Please help...I'm confused and I think my doctor is too

Heres a quick history.

I had the right side of my thyroid remove in 2010. Upon biopsy, they descovered I had cancer. It was small enough that they got it all and I didnt need treatment.

I have chronic sinus infections and a history of ovarian cysts.
Here's my problem.... My urine calcium is 3Xs the max limit, my blood calcium is 9.6 and the have found that I have a small amount of IgG in my Urine.

My doctor has told me it could be caused from one of three things... She said, parathyroid dease, cancer....after she said cancer I didn't here what the third thing was.

Has anyone have any idea what this could all be caused from?
Physically, I am always tired and unsteady.

Anything really...Please help me understand this.

[Kristina538]

Did your doctor test our thyroid levels?  It was my understanding that you can still go hypo and need supplementary meds if your left side is not managing to produce enough hormone?   I had 3 sinus infections in a month when I was hypo - I think swelling of tissue and dehydrated nasal passages cause it and I got through with a cortisol nasal spray that I used daily.

Sorry I can't help with the urine calcium;  did she test magnesium as well.

I would've thought you were subclinical hypthyroid at least?

[Red_Star]

Hypercalciuria is the medical term for excessive urinary calcium excretion.
The following are possible causes for hypercalciuria from DiagnosisPro:

40 possible causes found:

Trauma Causes:
Fractures, general

Surgical, Procedure Complication:
Parathyroidectomy

Granulomatous, Inflammatory Disorders:
Sarcoidosis

Neoplastic Disorders:
Metastatic bone disease
Multiple myeloma
Reticulum cell sarcoma

Allergic, Collagen, Auto-Immune Disorders:
Ulcerative colitis

Metabolic, Storage Disorders:
Hypercalcuria, idiopathic
Fanconi's syndrome, adult (acquired)
Fanconi's Hereditary Renal Disease
Wilsons Disease
Aminoaciduria
Cystinosis
Hartnup disease
Hypophosphatasia

Biochemical Disorders:
Hypercalcemia
Nephrocalcinosis

Congenital, Developmental Disorders:
Medullary cystic kidney disease
Renal tubular acidosis
Distal renal tubular acidosis/type 1
Medullary sponge kidney disease

Hereditary, Familial, Genetic Disorders:
Hyperparathyroidism, neonatal, hereditary
Familial hypocalciuric hypercalcemia
Gittleman's syndrome
Bartter's syndrome

Anatomic, Foreign Body, Structural Disorders:
Kidney stone/urolithiasis/nephrolithias

Functional, Physiologic Variant Disorders:
Bed rest, prolonged
High calcium diet

Vegetative, Autonomic, Endocrine Disorders:
Hyperthyroidism (Graves disease)
Hyperparathyroidism, primary
Acromegaly (Gigantism)
Cushing's disease/Syndrome

Reference to Organ System:
Paget's disease (osteitis deformans)

Drugs:
Ammonium chloride Administration/Toxicity
Calcitriol (Rocaltrol) Administration/Toxicity
Chlorothiazide (Diuril) Administration/Toxicity
Vitamin D Administration/Toxicity
Hypervitaminosis D
Mercurial diuretic Administration/Toxicity effect
Milk-alkali syndrome

[Cammie5269]

All of my thyroid and parathyroid levels are normal. Thats where I am getting confused because the parathyroid controls your calcium levels.

[flyingfool]

Please post your Thyroid levels and their reference ranges as they vary form lab to lab!

Normal doesn't mean anything.  What that usually means is that you are somewhere within the reference ranges.

However MANY, MANY people have symptoms and need medication while they are within but on the low side of the reference range.

Many people find that they need to be in the MIDDLE of the reference range for the FREE T4 and also they need their Free T3 to be in the UPPER 1/3 of the range in order to be relieved of symptoms.

So as you can see simply being somewhere below mid range on either of these MAY need to have further medication to feel well.

Also be sure if you did not have the FREE T3 and FREE T4 tests done to get them done.  Understand that they are different than "total" T3 and "TOTAL" T4. The "total" test includes both free hormone molecules and those attached or bound to a protein which makes them useless.  So the "total" test is outdated and of little value.

[Cammie5269]

PTH is 24.6 ref. range is 10.0-65.0        TSH 2.45 ref range is .35-5.50
total T4 is 8.4 ref range is 4.5-10.9
total T3 is 29.6 ref range is 22.5-37.0
FT4 is 2.49 ref. range is 1.20-5.10
FT3 is 2.6 ref range is 2.3-4.2

[flyingfool]

You are low on both FT3 and FT4.  No reason why you're not feeling well.

Mid ragne FT4 is 3.12 and you are testing @ 2.49
Upper 1/3 of FT3 is 3.6 and you are testing @ 2.6

You need medication or an increase in your meds!!!!!!!

