Blood tests

[astunally]

Hello All, was just wondering if I need to be fasting to take my blood tests, I need to do them now , doctor wants me to do TSH to see if I need to increase my meds. I think I saw somewhere that you don't need to be fasting, I do know you say I have to take T$ and T3 blood test as well, which I will take also .
Thank you for your great support .
Sandra

[astunally]

Hello again Barb,
how will I know if I have Pernicious Anemia? I will do like you said and take supplements for a few weeks and retest. Is there a test to see if I have PA or not. I have been reading about it and its very important I guess. I suppose it all depends on symptoms on what tests should be done to see if anything else might be wrong or if there is any other illness. Thanks again for your advise.
Sandra

[astunally]

Yes I've had an ultra sound done about 2 months ago on my thyroid but the doctor just said I had thyroidtitis .
Thank s for the info on the creams , I will try and find them here .
Sandra

[Barb135]

While Hashimoto's is, typically, associated with hypo, it can be characterized by periods of hyper in the early stages. You may have nodules that are secreting hormones, independently of the thyroid, which, combined with thyroid medication can cause you to go hyper; not to mention that your thyroid hormone med dosage could be too high.

Have you had a thyroid ultra sound to determine whether or not you have nodules on your thyroid? If not, you should.

There are hypoallergenic moisturizing creams/lotions on the market; have you tried any? Some are more expensive, but if they work, it's worth it. Do you put moisturizers on your chest/legs?  Those seem to be the same places I have the most trouble with....... some products containing oatmeal (body wash or lotion) seem to work best for me.

[astunally]

I have always been a bit sensitive to any kind of moisturizing creams and am now as well, my chest and legs itch the most.
But if I have Hashimotos, how can I be hyper? I'm a bit confused as at first the doctor said I was in between the 2 and then last month that I was definatly Hypo, now after a month I'm Hyper. Is this normal until I get my meds at the right dose?

[Barb135]

50 ug is the same as 50 mcg (micrograms), which is the typical way to measure levo.

Feelings of heart issues, such as flutters, palpitations, etc are a very common symptom with hyperthyroidism, though they can also be associated with hypo.  Based on your lab results, I'd think they are hyper not hypo.

How does your skin react to moisturizing lotions?  

[astunally]

I'm taking levothyrox 50 ug ( not sure about the sign before the g it looks like a u) . I will look into B12 vitamine as well. My heart seems a bit funny these days to , like i get what I feel as a flutter , not fast though and dry itchy skin.

[Barb135]

Are you taking 50 mg or 50 mcg of levo/day?  

Yes, you need to see a doctor soon, so you can get a different dosage.  You might talk to him/her about alternating 25 mcg and 50 mcg to get 32.5...

No amount of thyroid med will increase B12 levels.  You need B12 for that.

[astunally]

ok, a month ago my FT4 was very low and now in this short time is too high, I'm on 50mg a day , and still haven't seen a doctor here yet, hope to soon. I didnt supplement as my doctor said that the meds I am taking will put everything right , well I know thats not right. Not sure what to do next until I see the doctor. Thank you for taking to time to help me , much appreciated
Sandra

[Barb135]

Your FT3 and FT4 are too high.  You should cut back on your med, not increase. Some symptoms can be associated with either hyper and hypo, such as all of the symptoms you listed above.

Rule of thumb for FT4 is mid range; most people feel best with FT3 mid to upper third of its range. Your FT3 is actually over range.

Your B12 is way too low....  are you supplementing that, at all?  You should try taking an oral supplement for a few weeks, then retest to see if your levels are coming up; some people don't absorb B12 (Pernicious Anemia), and have to inject to bypass the stomach ...... I have to inject weekly in order to keep my levels high enough.

[astunally]

I have the usual symptoms for hypo, but these days am getting hot flashes as well. very bad memory, can't concentrate for very long, dizzy at times, nausea, tiredness doesn't seem to be much of a problem, just get tired when I am short of breath , I have asthma which has got worst lately.

[gimel]

Even more important than lab test results is how you are feeling.  What, if any, symptoms do you have?  

[astunally]

Here are my blood tests, leadless to say am more confused then before ,
FT4   1.5  ng/dl          range 0.82 - 1.63
FT3    3.92  pg/ml      range 2.1 - 3.8
Results obtained by automated quantitative test ELFA technique by VIDAS instruments.

TSH ELECSYS              0.35 mlU/ML        range 0.27 - 4.2 mlU/ML

Vitamine B12     73  pg/ml      range 100 - 700

If you can amke any sense of the results I would be very grateful .

