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FT4 to FT3 Conversion Problem --- Doctors Do Not Order Correct Tests
Back in April 2011, I posted in a different thread that I felt I had an FT4-to-FT3 conversion
problem. My FT4 was rising, while my FT3 was staying the same. My hypothyroidism symptoms
(arthritic pain in hands, pain in knees, sluggishness, memory lapses) were bad.
Here is the thread:
http://www.medhelp.org/posts/Thyroid-Disorders/I-Stop-Taking-Vitamin-D-Free-T4-Goes-Up-Free-T3-Stays-Same/show/1500525
The poster known as gimel said that I should be tested for the following:
(vitamins A, D, B12) and (RBC magnesium, zinc, and selenium).
gimel said that deficiencies in some or all of these can cause hypothyroidism symptoms.
I sent an email to my endo, asking for these 6 tests. The endo said that he would order the
vitamin D test but that the other 5 tests are not tests that he normally orders. The endo said
that I should ask my primary-care physician (PCP) for the other 5 tests.
I sent an email to the PCP, asking him for these 5 tests. Like the endo, the PCP said that he would
be willing to order the vitamin D test. However, the PCP wanted to see some information about the
usefulness of the other 5 tests.
So, I did some research.
I found the following website:
http://www.thyroid-info.com/articles/topsupplements.htm
This website shows the relation between thyroid function and vitamins E & D, selenium, and zinc.
The website also mentions vitamins A & C, Omega 3 & 6 fatty acids, and free-form amino acids.
I also found this website:
http://www.*************************/lab-values/
This website explains the tests for vitamin B12, ferritin, and RBC magnesium.
However, the most shocking discovery that I made was this website:
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php
This website explains that, if a person has autoimmune disease, then vitamin D may make the
autoimmune disease WORSE. My hypothyroidism stems from autoimmune disease. If vitamin D will
make my autoimmune disease worse, then that may explain why my FT4 and FT3 levels went down
when I used vitamin D, even though I used vitamin D and Synthroid far apart from each other.
So, I sent an email to the PCP, telling him about all 3 websites. I said that I should
*definitely* be tested for vitamins E & D, selenium, and zinc. I said that *maybe* I should
also be tested for the following: (vitamins A, C, B12), RBC magnesium, ferritin, Omega 3 & 6
fatty acids, free-form amino acids, and the adrenal glands and stress hormones.
The PCP said that he sees no usefulness to any of these tests, other than the vitamin D test. The PCP
did, however, say that he suggests taking a vitamin and mineral supplement + vitamin E.
First of all, why did the endo tell me to ask the *PCP* for the following 5 tests: (vitamins A, B12)
and (RBC magnesium, zinc, and selenium)? If these tests are thyroid-related, shouldn't the *endo* be
handling them?
And why would the PCP tell me to take vitamins and mineral supplements without first testing me to
find out which vitamins and minerals I am deficient in? He tells me to take vitamin E without testing
my vitamin E levels. Without a blood test, how do I know how much of a dosage of vitamin E I need,
if any?
And the one test the PCP *does* want to give me is for the substance (vitamin D) that I can't
swallow, no matter what, because that substance makes my autoimmune disease worse.
What is going on here?
Thanks for any answers.
problem. My FT4 was rising, while my FT3 was staying the same. My hypothyroidism symptoms
(arthritic pain in hands, pain in knees, sluggishness, memory lapses) were bad.
Here is the thread:
http://www.medhelp.org/posts/Thyroid-Disorders/I-Stop-Taking-Vitamin-D-Free-T4-Goes-Up-Free-T3-Stays-Same/show/1500525
The poster known as gimel said that I should be tested for the following:
(vitamins A, D, B12) and (RBC magnesium, zinc, and selenium).
gimel said that deficiencies in some or all of these can cause hypothyroidism symptoms.
I sent an email to my endo, asking for these 6 tests. The endo said that he would order the
vitamin D test but that the other 5 tests are not tests that he normally orders. The endo said
that I should ask my primary-care physician (PCP) for the other 5 tests.
