Wife's latest lab results & Dr visit

[flyingfool]

Well good news/bad news situation.

My wife had her first visit with the new Dr with the new HMO.  She had gotten blood drawn a few days before the visit.

First the good news:

The Dr actually tested her for both Hashi's antibodies and also BOTH Free T4 and Free T3.  This is the first time we've ever been able to get a Dr to test for these! :)

Also the Dr asked a lot of questions and actually spent a substantial amount of time with her.  Far more than any Dr in the past.

here are my wife's test results dated 3/7/12

TSH = 0.523
FT4 = 1.06 (0.78 - 2.9)  mid range = 1.84
FT3 = 3.26 (2.77 - 5.27) mid range = 4.02 and upper 1/3 = 4.44
TPOab = 72 High (0 - 35)
TGab=  20 (0 - 40)

She has been showing signs of needing more medicine.  Primarily more fatigued and inability to sleep well.  Not to mention almost all the other classic signs of being hypo but just gotten a bit more intense.

Further good news was that the Dr is referring her to an endo.

Bad news:
My wife asked about T3 medication and the Dr said she was "uncomfortable" prescribing T3 meds.  Dr. said she was a bit confused as she thought the labs showed if anything that she would be hyper but showed all the signs of being hypo.

My wife then asked about raising her T4 (levo) dosage she is currently taking and has been for months 125 mcg.  The Dr did re-upped her prescription for the 125 mcg and then also prescribed her 137 mcg and told my wife to alternate taking the 125 one day and then the 137 the next day at least until she sees the Endo.  That is pretty conservative med increase in my opinion with an average of ONLY 6 mcg per day bump.  But at least it is something.

Clearly my wife is finally diagnosed with Hashi's with the high TPO which is no surprise to me but it just is final confirmation.  Although my wife did not mention (we only spoke on the phone) that the Dr mentioned anything about Hashi's.

I personally don't really know why the Dr is confused.  She is only 29% of the range in FT4 and only 40.5% of FT3 range.  Rather than a target of 50% and 67% respectively.

At least maybe we have a chance with seeing an endo.  But I don't have a lot of hope that an Endo is any better than any other Dr.  But MAYBE the endo will at least consider prescribing a T3 med.

I know that TSH can be suppressed. But do you think that my wife's TSH is suppressed with only a T4 medication at only 125 mcg? I could understand at 200 or with a T3 but not sure about suppression at only 125 mcgs.

Thoughts?

[Barb135]

I'm glad to hear that your wife finally may have found a doctor that can/will send her on to better treatment.

If her doctor was "confused" by a TSH of 0.52 (not hyper), she'd be WAY out of her realm with my TSH of < 0.01 and just now resolving hypo issues......

Best of luck....

[gimel]

So glad to hear that your wife finally got the additional testing she needed, including finally the tests for thyroid antibodies.  Her TSH of .52 is not even suppressed, and it should not worry the doctor even if it were.  As thyroid meds increase, the TSH goes down of course and natural thyroid production with it.

I can give you some links that talk about TSH suppression being an expected outcome for many patients, in order to raise the total levels of Free T3 and Free T4 enough to relieve symptoms.  In fact there are studies that say that test results in general are very unreliable when already taking thyroid meds.  Note this quote from this study in the British Medical Journal.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341585/pdf/bmjcred00253-0040.pdf


"We consider that biochemical tests of thyroid function are of
little, if any, value clinically in patients receiving thyroxine
replacement. Most patients are rendered euthyroid by a daily dose
of 100 or 150 ,tg of thyroxine. Further adjustments to the dose
should be made according to the patient's clinical response. In our
laboratory 36% of all thyroid function tests are performed to
monitor thyroxine replacement. To stop doing these tests in such
patients would cause considerable saving in the costs of reagents in
laboratories using commercial kits.
Our findings emphasise the need for laboratories to make their
users aware that the reference ranges for serum thyroxine, free
thyroxine, and thyroid stimulating hormone concentrations in
patients receiving thyroxine replacement are considerably different
from the conventional ranges; they should also point out the limitations of these ranges."

So if you consider the unreliability of thyroid testing after medication, along with the flawed reference ranges, is it any wonder that the best way to treat a hypo patient is clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, rather than by test results only?

[goolarra]

Actually, your percentages are considerably off.  You wife's FT4 is only 13% of range, and her FT3 is only 20% ouf the range (both numbers rounded).  

However, the balance of FT3 to FT4 is nice...no conversion issue there that I see.

If she's still having symptoms, there's plenty of room for an increase.

"Dr. said she was a bit confused as she thought the labs showed if anything that she would be hyper but showed all the signs of being hypo."  Obviously, the doctor could not have been looking at anything but TSH when she said that...hypER?????  Good that you're getting a referral...you're obviously out of this doctors expertise and comfort range (good that she knows her limitations!).

[Red_Star]

Not sure about 125mcg lowering TSH to 0.5m/L.  TSH can be suppressed by TSI antibodies, low cortisol and if the blood test was taken later in the day and if you ate before the test.

I found this from "Modern management of thyroid replacement therapy" - Australian Prescriber:

"The dose is dependent on body weight and age. Children require larger doses of thyroxine per kg body weight than adults who require approximately 1.6 microgram/kg/day.2 Most adults will maintain euthyroidism with a dose of thyroxine of 100-200 microgram/day. There may be a decline in thyroxine requirements in the elderly."

1 kg = 2.2 pounds for you Americans. :)