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Help Interpret Levels Please !

Can anyone interpret my recent thyroid levels please.  I am currently on Levothyroxine alternating .50mcg & .75mcg.

TSH  .86
T3    2.9
T4    1.4

Thank you !
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Avatar universal
Thanks...I have a question for you.

Do you think acid reflux can cause bilateral arm and leg weakness, dizziness, lightheadedness and fatigue?

I struggle with really trying to figure out which one it is.  Is it the acid reflux, thyroid, herniated cerebellar tonsils or ?

They are sending me for vestibular testing in March for the dizziness however I don't think they will likely find anything on the testing.

My ekgs are always showing a Short PR Syndrome so this is very frustrating because apparently it is an extra electrical pathway so I recently made an appt. with an electrophysiologist to get his opinion on all these palpitations and such.  So frustrating.

The neurologist thinks its all migraines but I didn't know one gets palpitations with migraines.  Menopause maybe but migraines not sure.

Can I get your opinion on this please.

I also get coldness in my leg from knee to ankle....it is a very strange symptom and the neurologist of course ordered a lumbar MRI which showed nothing.
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Avatar universal
Thanks...I have a question for you.

Do you think acid reflux can cause bilateral arm and leg weakness, dizziness, lightheadedness and fatigue?

I struggle with really trying to figure out which one it is.  Is it the acid reflux, thyroid, herniated cerebellar tonsils or ?

They are sending me for vestibular testing in March for the dizziness however I don't think they will likely find anything on the testing.

My ekgs are always showing a Short PR Syndrome so this is very frustrating because apparently it is an extra electrical pathway so I recently made an appt. with an electrophysiologist to get his opinion on all these palpitations and such.  So frustrating.

The neurologist thinks its all migraines but I didn't know one gets palpitations with migraines.  Menopause maybe but migraines not sure.

Can I get your opinion on this please.
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649848 tn?1534633700
COMMUNITY LEADER
Acid reflux is a prime symptom of hypothyroidism, so once your thyroid levels are where you need them to be, you shouldn't need the protonix.

I had GERD/acid reflux for years and my doctor prescribed Aciphex for it.  I was on that for nearly 10 yrs, then my insurance company refused to pay for it, so I went to omeprazole, which didn't help at all. I got off all of that stuff once my thyroid levels were right; now the only time I get acid reflux is if I eat too close (within 3-4 hrs) to going to bed.  

We often find that acid reflux happens, not because of too much acid, but because of too little.  My first line of defense for acid reflux, now, is a couple sips of dill pickle or green olive juice.  I also, sometimes, drink a glass of warm water, with a tablespoon of apple cider vinegar and a teaspoon of honey.

T3 med can be taken with food, but T4 med can not, so if you're splitting your dose of T3, taking 1/2 at lunch time usually works well.  
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1756321 tn?1547095325
You can take both T4 and T3 at the same time. :)
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Avatar universal
Thanks....for all the responses.

Do you know if the T3 can be taken at the same time as T4 in the AM dosage?

I am aware not to take any other medications/supplements with the T4 but do not know about the T3.

Thank you again.
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1756321 tn?1547095325
No problem.  It is not illegal to prescribe acid blockers long term but it's not healthy either.  

Two steps are required to absorb vitamin B12 from food. First, hydrochloric acid (stomach acid) separates vitamin B12 from protein. After vitamin B12 is released from the protein, it combines with intrinsic factor and is absorbed by the body into the blood stream.  

Acid blocking drugs block the release of stomach acid from the parietal cells and can also block the parietal cells from releasing intrinsic factor. Untreated B12 deficiency can lead to permanent neurological damage that is irreversible if not treated in time.
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Avatar universal
Wow....I was under the impression that I would be on it longterm.  If this is the case why is my rx for 90 days with 3 refills !

My mother was on PPI for years and had to have hiatal hernia surgery last spring...they told her after a major surgery to stop all calcium supplements (she has osteoporosis) and to continue the PPI.  Very interesting.

She has major memory loss since her surgery and I have pleaded for her to demand a B12 test and for whatever reason she doesnt do it.  The only thing I can do is call her doctor myself and tell them.  They are useless to her anyway.  She went to the ER with excrutiating pains and after several tests they told her to see a cardiologist and released her.  NICE...that is when her boss (an oncologist) told her to go to GI and luckily she did but unfortunately the hernia was very large and lots of damage was done.