I sent an email to the PCP, asking him for these 5 tests. Like the endo, the PCP said that he would
be willing to order the vitamin D test. However, the PCP wanted to see some information about the
usefulness of the other 5 tests.
So, I did some research.
I found the following website:
http://www.thyroid-info.com/articles/topsupplements.htm
This website shows the relation between thyroid function and vitamins E & D, selenium, and zinc.
The website also mentions vitamins A & C, Omega 3 & 6 fatty acids, and free-form amino acids.
I also found this website:
http://www.*************************/lab-values/
This website explains the tests for vitamin B12, ferritin, and RBC magnesium.
However, the most shocking discovery that I made was this website:
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php
This website explains that, if a person has autoimmune disease, then vitamin D may make the
autoimmune disease WORSE. My hypothyroidism stems from autoimmune disease. If vitamin D will
make my autoimmune disease worse, then that may explain why my FT4 and FT3 levels went down
when I used vitamin D, even though I used vitamin D and Synthroid far apart from each other.
So, I sent an email to the PCP, telling him about all 3 websites. I said that I should
*definitely* be tested for vitamins E & D, selenium, and zinc. I said that *maybe* I should
also be tested for the following: (vitamins A, C, B12), RBC magnesium, ferritin, Omega 3 & 6
fatty acids, free-form amino acids, and the adrenal glands and stress hormones.
The PCP said that he sees no usefulness to any of these tests, other than the vitamin D test. The PCP
did, however, say that he suggests taking a vitamin and mineral supplement + vitamin E.
First of all, why did the endo tell me to ask the *PCP* for the following 5 tests: (vitamins A, B12)
and (RBC magnesium, zinc, and selenium)? If these tests are thyroid-related, shouldn't the *endo* be
handling them?
And why would the PCP tell me to take vitamins and mineral supplements without first testing me to
find out which vitamins and minerals I am deficient in? He tells me to take vitamin E without testing
my vitamin E levels. Without a blood test, how do I know how much of a dosage of vitamin E I need,
if any?
And the one test the PCP *does* want to give me is for the substance (vitamin D) that I can't
swallow, no matter what, because that substance makes my autoimmune disease worse.
What is going on here?
Thanks for any answers.
This is why SYMPTOMS are to be primary with blood labs being secondary to proper treatment.
Also most all the discussion talks about the variability of TSH. And most of us here know that TSH is virtually totally useless and is so variable. The discussion above is just further proof as to how variable and unreliable and obsolete the TSH test is.
As far as T4 I'm not so sure. I would seem to make some sense that the FT4 number MIGHT be slightly higher. After all you ARE putting medication onto your blood. But what significant amount that would be I guess is the debatable question. Something that we know takes weeks to stabilize in the blood would certainly suggest the single daily dose wouldn't have a very significant alteration.
T3 knowing that this is active and immediately available in hours seems clearly to suggest that T3 medication should not be taken before a test.
I think the REAL point that should be considered is that the testing time AND whether or not you have eaten and/or taken medication should be as close to 100% consistent as possible.
Then symptoms with a consistent testing lab, testing time, fasting and medication before the tests remaining constant. Compare the symptoms with the blood tests and keep adjusting slowly the medication to alleviate symptoms is what is needed. The lab numbers are relative to the symptoms, not the other way around.
One endo we've seen when asked about separating the medication from food said. Sure absorption is affected. But if you take the medication and eat similarly each day, all that needs to be done is raise the dosage to make up for any loss of absorption. In his experience he would rather have the person take thier medication when it is convenient AND consistent. The consistency of the person taking the medication and nor forgetting or what not is dramatically decreased when it best fits in with the individual persons lifestyle. In other words, he would rather just prescribe a higher dosage than would otherwise be necessary if the person was consistently taking their med with breakfast for example every day. Than a person who forgets every few days to take medication because they forgot to wait for X amount of time after eating etc.
