Bloodwork and clueless

[alfonsina]

I had my boodwork results today during my doctor's visit.
I have been taking Nature thorid for about three months, however, I started on a very small dose due to some reations to the medicines.
I started with 8 mcg a day and increasing doses every three weeks. For the last three weeks I have been taking 1/2 of grain (32 mcg).

My TSH is 1.2 Three months ago it was 2.0
My  FT4 is in the low range. Three months ago it was the same
My FT3 is low. Three moths ago it was low too, same numbers(sorry I forgot to request a copy)

My doctor said to keep increasing the doses because to be honest I do not feel any better.
As far as I understand the only thing that is moving with the medicine is my TSH which was not so bad in the beginning.
So if my TSH continues to drop with the medicine and reaches the lowest point what is going to happen to my T3 and T4? why aren't they going up with the medicine?
If my TS H continues to drop I am going to have to stop the medicine and probably my T3 and T4 are not going to reach the high limit where I think I would feel much better. Is that right?
My doctor could not explain why my free Ts haven't moved. Nature throid has t3/t4 so shouldn't I have better numbers after three months?
I tested negative for antibodies.
I feel the same, no changes in my BBT  and pulse. Not to mention the difficulties to get Nature Throid.

Thank you

[goolarra]

You do have plenty of "room".

I have a congenital heart defect that causes me to have frequent tachycardia.  It was totally under control without heart meds until I started levo.  In addition, my PCP started me on way too high a dose.  My tachycardia went wild.  I had to back way down to 25 mcg and had to start taking meds to control the tachy.  Every increase was a struggle for me, and I had to do it in baby steps.  Believe me, I know about increases not being fun!

I actually started to feel better almost immediately after getting on levo.  It might have been because of the high dose the PCP put me on.  The poroblem for me was that I felt fine, but the doctor kept saying I needed to take more.  I finally got to the point where I couldn't agree with her any more and found an endo, who I really like.

All you can do is take it one day at a time and have patience, patience, patience.  Many of us are extremely sensitive to thyroid meds and just have to move at a snail's pace and let our bodies become accustomed to the hormones.

It's good that the symptoms you experience right after an increase go away after a while.  I had to decrease several times, and my symptoms still didn't go away.  Ver discouraging...

[alfonsina]

My doctor agreed to the increase."We still have room," he said.
I have been now, for a week, at 40 mcg naturethorid (he suggested to add cytomel again, because of  my T3, but I have had reactions to it and also naturethroid already has T3, so I said no).
I am planning to have another increase and get at 48mcg (3/4 of a grain)and see how I am feeling.
I can not have higher increases because I can not tolerate it.
I have been increasing my meds for about three months now, little by little, every two or three weeks, and I can tell it has not been any fun.
I got reactions anyway (terrible itching in mouth, runny nose, congestion, sneezing, chest pressure and some hives), but I hang in there until they start to minimize (till the next increase). Sometimes I wonder if I am allergic to thyroid medicine at all.
I take my pulse every day (always between 55 and 65 per minute) and my BBT almost  every morning. I will have  another boodwork by the end of November.
I was wondering how other people have been tolerating their increases, if it's been as hard as it has been for me and if they started to feel better before reaching a stable dose. I still do not know what is my right dose, but after I had to quit the first time and start all over again due to reactions, I am just taking it a day at a time.

[goolarra]

As I said, the percentage of Hashi patients who only have elevated TGab is relatively small, but if you want to cover all the bases, you should have it done to confirm.

Hashi's is treated exactly the same as hypo caused by any other reason.

Before starting meds, your FT3 and FT4 were clearly hypo.  Your TSH was and continues to look good, but it is the least important of the thyroid tests.

My FT3 and FT4 were quite stubborn for a long time and refused to move up even though I was increasing meds regulasrly.  It wasn't until I got close to the dose that I am on now (and have been on since January) that things started to move up even a little bit.  

If I were you, I think I'd try increasing your dose.  I'd also be sure to have labwork 4-5 weeks after each increase to see where the increase has gotten you and how your symptoms have responded.  Have you tolerated the increases well so far?

[alfonsina]

I am going to request a TGab test.
I am just thinking if people with diagnosed hashi's are also treated with only thyroid medicine or they have to follow a different regimen?


Before starting the medicine my labs were:

TSH 1.48 (0.34-5.60)
FT4: 0.64 (0.58-1.64)
FT 3: 2.3 (2.5-3.9)

My last lab (a week ago) showed no significant difference in my FT4 and FT3 (they did not move actually).
My TSH is now 1.2

[goolarra]

It couldn't hurt to have TGab tested.  I might not run out and get it tomorrow, but it certainly wouldn't hurt to include it in your next regularly scheduled labs.

Do you have actual results of FT3 and FT4?  If they are very low in the range, then you could definitely try increasing your meds to nudge your FT3 and FT4 up in the range a bit to see if that alleviates symptoms.  

Can you post your FT3, FT4 and TSH history?  I'd like to see the actual numbers.  

[TamraW]

Rarely, a person will not have elevated antibodies and still have Hashi. A good endo can make this determination with a thyroid ultrasound and examining patient history and other labs.

:) Tamra

[TamraW]

You either need to have elevated TGab or TPOab in order to have Hashi's. The doc only did half of the Hashi testing.

Request the TGAb.