Thanks for all your information.
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1756321 tn?1547095325
Protonix can be used for treatment up to 8 weeks with an additional 8 weeks of treatment if needed. A good article by Chris Kresser too - FDA sounds alarm on dangers of antacid drugs. About time. My mother had severe life threatening conditions after almost 6 years on nexium.

"The FDA report cautions against high doses or prolonged use of PPIs, because they’ve been shown to increase the risk of infection, bone fractures and dementia.

But the danger doesn’t stop there. As I pointed out in my series, all acid stopping drugs (not just PPIs) inhibit nutrient absorption, promote bacterial overgrowth, reduce resistance to infection and increase the risk of cancer and other serious diseases."
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Avatar universal
I dont quite understand the portion of your post with PIPs 4-8 weeks but Protonix additional 8 weeks.
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Avatar universal
When they admitted me thru the ER in 2010 was because I was experiencing the neurological issues and my ekg was terrible.  After 3 days of scanning, stress testing and heart monitors they concluded that my heartbeat was not testbook normal but must just be normal for me.  My B12 level was 238 and they commented all bloodwork normal.

Followup with PCP was a neurologist referral.  He found nothing.  After months of still feeling absolutely terrible I went to GI and received endo/colonoscopy as I was continuously losing weight.  H. Pylori and gastritis was found and PrevPak erradicated the H. Pylori.  Later tested negative for the Pylori however my stomach remains red but gastritis is inactive.  So still being sick I landed back in neurologist and saw the partner of the practice.  He quickly t reprimanded me for being there as his partner had seen me 5 months prior and found nothing.  In tears I explained to him I had H Pylori and read about a B12 deficiency connection and that my lower back and thighs were burning so he quickly changed his attitude, looked at my prior records and told me to quickly get downstairs to pharmacy for rx and get blood drawn in lab then get right back up for injection of B12.  WHAT....crazy.  I forgave him quickly because he at least did something about it unlike the many other drs. I had seen.  So about 9 doctors and a 3 day hospital stay with an array of drs. did not pick up on my B12 deficiency.  Scary !  If I was not such a persistent person I would be in pretty bad shape and who knows where that B12 level would be.

I did want to ask you about palpitations.  I seem to get them at most odd timing.  Laying down to relax or waking from sleep.  More odd is when I turn over in bed BAMMMM there they come.  That is so scary and I start wondering if I am straining my body too much while turning over that palpitations set in.  

Also on both thumb nails I have horizontal ridging.  This is very noticable and not sure what it is.  Asked the DO and he said prior disease process, picking at the nailbed and vitamin deficiency.  So I do tend to always mess with my cuticles however when I stopped it went away then came back worse.  Not sure which vitamin deficiency this would be since I already take the injections of B12.

Or if it could be related to thyroid as well.

Can the T3 and T4 be taken together in the morning or is there a wait time for the T3?  

Again, thank you so much because I receive more information and help on this forum than any dr. has provided.
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1756321 tn?1547095325
I have an extremely low level of prostaglandins so the very few times in my life I've had a headache were due to reasons other than high prostaglandins. I have no menstrual cramps either which is due to low prostaglandins as well.  One of my reasons for a headache, actually migranes, was magnesium deficiency. Magnesium supports the production of nitric oxide which is essential for arterial relaxation.

My mother used to suffer severely with GERD and LPR. Within weeks of stopping nexium and starting betaine HCI with pepsin supplements (to increase stomach acid) and digestive enzymes supplements (to improve digestion) both conditions went away.

Hypothyroidism is one of the many causes of low stomach acid just to add. Stomach acid is needed for nutrient absorption to killing off bacteria, fungi and parasites.  The FDA's approved Proton Pump Inhibitors (PPIs) dosage for GERD is 4 to 8 weeks with the exception of Protonix listing an additional 8 weeks.


***

Anti-inflammatory Effects Of Omega 3 Fatty Acid In Fish Oil Linked To Lowering Of Prostaglandin...

"First, the much fewer prostaglandins are made from omega 3 fatty acids as compared to the other class of fatty acids in the body, the omega 6 family of fatty acids that originate in the diet from leafy vegetables and other plant sources.

