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What else should I test after total thyroidectomy?
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What else should I test after total thyroidectomy?

I had a total thyroidectomy in Feb 2013 for suspicion of papillary carcinoma.  The biopsy came back benign.  I also had a stroke in 2011.  Small, right frontal lobe stroke due to a PFO in my heart.

I feel awful still.  I am on 112mcg of levothyroxine.  My latest TSH was 0.40, which my doctor considered normal enough.  My calcium has been borderline low, and my Vitamin D was low also.  

What other blood tests should I run (I work in a lab) to find out what is going on?  I am tired all of the time, no energy, I still have tingling in my hands at times (calcium low).  

I have no insurance, so I can't afford to go see a endocrinologist right now.  HELP!
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1756321_tn?1377771734
Calcium serum is not accurate. I know this well from suffering deficiency symptoms with calcium serum in normal range. My ionized calcium showed calcium deficiency. The slam dunk test for me is the chvostek sign. When that sign goes away I not longer suffer calcium deficiency.  

You can check out the chvostek sign demo on youtube. Vitamin D is needed to absorb calcium just to add. You might find you feel better when both calcium and vitamin D are in good supply.

You might also feel better adding T3 to your T4 medication. Some people prefer natural desiccated thyroid extract over synthetic hormones. Other labs to consider is a full iron panel, vitamin B12, folate.
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Avatar_f_tn
Iron panel is fine, B12/folate was in normal range.  I've always had the ionized calcium done.  I can usually tell when my calcium is low, I have hand cramps, or my jaw muscles will cramp when chewing.  

I will have my T3 free and T4 free results back tomorrow.  
Thanks for the chvostek sign tip...it's good to know I'm not crazy and I know what I'm talking about even when my calcium levels are normal!
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1756321_tn?1377771734
What are your iron, B12, and folate results?
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Avatar_f_tn
Can't find the iron results.
B12 was 481,
hemoglobin was 12.6,
Vit D was 26 (normal 30-100) D3 26, D2 <4
Ionized calcium was 1.14 (1.12 - 1.32)

The last time I tested my free T4, it was high (1.7) and my T3 free was normal.  

We can't seem to get my TSH stabilized.

I've gained 30 lbs since my surgery. I've been hyper the whole time but I don't have the symptoms of it.

GAAAHH!!!
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1756321_tn?1377771734
I couldn't lose weight being hyperthyroid. Not only did I have severe insulin resistance to start with but overmedicating on thyroxine caused impaired glucose intolerance (aka pre diabetes).  

Vitamin B12 is considered deficient in Japan when level drop below under 400 pmol/L (550 pg/mL).  The average person starts to store vitamin D at 100 nmol/L (40 ng/mL) but at virtually everyone stores vitamin D at 125 nmol/L (50 ng/mL).
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Avatar_f_tn
I have insulin resistance also.  I just had my labs drawn,

FT4 - 1.1           0.7 - 1.5
FT3 - 2.3           1.7 - 3.7
A1C - 5.6          <5.7
Est. Glucose 114

Creatinine Kinase  323      20-225

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649848_tn?1357751184
Your FT4 is just about perfect at 50% of its range.  Rule of thumb is for FT4 to be mid range... can't get much better than that.

Your FT3, on the other hand is pretty dismal, even though it's in "normal" range.  Rule of thumb is for FT3 to be in the upper half to upper third of its range.  Yours is only at 30%.

Just because your TSH is low, doesn't mean you're hyper.  You're only hyper if you have hyper symptoms and you don't; you actually have hypo symptoms.  Remember, TSH is a pituitary hormone, trying to stimulate the thyroid; it neither causes nor alleviates symptoms and is affected by so many variables, it's pretty much useless.

There are quite a few parameters that can be "in range" and still not be adequate for the individual, usually, because the ranges used are way too wide.  Vitamin B12 is one of those things, as are FT3 and FT4, calcium, vitamin D and others.

The elevated Creatinine Kinase could indicate a neuromuscular disease, or it could be caused by accidentally hitting a muscle during the blood draw.  There are several different CK enzymes found in different parts of the body.  You should retest, then talk to your doctor about the elevated level.

