Liver and T3 conversion / high Bilirubin anyone?

[LazyMoose]

I bet Stella knows this (?), but it's also a poll / question for any that have it - so please respond, its a rare question!  

My question comes up after I was reminded that T3 is converted via the liver on another post. Thyroid is linked with so much other stuff its hard to keep track!

I, like many here, might have a T4 to T3 conversion problem that does not show on the lab tests. I dont know how a conversion issue is proven, is there a way? My docs dont seem to know or care about conversion. All I know is I feel somewhat better with T3 in dessicated and I am driven to find out the very reason. Below may or may not be the reason why.

I just had a AMA comp panel (physical), and for years my Bilirubin is over the range (double!). Doc always brushes off the high Bilirubin since the other liver tests are OK. This has something to do with the liver and Juandice. My other liver tests (Alkaline Phosphate, AST and ALT) have always been and still are in the middle range, they are OK!. There is a name for this unbalanced condition.

My question(s): 1) Does anyone else have high Bilirubin with Hoshi's and have the other liver tests in range?

2) Anyone no what high Bilirubin has to do with the Liver converting T4 to active T3 in a Hoshimoto Hypo person?

Thanks, getting educated on this for my next appt if need be. I will admit I don't know much about the liver, but I know enough to take it easy on Tylonel (and booze)!

Moose

[goolarra]

I don't have the liver imbalance, but one thing struck me in your post..."I, like many here, might have a T4 to T3 conversion problem that does not show on the lab tests."  A conversion problem should be apparent on lab tests IF the physician reading them has any real expertise in thyroid issues.  What is your FT4 and FT3?

[thyroidian]

hi, ive just read your post, ive had graves disease for 11years, and i have a high bilirubin level in my blood, it also shows up in my urine as well, but dont know what it means?
The doctors dont seem to be interested in it. So i would be interested to know more if you find out please let me know.

[redheadaussie]

There are some many reasons why a person has high levels of biluribin  in their blood. I have not seen any of them related to thyroid disorder though. Hepatitis is a common reason. Often it is just one of those things that some people have higher break down of red blood cells than others.
There IS a test to find if you have a conversion problem. It is called Reverse T3. Unfortunately you may have to fight to be heard on this one, as many doctors do not even believe in it to start with. Also it is expensive. BUT having said that, if you find you have a high level ( it is worked on a mathematical formula and very confusing too!) then you know you have a conversion problem.
I myself am going through the whole works of the conversion of doctors into believing the results of my own conversion problems!
Cheers!

[Smilerdeb]

High bilirubin level is usually with either high cholesterol or Gall bladder problems.
Get those checked.

[stella5349]

OK - In my eyes - here's the jest...

On the conversion tests... RT3 can be associated with a conversion issue - but it is only one sided. A reverse T3 is the test to determine if the T4 conversion is storing the active hormone and really turning it backwards into RT3 - that is why the idea of removing the patient off T4 meds and putting them on a T3 ONLY med is given. To eliminate the reverse T3 hormone and release it to active T3 - with only a T3 med used.

On the conversion issues - that is pretty simple. An educated look at the Free testing can determine if you have a conversion issue. a high FT4 reading and a low T3 reading on any thyroid meds - could determine a conversion issue. That is simple math. BUT a range of testing on frees is look at and if you fall within the normal limits then usually a doctor will only look at one test or the other to determine the increase or decrease of meds to balance it out - of course with the TSH being their guide more so than the others.

You have a high enzyme count when it comes to the bulirubin results. It is enzymes of the liver that is creating that. Can Hashimoto be associated with that? Most definately.

AMA tests and Alkaline Phosphate, AST and ALT determine different issues of the liver and what is faulty. Can it peg out thyroid levels - no I don't think so.

But you have to always keep in mind that the liver is our filteration of us as living beings. What we take in - must be purified for our bodies to live well. Meds in any form - if swollowed - must be filtered through our livers and this will caused disruption.  Keeping the body cleansed is the best and BTW - a good lemon and water drink is wonderful to keep that organ clean.

