New New Labs and a weird new symptom?

[Brucergoldberg]

WOW.  im finally getting there.   DId i overshoot?    I have a new symptom that started yesterday.  I have pain in the area where the thyroid was removed.  I have never had this before until now.

My new labs on 340 MCG T4

TSH 2.15     range .4 -4.50
t4 free  1.6    Range  0.8 -1.8    WOW
t3 free   3.6!!!!    range   2.3-4.3


last month:


tsh 5.88   range .4 -4.5      ALMOST IN RANGE THANK YOU G-D
t4 free 1.4   0.8-1.8     UP TWO NOTCHES!
t3 free  2.8  2.3 -4.3     STAYED THE SAME

take my meds at night, make it til about 5 pm the next day and then the anxiety sets in etc.  Latest symptom is a weird pain where my thyroid used to be 9 months ago.  Am i going to fast?

Was on 340 MCG   just got bumped to 345 MCG to try to get me up a notch higher.....  

[stylegirl]

thx again, flying fool! i was thinking i might need a decrease in the T4 myself... I'll ask my endo...  :)

[flyingfool]

Your Free T4 are 72.6% of the range while your Free T3 is only 8.3% of the range. This suggests a significant conversion problem. That is for some reason your body is not converting the T4 into T3 efficiently, or is converting it to revers T3 which is not usable in your body.

You need a source of T3 which you are getting but maybe not enough.  You may want to discuss with your Dr a bump up in your T3 dosage and also a corresponding DECREASE in your T4 medication.  

The rule of thumb is that for every 5 mcg of T3 added you reduce the T4 by 20 Mcg.

If you are not having significant symptoms then maybe only a small bump in the T3 med is necessary.

As I posted above the target for many to feel well is FT4 50% of range AND FT3 to be 66.7% of the range.  You are at 73% and only 8%.  Over onFT4 and significantly under on your FT3.

Understand everyone is different but your numbers seem out of balance and you may want to try to get them better balanced.

[toni2251]

Hello,
I was reading your post and you sound very similar to me. I to had serious sinus surgery due to swollen nasal turbinates. Also, back pain, horrible nerve pain in my shins, headaches, I literally could go on and on.  If you have an autoimmune issues you are also dealing with nutritional issues that can lead to pain and disease.  There are a few things that helped me. My doc found that I was low in vitamin d, b12, magnesium, calcium, my t4 was low like yours so added cytomel twice aday.  I really had to reduce my stress. It was a key factor to my back pain. I also have changed my diet with juicing, fruits and veggies. B12 changed my life. The nerve pain really improved but has not diminished. Also levoxyl has helped better than levothyroxine. My sinuses begin to heal. My body is healing, I'm just dealing with depression from taking levoxyl. I cannot understand it but I know I will find the answers soon.  I hope these things help some, but nutritional defiencies can truly cause some serious issues. Just look into those things and keep calm and try to stay at peace. This will relax muscles in the entire body and help to relieve some contractions that cause pain. Don't misunderstand. I do not underestimate your condition which truly may need more attention, but please consider the follow info because it is all related with autoimmune issues. Hope it helps!

[stylegirl]

Also hope you're still doing well, Brucer... I've very much enjoyed your posts!

[stylegirl]

Hope your pad charges fast, toni!

[stylegirl]

Thx, flyingfool... LabCorp (last test site) ranges are below:

TSH 0.66  (0.450-4.500)
FT3 2.2  (2.0-4.4)
FT4 1.51  (0.82-1.77)

I was diagnosed 4 years ago with Graves and underwent RAI, so yes, I am now finally hypo. It is an autoimmune disease though, which my siblings are both hypo, but not autoimmune.

I agree the FT3 could be higher, but I am not at all fatigued any longer. I also realize being hypo can present joint pain, but the pain I'm experiencing now is more in my back than the previous minimal wrist and thumb joint pain I experienced while being in the 6.0 TSH range.

