Hypo

[Jules82566]

I am back yet again, feeling like I have no clue about a few test results.  Briefly, it's been a year since diagnosed with hypothyroidism and am currently on Levothyroxine ( 112mcg ).   It's been almost 6 weeks on this new dose but I'm still having several symptoms.  I will have bloodwork done in about a week and have insisted on having my FT3 done ( with the usual TSH and FT4) since it has never been done from the  beginning. Once I have all of those, I will post them and see what feedback you might have for me but...

My question is this.  Here is the latest results after seeing an Endo and quite honestly, he didn't seem to concerned with the results or how I've been symptomatic. I'm seeing  numbers WAY out of range and wonder why I shouldn't be concerned.  Any feedback you have on these 2 tests is much appreciated.

Thyroid Peroxidase Ab >470 0 - 30 IU/mL
Thyroglobulin Ab >82       0 - 40 IU/mL

[Jules82566]

Thanks again! I will keep you posted :)

[gimel]

If you are going to try and persuade/cajole your current  doctor into treating you properly, then here are links that might influence how the doctor responds.  First are some links about the benefit of adding some T3 to meds when conversion of T4 to T3 is not adequate.  

http://www.worldlinkmedical.com/blog/hypothyroid-symptoms-but-normal-tsh-levels-how-to-treat-symptoms-of-low-thyroid-by-optimizing-free-t3-levels/

http://www.*************.com/heart-disease/c/1435/95058/t3-forgotten

http://www.eje-online.org/content/161/6/895.full

Second is a link to a scientific study that concluded that Free T3 correlated best with a composite score of hypo symptoms and that Free T4 and TSH did not correlate at all.  When you think about it, this is only logical because only Free T3 is metabolically active at the cellular level.  

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

And since you are going to get some more testing done, it might be good to go ahead and request test for Reverse T3 as well.  Since serum thyroid levels do not always accurately reflect tissue thyroid levels, there are reports that the best blood test measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3.  You might also be interested to know that two other measures of tissue thyroid levels are the Basal Metabolism Test and Basal Temperature Tests.  

[Jules82566]

That, my friend, was EXACTLY what I was asking.  I don't know this to be the case but perhaps I do need to be on a T3 med as well as the Levo.  Trust me when I say, what we are doing...is NOT working.  I know my body better than anyone and I'm far from a hypo...chondriac :)  Heck, I hadn't needed a dr. in almost 15 years, that is how healthy I am.  It's frustrating to be so on top of taking care of yourself and the dr's don't seem to care.  I've been calling around to find a new dr but can't seem to find one taking on new patients and my insurance so it's been a long haul.  I've decided to give my GP one more chance and try to be insistent of finding better solutions to correct my symptoms.  I am going to be patient and see what the new blood work reveals and go from there.  Thanks so much for your input, much appreciated!

[Jules82566]

Trust me when I say, I used the terms "doing nothing" loosely.  I've been VERY proactive in getting my health to a point that I can live with.  I've had to fight tooth and nail with my General Practitioner AND the Endocrinologist to get them to listen at all.  If I was mum about what was going on with my body, I would still be on .88 mcg of Levo and feeling like garbage.  I'm currently on 112 after insisting my numbers were still too high.  I am having blood work done soon and have an appt. with my GP to see what other alternatives I have.  I am still constantly freezing, I take naps and sleep 10-12 hours a night, have horrible (heavy) menstrual cycles ( i never had until I became Hypo), and I can't lose 1 lb no matter how hard I try.  I eat very well (no junk) as I used to be into bodybuilding so I know what to eat and what not too.  I have a cleaning business and do all of my own cleaning full time AND work out EVERY day but still...can't lose 1 measly pound.  I've gained six in the past few months alone.  I appreciate your positive outlook and I am keeping positive as well but it's been almost a year since I was diagnosed and I spent the entire winter in bed freezing and feeling like nothing mattered.  It's about time to figure out that what we are currently doing, is NOT working and move onto something else.  Sorry as I am feeling a bit frustrated as of late.  I'm currently reading a GREAT book ( living well with Hypothyroidism ) and it has a lot of useful information in it - have you read it?

[gimel]

In general, if you have symptoms, it means that something is not right and you may need more in the way of meds or supplements.  You won't really know what is needed until you get the additional tests done.  Make sure that the doctor agrees with the Free T3 and Free T4 tests and puts those on the lab order.  I would even go as far as making sure the lab personnel know it is to be Free T3 and Free T4, not Total T3 and T4.  You might be surprised to learn how often they operate on auto pilot and do the usual tests.  

You also need to know that being an Endo  doesn't guarantee a good thyroid doctor.  Many of them specialize in diabetes, not thyroid.  Also, many of them have the "Immaculate TSH Belief" and only want to test and adjust meds based on TSH.  That absolutely does not work.  TSH is a pituitary hormone that is supposed to accurately reflect levels of the biologically active thyroid hormones, but it cannot be shown to correlate well with either of them, much less with symptoms which are the most important.  Some Endos only use "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the range is adequate.  That also is false.  

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

So it might be a good idea to ask the doctor about his willingness to treat clinically, and also to prescribe T3 type meds such as Armour and Cytomel.  If not, then you will need to find a good thyroid doctor that will do so.

[courtney48]

My understanding of my hypothyroidism is that my thyroid is going to fade away whether I take levothyroxine or not.  Taking the medicine supplies my body with the hormones that the thyroid is making less of and eventually may not make at all.  

For you, I don't see that you are doing nothing, but rather you are taking a med that is hopefully helping.  I say that to encourage you to see that taking your medicine is proactive for your health as opposed to seeing the matter like you are doing nothing.  Hopefully as you continue working with your doctor, you'll be better served and will be less symptomatic.

Is your doc telling you all is fine or is that an worry of yours?  You said you have upcoming labwork so that should help determine how to procede.  

I agree with others to have blood work to look at vitamin levels.  I have recently had a thyroid u/s and also a dexa scan to measure bone density.  you might talk with your doctor to see if these would be appropriate for you.

Good luck.

[Jules82566]

Ok.  So I get the Hashimoto itself but as far as my being on simply a T4 medication, do I need something else? Or do I do nothing while my thyroid fades away?  I did have a B12 done and my results were:

Vitamin B12 1592 (211 - 946)

As I stated in my original post, in a couple of weeks I am due for bloodwork and I've requested that FT3, FT4 and TSH all be done.  

This is all very confusing for me but the bottom line is...If my doctor says everything is fine and I'm still feeling symptoms, I need some direction to lead her so that I'm getting the best possible medical attention.  

[gimel]

Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I would suggest that you add those to the Free T3 and Free T4  tests to be done, along with a full iron test panel.  Deficiencies in these areas can mimic hypo symptoms so you need to test them as well.

[Red_Star]

Hashimoto's thyroiditis is a progressive disease where the thyroid antibodies begin to destroy natural thyroid gland protein cells.  Those with very high elevations of thyroid antibodies may see faster cell destruction and damage to the thyroid gland.  Selenium may lower TPO antibodies but has not been shown to have any effect on Tg antibodies. There are anecdotal reports of a gluten free lowering Tg antibodies however.

[goolarra]

Elevated TPOab and/or TGab indicate Hashimoto's thyroiditis is the cause of your hypo.  Hashi's is the most prevalent cause of hypo in the developed world.  It's an autoimmune disease.

DON'T freak out about the numbers!  Antibody counts are often in the high hundreds or even thousands.  Just to give you some perspective, my TPOab on diagnosis was 900+, and my TGab was 3,000+.  The results are basically positive or negative, and the raw numbers mean little.