Insight- Lab Results Posted

[katinsc]

First time poster, so this may too much information.
I have three autoimmune diseases. Back in 1992 I was diagnosed with hypothyroidism. It took until 2014, when a Dr. finally tested me and confirmed that I have Hashimoto. I have been had every color of Synthyroid and would tell me Dr that I still felt bad, so she increased or she decreased depending on my symptoms. My nails are brittel. I kept telling the Dr that I thought I was allergic to the fillers but she said that was preposterous. I have chronic excessive hair loss for the past 10 years. One time I save a baggie of my hair to give to the Dr and she told me I was too VAIN.  She was fired that day.  So, i went off Synthroid for awhile, in about a month, my hair grew back, shiner, stronger. My nails grew past my finger tips, strong no peeling, i was energetic, weight was coming off, face thinner.  When i finally went for labs to see an ENT- yikes my lab results were off the chart. so back i went on synthroid, within a month all side effects returned.

Is it possible to feel great and not need pills when you test results say something different?

I now go to an ENT but get to see her once a year if I am lucky and she doesn't cancel the appointments, but i get lab every 3-6 months and get adjusted that way. I finally convinced this DR to prescribe Armour.  I was first on 60 mg then 90 Mg, that alternativing every other day, no I am on 90 mg daily.
I was taking them in the morning, no food.  I have read that some take them twice a day (splitting), do people see improvements, is this before or after food. Also, what about the timing with Lisinopril HCTZ (am)?
I have gain incredible amount of weight (15 lbs in one yr, 25 lbs since 2013) so possibly the splitting would help.
I started seeing a Naturopathic to see if it was my adrenals, but cortisol came back in range. I have trouble sleeping, up every two hours.

Here are my latest results.
Taken 3/31/15

Vitamin d 38 range 20-80
Vitamin D   39.9   30-100
T3 free 4.8 range 2.0-4.4
T4 free .91 range .82-1.77
TSH 7.610 range 0.45-4.500


on a different note: My last three years of labs and notice my Glucose has been high (122mg Range 65-99). Only natural fruits, no packaged, sweets, candy, soft drinks. So that is troubling.


Is there any insight you could give from what you see?

[gimel]

First question is did you take your med the morning of the blood draw for tests?  If yes, how long after your dose was the blood draw?  What cortisol test(s) were done?  Can you please post lab results from the time you were taking the Synthroid and also identify the dosage?  Have you had any iron tests done?  Any B12 tests?

[katinsc]

I took the full dosage that morning, about 2 hours before blood test.  Will all other thyroid testing listed below I took the pill prior to the test. I would say up until 2011 all blood was drawn mid day.

I had Cortisol AM, blood work in 2013, at that time it was 27.3 (6.2-19.4)
I recently did a salvia test: Free Cortisol Rhythm - Saliva
6-8 AM 15 Normal 13-24 nM
11:00 - 1:00 PM 3 Depressed 5-10 nM
04:00 - 05:00 PM 5 Normal 3-8 nM
10:00 - Midnight 2 Normal 1-4 nM
06:00 - 08:00 AM
Total Cortisol Output: 25 22 - 46 nM

This is the blood history I have:
Taken 4/2007

T3 TOTAL 111 range 60-181
T3 uptake 33 range 22-35
T4 Thyroxine 13.6 range 4.5-12.5
T4 free 4.5 range 1.4-3.8
from results increased me to Synthroid 125mcg from 112mcg

next lab results 3-27-2008
Free Thyroxine Index 3 range 1.2-4.9
T3 uptake 33 range 22-39
T4 Thyroxine 9.2 range 4.5-12.5
TSH  2.393 range .350-5.50
no change in dosage

next lab results 9-2009
Free Thyroxine Index 3 range 1.2-4.9
T3 uptake 35  range 24-39
T4 Thyroxine 11.7 range 4.5-12
TSH  .0394 range .450-4.50
changed me to 100mg

