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

[flyingfool]

Well the numbers do not really mean anything if you feel fine.  

Do you have any Hypo symptoms?  The fact that you are losing weight would be an indication that Hypo may be under control.  At least to a certain extent.  I have read MANY accounts where weight loss does not occur until they were spot on in their sweet spot for medication dosage.  Everyone is different.

As a general rule many people report that they need to be mid range on their FT4.  You tested at 1.07 and the middle of the range you listed would be 1.28 so that would indicate you are not up to mid range.  Similarly most people need to also have their FT3 to be in the upper 1/3 of the range.  You tested at 3.04 while upper 1/3 of the range is 3.70 again showing a bit lower than that.  In fact mid range is 3.4.

So as long as you feel well and symptom free, I'd say leave things alone.  If you still have symptoms it would appear that an increase in your T4 med could be something to consider.

[goolarra]

How long had you been on the 50 mcg before the blood was drawn?

[Danniabg]

Hi and thankyou for the responses so far.
I feel fine.
My aching shoulder/neck and wrist has disappeared, I don't seem quite as tired as I was, concentration seems better, my hair has stopped falling out.
I am a bit wakeful at night, though fall asleep really easily.  Find it hard to get out of bed in the am. Have dry, cracked heels, my periods had regulated over the past 8mths, but this week started my 2nd one for the month, so not sure what is happening there.

Hi Goolarra, I have been on the 50mg since mid Oct, on the day of the test I didn't take my pill (not sure if that is important).

Thanks once again for your feedback.

[goolarra]

That's good...your dose had had plenty of time to stabilize before the blood draw, so the numbers should very accurately reflect the 50 mcg dose.

Reproductive hormones and thyroid hormones are both part of the endocrine system, so a change in one can have repercussions in the other.  It might be that your period is just reacting to the "new" presence of thyroid hormone in adequate amounts.  I'd give it a bit and see if it all falls back into equilibrium again.

Other than that, I agree with flyingfool...if you feel well, why rock the boat?  We're all comfortable at different levels, so symptoms are the true test.  As flyingfool pointed out, your FT4 and FT3 are a bit on the low side, so there is room for a little increase should you feel that you need it.

Sounds like you're on your way...congrats!

[Danniabg]

Thanks, that's made me happy :)
I am a little apprehensive about doing it without my endo's say so but I wonder if a small increase might help my energy levels a little more, I was thinking maybe an extra 25mgs every other day, what do you think.
Obviously I understand it is my choice, but I appreciate feedback.

The 2nd period, is actually more of a 'phantom' I seem to have all the symptoms, sore boobs, low stomach pain, but not much in the way of blood over the past week, so not sure what's going on there!

Thanks for your advice and a very Marry Christmas to you all :)
Nikki

[goolarra]

One of the problems with increasing on your own is that you'll run out of meds before your prescription is refillable, no?

I'm sending you a PM.

Merry Christmas!

[Danniabg]

No I can refill as I wish :)
Ok thanks :)

[Danniabg]

Hi again
So this month I have had one 'normal' period on the 6th (25 days since my last)
then a 'show' on the 19th, not much blood, but sore boobs so I felt I was coming on. This lasted a couple of days, then went then on the 25th I have fully come on (no other symptoms though) heavier flow than normal and no let up as yet.
For 2 years since coming off the contraceptive pill and before I saw my 1st Endocrinologist, I had been having irregular periods, (2 a month pretty much) My gynae put me on a low dose of HRT for 6 mths (from Oct last year), and this regulated them up to now.
The 1st Endo said thyroid probs had nothing to do with periods, but from what I am reading it could be relevant, though I don't hear much talk of irregular periods on here.
Hopefully your comments Goolarra will be the cause here, but just wondering if others have had this happen or similar?
(Maybe I should start a new topic?)
I have regular smears, and all normal so far.

Thanks
Nikki

[goolarra]

We do hear a lot of talk of irregular periods and women who are trying to conceive, but can't, due to thyroud hormone imbalance.  I don't know where endo #1 has been, but perhaps that's why there's an endo #2!  LOL  

Starting a new thread is an excellent idea.  Then, you can get this specific question into the headline and hear others' experiences.  It might get kind of lost this far down in a thread that had another topic to begin with.

[Danniabg]

Hi all,
Well it's been a while but I just had another set of testing done.  
(My first since December 2011)

FT3 - 2.84  Range (2.5-4.3) Was - 3.04
FT4 - 1.37  Range (0.71 - 1.85) Was - 1.07
TSH - 2.23  Range (0.49 - 4.67) Was - 4.11

Feeling fine, no real hypo symptoms apart from probably more constipated than I was, have had 24 hrs of indigestion and I never get indigestion (just read today that thyroid patients are prone to it?), periods still all over the place, hair fall (but I tend to always have this every summer) vertically ridged thumbnails/toenails, nails growing really quickly, seem more prone to painful acne around my period when my skin was always quite clear, sleeping seems fine, aches minimal, not tired, so I'm doing ok I think.

Cholesterol mid range which was a surprise as I've not been behaving really, but am exercising every single day.

Meds since last testing are still at 50 mgs every other day, and 62.5mgs the other days.

Any thoughts/advice appreciated.
Thanks everyone :)

[gimel]

Nice to hear from you again.  From your test results I'd say that your Free T3 is fine, but you are not converting enough  T4 to T3, since your Free T3 is too low in the range to relieve symptoms for most hypo patients.  You could increase your T4 med to try to drive your Free T3 higher, but I think the best approach is to try to get a prescription for a source of T3.  This could be either a small dose of a T3 med like Cytomel, or generic.  Or you could also switch part of your dosage to a T4/T3 combo, like Armour Thyroid, or equivalent.

Many of our members report that symptom relief required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range.  So you have a lot of room to increase your Free T3 level, as necessary to relieve symptoms.

Also, if you haven't been tested for Vitamin D, B12 and ferritin, those are frequently low for hypo patients.  Those are also important, and typically they need to be above the middle of their ranges.  

[Danniabg]

Hi Gimel,
and thanks :)

Aww, I was so hoping there wouldn't be an issue, as you may remember I live in Bulgaria and my endo (who is the best in my area apparently) will not entertain FT3 & FT4 results, infact the whole of the Bulgarian endo society is the same, so I will just have to try upping the Thyroxine to 62.5 every day I guess and see what happens for a few weeks.

I wonder what she would say going by just my TSH.

I might ask if I can buy the Cytomel (liothyrorine Sodium isn't it) over the counter if I don't get on with upping my dose.

I'm very grateful for your help you know, as much as I know I should see my endo but I just know it will be a waste of time...and money :(

[gimel]

Sorry, when I looked at my last post, I see a mistake.  I said,  "From your test results I'd say that your Free T3 is fine, but you are not converting enough  T4 to T3, since your Free T3 is too low in the range to relieve symptoms for most hypo patients."    

What I meant to say was,  From your test results I'd say that your Free T4 is fine, but you are not converting enough  T4 to T3, since your Free T3 is too low in the range to relieve symptoms for most hypo patients.  

[gimel]

If at all possible, I would get those other tests done.  Maybe they will do those in Bulgaria.  

Are T3 meds even available there?  If not, if you can at least get a prescription, you might be able to purchase from a site that I know in Canada.  I know of a lady in India that is going that route.

[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

[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]

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.

[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]

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. :)

[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]

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]

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]

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.

[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.