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"Optimum" T4? High blood calcium and PTH results?
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"Optimum" T4? High blood calcium and PTH results?

I was able to get an appt. with the endocrine clinic at a local hospital.  Since I'm still classified as "euthyroid", but still suffering severely from symptoms, I would love to compare lab results, so that I can go in armed with some data.  Could you please post your personal "optimum" T4 (since I know that's what most doctors go by)?  Also, if anyone has had high blood calcium and had their PTH tested, could you please post your levels?  (I have read that PTH levels can be deceiving in detecting a parathyroid problem.)

Thank you!
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Avatar_f_tn
You're right that your labs are here, there and everywhere.  

It's quite possible the bradycardia was cause by the methimazole you took.  On 1/31/13, your TT4 was a little on the low side, so it's quite possible that the methimazole tipped you over the edge into hypo.  Let's hope the labs you are waiting for will include frees.

Many of us find that FT4 has to be about midrange, and FT3 upper half to upper third of range to feel well, but those are just guidelines until we learn our own, personal comfort zone.  I feel fine at lower levels, but most people on this forum would be horribly hypo with my labs.  Many doctors practice "reference range endocrinology:...the belief that everyone should feel well as long as they're in the range.  Not true.

Hope you get your new labs soon.  
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Avatar_f_tn
I'll be the first to post, which will just give you some perspective, since I'm the "aberration" on this forum.

I'm quite comfortable with FT4 in the lower end of the range, in fact, I can go slightly below and still feel well.  The last time I had blood drawn, my FT3 had tanked to well below range, yet I had NO hypo symptoms.  I was totally blindsided by my labs because I felt absolutely no different than I had six months before, when labs were much better.  In fact, I was so surprised that I had labs repeated.  (There was no lab error.)

The goal of treatment is to feel well.  Meds should be adjusted until you are symptom-free (allowing time for healing after reaching good FT3/FT4 levels), regardless of actual numbers.  We all have to find our own, personal range.    

  
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4939681_tn?1361302899
I guess I'm just really scared by the experimental phase of "treatment" because of my violent swings symptom wise.  I honestly don't know which way to go.  Some days I feel hypo, some hyper and I can't imagine exacerbating either of those symptoms.  I did take some methimazole for a few days when I felt like I was having a hyper phase hoping that it would work, but then had such awful low blood pressure, slow breathing and bradycardia that I felt an electric ping a couple of times in my sleep, as though my body was trying to jolt my heart back into rhythm.  It was weird, no anxiety, but like my body was trying to say "hey, heart!  you need to beat."  After that, I kind of swore off experimenting.  Were you closely monitored while your meds were being adjusted?
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Avatar_f_tn
I was.  When my endo was actively adjusting my meds, I'd have labs 4 weeks after an increase and see him at 5.  

It takes a while for us to know how we each feel when a little hypo vs. a little hyper.  Sometimes, it's hard to sort the symptoms out between the two.  

I know you posted them in another thread, but could you post your labs and ranges again...my memory's not that good!

Besides the experiment with the methimazole, are you on other meds?  How much methimazole did you take?  
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4939681_tn?1361302899
Thanks so much for your reply!  How terrible is it that 4-5 weeks seems like an eternity to me?  I'm currently not taking any other meds.  I do occasionally take iron supplements and magnesium (bc my blood calcium is always high).  I only took 10 mg of methimazole for 3 days, so maybe the bradycardia was a coincidence???

Labs:
Waiting for my most recent (1.5 weeks ago) results to be mailed to me, but they were within range except for my calcium.

1/31/13:  T4 total 7.4 (range 4.5-12.0), TSH 2.37 (range .4-4.5)... also things that were low or high... WBC 4.1 (range 3.8-10.8), RDW 16.2 (range 11-15), sodium 138 (range 135-146), bilirubin total 1.1 (range .2-1.2), AST 13 (range 10-30), ALT 10 (range 6-40), calcium 10.5 (range 8.6-10.2)

11/8/12:  T3 total 96 (76-181), TSH 2.13 (.4-4.5), FT4 2.6 (.8-2.7), TPO >1000 (normal <35)... WBC looked good then, however Albumin 5.5 (3.6-5.1), A/G ratio 2.3 (1-2.1), calcium 10.4 (8.6-10.2)