Second, the omega 3 fatty acids compete with omega 6 fatty acids for the same binding site on the COX 1 enzyme that converts the omega 6 fatty acids to prostaglandin (which is why the COX 1 enzyme and its COX 2 cousin are the targets of anti-inflammatory drugs like ibuprofen). The more omega 3 fatty acids present to block the binding sites, the fewer omega 6 fatty acids are able to be converted to prostaglandin.

Third, although omega 3 fatty acids also are converted to prostaglandins, the prostaglandins formed from omega 3 are generally 2 to 50 times less active than those formed from the omega 6 fatty acids from dietary plants."

***

Excerpt from the article "Tripping Lightly Down the Prostaglandin Pathways"...

"Tips for Tripping Lightly Down the Prostaglandin Pathways

1. Avoid all hydrogenated fats
2. Avoid high levels of processed omega-6 vegetable oils, especially soy, corn, cottonseed and safflower oils
3. Use high quality butter
4. Use small amounts of flax oil in salad dressings.
5. Use coconut oil or whole coconut milk in cooking
6. Supplement with cod liver oil and evening primrose, borage or black current oils
7. Eat organ meats and fish eggs occasionally
8. Eat good quality eggs frequently
9. Eat raw meat or fish occasionally (Note: Fish should be marinated in an acidic medium, and meat should be frozen for at least 14 days before preparation, to avoid parasite contamination.)
10. Avoid high phytate foods that block zinc. These include grains, legumes and nuts that have not been properly prepared to reduce phytate content. Modern soy foods have potent zinc-blocking effects.
11. Avoid refined sweeteners like sugar and high fructose corn syrup
12. Eat and drink in moderation—but don't deprive yourself of delicious traditional foods."
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649848 tn?1534633700
COMMUNITY LEADER
Thank you for the link; I'll take a look at it.

Ranges for a lot of things in the U.S. are way too broad, which puts a lot of people in "normal" categories when they shouldn't be, such as the B12.  Just think if the bottom of the range for B12 in the U.S. were 500 instead of 200, the thousands of people with levels between 200 and 500 would have to be treated.  As it is, those are all considered "normal" and doctors can ignore any B-12 related symptoms, since levels are normal.  This applies to thyroid hormone levels as well as other parameters.

Sorry, I forgot to address the ferritin issue.  Ferritin is raised by taking iron; however dosing iron isn't as cut and dried as some other things.  Your doctor would be the best one to tell you how much to take, but you can get supplements on your own, as well.  I think the one I was taking was 30 mg.  Be sure to look for one that's non-constipating, since that's a trademark of iron supplements.  
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Avatar universal
Thanks again.

Here it is for you :-)

http://umm.edu/health/medical/altmed/condition/migraine-headache

Scroll pretty far down for SUPPLEMENTS section....although all the information is very interesting.

I had my B6 checked before...I remember something about it needing to be frozen and such....results came back good :-)

What I also find interesting when it comes to levels of vitamins is how our ranges are so much different than those of other countries such as Japan.  
My daughters pediatrician is Japanese and for any complaint she has his response is.......eat fish !  LOL, he is awesome as well.

Enjoy !

BTW, what about the Ferritin ?  Sorry !

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649848 tn?1534633700
COMMUNITY LEADER
A standard CBD/BMP doesn't, typically, show magnesium levels.. That has to be ordered as a separate test.  

I'm not a doctor so I can't tell you exactly what dosages of vitamins/minerals you should be taking, but I can give you general ideas.

Since you've had a hysterectomy, you should probably be taking about 1000-1200 mg calcium daily (preferably in 2 doses, since the body can't absorb more than 600 mg at once), along with 200-400 mg (usually 200 mg) magnesium and around 2000-4000 IU vitamin D (50K might have been too much).  Magnesium and vitamin D are necessary for the absorption/metabolism of calcium.  Do not take calcium or magnesium within 4 hours of thyroid replacement hormones, as they inhibit the absorption of the thyroid  med.

The main B vitamin, other than B12 that you might be deficient in is folate, but you can get a good quality B complex to make sure you get them all.  One thing to note is that vitamin B6 (pyroxidine) can cause vivid or disturbing dreams, so you'll want to beware of that.  I can only take my B complex once/twice per week, for that reason. Fortunately, the only B deficiency I have is B12, for which I inject weekly.