next one I could find- 12/2011
Free Thyroxine Index 2.1 range 1.2-4.9
T3 uptake 26 range 24-39
T4 Thyroxine 7.9 range 4.5-12
TSH  70.020 range .450-4.50 - this is when I stopped taking them and was feeling great, hair growing, nails growing.  I know... HIGH
after the large smack from DR i think this was 150mg for three months then back down to 125 mg

next one I found 10/2013-
T4 free 1.72 range .82-1.77
T3 free serum  4.2 range 2.0-4.4
TSH .92 range .45-4.5
stayed on 125mg

next one I found 2/2014
T4 free 1.05 range .82-1.77
T3 free serum  2.1 range 2.0-4.4
TSH .485 range .45-4.5
put me on Armour 60mg

I can't find the one in 9/2014, but this is when i was told to alternative 60mg and 90mg daily

last one posted in first email. I know my tests results are sporadic I moved in 2012 so many files still packed away.

It doesn't appear that I have any iron or B12 tests performed.  

[gimel]

In a nutshell, you really don't know where your thyroid hormone levels are at present.  I say that because you are taking your total dosage of Armour Thyroid in the morning.  Usually it is better to split the dosage of any med containing T3 and take half in the morning and half in the afternoon.  The reason for that is the half life of T3 is less than a day.  You get the max. effect of the T3 med in about 4 hours and then it dissipates over the next 4 hours.  Splitting the dose helps even out the effect over the whole day.  

So, clearly your latest Free T3 test result is a false high result.  In addition many of the earlier tests were outdated and not very useful.  Tells me the doctor is also probably outdated.  Plus the doctor was probably dosing you based on your TSH results, which doesn't work.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting the biologically active thyroid hormones, Free T3 and Free T4,  as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results and especially not TSH results.  I doubt that your ENT is the doctor you need, based on incorrect instructions about alternating your Armour dosages, and then not instructing you to split the dose.  So, if you will tell us your location, perhaps we can suggest a doctor, based on patients' recommendations.  

At first opportunity you need to get tested for Free T4 and Free T3.  I also suggest testing  Reverse T3 to establish a baseline for that.  Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, those need current test results.  D and ferritin are very important for adequately metabolizing thyroid hormone.  If you can go ahead and get those done even before you find a new doctor, then we can help interpret and advise further.  

[katinsc]

I live in Charleston SC
Should the dosage be take on empty or full stomach.?
By taking my pill before blood tests it skewed the results?
How does someone go about getting those tests without a lab order from Dr?
Thank you so much, this has given me hope. I feel like I relied on Drs to help me but I need to learn and educate myself more on my health. This is a start.
I am glad I found this site and thanks for talking the time to respond.

[gimel]

T4 med absorbs best on an empty stomach, but that is sometimes hard to do.  T3 absorbs easily.  So with a combo med like Armour, I just try to be as consistent as possible with how I take the med.

Yes, taking the whole dose of Armour about 4 hours before the blood test would give a false high result, not representative of overall effect of the T3 in your med.  

If you cannot get a doctor to order those tests for you, then you could use one of several sources that will arrange for you to have blood drawn at a location near you.  The costs are reasonable.  This is a link to one of those sites.

http://www.healthcheckusa.com/

I just sent you a PM with doctors info.  To access, just click on your name and then from your personal page click on messages.  

[katinsc]

I finally received my lab tests, it took me awhile to get my Dr to approve the request

TSH-           .633      Range.  .450-4.50
Free T3.      3.0.       Range 2.0 - 4.4
Free T4.       .92.      Range.  .82- 1.77
Ferritin.         147.     Range 15- 150
Vitamin B12.  741.     Range 211-946
Vitamin D.      38.0.    Range 30.0- 100
Reverse T3.    9.0. (L). Range 9.2- 24.1

would like to hear your insight. Thanks
My Dr is away and has not provided any clinical review yet, I think her PA will look at them and let me know.

