Need help understanding Lab Results.... Barb135...it's the Lurker :)

[yepthatsme]

Background from my first post.

http://www.medhelp.org/posts/Thyroid-Disorders/Thyroid-Forum-Lurkerneeds-advicethoughts/show/1293989

TSH       1.24               0.450 - 4.500

FT3        4.0                 2.0 - 4.4

FT4        1.08               0.82 - 1.77

TPOab    296                0 - 34       AB's on attack ?

TSI         42                  0 - 139     So, it's not Graves...hope that's correct.

The TGab was ordered, I don't see it on the final test results.
It was on the order, DD even talk to the lab tech (she knew him) & told
him to double check all test's were listed.
Would it show on the results as another name?

Other test's listed off range....

Eos  11 High                                     0-7
Monocytes (Absolute)     1.1  High      0.1  -1.0
Eos (Absolute)               1.1  High      0.0 - 0.4

Calcium, Serum              8.4 Low       8.7- 10.2

HDL Cholesterol              36 Low        >39       (Last Lab 26)

Vit. D & B12 both tested within range.  :)


Interpretation of lab's and any advice would greatly be appreciated.

[RenKat]

Please excuse the typos.

[RenKat]

Hi, Barb135,
Goolara suggested I consult with you.  I have a slight delimma, and hope you can assist!  I have hashimotos, diagnosed 8 years ago, but 20 years hypo thyroid.  52 yo female, post menapausal, etc.  I am in FLA, and have 2 endos, both really not all that. lol.  So, here is the War & Peace version of my situation.

One, on my insurance, just complied to fill my request to try Armour (again) @ 60 mg.(under duress, of course).  However, he argued my exhaustion, 10 lb weight gain, and confusion were not thyroid related, suggesting we do a cortisol test, forgetting that we did this last year.  I might have 'passed with flying colours', but I was bed riddern for 2 days.  I didn't get a copy of the labs, until I left, and suffice to say, he seems to have totally ignored them.  They don't seem right at all.
And this adds to my reservations about starting Armour at this dose.  Goolara's insight only strengthened my hesitation, and suggested I ask if you know of any doctors, since you reside in FLA?

Anyway, below is the labs, and what I was on/am on..

Sept 2012:                                                 Oct 2012:
Levoxyl 75 mcg, 5 x wk                            Levoxyl 75 mcg 7x wk
Cytomel 10 mcg, 7x wk                            Cytomel 10 mcg, 7x wk

TSH :   .97 (0.40-4.50)                            TSH:     0.24   (0.40-4.50)
T4:      1.0  (0 .8-1.8)                                T4:         0.9     (0.8-1.8)
T3, Total  93 (76-181)                             T3,Total:   82   (76-181)
T3, Uptake 31  (22-35)                            T3, Uptake    N/A
T3, Reverse  13 (11-32)                          T3, Reverse 17 (11-32)

Out of pocket endo advized to increase the Levoxyl to 7 x weekly, adding casually I could increase the Cytomel.  If I were to do that, d I DEcrease my Levoxyl??  Good God, this freaks me out!
He also added, that whatever I was doing in June, do that.  
Well, gee, I got really sick in June/July and remember little about what I was on, but know that in August, insurance endo had dropped me to 50 mcg of Levoxyl and everything got messy from there.
The insurance endo, btw, totally dismissed the recent labs as nothing wrong that was 'thyroid related', but as I stated, did agree to the Armour switch, at 60 mg.  Goolara wrote in, with ratios and a warning, that at 10% now, in t4, I would be likely to crash.  

I live in Tampa Bay, have been to Rasulo in Brandenton who charged me to hell and back, and left me in a bad place.  If you can advize, or even, recommend someone, I would appreciate it.  I have intention to discuss with out of pocket first, and hope he can comply.  And admit, that, I am really reluctant to deal with the other, should he not.  I just saw him last week.  Please help, if you can!

[yepthatsme]

Wouldn't you just know it?

Got a call from the new endo's office this morning.
They called to cancel the appt.
New endo is starting her own practice...
Plans are so..new that even the receptionist...isn't even sure...
they take DD's insurance.

DD did ask if...she treated symptoms instead of going by
lab result's only...she does.

That light at the end of the tunnel...
Seems to be getting more distant.

Barb...I read your post in Smilerdeb's posting.
I'm sorry your feeling so overhelmed...like Deb...
your life experience is priceless. The hope...you give
to so many would be missed...if, you were to leave.

I'm hoping you decide to keep sharing that hope.

