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Ahh-Haa! Past test results. What do you think?
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Ahh-Haa! Past test results. What do you think?

Okay. My doctor emailed me the past results. I go in for my next set of tests at the beginning of February. My current meds are Tirosint 150mcg and Cytomel 10mcg.

Component   Standard Range   4/21/2011      5/23/2011 7/1/2011     11/10/2011

TSH           0.450-4.500 uIU/mL      65.400         0.917          10.550           14.020

T4,FREE        0.82-1.77 ng/dL           0.52         1.88             0.89          0.67
(DIRECT)

TRIIODOTHYRONINE 2.0-4.4 pg/mL 1.9           3.6
, FREE, SERUM


And then these results were from April 2011 and I'm not sure if they help (or not):

Component                                 Your Value            Standard Range                Units
GLUCOSE, SERUM                               96                           65 - 99                       mg/dL
BUN                                                         8                             6 - 20                       mg/dL
CREATININE, SERUM                     0.88                        0.57 - 1.00                       mg/dL
EGFR IF NONAFRICN AM                        84                            >59 -                     mL/min/1.73
EGFR IF AFRICN AM                                96                            >59 -                     mL/min/1.73
BUN/CREATININE RATIO                         9                            8 - 20
SODIUM, SERUM                              140                          135 - 145                       mmol/L
POTASSIUM, SERUM                       4.5                          3.5 - 5.2                       mmol/L
CHLORIDE, SERUM                               102                          97 - 108                       mmol/L
CARBON DIOXIDE, TOTAL                         22                           20 - 32                       mmol/L
CALCIUM, SERUM                                9.6                          8.7 - 10.2                        mg/dL
PROTEIN, TOTAL, SERUM                        7.4                           6.0 - 8.5                           g/dL
ALBUMIN, SERUM                                4.7                           3.5 - 5.5                           g/dL
GLOBULIN, TOTAL                                2.7                           1.5 - 4.5                           g/dL
A/G RATIO                                        1.7                           1.1 - 2.5
BILIRUBIN, TOTAL                                0.3                           0.0 - 1.2                         mg/dL
ALKALINE PHOSPHATASE, SERUM         68                           25 - 150                            IU/L
AST (SGOT)                                         11                            0 - 40                            IU/L
ALT (SGPT)                                         16                            0 - 40                                IU/L
VITAMIN B12                                        343                         211 - 946                           pg/mL
VITAMIN D, 25-HYDROXY                       16.1                     32.0 - 100.0                           ng/mL

Okay...now what? Do I need to ask for certain tests to be taken again? Or any additional tests that you would recommend me to ask about? Thanks for your help. You guys will never know how much I appreciate your input and support :)
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19 Comments Post a Comment
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1956603_tn?1325039786
Btw...guess I should mention
Meds in April: none. (I hadn't taken anything in approx 2 yrs prior to the blood work. I was in denial/boycott)
Meds in July: Tirosint 150mcg.
Meds in Nov: Synthroid 175mcg
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Avatar_f_tn
What were you taking when your FT4 was 1.88 and your FT3 was 3.6?  I'm assuming those two numbers go together...formatting sometimes gets lost on this site.
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1956603_tn?1325039786
I was taking Tirosint 150mcg. I am on Tirosint 150mcg now and have started taking Cytomel 10mcg in addition to the Tirosint.
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649848_tn?1357751184
I'm confused (I know, that's not unusual........lol)

It looks like your May 2011 labs were: TSH = 0.917; FT4 = 1.88; FT3 = 3.6.  Is this correct?  You said above that you were on 150 mcg Tirosint in July 2011; were you on the same thing in May?  

If you were on 150 mcg Tirosint in July, then 175 Synthroid in Nov, now back to 150 Tirosint, why the switches back and forth?

Your vitamin B12 is way too low in the range; did your doctor suggest that you supplement that?  