Now - with Hashimoto hypothyroid - we swing into rages of hyper and hypo. Where are those hormones going? You guess it - the liver. the liver will fall responsibile to filter out the bad hormones- access - so where to those excess hormones store. Liver.

Slow production (hypo) causes the liver to become starved too. It knows it must filter the bad - but it won't work properly when nothing is feeding its way. What will it do? It (as weight is for hypo's) stores the bad stuff inside and becomes ill itself - because the body is not moving in the right gears to keep everything well.

Hense - high tests

Flush your livers - it's our life filtering machine.

[stella5349]

Oh and ditto on Smiler Deb - it's so associated with high cholestrol tests.

[LazyMoose]

Goolarra and/or anyone good with labs:
I'm due for a new test in two weeks, here is some past labs. For some reason my muscles recover quicker on dessicated, its a fact after 5 months of trial. Less brain fog too. But still a little tired.

Keep in mind I dont know if I ever had the old Armour, As I switched in mid may from Synthroid.

June: alternate between 90mg and 105mg Armour per day

free T4     .71     range is   .71 - 1.85 ng/dl
TSH       3.87     range is   .30 - 5.00 uIU/ml
free T3    3.08     range is 2.30 - 4.20 pg/ml

August alternate between 105mg and 120mg Armour per day
free T4     .87     same range
TSH       2.56     same range
did not do free T3 this time

I was still ramping up on the Armour a little between June and August, I am now on a generic dessicated with the same ratios per grain of T3:T4 as Armour. Was ramped up again to 2 grains (on this generic 2 grains is 130mg like Nature -Thriod mg's).

I will ask specifically for free T3 on my next test in two weeks

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Smilerdeb :
-My doc got back to me - High Bilirubin, but with good labs on other Liver functions is called Gilbert's Disease and is genetic. He says its not really a disease - still makes me wonder. My cholesterol is really good for a 42 year old. I will ask about the gallbladder, good point! (hope my doc wont put up a fuss, when dont they?).

Stella:
- I will look into a good liver cleanse, Enzyamatic Therapy brand should be safe and is from the cheese head state! He// we got Brett Favre now, might as well try your brand of liver cleanse too! Purple and Gold really aren't his colors though.

Thanks all - everyone

[LazyMoose]

I will ask my doc about reverse T3 test if needed after you guys look at my labs.

Thanks

[stella5349]

After all his moodiness, Mr. Farve doesn't look good in any colors in my opinion. . You don't necessarily need to go straight for the gusto on a harsh liver cleanse. Purifying the liver should be a simple daily thing to keep levels good. Depending on the toxin level your liver is at - this is where you learn what's best for you too.

Straight lemon water throught the day is wonderful and there is a supplement that could help too. Bioavailable Diindolymethane ( or DIIM) for short can help rid those toxins too. It doesn't give you the nasty side effects of a cleanse either.

[Smilerdeb]

Iced lemon tea does it for me....I had bad levels from anti-thyroid meds and the iced lemon tea fixed my liver up.

[goolarra]

WHY don't they do FT3 every time, especially when you're on a T3/T4 combo med?  That's a rhetorical question....

So, in June, you were still pretty hypo with a TSH of 3.87 (currently accepted range is 0.3-3.0 - your lab and doctor, like most, are using the obsolete range).  FT4 was on the floor, but FT3 was into the mid third of the range.  You were definitely not lacking T3 relative to your T4 levels.

How long after the switch from Synthroid to Armour were those June labs run?  Did you take your Armour before the labwork?

By August, your TSH had fallen into range, and your FT4 had improved, though still pretty dismal.  Unfortunately, we have no clue what FT3 was doing.  

Do you know what your FT3 and FT4 looked like prior to starting Armour?

It will be interesting to see your labs in a couple of weeks.  WIth the last complete labs done in June (3-4 months ago), and incomplete labs with no T3 done in August, and meds changes in between, we don't have a lot to go on.  

Your muscles recover quicker on Armour because of the T3 content.  The biologically most active hormone is available to them.  However, in June, your FT4 was so low that there was very little T4 available for conversion to T3.  When that's the case, your body will "protect" itself.  The brain, the heart, other essential organs get their share before the muscles (which are expendable - you and your body may disagree on this point!) do.