Again shooting for something mid range FT4 AND UPPER 1/3 FT3.  You have plenty of room or improvement.

Symptom relief is the most important thing.  And the levels above are rule of thumb but FAR, FAR better than the too broad reference range.

[flyingfool]

Opps. I meant to say no wonder why you're not feeling well.  

Really to me there really should be nothing confusing about why you're not feeling well with both your Ft4 and FT3 being low.

Low in reference to the middle and upper 1/3 which is where many people feel symptom relief.

Your FT4 and FT3 are at 40% and 47% of the range respectively instead of 50% and 67%

The only reason your Dr is confused is because you are within the refernce range so that to him means that you should feel well.  This is called reference range endocronology.  And is only slightly improved version of the miraculous TSH belief in the medical industry.

The "reference" or so called "normal" ranges are FAR too broad. It is the result of statistical analysis.  Simply stated most statistic "bell curves" are done using 95% of the population fitting into the curve.  That is they take 2.5% of the very low Thyroid population and 2.5% of the very highest levels of Thyroid and remove them from the sample. Leaving the remaining 95% of the population will fit into the curve.  This works OK for errors in manufacturing of cereal of something.  But doesn't work at all for human beings.

You see FAR more than 2.5% of the population is Hypo (low Thyroid) but since they "fit" within the so called "normal" 95% range they are thus considered "normal".

To me this would be analogous to taking a sampling of the entire population regarding legs.  But we'd only rule out people who are actually missing a leg or have 3 legs and throwing them out of the sample. Thus the remaining people all have normal legs right?  Even people with broken legs would fall within this 95% hypothetical situation.

As insane as they leg sample scenario is, that is EXACTLY what they do  with Thyroid by only throwing out the bottom 2.5% when it is possible up to 10 to 20% of the population is low Thyroid.

This is why the better target to shoot for is the middle of the range for FT4 and upper 1/3 part of the range for FT3.  This has proven more realistic form many people and many, many people on this forum.

If the medical industry would simply bump up the lower limits of both the4 FT4 and FT3 range.  A lot of people would be treated properly and feel much better. Instead we have a situation where many people feel horrible and remain feeling horrible and are often given many other medications to help alleviate symptoms that Dr's simply can not believe is simply lack of Thyroid.  Instead they put 100% faith in TSH and the "reference" ranges.

[Cammie5269]

This makes complete sense to me. I don't want to be within range, I want to feel better.
Would any of this have anything to do with high calcium in my urine or a slight band of igG in my urine? How do I get my doctor on the same page? I realize my Dr has many patients but I only have one Endro and getting questions answered or getting in to see her takes forever.
I am scheduled to have blood work done and a new 24 urine test done this week. What should I be asking about these results?

[Cammie5269]

Also, I was in the ER last night for 5 hours. Dizzy, fatigued and high BP. Could this be related. The ER doctor gave me an anti-inflamitory and sent me home :(

[Cammie5269]

.Also, I was in the ER last night for 5 hours. Dizzy, fatigued and high BP. Could this be related. The ER doctor gave me an anti-inflamitory and sent me home :( .

[flyingfool]

I know some people. Not all by any means. That were Hypo and had high blood pressure. And when got Thyroid under control the BP started to become controllable.  Not saying this is the case for you. But I suppose it is possible.

I know nothing about high urine calcium.  But I do know that calcium supplements will affect and (reduce) the absorption of Thyroid medicine. As such you should take the Thyroid and Calcium supplements at least 4 hours apart.  

Not sure how already having high calcium in your blood would effect this.

If you are having a 24 hr urine test. Maybe ask for a cortisol adrenal test as well.  Many people who have been Hypo for a long time can get adrenal fatigue as the adrenals try to "make up for" the lack of Thyroid.  I believe that they can test for this with 24  hour saliva and/or urine test for this as well.

Dizzy and fatigue are also Hypo symptoms.  But may have been a result of the high BP.

Several people will claim that when they stand up they got light headed with Hypo. My oldest daughter is complaining of this along with other symptoms of low thyroid including chronic sinus infections over many years. . She is only 18 but her mother (my wife) as well as her grandmother is Hypo.  

Have you been tested for Vit D, B-12 and Iron?  These also are symptoms of fatigue and is common for people with Hypo are low in these as well.  I think low B-12 can give dizziness, also tingling in hands/feet/extremities.

[Cammie5269]

I have a every strong family history of thyroid issue, everything from hypo to cancer. One whole family had cancer, i have one cousin with hashimoto, my mother has hypo and I had cancer in my right side and only that side was taken out.  I think this is why I'm so concerned. I would feel better if the whole thing had been taken out.
My last cortisol test was in Nov, 2011, I read at 15.8 with the range being 4.0 - 50.0. My ACHT was 27 with range being 6 - 50. My vit. D was 33. She also did an Aldpra test which was 28.9 with range being .9- 28.9. I don't know what this test is.....
The high BP could be caused from the stress of all this. I do notice there are times (days at a time) that my pulse is low, lowest being 60 bpm.