Again I think that keeping everything consistent is most important. Whether a person wants to maximize the efficiency of the medication by separation of food and timing etc is a personal decision.
A person who does NOT take medicine and fasts for an early morning blood test seems like about the most perfect consistent thing that could be done. So I see nothing wrong with this and maybe even the best thing to do. But that may not work out for some people's life or work schedule.
Also most all the discussion talks about the variability of TSH. And most of us here know that TSH is virtually totally useless and is so variable. The discussion above is just further proof as to how variable and unreliable and obsolete the TSH test is.
As far as T4 I'm not so sure. I would seem to make some sense that the FT4 number MIGHT be slightly higher. After all you ARE putting medication onto your blood. But what significant amount that would be I guess is the debatable question. Something that we know takes weeks to stabilize in the blood would certainly suggest the single daily dose wouldn't have a very significant alteration.
T3 knowing that this is active and immediately available in hours seems clearly to suggest that T3 medication should not be taken before a test.
I think the REAL point that should be considered is that the testing time AND whether or not you have eaten and/or taken medication should be as close to 100% consistent as possible.
Then symptoms with a consistent testing lab, testing time, fasting and medication before the tests remaining constant. Compare the symptoms with the blood tests and keep adjusting slowly the medication to alleviate symptoms is what is needed. The lab numbers are relative to the symptoms, not the other way around.
One endo we've seen when asked about separating the medication from food said. Sure absorption is affected. But if you take the medication and eat similarly each day, all that needs to be done is raise the dosage to make up for any loss of absorption. In his experience he would rather have the person take thier medication when it is convenient AND consistent. The consistency of the person taking the medication and nor forgetting or what not is dramatically decreased when it best fits in with the individual persons lifestyle. In other words, he would rather just prescribe a higher dosage than would otherwise be necessary if the person was consistently taking their med with breakfast for example every day. Than a person who forgets every few days to take medication because they forgot to wait for X amount of time after eating etc.
Again I think that keeping everything consistent is most important. Whether a person wants to maximize the efficiency of the medication by separation of food and timing etc is a personal decision.
A person who does NOT take medicine and fasts for an early morning blood test seems like about the most perfect consistent thing that could be done. So I see nothing wrong with this and maybe even the best thing to do. But that may not work out for some people's life or work schedule.
I believe this is only YOUR opinion, Barb. I take T3 so I always have my labs done first thing in the morning, so it's a moot point for me personally. However the last naturopath I consulted told me neither thyroid medication should be taken before the test, and I've read differing opinions to yours as well. My doctor now prefers that I do not take either T4 or T3 before my labs, and the lab told me it's best not even to have had anything to drink before the test. Here is one differing opinion, from Mary Shoman's website:
"Usually, our doctors tell us that fasting is not necessary for thyroid blood tests, nor does it matter when tests are done -- particularly TSH tests. Only those patients taking an external source of T3 -- such as Cytomel, Armour Thyroid, Nature-throid, or a time-released T3 medication -- need to be aware of when they've taken their medication and the timing of testing, as T3 is active only for hours in the body, while T4, both synthetic and natural, has a much longer period of activity. Given that TSH tests reflect the impact of several weeks of medication, it's hard to argue that time of day or fasting would have an impact on the testing and results.
Interestingly, however, research by Scobbo et. al. in 2004 showed that TSH tests declined in 97 of 100 of the people studied -- by an average of 26.39% -- when compared to early morning, fasting, TSH test results. This resulted in as many as 6% of patients being reclassified from the diagnosis of subclinical hypothyroidism to "normal."
Researchers concluded that the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement.
Implications for Patients
Essentially, these researchers retested patients later, when they could get a normal range result and declare the patients to be free of hypothyroidism.
Doing so, however -- retesting a patient without fasting, later in the day, in order to see if an elevated TSH level will then drop down to be "borderline normal" -- is questionable medicine, at best.