The allergy symptoms are the typical sneezing and running nose. The Zyrtec and Allegra I took to relieve those symptoms exacerbated the back pain and upon continuation of the drugs led to extreme thoracic, lumbar and nerve pain in my arms and legs. I literally felt like one of those little dolls made out of beads that when you push the button on the bottom, they collapse and when you let go, they pop back up! My spine felt like if I just moved a little the wrong way, the whole thing would collapse!

So I have now been off the Allegra for 3 days. The nerve and joint pain has mostly subsided and the back pain lessened, but still quite bothersome. I am also just waiting for the sinus problems to reappear. I don't then know how to quell those, as it seems like the antihistamines cause more problems than good.

I am wondering if the autoimmune disease has anything to do with the allergy symptoms. I know that the adrenals produce histamines and wonder if the disease somehow caused overproduction of histamine??? I had the ACTH test for the adrenals though and was told they were ok.

Stumped, with an achy back...  :(

[flyingfool]

you still did not list the reference ranges for each of the tests. These usually show up within parenthesis to the right of the test result.  

For example:  FT4 1.51 (0.8 - 1.8)

The numbers in parenthesis is the reference or sometimes called the "normal" range.  Normal being a statistical term. not the same as the opposite of abnormal.  Statistical "normal" means that if testing the entire population, 95% of the people would fall into this range.

I'm also interested in your "allergy" symptoms.  

As sinus problems are relatively common with people who are "hypo".  As are menstrual issues and abnormalities.  Joint pain is also but your back pain it seems you've found the cause of.

Using ranges we often see, Your FT4 seems like a pretty good number, but I think your FT3 is a bit low.  You being cold/freezing is also a classic sign of Hypo.

Since your body ONLY uses Free T3 hormone at the cellular level.  If you have a conversion problem you can have all the FT4 in the world but if there is not enough conversion of T4 into the FT3 that is needed. You will still be Hypo at the cellular level.  Also if the other medications have had impacts on your liver, the majority of the conversion of T4 into T3 takes place in the liver.

So in my mind it is possible that you in fact are hypo and need T3.  You may be very sensitive to the T3.  Many people have to start this VERY slowly at very small doses. You may also want to split the medication into two doses a day.  

T3 is used almost immediately (in terms of hours) while T4 is a storage hormone and takes weeks to stabilize in your blood. This is another reason why you may want to take T3 (Cytomel) in 2 or more doses so that it helps level out the amount in your blood rather than a single blast in the morning.  Most people take the 1st dose in the morning (along with T4 medication if they are taking it) and then take the 2nd dose of T3 in the early afternoon around 2PM.  Taking it later can cause some people trouble sleeping.

Please tell us more about your allergy like symptoms as well as getting the reference ranges.

Simply being somewhere within the so called "normal" range is NOT good enough for MANY people.  The better target for many seems to be to have the FT4 to be in the MIDDLE of the range (50%) AND ALSO their FT3 to be in the UPPER 1/3 (66.7%) of the range.  Notice that these are considerably up into the range.

Often times Dr's will tell a patient that they are "normal" and it "can't be their thyroid" simply because the numbers fall somewhere - usually in the very low end of the range.

[toni2251]

Hi I want to reply to you but my iPad is about to die. I have been through almost everything you've been through. I will post as soon as I charge my i pad. Talk to you soon.

[stylegirl]

Thx, Gimel... I'm new to the community, so still trying to figure it out!

My lab #'s and med dosages are in the copy above, but buried... LATEST (12/24/12) labs are:

TSH 0.66
FT3 2.2
FT4 1.51
still am on 75 mcg generic levothyroxine (Lannett, manufacturer)

T3 was also generic and was 5 mcg, which I took with the levo in the morning for about a month... it didn't seem to do much, so I stopped it.

