Purpose of thyroid medication when blood work is normal

[sharon_lee]

I have a goiter, 1"x1"x 2" and a 2 centimeter nodule, it was tested negative for cancer or any inflamation, or disease.
I'm confused about why I started on 100MCG Levithroxin (sp) it took my counts to double normal, now I am on 88MCG...I'm wanting to know what the goal is in this up and down...I get so ill with each change for about 5 days.
Are we trying to take the level high, then low, then level, or what is the purpose?
My Dr. will not tell me anything, he just writes a prescription, and if I ask a question I get yelled at, I don't know anything about this, except what I have read on the Internet.
I'm also being treated for PTSD with Clonipin, and Xanax and Hyomax for Irritable bowel. Sharon

[sharon_lee]

The biopsy incicated no evidence of Hashi's...these are the tests on my lab sheet;
Anti DNA DS
Anti Microchondrial Ab
Anti SSa, SSb
Anti Sm ab
Sedrate
Lyme Ab
CRP-cardiac
T3,T4
TSH 3rd generation.
Here are the comments from my FNB: The fine needle aspiration slides are remarkable for occassional small clusters of bland thyroid follicular epithelial cells. The cellularity is relatively low. No repeated microfollicular complexes to suggest a follicular neoplasm are seen. No cytologic ar architectural features to suggest papillary carcinoma are seen. No psammoma bodies are identified. Hurthle cells with admixed lymphocytes to suggest Hashimoto's are not identified. The findings are most consistent with nodular hyperplasia. Clinical follow up is recommended.

My new Doc, did say, he does not trust FNB and If I remember right..(horrible memory) he said, he will be having it redone, but he mentioned another something besides ultra sound being much more accurate.
I'll have the labs done on the 15 or 18...then see the Dr. the 27th. of April.I don't see a TSI anywhere on the lab sheet.
My Psychiatrist asked Thurs. why is it, that Psychiatrist know what to test for and Internists, don't? My new physician is both a D.O. and Internist. Thank you, for your question, as I am clueless about what to ask for...this Dr. will order any test, I ask...he said, he does not mind doing that when I ask about this or that test or question...
Thank you, thank you, thank you, for your response...
For it sounds like most folks on here have miserable up and downs...I just want so to be like many I have talked to here at home, who say, they felt great after the first pill and are doing fine...For them, it is wonderful, and I'm not being sarcastic...just look forward to one day feeling better...if I understood my Dr. correctly, he indicated this is going to take time.

[Smilerdeb]

Have you been tested for Graves Disease and Hashi;s.......antibody testing ?
TSI is the antibody test for Graves...this would explain a few things.

[sharon_lee]

forgot to add to watch list....so wrote this so that I could....

[sharon_lee]

My new Doc, did rule out conversion as an issue...he ordered a mound of blood work..urinelasis, chest x-ray, did an EKG and diagnosed atrial firbrilation...He is very thorough...
I had to go in a few days ago, as I was a mess, and he said, I have too many issues to do phone, he had to see me....he studied me with his eyes for a few minutes, then looked at my daughter, and said, your mom is ill...look at her, she looks awful, pale, lost 3 more lbs..sores on an in the mouth...He said, again, she is ill. He ordered another mound of blood work...to be done 10 days before my appointment, on the 27th. My thyroid counts are not coming down much...so I wait...Saw my psychiatrist yesterday, and he why in ....did this other Dr. put you on such a high dose of thyroid, when your counts were normal...and he only tested for TSH and T4, He said why is it that psychiatrists know what tests to do for thyroid and Internists don't....?? I take my labs with me for him to look at and he said, my new Dr. is doing it right...my psychiatrist mentioned his concern about my conversion...but the blood work ruled that out...He did say, though that anyone who works with you need to know that you are slow to metabolize, they have to start you very low and work up, and I don't do well with meds...
So it has been quite a week, and I am so so grateful that I found a new Dr.
First visit he spent 2 hrs. with me, the second, a work in, no less, he spent 1 hr.  He said he is really leaning toward an auto immune disease with me...and he said, they can take time for ferret out....he said, once we figure it out, "I will send you for a second opinion."
I've never had a Dr. tell me that, usually they seem to want to avoid it...
I came home from the psychiatrist appointment yesterday, and laid down, (which I rarely do in the day time).... and was awakened by a phone call just over 3 hrs. later...then went back to bed after my 10 PM meds, and a phone call at 7:30 awakened me this morning....yes, I'm still tired, and plan to lay down again...and rest...as when I got up yesterday I checked my BP which was low for me, and my heart rate was 77, I've been hanging in the 90's - 100 + . So I am telling myself, that my body needs the rest...
Thank you for being here...I just haven't been on for awhile, as I have not felt like it...
Oh by the way, my labs on 3-30-10 are:
TSH 0.011 (L)...my labs values are.......0.450-4.500
T4 13.7 (H) .........................................4.5-12.0
T3 156...........................................71-180
TPO 7............................................0-34
That's enough from me for now...
I do love this site...