(((Hug's))) to you....

[cknight517]

I will definitely do that. It will be really hard to cut those things out but if it will make me feel better overall I will definitely do it. I will definitely be visiting my local health food store and reading up on things. I appreciate it!

[LazyMoose]

Remember, I am not a doctor. And I learned this from a holistic doc, so its nothing scientific, but its nothing new either.

You need to do this first thing in the morning before swallowing anything. For accuracy, I was told to do this at least a week. It might vary depending on what you ate for dinner. But if you fail more than pass and seem to have some digestive issues, you could possibly benefit from eliminating a few things for as long as it takes to pass the test regularly. For me it was around 4 months.

There is good info on the web, even handouts in heath food stores. Eating whole foods for this time is best, cut out sugar, carbs and gluten containing foods. No soda pop, cookies ect. Take probiotics (at the drug store) to replace the bad bacteria with good.

[cknight517]

I took the Candida test and I failed. Where do I go from here? What do I cut out and what can I have? I really appreciate your knowledge because when I look it up online, different sites say different things.

[yepthatsme]

Yes, "blending" the Armour & EFRA would be the best. DD is "hyper" now, can't hardly slow herself to a slow run. Mood swing's too...so, throwing her right into EFRA would more than likely send her to the moon.
Would you say..to start by adding 1/4 of the EFRA...while, taking 1/4 of the Armour out...for say...a week at a time?
Or, even slower...with her presenting with hyper symptoms?

I'm totally amazed at the google Candida test.
So easy, and able to test at home.
Just reading and thinking....DD is "not" going to pass!

I'll send her up tonight with a clear glass of water.

"Sugar"... is formost in my mind right now....WOW.
That's not going to be something...she will want to "digest".  
That's a oxymoron for sure!

Thanks, for your advice & suggestion's.

That's my DD in the above post.
I'm sure she will be reading your post....soon. :0

[LazyMoose]

Yes ERFA splits well with a splitter, you can even break it in half - no crumbling.  I am not at full dose yet even after 2.5 months, I need to increase really slow. So that said, I can only say its close to old Armour, maybe a little stronger than new Armour. Its best to start a little hypo than get hyper from a new med at full dose. If you 'blended' the Armour with ERFA for a few weeks, thats easier on the body!

The Candida thing surprised me. There is other bacterial overgrowth (we all have some), it can be other types, I am really using Candida as a general term. Goggle Candida saliva in water test, or candida glass of water test. A home test to do 1st thing as you wake up. I had other people I know do this test, (they laughed) but they passed it, I failed every time, I had it.

When I fixed this by avoiding what it feeds on for 3-4 months, and taking a lot of probiotics, my digestive issues got way better, but did nothing for hyothyroid, some claim it does. But some symptoms can be similar.

[cknight517]

I just wanted to post and thank you both for helping and caring enough to share what you know. You both are going through alot yourselves and it touches my heart that you reach out to others. It's hard being so young dealing with so much but with great ppl with big hearts like yours it lifts the weight alittle to see it.

And to yepthatsme.. you are a very special woman and i am very proud to have you as my mother. I love you more everyday! :)

[Barb135]

You're doing just fine.

Looks like you have the list of  questions down pat.  Have you copied them on a sheet of paper to take with you; don't rely on memory, because if you are anything like me and a lot of others, things just fly right out of the top the head as soon as you get in with the doctor!!!  

Actually it would be nice if you could get the answers to those questions PRIOR to the appt, as that might save a trip, if she doesn't agree to some of the items.  

I'm not on the ERFA (or Armour), so unfortunately, I can't answer your questions about the dosing.  LazyMoose is on it, I'm sure he will chime in as soon as he reads this.

Cutting back on the "white's" is an excellent idea, in fact that's a healthy policy for all of us.  G/F certainly has its place, may not be for everyone or maybe a period away from it would allow things to settle and she might be able to introduce it again very slowly at some point.  That' would be something to discuss with the doctor.

I agree that the candida could be an issue.  LazyMoose can answer better than I can, but I would say sugar is one thing that should be cut, since most yeasts (which candida is) feed on sugar (lactose is also a sugar from milk).  Not to mention the need to stay away from it for blood sugar purposes.  It doesn't hold true for everyone, but PCOS and insulin resistance can sometimes be seen together (they both also cause weight gain/prevent loss).  Have you tried a natural sweetener (not artificial, but "natural"), such as stevia or agave nectar?  They satisfy the "sweet tooth", but don't mess with other things.  But again, they might not be feasible for everyone.