As you know, then, anxiety makes everything seem much worse than it really is, so sometimes a mild anti-anxiety med can be helpful, because, as in my case, it eased the anxiety, which in turn eased the symptoms and I was able to break the cycle. As noted, I've been off it for over a year now.

I am interested in the U of MD website regarding magnesium and riboflavin.  I'm off to get ready for bed,  now, but I'll take a look at it as soon as I can.. Thanks.
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Avatar universal
Thank you very much.

I do not supplement Vitamin D, Omega 3 or Magnesium.  I present in the office and the first thing I ask is to test my vitamin levels because if I am
B12 deficient with no known reason I could very well be deficient in other
vitamins/nutrients.  A standard CBC/MBP is ordered and that's it.

Could you let me know suggestions on what dosages to take of which vitamins and to get the ferritin levels up is iron?   I had a hysterectomy in 2012 and should be on calcium but according to what I have read calcium/magnesium/D work together and should be balanced properly.
I do recall prior to all this happening in 2010 that my primary at the time put me on the 50k vitamin D and I felt as though I had more pain and fatigue on that medicine.  I am hypersensitive to medications.


I was rx Omeprazole by Cardiologist 2 months ago for acid reflux.  She just changed it to Protonix as it is supposed to be longer lasting.  When I bend over I get very strange symptoms and she said she believes it is acid reflux because bending at the stomach and pressure, etc.  In the mornings I feel terrible so this is another reason behind her theory.

Anxiety....you aren't kidding.  I will definitely say yes to that.  Never had anxiety in my life until all this happened.  You are right...when a dr. can't tell you what it is and you experience these terrible issues it is overwhelming.  I know that when I get palpitations weakness sets in then a terrible headache like a vicious cycle.  The days (rare) that I have no symptoms I am cool as a cucumber with no worries and having a great day.  Make one wrong move and BAMMMM back to square one.  

My PCP/DO does not offer to rx me anti-depressants as he knows there is the problems are causing the anxiety not anxiety causing the problems.  He is great....I must admit....probably the only dr. that I have complete confidence and trust in.  

Again, if you can give me a basic idea of vitamins and such that would be great help.

BTW when I saw a NL at the neuromuscular clinic at U of MD for migraines he said 400mg magnesium and 400mg B2 (riboflavin) for migraine relief.  You can read more on the University of MD website if you are interested in that.

I would also wonder what other B vitamins I may be deficient in.
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Avatar universal
I will let PCP/DO know next week when I visit him.  He is very easy going and doesn't have a problem ordering anything.

I was tested for both of those antibodies in 2011 and they were negative but doesn't hurt to do it again.

Thank you.

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649848 tn?1534633700
COMMUNITY LEADER
I forgot to  mention that you need to get thyroid antibody tests to confirm Hashimoto's.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).

If either of those are positive, Hashimoto's will be confirmed.  If you have Hashimoto's, your thyroid function will continue to decline as the antibodies destroy healthy tissue, so your thyroid will be unable to produce adequate hormones.
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649848 tn?1534633700
COMMUNITY LEADER
Sorry I've been sort of offline for a couple of days.  Everyone else has pretty much filled in the blanks, but I'd just like to reiterate that simply having your levels "in range" is not enough to alleviate symptoms.  

We know you're doing the monthly B-12 shots and if you'd had a shot just prior to the blood work and your level was only 681, you might need the more often for a while, in order to build up your levels better.  I find that I have to keep my level right near the top of the range (1100) in order to alleviate symptoms.

Are you supplementing vitamin D, magnesium and Omega 3?  Vitamin D deficiency can cause many hypo like symptoms.  Magnesium deficiency can cause a lot of joint/muscle aches/pains, as well as many other symptoms.  

Your ferritin isn't "horrible" but it could stand to be a bit higher.  Recommended is around 70.

You need to work on getting your vitamin/mineral levels up high enough to alleviate any symptoms that deficiency may cause.  Once that's done, you can concentrate on the thyroid issue.  In the meantime, I still think your doctor was right in adding the cytomel, but I also think s/he should have decreased your T4 med.

You may have other things going on, but you have to address the known factors, then work on whatever symptoms are left.

