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Insight on Lab Results
Hello, would like insight or feedback on my lab results. I am taking Armour, up until a month ago I was on 90mg daily, I was on that dosage for two years. In Oct 2015, finally started seeing some improvements in my symptoms: hair stopped falling out, even saw some hair growth, nails were growing to the point where for the first time in 15 years bought nail polish as they grew past my finger tips.
Then in April 2016, my endo changed my dosage to 65mg daily. I immediately started losing clumps of hair, gained weight, nails all broken.
To put it in perspective, this was my result in July 2015, - at 90 mg. In a few short months, my hair stopped falling out, nails were growing, I lost 15 lbs, my energy level increased.
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
April 2016- Based on the below results Dr changed my dosage to 65mg. I told her that I was feeling so much better on the current dosage. She told me if I was feeling any symptoms that she would reevaluate.
TSH- .117 Range. .450-4.50
Free T3. 32. Range 2.0 - 4.4
Free T4. 1.12 Range. .82- 1.77
Ferritin. 218 Range 15- 150 - That is real high, but Dr didn’t address
Vitamin B12. 1000. Range 211-946
Vitamin D. 44.8. Range 30.0- 100
Reverse T3. 9.5 Range 9.2- 24.1
May 2016- I asked for new lab work, within the first week of new dosage hair was falling out in clumps, all my nails broken and by the end of May I gained weight, no energy.. Just heard from Dr. Results are GREAT, will not adjust. My T3 and T4 have dropped… I don’t know that much but I think that is not good.
TSH- 1.49 Range. .450-4.50
Free T3. 2.3 Range 2.0 - 4.4
Free T4. .76. .Range. .82- 1.77
Can someone give me some insight on my results… My high Ferritin level also concerns me..
I have fired three Dr before as they treat by TSH levels, one even told me that I was being vain because of my hair loss. I live in SC, I heard of a Dr. Lovegrove in Mt Pleasant and Dr Hisborn in Greenville SC, has anyone heard of them or any feedback from others?
Thank you
Kathy
Then in April 2016, my endo changed my dosage to 65mg daily. I immediately started losing clumps of hair, gained weight, nails all broken.
To put it in perspective, this was my result in July 2015, - at 90 mg. In a few short months, my hair stopped falling out, nails were growing, I lost 15 lbs, my energy level increased.
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
April 2016- Based on the below results Dr changed my dosage to 65mg. I told her that I was feeling so much better on the current dosage. She told me if I was feeling any symptoms that she would reevaluate.
TSH- .117 Range. .450-4.50
Free T3. 32. Range 2.0 - 4.4
Free T4. 1.12 Range. .82- 1.77
Ferritin. 218 Range 15- 150 - That is real high, but Dr didn’t address
Vitamin B12. 1000. Range 211-946
Vitamin D. 44.8. Range 30.0- 100
Reverse T3. 9.5 Range 9.2- 24.1
May 2016- I asked for new lab work, within the first week of new dosage hair was falling out in clumps, all my nails broken and by the end of May I gained weight, no energy.. Just heard from Dr. Results are GREAT, will not adjust. My T3 and T4 have dropped… I don’t know that much but I think that is not good.
TSH- 1.49 Range. .450-4.50
Free T3. 2.3 Range 2.0 - 4.4
Free T4. .76. .Range. .82- 1.77
Can someone give me some insight on my results… My high Ferritin level also concerns me..
I have fired three Dr before as they treat by TSH levels, one even told me that I was being vain because of my hair loss. I live in SC, I heard of a Dr. Lovegrove in Mt Pleasant and Dr Hisborn in Greenville SC, has anyone heard of them or any feedback from others?
Thank you
Kathy
To my knowledge, you need a prescription from a medical professional authorized to Rx that medicine in the state in which you live.
Although I may have heard a rumor of people getting it mail ordered from out of the country. But I have no idea on the legality or even if those rumors are true.
Although I may have heard a rumor of people getting it mail ordered from out of the country. But I have no idea on the legality or even if those rumors are true.
This is why TSH is basically a screening test at best. And not a particularly great one at that IMHO.
If the ACTUAL hormones that your body uses are Free T4 and Free T3. Why would not after you are diagnosed those be the ONLY two things along with your symptoms that need to be looked at? It seems so common sense to me it borders on ridiculousness to continue to use TSH.
You are trying to kill a fly with a sledge hammer (TSH). A sledge hammer is a great tool for an APPROPRIATE use such as splitting concrete slab. But you are trying to optimize a balance of hormones that is delicate. And you only need an archeologist hammer (FT4 and FT3) to finely dig down to the dinosaur bone slowly and carefully without doing damage.
If the ACTUAL hormones that your body uses are Free T4 and Free T3. Why would not after you are diagnosed those be the ONLY two things along with your symptoms that need to be looked at? It seems so common sense to me it borders on ridiculousness to continue to use TSH.