I agree that adding a small dose of T3 med, will go a long way toward getting you feeling better, and possibly helping you to lose weight, though some of us really have to work hard at that, even with adequate thyroid hormone levels.  Insulin resistance can make it next to impossible to lose.  I, too, have insulin resistance and weight loss is very difficult.
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1756321_tn?1377771734
Both hypothyroidism and hyperthyroidism can cause high creatinine kinase levels.

Insulin is the fat storing hormone! But insulin also plays a central role in storing magnesium.  I had moderate/severe magnesium deficiency due to insulin resistance which worsened to severe after surgery (stress lowers magnesium) and vitamin D supplementation (the body uses magnesium to convert inactive vitamin D to active vitamin D).

Besides not being hyperthyroid anymore, I have cut out the sugar and refined carbs and my eyesight has improved to some degree, appetite has mildly improved, lost over 6kg so far, hip to waist ratio went from 0.96 to 0.90. A long way to go but i'm on the right track now. :)
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649848_tn?1357751184
You should also check your thyroid antibodies, to determine whether or not you have Hashimoto's Thyroiditis.  If you, your thyroid function will continue to decline as the antibodies destroy healthy thyroid tissue.

The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab). You need them both, as some people only have TPOab, some only have TGab and others have both.
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Avatar_f_tn
My doc called about the elevated ck. asked if I'd had any unusual muscle cramps or joint pain. I honestly don't know what's unusual anymore, I feel so bad so much if the time, although no one would ever guess!  I'm to stay well hydrated, no strenuous activities and retest on a week along with a cmp.

I Will have the other antibody tests ran next week.
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Avatar_n_tn
Hi!  I'm new to this forum. I wanted to write because our history is similar.  I had a large nodule on my neck that was diagnosed as papillary cancer in Aug. 2011. Previously, I hadn't felt well in years, but my TSH was always normal.  The only lab result that looked abnormal was my antibodies.  I had Hashimotos disease too. So, I had my thyroid removed Aug. 2011 and am still trying to find the right meds for me. I started on Levoxyl( then they pulled it off the market), then levoxothyroxine, then Synthroid.  All of these worked for me number- wise, but I never felt good.  I've spent a lot of time reading all of everyone's comments on different forums. The main thing I learned is that the Dr. should also be checking your T3 lab work (mine has never been checked). I recently got my Dr. to prescribe me Armour.  It has T3 and T4.  I started feeling better, calmer after 1 week. I'm at 11/2 wks. now and I hope it keeps working.  I'll have labs drawn in 1 month. I wish you luck!  I don't have an endocrinologist, I see an ENT. Maybe your primary physician will run the lab work for you. Let me know how you're doing. Thanks!
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PS When I just complained to my doctor about my continuing symptoms ( wt gain, fatigue, dry skin, moodiness,poor vision, mental fog etc), he recommended that I get tested for sleep apnea.  Hence the reason I went looking for answers online. Love these doctors.
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1756321_tn?1377771734
I meant mild and eventually a moderate magnesium deficiency with insulin resistance. No edit button. :)
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Avatar_f_tn
Those are a lot of the same symptoms I'm having!  My tsh was always normal, even with the 4cm nodule!  My doc is wushu washy and only looks at numbers. I'm in the process of trying to find a new one that doesn't cost an arm and leg!
I wish you continues luck on the armour!  I'm going to push for that after reading some other blogs about it!  I just want to be able to function!  I've went back on my Wellbutrin to deal with the depression/mood issues. (They put me on it after my stroke to help with that).
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Avatar_f_tn
Well I repeated my CK levels as well as doing a CMP.

Everything was within normal range on the CMP with the exception of:
Calcium 7.8 (8.4-10.5)
EGFR 58 (above 60)
CPK 288 (20-225)  which is down from 323

Can this be dehydration?  Caused by the low calcium?  What dosage of calcium/d3 should I be taking?

I've stopped drinking all caffeine and do feel better, not having the racing heart feeling.  I'm drinking more water...although I know probably not enough.  That is my concentration this week.  

I've also gained another 3 lbs. in the last 2 weeks.  
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