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Inaccurate FT4?
First, thank you very much for your help. Here is my question:
I e-mailed you before with my test results, so this might sound familiar. My Rheumatologist odered a TSH/FT4 when I complained of ongoing fatigue. She referred me to my GP when the results indicated problems. He reordered the tests (6 days later):
TSH 0.453 (1st) 0.746 (2nd) Range .4-4.2
FT4 0.5 (1st) 0.6 (2nd) Range .8-1.9
T3 N/A (1st) 145 (2nd) Range 82-179
Based on these tests, my GP started me on Levoxyl 75 mcg (11 days ago). I was feeling worse, not better, so yesterday he said that he had spoken to an Endo specialist who said 1) I was not hypothyroid 2) The FT4 test is not always accurate
So, my GP is having a Total T4 and Thyroid uptake ran, along with a Prolactin level drawn. I know that low FT4 and low TSH usually indicate a pituitary problem (I'm an RN, but this is not my speciality!) Now, that I've given you the data, here is my question: How long should I be off the Levoxyl before I will see accurate resuls with the Total T4 and Thyroid Uptake? Obviously I want this resolved as quickly as possible, but I want the results to be clues as to what is really going on. Perhaps of interest, I have also had problems with SOB recently, so he is ordering a stress test (new onset, within the last month or so).
Thank you again so much for your help; my mind does not seem as clear as normal and I'm just not sure about all of this!
I e-mailed you before with my test results, so this might sound familiar. My Rheumatologist odered a TSH/FT4 when I complained of ongoing fatigue. She referred me to my GP when the results indicated problems. He reordered the tests (6 days later):
TSH 0.453 (1st) 0.746 (2nd) Range .4-4.2
FT4 0.5 (1st) 0.6 (2nd) Range .8-1.9
T3 N/A (1st) 145 (2nd) Range 82-179
Based on these tests, my GP started me on Levoxyl 75 mcg (11 days ago). I was feeling worse, not better, so yesterday he said that he had spoken to an Endo specialist who said 1) I was not hypothyroid 2) The FT4 test is not always accurate
So, my GP is having a Total T4 and Thyroid uptake ran, along with a Prolactin level drawn. I know that low FT4 and low TSH usually indicate a pituitary problem (I'm an RN, but this is not my speciality!) Now, that I've given you the data, here is my question: How long should I be off the Levoxyl before I will see accurate resuls with the Total T4 and Thyroid Uptake? Obviously I want this resolved as quickly as possible, but I want the results to be clues as to what is really going on. Perhaps of interest, I have also had problems with SOB recently, so he is ordering a stress test (new onset, within the last month or so).
Thank you again so much for your help; my mind does not seem as clear as normal and I'm just not sure about all of this!
I am from the States too and I have real good Insurance, which is the difference between HMOs and a few others. I can go to any doctor/specialist without referrals. And the doctors seem to know our Insurance plan very well.
However, Doctors do have to check in with Insurance when it comes to hospital and surgery to verify coverage. I did have a not so informative appointment with an endo. once. I think he dealt with diabetes more than thyroid and I since have learned better. There is no waiting for appointments. Although in my state, it is getting so over crowded that hospitals are running out of bed space and have to fly patients to other near by states. And there is a shortage of type 0 neg (0-) blood. I guess before any operation for me, I'll have to stock up on my own blood, it there is time. ;)
My original doctor in 97' was very through, in fact too through as far as I am concerned, LOL! Not only did he find Graves' he also found three other health issues not listed below. I was losing weight, weight at the time under a 100 lbs, so doctor wanted to make sure it wasn't from other health conditions, however the other three conditions were not the cause of weight loss but rather it was due Graves'.
I sacrificed better paying jobs for better benefits . On the other hand, I can't complain about wages which weren't too bad either.
Just want others to know, especially ones from different countries, not all Insurance Company/coverage's are the same nor equal. There are varying digress of Insurance.
Adrenal and thyroids share some of the same symptoms. Below is just a few site to get you started. I hope they are informative and helpful to you.
http://directory.obscureresearch.net/Thyroid_and_Adrenal about 6 pages worth
http://www.ei-resource.org/adrenal.asp The Adrenal - Thyroid Link
http://thyroid.about.com/cs/endocrinology/a/adrenalfatigue.htm Adrenal Fatigue / Adrenal Exhaustion (this site has some symptoms listed. Be sure to go here for Metabolic Scorecard: Symptom Matrix with information on how to evaluate your symptoms in greater detail)
Good luck!
