Labs

[Gloworm358]

Can someone interpret how my Labs look? 4 months on .50 mcg Synthroid. Hashimotos with goiter/nodules.
I have attempted to find my old post from a while back but cannot locate it. Trying to get more familiar with board options. Apologies.

Free T4 1.32 range .82-1.77
TSH .650 range .450-4.50
Free T3 3.3 range 2.0-4.44
B12 529 range 211-946
Vitamin D 24.8 range 30-100 (I know this means I am D deficient)

TIA!

[Gloworm358]

Thanks!!

[goolarra]

For meds to help shrink a goiter, you have to be on a sufficient dose to give it a rest.  Perhaps your doctor should have taken the fact that it didn't shrink as an indication that your dose was too low?

I would think your thyroid would be on it's last leg at this point, but sometimes the destruction takes a long time.  Mine, at least, has died peacefully.  I think most do since they get to a point where they are producing so little that they can't flare up anymore.  

A deficiency of D or B-12 will make you tired.  A deficiency of both is a double whammy.  Give it a little time.

[Gloworm358]

My Endo seems to think that since the thyroid has not shrunk over the last year on meds, that the compression only has the capability to get worse or remain the same, in which case she says that compression issues could exist for a long time before thyroid begins to die. She didn't discuss any additional health worries that concern her in terms of the size.
I am 37 now and while I have been treated for Hashis for a year, the amount of scar tissue and size indicates that I have had thyroid swelling for 6-8 years at this point. Do I have that many more years before it dies? I mean, I assume I'd rather it died than go through surgery. But I really don't know that much about it to be honest. I'm google-learning now concerning the surgery and indications to remove the thyroid.
I was a little surprised that we were discussing taking it out.  
I am happy to move my Synthroid up a bit. I'm taking a 50 mcg and cutting a 25 mcg in half. Been on the new dose for 3 days and have been SOOOO tired. But I'm sure that's my Vit D and B that I'm trying to get up, and not med changes. And of course I'm hyper aware of anything to do with my body these days, which probably isn't a good thing ;)

[goolarra]

The object of thyroid treatment and thyroid surgery (except in the case of cancer) is to feel well.  If the compression doesn't bother you all that much, perhaps it's not worth the surgery.  Has your doctor indicated that the compression might create further health issues?  

Once your thyroid is dead, it typically starts to atrophy.  Mine is a lot smaller than it was a few years ago.  

Low BP is a symptom of hypo.  Increasing your meds might raise it, too.

[Gloworm358]

Thanks so much for the reply!
I had my appt. My thyroid has not decreased in size, but it hasn't increased much (minimally) either. However, my Endo at this point, after a year on meds with no thyroid/goiter shrinking, has suggested that we think about removing the thyroid due to compression on the windpipe. As she put it "You're young, and you have a lot of years left to deal with compression issues." She believes it's not shrinking bc it is mostly scar tissue.
At the appt my BP was low (89/50) and she believes that is due to issues with my cycle (adenomyoisis, csection scar interior bleeding, increased uterus size), for which I am finally having a hysterectomy in December of this year. Due to that, she would like to discuss removing the thyroid after my surgery in December in the hopes that my BP will normalize. She has suggested that if we do decide on thyroid removal, we should aim for  next Spring.
She did increase my Synthroid in the meantime from 50 to 62.5. She also said that if we do see a decrease in thyroid size when I go back in March, that we could decide against a thyroid removal at that time.
However, I know that removing the thyroid brings about a host of other issues. Is it better to just live with the compression issues in my case (which don't seem to be that bad at all) or to deal with the side effects of removing the thyroid?

[goolarra]

The fatigue may have had to do with your D level.

Some people find selenium helpful for that tight, or full, feeling in the thyroid.  You might try that.  Follow label directions, though, since too much selenium is worse than too little.  Your ultrasound will confirm if your goiter is getting larger.  If it is, a little increase might help shrink that.

It's never a good sign when a doctor doesn't embrace FT3.  However, if she orders it at your request, you could be doing worse with someone else.  Your FT3 doesn't indicate, at this time, any conversion issue.  

One explanation for the small change in FT4 could be that your thyroid continues to produce less and less all the time.  Your numbers aren't terrible, but they're also not what we'd consider optimal.  So, it's a matter of if you're happy with how you feel or not.  If you are, you could stay at 50 mcg; if not, there's plenty of room in your labs for an increase.  If I were you and I thought I could feel better, I'd probably try an increase to get FT4 closer to 50% of range to see if that helps.

[Gloworm358]

I think I'm also feeling a little disheartened that my FT4 is close to what it was a year ago before I was even taking medication (1.06 a year ago, 1.13 now).

[Gloworm358]

Thanks for the reply :)
Back to taking my D vits, so hopefully that will go up soon.
I'm feeling pretty ok. I was very tired last month for a couple of weeks, but that seems to have gone away. I've had increased difficulty swallowing and a choking sensation at times (goiter), but I honestly don't know if I'm concentrating on it too much or if it is a legitimate issue. I hope to have more info next Tuesday after my ultrasound.
Based on my numbers and how I feel, do you think I'm good to stay at 50mcg? My Endo doesn't even regularly run FT3 (I demand it), and I wonder if I need to find an Endo who looks at all the numbers. I LIKE my Endo, but her lack of interest in my FT3 makes me uncomfortable with my treatment.
Thanks!

[goolarra]

Your FT4 is still a little on the low side at 33% of range.  FT3 is at 33% also, which is low of the upper half target.

As you said, your D is way too low.  Mushrooms?

How are you feeling?

[Gloworm358]

Updated labs prior to ultrasound and endo appt next Tuesday.