Same with the vitamins and minerals.  I take some that only cause  my doctor(s) to roll their eyes and ask "why", so that also is one to take up with the doctor.  Just be mindful that some vitamins/minerals can be toxic if too much is taken.

I do hope you have a large block of time scheduled for the doctor; this could take a long time!!   LOL

It took me a while after being diagnosed to realize that treatments for thyroid issues can vary so much from one to another.  What works for me, may not work for your daughter; however, (and I can only speak for myself here) if I've been able to lend a bit of support to help you feel more comfortable and/or pass along some ideas to help you and your daughter cope easier, I will be thrilled.

At any rate --- I cheer you on and will wait anxiously to hear how the visit goes.

[yepthatsme]

LazyMoose...Yes, I talked to DD again about EFRA...
I think, it's the best decision too. She has agreed. I'm hoping the switch, isn't too
complicated.
Just in case the new endo...doesn't work out, & will have to use the GP.
Would her dose be the same (60 mg Armour)...after the ab attack?
I know the mg is the same between the two.
Do you find, that the pill's split easy?


DD has tried the gluten diet....week's prior to lab testing.
She went milk free to lactose free last year. It did help with her stomach issue's.
We have cut way back on the "white's".
Sugar is the hardest for her...but, she's staying very moderate with intake.
Not total gluten free...

Candida...yes, I do need to do research here.
She actually scratches her tongue with her teeth. ???
That make's sense why, she does this...now.
Doesn't have the white coating on the tongue...but, does have spot's on the side of her tongue.

Vit. & Supplements...Take's enough to choke a horse. :::Eeek:::
We had a consult with a compounding pharmacist awhile back...she is also having issue's with PCOS. At the time vit.'s/supplements were reviewed.
After reading here...I think, we need to go back over the list.
I don't feel she get's enough of example...her selenium.

Barb135...

Your right!
I shouldn't "assume" anything. Can't even begin to tell you...how many time's...
I've gone.. no where with that,

This morning I googled the new endo.
She has been in practice for 5 years. Graduated from Harvard, residency with John Hopkin's. This will be the youngest doctor that we have seen. So hopefully, she isn't set in stone.
I'm not buying anything..no book's, supplements...nothing. :)

I found the "Interview for Endo's" here at MedHelp.

Quote...

Question #1 - Which tests does the doctor routinely order and use to treat his thyroid patients and adjust meds?

If they say "TSH only", run. don't walk away!  If they say TSH and FT4, you can walk this time.  If they say FT3, FT4 and TSH, they've passed question #1.

Question #2 - Which meds is the doctor open to using...T4-only, synthetic T3/T4 combos, dessicated?  

I believe they should be open to all three.  This will weed out doctors who only treat using one or two of the three.  Some of us only function well on one of the three, so we don't want our options limited.

Question #3 - Does the doctor have first-hand experience treating thyroid in somone with LBBB (and any other health issues that you think might conflict with thyroid treatment)?

Question #4 - Does the doctor recommend therapy and expect the patient to follow it or does he work with the patient, sharing all test results and informing her of all options so that doctor and patient can come to a mutually agreed upon treatment plan?


NOW...if...she get's past all that...

She will have to show alliance by faxing off the prescription for Thyroid to EFRA. ::wink::


Just want the both of you to know...how much I appreciate your thought's and advice.
You both are volunteer's with your own health issue's, with families to care & support.
Hope you both recieve 10 fold back...what you give daily.

I lost my prior post... :::who know's::: it's floating???
If, this happens to show up in different format....you'll know....I hit something...
I shouldn't have. :::roll-eye's:::

Sorry. I'll get the hang of this...sooner or later.

[Barb135]

Do not "assume" anything about the doctor you are going to see.  Yes, there will be regulations in regards to her practicing at the hospital; however, that's not going to guarantee that she doesn't have some funky ideas............ that's not to say you should not see her.  Just note that if she offers something that sounds too good to be true, it might be.  

[LazyMoose]

She might do better on ERFA. Its known the change from new Armour to ERFA is easier than from new Nature Throid to ERFA (what I did).

You need to sometimes take a step back and look at the whole body, seems like you know that. Keep reading and learning here. With all the talk about gluten, understand the difference from Celiac (the test you got) and glutin intolerance (no test avail). Learn about digestive Candida and vitamin / mineral supplements testing per hypo patients - thats a lot that you have not covered.