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
However, Doctors do have to check in with Insurance when it comes to hospital and surgery to verify coverage. I did have a not so informative appointment with an endo. once. I think he dealt with diabetes more than thyroid and I since have learned better. There is no waiting for appointments. Although in my state, it is getting so over crowded that hospitals are running out of bed space and have to fly patients to other near by states. And there is a shortage of type 0 neg (0-) blood. I guess before any operation for me, I'll have to stock up on my own blood, it there is time. ;)
My original doctor in 97' was very through, in fact too through as far as I am concerned, LOL! Not only did he find Graves' he also found three other health issues not listed below. I was losing weight, weight at the time under a 100 lbs, so doctor wanted to make sure it wasn't from other health conditions, however the other three conditions were not the cause of weight loss but rather it was due Graves'.
I sacrificed better paying jobs for better benefits . On the other hand, I can't complain about wages which weren't too bad either.
Just want others to know, especially ones from different countries, not all Insurance Company/coverage's are the same nor equal. There are varying digress of Insurance.
Adrenal and thyroids share some of the same symptoms. Below is just a few site to get you started. I hope they are informative and helpful to you.
http://directory.obscureresearch.net/Thyroid_and_Adrenal about 6 pages worth
http://www.ei-resource.org/adrenal.asp The Adrenal - Thyroid Link
http://thyroid.about.com/cs/endocrinology/a/adrenalfatigue.htm Adrenal Fatigue / Adrenal Exhaustion (this site has some symptoms listed. Be sure to go here for Metabolic Scorecard: Symptom Matrix with information on how to evaluate your symptoms in greater detail)
Good luck!
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
Hey again,
I did a quick google - and I think your LPN is our Div 2. Div2 is usually a 12 month course at a technical college (we call them TAFEs) and must work under the indirect or direct supervision of a Div1. Here both Div2 and Div1 are Registered Nurses and are regulated by the same body. Div1 is a 3 year university degree - which I am in my final year of!!! I gained my Div2 at the end of my 2nd year of my degree (another pathway for nursing students to get practical experience by working). We also have PCA /PCW, (personal care attendent or worker - not regulated at all though), which I worked as for the first two years of my degree) which is basically a nurses aide, do you have that too?
I'm not sure which area I want to specialise in yet, it's early days. That said A&E, or ICU seem pretty interesting but like you said very stressful and full on. You would never get bored in a job like yours I imagine! Have you been in that area a long time (long term stress)?
We don't classify our hospital's in the way you guys do - nor do we have insurance companies telling our general practitioner what we can and cannot test for. Our health insurance generally only kicks in when you are admitted to hospital (not in an emergency situation) otherwise Medicare covers a portion of all out-patient costs. But the portion Medicare covers has remained the same for many years while costs continue to rise and it is the patient who ends up bearing it.
I get really confused when people talk about all these restrictions your insurance companies impose on you? How does that work?
Great to get your reply! I notice that you also posted on the doc's side of the forum, good idea! It will be interesting to see what he says.
I've gotta go - starting an early shift shortly.
Cheers
Jenipeni
I did a quick google - and I think your LPN is our Div 2. Div2 is usually a 12 month course at a technical college (we call them TAFEs) and must work under the indirect or direct supervision of a Div1. Here both Div2 and Div1 are Registered Nurses and are regulated by the same body. Div1 is a 3 year university degree - which I am in my final year of!!! I gained my Div2 at the end of my 2nd year of my degree (another pathway for nursing students to get practical experience by working). We also have PCA /PCW, (personal care attendent or worker - not regulated at all though), which I worked as for the first two years of my degree) which is basically a nurses aide, do you have that too?
I'm not sure which area I want to specialise in yet, it's early days. That said A&E, or ICU seem pretty interesting but like you said very stressful and full on. You would never get bored in a job like yours I imagine! Have you been in that area a long time (long term stress)?
We don't classify our hospital's in the way you guys do - nor do we have insurance companies telling our general practitioner what we can and cannot test for. Our health insurance generally only kicks in when you are admitted to hospital (not in an emergency situation) otherwise Medicare covers a portion of all out-patient costs. But the portion Medicare covers has remained the same for many years while costs continue to rise and it is the patient who ends up bearing it.
I get really confused when people talk about all these restrictions your insurance companies impose on you? How does that work?
Great to get your reply! I notice that you also posted on the doc's side of the forum, good idea! It will be interesting to see what he says.
I've gotta go - starting an early shift shortly.
Cheers
Jenipeni
Thank you for your thoughts on this! You have made me think of several things that I will consider getting tested! Here in the States, your primary MD is often a "gatekeeper" and authorizes all testing or visits to Specialists. I'm not sure that he is being as thorough in follow-up as I would hope; I think I should have been referred to an Endo Specialist a few weeks ago!
Yes, the prolactin level is to check for Pituitary function. I suppose that I could go ahead and have that drawn this week and do the other testing (for Thyroid function) in a few weeks. I just want to find out as soon as possible what is going on and at least maybe the Prolactin level will give me a clue. It was so kind of you to look up the half-life on Levoxyl. Thank you very much!