It's particularly questionable, given that researchers have not established that the earlier, fasting level results are any less valid than the later, non-fasting, "normal range" results. Researchers also don't even know how fasting affects thyroid function or TSH values, or why TSH values would be different based on fasting or non-fasting.
In some cases, if you are having your thyroid testing done along with other bloodwork -- such as glucose, insulin, or cholesterol levels done -- you will be asked to fast, and have your test done first thing in the morning. In other cases, your doctor may not dictate when to have your TSH test, or whether or not to fast. But be aware that if you test later in the day and you've eaten, you are likely to have a lower TSH level than if you test earlier in the day with fasting.
Other Findings
Other information actually supports the idea that patients should not take any thyroid medication the day of testing, until after tests are completed.
The Thyroid Manager online textbook mentions that
Serum T4 concentrations peak 2 to 4 hours after an oral dose and remain above normal for approximately 6 hours in patients receiving daily replacement therapy.
For this reason, thyroid expert Richard Shames, MD has the following recommendation:
I absolutely recommend that patients have any morning blood tests evaluating the thyroid before taking any thyroid medication. I have always told my patients to do it this way."
Since it is just as easy, at least for me, to go to the lab and have the draw done first thing in the morning, and since in fact when endos drew my blood in their office later in the day after I had taken my meds, my FREE T4 as well as my FREE T3 was elevated more than it was when I had the tests done in the lab before I took my meds.....and since it is easy enough already for endos to mis-diagnose labs based on their own agenda (forgive my bitterness, but this is MY experience)....I personally choose to err on the side of caution and not take my meds before the blood draw.
Because there seems to be controversy, perhaps readers should Google "thyroid blood tests" and decide for themselves. If readers want to consider actual science and not patient-oriented websites and forums, pose your question something similar to this :
"Should thyroid medication be taken before a blood test meta-analysis." By putting the words "meta-analysis" after any query you are more likely to be taken to articles in medical journals.
"Usually, our doctors tell us that fasting is not necessary for thyroid blood tests, nor does it matter when tests are done -- particularly TSH tests. Only those patients taking an external source of T3 -- such as Cytomel, Armour Thyroid, Nature-throid, or a time-released T3 medication -- need to be aware of when they've taken their medication and the timing of testing, as T3 is active only for hours in the body, while T4, both synthetic and natural, has a much longer period of activity. Given that TSH tests reflect the impact of several weeks of medication, it's hard to argue that time of day or fasting would have an impact on the testing and results.
Interestingly, however, research by Scobbo et. al. in 2004 showed that TSH tests declined in 97 of 100 of the people studied -- by an average of 26.39% -- when compared to early morning, fasting, TSH test results. This resulted in as many as 6% of patients being reclassified from the diagnosis of subclinical hypothyroidism to "normal."
Researchers concluded that the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement.
Implications for Patients
Essentially, these researchers retested patients later, when they could get a normal range result and declare the patients to be free of hypothyroidism.
Doing so, however -- retesting a patient without fasting, later in the day, in order to see if an elevated TSH level will then drop down to be "borderline normal" -- is questionable medicine, at best.
It's particularly questionable, given that researchers have not established that the earlier, fasting level results are any less valid than the later, non-fasting, "normal range" results. Researchers also don't even know how fasting affects thyroid function or TSH values, or why TSH values would be different based on fasting or non-fasting.
In some cases, if you are having your thyroid testing done along with other bloodwork -- such as glucose, insulin, or cholesterol levels done -- you will be asked to fast, and have your test done first thing in the morning. In other cases, your doctor may not dictate when to have your TSH test, or whether or not to fast. But be aware that if you test later in the day and you've eaten, you are likely to have a lower TSH level than if you test earlier in the day with fasting.
Other Findings
Other information actually supports the idea that patients should not take any thyroid medication the day of testing, until after tests are completed.
The Thyroid Manager online textbook mentions that
Serum T4 concentrations peak 2 to 4 hours after an oral dose and remain above normal for approximately 6 hours in patients receiving daily replacement therapy.