[yepthatsme]

LazyMoose/Barb135...When I first saw the lab's, I knew it was an ab attack.
That didn't worry me as much as the symptoms she was having.
Her symptoms went from hypo and presented with a drop in weight, rapid heart beat
(GP gave her beta blocker Metoprolol 25 mg), she was anxious, moody, hand tremor's,
going to the bathroom more often, ache's and pain's...biggest issue was not being able to sleep...(GP gave her a sleeping pill). The blocker has slowed the heart beat's, the sleeping pill and blocker together...has allowed her to sleep at night.

She's 25...does this mean she will FOREVER have to have both medication's?
We surely hope not.

I understand the AB attack's will continue to happen until, the thyroid die's...nothing to keep that from happening. I know there isn't a cure all.

My brother has had thyroid issue's all of his life. When, his thyroid died (2 year's ago)...he was on a high dose of synthroid. This past year, he write's to tell me, he's being treated for MS.
Muscle ache's pains, fatique...can't sleep & the list goes on. He see's a doctor...who tell's him...it's MS. He's 53, MS doesn't run in our family...thyroid does.
He shell's out $8000. for a MS treatment, wanting to feel better.
His GP never mentioned T3. Ever. When...I mentioned maybe, he should check with an
endo about his T3 level's...he thought I had lost my mind...because, his thyroid is "dead". That it's mute now...his job is gone at the end of the month.

Can't lead a horse to water...and make him drink...can ya?

Sorry got a bit off post...so, many thing's...so fustrated.

Anyway...after talking with DD, she want's to continue on with her Armour for now...
(since her insurance will cover).
We are looking to maybe, adjust her Armour for symptom relief.
She is currently taking 60 mg of Armour.

Her current level's are;

FT4  1.08     0.82 - 1.77    
FT3  4.0       2.0   - 4.4

Both TF4 & TF3  are in the upper range.

With having the recent AB attack...
Does that mean...with time..the FT's will settle back into range?
With no need for the beta blocker/sleeping pill?
No medicine adjustment?

I can't imagine her going back hypo...with a (beta blocker)...
AND...crawling, dragging around the floor.

Or...that her Armour might need adjustment?
In order for her heart beat, sleeping pattern's to return. (Not that her sleeping pattern's
have ever been normal).
Even with the blocker...you can almost see her sitting on the edge of her seat...wanting
to run..run..run. You also see the tired...from all of it.

Is there somewhere...I can read about medicine adjustment's?
Wait and see???

With the new endo appt. Aug. 05...I'm not wanting to go in dumbfounded, without  direction. What's new...eh?

Barb I felt the whoa...concerning the holistic endo. She's in a small town hospital about
45 minute's from here. I'm assuming she is regulated by hospital regulations.
I'm not expecting a cure...just some if any, relief of symptom's.

We went through the book and diet concern's with our "Top Thyroid Doctor". The one who didn't know jack squat. Yea, if she had just gotten up off her lazy bum...and following his suggestion's in HIS book...she would be free from all symptoms today.(Roll Eye's).
Guess that explain's why his office was empty the last 3 time's we tried to get her lab's.

Just wanted to tell you...I was sorry to hear about your aunt's breast cancer.
She's blessed to have you looking out for her. With your 10 hour days...you must be
totally exausted. Not only that....but, your dealing with your own health issue's as well.
While sending my prayers up...I'll be including the both of you.
Your dealing with so much...now, here I am...asking for more. :(

LazyMoose...I thank-you ...for your time and response.
It's good to hear the Erfa...is good for you!
Really wanted my DD to take that route...but, it's her decision.
She saw the allergist last week...no allergies.
Her gluten came back negative. So.....
We'll see....time, tell's all.
Best of wishes.

Any extra thought's...link's...advice...is always...welcomed.

[Barb135]

Sorry, I just went back and saw the TSI -- you are right; no Graves.

[Barb135]

You said your daughter was first dx'd with Graves, then it was changed to Hashi"s.  Why was she dx'd with Graves?  I don't see a TSI, which is the antibody test that would confirm Graves.

LazyMoose is right - once the antibodies are there, they will be there for life; they may go up or down, but they won't go away.  It takes a lot of patience to manage Hashi's, please keep that in mind at all times, no matter how badly you want for daughter to get "well".

You said you are seeing a holistic endo on Aug 5.  I wish you well, with that, but I would also like to caution you, in that some holistic doctors offer a "cure" for Hashi's and please know that there is not one.

[LazyMoose]

Lots of info. First of all, don't get bent by looking at Antibody levels. They are there to stay, and might go up or down, but wont totaly go away.