I am not convinced that the back, joint and nerve pain have anything to do with the thyroid, as they were much too extreme and other Ankylosing Spondylitis or lupus-like symptoms presented themselves. Also, the fatigue did not accompany this last round when I tried generic a
Allegra for a wee. I also don't think the generic over the brand has any real bearing.

I took the Zyrtec at night without incidence for a couple months before starting the Levothyroxine, so I'm wondering if there is some correlation there. I learned about the negative effects of the Zyrtec from someone on the back and neck community, so they were not in the thyroid boat, which kinda destroys my theory there!

Thx again and I will start a new thread when I do some more research. Any others' opinions appreciated though...

[gimel]

Rather than attach your post to this thread, you will get much more response if you click on the green post a comment button and re-post under your own name.  Along with that, please post the reference ranges for the thyroid test results, as shown on the lab report.  What was the dosage of Cytomel you tried?  Did you take it all at once?  Have you been tested for Vitamin D, B12, ferritin, and a full iron test panel?  If so, please post those along with ranges.  What test was done for adrenal function?

More questions to follow.  LOL

[stylegirl]

By late September I began to experience more wrist and hand joint pain and an odd pain in the tendon connecting the shoulder muscle to the mid right arm muscle, as well as mid back pain.

By early October my TSH was down to 0.17, so the endo lowered my levothyroxine to 75mcg. She did not order a FT3 test at that time. She also agreed to add 5mcg cytomel (generic).

I had an L5-S1 fusion almost five years ago, but this pain was in the thoracic area. On October 2, 2010, I called my back surgeon who ordered xrays of the thoracic area which were unremarkable, but the rheumatologist still continued to point to a spinal issue, so the back surgeon agreed to an MRI on my lumbar as well as thoracic spine which again revealed that the spine was fine. They suggested it was muscular in nature, proscribing a muscle relaxer (tizanidine), which did not help.

By early November 2012, my counts were TSH 0.25, FT3 3.1 and FT4 1.4, but the back pain ensued, which was worse at night while sleeping than during the day. I eased it as much as possible with acetaminophen, as I still could not take NSAIDs.

By mid November 2012, the back pain was excruciating after being in bed for more than four hours. I would get up and go to the bathroom and just walking and moving seemed to help a bit. I would usually then go to the sofa and sleep semi-propped up which also seemed to help. I also found an older prescription for methocarbamol (muscle relaxer, anti-spasmodic) and hydrocodone/acetaminophen 5/500, which seemed to help, although they made me constipated. I also quit taking the generic Cytomel, thinking maybe it was the culprit and that it had not improved my condition since starting it.

THEN on December 4, 2012, I came across these medhelp posts and read one posting in which the female had the same back issues and she said she quit taking Zyrtec and her pain immediately subsided. That night I did not take the Zyrtec and voila! A great night of sleep!

By December 10, 2012 I was experiencing extreme fatigue and returning back pain. My pcp ordered a renal panel and kidney ultrasound, which again were unremarkable. I then on December 14, I had an adrenal test which ALSO was normal! On December 17, 2012, my fatigue was so bad that I went back to my pcp and she then surmised most of my problems were from lack of good sleep due to the back pain. She told me to take melatonin, so I bought 5mg tablets, which seemed to help a bit, but I was still waking up after four hours of sleep.

On December 20, 2012, I decided to try the generic Cytomel once again, but it seemed to make my heart beat hard, so I stopped it again after one dose. On a good note, I had a follow-up scan of my leg with the DVT and it had resolved itself, so I could quit the warfarin and now I can take Alleve when necessary for any pain!!!

Just before Christmas my sinus allergies came back with a vengeance! I couldn't quit sneezing and blowing my nose each morning.

I then thought that just maybe my back pain could have resulted from the generic Cytomel, as I had stopped taking it shortly before stopping the Zyrtec. So to relieve the allergies, I took a Zyrtec that night... the pain started back! After that one dose I immediately quit the Zyrtec again and put up with the returning allergies for about another week.