For this reason, thyroid expert Richard Shames, MD has the following recommendation:
I absolutely recommend that patients have any morning blood tests evaluating the thyroid before taking any thyroid medication. I have always told my patients to do it this way."
Since it is just as easy, at least for me, to go to the lab and have the draw done first thing in the morning, and since in fact when endos drew my blood in their office later in the day after I had taken my meds, my FREE T4 as well as my FREE T3 was elevated more than it was when I had the tests done in the lab before I took my meds.....and since it is easy enough already for endos to mis-diagnose labs based on their own agenda (forgive my bitterness, but this is MY experience)....I personally choose to err on the side of caution and not take my meds before the blood draw.
Because there seems to be controversy, perhaps readers should Google "thyroid blood tests" and decide for themselves. If readers want to consider actual science and not patient-oriented websites and forums, pose your question something similar to this :
"Should thyroid medication be taken before a blood test meta-analysis." By putting the words "meta-analysis" after any query you are more likely to be taken to articles in medical journals.
COMMUNITY LEADER
"ALL endos should know and should inform patients of the importance of not eating or taking thyroid meds before the blood draw."
Fasting is not necessary for thyroid blood work. It's only necessary for such things as cholesterol, etc. Ask your doctor whether fasting is necessary or not.
Not taking thyroid med prior to thyroid labs, applies only in the case of a T3 med, because of the short time it gets into/out of the system. T4 meds can be taken prior because it takes them so long to reach potential.
Fasting is not necessary for thyroid blood work. It's only necessary for such things as cholesterol, etc. Ask your doctor whether fasting is necessary or not.
Not taking thyroid med prior to thyroid labs, applies only in the case of a T3 med, because of the short time it gets into/out of the system. T4 meds can be taken prior because it takes them so long to reach potential.
Silly me, of course I meant a hematologist....doi ! My B-12 and D levels were really low below range and my RBC enlarged. The hematologist diagnosed pernicious anemia. The brand of liquid B-12 she told me to take is NOW brand Ultra B-12, which you can find at Whole Foods but is cheaper at some health food stores. It contains all the B's and folic acid as well. The 5000 units of B-12 is sourced from methylcobalamin, cyanocobalamin, and dibecoside in co-enzyme form, which are synergistic. The only other brand she recommended was the Jarrow you have been taking, but she said the NOW sublingual was superior.
Sorry if the endo story was unclear. Also gratuitous no doubt, but to clarify...I got worse of Synthroid only and didn't get better until I took levothyroxine generic and Cytomel together. My TSH has never been high in range, but I had ALL the symptoms of hypothyroid, not just the few grosser ones I mentioned. After a year of complaining and hair loss, I was finally sent for an ultrasound, which showed nodules on both nodes. I was initially put on Synthroid "to control their growth." The symptoms got worse, but went away with the addition of T3. I tried Armour...it made me worse and I went back on T4/Cytomel and got better again. Then the drugstore changed the Cytomel to generic T3 and I didn't notice. 4 months later, I was sick again. I was sent to a series of endos, all who only looked at my T4 and of course did obsolete total and uptake tests. The one FREE T4 test I had showed the level to be at the bottom of the range which of course endos deem to be "fine" even if symptoms continue to worsen. My TSH went from its historic .89 up to 1.6 but this was considered inconsequential. Finally as my health continued to decline, my PCP took pity on me and let me get blood tests every 6 weeks for over a year that included FREE T3 tests (very low to start) and adjust the levels of my medications until they were in the middle (T4) to the upper 1/4 (T3) of the range. At that point my TSH was suppressed way below the range, but she felt comfortable with that after reading science from medical journals that I took her. She was appalled at my callous treatment by the various endos, as she watched me gain 15 lbs of edema in 3 weeks after they lowered my meds because of my TSH. It seemed pretty clear to me that I was dealing with a conversion problem, and she agreed. But then I started to gain weight and had a gradual resumption of some symptoms such as edema of the extremities and abdomen, hair loss again, leg cramps, foot spasms, and more. I went and had rT3 tested and it was high-out-of-range and with a low ratio to T3. So I had to go off levothyroxine completely for 3 months and have blood tests again once a month until the rT3 cleared. During that time, I had to take extra T3 to try to make up for the deficit. Blood tests showed my TSH still low (but this is to be expected after having it surpressed for a long time) my FREE T4 below the normal range, and my FREE T3 at the very bottom number of the range. The last endo I saw did not see fit to remark on this. Now I am back on a low dose of T4 and my usual dose of Cytomel for one month. I have to wait 2 more weeks, then go in for a new blood test and see where I am. Feeling really awful...the edema went away after a week off T4, but now has returned in spades, worse than before. Both my antibody tests have always been normal. I will test PTH at the next blood draw.....had it done only once back in 2005 when I first went to an endo. I hope that clears things up.