The flip flopping from hypo to hyper can happen in the early stages of Hashimoto quit frequently in some people. But to really know you need to compare labs with symptoms. Severely hypo can actually feel hyper in some as anxiety builds and insomnia takes over.

The new formulations of Armour and Nature Throid have had very strange symptoms and lab results in some people. Just because there is an abundance of 'free' thyroid levels in ones blood dose not mean cells are absorbing it - for whatever reasons is to blame ,  fillers that bind hormone,ect. Yes my TSH went to the sky on NT, along with FT3. The 'new' Armour actually worked better for me that 'new' Nature Throid. So far Erfa feels like old Armour, good.

Most of the online Canadian pharmas work similar. Doc faxes script. You fill out and fax a patient questionable and order / pay with CC online. Wait 3 weeks. Arrives at your desired address. The difference is cost and how much some Canadian pharmas will send at once.

[cknight517]

bump

[yepthatsme]

I'm new to the site...somehow, I posted to Adrenal forum.

I've been lurking for awhile, I liked how member's responsed and their
willingness to share knowledge with other's. I'm still learning...I've taken alot
in...but, not nearly enough to totally understand. What I'm looking at on lab's....
or, the dosing up or down, when...lab's are off/or symptoms arrive.

The lab result's are my DD. At the age of 16 she was dx'ed with Graves.
That was changed 2 days later to Hash.'s. No medication.
For years, she has switched between hypo & hyer symptoms. She has jeans..that
range between size 5 up to size 18. Right now she presents with hyper symptoms..it changed from hypo around the 1st of this month. Before, this switch she presented with
hypo symptoms for nearly 4 years. Year before the birth of her daughter.

In 2008 she saw her first Endo...he placed her on 25 mcg dose of Synthroid.
She did not react well to synthetic. He ordered a thyroid ultrasound...it came back with no evidence of malignancy with note of Hurthle cells and lymhocytes consistent to
Hashimoto thyroiditis. Her dose stayed the same, he really didn't seem to care how
she was feeling. Did not/would not prescribe Armor.

We switched doctor's late 2008. He was listed on "Top Thyroid Doctor's" for our state, only 30 minute's away. Thought,I had found my knight in shinning armor. :)
He did rx the Armor 60 mg. He was more about diet, & his book. When, her number's started going berzerk....he pretty much told her, she needed to FIX her diet...get up off the couch...and move.
She has a 3 year old...she's not moving? My husband is diabetic, we eat healthy...my DD & her DD live with us.
It's like he freaked...and didn't know what to do...except, to attack her for diet/exercise.
No plan...no advice. Threw his hands up...that was it.

Right now we are back to her GP, who know nada about thyroid...and will tell you so.
He's willing to work with us, that's a big plus.
Yet another endo appt. coming up Aug. 5. This endo is homeopathic. We will see how it goes.

No, the antibodies aren't a new find.
I asume that is the reason for the switch back and forth between hypo/hyer.
Another thing, I've been thinking about is the reformulation of Armor.
Do you think...that would have thrown her off?
Or, antibodies...are just that, & work independently?

I've read several of your post's too.
Wasn't it you...that had your TSH rise? Due to reformulation?

My next thought is to try Thyroid from ERFA.
If, the new endo won't do the rx...the GP would.
She is so sensitive to medication's...I'm wondering if, the new filler might
have something to do with antibodies...or, the switch?

One question on ERFA....you get the prescription from your doctor.
With Thyroid only...fax it in...pay with CC...
Do they ship right to your house? Or, does it have to go through a pharmacy?

I'm so hoping they don't cut the thyroid off from Canada.

But, from what I'm reading here...there is many who don't do well on the reformulated.
Snythroid is out of the question, for her.

Well...I've nearly wrote a novel here...I'm sorry.
I do appreciate the time you have given to post back.

One more...when, ab's attack...it's just die's down on it's own?
Anything you can do...with the constant switching back and forth?
We're looking for that even balance...that other's talk about here...with just the tweet's...
here and there.
Am I looking for something...that won't be happening?

See...I'm clueless...but, trying. :)


Thank-you LazyMoose.

[LazyMoose]

I think you meant to post this on the thyroid forum?

Anyway, that thyroid lab looks pretty good. So your on thyroid meds (no mention of it), or your body converts from T4 to T3 very well. Yes, you have antibodies, so if this is a new find , I would suspect your frees will drop in the future and TSH will rise. Often antibodies appear first with out much change on the thyroid hormone levels T3, T4.