Help with lab results, new Dr. said abnormal but don't worry?

I have gained 45 lbs in the past year (25 since August).  I ran my 4th marathon in April, so I'm usually not one to sit around, however I can barely get up and moving these days I'm so tired.  My doctor in August said I was slightly hypo and put me on 50mcg synthroid.  (TSH 3.65...increase from 1.24 a few months earlier).  No T4 values.  I have moved and saw a new doctor in the area.

Since being on synthroid I've gained 20 lbs and feel more tired than ever.  I was also vitamin B and D deficient.

This new doctor spent 5 minutes with me, never looked at the records my old endo sent over, just ordered more blood work.  He called me and said everything was normal, just keep what I was doing and he'd see me in 3 months.  I asked him why I was still gaining weight and he said he didn't know because everything was normal, but since he still didn't have a chance to look at my old lab results, and things were "normal" I should not change anything.  His nurse forgot to order my vitamin B panel, oh...and I did have some unusual blood work, but he didn't know what it meant, and it was too complicated for him to explain to me in lay man terms...so don't worry about it.  What?  So I requested a copy of the lab tests and here's what it says.  I asked him about my being diagnosed with insulin resistance and he brushed that off and said to just keep doing what my other doctor told me to do.  (I'm taking

TSH 0.60uIU/ml
T4 Free (direct)  1.1 ng/dl  (I've read this may not be as high as it should be?)
Est Av Glucose  100mg/dl  (fasting...I've read this could be a sign of pre-diabetes?)
Vitamin D25  36.0/ng/ml
Anion Gap 4 mmol/L  (this is the one he said was low, he couldn't explain why, but couldn't explain it to me because it would be way over my head and he couldn't bring it down to lay man terms).  What I'm reading about this is that it could be due to hypothyroidism, myeloma, among other things.  

I keep gaining and gaining and gaining.  I'm tired, can't remember where I park my car when I go shopping, am scatter brained, have zero energy...this is not me.  I just want to be me again.

BTW...I was less than impressed with this doctor.  I am going to call see another doctor.  Hopefully my insurance company won't give me a hard time about it.

Thanks everyone.

[Penguinz68]

Also, my GFR non AA is 89ml/min/1.73  What I'm reading says this could indicate mild kidney issues, which could bring down the anion gap.  

I am reading a bunch of things that say I should look into these results, but the doctor said he will see me in 3 months.  Thoughts?

[FTB4]

Right off the bat! Yes get another MD, this guy is a quack, he could not explain in any terms, because he don't himself.  Could you post the ranges that came with those labs, without them we cannot tell, ranges very from lab to lab, Vitamin B deficiency can really beat you up mentally and physically. Many thyroid sufferers also have issues with absorbing nutrients and minerals from the diet, and it is very common with Vitamin B and D, I would start taking Vitamin D supplements of 1,000mg per day and also B, take them at least 4 hours apart from thyroid meds, also take 400mg of Magnesium Glycinate twice per day, 1 4 hrs after thyroid meds and 1 at bedtime, Magnesium helps relax you and helps the Vitamin D. Make sure when you purchase these that you read the ingredients, if they contain Soy, get one that does not. When you get your new MD, Request Free T3 and Free T4 with the blood work, these labs are very important, do not just settle for TSH, and when the results come in post them here with the ranges provided for each.   Best Wishes FTB4

[Penguinz68]

Thank you!  Unfortunately they sent me the results, but the ranges are cut off, so I don't know what they would be.  I'll try getting them to send them to be, but I am not holding my breath.  I plan on taking vitamin D and B again, and will definitely try the Magnesium Glycinate...thanks.  :)

[LazyMoose]

TSH is just a signal from the pituitary telling the thyroid what to do. Its not that accurate either.

t3 and t4 are the actual thyroid hormones and are best measured by the free t3 and free t4 test. these measure the amount that is free in your blood for cells to use. t4 is the storage hormone that is supposed to be converted to t3 by your body. t3 is what your cells actually consume.

so you can see why the free t3 and free t4 tests are important. and if you are in the low end , but still in range, you can still have some symptoms.

[gimel]

Just to supplement the good info already give you by FTB4, many times doctors have the "Immaculate TSH Belief" and only want to test and medicate based on TSH.  That absolutely doesn't work for everyone.  Other doctors that go beyond TSH often revert to "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the range is adequate for you.  That also is wrong.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

If your doctor is unwilling to treat clinically as described, then you are wasting your time there.   Better to spend your time finding a doctor that will treat hypothyroidism clinically.

[Penguinz68]

Thank you gimel, I appreciate your response.  Based on your response to my posts in the past I actually requested a Free T3 and T4, but he only tested T4.  This is so maddening!  

[gimel]

That is a common occurrence.  The best way to avoid it is to make sure the doctor verbally agrees with you on tests you request, and then make sure it is correctly identified on the lab request.  I even suggest going further and asking the lab personnel drawing blood for the test what tests are to be done.  Many times they operate on auto pilot and do the same old, same old, and overlook Free T3.  

Since you will have to return to get a Free T3 test, I also suggest that you should request test for Reverse T3 as well.  There is good info that the very best measure of actual tissue thyroid levels is the ratio of Free T3 to Reverse T3.  If not tested for Vitamin D, B12 and  ferritin, good idea to get  those also.

[flyingfool]

Check out this site on Hypo.

it is the national academy of hypothyroidism

www dot nahypothyroidism dot org

All the articles are footnoted extensively. Of particular not you may want to look under the orange heading "Thyroid Hormone Transport" and specifically the conditions associated with abnormal thyroid transport".  

I think there and in at least one other place this site discusses extreme exercise affecting the ability of your body to resist thyroid hormone and may also for insulin as well.  You running marathons would certainly qualify for strenuous exercise.

What this means in the end IF this is true in your case, is that you will need to have blood levels of thyroid that are HIGHER than what would otherwise be expected for a healthy person.  Since your body is in what a laymen would call "resistant" than you need to make up for that inefficiency with additional hormone levels in the blood than what the Dr may normally consider "normal".

All of the symptoms you've listed are consistent with being Hypo.

You definitely need to find a new Dr.

You may want to preview the Dr's before you even go.  By asking for the Dr or the nurse that they work with to ask a few questions.  Specifically ask if the Dr treats many Thyroid patients, if the Dr is open and tests for Free T4 and Free T3 in addition to just TSH.  Ask of the Dr prescribes T3 medication or natural dissected thyroid.  Ask if the Dr uses symptoms and blood labs or if he just uses TSH or reference ranges.

[Angelofmercy45]

Hi,
   I have had 2 episodes of chest pain in the last 6 months, followed by an elevated D-Dimer.  They checked my lungs both times but found no clots.  I recently got out of the hospital, with an exacerbation of COPD, and my D-Dimer was high then too.  I have taken thyroid meds for years for hypothyroidism, but within the six month span I've talked about, I have lost 40 lbs without trying.  I'm 5'9" and now only weigh 121.  I feel like I'm disappearing.  This last time, they happened to catch a one and one half cm nodule on my thyroid.  I have had neck and headaches on that side, but have been attributing it to TMJ which I have had since I was young.  Now I'm not sure.  I have read that high D-Dimers can be related to cancer, and now I'm scared.  The first time my D=Dimer was high, I had no infection....the thought I was having an MI, which I wasn't.  Could this be related to thyroid cancer?  My Mother had her whole thyroid removed for a large goiter, and eventually died of an unrelated cancer.  I guess I'm just looking for answers and am worried.  Any thoughts?
~Holly~