Sandra

[astunally]

Ok. I have redone my tests and found another lab near me which seems to know what I'm talking about , I'm happy to say , so I made sure it will be Free T3 and 4 plus cbc and B12 , as I have anemia I thought I might as well do them all.  I suppose in a way I'm lucky here as if I pay I can get the blood test I want. You can even ask for antibiotics over the counter here , not good really , one day hopefully it will improve. There are some very good doctors here but like I said before all depends on whose doing the results, if they have read them proper or not.
Will let you know tomorrow the results. Also forgot to say, the nurse also recommended a doctor who her mother goes to, so I will check him out :)
Sandra

[Barb135]

Ahhh, now I understand better about why it's hard to get the tests.  Yes, you have to specify that you want FREE T3 and FREE T4, otherwise you will get the totals.

I wish we could just go and get whatever tests we want; we can only get them, if our doctors think they are necessary and many doctors refuse to order the proper tests.

I do hope you can get the FT3 and FT4..... when you go to the lab, you might want to use the term "free" for each, rather than FT, in order to make sure they understand what you want.

Yes, it's best to keep the same medication/manufacturer, but sometimes we don't do well with med from a particular manufacturer, so we try another.  I recently ran into this when my pharmacy filled my script with drugs from a different manufacturer than I normally get...... I did horrible and had to call the pharmacy to make sure they gave me the right med.

What brands/types of thyroid med are available to you?  Do you have desiccated hormones, or T3 available, if you need it, later on?

[astunally]

I live in Tripoli, and health care is not too good at the moment after the revolution , I went to Tunisia as I was so unwell and got the blood tests done there. This is where they found I had Hashimoto's .Like I said before my doctor there has only asked for TSH blood test after precribing me with 50mg levo .
Here I can go and ask for what ever blood test I need as I pay for them but the problem is not all places are good and I now relise I will have to ask for FT3 and FT4 . Tomorrow I will ask if they have the blood tests avalible, I'm hope they do . Also , is it important to keep to the same brand of medicine?
Will let you know what happens . and thank you again .

[Barb135]

You posted an FT4 result, from before when your TSH was 46.24, so they must, at least, do that one.  Do you go to the same lab each time?  Does your doctor have to write an order for the tests, or do simply ask for what you want?

If you are having hypo symptoms, I think your T3 and T4 levels are low enough to warrant a small increase.  You should talk to your doctor about that. You might ask about alternating 50 mcg with 75 mcg for an average of 62.5 mcg/day.

Keep looking for a good thyroid doctor.  Try to learn as much as you can, so you can ask your doctor for the things you need, as many doctors only go by standard protocol, which is not good for all of us.

[astunally]

Ok , then I will ask again for a free T3 and T4 blood test again, that is if they do them , not sure what to do, I thought I had found a doctor but am still looking for a good one here. Do you think my medication should be increased or should I wait until I do the test again? It would be very impractical and expensive for me to go to Tunisa every time I need a blood test. Will check again tomorrow and let you know, thanks for the advise , I'm very grateful to you .

[Barb135]

Unfortunately, your T4 and T3 are total, not free, so they really tell us very little.  

Of the T4 and T3 in your blood, some of each is attached to proteins, which cause them to be unusable.  The "free" amounts are what are actually available for conversion (FT4) or actual use by the individual cells (FT3).  When you test total, you get both protein bound and unbound amounts.  We're interested in the unbound amounts.

Even at that, while your levels are "in range", they are still quite low. Your T4 is only at 22% of the range, with T3 at only 55% of its range.  Of those totals, we don't know how much of them are "free".....

Rule of thumb is that FT4 should be around mid range and FT3 should be mid range to upper third of its range. And that's FT4 and FT3, not total.

[astunally]

These were my last test results , all a bit confusing to me I'm afraid .

FT4       5.12 pmol/L            range 9-20
          3.98 pg/ml

TSH    46.24uUI/mL            range 0.25-5

[astunally]

Hi, here are my results, but ,
"just a bit hard here finding a place that will get proper results." I meant that here the person who takes my blood test might not be qualified to do it, very bad health care and a lot of wrong test results :(  .
Any way this is the results I recieved today ,

T3 (total) ELECSYS       2.29  nmol/l         range 1.3 - 3.1
T4 (total) ELECSYS       91.34 nmol/ml       range 66 - 181
TSH ELECSYS              0.35 mlU/ML        range 0.27 - 4.2 mlU/ML

From what I can see they look to be in normal range, I need also to do CBS for blood.
Sandra

[Barb135]

Will look forward to seeing them.

[astunally]

Yes , I just got my tests done , results tomorrow , will post them then
Sandra

[Barb135]

"just a bit hard here finding a place that will get proper results."  Can you get the FT3 and FT4 tests done?

[astunally]

Thank you once again, I am only on the levo 50mg at present and will ask for the other tests to be done as well ,just a bit hard here finding a place that will get proper results. Anyway I really appreciate your advice. Will let you know what the results are when I get them .
Sandra