I tried Benedryl, but it made me tired. I started taking Allegra (generic) about a week ago and my back pain is not only worse, but my joint and nerve pain are horrible! Most of my symptoms seem to it seems to because of or aggravated by the antihistamines. I stopped taking the Allegra this morning and will see how my back pain is tonight and how the nerve symptoms are tomorrow. Now I don't know what to do about the allergy symptoms!

My latest thyroid counts (12/24/12) were TSH 0.66, FT3 2.2 and FT4 1.51, so my brain says that my symptoms are not a result of the thyroid issue, but possibly an autoimmune issue.

Could my body be producing too many histamines as a result of an autoimmune disease rather than my allergy symptoms being caused by external factors? I read that the adrenals produce histamines, but my adrenals tested fine.

I also read that Cetirizine (Zyrtec) can cause immune-mediated reactions in the liver, and I believe liver issues can cause back, nerve and joint pain. Could it be that because the liver metabolizes these antihistamines that they are causing toxic effects and giving me the symptoms???

I have all the symptoms of Ankylosing Spondylitis, but that is usually found in men and at a much earlier age... I am a 57 year old female! At times the lymph nodes under my arms are sore. I also have had some afternoons where my body temperature has dropped to 96.4 and I am freezing! Many of my symptoms also seem to have an inflammatory nature...so I'm hoping it's not cancer.

Any help is appreciated...

[stylegirl]

Hey Bruce... found these forums googling "flank pain while sleeping" and have read MANY! You seem to have, or have had, many of the same symptoms as I.

I will preface my story with the fact that my grandmother had a goiter and died of a coronary occlusion at age 53. I do not know any of the specifics and if the heart condition was a result of the thyroid condition.

My brother and sister (both younger), were diagnosed with hypothyroidism many years ago, although not autoimmune, and have both been on Synthroid, with no negative side effects.

My issues began back in March 2009, when diagnosed with Graves disease. The thyroid scan showed no nodules or tumor, so I opted for RAI instead of medication, which I now regret, as I ended up with Graves Opthalmopathy and proptosis of only one eye, as well as becoming hypothyroid and on levothyroxine as a result.

The thyroid took about a year and a half after the RAI (late 2010), to even get the TSH up into normal range. It remained in normal range until the beginning of 2012, when it began to enter the hypo range.

In March 2012 I was beginning to experience fatigue and nasal congestion. My pcp pu me on Zyrtec which ended up exacerbating my fatigue, so I discontinued using it. My blood tests also showed a positive ANA which did not alarm me. After all, I had been diagnose with Graves.

May 2012, I had made an appointment to see a new endocrinologist, as my old one didn't even test FT3 which I had read was important. He also dismissed fact that while on my way to becoming hypo I told him I was gaining weight and couldn't lose it even with increased exercise and decreased calorie intake. I had to wait until August of 2012 to get into the new endo, so did not begin levothyroxine treatment, even though it was probably called for at that time. (TSH was 5.48, but FT3 was ok at 2.39 and FT4 1.04).

Also in May, my nasal congestion worsened and I was waking up with near panic attacks from not being able to breathe. I saw an ENT who diagnosed me with rhinitis and prescribed prednisone, which did not help. I ended up having turbinate reduction surgery and again starting taking Zyrtec (generic) at night so as to avoid daytime fatigue and flonase steroidal nasal spray(generic).

At that same time I also began post meno bleeding and had a D&C which showed no cancer. My OB put me on progesterone which did not stop the bleeding, so he then put me on a birth control pill, norethindrone, which did stop the bleeding, but I ended up in the hospital (August 2012), with a DVT, which I attribute to the birth control pill.

I then had to start Lovinox shots followed by warfarin. My female hormones were also way off menopausal range and with a high prolactin count. Let me say that it was a couple months of hell!

By July 2012 I was beginning to experience minor joint pain in my wrists and thumbs. I went to a rheumatologist who tested for RA and lupus with negative results.

