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Avatar universal

Do you agree with the treatment?

In 2006 my wife Carol was diagnosed with Hyper Thyroid and took the RI pill on 03/02/2006. The medication prescribed was the generic form of Synthroid 88mcg which was a yellow pill. After almost a year she was not doing good at all experiencing anxiety, no appetite, weight loss, feeling cold and constantly pacing around the house. To help with this she was on Paxil a well as Alprazolam.

The Endocrinologist was ok with the TSH/T-4 results but suggested a very small % of patients are allergic to yellow dye so on 03/02/07 she changed the med to 112mcg of Synthroid which wasn’t yellow. In a matter of a few weeks she was like a new person and weaned herself off of all tranquilizers. From 03/02/07 until 04/29/08 or over a year she was fine.

On 01/29/08 after reviewing the recent TSH/T-4 results the Dr. changed her med to Synthroid 100mcg which was a yellow pill.

On 04/29 after going to the dentist and being informed of extensive bone loss and the possibility of her losing her teeth she immediately developed the same symptoms she had when she was having problems with the thyroid.

Both she and I found it strange how a trauma such as being informed of bone loss could cause the same symptoms the thyroid did. After a while we both realized the med change on 01/29/08 was to a yellow pill.

On 06/03/2008 she was seen by the endocrinologist and we reviewed the above as well as other TSH/T-4 tests and the doctor changed the med again to Synthroid 88mcg.

It’s now 1 month and her hands are trembling very badly and I’m very concerned. She always had a slight tremble but nothing like this. The family doctor has her back on Paxil and generic Xanax but I feel it’s a thyroid problem and not a nerve problem. I can’t understand why the endocrinologist took her off the 112mcg as she was very normal taking it. I would appreciate any thought you have.

Limits 0.350-5.50 4.5-12.0

Date TSH T-4 Med
12/01/05 0.01 2.4 None
01/26/06 0.70 1.1 None
03/02/06 Took RI Pill
03/06/06 3.13 1.3 None (Meds were no started at this time)
07/06/06 13.88 1.3 88mcg Generic (Levothyroxine Yellow??)
11/08/06 1.549 11.4 88mcg Generic
02/27/07 7.0 7.5 88mcg Generic
03/02/07 Started 112.mcg Synthroid
05/29/07 1.55 11.1 112 mcg Synthroid (Rose Pill)
01/21/08 0.615 12.2 112 mcg Synthroid (Rose Pill)
01/29/08 Started 100 mcg Synthroid Yellow
05/20/08 0.954 11.2 100 mcg Synthroid (Yellow Pill)
06/03/08 Started 88mcg Synthroid (Olive Pill)

12 Responses
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213044 tn?1236527460
I think adrenal testing would b a good idea if it has not been done yet.
Helpful - 0
Avatar universal
I feel sorry for your wife, but we all have some sort of Thyroid problem, otherwise we won't be here.  Since we got this problem already, all we can do is do the best we can.
Many people suffered for a year or two after RAI before they found their optimal point. unless she has other problems, (if thyroid only) she should be fine once she has the correct amount of supplements.  I wonder what was wrong with her taking 112 mcg synthroid at that time?? But From your posts here it is a little confusing, not many people back to hyper after RAI, your wife may be one of those rare cases. Anyway, AR-10 gave you a good amount of details already. her advise is a good one. Only one thing I want to add here is the bone loss. Long term hyper can cause bone loss, so if that was indicated by her dentist already, you may want to schedule a bone density test for her, no hurry, but it is good to know and treat it early.  Good luck to you and your wife.
Helpful - 0
Avatar universal
My wife was retested Thursday and here's the results. First of all her potassium and sodium was normal.

T-3 was 116------Limit 85-205

TSH was 1.471 limit 0.350-5.500

Thyroxine T-4 was 10.0 Limit 4.5-12.0

Since he took her off her BP med I was taking her BP's every day and sometimes twice it was somewhat high but her pulse rate was always over 100 and one time was 120. That and the trembling made me think she was hyper again.

Right now I'm confused as to what's wrong.

Jim



Helpful - 0
Avatar universal
I'm going to ask for the tests you recommended. As far as deficiencies goes she has those too. She fainted on 06/25 and I took her to the doctor and he did labs.