[sharon_lee]

I called my current Doc...as my voice is very horse, sore mouth, deep chest ache, gut stuff....etc. etc. I said, I know that my counts are too high...she said, let me put up a note to see what he wants you to do...She came back some time later, and said, he said, by way of his receptionist, you are just going to have to tough it! I just had to share that!!! Unbelievable. I called my soon to be new Doc, and bless his heart, he has been out with the flu...I cried momentarily, and then, said, to myself...I am so glad that I am getting away from this man. I've no doubt I am overmedicated! I can feel it. Thank the Lord, that he dropped my dose  a smidgen or I would really be overmedicated...and I so apprecite your pointing out about the goiter and nodule, possibly leaking, and the possible conversion issue...

When my daughter called this am she asked how are you doing this morning, I said, oh, just ducky...she said oh my god you sound awful....I said, it is just my thyroid med, I do not have a cold...she said, but mom it isn't raining yet if you are feeling ducky, I said, ok fine then I'll be froggy...gotta have humor.
Oh of all the things today I received in my e-mail there was an article on Hypothyroid 101....excellent article about the Docs going by the old numbers that they have recently changed the numbers and they are lower now...copied and pasted from the article put out by about.com

Different labs have different values for what is normal. The endocrinology community says that normal range is actually .3 to 3.0. But at the lab my doctor uses, the normal range is .5 to 5.5. A TSH of less than .5 is considered hyPERthyroid, and a TSH of more than 5.5 is considered hyPOthyroid. Other labs might use .35 to 5, or .6 to 5.2, etc., but it's important for you to know the values at YOUR lab.

I'm sure that you are already aware of this...I just want to learn all I can, as I know that I have to my own health advocate.
Have a blessed day.

[sharon_lee]

Again thank you, I did not express myself well, I most definitely want to get the additional tests, you mentioned, with this new Dr. When my daughter mentioned her thoughts, she is saying if he is not willing to work with me, by ordering the tests. I just want a full Thyroid evaluation, (Thanks to your comments on the site, I now know what to ask for) except the uptake scan, and ultrasound, and fine needle biopsy, As I had all of those the end of Dec. I wish I could do them today...but the one I am seeing only does the two, TSH  and T4, Free (direct) and only uses 1 med. Levo. He made that abundantly clear, before I knew a thing about the thyroid, and I am still not well versed on it, I ask the currnet Dr. wouldn't it work better if two different medication were used? That is when I was told  he only uses one, and we just keep reducing or increasing until my counts are more like normal. His nurse also told me that I would go the opposite direction with the dose, meaning low..and that we would be yo yoing for awhle. So I will not bother to ask again. We had an endo. here, and she just left town. We seem to be loosing lots of our Docs. So that may have been my pharmacists only experience with Endo. His wife was a thyroid patient, but had most of hers removed and over time no longer has to take meds..She alos had a goiter and nodule. She is a pharmacist, also.
When I noticed on the new Dr. appointment card that he is D.O and Internal Medicine...I was happy to see the D.O. as I have always had good results with D.O.'s, even before I knew I had thyroid issues....I told my counselor, that I'm beginning to think that all of this up and down, panic attacks, etc. may well be related to my Thyroid...I have not been well for many years...and even ask the Psychiatrist I see periodically, if women or men who had endured abuse in childhood, are just destined to live life seemingly constantly struggleing with health issues? His reply was absolutely NOT! He also looked at my test results, but said, it has been so long since he studied it, that he would not want to comment and be wrong.
I'm so very grateful for your sharing you experience and what you have learned...as it will help me, and the timing could not be better, since I am going to a new Dr. soon.
My problem all my life has been the inability to gain weight..I finally did before Mandy died, and got up to 132...and lost down to 109...and can't seem to gain much of it back. I don't like being told frequently that I am so skinny. The Dr. I am seeing currently even asked what is with all of this weight loss? I said, I don't know, I'm sure not doing it on purpose. End of conversation.
I'm so happy that you are doing well, and I know that I will, and in part due to your sharing your experience and hope with me.