I finally made it to the new endo in late August 2012. At that point my counts were TSH 6.175, FT3 2.63 and FT4 1.01. She ordered pituitary scan which came out negative for pituitary tumor and put me on 88mcg levothroxine (generic).

[Brucergoldberg]

oh id pull a stella from time to time.   Gotta keep my name on the board...  

[Barb135]

Not sure I'd go for that increase, but you gotta do what you gotta do.... do make sure you keep a close eye on that FT4; you're kissing the top of the range.  I'd give my eye teeth if I could get  my FT3 up to 3.6....

Hope you keep feeling better....... and I agree with gimel - can't imagine the forum without Brucegolberg, but then I know where to find you.......  LOL

[gimel]

Great to hear Bruce.  It has been a long trip for you.  Hoping you truly are in the "sweet spot" for yourself.

Can't even imagine the Thyroid Forum without Brucergoldberg.  LOL

[Brucergoldberg]

Today i felt great.   Best ive felt since 2009.   I picked up my new dose today,  which is 345 mcg   up from  340 mcg.  This is where i land.   Im coming in for a landing.   Im waiting 6 weeks before my next test.

I often wonder if people stop posting after they get better.   I am about to find out.   :)   thanks y'all!!!

[Totie]

"obsessing"  

Being the operative word.

[artfemme]

Excellent news, Bruce ! I seem to remember you didn't do well on time-release, which would be my only other suggestion. Good for YOU, hope whatever you and your doc decide, that you continue to feel so much better.

[kl42]

bruce listen to your doctor not these  web experts

[flyingfool]

Getting "a" number "a little bit better".  means nothing.  because everybody's number that is optimum for them individually is specific to a person.  So "better" is a COMPLETELY relative term.

Bruce this is probably the best you have ever felt.  And you are now messing around with TWO or more hormones now that you are adding Estrogen/Testosterone into the mix as well as Thyroid.

I would not recommend doing anything but going SLOW, SLOW, SLOW.  there are a LOT of things that need to settle out. ANd hormones are very complex and any one seems to affect another and the ripple effect goes on for a long time.  Kind of like dropping a rock into a small calm pond.  The ripples are many and go out and reach all side of the pond and are reflected back.

Since you are now throwing multiple rocks into the proverbial pond.  I would REALLY, REALLY want to wait and let the waves settle out so your body can adjust and stabilize.  

Then only change one thing (only toss one rock) into the mix (pond) at a time.  And I would recommend the rock be more like a pebble than a rock.

Just my opinion.  Take if for what it cost you for me to provide it.

[Barb135]

Stop obsessing about every single sensation or pain and let it all settle, or you'll  make yourself nuttier than you already are.......LOL

[kl42]

id get that numbers a little better then stop . be carefull not to go hyper. a 5  probbale wont do it but you retEst every 4 weeks so you will know. then hold  and rtetst  every 6 weeks. you can still go hyper later as your body adjust to the meds.  but be carefull now with increases. your close now. kEVIN

[flyingfool]

I agree with Goolarra & Barb.  Stop where you are at and wait a while.

Often times symptoms lag behind blood labs.  

you have been on a roller coaster from hell for a few years. Why not wait 6 more weeks?  What the heck is  6 weeks compared to several years!

I agree a 5 mcg jump is a very small percentage bump.  But I would wait at least 6 weeks. Maybe more depending upon what the next blood labs showed.

[Barb135]

TSH is diddly squat... your FT levels are better than mine, after 5 yrs on med - agree with goolarra; stop and let it all settle.

As for the pain where the thyroid used to be?  I have pain in my mouth sometimes, where there used to be a tooth, but is no longer.... I've heard of people who have lost limbs, but still have pain where the limb(s) used to be...... it's a phenomenon for which there often isn't an explanation.

If I took note of every ache/pain/odd sensation, I'd just have to lay down and die, because there would be too many symptoms to chase. Stop obsessing and move on with your life.