Updated Test results

[Danniabg]

At the recommendation of Gimel and after reading many times on here regarding test results, I have mine updated now with the Free T3 & T4.  I can't see my endo at the moment as she isn't working since breaking her leg, so would appreciate advice please.

History: I had a partial thyroidectomy in July this year, due to benign nodules on my left gland.
In Sept I was diagnosed Hypo
TSH was 6.17 uIU/ml (0.27-5.0/ for monitoring of therapy it says then these numbers 0,2-5,50) (I live in Bulgaria btw)
I didn't have the Free ones done then as only discovered them on here.

Had the test done this week after being on 25mgs of Levothyroxine for the first 2 weeks, then 50 mgs per day.
TSH now 4.11 uIU/ml (0.49-4.67/ for monitoring of therapy then 0,2-5,50/)
FT3 3,04 (2.5-4.3)
FT4 1,07 (0.71-1.85)

And my cholesterol has come down from 6.7 to 5.9 (6.5 - 4.5) but I did have it lower than that pre op.

I did have a full blood count, but all the numbers are within range, so seems ok.

I am losing weight quite easily I have to say, I am now the lightest I have been in over 10 years so happy about that!

I would appreciate Gimel and anyone else's feedback on what the thyroid figures mean please as I can't see my endo :)

Thanks in advance
Nikki

[Danniabg]

Hiya Gimel, thanks:)
Unfortunately living in Bulgaria and they don't offer RT3 testing. :(

I've been taking about 375 mgs Magnesium at night since supplementing with VitD.

I can't believe it went on 2 grains and is now back with a vengeance on 2 and 1/4. I'm reluctant to take more in case I am pooling, so tempted to go back on T4 only!

[gimel]

Just a couple of thoughts.  First, although you are probably tired of tests, it might be a good idea to test for Reverse T3, along with the Free T3, to see the ratio.  The ratio of Free T3 to Reverse T3 has been reported as being the best measure of actual tissue thyroid levels.  High level of Reverse T3 is not a common occurrence, but it it exists, it can offset the Free T3 effect.  

Second is to try a magnesium supplement such as magnesium glycinate, or magnesium citrate and see if that helps with the shoulder/neck aches.  When supplementing with Vitamin D, it is recommended to also include magnesium.

[Danniabg]

My shoulder/neck ache came back - it went when I increased to 2, and my basal temp went down for a few days in a row.
But I still have these symptoms now :(

[gimel]

Smart lady,  Don't know enough about iron/ferritin to draw any conclusions.  I did wonder if the iron supplementation could be causing your ferritin to be a bit high.  Also, have a look at this link and see what you think.  

http://labtestsonline.org/understanding/analytes/ferritin/tab/test

As for the Free T3 level, it is a bit high.  What was the basis for increasing med by 1/4 grain.  What symptoms are you still having?  

[Danniabg]

Hiya :)

No, I took it at 1pm the day before and drew bloods at 9am the next day.
I was also off all iron for 4 days before.

Thanks

[gimel]

Good to hear from you.  First I have a question.  Did you take your NDT before the blood draw for the tests?

[Danniabg]

Hiya everyone,
It's been a while but I just had some tests in and would like to share and get opinions.
I've been on NDT (Thyroid-S) now for 8 weeks and am on 2 and 1/4 grains, I was on 2 grains at the time of the tests below.

TSH 0.014 (0.27-4.20) :) Down from 2.23
FT3 4.97H (1.45-3.48) This range was (2.0-4.4) in Oct 2012
FT4 1.37 (0.93-1.70)
Tpo 9.38 <34 (Up from 6.34 despite being on Selenium)
TgAb 9.8 <115 (down from 10.0)

Vitamin B12 1089.4 H (191-663)
Up from 205, only been supplementing with 5000 mgs daily since beg of Dec 2012.

Vitamin D3 66.2 (Up from 38 in Oct 2012) :)
Ferritin 130! (Up from 48.3 in Oct 2012)
Iron 14.6 (6.0-26.0) Up from 12.9 in Oct 2012
TIBC 56.7 (47.0-77.0) Up from 54.6 in Oct 2012
HCT 0.40 (0.35-0.44) Unsure if these 2 help for Iron numbers
HGB 138 (115-160)

Potassium 3.78 (3.5-5.6) (Tourniquet used)
Sodium 139.8 (135-152)

So as you can see I have got my B12 up, I'm a bit worried about my high Ferritin and still my Iron maybe low.
Plus my FT3 seems very high.

Any advice is welcomed, thanks. :)

[Red_Star]

I have a rare autoimmune condition called juvenile pernicious anaemia. My sister has this condition as well just to add.  I need to take B12 daily for life. Symptoms show up just three days after i stop taking my B12 spray. Crazy but true. :)

[Danniabg]

Hiya, no worries at all Red Star,
I ordered BetterYou B12 Boost Oral Spray - with Chromium & Green Tea - 25ml, it says it delivers 1200 mcg and lasts 40days with 4 sprays per day! Seems a lot but I can't see me using it that many times as I have also got Jarrow Formulas, Methyl B-12, 5000 mcg, 60 Lozenges coming.
Do you only use it when you feel you need it, like when you're tired or dizzy maybe?

