Please Help Me Understand TSH Results

[tjburly]

Husband had TSH done on 1/12/09.  TSH was 0.521; T4 was 10.9 and T3 Uptake was 30.  On 3/10/09 lab results indicate TSH was 0.050L.  Seems that all the time our MD increases the Levothyroxine and then reduces it again.  He had been on 300 mcg of Levothyroxine and now is on 175 mcg.  Can someone please help us understand all this! Seems that every time it is reduced, we end up with the Levothyroxine being increased again.  He has symptoms of impaired memory, fatigue, etc. but nothing is showing up from a CT of the brain.  Labs on 3/20/09 indicated that Vitamin B12 and Folate were 279 and Vitamin B6 was 6.2 (Vit. B1, Whole Blood was 69.6).  Any comments, suggestions, etc. would be appreciated.

[goolarra]

I can believe the stroke was related to the meds. Not only is the change from 300 to 175 and vice versa a big change, but 300 is a very large dose.  I know some pretty substantial men who are on 200-225.  If your current internist/PCP is the one who recently reduced the dose from 300 to 175, I'd still consider finding someone else.  Very small changes can make a big difference...your husband's body must be just being tortured by those big adjustments  I'd definitely stay away from the nurse practioner, too.  Even a lot of doctors don't understand the subtleties of thyroid...also your husband has just too much going on.

I understand your frustration in finding an endo in a rural area.  Here in central Oregon, there are three, and two are affiliated with a clinic that I consider a "factory".  The third is mine.  If he doesn'tt work out as time goes on, the next nearest market is Eugene, 125 miles away.  Yes, it is gorgeous here, but there are also drawbacks.  We both married into the Pacific NW!  My husband is from Eugene originally, and I'm a New Englander (RI).  I think it will pay off for you if you find someone who really knows what he's doing.

The pharmacist must love to see you coming!  Something very drastic has to happen with health care.  We've just found out that our economic policies were unsustainable...I don't think it's going to be long before out health care policies crash and burn, too.

You may be tired all the time, but it sounds like it's for good reason.  You appear to have a lot to do and a lot to worry about.  That's more taxing that running a marathon.

Hopefully spring is making itself more apparent there than here.  A little sunshine wouldn't hurt anything!!!

Good luck with your search for a new doctor.

[tjburly]

I just read your profile!  Hubby and I lived in the Pacific Northwest until moving in 2001 to West Tennessee.  We lived in Longview, Washington.  I am a native Tennesseean and he was a native Washingtonian, so he had lived there all his life until we married.  The Pacific Northwest is just beautiful.  I absolutely loved it there!  Moved back to take care of my mother who had Alzheimers (she died in 2002), and since I had a home here prior to our marriage, we have remained here.  I loved Oregon!  Some of our best friends live in Rainier, OR (just over the Columbia River bridge).  

[tjburly]

Thank you so very much for the info.  Hubby had an endo at the time of the stroke last yr.  The endo kept increasing the Levothyroxine up, up, and up and got all the way to 300 mcg.  The doctors at the hospital questioned the level of med and really thought that his stroke had been brought about by the medication regimen he was on.  They did not think particularly favorably of the endocrinologist and they just flat out said that we needed to find a new PCP, which we did.  We switched to an internist who also has a background with tx of diabetes (but I don't know about the thyroid tx as far as his background goes).  He changed some meds, etc., but now we usually see his nurse practitioner(s) (just because they are more accessible).  Sounds like we need to make some changes again.  When the nurse practitioners change the levothyroxine levels they do it under the direction of the supervising internist.  So, we need to start looking for another endocrinologist now.  There is only one in the nearby city that I work in (he's the one we quit seeing).  I think the nearest endocrinologist now is about 100 miles or more away, but we will just do whatever needs to be done.  Whew, I never knew this could be so complicated.  I also have thyroid problems and when we were seeing the endocronologist (prior to hubby's stroke), the endo told me that I have thyroid nodules, did a scan and said we'd just watch it.  When I go to the internist now, they just feel of my neck and say they can tell they are there (I can't even when I try to find them).  I am on 150 mcg of Levothyroxine.  I take the Levothyroxine, the Byetta 10 mcg for the diabetes;  Prevastatin 40 mg; Amitriptyline 25 mg (2 at bedtime - switched from Topomax 100 mg 2 at bedtime for management of migraine headaches), and Activella 1./.05 for horomone replacement.  Between hubby and me, the pharmacy is making good money for our business!! (our pharmacy bill is more than the mortgage payment and I pay over $800 per month for group insurance coverage at work but that's another gripe, sorry....).  Anyway, I am ALWAYS tired, ALWAYS, have gained weight, can't get it off no matter how much I diet and exercise.  The nurse practitioner said that my sluggish thyroid, the diabetes, and menopause (not to mention a stressful job) were all slowing my metabloism to a crawl.  I never knew that the thyroid could wreak such havoc!!  I am so greatful that I found this web site and to know that hubby and I are not the only persons dealing with these problems.  Thanks so much for all that all of you do here to help the rest of us cope with these troubling issues.