TSH 2.01 Range .450-4.50
FT4 1.13 Range .82-1.77
FT3 2.8 Range 2.0-4.4

And my Vit D is back to 27 bc I had a stomach bug and my stomach has been ridiculously sensitive to vitamins.

[goolarra]

Your B-12 is way too low.  In many countries, B-12 range starts at 500.  So, if you lived somewhere else, you'd barely be in range.  Many people need B-12 in the top of, or even above, range.  Have you tried supplementing with just B-12 (not complex)?  Once you do, be sure to be tested again.  Pernicious anemia, the inability to absorb B-12 through the gut, is another autoimmune disease.  If you have PA, oral supplements will do you absolutely no good whatsoever.

I'm not a big believer in supplementing "just in case".  If your selenium level is low, it could impact conversion.  Be careful of selenium, though, and follow label directions.  Too much selenium is worse than too little.  Brazil nuts are a great source of selenium...1 or 2 a day is plenty.

I take magnesium because I have a heart arrhythmia.  Which magnesium you take is of the utmost importance.  Mag oxide is just about useless (except as a laxative).  You want mag citrate or mag glycinate if you want your serum mag level to go up.  Ideally, it's best to test for deficiency before beginning any supplement.

Mushrooms are also a great source of D, and they have very few calories.  

If you can get your nutrients from food, you're much better off than with supplements.  

[Gloworm358]

And while I'm discussing vitamins, I read on here of people taking magnesium and selenium, etc. Is there anything else I should be taking besides my normal D3 (4000IU p/day) and the B12 or BComplex I'm adding?
Thanks!

[Gloworm358]

This was my January number. I haven't been tested again since then.

B12 529 range 211-946

[goolarra]

If she said B vitamin"s", she probably meant B complex, but I'm only guessing.  B-12 deficiency can certainly cause unbelievable fatigue.  You should give her a call and pin her down.  Has she tested any of your B levels?  

[Gloworm358]

Since my levels are stable, Endo recommended simply upping B vitamins which apparently helps with fatigue? But I have no clue which B vitamins....help?! I was taking B at one point but I stopped due to stomach issues.

[goolarra]

Everything is pretty much the same.  D has come up some, but still has a way to go to be optimal for thyroid health.  

Adrenals are not my forte.  You're pretty low in the range, but I don't know if that's much of a problem or not.  

Are you going for an increase?

[Gloworm358]

Well, my labs actually look almost exactly the same. FT4 actually came up slightly. And Vit D is at 34.2 now Range 30-100.

TSH 2.79 Range .45-4.5

FT4 1.06 Range .82-1.77

FT3 2.8 Range 2.0-4.44

[Gloworm358]

Thanks goolarra!
I got some additional labs back today in reference to the hyperpigmentation issues I was having (I asked some questions on the Addisons Board as well). I haven't heard back from the DR yet, but my 8.8 morning cortisol level was within the ref range of 8.0-19. As long as it is in range, that number is fine, right? TIA!

[goolarra]

I do think a small increase would be good.  Just take it slowly, have labs about four weeks after an increase and do it again, if necessary.  It's not fun to be tired and freezing, although they're say 100+º here this weekend, so your personal a/c system might not be so bad!  LOL

It gets easier the more thyroid function you lose.  Once the thyroid is dead, it's a whole lot easier to manage.

[Gloworm358]

Thanks so much! Seeing that percentage really helps me understand where my numbers have moved to!
I had labs drawn this morning and will have results tomorrow. If my FT4 and FT3 have fallen more, would you think a small increase would be advisable? I don't want to go hyper, but I also hate being so fatigued and cold.
Hashimotos is the pits...never knowing when the thyroid is going to wake up and do some work is frustrating  

[goolarra]

Damn, that line looked so pretty when I typed it!  The 1.32 should be right under "Jan", and the 1.77 should be right under "High Range".

[goolarra]

Those really aren't small changes in FT3 and FT4.  If you look at FT4, for example, the change doesn't look like a lot, only 0.3.  But the whole range is only 0.95.  If you look at those two results as a percentage of range, 1.02 is only 21% of range, but 1.32 is 53% of range.  That's a huge move.  You were above the middle in Jan, now you're well down into the bottom quarter.

Here's how it looks visually on a line:
Low                                                                                   High
Range        May                        Jan                                Range
0.82           1.02                       1.32                                  1.77                        
----------------------------------------------------------------------------------

You can see how much your place has changed.

You can't really draw any conclusions about whether your numbers will keep going the wrong way.  When we lose thyroid function, it's seldom on a nice, smooth downward slope.  Instead, you can go along for a long time with little change, then suddenly fall off the cliff.  It's impossible to predict.  I agree with your doctor that an increase is in order if this continues.  Just take it slowly...  

[Gloworm358]

I'd love anyone's comments on this. For some reason I keep addressing my replies to only one person even when I'm posting generally :)

[Gloworm358]

Well, I put it off a few days to see if I felt better, but I'm still cold and spent most of the weekend napping which is odd for me.
Called Endo and they want to do another blood test since my last one was a month ago. She looked at my prior labs and said that my numbers had changed a good bit between January and May so we might need to increase if those numbers are still moving in the wrong direction.

In all your free time, can I ask more questions?

Last labs my numbers changes as followed:

Jan-May TSH moved from .65 to 2.8 Range .45-4.5 Target 1.5

Jan-May FT4 moved from 1.32 to 1.02 Range .82-1.77 Target 1.295

Jan-May FT3 moved from 3.3 to 2.9 Range 2.0-4.44 Target >3.22

Would such small changes in FT4 and FT3 cause hypo issues? I guess I'm wondering how much leeway there is in these numbers. And would these changes on the same 50 mcg dose signal that these numbers will keep going the wrong way?

TIA!