Aa
Dr reluctant to medicate
Sent by Katharineparr 42 minutes
Hi I have had hypothyroid symptoms for 3 yrs with varying low t3 and t4 levels plus positive ANA at 1.40 (testing for lupus).
My dr says my levels are not serious to warrant meds. If I post my exact results, could someone advise pls? Many thanks in advance.
Hi I have had hypothyroid symptoms for 3 yrs with varying low t3 and t4 levels plus positive ANA at 1.40 (testing for lupus).
My dr says my levels are not serious to warrant meds. If I post my exact results, could someone advise pls? Many thanks in advance.
Yes, please post and include reference ranges as they vary lab to lab.
Please list your symptoms.
Please list your symptoms.
Hello again, strangely, I posted my levels but I dont see the post, i'll try again now.
Oct 2009
FT4 0.80 (0.78-2.19)
Tsh 1.29 (0.465-4.68)
Jan 2010
FT3 1.95 (2.77--5.27)
FT4 0.97 (0.78-2.19)
TSH 1.06 (0.47
Oct 2009
FT4 0.80 (0.78-2.19)
Tsh 1.29 (0.465-4.68)
Jan 2010
FT3 1.95 (2.77--5.27)
FT4 0.97 (0.78-2.19)
TSH 1.06 (0.47
Sorry I hadn't finished, to continue:
TSH 1.06 (0.47--4.68)
April 2013
TSH 1.84 (0.40-5.00)
Total T3 94 (60-181)
May 2013
T4 5.42 (5.53-11.0) flagged Low
Ft3 2.89 (2.77-5.27)
TSH 1.350 (0.465-4.680)
Ft4 (0.83 (0.78-2.19)
Triglycerides, globulin, vitamin d, plasma urea nitrogen all flagged low.
ANA Positive at 1.40 with speckled pattern.
Anti Ro and Anti La at very low end of normal.
Aches and pains
Headaches
Slow metabolism
Fatigue
Low blood pressure
97.8 temperature
Borderline coeliac
Weight gain
Salt/sugar crave
Feel cold/ aversion to heat
Sorry to throw so much info that may not be relevant but wanted to give the whole picture.
Any help gratefully received.
TSH 1.06 (0.47--4.68)
April 2013
TSH 1.84 (0.40-5.00)
Total T3 94 (60-181)
May 2013
T4 5.42 (5.53-11.0) flagged Low
Ft3 2.89 (2.77-5.27)
TSH 1.350 (0.465-4.680)
Ft4 (0.83 (0.78-2.19)
Triglycerides, globulin, vitamin d, plasma urea nitrogen all flagged low.
ANA Positive at 1.40 with speckled pattern.
Anti Ro and Anti La at very low end of normal.
Aches and pains
Headaches
Slow metabolism
Fatigue
Low blood pressure
97.8 temperature
Borderline coeliac
Weight gain
Salt/sugar crave
Feel cold/ aversion to heat
Sorry to throw so much info that may not be relevant but wanted to give the whole picture.
Any help gratefully received.
Malabsorption of protein causes low globulin and low urea nitrogen and malabsorption of fat causes low triglycerides. Vitamin D deficiency can due to numerous factors but includes malabsorption.
There is no such thing as borderline celiac; you either have celiac disease or you don't. The link between celiac disease and autoimmune thyroid disease is well established just to add. ANA is positive in various autoimmune diseases (listed below). The speckled pattern is the most common and least specific ANA staining pattern.
The Rheumatologist - Know Your Labs...
"Autoimmune Disease:
SLE: 95–100%
Scleroderma: 60–80%
Mixed connective tissue disease: 100%
Polymyositis/dermatomyositis: 61%
Rheumatoid arthritis: 52%
Rheumatoid vasculitis: 30–50%
Sjögren's syndrome: 40–70%
Drug-induced lupus: 100%
Discoid lupus: 15%
Pauciarticular juvenile chronic arthritis: 71%
Nonrheumatic Disease:
Hashimoto's thyroiditis: 46%
Graves' disease: 50%
Autoimmune hepatitis: 100%
Primary autoimmune cholangitis: 100%
Primary pulmonary hypertension: 40%"
There is no such thing as borderline celiac; you either have celiac disease or you don't. The link between celiac disease and autoimmune thyroid disease is well established just to add. ANA is positive in various autoimmune diseases (listed below). The speckled pattern is the most common and least specific ANA staining pattern.