[Red_Star]

I'm only a month late at replying. lol I use a brand called BioCeuticals for my sublingual B12 spray.  One spray is 500mcg so i use about 4 or 5 sprays a day.  Good stuff. :)

[Danniabg]

Good advice as usual, thanks Gimel.

I must admit for the first time ever I've begun to actually take note of my body much more by using a daily diary of symptoms, food, activity, medication, blood pressure, pulse and temperature.  This way I can compare notes if I hit a wall later on.

I've even started to exercise again which I'm chuffed about though I'm doing that slow and sure too.

I just hope it stays this way! :)
Hope you're well too by the way, take care all xx

[gimel]

Very glad to hear that you are doing so much better, NIkki.  Seems that you are doing all the right things with supplements and meds.  

In my opinion, I think that if you have already improved  that much, you should consider deferring any increases for a while.  Keep in mind that symptom relief tends to lag changes in blood levels of thyroid hormone.  You have felt so bad for so long, now that you have increased your thyroid hormone levels, it might be best to give your body a chance to heal and see how much better you feel at current dosages.  

Slow and sure is always the best approach to increasing thyroid meds.   You never want to increase too much or too fast.  Remaining slightly hypo, while tweaking your meds and finding your "sweet spot" is miles better than taking a chance of flipping over into being hyper.  

[Danniabg]

Just an update...I've had some B12 injections, and will be supplementing with lozenges soon. I've continued to take the ferrous sulphate and upped my Vit C to 2000mgs spread through the day.
I've upped my D3 to 3000mcg per day.
And I got Cynomel (Cytomel) from Mexico so am on T3 (12.5mcgs) plus increased theT4 to 62.5mcg daily and I have to say I am feeling miles better.
I take the T3/T4 sublingually in case I'm not absorbing it well enough.

I don't have the brain fog, dizzy episodes or tiredness I had before.  My basal and average daily temps have risen although not up to normal yet, but mostly out of hypo range.

I will retest after Xmas, but I'm not sure if I should keep the T3/T4 combo as it is, or increase the T3, maybe just leave it until symptoms return or ??

Any advice is appreciated, thanks :)
Nikki

[gimel]

Great to hear that your village doctor is helping you make some progress.  Please keep us up to date on further developments.

[Danniabg]

I decided to see my local village Dr, and she looked at my vitamin results and is getting me some B12 shots as she feels a lot of my symptoms will be from this being so low.

I've also ordered some B12 spray and tablets and D3 and some better Iron pills, plus I'm now taking Selenium to keep the antibodies down as recommended by STTM.

My Dr. has been better than the endo as she feels that once my Vitamin/Iron levels are addressed then we can work on the Hypo stuff.
I haven't asked her about Cytomel yet, still waiting to see if it gets through.

[Danniabg]

Thanks Gimel.

The Sorbifer Iron says it's prolonged release I take it last thing at night. I can't really tell any difference from taking it yet (only a week).

As for the VitD3 (25 OH it says) my result was 38, and it actually states that 10-30 is deficient 30-50 is optimum and >70 is overdose. So I guess the range is more like 10-70 I don't know, but I don't get a lot of sunshine and am very pale considering I live in a hot sunny country that is having it's first rain tonight since May. (More like a hurricane!)

I've ordered some Cytomel from Mexico but don't know if it will get through customs yet or not.

[gimel]

Not familiar with that range for Vitamin D, but assuming it is correct, it doesn't appear that there is a lot to be gained by additional Vitamin D supplementation.  For B12, I take a 1000 mcg tablet daily.  For iron supplementation, which you really need, there are a number of options.

"But most patients and their doctors have found it necessary to supplement with iron tablets, which includes Ferrous Sulfate, Ferrous Glutamate, Ferrous Fumerate, etc. Supplementation needs to be spread out during the day, with food, for better absorption. Bluebonnet’s Ferrous Bisglycinate is a favorite among patients, but there are other good brands."

There is also one called Slow Fe that is reported to be good.

For thyroid,  it appears to me that further increases in T4 med will not likely be adequate to raise your Free T3 level enough.  Which leads us back to a source for T3.  Even if T3 meds are not available in Bulgaria, if you can persuade your doctor to give you a prescription, there are places you can order by mail.  Is this a possibility?

[Danniabg]

Hi Gimel :)

I have started to take some Sorbifer iron tablets (Ferrous Sulphate plus Vit C at night) but I need to change these as I am having trouble going to the loo now :(  (Any advice on what to take?)

Could I do with any additional VitD?