And yes, endos seem to always say that symptoms must be caused by something else. The last one, based on talking to me for 1/2 an hour at most, suggested I might be bi-polar (funny how my therapist never thought so..you know, the one I saw for several years for the severe depression and panic attacks that went away as soon as I took Cytomel, or the other one who said in her opinion my problem was hypothyroid) and he also posited that I was suffering from heavy metal poisoning because I take vitamins. Because he ignored my latest blood tests and ignored historic ones and because he also referred to me as both "Carla" and "Lisa" (nither of which is my name) in the letter he sent to my PCP (who couldn't believe it and told me to try to find another one) I intend to report him to my State medical board.
Meh. Lucky I had a PCP who is willing to deal with me and prescribe what I ask her for according to my blood tests, but she feels uncomfortable about it because (especially with rT3) she's exceeded her medical knowledge...she's an internist with a specialty in nephrology ! What does she know from the cursory classes in medical school long ago ? One would think that in a big city such as Los Angeles, with me being at one of the best hospitals in the city and with a PPO so I can go outside the hospital if necessary, that I could find a decent endo who would take my insurance. But NOooooooooo, apparently not.
Happy New Year. Wishing you well.
Sorry if the endo story was unclear. Also gratuitous no doubt, but to clarify...I got worse of Synthroid only and didn't get better until I took levothyroxine generic and Cytomel together. My TSH has never been high in range, but I had ALL the symptoms of hypothyroid, not just the few grosser ones I mentioned. After a year of complaining and hair loss, I was finally sent for an ultrasound, which showed nodules on both nodes. I was initially put on Synthroid "to control their growth." The symptoms got worse, but went away with the addition of T3. I tried Armour...it made me worse and I went back on T4/Cytomel and got better again. Then the drugstore changed the Cytomel to generic T3 and I didn't notice. 4 months later, I was sick again. I was sent to a series of endos, all who only looked at my T4 and of course did obsolete total and uptake tests. The one FREE T4 test I had showed the level to be at the bottom of the range which of course endos deem to be "fine" even if symptoms continue to worsen. My TSH went from its historic .89 up to 1.6 but this was considered inconsequential. Finally as my health continued to decline, my PCP took pity on me and let me get blood tests every 6 weeks for over a year that included FREE T3 tests (very low to start) and adjust the levels of my medications until they were in the middle (T4) to the upper 1/4 (T3) of the range. At that point my TSH was suppressed way below the range, but she felt comfortable with that after reading science from medical journals that I took her. She was appalled at my callous treatment by the various endos, as she watched me gain 15 lbs of edema in 3 weeks after they lowered my meds because of my TSH. It seemed pretty clear to me that I was dealing with a conversion problem, and she agreed. But then I started to gain weight and had a gradual resumption of some symptoms such as edema of the extremities and abdomen, hair loss again, leg cramps, foot spasms, and more. I went and had rT3 tested and it was high-out-of-range and with a low ratio to T3. So I had to go off levothyroxine completely for 3 months and have blood tests again once a month until the rT3 cleared. During that time, I had to take extra T3 to try to make up for the deficit. Blood tests showed my TSH still low (but this is to be expected after having it surpressed for a long time) my FREE T4 below the normal range, and my FREE T3 at the very bottom number of the range. The last endo I saw did not see fit to remark on this. Now I am back on a low dose of T4 and my usual dose of Cytomel for one month. I have to wait 2 more weeks, then go in for a new blood test and see where I am. Feeling really awful...the edema went away after a week off T4, but now has returned in spades, worse than before. Both my antibody tests have always been normal. I will test PTH at the next blood draw.....had it done only once back in 2005 when I first went to an endo. I hope that clears things up.