[Smilerdeb]

Sorry...forgot to mention.
On the brain scan, the frontal lobe of the brain would show up as 'damaged or deterioating' if your Hubby had any form of Dementia or Alzeimers.

[Smilerdeb]

Get another Doctor to treat his thyroid condition

Your Husband does not have the classic symptoms of Alzeimers as I work (and have been trained and done accredited courses) with Acute Dementia and Alzeimers Residents in a nursing Home and know the signs.
The brain scan would show up that the 'frontal lobe' would be damaged or 'dying off ' in activity if it was Alzeimers or early Dementia.
There are many conditions that come under the 'trem' Dementia and Alzeimers is one of them.
The headaches could be from the drastic drop or increase in the thyroid meds.
Alzeimers does not cause headaches.
Neither does any part of the frontal lobe of the brain deterioating cause headaches.
In regards to Alzeimers, your Hubby would have 'stages' where he has an obsessive disorder.
That is the first sign of early Alzeimers......
An OCD that mimics a 'trigger ' in his brain.
For example, he would start by 'undressing and dressing several times a day and folding his clothes up neat and tidy as if he was preparing himself for work the next day.
He would also suffer from 'Sundowners'.
This is where he is confused about what time to sleep and what time to be awake.
"Sundowners' (late afternoon period) also brings on aggression and causes frustration in the person.
Believe me, if your Hubby had Alzeimers, you would know the early signs.
Treatment of his thyroid is imperative as this would also stabalise his BSL (blood sugar levels).
Your Hubby is in a Catch 22 situation where Doctors are blaming one condition on another.
Sort each condition out and you will see a drastic improvement.
I hope that helps you.
Keep your chin up. x

[goolarra]

WOW!  That is a whole lot to get your mind around.  First, I think you should be canonized just for knowing all this...

I am totally inept at commenting on a lot of this, and I suspect your PCP/internist is also.  Drug interatctions are so complex...just two drugs and you have to wonder which is the culprit.  How do ten interact?  I'm sure no one knows.

My mother had Altzheimer's also.  At one point she moved into an adult care home.  There was a woman there who was virtually catatonic...she flipped through a family album constantly without seeming to see it.  At some point, and I have no clue how this happened or who instigated it, she got off all her meds.  She turned back into her old self...read, put a bird feeder outside her window, got interested in stuff again, chatted with all of us.  She eventually was well enough to move in with one of her children.

So, what can I offer?  I'd probably consider seeing an endo.  S/he could manage both the diabetes and thyroid. Your PCP/internist is showing  ignorance in adjusting your husband's levo dose so drastically. Going from 300 to 175 is not exactly what I'd call "fine tuning".  My endo recently adjusted my dose by 6.5 mcg (yes, the decimal point does belong there), and it sent me for a loop.  I hate to introduce yet another doctor, but feel it's necessary.  Your PCP has no clue.

Also, I'd try to eliminate as many non-essential meds as possible.  Definitely not diabetes meds and thyroid meds, but maybe some of the others.

Sleeplessness, panic attacks, etc. could all be due to overmedication on thyroid meds.  It could be that once that is adjusted properly, some of the other meds would become unnecessary.

We, on this forum (we're a bit odd!) seem to have a number of the cross-over symptoms.  Don't know if we're hypo or hyper or if it's the meds we're taking to counter the effects of the levo that cause some of our symptoms.