In addition, are you supplementing for the low vitamin D?  Do you have Hashi's?

What symptoms do you have?  Based on the thyroid results, and the low B12 and D, I'd guess you feel pretty crappy!!  
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1956603_tn?1325039786
Yes, those were my results for May. For the April test, I had no meds in my system because I stopped taking them two years prior. After seeing the April results, my doctor put me on Tirosint 150mcg. He tested me again in May and July. After seeing the July results, he wanted me to go to Tirosint 175mcg. Tirosint doesn't make a 175mcg so he called in Tirosint 150mg and Tirosint 25mcg. Well, that doubled my prescription payment making it almost $60 for a 21 day supply (My rx insurance saw it as two different meds...what jerks). So, I contacted my doctor and asked what else I could do. He changed me to Synthroid 175mcg. I stayed on that until he took the Nov test. The results,,,well,,,you see them. Synthroid doesn't work well for me and it literally makes me feel yucky! So, he told me to start taking Tirosint 200mcg. Within a few days, my aunt called me and said that she has similar thyroid issues and her doctor (in North Carolina) put her on Synthroid 125mcg and Cytomel 25mcg. I immediately called my doctor and ran it by him so he agreed to try me on Tirosint 150mcg and Cytomel 10mcg.

As far as the B12, no, he hasn't said anything about it.

The vitamin D: He had me take 5 billion mcg (just kidding) of prescription vitamin D once a week for 2 months and that is all. However, that was back in April 2011. I have Graves Disease. No, Hashi's that I know of...

I am feeling better now, but I fear that the Cytomel will be a temporary thing because I am sure that it will raise my Free T3 more than he will like and then I fear that he would take me off. MY BODY HATES ME!!! I have started the Autoimmune Tracker and Thyroid Tracker that this site provides. I am trying to keep track of all the symptoms so I can show him when I see him in Feb. I started tracking the symptoms from the first day that I started taking my Cytomel (in Dec). I only wish that I would've tracked them before so he could see my improvements. Even though I still feel crappy, I don't feel half as crappy as I did before the new prescriptions!
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Avatar_m_tn
25 mcg of Cytomel in addion to Tirosint is a big jump from nothing.  Many people may eventually reach 25 mcg of Cytomel but usually they have to work their way up in order to tolerate it.  

So I guess don't be surprised if you may have issues jumping right into 25 mcg.

Am I  missing something?  I thought Graves was a HyPER condition, yet they are clearly treating you for HyPO and your lab results would indicate you are HyPO as well.

here is a quote from Wikipedia: "Graves' disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones "

So why would they be treating an overactive Thyroid by giving you MORE Thyroid?

Are you sure you have Graves?
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Avatar_f_tn
Your labs in May really looked quite good.  Your FT4 was a little high, and it seemed like a slight reduction might have been in order if you were experiencing any hyper symptoms.  FT3 looked excellent.  

With those labs, I';d seriously question whether or not you need T3 added.  It looks like you were converting just fine.  How were you feeling then?    

You haven't had labs again since switching back to Tirosint again?
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1956603_tn?1325039786
Yes, I was diagnosed with Graves in 2004. I also did RAI in 2004. That's where the Hypo came from. My doctor said that I am "wired backwards". Not sure what that means, but I think that as soon as they try to regulate something, my body does the opposite.

I am on Cytomel 10mcg, not 25mcg (that was referring to my aunt). I know that was a little confusing. Sorry
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1956603_tn?1325039786
While my labs looked okay, in May, I felt horrible. I could sleep all day. I could not tell a difference at all. As stated, I didn't take any meds for a couple of years and the only reason that I went back to the doctor is because I was starting to experience the same hyper symptoms (sweating, heart palpitations, shaking, foggy brain, etc). After starting the Tirosint 150mcg (in April) I swear, I felt RUN DOWN!!!  I quit experiencing the hyper symptoms, but I didn't even want to breathe because I felt that wiped out. Wierd, huh? I felt hyper...they gave me Tirosint, and then I started feeling hypo!?!?! I don't understand
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Avatar_m_tn
Have you checked for adrenal fatigue with a cortisol test.  I understand that the 24 hour saliva or urine test is FAR superior to the one time blood test to check for this.  Cortisol helps with the whole Thyroid metabolism process.

