (ranges same all three times.)

This month, my TSH is 4.14; Free T4 was .9 and my Total T3 is 183. I was on 60 mg Armour and 25 mcg Unithroid.

I am wondering why my Total T3 is going so high and why can't I get my FT4 to the upper range? I have had Hashimoto's Disease (was dx'g a few years ago). My TSH changed so drastically in just 8 weeks!! Doc put me back up to my 90 mg Armour and kept the Unitrhoid at 25mcg. He is astonished that my levels increased so much but is clueless on why the Total T3 is doing what it is doing. He's not an endo, but he really is good about working with me.

Can anyone help me? My thyroid just won't level out and it hasn't stayed in one place since I was DX'd. I am totally done with menopause; I take not HRT's either. If you need more info, just ask. I really need some help.

Gail

[Mark Lupo, M.D.]

The TSH is more reliable in following treatment -- in your case the timing of the armour dose influences the t3 level as it will peak 2-3hours after a dose - that may explain the differences.  One thing I have seen clinically in using armour is that it is difficult to "fine tune" the treatment and thus great changes are seen in TSH (and symptoms).  Combining it with T4 (ie unithroid) gives more control and it may be worthile taking 30mg of armour in am and again at 2-3pm (products that contain t3 are best divided into two doses per day) and adjust the unithroid to get the TSH to goal (see below for a detailed explanation of TSH and hypo treatment).

The treatment of hypothyroidism means striking a careful balance between a patient's symptoms and the lab (usually TSH) value.  TSH is the most relied upon lab by thyroid experts world-wide to determine appropriate levels of thyroid hormone replacement.  It does not directly reflect tissue activity of thyroid hormone but there is no test available that does that and TSH is the best approximate we have now.

That being said, the target TSH is 0.5-2.0 for a patient on replacement.  In general, patients who are older or have heart disease do better with a TSH that is not <0.5 as shown in several studies that these patients have increased risk of premature death.

Younger patients who are otherwise health may feel better with a TSH that is slightly lower than 0.5.  There are definite risks associated with TSH <0.1 even in patients who "feel fine" -- studies show that a TSH this low over time can significantly alter heart function.

[ancientmariner]

I have read that TSH is pretty much useless if you have Hashi's. Also, your T4 may be staying low but your T3 going up because your body is converting all the T4 it can to try to make you feel well....I have read that Free T3, not total T3 is a better indicator, because the Free t3 is unbound, meaning that it's available for use, but the Total T3 is bound and unbound, so not all of it is usable.

[thyroid_confusion]

I usually have him do a Free T3, but since it is not on the lab form, if I don't mention it, he forgets to write it in and ask for it. Along with the August results, my Free T3 was 384 (230-420 range) and my Free T4 was still in the low range.

I'm trying to get my doc not to take much stock in the TSH, but he keeps telling me what a great indicator this test is, even though I keep telling him otherwise. Any info I can print out that will explain this to him better than I can?


Gail

[PNWBabe]

First let me say that I don't happen to believe that Armour is harder to "fine tune" than any other type of thyroid medicine available. It's a matter of patient wellbeing, symptoms and not completely relying on black marks on a piece of paper trying to tell you that you should "feel good". It's my opinion that increasing your Armour is a good idea since the decrease caused your TSH to go up dramatically. As you have read/studied, antibodies can cause problems with any of the thyroid tests that are run and the Free's are a much better judge than going by just TSH. Let me recommend a great book, "Hormones, Health and Happiness" by Steven Hotze, MD. His take on thyroid is one of the best and most comprehensive that I have read in recent months. He really "gets" it! You are blessed to have a doctor who will work with you and prescribe Armour. You are your own best advocate in regards to your health and I encourage you to read as much as you can, join support groups, such as the natural thyroid yahoo group and remember that your doctor is your employee. He is being paid by you to help assist you to great health, not just good health.

[thyroid_confusion]

I will have to join the thyroid group at Yahoo. I am on the one at about.com but have only received one message on this same problem, so I'm still stumped. I just don't want to go hyper again. In April my TSH was down to <.01 and that was when I had been on 105mg Armour and 50mcg Unithroid. I'm a bit nervous about the heart issue. I will be 55 this month and would love to live w/o heart problems. I am currently taking 90mg Armour and 25mcg Unithroid. I have this strange feeling that this will not correct my Free T4 and bring it to the upper range???? I will get that book by Steven Hotze, too. Thanks for recommending it to me. I'm just so frustrated with trying to feel better. I did feel great at one point during the summer but when my TSH went so low, doc was very concerned about Osteosporosis and I do have Osteopenia, so that is a worry. I think I will take Dr. Mark's advice and divide my Armour up each day, only I take 90mg not the 60 he mentioned. Do you happen to have a link to that natural thyroid group at yahoo?

Gail

[PNWBabe]

Hi Gail,
I think we are unable to post links here, or at least that was my observation a few weeks back. Just go to yahoo, click on groups, and type in natural thyroid hormones into the "search" box.
I do agree with Dr. Mark that splitting your dose should help you. I split my dose throughout the day and it has made a tremendous difference in how I feel.

I hope to see you in the yahoo group soon!

PNWBabe

[thyroid_confusion]

Thanks! I actually did just as you suggested and signed up for the forum at Yahoo.

I was wondering if you had an opinion on the meds I am taking at the moment. Are you familiar with Armour dozing? I am wondering if maybe I lowered my Armour to 75mg and up'd my Unithroid to 50, that maybe I could get my FreeT4 up to the upper range and get my TSH back down to just below one. My doc has me back on 90mg A and 25mcg U and I became hyper on that dose before so I'm a bit nervous about staying there. I remember someone telling me there is something about the t4/t3 correlation with armour and how to add the T4 med, but I can't seem to grasp the concept.

Thanks for any advice you can offer.

Gail

[PNWBabe]

Hi there,

I am not able to comment about dosage changing as I am not a medical professional. I can tell you how I split my dose :) I take 1 1/2 grains upon rising in the morning, and I take it between my cheek and gum so that I don't have any loss of meds to the liver. I also take some adrenal support at the same time. About 4 hours later I take another small dose of adrenal support and about an hour after that I take another 1 1/2 grains in the same manner as before, between cheek and gum. Four hours later I take another 1/2 grain and then a 1/2 grain at bedtime for a total of 4 grains, all done sublingually.

Glad to hear you have joined the group, see ya there!

PNWBabe