The Rheumatologist - Know Your Labs...
"Autoimmune Disease:
SLE: 95–100%
Scleroderma: 60–80%
Mixed connective tissue disease: 100%
Polymyositis/dermatomyositis: 61%
Rheumatoid arthritis: 52%
Rheumatoid vasculitis: 30–50%
Sjögren's syndrome: 40–70%
Drug-induced lupus: 100%
Discoid lupus: 15%
Pauciarticular juvenile chronic arthritis: 71%
Nonrheumatic Disease:
Hashimoto's thyroiditis: 46%
Graves' disease: 50%
Autoimmune hepatitis: 100%
Primary autoimmune cholangitis: 100%
Primary pulmonary hypertension: 40%"
Hello and thank you very much for taking the time to reply.
Woukd you have any insight aas to whether I should persue the hypothyroid path with my doctor? She has prescribed a few years ago but we stopped as the synhroid exacerbated my hair loss and blood levels weren't deemed serious enough to continue to medicate.
She feels that I have convinced myself that I am hypo but levels not bad enough to medicate. My feeling is that I'd like to try armour or T3 only to see if my symptoms alleviate.
I tested neg for rheumatoid arthritis, I can give my level later today if significant.
Thanks somuch again. I was at a bit of a loss.
Woukd you have any insight aas to whether I should persue the hypothyroid path with my doctor? She has prescribed a few years ago but we stopped as the synhroid exacerbated my hair loss and blood levels weren't deemed serious enough to continue to medicate.
She feels that I have convinced myself that I am hypo but levels not bad enough to medicate. My feeling is that I'd like to try armour or T3 only to see if my symptoms alleviate.
I tested neg for rheumatoid arthritis, I can give my level later today if significant.
Thanks somuch again. I was at a bit of a loss.
COMMUNITY LEADER
Yes, I think you should pursue the hypothyroid issue with your doctor. Your levels are very low in the range and many/most of us would feel hypo, with those levels.
I suspect that your doctor is reacting to the TSH, which is "perfect"....... that doesn't mean you aren't hypo. Your symptoms consistent with hypo and symptoms are often present long before labs indicate a problem.
You should also ask to get Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab). These will tell you whether or not you have Hashimoto's Thyroiditis, which is progressive and as thyroid tissue is destroyed, your thyroid will continue to make less and less hormones.
T3 only medication is prescribed only in very special circumstances, quite rarely. If your doctor would start you on a thyroid medication, it would probably be either a T4 only med, such as synthroid, or a desiccated such as Armour, though many doctors refuse to prescribe desiccated hormones.
Hair loss is a symptom of hypo, typically not from synthroid; however, it's not unusual when first starting a thyroid medication, to have symptoms get worse, or new ones appear, as the body adjusts to the added hormones.
My daughter has lupus, too, but I also believe she's hypo, and that a lot of her symptoms would go away and she'd need less of the powerful drugs, if she were on thyroid medication.
I suspect that your doctor is reacting to the TSH, which is "perfect"....... that doesn't mean you aren't hypo. Your symptoms consistent with hypo and symptoms are often present long before labs indicate a problem.
You should also ask to get Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab). These will tell you whether or not you have Hashimoto's Thyroiditis, which is progressive and as thyroid tissue is destroyed, your thyroid will continue to make less and less hormones.
T3 only medication is prescribed only in very special circumstances, quite rarely. If your doctor would start you on a thyroid medication, it would probably be either a T4 only med, such as synthroid, or a desiccated such as Armour, though many doctors refuse to prescribe desiccated hormones.