And yes, endos seem to always say that symptoms must be caused by something else. The last one, based on talking to me for 1/2 an hour at most, suggested I might be bi-polar (funny how my therapist never thought so..you know, the one I saw for several years for the severe depression and panic attacks that went away as soon as I took Cytomel, or the other one who said in her opinion my problem was hypothyroid) and he also posited that I was suffering from heavy metal poisoning because I take vitamins. Because he ignored my latest blood tests and ignored historic ones and because he also referred to me as both "Carla" and "Lisa" (nither of which is my name) in the letter he sent to my PCP (who couldn't believe it and told me to try to find another one) I intend to report him to my State medical board.
Meh. Lucky I had a PCP who is willing to deal with me and prescribe what I ask her for according to my blood tests, but she feels uncomfortable about it because (especially with rT3) she's exceeded her medical knowledge...she's an internist with a specialty in nephrology ! What does she know from the cursory classes in medical school long ago ? One would think that in a big city such as Los Angeles, with me being at one of the best hospitals in the city and with a PPO so I can go outside the hospital if necessary, that I could find a decent endo who would take my insurance. But NOooooooooo, apparently not.
Happy New Year. Wishing you well.
Hi, artfemme.
Every thyroid blood test that I've had, was administered to me BEFORE I took my thyroid medicine and BEFORE I ate anything.
I'm sort of a night owl. I go to sleep late and wake up late. I have thyroid blood tests done between 12 PM and 2 PM.
Now, the story that you tell about your own dealings with a bad endo is a little hard to understand. A little clarification may be helpful. You say that you experienced cessation of T4 and extra supplementation of T3. So, does that mean that you stopped taking T4 medicine (such as Synthroid) and started taking T3 medicine (such as Cytomel)?
Also, you say that your TSH was sub-normal. So, was the TSH value higher than the normal range? Or lower than the normal range?
And you say that a phlebotomist prescribed Vitamins D and B12 for you. Since phlebotomists (people who draw blood in blood tests) are not doctors and can't prescribe anything, I'm assuming that this phlebotomist simply advised you to take these vitamins. Is that the case? If yes, that would be kind of unusual. In my experience, phlebotomists usually do not offer any medical advice. In fact, one of my phlebotomists even told me that she had no idea was TSH meant. :)
As for your endo's saying that your macroglossia, hoarse voice, and partially missing eyebrows were caused by something other than hypothyroidism (presumably because your thyroid test results were within a certain "normal range"), that seems to be a common practice among endos. My current endo said the same thing. She, too, doesn't know what "else" could be causing these symptoms. She simply told me to talk to my PCP.
Every thyroid blood test that I've had, was administered to me BEFORE I took my thyroid medicine and BEFORE I ate anything.
I'm sort of a night owl. I go to sleep late and wake up late. I have thyroid blood tests done between 12 PM and 2 PM.
Now, the story that you tell about your own dealings with a bad endo is a little hard to understand. A little clarification may be helpful. You say that you experienced cessation of T4 and extra supplementation of T3. So, does that mean that you stopped taking T4 medicine (such as Synthroid) and started taking T3 medicine (such as Cytomel)?
Also, you say that your TSH was sub-normal. So, was the TSH value higher than the normal range? Or lower than the normal range?