Also as Barb stated above vit B12 deficiency can also cause severe fatigue etc and you are on the low end and could use some improvement there.  I think another symptom of low B12 can be tingling of the extremities like hands & feet (fingers & toes).

Vit D as mentioned is also very low which is a  contributing factor for fatigue.

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Avatar_f_tn
It all sounds very odd, but there are a lot of things going on here, and you've never gotten your labs into proper range, except for a very short time.  If you'd sustained them there, you might have felt better and better as your body had time to heal from being hypo.  We often find that once FT4 is midrange and FT3 is upper half, symptoms sometimes remain until our bodies heal and rebalance.  The longer we were hypo, the longer that can take, and you were hypo for a long time.  

Your labs were only optimal for a very short time, then started down again.  

Let me just clarify again.  

5/23/11
TSH 0.917
FT3 3.6 (2.0-4.4)
FT4 1.88 (0.82-1.77)

You had been on 150 Tirosint since 4/21/11.

7/1/11
TSH 10.55
FT4 0.89

You were still on 150 mcg Tirosint.  No meds change had been made after your 5/23/11 labs.  Is this correct?  Are you sure you weren't switched to Synthroid in May?  I'm only asking because this is one of the first things I think has to be explained.  Your labs tanked, and if your meds hadn't been changed, we need an explanation for that.

Your May labs are the only ones where you have enough FT4 available for conversion.  You are extremely hypo in all the rest.  Your FT3 in May did not indicate a conversion problem.  It was already almost in the top third of the range.  Another phenomenon we often see is that once FT4 is stable and midrange, FT3 will continue to rise for a while as conversion ramps back up again.

I'm really not surprised you never felt any better.  Your labs barely peaked for a moment there in May, then they began to fall again.  

Sweating, heart palps, shaking and brain fog can all be symptoms of hypo as well as hyper.  Some symptoms "cross over", and we often see people experiencing the same symptoms whenever thyroid hormone levels are off, whether too high or too low.

So, please check on the change from Tirosint to Synthroid, and we can go from there...  

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1956603_tn?1325039786
I just checked my rx and I started taking Synthroid 175mcg on Aug 8,2011. So I took Tirosint 150mcg from April until Aug. Then Synthroid from Aug to the end of Dec. And now again Tirosint 150mcg with Cytomel 10mcg  starting two weeks ago. My labs are going to be checked again the first week of Feb.

Another question I get asked is: Do you take your meds daily? Answer: Most of the time. I might miss one dose a week...if that. I can't seem to remember to take it on Sundays, don't know why, but I guess because I get up, get the kids ready for church, etc...I tend to forget until mid afternoon and then it's too late.


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Avatar_m_tn
Not sure the Synthroid is too late just because it is later in the day.  T4 takes weeks to stabilize in the blood.  Being a few hours late is a small percentage of something with such a long half life.

T3 (Cytomel) is a different story.  As it's half life is measured in hours as it is immediately available for use by your body.
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Avatar_f_tn
Well, then, I'd suggest that the change from Tirosint to Synthroid had very little to do with your your labs and symptoms remaining so hypo.  Your labs were hypo on 7/1/11...a whole month before the switch to Synthroid.  You were switched to Synthroid, and, since then, you've only had one set of labs in November, but they didn't change drastically from the 7/1 labs when you were still on Tirosint.