[Barb135]

You wrote: "my daughter said, if we are not content that this new Dr. will listen and be willing to investigate these other options, i.e. tests."   Why do you not want to go ahead and get the tests?  That's what's going to help you in the long run because it doesn't sound like your doctor is taking your symptoms into consideration much.

I don't agree that all endo's are into the numbers-- I have one who looks FIRST at my symptoms, then at the numbers.  My TSH stays *very* low -- in fact, much lower than yours, but so long as I feel good and my FT3 and FT4 are good, he leaves things alone.  See the key here is the FT3 and FT4 -- I've had other doctors who adjust my med based solely on TSH and because it stays low, they assume I'm hyper when I'm not.  I even had to point out to my "newest" pcp, not to long ago that my FT4 and FT3 are good and in order to keep them there, my TSH is going to stay low.  It was actually sort of a "shocker" for him, but he didn't try to change my med again.

The problem with endos is that a lot of them are more into diabetes than thyroid, so you have to make sure you get one who knows thyroid.  And you don't even really have to see an endo -- just a doctor who understands thyroid, is willing to look at your symptoms, as much or more than the labs and treat you accordingly.  

Another thing is that apparently there's not much covered on thyroid issues in med school and I'm not sure whether doctors have to get CEU's to renew their licenses or not, but apparently they don't take classes on thyroid, that will get them up to date with the testing/treatments.

I think there are probably quite a few of us on this forum who are finding that once we put all the symptoms together, we've struggled with untreated thyroid issues for much longer than we realized.  I'm actually dating mine back to around 20-30 yrs ago, when I felt like dog doo all the time, suddenly gained about 20 pounds, struggled to lose it and couldn't, then all of a sudden for no apparent reason, it just fell off.  I cycled like that for many years and although I'd point out the gains/losses to my doctors, they always blew me off as eating too much, not exercising enough, etc.  The whole time, I fought fatigue and other symptoms that were all "blown off" -- oh, the fatigue was often put down to depression and of course, they were all quick to offer anti-depressants, but never any thyroid tests!!!  At one point, I dropped all the way back to 75 pounds and even on my small 5' frame, I was nothing but skin and bones; still no one checked my thyroid.

  

[sharon_lee]

Thank you, so much for sharing this information with me...you have shared things I had no idea about, and as I say, knowledge is power! Great point about the nodule possibly leaking some hormone...gads, is it any wonder we are like yo yo's...I wonder if many Dr. have even put much energy into learning all about the thyroid...we do have a teaching hospital about 4 hrs. away...OHSU, my daughter said, if we are not content that this new Dr. will listen and be willing to investigate these other options, i.e. tests. Then she is driving me to Eugene...about 1 1/2 hrs. away...or OHSU...My pharmacist friend, told me that endo Doc's are to into numbers, and he does not agree with that...

Oh, this heart rate of mine has been 100+ for the past yr. or more...this yahoo, just says, your heart is a little high and you BP is a little high, and that is the extent of our conversation. I've had a high heart rate as long as I can remember, as I went to enter an exercise class, and the nurse checked my pulse and refused to allow me to take her class....who knows, maybe I have had this thyroid stuff much longer than I just learned..????

My heart rate is now at 89. BP 113/66  I just did too much today, went to Church and mowed the lawn...which should not be too much, but since being sick, I can't do much. without this affect...frankly I have not seen my BP this low in a very long time...nor have I had a pulse rate so high, as since all of the treatment started, and know that I do keep track of my pulse...if something does feel right, I will go to the ER.
Again, thank you, you have been more helpful that you know...
Continue to stay quite well...I appreciate your being on the site, and your insight...

[Barb135]

Yes, your FT4 is very high. You still need to know what your FT3 is.  

It's possible that the nodule on your goiter is leaking some hormone also, so that, along with your med is just too much.  And it's very possible to jump back and forth between hyper and hypo.  I have a mulitnodular goiter and I've concluded that I jumped back and forth for years before I finally went completely hypo, but I knew nothing about thyroid issues at that time and none of my doctors ever considered it either.  The doctor who dx'd me didn't even want to test my thyroid, when I asked about it.  But finally did.

