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What tests should I ask for?
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What tests should I ask for?

Brand new to this: Bloodwork results 1/13/09: TSH 39.20, Free T4 0.9 Taking Levothyroxine 112mcg as of 1/14/09.

This is all I have to put forward for the thyroid at this time. I am going back in 2 weeks to have more bloodwork run and I want to be very specific in what I ask for, and this is where I need your help.

Dr. Lupo suggested this may be Hashimoto's (is there a specific test for this?). And with my history of breast cancer he's suggested a thyroid ultrasound. I will request that, for sure.
I've read many times in here about needing specific things to get an accurate reading of what is going on and I know that if I don't request them, it won't happen.

Please help me with this.

Here are my stats:

I'm 53 yr old breast cancer survivor currently taking tamoxifen. Father & sister are hypothyroid. Have family history of cancer, heart, diabetes and thyroid. Symptoms presenting are: muscle weakness (have gone to squat down a few times and ended up flat on my back) (have gotten down and can't get up), insomnia, dizziness, extreme muscle cramping mostly in hands (painful) and feet. I could not stretch at all because I could feel a charley horse coming in to the calf muscles. Brain fog... oh my yes to the brain fog! I thought it was chemo brain, and part of it may be! I don't know anymore. I've had my left arm do pins & needles while at work, and tingling of my face. Loss of appetite on occasion. Not thirsty! I have to force myself to drink water. Hot flashes, big time, then swing to being cold. Last set of hormone tests 3 months ago by oncologist said still perimenopausal. The hot flashes hurt and so does the cold which makes no sense to me. Unbelievable amounts of stress at work which triggers some anxiety. Other than all that, life is good :)
My doctor did not see a reason to order Free T3. Since I'm still learning this I need to know what to ask for and why I'm asking for it. I don't want to play around with this. I learned the hard way with cancer to take control of my health care. Thank you all for your consideration and help.
Tags: Thyroid, tests
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213044_tn?1236531060
Ask for thyroid antibody tests.

TPOab - thyroid Peroxidase antibodies
TGab - Thyroglobulin antibodies.

Ask for a vitamin D test.

You can get around to insisting on a Free T3 test after your thyroid levels are closer to normal. Right now it would be wasted money.

It takes six weeks for Levothyroxine to come up to full strength in your system. When you start the drug, or any time the dosage is changed, it takes six weeks to get an acurate test result. So asking for another TSH test or a Free T4 test would not tell you much four weeks after starting the drug.

Levothyroxine is a generic drug. With thyroid problems, most people prefer a brand name rather than a generic. Some people get along fine on Levothyroxine, and I do not mean to knock their success. Most people would recommend you ask for a name brand form of levothyroxine rather than the generic.

Get copies of you test results.
Welcome to the board.
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739091_tn?1300669627
Thank you, I'm printing this to take with me.

My doctor wants to re-do the labs at 4 weeks. I will talk to her about waiting 6 weeks. Thank you so much!
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213044_tn?1236531060
If she wants to retest your levels when you see her, that's ok. If she does, then it would be wise to check them again a month later.

That would put you eight weeks into the medication, and give a firm indication as to whether the dosage you are taking needs to be changed.

When your problem is first discovered (the fact that you are severly hypothyroid), it is always a guess as to how much medication is required, because it is unclear how long the problem has been brewing, or exactly what the cause is. So you may need 112mcg, or 150mcg, or 100mcg, or 50mcg. It's a guess on the doctor's part as far as the initial dose.

Checking it at four weeks will show how the numbers are trending, and if it turns out that you only need 75mcg to bring your levels into line, it might stop you from inadvertantly going hyper from too much levo. If your TSH and Free T4 are suddenly perfect, the doctor may see that as an indication that your dose is a little high.
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739091_tn?1300669627
Ok, that all makes sense. I feel like I have a plan in place now, thanks to your wonderful suggestions.

Now I just need to keep a positive attitude with myself and my doctor to get the right testing and the right treatment. I've got the time for us to get it right.

Thank you so very much :)
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Avatar_f_tn
Great postings AR-10.........
Believe me Sue...AR-10 has been my lifesaver MANY times lol.
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393685_tn?1325870933
I agree - the tests AR gave are great.

In addition to those tests I would see if you can get re evaluated on either the last test on your FSH LH panels - or take them again. Viewing over the tests with another doctor may uncover more than jsut being in a perimenopausal situation. The reason I push on this thought is your age factor - and your high TSH.

Take a look at the estrodiol - Progesterone tests closely. Know what normal numbers should be for example your estrodial counts should be within the 200 markers and Progesterone around 10-20. Sometimes viewing them individually helps unlock something too.

There is a "big" range to be normal in perimenpausal stages especially as hypothyroid as you are - and sometimes a little help there can make a world of difference.

Since AR looked at the Vit D too - throw in a Vit B with it too :) I also agree with AR on the Free T3 test at this time - BUT I would seriously consider it being ran  at your next draw. As he said - getting that is sometimes challenging - but for many is worth it.

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739091_tn?1300669627
I'll call my oncologist tomorrow and ask for those test results. They will do them again I think in March. One of the hematology oncology group is determined to get me off tamoxifen and he swears I'm postmenopausal even though the tests say otherwise. I don't mind coming off of it but if they put me on the wrong medication and I'm still producing estrogen it will give me breast cancer again, somewhere else. I was ER & PR positive 90% and HER2 negative so I've got a hormone fed cancer.

Thank you so much for your input as well. I'm growing my list here! :)

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739091_tn?1300669627
Finally... a few answers. I'm swinging into Hyper mode now. I'd like to hear what you think of these test results because I really have no idea what they mean.

TSH went from 39.20 to 0.26    she changed dose from 112 mcg to 100 mcg yesterday

Thyroglobulin Antibodies came in high at 93  units IU/ML   Range <20

Vitamin B12 411 in the lower spectrum of the range 200-1100

G TPO Thyroid peroxidase antibodies (nothing listed under results) units<10,
Flags IU/ML, range <35   Why would there be no results? Any ideas?

Free T4G               Result 1.5    Units NG/DL Range 0.8-1.8  (had been 0.9)

Iron    68    range 40-160

Calcium              9.2    range 8.8 - 10.2  (same as last time)
Potassium          4.3    range 3.5 - 5.3  (down from 5.2)
Triglycerides a bit high but cholesterol was wonderful!
on my CBC   everything within range exept for one:

Absolute Eosiophils    536   cells/ul     range 15 - 500

I have no idea why I have no Vitamin D results. That had to have been an oversight on the prescription order. I will get that done too. And on Monday, I go to my oncologist and will have hormone tests run again to determine if I am menopausal, YET.

Ok.. what do you think of those levels?
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739091_tn?1300669627
I hope you are here today. I'm wondering what you think of these results!
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