Since you're on meds with a high T3 ratio, it IS difficult at this point to figure out if you have a conversion problem.  When you were on Synthroid, were labs ever run that had TSH and FT4 in range (and off the floor)?  However, until your FT4 gets up higher in the range, I wouldn't be too quick to jump to the conclusion of a conversion issue.  Before you think about a conversion issue, you have to have enough T4 there TO convert.  Your FT4 still has a long way that it can go.  

Is your fatigue sporadic?  Certain times of day?  Do you split your Armour dose?

[LazyMoose]

How long after the switch from Synthroid to Armour were those June labs run?  Did you take your Armour before the labwork?  I was on Armour for about 12 weeks prior to that June test. The test prior to that looks better but the doc did not ramp me up so I felt hyper and shaky - dont think the test is worthy since I felt realy bad. I have my lab work at 8:30 am before I take my meds to be consistant.

By August, your TSH had fallen into range, and your FT4 had improved, though still pretty dismal.  Unfortunately, we have no clue what FT3 was doing.  I cant believe they did not do T3, very dissapointed!!

Do you know what your FT3 and FT4 looked like prior to starting Armour? My last test on Levothyroxin after 10 years was Jan this year:

Free T4    1.4       range .71 - 1.85
TSH           .67     range .30 - 5.00
Free T3    3.49     range 2.30 - 4.20

During this time (above) my fatigue was very sporatic (sitting and driving) and I had major muscle spasms. This was with a good multi vitamin. I do know something about vitamins / supps. I take more Mag and potasium for muscles, it helped a little, but not for fatigue.
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After months of Armour I am less tired but not yet normal energy. I have to keep active. I am now layed off work so its hard to judge my energy levels.  My doc would not test for D, said its not proven! I tried 3000 ui of D last month and it might have helped. I lowered back to 1000 ui of D because you cant try out two new things at once- I really need for the dessicated to level out before I try changing vitamins to know what helps and what does not. So, time is on my side for that, until my ins runs out. If that happens I will use a new cash doctor I spoke with and a cash lab I found.  Doctor $40 , lab $80.

thanks

[goolarra]

I know, getting FT3 is like pulling hens' teeth.  I have to check on this before every blood draw.  

I find your January test interesting because even though you were on a T4-ony med, your FT3 looks really very good...it's at the very top of the middle third of the range.  So is your FT4 for that matter.  And January labs look way better than either June or August.  

When I was hypo, sitting was deadly for me.  As long as I kept moving, I was fine, but the minute I sat for more than about ten minutes, I was asleep.  I'd categorize it more as a kind narcolepsy than fatigue.  As long as I kept moving I had plenty of energy.

Good idea...only change one thing at a time, otherwise you have no clue.  

It looks a lot to me like you're one of those people who has to have FT3 and FT4 well up in the range before all your symptoms are relieved.  I don't really see any indication of a conversion problem.  (RT3 would confirm that.)  Your labs really did look good in January, and with just mild fatigue lingering, a small meds adjustment to nudge your numbers up just a little might have done it for you. I'll be interested to see what's going on now.  

[LazyMoose]

I do feel better now on dessicated (with not so fantastic labs) than in January with good lab levels on T4 only. But I'm still not symptom free. Even though my Jan labs numbers look good, I felt like garbage, - like many years prior. I was the classic looks good on labs, but still symptomatic T4 patient. So if its not a conversion issue its good to know. I always look for a reason for things, somethings take longer to figure out.

Will post new labs in a few weeks.

[ann4512]

hi bilirubin is called gilbert syndromedoc arnt to worried about it,well that's what my doc told me last week.i have grave's one year now but i did have a high bilirubin when i was expecting my daughter 2 year's ago it did settle down it was in the thousand figure's it's now at 48 in july it was at 38 but was told not to worry you can look up on computer to get more info ,xxx

[goolarra]

Well, there is no point in having "perfect" numbers and feeling like cr@p.  The object is to be symptom-free.  