Thank you for taking the time to try and help me understand all of this. My stress levels are become more tolerable with the information your giving me.

[AJWS6]

Hi Cammie, try to relax, it's natural to stress out, when your health is not optimal.  Yes, stress can cause high bp.  

I've alway's had natural low pulse, down to 55, on average around 65, with normal bp,.  Cardiologist told me, that's because my heart is in great shape, very atheletic.  

Address concerns with physician, call clinic soon as possible, tell them your not feeling well, or as I and many have done, seek an opinion of another physician and take all your labs with you.  Surely hope you find the answers you seek soon.  Wishing you well.  

[Cammie5269]

Thank you AJW. I am trying to keep it under control. I went for more blood work today. I'll know more on the 15th after I see see my Endro. The only problem with going to another Dr, is theres only one in my area....lol...Olean NY is not that big. I have thought about going to someone in Buffalo but its an 1.5 hour drive....

[Cammie5269]

OK here are my latest results.
TSH is 1.44...Ref Range .35-5.50
FT4 1.08...Ref range 0.7-1.48
FT3 2.8 Ref range 2.3-4.2
AntiThyroglobin 14

I am so tired ALL the time. I think it's do to my FT3

[redheadaussie]

G'day I am going to tell you something that will make you go, WTF? Just because your Parathyroid levels are good does NOT mean you don't have hyperparathyroidism. Good huh?
Here is the link to a fantastic site...you will have to copy and paste into your browser to look at it.  http://parathyroid.com/diagnosis.htm

You can have skewiff levels for quite sometime of thyroid if you have only one side. It can take many months for the other side to pick up the slack or go into spaz mode and go too much (hyper) as it adjusts, or it never recovers and you need meds.

  Just as an aside, do you know what type of cancer it was? Papillary, follicular, etc? I am curious as you say they got it all. Many people need radiation therapy after to make sure ALL cells are gone.

To let you understand why I know these things, I have parathyroid damage from my thyroid surgery. I had one side taken out then went hypo, then months later had the other side out due to a form of pre-cancer Hurthle cell adenoma. No radiation is needed in that case.

The sinus issues are often totally unrelated to thyroid issues. It's difficult for most to realise that not everything is thyroid related however, a lot it is!
You may have a tendency to them and need a stronger antibiotic to clear it up.

Your FT3 is a tad low and no doubt you will feel cruddy on that level. However I would still give the remaining side a chance to kick in per-se and see how you go.
I have extremely low FT3 and have for nearly 5 years since my remaining side was taken out. So maybe give it a few months (or what you feel is a reasonable time frame) and see how you feel and get retested.
Oh! BTW if your calcium levels are off this can affect thyroid levels so maybe by getting the parathyroid checked correctly and treated you may well find the levels start to rise of their own accord, which does happen.
Cheers!

[Cammie5269]

Here are my new labs
TSH 1.44
FT4 1.08 ref. range 0.7-1.48
FT3 2.8 ref. range 2.3-4.2
I see my Endro tomorrow. I KNOW things are off. I'm freezing almost always. Headache, fatigue, short of breath, weak.... I seem to have it all.
I just hope my doctor listens to my symptoms and doesn't only go by the "within range" attitude.
My question is what is the best medication. I seem to have reactions to a lot of things. I have never been on thyroid meds and don't know anything about them.

[gimel]

For help with your Endo appt. tomorrow, I think you can be better prepared to get what you need if you read through this info written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

Most doctors only want to prescribe T4 meds.  I have to agree that T4 meds are easier to administer.  They are much slower acting than meds containing T3.  However, Free T3 is the biologically active thyroid hormone that largely regulates metabolism and many other body functions.  The T4 med has to be converted to T34, to perform the necessary biological activity.  Hypo patients taking T4 meds frequently find that their body does not adequately convert the T4 to T3, resulting in a need to drive Free T4 ever higher in its range, in an attempt to relieve symptoms through conversion of the excess T4 to T3.

Based on my own experience with this, and knowing what I have learned, If I were in your shoes, I would ask to be put on a NDT type med, such as Armour Thyroid or Nature-Thyroid. Yes, I know that not everyone will agree with this.  It is just my own preference, based on long years of taking 200 mcg of T4 med and still having hypo symptoms until I switched to NDT med.

This recommendation may well be academic anyway.  The number of Endos that will prescribe NDT type thyroid meds seems to be few and far between.  He will tell you there is no benefit from T3 meds.  That is true only when there is no problem converting the T4 to T3.