And you say that a phlebotomist prescribed Vitamins D and B12 for you. Since phlebotomists (people who draw blood in blood tests) are not doctors and can't prescribe anything, I'm assuming that this phlebotomist simply advised you to take these vitamins. Is that the case? If yes, that would be kind of unusual. In my experience, phlebotomists usually do not offer any medical advice. In fact, one of my phlebotomists even told me that she had no idea was TSH meant. :)
As for your endo's saying that your macroglossia, hoarse voice, and partially missing eyebrows were caused by something other than hypothyroidism (presumably because your thyroid test results were within a certain "normal range"), that seems to be a common practice among endos. My current endo said the same thing. She, too, doesn't know what "else" could be causing these symptoms. She simply told me to talk to my PCP.
Hi, subire. Thank you very much for the kind words! I really appreciate them!
As for Vitamin B12, the website www (dot) stopthethyroidmadness (dot) com/lab-values
states that, for a normal range similar to (180 - 900), a good value for B12 is 800 or higher. After taking 1000-mcg Methyl B12 lozenges (made by Jarrow Formulas) every day, from mid-September 2011 to early February 2012, my B12 level in early February was 887 (normal range = 211 - 946).
However, Endo 1 (my current endo's immediate predecessor) advised me to take the B12 lozenges only three times per week, which I've been doing since mid-February 2012. As a result, my B12 level dropped. The B12 level was 637 (normal range = 211 - 946) in mid-April 2012, and 626 (normal range = 180 - 933) in late October 2012.
Maybe I should go back to taking the B12 lozenges every day.
You mentioned Liquid B Complex, and I found a Liquid B Complex product on the following website:
www (dot) gnc (dot) com/product/index (dot) jsp?productId=11535359
But this product includes Vitamin B6, and I have heard that Vitamin B6 may cause people to have intense dreams. Supposedly, Vitamin B6 helps with amino-acid production for neuro transmitters like serotonin and melatonin, which regulate our sleep and dreams.
Also, the B12 in this Liquid B Complex product is Cyanocobalamin, as opposed to Methylcobalamin, which supposedly is absorbed better by the body.
So, Liquid B Complex may not be the right product for me.
As for liquid Vitamin D, I remember finding such a product, but I think it had calcium or soy. Calcium and soy interfere with the absorption of thyroid medicine into the blood.
Once again, subire, thank you very much for your words of encouragement!
As for Vitamin B12, the website www (dot) stopthethyroidmadness (dot) com/lab-values
states that, for a normal range similar to (180 - 900), a good value for B12 is 800 or higher. After taking 1000-mcg Methyl B12 lozenges (made by Jarrow Formulas) every day, from mid-September 2011 to early February 2012, my B12 level in early February was 887 (normal range = 211 - 946).
However, Endo 1 (my current endo's immediate predecessor) advised me to take the B12 lozenges only three times per week, which I've been doing since mid-February 2012. As a result, my B12 level dropped. The B12 level was 637 (normal range = 211 - 946) in mid-April 2012, and 626 (normal range = 180 - 933) in late October 2012.
Maybe I should go back to taking the B12 lozenges every day.
You mentioned Liquid B Complex, and I found a Liquid B Complex product on the following website:
www (dot) gnc (dot) com/product/index (dot) jsp?productId=11535359
But this product includes Vitamin B6, and I have heard that Vitamin B6 may cause people to have intense dreams. Supposedly, Vitamin B6 helps with amino-acid production for neuro transmitters like serotonin and melatonin, which regulate our sleep and dreams.
Also, the B12 in this Liquid B Complex product is Cyanocobalamin, as opposed to Methylcobalamin, which supposedly is absorbed better by the body.
So, Liquid B Complex may not be the right product for me.
As for liquid Vitamin D, I remember finding such a product, but I think it had calcium or soy. Calcium and soy interfere with the absorption of thyroid medicine into the blood.
Once again, subire, thank you very much for your words of encouragement!
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