Hair loss is a symptom of hypo, typically not from synthroid; however, it's not unusual when first starting a thyroid medication, to have symptoms get worse, or new ones appear, as the body adjusts to the added hormones.
My daughter has lupus, too, but I also believe she's hypo, and that a lot of her symptoms would go away and she'd need less of the powerful drugs, if she were on thyroid medication.
I'd definitely pursue it with my doctor.
Your FT4 is on the floor of the range and has been since 2009. Many of us find that FT4 has to be midrange before our hypo symptoms are resolved.
Your FT3 is also just barely in range and actually dipped below in 2010. Upper half of range is the rule of thumb for FT3.
You might ask your doctor to test for thyroid antibodies. TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's. This could be what's giving you the positive ANA. You have to test both TPOab and TGab as some of us with Hashi's are TPOab positive, some TGab positive and some both.
When starting meds, it's not unusual for hypo symptoms to become worse for a while until your body rebalances and you get to the correct dose. I think you'd feel better on thyroid meds. Until your FT4 is somwhere around midrange, you really can't draw any conclusions about whether you need to add T3 meds or not. I think another try with levothyroxine is another option for you.
Your FT4 is on the floor of the range and has been since 2009. Many of us find that FT4 has to be midrange before our hypo symptoms are resolved.
Your FT3 is also just barely in range and actually dipped below in 2010. Upper half of range is the rule of thumb for FT3.
You might ask your doctor to test for thyroid antibodies. TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's. This could be what's giving you the positive ANA. You have to test both TPOab and TGab as some of us with Hashi's are TPOab positive, some TGab positive and some both.
When starting meds, it's not unusual for hypo symptoms to become worse for a while until your body rebalances and you get to the correct dose. I think you'd feel better on thyroid meds. Until your FT4 is somwhere around midrange, you really can't draw any conclusions about whether you need to add T3 meds or not. I think another try with levothyroxine is another option for you.
I forgot to mention your thyroid labs. My brain. :) Your thyroid labs are seen most typically with euthyroid sickness syndrome (ESS). Malabsorption is one of the reasons for ESS.
"The usual treatment of hormone replacement therapy for hypothyroidism will not correct euthyroid sick syndrome. Instead, treatment to correct the underlying disorder is given and the problem usually corrects itself once that has been given." - Euthyroid Sick Syndrome: The Basics
"The usual treatment of hormone replacement therapy for hypothyroidism will not correct euthyroid sick syndrome. Instead, treatment to correct the underlying disorder is given and the problem usually corrects itself once that has been given." - Euthyroid Sick Syndrome: The Basics
I posted before i had finished. But good news is barb and goolarra mentioned all about Hashimoto's and trialing medication. My lazy brain is happy. :)
Malabsorption of ___________. Please fill in the blank! LOL
Isn't ESS nothing but the temporary, adaptive reaction of producing more RT3 compared to FT3 during periods of severe illness (non-thyroidal), trauma, starvation, etc? It's just our body's way of taking it down a notch until the stressor clears. Also, doesn't it occur most often with patients hospitalized for acute disorders (although chronic illness can be a factor as well)?
Isn't ESS nothing but the temporary, adaptive reaction of producing more RT3 compared to FT3 during periods of severe illness (non-thyroidal), trauma, starvation, etc? It's just our body's way of taking it down a notch until the stressor clears. Also, doesn't it occur most often with patients hospitalized for acute disorders (although chronic illness can be a factor as well)?
_______ is the answer. LOL. I'm no expert on the subject but i did find this article which is interesting...
"Sick Euthyroid Syndrome (SES): a medical condition (not disease) where the patient exhibits many symptoms of hypothyroidism – fatigue, weight gain, insomnia, dry skin, depression, anxiety, decreased memory/concentration, low libido, muscle pain, etc – and yet have normal or low/normal levels of throid stimulating hormone (TSH), T3 and T4. (Dr. Massey video on SES, click here)
SES is the result of more stress than the body can handle and the body is trying to conserve resources. The body begins to make a type of thyroid hormone (reverse T3) that shuts the body down…to hibernate.