Three things were wrong.

Chloride was low at 77 (norm 97-108)
Potassium was low at 2.9 (norm 3.5-5.2)
Sodium was critical at 116 (norm 135-145)

He called the next day with these results and we had to go back and retest to confirm these results. When he called with the new results he said the potassium went up but the sodium didn't so he told her to stop taking her Lisinopril as that might be the culprit.

He ordered the same tests for 4 days later and said the Sodium went up to 28 and didn't mention the other 2 so I assume they weren't a concern. With that he scheduled a visit for her this Thursday as I mentioned to check her BP since she stopped taking the Lisinopril.

I would assume he will do labs again to check if there has been any more improvement.

That's when I'm going to ask for the tests you suggested.

She's trembling real bad in the AM and it's got me very concerned. She also has no appetite and that's why I think she fainted.

Thanks again for your thoughts.

Jim
Helpful - 0
213044 tn?1236527460
The tests that say thyroxine(T4) are Total T4 tests.

They measure at the high end of lab range, which indicates too much medication, reflected by the lower TSH.

If they were Free T4 tests, they would still measure high, but not as high as the results you list for the Total T4.

This is a guess, but I'll bet between September and November a different doctor started running tests. Not that it's important, but it is the best explanation for the switch from a Free T4 test to a total T4 test.

Your immediate concern is finding out if your wife is hypo or hyper at the moment. By Thursday, she will have been on the new dosage for five weeks. It takes six weeks for a med change to come up to full potential, but five weeks is close enough for a retest.

Ask for a TSH, a Free T4, and a Free T3. The Free T3 has to be sent out to be processed, and takes about five days to get a report back.

The Free T3 should show a result that is between half way and two thirds the way up the lab range. Three or four points below upper limit is optimal. The lower half of the range indicates too little hormone. If it is just below upper limit, slight hyperthyroidism can be experienced.

Not to confuse you, but a Free T3 test is quantified using two ways of listing the test result. The lab range is aproximately 2.30-4.30, but some labs list it as 230-430. So, the result may be 3.82, or 382. They are the same result. But when I say optimal is three or four points below upper limit, I am talking about a result of 3.8, not 426, if you understand my rambling.

The free T4 should also be between half and two thirds up the way on the lab range. It can be in the lower half of the lab range and be fine as long as the Free T3 is where it needs to be. There is more leeway in what your Free T4 level is. As long as there is enough to provide enough free T3 through conversion, the body is happy.

The TSH should be between 0.8 and 1.8. Anything higher than 2.5 is too high and indicates the need for more hormone, or medication. Anything lower than 0.4 indicates too much medication, and suggests that the Free T3 is too high.

As for other tests, you might ask the doctor about possible deficiencies in vitamins and minerals and see if there have been any tests run to check for "the usual suspects" that show up with thyroid problems.
Helpful - 0
Avatar universal
Shes going to be retested in August,October and December and I have the RXs for those tests and they all are requesting Free T-4 and TSH.

After review of the tests result here's what I found. I'm going type it exactly as it is on the reports as I thought everything was a T-4.

Took Radioactive Iodine on 03/02/06

On 03/22/06 Free T-4 was 1.3 and TSH was 3.1 (Range 0.8 to1.8 and 0.40 to 5.50)

On 07/22/06 Free T-4 was 1.3 and TSH was 13.88 (Range 0.8 to1.8 and 0.40 to 5.50)

On 11/08/06 Thyroxine (T-4) was 11.4 and TSH was 1.549 Range 4.5-12.0 -0.350-5.500

On 02/27/07 Thyroxine (T-4) was 7.5 and TSH was 7.033 Range 4.5-12.0 -0.350-5.500

On 05/30/07  Thyroxine (T-4) was 11.1 and TSH was ???????

On 01/21/08  Thyroxine (T-4) was 12.2 and TSH was 0.615 -4.5-12.0 -0.350-5.500

on 05/20/08 Thyroxine (T-4) was 11.2 and TSH was 0.954 -4.5-12.0 -0.350-5.500

You were spot on that the first few were Free T-4 and also about the lab changes so are the other ones the Total T-4 tests?

Since the endochrinologist is not ordering tests until August what tests besides the T-3 would you suggest as we are going to our regular MD this Thursday.