You are trying to kill a fly with a sledge hammer (TSH). A sledge hammer is a great tool for an APPROPRIATE use such as splitting concrete slab. But you are trying to optimize a balance of hormones that is delicate. And you only need an archeologist hammer (FT4 and FT3) to finely dig down to the dinosaur bone slowly and carefully without doing damage.
COMMUNITY LEADER
We do, typically, recommend splitting dosages of meds with T3 in them, since T3 enters the system quickly and is out of the system within a few hours. By splitting the dosage, you keep the T3 more stable over the course of the day, eliminating the up and down of getting your full dose of T3 all at once in the morning, then having none later in the day...
Typically, it's best to take half first thing in the morning and the other half about noon or early afternoon. If you can take your second dose about an hour before lunch, when your stomach might be relatively empty (though it's understandable that it won't be as empty as it is in the morning), that would be good.
I'm on the fence about adding another 15 mg, at this point, because it's a pretty sure thing your TSH is going to be suppressed again... I do totally agree with gimel about the suppressed TSH issue; I've been fighting that for years so I'm well aware of what you're going through. I'm afraid you might end up having to find a different doctor, because this one seems way to stuck on the TSH level.
I can't tell you what to do, but personally, I'd hold off on adding more, right now on the chance that I'd need it later. I "would" start looking for a different doctor...
Typically, it's best to take half first thing in the morning and the other half about noon or early afternoon. If you can take your second dose about an hour before lunch, when your stomach might be relatively empty (though it's understandable that it won't be as empty as it is in the morning), that would be good.
I'm on the fence about adding another 15 mg, at this point, because it's a pretty sure thing your TSH is going to be suppressed again... I do totally agree with gimel about the suppressed TSH issue; I've been fighting that for years so I'm well aware of what you're going through. I'm afraid you might end up having to find a different doctor, because this one seems way to stuck on the TSH level.
I can't tell you what to do, but personally, I'd hold off on adding more, right now on the chance that I'd need it later. I "would" start looking for a different doctor...
1 Comments
One more question, is it possible to purchase my own Armour prescription online without a Dr prescription. If I order my own labs and I share my results and based on the SME (subject matter experts) you all determine I should increase or decrease can I purchase my own. You can PM if needed.
It really bothers me when I hear of a doctor that still believes that a suppressed TSH automatically means that you are hyperthyroid and must reduce med dosage, when there is so much evidence readily available that is not the case. For example note the findings in this study that was done in 1986, but still valid.
Frasier WD, Biggart EM, O’Reilly D St J, Gray HW, McKillop JH, Thomson JA. Are Biochemical Tests of Thyroid Function of any Value in Monitoring Patient Receiving Thyroxine Replacement? BMJ 1986;293(6550):808-10
“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.”
Of 148 patients attending an outpatient clinic, 148 were classified by their clinical status by 4 qualified consultants with experience in thyroid disease. Of those 108 were classified as hypothyroid and from biochemical testing, their TSH ranged from 0.1 to 19.7. The TSH for 22 patients classified as hyperthyroid ranged from 0.1 to 14.4. The TSH for the 18 patients classified as hypothyroid ranged from 0.1 to 123.5 Clearly this shows the futility of trying to medicate a hypothyroid patient based on TSH.
In addition, although TSH is supposed to accurately reflect the thyroid status of a patient, TSH cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate with symptoms, which should be the main concern.
In this link you can see just how poorly TSH correlates with Free T3 and Free T4. If the correlation were good you could take a TSH level and predict what the Free T3 or Free T4 would be. Clearly that is impossible because the correlation is so poor. So what is it that TSH is supposed to reveal? Not very much if you look at fig. 2 in the following link and also read through the additional links.
http://www.clinchem.org/content/55/7/1380.full
In addition, it is quite common for TSH to become suppressed when taking enough thyroid medication to become euthyroid clinically. That does not mean you have become hyper, unless you do have hyper symptoms due to
excessive levels of Free T3 and Free T4/ But if FT3 and FT4 are within range, how can a doctor claim you are hyper based on TSH, which doesn't correlate with either FT3 or FT4 or symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/3687325
"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 "
http://www.bmj.com/content/326/7384/311
"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."
http://www.ncbi.nlm.nih.gov/pubmed/1366242
"When TSH was suppressed, FT4 was elevated in 30.4% but normal in 69.6% of patients."
So you can give this info to your doctor and try to get her to accept that she is wrong about suppression of TSH when taking thyroid med. Or you can look for a good thyroid doctor that understands about clinical treatment by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just lab results.