Keep an eye on that heart rate -- if it continues to stay high like that, you might need to consider going to the ER.

[sharon_lee]

PSS...........blame it on the thyroid...
Just pulled out my last lab and there was a
T4, Free (Direct) it was (H) 2.52ng/dL  the range is 0.82-1.77
TSH  (L)   0.024  range  0.450-4.500

[sharon_lee]

PS
Don't know if this makes a difference, in the treatment, I have a 1"x1"x2" goiter, and a 2 cm nodule.
My counts were normal when we started...I guess they are trying to shrink the goiter...and I don't know if in order to do that, they have to take me way up, then way down...then ?
So much to learn...

[sharon_lee]

Thank you, so much for your feedback...When I ask the Dr. office where I am currently until I can get into my new one on the 15th. his nurse said, they only use one, and that is Levothryoxin...for everyone....
I know from the way my body is acting I am still on too much...when I had it filled my pharmacist said, he did not reduce that much at all, I told him my counts...my Pharmacist studied Thyroid...but decided he did not want to work with it, as it was too confusing...and he is a brain. Anyway I just came in from mowing...and my BP is 110/63 and pulse 112
Seems when my pulse is up the BP is down., that tells me something.....I've not had as low a BP in a very long time....and that heart rate is rediculous. No wonder I felt light headed and hot....exhausted.
I have copied and pasted your post into my e-mail, I do hope that is ok...so that I can write from it what I want the new Dr. to look at...my current never did Free T3 or 4 he only does TSH and T3. I appreciate your mentioning the conversion problem, my body has never reacted the way it should to meds...it tends to do the opposite, as in they put me on antidepressants, and behold I got much worse, and very suicidal....a wise nurse in the hosp. figured out the problem...and told the Dr. It was causing the very thing they gave it to me to stop...
I have a family history of not reacting well to medications. Then again, maybe we just needed good Dr. that would listen, and if necessary do some homework and figure out what they can do that just might work.

[Barb135]

What was the lab's reference range for that FT4?

You should not have adverse side effects from the levothyroxin unless you are sensitive to one of the fillers used.  The fatigue, exhaustion, etc are symptoms of your thyroid issues -- in your case, apparently hyper right now from being over medicated.  

I'm happy to hear that you are going to be seeing a different doctor -- as I was reading this thread, my first thought was that you need a doctor who is going to treat you according to your symptoms, more so than the lab work.

It's not unusual for people to still feel bad at 6 weeks into the diagnosis, and don't feel badly about "grumbling" -- we all do it.  I've been at it for right close to 2 years and have just recently gotten my levels to a point where I feel quite well.

When you see your new doctor, ask him to check your Free T3, as well as Free T4 -- I'm wondering if you might have a conversion problem.  See, levothyroxin is a T4 only med and T4 is not used directly by the body; it must be converted to T3, which is the hormone that actually gives us our energy, sets our heart rate, body temp, metabolism, etc.  It's possible that you might not be converting the T4 to T3 properly.  I have that problem, but the only way you can determine for sure is to be testing both FT4 and FT3.  TSH is much less important than these 2 thyroid hormones.  But of course, you said you had lost weight, so maybe your FT3 levels are high also.  It's important to know either way.  

I have a conversion problem and I take both levothyroxin (T4 med) and cytomel (T3 med).  Although my dose of cytomel is very small, it does wonders for the way I feel. I had a doctor who also refused to test FT3, and was basing my dose only on TSH, so he was keeping me sick.  

Wishing you the best of luck and please try to be patient with this -- it often takes a long time to get the levels where YOU need them to be.  I know it might seem easy for me to advise patience, but I've been down the road, and I know how hard it can be.

[sharon_lee]

I guess for now I am learning that I will be yo yoing all over the place until the numbers are leveled out again...It sure isn't fun, as I can't really plan anything in advance, as I don't know how I will feel tomorrow..today, was good, yesterday...not good. I so see my new Dr. on the 15th. I'm anxiously awaiting that visit...
I need to have cataracts removed, but some have said, it is best to wait until I am more level, as my vision will change daily...and I sure have found that to be true. Thank the Lord, those headaches have subsided...they would start just on the bone behind my ear, and radiate right up behind my eye. I also have glaucoma, and had another rupture at my last visit. Some have said that those headaches behind the eye need immediate attention, as that could mean more vision loss. Boy oh boy...I now have to use a magnifying glass to read smaller print...I'm thinking that once we get my counts more normal, many of these other problems I have been dealing with for the past few years, may be for the good. Here I am grumbling at 6 weeks into the diagnosed illness, and others have been struggling for years...I thank God for every good day!