:) Tamra

[alfonsina]

Do you think that I should be tested for TG antibodies as well?

I correlated the increase of symptoms to general anesthesia because it was pretty obvious to me that something had changed in my body after the procedure.
After researching for a while and noticing that my thyroid was not working properly due to my symptoms I found an information sheet about hypothyroidism where it says that "a patient may need special attention if in addition to suffering from thyroid problems he or she is
1.- Older or has a weak heart
2.- Pregnant
3.- Having surgery.A person should have enough T4 in his or her system before surgery to undergo the anesthesia and have a satisfactory recovery. If an individual is unable to take medicine by mouth, T4 can be given intravenously after surgery".

That sounded more reasonable to me than all the explanations about post stress surgery that doctors gave me, mainly because at some point stress has to go away and you, sooner or later, start to feel yourself again (whatever your state was before surgery). But that was not my case.

[goolarra]

Some of us with Hashi's have elevated TPO antibodies, some have TG antibodies, and some have both.  While the percentage of people with only TG is small (@ 5%), if you've only tested TPO, it's not absolutely definitive that you don"t have Hashi's.

Your FT3 and FT4 have stayed about the same (do you have the actual numbers and their reference ranges?) while your TSH  has gone down.  This indicates to me that the added hormones you are taking has lowered your TSH so that your thyroid is producing less to make up for the hormones you are taking.  Some of us are comfortable in the lower end of the FT3 and FT4 range (I am), and your TSH would indicate that your pituitary is comfortable in the lower end of these ranges also.  Furthermore, your "trial dose" of thyroid replacement hormones hasn't done you much good in terms of relieving symptoms.

It's interesting that you can correlate the increase of symptoms to general anesthesia.  Do you know what the anesthetic was, and have you researched its effects?  Just brainstorming here...

[alfonsina]

I was looking at my results and what I found was :
tested for:

TPO, ATA, TOXO IGM, ANA, ANTI -DNA
all of them either negative or in range
I did not see any  with the name of TGab

Although my  doctor said he would test me for hashi's.

My symptoms got way worse some years ago when I had surgery (not thyroid related) under general anesthesia.
I never understood what had happened. Doctors all told me it was due to stress. But I never recoverd so I was never convinced this was the reason.

[goolarra]

So, you're looking at something like twenty years worth of symptoms (approximately), but you tested negative for antibodies.  Do you know if they tested both TPOab and TGab?  The reason I ask is that if you test positive for antibodies (i.e. you have Hashi's), the antibodies can take decades to destroy enough thyroid function for you to have serious hypo symptoms.

Have your symptoms gotten worse over the years?

[alfonsina]

I am in my mid-thirties.

[goolarra]

How old are you now?

[alfonsina]

Thank you very much for your responses they are very helpful.

My doctor did not determine the cause of my hypo condition, but I told him I started to have symptoms  when my puberty started.

I feel very hypo still. I continue losing hair, hair does not grow long and it is very, very dry and coarse. My skin is dry  ( I have dandruff on my cheeks) and itchy, I have constant sinus infections, white stones, dry eyes, anxiety/depression, irrregular and painful periods, joint pain, I have to take a nap even when I do not want to, adult acne, insomnia, curvy (like a spoon) nails (they do not grow because they break easily) and I am cold all the time above all my feet and hands.
There have been some days where I feel a bit better and I think the medicine is finally working, but then the next day I feel bad again. Plus I tried to increase my dose two days ago and I got all these allergy like reactions. Gonna try again tomorrow.

Do you think my FT3 and FT4 will go up eventually?

Thanks again

[goolarra]

I agree with gimel.

Do you still have hypo symptoms?  If so, can you describe them more specifically?

I think one of the reasons your FT3 and FT4 have not gone up significantly is that you have been on a very low dose.  You've only just gotten up to 1/2 grain, and that's only been for a few weeks.  Also, if your thyroid is failing, you could be losing more thyroid function all the time, in which case you're chasing a moving target.  The less hormone your thyroid produces, the more replacement you need.

You might feel better at the high limit of the range, but not necessarily.  We all have a portion of the range in which we feel good, but that can be anywhere in the range (and in rare cases outside of it).  I'm one of the people who is quite comfortable in the lower end of the range.  If I got to the upper limit, I'd be raging hyper!

[gimel]

TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn.  TSH is inadequate as a diagnostic for thyroid problems.  At best it is an indicator, to be considered along with the more important indicators ,  which are symptoms and the levels of the actual, biologically active thyroid hormones, which are FT3 and FT4.  
In my opinion, the very best way to treat a thyroid patient is to test and adjust the levels of the active thyroid hormones, FT3 and FT4, with whatever meds are required to alleviate symptoms.  Symptoms are what you are trying to treat, not test results.

Frequently, treating symptoms will result in the TSH level being suppressed to the low end of its range and below, resulting in the doctor telling you that you are now hyper and you need to reduce meds.  You are really not hyper unless you have hyper symptoms, so don't accept that.  Just keep insisting that you want your symptoms treated by slowly increasing your meds and raising the FT3 and FT4 levels until symptoms are alleviated.  For info, My TSH has been less than .05 for well over 20 years, in order to get my thyroid hormone levels into the upper part of their ranges and alleviate symptoms.

Did your doctor determine the basic cause for your hypo condition?