Most physicians do not believe that SES exists outside of the intensive care unit and that it is rare in the general public. However, recent medical research has demonstrated that symptoms of sick euthyroid syndrome is often found in patients with stressful, chronic illnesses such as cancer, diabetes and heart disease….if you look for it. Dr. Massey has also diagnosed SES in patients with severe, chronic stress without other diseases. Treating SES can restore energy and vitality. By definition, patients with SES also have adrenal fatigue.
There is no traditional medical therapy for sick euthyroid syndrome. However, integrative medicine combines the best of traditional medicine and complementary and alternative medicine…and has a solution. SES is not a disease and therapy is not a life-long process. Most patients with sick euthyroid syndrome, if properly treated, do very well in the short and long term.
ALT-MED integrative medicine approach it tailored to the specific patient and may include the following:
Tests to confirm SES and adrenal fatigue
Specific thyroid medication – short term
Specific supplements to help with adrenal function and stress
Intravenous vitamins
Lifestyle changes
Energy medicine to reduce stress and balance energy flow
Acupuncture to reduce stress, increase energy
Massage therapy to reduce stress, increase “relaxation” hormones"
Alt Med - Sick Euthyroid Syndrome
"Sick Euthyroid Syndrome (SES): a medical condition (not disease) where the patient exhibits many symptoms of hypothyroidism – fatigue, weight gain, insomnia, dry skin, depression, anxiety, decreased memory/concentration, low libido, muscle pain, etc – and yet have normal or low/normal levels of throid stimulating hormone (TSH), T3 and T4. (Dr. Massey video on SES, click here)
SES is the result of more stress than the body can handle and the body is trying to conserve resources. The body begins to make a type of thyroid hormone (reverse T3) that shuts the body down…to hibernate.
Most physicians do not believe that SES exists outside of the intensive care unit and that it is rare in the general public. However, recent medical research has demonstrated that symptoms of sick euthyroid syndrome is often found in patients with stressful, chronic illnesses such as cancer, diabetes and heart disease….if you look for it. Dr. Massey has also diagnosed SES in patients with severe, chronic stress without other diseases. Treating SES can restore energy and vitality. By definition, patients with SES also have adrenal fatigue.
There is no traditional medical therapy for sick euthyroid syndrome. However, integrative medicine combines the best of traditional medicine and complementary and alternative medicine…and has a solution. SES is not a disease and therapy is not a life-long process. Most patients with sick euthyroid syndrome, if properly treated, do very well in the short and long term.
ALT-MED integrative medicine approach it tailored to the specific patient and may include the following:
Tests to confirm SES and adrenal fatigue
Specific thyroid medication – short term
Specific supplements to help with adrenal function and stress
Intravenous vitamins
Lifestyle changes
Energy medicine to reduce stress and balance energy flow
Acupuncture to reduce stress, increase energy
Massage therapy to reduce stress, increase “relaxation” hormones"
Alt Med - Sick Euthyroid Syndrome
Okay, blank it is!
"The body begins to make a type of thyroid hormone (reverse T3) that shuts the body down…to hibernate."
My point exactly. RT3 production increases when the body needs to scale back metabolism a little in response to (mostly) acute diseases, trauma, surgery, etc. It's actually more like torporing than hibernating (picky, picky).
So, do we really have a separate syndrome here, or are we looking at a "normal" (in the face of abnormality) bodily response?
"The body begins to make a type of thyroid hormone (reverse T3) that shuts the body down…to hibernate."
My point exactly. RT3 production increases when the body needs to scale back metabolism a little in response to (mostly) acute diseases, trauma, surgery, etc. It's actually more like torporing than hibernating (picky, picky).
So, do we really have a separate syndrome here, or are we looking at a "normal" (in the face of abnormality) bodily response?