[sharon_lee]

Thank you, for sharing about Christopher...Sometimes we have to make some noise, to honor our lost loved one....It took nearly 4 yrs. but worth every meeting and phone call. Yes, God is GOOD!

Well they changed my med dosage and decreased it nearly 2 weeks ago...and behold I am doing the voice thing again...and my lips are very red, and sore, as is my tongue...then of course there is the gut stuff...I felt when he reduced it that he did not reduce it enough, and I asked about 2 drugs, as one count was way too high on the Levothyroxin 100MCG and one way too low....so he reduced it to 88MCG...I asked about using two different medications, and the nurse said, he does not do that...only the one. I'm so grateful for these forums so that I can share my symptoms. Not to get answers per say, but some have some relevent suggestions, and we certainly have empathy for fellow sufferers. I was thinking last night, that I may have nearly as much knowledge about the thyroid, meds, etc . than my Dr. Certainly I will before this is all over....for I fear I have a long road ahead of me....I was planning to go to Church today, but have decided I just don't have the energy to drive across town, and then sit through the service, and they are always good, then drive home....Like one of the elders told me, you can just do what you can do, and don't worry about what others think. Have a wondnerful day...the sun is shinning here and I love it...maybe go sit on the porch later or go for a walk...and appreciate God's creation.

[blsdnsvd]

I also had a cousin who was struck and killed in an intersection by his home, about 9 yrs ago and the city named that intersection "Christopher way"...(it was an area where a pedestrian bridge connected and kids rode their bikes on an off the pathway)  I pray that in awareness, folks would slow down and be considerate of pedestrians. I'm happy for you and your family. God is Good!

Sometimes these doc's jus say whatever comes to mind at the time. We all have a long walk when it comes to getting back to normal concerning the thyroid issues.
In the end, we will all come through. It is a blessing to be able to meet and talk to others who are in the same situation and a true blessing to be able to get answers.
Be Blessed and hang in there!

[sharon_lee]

Hi...Gosh, I don't like this disease. I can only pray that the new  Dr. will give me more information and listen to me and ans. my question..I'm tired of this walk in the door, how are you today, to which I generally answer, I sure would not be here in your office if I felt good and had no medical problems he listens to my heart, sometimes, usese his little hammer to check my reflexes, does the range of motion stuff, writes a prescription, and out the door he goes. ...Today I have pins and needles in my arms legs and body...feel exhausted...I'll quit with the gripping, and say what I started to say....yesterday, I finally was able to pick up all of my lab work! Yeah...from now on, I will ask them to mail it to me, or go back and pick it up.
Also..great news for my family...yesterday the city called and they are going to put up two sign on the curvy, narrow, winding road where my granddaugher was killed, Sept. 18, 2006...Beneath the signs will be a rider,
      In memory of
Mandy Renee Cochran
         1988-2006.

We are going to push it further, and the city thought it a great idea, to see if the high school will be willing to use this road in their drivers education classes, and stop at the site of her death, and talk about what was going on, that too her life. The signs go up next week, and they will call us ahead of the instillation. What a glorious day that will be, for us!

Now that I have won that battle, I start the fight for my health. You see since she died, the Dr.'s have all blamed my symptoms on grief.....I knew there was more and I knew that it was physical. Every time the Dr. would squeeze my shoulders checking for tightness in the muscles from the whiplash and fibromyalgia, I would tell him, I feel a chocking sensation when you do that...he said, oh it is just tight muscles.

Thank you, all for your encouragement, and positive words, and for those who feel like they want to quit, I have been there many times..so much so that my therapist calls me daily, yes, 7 days a week.
Together we can do this! Alone is almost too much to deal with, thank God for whoever started this site...and another one I have found that I am learning from...
Blessing,
Sharon

[blsdnsvd]

I have learned to get copies of all of my medical reports including: bloodwork, lab work , sono's, scans, fna's...everything...in the event that you have to look back or even give a copy to another doc..because they do ask for recent work that was performed... Also, be sure to keep check on the goiter and you can also go for a second opinion if your doc seems to laxed...Be Blessed!