You could have a conversion issue...I'm not a doctor, but I just don't see it in the labs you've had so far.  Usually, if there's a conversion issue, FT4 will be high (or higher) and FT3 will stay low.  Of course, once you're on a med with T3 in it, that can get a little muddled (less so if you consistently take your meds after your blood draw).  But, I don't see it in your January labs, either.

You may just need a little increase in your Armour.  It'll be interesting to see the labs.  

[goolarra]

Oh, and I keep meaning to ask...Who is Billy Rubin, anyway?

[redheadaussie]

Billy Rubin is the cousin of Arthur Ritis!

[LazyMoose]

Goolarra -"WHY don't they do FT3 every time, especially when you're on a T3/T4 combo med?  That's a rhetorical question...."

I just asked the clinic to include my free on my lab test this week T3 since I was taking T3. There answer "we usually don't test T3 on patients taking it because the T3 in Armour will falsely elevate it, it will not be accurate" That was the nurse I always have to talk to. She needs to stop playing doctor, I am losing patients with this woman.

Well, they might as well not test T4, since I am taking that also!

This is supposed to be the best Endo place in this state, they clearly don't know much about managing thyroid. I didn't even think of asking about Reverse T3, I'm sure they think that is non-sense. I will have to demand free T3. Even though the doc did prescribe Armour at my request after years of symptoms on T4, this is clearly what I call a TSH, Synthroid clinic! That's the age we live in. They didn't want to do vitamin D either, that's a subject on another post!

Inadequate medical testing  is what let a sometimes curable disease take my fathers life in 1993 so I have developed zero patients for clinics that only treat symptoms half heatedly after the fact. We are their customers and they don't get this.

Geez, I had to vent twice today- about our medical system!

Anyone with a great doctor - remember to be thankful you found him/her !

Moose

[goolarra]

I wish I could tell you you're overreacting, but your tirade about the medical/industrial complex pales in comparison to some of mine.  I haven't had a PCP do anything right lately.  On the other hand, I have found a great endo (sheer luck) and recently saw another specialist who impressed me.  I'm really beginning to believe that you now have to diagnose yourself and refer yourself to someone who knows something.  If you need a tetanus shot, see your PCP, otherwise, forget it.  Of course, as with your experience, a specialist isn't any guarntee, either.

The T3 in Armour will effect the test, but if you consistently don't take it until after the bloodwork, there isn't much hanging around from the day before.  Furthermore, as you said, why test T4 based on the same logic?  

You're right...we are the customers and we're paying dearly for the round 'em up, move 'em through medical mentality.  

Just remind them you're paying for this, and you want FT3.    

[LazyMoose]

Well said.

And Billy Rubin? ......I think he was in a Monte Python movie.

: )

[stella5349]

what a rediculous comment made by your doctors office.

"There answer "we usually don't test T3 on patients taking it because the T3 in Armour will falsely elevate it, it will not be accurate"

Oh my Lord.... If you are taking anti cholestrol meds - aren't they going to test your HDL and LDL to see if it's working?"

Where are these doctors getting these answers?

I am finding the the "best" so called thyroid doctors/specialists are the most closed minded.

It seems - at least as I take it - the little guys in a hole somewhere are really the ones who look at these tests and people walk out much better from them then going to the biggest hospitols around.

[LazyMoose]

My thought on specialists also! They hate that fact that I'm on dessicated. When I told them about the shortage, I think they silently smiled. Then I found the generic and they fround (on the phone). There speech of "we have 700 thyroid patients and only 15 on Armour, so you probably dont need it either!" Well maybe I am # 16.

The thing is, the Mayo Clinic in this state does not reflect at all with the rest of the medical community here.

Yes, some hole-in-the -wall , old school docs are the best.

[LazyMoose]

I think the thing is with these doctors  comments, is they think patients are stupid and can not possibly understand the human body. When we know more on a specific subject they feel threatened. And they should, that is exposing there lack of interest in a specific subject. It blows me away when a doctor starts off with "well back in medical school , bla bla ,bla"  Which tells me some never self learn after school. Once out of med school thats it, and close the mind.

I think the real difference is in a doctor who is just in it for the money and status (80%-90%?), and those that have a real interest in healing people. If not interested in healing people one should not be in medical, duh.