Good luck to you tomorrow.

[flyingfool]

You definitely have some work cut out from you I'm afraid.  The lab results don't look horrible and all are within range (for whatever that's worth)   However most importantly you clearly sound like you are Hypo from your symptoms.

I fear that because your numbers look so well you may face an up hill battle trying to convince the Dr that you need medication at all.  I hope that I'm wrong.

The general rule of thumb target is to have your FT4 mid range (50%) and you testing at 1.08 is almost exactly mid range at 49%.  (50% would be 1.09).

And the rule of thumb for FT3 is to be in the upper 1/3 (66.7%) of the range.  You are testing at 2.8 (26% of the range) and upper 1/3 range you would need to be at 3.6.

The fact that your FT3 at 26% of the range compared to your FT4 being at 49% of its range suggests that you may likely have a conversion problem of some kind.  This may be a Reverse T3 problem, or simply just a poor efficiency issue from the conversion of T4 to T3 or something else is going on.  Have you had your adrenals tested as that can also play a role in conversion?

Since your T4's are about where most people would love to see them, but your FT3 being quite low in the range, I would strongly encourage you to discuss with your Dr. the idea of prescribing a starter dose of a T3 med to get your FT3 levels up some.  

If I recall correctly you are under a lot of stress which is also consistent with potential reverse T3.  So you may also want to talk about getting the RT3 test done as well to see if that is an issue or not.

I have absolutely no problem with Natural Dissected Thyroid (NDT).  But since your FT4 levels are just about exactly mid range, I'm not sure you really need any more T4. Getting your T3 levels up would seem to be more the concern.

If you are started on a T3 medication, make sure you discuss with your Dr a starter dose of an amount over about 10 mcg as many people have reported trouble tolerating a starter dose of T3 that large.  Some people can handle it.  Many others have to start out with smaller doses and work their way up.  This can be done by stepping up every few days or so.  Again discuss this with your Dr.  Also T3 meds are usually taken half in the morning and half in the early afternoon to help level out the amount of T3 available throughout the day. Rather than a single blast all at once since T3 is available by the body to be used immediately unlike T4 which must be processed and converted into T3 before use.

[Cammie5269]

After seeing my doctor yesterday, it seems my thyroid levels are a lesser problem unless this is all somehow conacted. She is now trying to rule out Multiple myeloma. My urine calcium is high, as is my alpha2 and mono(something). I go to see an Oncologist next Friday. BUT In talking to her I found that other things can cause these levels to be off. Such as dehydration (i am), Ovarian cyst (which I have). I understand that I am going through the "rule out" process but I am terrified. Even if theres a slight chance. I don't have the exact levels and names of the test, as soon as I can I will get them and post them.  

[danie17075rm]

Is there any chance your vitamin D is low?  On the parathyroid website, Dr. Norman says that there is no way a vitamin D deficiency will cause elevated calcium.  It did in my case.  When I had my thyroid removed, I made the surgeon examine all the parathyroids (he said he located them all and they were fine).  This might not be related, but it is also another thing to think about.  Good Luck.  I really help everything turns out okay.

[Cammie5269]

My VD is low. Im nervous about taking though because I don't want my calcium to go higher :/

[danie17075rm]

I had the same problem! When I first started taking it, my heart started racing from it and I felt really sick.  I didn't feel comfortable until the thyroid surgeon physically examined my parathyroids.  Hopefully your testing will give you some new answers.  Sometimes it is so confusing as to what we are supposed to do.

[ChitChatNine]

My calcium is normal with or without prescription doses of Vit D.  Mine has been tested because I am prone to calcium oxalate kidney stones.  You could ask your doctor to be sure ....

[flyingfool]

Your Free T3 are still low.

Since your body ONLY uses the Free T3 molecule that 26% of the range when you'd like to be well above 50% still is a concern I would think.  Many people will have hypo symptoms with the FT3 that low in the range.

Yes it is possible that something else is causing the FT3 to be low.  And you definitely would want to get to the bottom of that.  But you also may want to consider a T3 med to help you with some symptoms until you can reach conclusions.  Who knows, you may find some of those other things stabilize as a result as well.

Since Thyroid plays such an important role in the metabolism and cellular function stabilizing that metabolic rate may help all sorts of areas.  Maybe not but isn't knowing your so low in FT3 not want to make you want to at least fix that?

[Cammie5269]

I ask my endro to give me something for my FT3 and she said " no one is optimal". So, I am thinking I will be changing doctors.
I also had an ultrasound of my thyroid (left side, had the right removed). The tech said one of my parathyroids were enlarged. I am concered that I will have to have it removed. My PTH has always come back normal, but I've been told that if my Vit.D is low it won't give a good reading. Any thoughts?