Hope this is of some help...

[tjburly]

I forgot to mention that the labs of 3/10/09 do not include the T4, the T3 or the Free Thyroxine index.  Just as another bit of info, his diabetes seems fairly well controlled and the highest reading he has had on that is 126.  I am now asking the nurse at the Internist's office to always fax to me the labs.  It was only after I did this and compared the two TSH levels (0.521 on 1/12/09 and the TSH level of 0.050 L on 3/10/09 that I detected a fairly big difference.  I called the clinic back and insisted that the doctor look at these numbers and compare them.  At that point, they decreased the Levothyroxine from 300 mcg to 175 mcg.  Another thing is that he is ALWAYS tired; can't sleep, etc.  I have a hard time distinguishing whether he is hypo or hyper.  Do other people experience this in their thyroid treatment?  Thanks so much.

[tjburly]

Thank you so very much for responding.  For the TSH level on 1/12/09 of 0.521 the reference range was 0.450-4.500; the T4 reference range was 4.5 to 12.0 (his was 10.9); the T3 Uptake reference range was 24-39 (his was 3.3)and the Free Thyroxine index was 1.2-4.9 (his was 3.3).  The labs of 3/10/09 that indicated a TSH of 0.050L show a reference range of 0.450-4.500.  I thought that cutting him back to 175 mcg was a big change, but this just keeps happening.  Symptoms that he was exhibiting on the 300 mcg included tremors, very bad short term memory problems, his color was terrible (almost gray), so much so that the physician told him he "looked sick."  He had a stroke in February 2008 (slight stroke) and in July 2008 had to be hospitalized for panic attacks, etc.  The doctor at the mental health hospital said that she did not think his symptoms were indicative of a mental health problem but rather a medication issue (thus the thyroid medication issue came up  -  he was taking 300 mcg at that time).  His internist then decreased the Levothyroxine gradually and he has done pretty well, but as time went on, they gradually kept increasing the Levothyroxine (based on labs).  After having the labs drawn on 3/10/09 he went back to his neurologist who treated him for the stroke and she is the one who wanted labs drawn to check for Vitamin B deficiencies.  He has an appointment with a neuropsychologist on Apr 10 for a comprehensive exam regarding his memory (I believe to check for Alzheimer's, etc) and that will be followed up with a trip to the neurologist again the following week.  It is almost like a delay in memory issues.  Another new issue is headaches - he used to never have headaches.  He will start to speak and then it's like he can't get it out, or he will forget what he is going to say, but he always remembers it later (my mother had Alzheimer's and her symptoms were not like this).  It is very frustrating because he takes so much medication as he is diabetic (takes Actos 30 mg and Glimepride 4 mg 2 times a day) has chronic pain issues from 3 previous back surgeries and fusion of his vertebrae (takes Lyrica 150 mg 2 x a day) and peripheral neuropathy; takesTriglide l60 mg daily; Vytorin 10/40 once a day; Plavix 75 mg daily; Avinza 90 mg ER CAP King daily for pain management; KLOR-Con 10 (potassium) daily; Digoxin 0.25 for his heart; Prozac 40 mg (prescribed after the mental health hospitalization last June); Indomethacin 25 mg and Topomax 50 mg twice a day (prescribed by the neurologist for the headaches).  I realize that it must be hard for the Internist to manage everything based on all his medical problems, and we try to keep everyone on the same page (the internist who is the PCP, the mental health clinician, and the neurologist), but it seems to me that the problems always seem to worsen as the levels of the Levothyroxine are increased.  I wish I had known about this forum long ago.  I appreciate so much your input.

[goolarra]

Can you post the reference (normal) ranges oin the above labs?  Also, has he had free T3 and free T4 done?

The change in meds from 300 mcg to 175 mcg is a BIG change.  Why is the doctor making such sweeping changes?  With those kind of adjustments, it's no wonder he's up and down so much on dosage.  From what you've provided, he appears HYPER at this point.  I know the symptoms appear hypo, but lots of symptoms cross over between hyper and hypo...they seem to be symptoms of "not right".

I know nothing about the vitamins, but I'm sure someone else will give you an idea.