Frasier WD, Biggart EM, O’Reilly D St J, Gray HW, McKillop JH, Thomson JA. Are Biochemical Tests of Thyroid Function of any Value in Monitoring Patient Receiving Thyroxine Replacement? BMJ 1986;293(6550):808-10
“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.”
Of 148 patients attending an outpatient clinic, 148 were classified by their clinical status by 4 qualified consultants with experience in thyroid disease. Of those 108 were classified as hypothyroid and from biochemical testing, their TSH ranged from 0.1 to 19.7. The TSH for 22 patients classified as hyperthyroid ranged from 0.1 to 14.4. The TSH for the 18 patients classified as hypothyroid ranged from 0.1 to 123.5 Clearly this shows the futility of trying to medicate a hypothyroid patient based on TSH.
In addition, although TSH is supposed to accurately reflect the thyroid status of a patient, TSH cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate with symptoms, which should be the main concern.
In this link you can see just how poorly TSH correlates with Free T3 and Free T4. If the correlation were good you could take a TSH level and predict what the Free T3 or Free T4 would be. Clearly that is impossible because the correlation is so poor. So what is it that TSH is supposed to reveal? Not very much if you look at fig. 2 in the following link and also read through the additional links.
http://www.clinchem.org/content/55/7/1380.full
In addition, it is quite common for TSH to become suppressed when taking enough thyroid medication to become euthyroid clinically. That does not mean you have become hyper, unless you do have hyper symptoms due to
excessive levels of Free T3 and Free T4/ But if FT3 and FT4 are within range, how can a doctor claim you are hyper based on TSH, which doesn't correlate with either FT3 or FT4 or symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/3687325
"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 "
http://www.bmj.com/content/326/7384/311
"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."
http://www.ncbi.nlm.nih.gov/pubmed/1366242
"When TSH was suppressed, FT4 was elevated in 30.4% but normal in 69.6% of patients."
So you can give this info to your doctor and try to get her to accept that she is wrong about suppression of TSH when taking thyroid med. Or you can look for a good thyroid doctor that understands about clinical treatment by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just lab results.
COMMUNITY LEADER
katinsc... your iron panel looks okay, meaning your iron level is not too high though your iron level could possibly be a bit higher. Anyway high iron is not what's causing your ferritin to be high. As I noted, inflammation can cause ferritin levels to be high and inflammation is quite common with hypothyroidism.
You should talk to your doctor about getting your dosage increased, at least back to where it was before your doctor decreased it.
You should talk to your doctor about getting your dosage increased, at least back to where it was before your doctor decreased it.
4 Comments
I took you advice and reached out to her, she said I had little room to move up but agreed to compromise and go with 90 mg alternating with 75mg every other day.
This may leave you feeling like a yo-yo.
Alternating days with a straight T4 medication makes sense as it takes WEEKS to stablize in your blood.
Amour has a lot of T3 in it. And it is used up literally in HOURS. This is why you should be splitting your Armour dose in half taking half in the morning and half in the early afternoon.
The T3 in the armour peaks in your blood about 4 hours after you take it. after that it s tarts to wane off. Which is why taking the 2nd dose in the afternoon helps keep the blood levels more level as the 2nd dose is ramping up, as the 1st dose is wearing out.
So alternating days of dosages of Armour may have a yo-yo efffect as you may feel better on the high dose day, and worse on the low dose day.
yes it is true there is also T4 in Armour. But it is in smaller amount and taking a small amount and averaging out the increase with altnernating amounts to a VERY small increase in the T4 levels.
I would recommend you still fight for a constant 90 mg every day.
Alternating days with a straight T4 medication makes sense as it takes WEEKS to stablize in your blood.
Amour has a lot of T3 in it. And it is used up literally in HOURS. This is why you should be splitting your Armour dose in half taking half in the morning and half in the early afternoon.
The T3 in the armour peaks in your blood about 4 hours after you take it. after that it s tarts to wane off. Which is why taking the 2nd dose in the afternoon helps keep the blood levels more level as the 2nd dose is ramping up, as the 1st dose is wearing out.
So alternating days of dosages of Armour may have a yo-yo efffect as you may feel better on the high dose day, and worse on the low dose day.
yes it is true there is also T4 in Armour. But it is in smaller amount and taking a small amount and averaging out the increase with altnernating amounts to a VERY small increase in the T4 levels.
I would recommend you still fight for a constant 90 mg every day.
Ok, I feel successful!!! She agreed to go to 90 mg a day and if my TSH becomes suppressed I would not stay on that dose unless you want to develop atrial fib and possible stroke, rx sent in, gets labs in 2 month.
Yeah!!!!
Barb-
So you recommend splitting dosage. Empty stomach both times, desirable time intervals?
Yeah!!!!
Barb-
So you recommend splitting dosage. Empty stomach both times, desirable time intervals?