[sharon_lee]

Welcome aboard, I came across this site purely by accident, or God incident, as I call them. Thank you, for your sympathies for Mandy...she was my only grandchild.

So I have kind of learned today, that I will yo yo for awhile until they get these counts back to normal range. No, I do not have the results of my fna biopsy paperwork in front of me, only what the Dr. said, He said, there were no signs of cancer, disease or inflamation. These biopsies were all taken from the nodule...they had talked about aspirating the goiter, and in a way I kind of wished they had, but have heard that whent hey do that, they sometimes come back. I was too high, and the dosage they just gave me Friday, is lower, so I will start going the other direction. The nurse said, I will go up and down for awhile, until they can get it stabalized...By the way, I am planning to go to the Dr. office and get copies of all three lab test  done at the hospital..

[blsdnsvd]

I am beginner as well...LOL...and please except my deepest sympathy in regards to your granddaughter....

You may becoming hypo due to the dosage of the synthoid...if it's too low, you will experience those symptoms. It's like a waiting game, Do you have the results of your fna biopsy??? Were there any abnormal cells at all??? Sorry for all of the questions,

[sharon_lee]

My Dr. didn't state hypo or hyper until I asked last week, which one am I? He said, definately low! I've experienced the side affects that you mentnioned, especially fatigue, and exhaustion, the past week headaches, and anxiety....I had a hysterectomy at age 27 so don't have that, now I have severe vaginal atrophy. I was treating with estrogen and Progestrone, and they stopped it, for now, until I am more level. Some of my symptoms seem to be more on the hyper side, ie. I've lost 23 lbs., of course I attributed that to the death of my granddaughter...I must be in the hypo stage now, with my count where they are, maybe not...this is all so new to me, and I have a Dr. that won't tell me anything. I have to asked and his answers are curt as he goes out the door. My daughter just suggested that I make an appointment before the one month, and talk to him about the numbers on the kidney part of my blood work...The nurse I spoke with at lenght today, was awesome, and said, that I should have a full kidney, liver and thyroid work up, and definitely a urinalisis.  Yes, I did have an ultrasound, and a 2 day thyroid uptake scan, then a fine needle biopsy. Thank you, for you note..this is all so new to me...

[laura1967]

Most of your symptoms should subside "when" you reach optimum levels. The correct labs that should be run are TSH, Free T4 and Free T3. Any of the other tests such as Totals, etc are outdated and not longer used. The other very important thyroid tests that should be done to see if you have autoimmune disease is for Graves and Hashimoto's autoimmune thyroid disease.
In the case of a goiter, your thyroid can actually squeeze out some extra hormone here and there and can make you feel aweful as well.
Apparently your thyroid is fluctuating from the goiter.
When mine swells I like to put ice packs on it and it really helps.  :)

[blsdnsvd]

Did your doctor state that you were hypothyroid, meaning that your thyroid is not producing enough hormones (underactive). I had a Total Thyroidectomy due to a Goiter w/multi nodules which were benign for cancer.  I am on synthroid due to not having a thyroid and this hormone replacement is needed to take the place of the thyroid. I have noticed side effects, such as: exhaustion, fatigue, anxiety, headache,
menstrual changes,and muscle cramps. This is due to the hypo symtoms, which i should have stated in my first post. You will more than likely not have many of these symptoms because your thyroid is still functioning. I am assuming that you did have a ultrasound and fine needle biopsy of the nodule??

[sharon_lee]

Thank you,so much for your post. The Dr. told me there were not ill affects from Synthroid. Where can I find out about them?

I talked with a nurse from my Dr. office this a.m. and she seemed surprised that all he ordered was the thyroid blood work...I ask what our goal is, and she said, to get me back within normal range...So I am sure you are right about the shrinking of the goiter...he said, the med will not shrink it, but could keep it from growing. We don't have an endocronoligist (sp) here...she just left town.
Thank you...
Blessing,
Sharon

I pointed out to her that at the bottom of the page of the first lab work, before medication...indicated that I have kidney counts that indicate that I may have chronic kidney disease. Though he has never oredered a urinalisis. (this is just a side note) The lab even wrote on it, NOTE: and said, this patient may have CKD.