What Tests needed for Hypo

[Prism45]

Hi
I have an appt with a new Dr regarding being Hypo and am wondering if anyone can give me advice on which tests I should request to be done.  A specialist in an unrelated area diagnosed me 5 weeks ago using tsh and free t4 and put me on levothyroxine 100 mcg.  I ended up with racing heart, headaches, irritability (nice word for it LOL), insomnia, overheating.  I then dropped down to 50 but this does not seem to be correct either since the hypo symptoms are hitting hard especially the fatigue.    

I would like to approach this new Dr. having some understanding of what test I need but at the same time I do not want to be offensive about it.  So I thought I would put together a list of my symptoms and the lab tests that the other Dr. did.  Then have on the list my understanding of what tests need to be done for medication adjustments.  Including items like d3 and b12 that hypo people are generally low in?

I have had problems in the past  with communication regarding this.  I have been dismissed and brushed off and would like that to stop.  So if anyone has any advice regarding this I would appreciate hearing from you.

[Barb135]

Whenever you post on a thread, you will see a box, just below your post, to the left of the green "Post a Comment" button.  Click on that box and you will get an e-mail update, letting you know that someone posted.  Well, you will if you have your settings on to receive updates.

I'm looking forward to seeing your new labs.  It will be easier if you go ahead and post them in this thread, then we will have all of your information together in one thread, so we won't all be asking the same questions over again.

[Prism45]

Thank you so very much for your response.  I think I still have a very large learning curve for knowing when there is a response to a thread.  I have finally gotten the test results back and am going to post them for input.

[Barb135]

Wow, your FT4 really was low; too bad they didn't do an FT3 at the same time, but hopefully, you can get the new doctor to do it.

Your vitamin D level is still way too  low.  Optimal is is 50-80.  Be sure your new doctor knows about these low levels; he might prescribe a mega dose to get your levels up.

Do let us know how it all turns out.

[Prism45]

WOW!  Thank you for all of the explanations.  This is wonderful.  I was not sure of the name on all of them.  

You are right my prescribing doctor is not the doctor to continue with on this.  So hopefully, this new one will be good for working with me on getting the right tests and getting not only the numbers to reflect that it is under control but also the symptoms.

The test results are 11.74 TSH (they just said it should be 2.5 or under)
Free T4  is 0.9 (0.8 - 1.7)

I currently take 4,000 d3 about a year ago I was diagnosed deficient.  The last test in oct.  had me at 33 on a range of 30-80.   I was excited to actually be on the range :)

[Barb135]

Do you have results for the Free T4 and TSH that were used for your diagnosis?  If so, it would be helpful if you could post the results and reference ranges so we can better assess your situation.

Were you tested for Hashimoto's Thyroiditis?  

The tests you need to ask for are Free T3 and Free T4, and be sure these are FREE, not Total, as they aren't the same tests and tests for Total T3 and T4 are considered obsolete.  Along with Free T3 and Free T4, you will get a TSH.  Don't let them get by with testing only TSH, which is a pituitary hormone and doesn't always reflect actual thyroid function.

If you haven't been tested for Hashimoto's, you should ask for antibody tests, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  

Hypo people aren't generally low in vitamins/minerals, but there are a few that some are low in.  Those include Vitamin D, B12, and ferritin.  I, typically, only recommend these if the patient exhibits symptoms of deficiency, because doctors sometimes balk when people come in with too long lists of things to test for.

Vitamin D deficiency can cause some hypo like symptoms. Vitamin B12 would be one for you to be tested for, because of your fatigue.  While that is a hypo (and hyper) symptom, it's also a prime symptom of B12 deficiency, as is easy bruising, numbness/tingling in the hands/feet.

Ferritin is the iron storage hormone, and since iron is necessary for thyroid hormone metabolism, it's often recommended that ferritin be tested.  Iron deficiency also causes anemia.

So now, I'll put the list all together... the tests you need are:
Free T3, Free T4, TSH, TPOab, TGab, Vitamin D, Vitamin B12, ferritin.  

It would also be in your best interest to ask for a thyroid ultrasound to determine whether or not you have a swollen or inflamed thyroid (goiter) and whether or not you have nodules on your thyroid.  Nodules are very common and usually nothing to worry about; just nice to know if they're there or not.

Sounds like your prescribing doctor didn't really know how to prescribe thyroid med... Typically, it's best to start out low with thyroid hormone replacement, and increase as needed/tolerated.