So, the question now becomes:  What happened between 5/23/11 and 7/1/11 that made your levels change so drastically on the same dose of Tirosint?  You could perhaps have had a sudden drop in thyroid function, but you've had RAI, so that's unlikely.  You might not be absorbing your meds as well as you were before.  Were there any lifestyle or diet changes during that period?  Did your general health change?  Trauma?  Stress?  G/I issues?  New meds or supplements that you added?

Of course, it doesn't help to miss a dose.  Missing one 175 mcg dose is equivalent to lowering your dose to to 150 mcg per day, which is a significant change.  I agree with flyingfool, btw, if you discover in the afternoon that you've missed your dose, I'd take it then.  Even if the conditions aren't exactly right (fasting, etc.), getting some of that dose into your system is better than getting none.    

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1956603_tn?1325039786
Thanks goolarra and flying fool.

I'm not sure what happened between May and July. I do have an appointment with a GI doctor on the same day as my Endo (they are in the same building). Maybe I can get some answers that make sense from the GI, too. My doctor wonders if I may have absorption issues due to an underlying GI problem. Guess that makes sense, huh?

As far as the Tirosint, I thought that you HAD to take them in the early morning. So, it's good to know that I should aim for the morning, but take it asap if I forget. As far as the Cytomel, my label says to take 5 mcg twice a day (to equal 10mcg daily). I have been taking it every 12 hours. Is that correct. I tend to take the Tirosint and 1st Cytomel at 8am. So then I should be taking the 2nd Cytomel at 8pm, right?

Thanks for taking your time to help. Lord knows, I need it. Lol. I feel like no matter how many questions I ask my doctor, they are never the right ones because I know very little about these meds and what;s going on with me. I just let him draw blood and tell me what to do next. I've been solely depending on what he knows. It's been great sharing my bad habits with y'all so I can have some understanding on what;s going on with me. I appreciate it more than y'all know :)
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Avatar_f_tn
I think your endo has the right idea...G/I problems could very well be compromising absorption.  I think it makes total sense to explore that.

It's definitely BEST to take any T4 meds first thing in the morning on an empty stomach to maximize absorption.  However, if you forget and remember within, say, 12 hours of your missed dose, I'd take it when I thought of it.  Even if your stomach isn't empty, some will be absorbed.

Most people take their first dose of T3 along with their T4 first thing in the morning as you're doing.  However, many take the second half much earlier than you have been.  They find that they don't get the "peaks and valleys" during the day if they take the second dose from late morning to mid-afternoon (depending on schedule, of course).  Many people find that taking the second dose later than about 3:00 pm (on a "normal" sleep schedule) can interfere with sleep.  You can experiment with what time works best for you.  If 8:00 pm doesn't affect your sleep and you don't have an energy letdown in the afternoon, that's fine also.

You don't have to take T3 on an empty stomach like you do T4, so you have a lot more wiggle room.  
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1956603_tn?1325039786
Good to know, about the T3. I am not sure if it affects my sleep or not. Ever since I was diagnosed with Graves (in 2004), I've never got a full nights sleep. I typically go to bed between 2am to 3am and then I wake up to start me day around 7am. It's frustrating, but I have been like this for so long, that I guess I am just dealing with it. I feel sluggish most of the day, but I guess that is normal if I'm only running off of 4 hours nightly sleep for the past 7 years. However, I am going to start taking my 2nd Cytomel around 3pm and see if I notice a difference :)
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Avatar_m_tn
Good info from goolarra.  I just wanted to add my own experience with taking a T3 med (Armour in my case).  I take 2 grains in the morning and one in the early afternoon, around 1 or 2 o'clock.  The T3 effect peaks about 3 hours after taking it and then gradually tapers off over the next 21 hours.  I found that by waiting until later than 2 for my afternoon dose, it did affect my sleeping.  But then that is only my experience.  Everyone is different.
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1956603_tn?1325039786
Good to know. I will start taking my second dose at 1pm to 2pm. I took it at 3pm, yesterday and still didn't go to bed until 2:30am :( At this point, I will try anything. Lol
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