A good question. I think ESS for acute severe illnesses and CSS (Chronic Sick Syndrome) for chronic diseases. How about that? :P
Thought i might fill in the blank wandering past :) ESS can be due to malabsorption syndromes (failure of normal intestinal absorption). Examples: Celiac disease, inflammatory bowel syndrome.
Ok it's going to take me a while to absorb (ha ha) all of your information, but I would just like to take the time to say how incredibly grateful I am to you all for taking the time to consider my situation. I have never used a forum before but desperation drew me to it as a last resort.
I just wanted to say thank you all so much. Just to know I'm not considered a time waster is invaluable.
Thanks guys.
I now need to consider how to approach my doctor further.
All the best and thanks again. I'll let you know how I make out and any more advice, I am grateful for, should you have any more thoughts.
I just wanted to say thank you all so much. Just to know I'm not considered a time waster is invaluable.
Thanks guys.
I now need to consider how to approach my doctor further.
All the best and thanks again. I'll let you know how I make out and any more advice, I am grateful for, should you have any more thoughts.
For your discussion with the doctor, you might be able to make good use of this link, written by a good thyroid doctor.
http://hormonerestoration.com/files/ThyroidPMD.pdf
http://hormonerestoration.com/files/ThyroidPMD.pdf
Hi again. Further to my last post I saw my doctor to discuss the blood tests I had to investigate the positive ANA.
The follow up ANA is not back yet (unsure as to whether it was indeed done)
The Lymes Disease was negative.
I had an Epstein Barr virus evaluation which has 'infection' in small letters on it and I was told the markers show that I had it in the past and its a deactivation.
EBV nuclear antigen igg antibodies >=1.80 ref range <1:5
As I say, I didn't find it easy to read..nor the following...
Rheumatoid factor <8.6 Negative <12 normal Units iu/ml
ESR was 3.0 mm/hr <20.0
Does this have any bearing on hypothyroid diagnosis?
I was told that this was good news as now we know why I had a positive ana and hypo symptoms but does mono make you feel like this all of the time? I do have bad flares when I feel worse but the symptoms are always there...
I was also told that it would do harm to medicate for hypothyroid symptoms when I have normal bloods.
I did ask for the TPOab and TGab also RT3 and FT3, as suggested, I hope that was the right thing to do.
If you have the time please let me know your thoughts on this progression (?).
Many thanks again.
The follow up ANA is not back yet (unsure as to whether it was indeed done)
The Lymes Disease was negative.
I had an Epstein Barr virus evaluation which has 'infection' in small letters on it and I was told the markers show that I had it in the past and its a deactivation.
EBV nuclear antigen igg antibodies >=1.80 ref range <1:5
As I say, I didn't find it easy to read..nor the following...
Rheumatoid factor <8.6 Negative <12 normal Units iu/ml
ESR was 3.0 mm/hr <20.0
Does this have any bearing on hypothyroid diagnosis?
I was told that this was good news as now we know why I had a positive ana and hypo symptoms but does mono make you feel like this all of the time? I do have bad flares when I feel worse but the symptoms are always there...
I was also told that it would do harm to medicate for hypothyroid symptoms when I have normal bloods.
I did ask for the TPOab and TGab also RT3 and FT3, as suggested, I hope that was the right thing to do.
If you have the time please let me know your thoughts on this progression (?).
Many thanks again.
Sorry, there was an autocorrect- "deactivation" should read "reactivation".
Thanks so much again.
Thanks so much again.
As you posted above.
May 2013
T4 5.42 (5.53-11.0) flagged Low
Ft3 2.89 (2.77-5.27)
TSH 1.350 (0.465-4.680)
Ft4 (0.83 (0.78-2.19)
You were told it would do harm to medicate for hypothyroid symptoms when you have normal bloods. First, that is not really true. If you got no improvement from a therapeutic trial of thyroid med, you could stop and there would be no permanent effect on your body. Second, I don't read your results as "normal". I wondered if you have a pituitary/hypothalamus issue that is causing your TSH to remain relatively low, even though your Free T3 and free T4 are very low in their ranges. And, by the way, those ranges are far too broad because of the way they were established. Functional ranges for healthy adults wold look more like the upper half of the listed ranges.