Another question, since my FT3 and FT4 are still not at optimal level, I still have a supply of 15 mg, should I take that along with the 90mg? I believe I can refills that prescription 6 more times before it runs out of refills. Any thoughts? I know it's not what the dr prescribed but I barely go her to agree to the 90mg.
I agree that the Dr was ONLY looking at the TSH result.
The Dr was apparently not aware that it is common especially for someone taking medication with T3 in it (which Armour has a lot of T3 in it) to cause a suppressed TSH.
The Dr also didn't seem to give a rip about the fact that you reported feeling much better. And as stated by Barb, your levels were only begining to get into the range where sysmptoms are likely to decrease or be eliminated.
The result was the Dr lowered your dose and "Crashed" you. And this Dr will probably think the Current TSH is absolutely "perfect" as the medical schools teach them that the ideal TSH is between 1 and 2. And yours is almost exactly perfectly between that goal. They are also taught that TSH is the only thing that really matters. And that is an outright lie!
As you have proven that TSH has little to do with how you actually feel.
In fact I agree with Barb. If anything based upon your feeling better and the labs, even a small INCREASE in your Armour dosage would have been prudent. The fact that your Dr went the opposite way and you crashed PROVES that it was the wrong way to go. It also proves in my mind that your Dr if they do NOT listen to you about how more sickly you feel and will not raise your dosage to at least back to where it was. I would recommend RUNNING, not walking, away and find a new Dr. Because this one is sure to leave you feeling like crap and continue to not listen to you or how you feel.
The Dr was apparently not aware that it is common especially for someone taking medication with T3 in it (which Armour has a lot of T3 in it) to cause a suppressed TSH.
The Dr also didn't seem to give a rip about the fact that you reported feeling much better. And as stated by Barb, your levels were only begining to get into the range where sysmptoms are likely to decrease or be eliminated.
The result was the Dr lowered your dose and "Crashed" you. And this Dr will probably think the Current TSH is absolutely "perfect" as the medical schools teach them that the ideal TSH is between 1 and 2. And yours is almost exactly perfectly between that goal. They are also taught that TSH is the only thing that really matters. And that is an outright lie!
As you have proven that TSH has little to do with how you actually feel.
In fact I agree with Barb. If anything based upon your feeling better and the labs, even a small INCREASE in your Armour dosage would have been prudent. The fact that your Dr went the opposite way and you crashed PROVES that it was the wrong way to go. It also proves in my mind that your Dr if they do NOT listen to you about how more sickly you feel and will not raise your dosage to at least back to where it was. I would recommend RUNNING, not walking, away and find a new Dr. Because this one is sure to leave you feeling like crap and continue to not listen to you or how you feel.
Barb, it should have been 3.2.
This is last iron panel I had done-April 2016
Iron Bind Cap TIBC. 309. range 250-450
UIBC. 234. Range 131-425
Iron, Serum. 75 Range 27-159
Iron Saturation. 24. Range 15-55
I was sure how to interpret those numbers.
Kat
This is last iron panel I had done-April 2016
Iron Bind Cap TIBC. 309. range 250-450
UIBC. 234. Range 131-425
Iron, Serum. 75 Range 27-159
Iron Saturation. 24. Range 15-55
I was sure how to interpret those numbers.
Kat
COMMUNITY LEADER
Hi katinsc... Please verify the FT3 result in April. Was that really 32 or should it have been 3.2? It appears that like so many others, this doctor, too, is dosing by TSH levels, not symptoms or FT4/FT3 levels...
Even in April, your FT4 was short of the recommended mid range point, at only 32%.
The only thing good about your May results is the TSH, which is, basically, irrelevant... Your FT3 is way too low in the range and your FT4 is actually below range. Rule of thumb is for FT4 to be about mid range and FT3 to be in the upper half to upper third of its range. Your May FT3 is only 13% of its range.
You need to have an iron panel done to determine whether your actual iron level is high, making the ferritin level high or if something else is causing the ferritin level to be high. Inflammation can cause high ferritin and inflammation is common with hypothyroidism, which you, obviously have.
If your doctor is not willing to dose by symptoms and FT3/FT4 levels, I'd strongly advise finding a different doctor.
Even in April, your FT4 was short of the recommended mid range point, at only 32%.
The only thing good about your May results is the TSH, which is, basically, irrelevant... Your FT3 is way too low in the range and your FT4 is actually below range. Rule of thumb is for FT4 to be about mid range and FT3 to be in the upper half to upper third of its range. Your May FT3 is only 13% of its range.
You need to have an iron panel done to determine whether your actual iron level is high, making the ferritin level high or if something else is causing the ferritin level to be high. Inflammation can cause high ferritin and inflammation is common with hypothyroidism, which you, obviously have.
If your doctor is not willing to dose by symptoms and FT3/FT4 levels, I'd strongly advise finding a different doctor.
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