It's fun to talk to another nurse in a different country. What is a Div2 and Div1 nurse? We don't have that here. We have RN's and LPN's - I wonder if that is similiar? I work in a Trauma 1 Hospital (that means we are a large hospital that never goes on diversion -i.e. diverts patients- and takes every level of trauma). I do triage work - it is very exciting and yes, very, very stressful!
I don't know as much as I wish I did about Adrenal Fatigue (as mentioned by GravesLady), so I think I'll look that up too. Sometimes I know the stress I face in my job can be very overwhelming!
Thank you again so much for your help. And I will update you when I find out more. Good Luck in your studies - although you sound VERY bright!
Yes, the prolactin level is to check for Pituitary function. I suppose that I could go ahead and have that drawn this week and do the other testing (for Thyroid function) in a few weeks. I just want to find out as soon as possible what is going on and at least maybe the Prolactin level will give me a clue. It was so kind of you to look up the half-life on Levoxyl. Thank you very much!
It's fun to talk to another nurse in a different country. What is a Div2 and Div1 nurse? We don't have that here. We have RN's and LPN's - I wonder if that is similiar? I work in a Trauma 1 Hospital (that means we are a large hospital that never goes on diversion -i.e. diverts patients- and takes every level of trauma). I do triage work - it is very exciting and yes, very, very stressful!
I don't know as much as I wish I did about Adrenal Fatigue (as mentioned by GravesLady), so I think I'll look that up too. Sometimes I know the stress I face in my job can be very overwhelming!
Thank you again so much for your help. And I will update you when I find out more. Good Luck in your studies - although you sound VERY bright!
Thank you for your input! I've read quite a few posts over the last few weeks and you always sound so wise and well-informed! I can see from your list of conditions that you have been through a lot!
Did you find that you had to fight your doctors sometimes to pursue things? I often say that the insurance company runs things much more than your MD. The doctor can only order what he can get approved and justified through the insurance company!
I am going to try to find out more about Adrenal fatigue. I can see how that might be an issue.
Thanks!
Did you find that you had to fight your doctors sometimes to pursue things? I often say that the insurance company runs things much more than your MD. The doctor can only order what he can get approved and justified through the insurance company!
I am going to try to find out more about Adrenal fatigue. I can see how that might be an issue.
Thanks!
Free Ts are more accurate than Total T, especially when estrogen, which interferes with the Totals and does not effect the Frees.
How long you have to be off meds. depends on the Lab. Any where between 4 to 8 weeks in some cases. They wanted me off for 2 months, however I was on meds for at least two months. The Lab should have told you this.
Also the Lab should give you some instructions to follow for the day of
Up Take or else there won't be accurate results.
Another idea is, it could be adrenals. TSH and FT-4 second reading has raised a tad and should keep raising as adrenals heal, if its adrenals.
When test go to different Labs there might be a difference in levels then your previous levels because each Lab has its own methods and will differ from each other. So it doesn't necessarily mean the other levels were wrong or off.
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
mrean your first test were wrong or off.
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
How long you have to be off meds. depends on the Lab. Any where between 4 to 8 weeks in some cases. They wanted me off for 2 months, however I was on meds for at least two months. The Lab should have told you this.
Also the Lab should give you some instructions to follow for the day of
Up Take or else there won't be accurate results.
Another idea is, it could be adrenals. TSH and FT-4 second reading has raised a tad and should keep raising as adrenals heal, if its adrenals.
When test go to different Labs there might be a difference in levels then your previous levels because each Lab has its own methods and will differ from each other. So it doesn't necessarily mean the other levels were wrong or off.
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
mrean your first test were wrong or off.
Just my personal opinion and/or experience. Always discuss your health issue with your doctor , always adhere to your doctors advise and, you always have the right to a second opinion. Nothing is a 100% or a 100%, 100% of the time. However, we are not all alike!
GL,
1990 - Hyper/Graves'
1997 - Dia/RAI
1997 - MVP - Mitral Valve Prolapse
1999 - TED - slight Thyroid Eye Disease
1999 - Visible Nodule (suspect Marine-Lenhart-Syndrom/hyperfunctioning nodule)
2002 - IED - Intermittent Explosive Disorder (Graves' Range)
Hi there!
I looked up the prescribing information for Levoxyl for you;
http://www.kingpharm.com/uploads/pdf_inserts/Levoxyl_Web.pdf
which came from;
http://www.levoxyl.com
I was looking for the half life, but couldn't find it. I am in Australia and am on a different brand of thyroxine - Eutroxsig (I checked it has identical chemical structure to Levoxyl). So here is what my prescribing info says about half lives (you should be able to reliably use this info for you Levoxyl I imagine? I'm also a RN Div2 studying final year for Div1)
*For others reading this - a half life is the amount of time it takes for a substance to reach half of it's level in the blood from the time it is ceased.