Like some of the others, I had palps really bad when I was hypo and like you, I had them at night, which seemed to magnify them.  I went through the entire heart workup as well.  Bottom line is that a lot of it was caused by anxiety.  Many people will say they aren't anxious, but there's always a mental aspect to this type of thing - there's something wrong with us, we don't know exactly what it is and the more we worry and wonder, the worse it gets.

While anxiety is another symptom of being hypo, sometimes it's necessary to try a mild anti-anxiety med (not an anti-depressant), just to help you get over the rough spots.  I was on Buspirone for a couple of years until my levels got to where I need them, then I was able to get off them.  

Acid reflux is another issue for hypos and many have it and don't realize it.  It's often caused by not having enough stomach acid, rather than having too much.  When it get it, I try drinking some dill pickle or olive juice.
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Avatar universal
Thanks!  Hope so.  My fatigue is just awful and the palpitations awakening me from sleep is quite scary.  Made an appt. with an electrophysiologist just in case.
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Avatar universal
T3 is short-acting, so it will build up in your bloodstream after only a couple of days. Hang in there, and see how you feel after a week or two. Heart palpitations are a major hypothyroid symptom, so it should be interesting to see if they abate once you're at a proper dose of cytomel.
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Avatar universal
I hope so but I am still confused on the levels being in range.  Not sure how long it takes for this Cytomel to work either.
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Avatar universal
Thanks.  It's just crazy because so many specialists and not one of them definitively say....this is the problem.  It is not only frustrating but scary as
well.  

These palpitations drive me nuts.  They get me so worked up that I can't
get anything done due to the fatigue that sets in afterwards.  It is very strange
is all I can say.

How long did your palpitations last and how frequent were they.  Mine can last hours, day after day after day...they can wake me from my sleep as well.  I find that most times I get them is when I lay down which is contradicting since you are supposed to lie down when they present.  This is why my cardiologist thinks acid reflux is the culprit.  

I have been asked what comes first the migraine or the palpitations.  I believe the palpitations come first....then sets in the migraine.  Umphhhhhhhh.

Still confused as I thought my levels were good....but how long does it take for the Cytomel (T3) to start working?
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Avatar universal
Thank you.  I communicate on the Chiari Malformation forum as well.  Since there seems to be a thyroid concern as well I am going back and forth with the entire issue.  There seems to be my 3 NS who think there is no problem with the CSF flow and one retired NS who agrees with radiologist that anteriorly the CSF is fine but concerned about the flow posteriorly.  The retired NS also believes the palpitations are directly related to the tonsilar herniation.  With the last NS sending me for vestibular testing in March with 3 different appts. to complete the entire process....honestly, I don't believe a single thing will result from that appt. other than 180.00 in copays and a day wasted.

My array of NL have no clue and continue to dx me with migraines.  Anyone with all these problems going on is bound to acquire migraines at
some point anyway.  

A cardiologist who thinks it is acid reflux and wants to stress test me again.....I have had so much radiation in 3.5 years that I am not sure how much more my body should endure.  The palpitations have been the same for all these years so I am not sure what another stress test would even do at this point.  I was told to see an electrophysiologist specifically however when I asked my previous cardiologist his answer was....you already seen one when they did the tilt table study.  Ok....well considering that test was inconclusive and borderline at best for orthostatic hypotension that left unanswered reasoning behind the palpitations.

I am so stressed out about the entire situation it is terrible.  Then the drs. say stress relief is important.....thats great and I would probably have great stress relief if someone could figure out what this is.

The last NS's PA said they know it is something but believe it is not presenting in the "normal fashion" which is making it hard to dx.  Stress ???



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1756321 tn?1547095325
It has been estimated that over 90% of adults in the US don't eat enough omega-3 fatty acid in their diet. Krill oil supplements are recommended.

Many of those symptoms you list are seen with Chiari Malformation. There is no correlation between the length of tonsil herniation, symptoms or prognosis.  The disruption of cerebrospinal fluid (CSF) flow is a more important measure than the size of the herniation. A cine (stands for cinema) MRI helps to determine the amount of CSF flow. You might be interested in this thread from the Chiari community..

Unofficial Symptoms List:
http://www.medhelp.org/posts/Chiari-Malformation/Unofficial-Symptoms-List-/show/1192372



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