[gimel]

Since you did not take your med before the blood draw, these results are more representative.  Your Free T4 is too low in the range.  Needs to be middle of the range at minimum.  Your Free T3 is also lower than recommended by many members who say that symptom relief required Free T3 in the upper third of its range or as necessary to relieve symptoms.  Your ferritin is her that I would have expected, but no reason for concern at this point.  At next opportunity I suggest a full iron test panel (serum iron level, TIBC, and % saturation).  Your B12 could be a bit higher, say around 850-900.  And your Vitamin D should be about 55-60.  

So you can supplement for the B12 and Vitamin D yourself.  As for your thyroid hormone levels, a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  I say that about TSH because many hypo patients taking adequate thyroid meds find that their TSH becomes suppressed.  That does not mean you are hyper, unless you have hyper symptoms, due to excessive levels of Free T4 and free T3.  You can get some good insight form this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

So,you are going to have to discuss this and convince your doctor to increase your dosage and treat you clinically, as described, or find a doctor that will do so.  

[katinsc]

Thanks, I am learning a lot by our dialogue. I want to make sure I ask my Dr correctly.
If I am currently taking Armour 90mg, then the next dosage would be 120mg? Is there any dosage in the middle?
Then check again in two months?

Thanks

[gimel]

You can get Armour in the following dosage.

Strength Code
1/4 grain TC
1/2 grain TD
1 grain TE
1 1/2 grain TJ
2 grain TF
3 grain TG (bisected)
4 grain TH
5 grain TI (bisected)

So, if needed, you could get 1/4 grain to add to your 90 mg (one grain).  If you are feeling really bad, I would return for re-test in 4 weeks.  As you start to feel better, you can stretch out the interval.  

[katinsc]

I provided my Dr with supporting information to increase my dosage... Her response... I appreciate your view point but I disagree with the need to adjust the Armour up. Given your TSH is on the low end pushing up the dose of Armour may put your peripheral numbers in normal range but will likely suppress your TSH. I would not recommend increased dose.
I pleaded my cases one more time citing why the TSH levels shouldn't be used to diagnose. since the TSH actually measures how well the pituitary is “talking” to the thyroid gland, rather than measuring actual thyroid hormones or, more importantly, the level of thyroid activity in the body.The TSH level is not a measure of thyroid hormone levels--only the free T4 and free T3 are. TSH is a measure of how much the hypothalamic-pituitary system is attempting to stimulate the thyroid gland. A "normal" TSH tells us only that the  person doesn't have failure of the thyroid gland. It does not tell us that they have sufficient levels of thyroid hormone.
Will see. She wanted to refer me to another endo, but I told her that I a, afraid that Dr Xxxxx, may not be as open minded as she has been and not be open to NDT treatment.

[gimel]

The following links may help persuade your doctor to consider a dosage increase.  Both show that TSH is frequently suppressed when taking adequate doses of thyroid meds.  The first study was with patients with central hypothyroidism.  The second study is with Hashimoto's patients.

http://www.ncbi.nlm.nih.gov/pubmed/12481949

http://www.ncbi.nlm.nih.gov/pubmed/1366242

Also, here is a good link.  Note this conclusion from the study.  "Therefore, the biological effects of thyroid hormones at the peripheral tissues—and not TSH concentrations—reflect the clinical severity of hypothyroidism. A judicious initiation of thyroxine treatment should be guided by clinical and metabolic presentation and thyroid hormone concentrations (free thyroxine) and not by serum TSH concentrations."

http://www.bmj.com/content/326/7384/311

And last, the study inf the following link concluded that, "Measurements of serum concentrations of total thyroxine, analogue free thyroxine, total triiodothyronine, analogue free triiodothyronine, and thyroid stimulating hormone, made with a sensitive immunoradiometric assay, did not, except in patients with gross abnormalities, distinguish euthyroid patients from those who were receiving inadequate or excessive replacement. These measurements are therefore of little, if any, value in monitoring patients receiving thyroxine replacement."

http://www.bmj.com/content/293/6550/808

If copies of those studies don't convince your doctor, then she is a lost cause.