Euthyroidism - half life of six to seven days
Hypothyroidism - half life of nine to ten days
Hyperthyroidism - half life of three to four days
Quote - "It also has a long duration of action occuring between one to three weeks even following dicontinuation of the drug"
So given this info, for accurate results (I presume you wan't to know what your body is doing on it's own?) with the Total T4 and Thyroid Uptake - I would think that you'd need to cease the Levoxyl for a full 3 weeks to be sure before having your tests done.
Fatigue and SOB - just some thoughts okay; What I wonder about is your haemoglobin levels. Could anaemia be a possibility - it would fit with the fatigue? If there's not enough O2 carriers (Hb for others reading this) this COULD be a cause of SOB, but it would have to be pretty severe? Alternatively do you have heavy periods / are you vegetarian? Just hypothesising, probably many other causes.
This is going off on a bit of a tangent and may not really apply - thyroid autoimmune antibodies are also associated with pernicious anaemia and when one autoimmune disease is present there is a higher liklihood of another one. As we know vitamin B12 is crucial in the development of RBCs (B12 absorbtion is deficient in Pernicious Anaemia for anyone else reading this), so maybe IF it is anaemia you might want to have your B12 levels checked and thyroid antibodies too.
I'm just curious; is the Prolactin draw just to look at Pituitary function OR are you also having breast discharge? If it is being done to look at Pituitary function why wouldn't they look at the other hormones produced here too? If suspecting a Pituitary dysfunction they should look at the other hormones too because not all Pituitary tumors are prolactin secreting. Remember Pituitary problems are pretty rare - don't worry about it, the odd's are in your favour.
If the Prolactin draw is because you are having breast discharge, get Testosterone done too - normal Prolactin and low Testosterone have also been associated with breast discharge.
I'm no expert in this area, although I'm always gleaning information about it as it is an area of interest, I had a TT almost 4 months ago.
I'm sorry - I think my post may have raised more questions than answers but go and get checked for anaemia while you are waiting for the Levoxyl to leave your system.
Love to hear how you go... post when you get some answers if you can.
Best wishes with everything
Cheers!
Jenipeni
I looked up the prescribing information for Levoxyl for you;
http://www.kingpharm.com/uploads/pdf_inserts/Levoxyl_Web.pdf
which came from;
http://www.levoxyl.com
I was looking for the half life, but couldn't find it. I am in Australia and am on a different brand of thyroxine - Eutroxsig (I checked it has identical chemical structure to Levoxyl). So here is what my prescribing info says about half lives (you should be able to reliably use this info for you Levoxyl I imagine? I'm also a RN Div2 studying final year for Div1)
*For others reading this - a half life is the amount of time it takes for a substance to reach half of it's level in the blood from the time it is ceased.
Euthyroidism - half life of six to seven days
Hypothyroidism - half life of nine to ten days
Hyperthyroidism - half life of three to four days
Quote - "It also has a long duration of action occuring between one to three weeks even following dicontinuation of the drug"
So given this info, for accurate results (I presume you wan't to know what your body is doing on it's own?) with the Total T4 and Thyroid Uptake - I would think that you'd need to cease the Levoxyl for a full 3 weeks to be sure before having your tests done.
Fatigue and SOB - just some thoughts okay; What I wonder about is your haemoglobin levels. Could anaemia be a possibility - it would fit with the fatigue? If there's not enough O2 carriers (Hb for others reading this) this COULD be a cause of SOB, but it would have to be pretty severe? Alternatively do you have heavy periods / are you vegetarian? Just hypothesising, probably many other causes.
This is going off on a bit of a tangent and may not really apply - thyroid autoimmune antibodies are also associated with pernicious anaemia and when one autoimmune disease is present there is a higher liklihood of another one. As we know vitamin B12 is crucial in the development of RBCs (B12 absorbtion is deficient in Pernicious Anaemia for anyone else reading this), so maybe IF it is anaemia you might want to have your B12 levels checked and thyroid antibodies too.
I'm just curious; is the Prolactin draw just to look at Pituitary function OR are you also having breast discharge? If it is being done to look at Pituitary function why wouldn't they look at the other hormones produced here too? If suspecting a Pituitary dysfunction they should look at the other hormones too because not all Pituitary tumors are prolactin secreting. Remember Pituitary problems are pretty rare - don't worry about it, the odd's are in your favour.
If the Prolactin draw is because you are having breast discharge, get Testosterone done too - normal Prolactin and low Testosterone have also been associated with breast discharge.
I'm no expert in this area, although I'm always gleaning information about it as it is an area of interest, I had a TT almost 4 months ago.
I'm sorry - I think my post may have raised more questions than answers but go and get checked for anaemia while you are waiting for the Levoxyl to leave your system.
Love to hear how you go... post when you get some answers if you can.
Best wishes with everything
Cheers!
Jenipeni
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