I did up my T4 by 1/4 tablet after the last test results so I would be taking 62.5mgs every day as apposed to every other, and I felt like a zombie for 3 days and felt really dizzy so stopped. Maybe I should have carried on?

I am going to email the Bulgarian Endo society to check about T3, but when I asked at the pharmacies here, they said no they didn't know what it was.

Thanks Gimel for your input as always. :)

[gimel]

Red_Star covered Vitamin B12.  I see that you also need to work on getting your ferritin increased.  Low ferritin can be associated with a number of symptoms.  Here is a quote about the best levels for ferritin.

"FERRITIN test: Measures your levels of storage iron, which can be chronically low in hypothyroid patients. If your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are in the 50′s, you are scooting by. Optimally, females shoot for 70-90 at the minimum; men tend to be above 100.

You should be off all iron for at least 12 houes before testing to see what your body is hanging onto."

Of course you also need to increase your Free T3 level.  Without the availability of any T3 med, you could try to increase your T4 med and see if there is any corresponding increase in Free T3, but that is most likely to be a very small effect.    Is the problem that T3 med is not available, or that your doctor will not prescribe the med?

[Danniabg]

Thanks for your comment regarding B12.
Can you or anyone point me in the direction of a tried and tested B12 spray or lozenge please? (What do you use Red Star?)

Hoping some others can comment on the rest of my results thanks. :)

[Red_Star]

Vitamin B12 deficiency symptoms are numerous but include brain fog and serious lack of concentration.  Hopefully you can find sublingual (under the tongue) B12; available in spray (my favourite!), tablets, lozengers, or drops.

"At least six neurological and psychiatric papers, in top medical journals, have shown that the normal range should be regarded as at least 500-1,300 pg/ml (rather than 200-1,100), since the cerebrospinal fluid level can be deficient when the serum level drops below 500, and neuropsychiatric symptoms often occur at serum levels between 200 and 500 pg/ml (VanTiggelen et al, Lindenbaum et al, Mitsuyama/Kogoh, Nijst et al, Ikeda et al, Regland)."

[Danniabg]

Also I forgot to say, I have a serious lack of concentration and brain fog just recently too lol, and I was having bouts of hunger that I just couldn't ignore and always went for salty foods, but since cutting down on carbs, eating more protein and eating little and often this has cured it, plus it seems to have helped the hypoglycemia too as I haven't had an attack for over a week now.

[Danniabg]

I hope you won't mind me asking for opinions on my labs again as I've not been feeling brilliant (tired with episodes of hypoglycemia) and decided to get some tests done.
As a recap I'm on levothyroxine (Euthyrox) only (50mg 1 day/62.5 the next and only have a 3rd of my thyroid since last July) I am learning about T3/NDT medicine and hoping to make the change over, although I can't get help from my Dr/Endo as I live in Bulgaria (though I am English) and they only go by TSH and I can only get T4 meds here frsutratingly.

I didn't re do my TSH as it seems pointless but on the 19.09.12 it was 2.23
(0.27-4.20)
FT4 (19.09 was 1.37) Now 1.49 (0.93-1.70)
FT3 (19.09 was 2.84) Now 2.93 (2.0-4.4)
Anti TPO (April 2011 9.22) Now 6.34 (<34)
Anti TG (April 2011 9.5) Now 10.00 (<115)

Magnesium 0.88 (0.65-1.03)
Vit B12 205.5 (191-663)
25-OH-Vit D3 38 (30-50) it states this is optimum level below is deficient and above is overdose.

Iron Panel
Ferritin 48.3 (6,0-159)
Iron 12.9 (6.0-26.0)
TIBC 54.6 (47.0-77.0)
I couldn't get the UIBC done.

Cortisol test
am 28.46 (<19.1)
noon 4.94 (no range given)
afternoon 6.79 (<11.9)
pm 3.42 (no range given)
I usually get to sleep well, but can be aware I'm awake in the early hours but I usually get back to sleep. A year ago, I would get up at 7-8am and want to go for a walk, but this year I haven't felt like that at all, I take my T4 at 8am then sleep until gone 9 most days.

For those of you who know about temperatures, I've been taking my temperature as it states in the STTM book and the highest has been 36.7 and this morning was the lowest at 35.6.

I can't get T3/NDT as yet, I am trying to, but in the meantime maybe I need to up my T4 meds??

Any comments on the results and/or advice will be appreciated.

Thank you in advance.
Nikki

[Danniabg]

Hiya again
I did ask about getting those other tests done and was met with confusion as I don't know how else to ask for them in Bulgarian, they understand the Vit D one and it is expensive so I'm thinking about that one for now.

I've decided to increase my T4 meds for 6 weeks, re test and see how it goes, in the mean time trying to find out about T3 meds here.

I hate self diagnosing but guess it has to be done when there is real no alternative, I am very thankful for the help here, especially yours Gimel, as I would be oblivious otherwise.

Thanks again