I appreciate the help you and others have afforded.
Helpful - 0
213044 tn?1236527460
The first few T4 tests look like Free T4 tests with a lab range of 0.7-1.8. Particularly the first test that shows her TSH as indicating she is quite hyper and a T4 of 2.4.

Then the test was changed to a Total T4, I am guessing. The lab results change dramatically, and a different lab range is also used.

A Free T4 test is either listed as such, or may be called a free thyroxine test, FT4, thyroxine(free), or T4(free).

A total T4 test is less acurate, and does not provide the best information. It is an older test, and measures both the bound T4 (unavailable for use) and the Free T4 (available for use).

A T3 test is rarely run, and there are a couple different types. Again, the only one worth paying for in most cases is the Free T3 test, and it should be run more frequently than it is.

Your body uses T3. Every cell in your body uses T3. T4 is converted to T3 as it is needed. Sometimes the body cannot convert T4 to T3 properly, and the two hormones fall out of balance. If the doctor wants a true picture of hormone levels, a Free T4 and a Free T3 are run as well as a TSH test.

The "Free" tests have only been in use for less than a decade, and some doctors are resistant to using them, preferring to do things the way they have always been done.

You can either run a Free T4 and Free T3, or you can run four older tests designed to almost show as clear a picture after some educated guessing is done by the doctor.

Free T3 is run less often than Free T4 for several reasons.
It costs more.
It takes longer to get the results back.
It often shows the same result as the Free T4.

So doctors skip it for convenience, thinking it will be redundant anyway. But it can show conversion abnormalities, and it is the only way to measure the active hormone that your body needs.

T4 is the fuel for your vehicle. T3 is the fuel/air mixture that is burned in the engine cylinder. Your fuel tank can be full, but if you do not have the correct fuel/air mixture feeding into the cylinders, the engine will not run.

I would ask your regular MD to run a Free T4 and a Free T3. Any doctor can run them, and it would be worth it to see what her Free T3 is. THAT is what should dictate how much Synthroid a person needs.
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Avatar universal
The last test she took was on 05/20/08. Her TSH was  0.954 and her T-4 was11.2. These results are from the 100 mcg Synthroid. She started the 88 mcg around 06/04.

None of her lab reports mention a Free T-3  or Free T-4. Should I ask our regular MD to check these values. Is Free T-4 different that just T-4 ?

Jim
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Avatar universal
She took the Radioactive Iodine  pill on 03/02/2006.
Helpful - 0
213044 tn?1236527460
Do you have labratory test ranges for the Free T4?

It looks like as of 11-08-06 they started using a different T4 test. The results change too dramatically to be the same Free T4 tests as were previously run. The TSH would look completely different if they were using the same T4 test.

The better question to ask is; do you know the lab range for the latest T4 test?

Trembling hands are usually one of the first signs of going hyper. Since the med dose was reduced, that seems unlikely.

Without knowing her Free T4 and Free T3 TODAY, any answer you get will be a guess. Free T3 is really the only thing that counts, when you get right down to it. The T4 could be perfect but if the T3 is too high or low, that is what the body will react to.

She needs to have her Free T4 and Free T3 checked in two weeks.
If both tests are not run, they are wasting her time.

From the look of her TSH, either 88mcg or 100mcg should be close. But now I'm guessing.
Helpful - 0
550622 tn?1247656720
Did Carol have the Radioactive Iodine to "kill" the thyroid?  If so, then she is now Hypo T and she would need to take Synthroid.  Makes since to me now.

However, if she didn't not take RAI, then she is Hyper T.  She seems to be having all of the symptoms of Hyper T.
Helpful - 0
550622 tn?1247656720
Good Morning!

I'm a bit confused as to why your wife is on Synthroid for Hyper T.  That is usually used to treat Hypo T.  I am Hyper T and am on Tapazole (Methimazole).  It has totally stopped my hands from trembling and the anxiety.  My Endocrinologist also put me on Toprol (a beta blocker) to slow my heart rate.  I was diagnosed last October.  I go in every 4 weeks for lab work.  My Endocrinologist keeps very close tabs on my lab work.

I would clarify with the doctor if she is Hypo or Hyper.
Helpful - 0
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