9/13/12: WBC 4.2 (4.0-10.5), ANA for lupus negative

8/14/12: TSH 2.86 (.4-4.5), T3 total 79 (76-181), T4 1.8 (.8-2.7)... was on 10 mg of methimazole at this time and come to think of it I was never told to stop taking it before testing... hmmmm

7/6/12: WBC 5.4 (3.8-10.8), MCH 26.3 (27-33), RDW 17.6 (11-15), glucose 97 (65-99), calcium 10.2 (8.6-10.2), T3 total 74 (76-181), TSH 2.73 (.4-4.5), FT4 1.0 (.8-2.7)... was on 30 mg of methimazole and not told to stop taking it before testing

6/8/12:  FT4 1.7 (.8-1.8), TSH .02 (.4-4.5), FT3 4.3 (2.3-4.2), calcium 9.9 (8.6-10.2), bilirubin total 1.1 (.2-1.2), AST 28 (10-30), ALT 40 (6-40)... just started 30 mg of methimazole not told to stop taking before testing

*5/24/12: FT4 4.26 (.82-1.77), TSH .015 (.45-4.5), FT3 9.1 (2-4.4)

*5/20/12: FT4 3 (.8--1.8), TSH .01 (.35-4.5), WBC 3.2 (3.8-10.5), AST 35 (0-40), ALT 56 (0-55), thyroid nodule (less than 1 cm) and heterogeneous texture

4/14/12: feeling severe symptoms for over a month... WBC 5.3 (5-10.5), hemoglobin 11.4 (12-16), FT4 1.27 (.8-1.8), TSH 1.29 (.35-4.5)

Sorry for the long list!  Just a copy and paste from my high/low complete history... and I know, testing is very here there and everywhere.  My doctors are not very consistent on their testing.  Thanks for taking your time to read!  I really appreciate it!
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Avatar_f_tn
You're right that your labs are here, there and everywhere.  

It's quite possible the bradycardia was cause by the methimazole you took.  On 1/31/13, your TT4 was a little on the low side, so it's quite possible that the methimazole tipped you over the edge into hypo.  Let's hope the labs you are waiting for will include frees.

Many of us find that FT4 has to be about midrange, and FT3 upper half to upper third of range to feel well, but those are just guidelines until we learn our own, personal comfort zone.  I feel fine at lower levels, but most people on this forum would be horribly hypo with my labs.  Many doctors practice "reference range endocrinology:...the belief that everyone should feel well as long as they're in the range.  Not true.

Hope you get your new labs soon.  
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4939681_tn?1361302899
Thanks you so much for all of your info!  I'll post my latest results when they come in.  I really appreciate you taking the time to look.
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Avatar_f_tn
My ionized calcium and PTH results (first Caion; and then PTH):
Oct1st 10 1.30 (ref. upper limit 1.30); -
Jan10 11 1.34; 76 (ref. 15-65)
Mar7 11 1.32; -
May25 11 1.25; 13 (ref. 1-7.5)
Aug10 11 1.33; 70 (ref.15-65)
Nov1 11 1.36; -
Jan20 12 1.35; 92
Feb2 12   - ; 90
Apr2 12 1.29; -
May25 12 1.30; 8.3 (ref. 1-7.5)
Aug 17 12 1.29; 7.6
Oct3 12 1.29; 67 (ref. 15-65)
Nov15 12 1.29; 64
Dec 11 12 1.26; 70
Jan6 13 1.29; -

My TSH is about 0.022. Free T3 is near the upper limit (Thyroid Erfa)

Your PTH should be measured.


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4939681_tn?1361302899
Wow!  Are they doing anything about your parathyroid?  Those are very consistently high results!  I'm so surprised that they just keep taking labs on you when they are so high.

I was recently told that my Caion was within range, but I've never personally seen the results, nor do I know when that was taken.  And my PTH was 37 (range 10-60), so that's well within range, too.  I've just read that PTH results can be deceiving, and you know... I keep hoping that this will all go away if something can just be removed.    How sad is it that I've felt so bad for so long that surgery is a "best case senario"?
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1756321_tn?1377771734
Thyrotoxicosis is a cause of high calcium. It's not a common cause but it is listed.

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