So I think your doctor is looking at your TSH, and overlooking everything else, such as the low levels of FT3 and FT4 and your symptoms. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
From the way you referred to your test results, I wondered if you are located in the UK, Canada, or Australia?
May 2013
T4 5.42 (5.53-11.0) flagged Low
Ft3 2.89 (2.77-5.27)
TSH 1.350 (0.465-4.680)
Ft4 (0.83 (0.78-2.19)
You were told it would do harm to medicate for hypothyroid symptoms when you have normal bloods. First, that is not really true. If you got no improvement from a therapeutic trial of thyroid med, you could stop and there would be no permanent effect on your body. Second, I don't read your results as "normal". I wondered if you have a pituitary/hypothalamus issue that is causing your TSH to remain relatively low, even though your Free T3 and free T4 are very low in their ranges. And, by the way, those ranges are far too broad because of the way they were established. Functional ranges for healthy adults wold look more like the upper half of the listed ranges.
So I think your doctor is looking at your TSH, and overlooking everything else, such as the low levels of FT3 and FT4 and your symptoms. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
From the way you referred to your test results, I wondered if you are located in the UK, Canada, or Australia?
ESR and RF are not needed for a diagnosis of hypothyroidism. However, ESR may be elevated due to many conditions including thyroid disease.
95% of adults have been infected with EBV. EBV can reactivate at any time but usually there are no symptoms. If you have symptoms of glandular fever/mono they are flu like symptoms including sore throat, low grade fever, fatigue, malaise, swollen lymph nodes (especially neck glands), poor appetite.
95% of adults have been infected with EBV. EBV can reactivate at any time but usually there are no symptoms. If you have symptoms of glandular fever/mono they are flu like symptoms including sore throat, low grade fever, fatigue, malaise, swollen lymph nodes (especially neck glands), poor appetite.
I think my dr may have been testing my ESR for evidence of lupus perhaps after my positive ANA?
Whatever I have that is causing my symptoms and Positive ANA, it is pretty constant and I am not sure that mono causes constant symptoms....
Nothing in the bloods i have had have ruled out hypothyroidism, however, perhaps my system is generally struggling causing the mono to reactivate...?
Thank you again so much. I seem to be looking for something else because my dr assures my I'm not hypothyroid..
Whatever I have that is causing my symptoms and Positive ANA, it is pretty constant and I am not sure that mono causes constant symptoms....
Nothing in the bloods i have had have ruled out hypothyroidism, however, perhaps my system is generally struggling causing the mono to reactivate...?
Thank you again so much. I seem to be looking for something else because my dr assures my I'm not hypothyroid..
Judging by your symptoms and your low in the range levels of Free T3 and Free T4, your doctor is wrong in assuring you that you are not hypothyroid.
Have you had a chance to read the link I gave you just above? Also, what about the question regarding where you are located?
Have you had a chance to read the link I gave you just above? Also, what about the question regarding where you are located?
Hi Gimel, thanks for your post. I did read the letter that you sent me the link to, it was very interesting. I haven't heard back re the Ana results to see if they were still positive, although this is something not uncommonly found apparantly with mono as well as hypothyroid sufferers..
I will try on Monday to suggest the TPOab and TGab again (and not RT3 and FT3?) and see if there is willing.
I could print the letter and take it in but not sure that wouldn't cause bad feeling which is better to avoid for my own sake.
Yes, It is a very small community (I can pm you if I can work out how)
I am so so exhausted - oh for some energy!
I will try on Monday to suggest the TPOab and TGab again (and not RT3 and FT3?) and see if there is willing.
I could print the letter and take it in but not sure that wouldn't cause bad feeling which is better to avoid for my own sake.
Yes, It is a very small community (I can pm you if I can work out how)
I am so so exhausted - oh for some energy!
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