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20202111 tn?1492379275

New Thyroid patient-need guidance on labs taken after start of medication

After 2 ER visits, 1 Urgent care visit and 7 visits with 3 doctors. I had zero resolve to why my feet were like blocks of ice and I was shivering, trembling, dizzy and constantly feeling like I was going to pass out.  Body temp of 95.  This started January 10th and by the time March rolled around, I could not even lift myself out  of my bed, I was so weak. When they had no answers, they prescribed one antibiotic after the other. So in the course of 3 months I was given 5 different antibiotics.  I told them I suspected my thyroid because years ago my health insurance actually allowed me to see a functional medicine practitioner and she had run labs on me, this was 2012 and she said I believe you are having trouble with your thyroid. She prescribed Nature throid and I filled the script and one week later, I was laid off from work. I did not take the medication as I did not have any one to guide me through it. When I began working again and was covered on a new health insurance plan I went to my primary physician ( the new insurance would not cover any visits to the functional medicine Dr) and I told him that my previous physician thought I had a thyroid problem. He ran the usual TSH and free T4 and said, nope you are fine.

Fast forward to March 2017. I know I'm new here and you don't know me, but I am far from a drama queen. I am not over exaggerating when I say I truly believed I was dying. I've never been so weak in my life. I could barely breathe, I was so weak and so cold. I had zero strength. I live alone with no family so it was very frightening. I kept picturing the evening news announcing that a 54 yr old woman was found 5 days after she died alone in her home., clutching a basal thermometer in her hands. Each day was getting worse and I was missing a ton of work. Finally bit the bullet and made the appt for the Dr. I had seen back in 2012, paying out of pocket. The appt was 03/15.  For 4 days I could not even move from the futon. Out of shear desperation on 03/14 I took out that script I filled 5 years prior and I took 1/2 grain ( 1 pill) of that Nature throid she had prescribed me. Within 2 hours I could stand, 5 hrs later my body temp slowly started rising. I was not even close to well, but that little experiment told me my body needed whatever was in that tiny pill. Saw the Dr the next day and she gave me a new script for WP Thyroid and started me on 1/2 grain and told me to raise by 1/4 grain every 3 to 4 days to tolerance. On 04/03 I reached the 1.5 grain mark. Below are my lab results taken 03/15/17. Then taken 6 weeks later on 04/26/16 to reflect numbers while on a low dose of thyroid medication. In that 6 wks I have researched everything under the sun about all of this and tried to plan my course of action.  I have multiple medical issues, type 2 diabetes, kidney stones, fatty liver, was tested back in 2014 for Cushings due to swollen adrenal glands found during my pap smear. Tests did not indicate Cushings per the endo. Who knows. I've been well aware of the major inflammation due to high C Reactive tests. Seems it's pretty standard for us Syndrome X patients to have most of these issues. I've tested vitamin levels, female hormones, saliva cortisol.  None are normal.

When I posted my first set of labs to the STTM ( stop the thyroid madness) facebook page. They told me I should not be on any medication. They said my thyroid showed it was working and until all the other issues are resolved I should not be on any medication. They said it would kill my thyroid.  I was so upset because without that medication I could not have returned to work. I don't have the luxury of staying home and healing adrenals as was suggested. I did contact my doctor and ask her if I was destroying my own thyroid by being medicated, she said she had never heard or read that. I had to take the chance.

I need to know what my goal is after these results. Continue on low dose NDT and add T3 as I work on getting vitamins, liver, adrenals, sleep etc resolved? I am stable, but not well. Not looking to feel like wonder woman, but need to feel stronger.  I have an appt scheduled next week to meet the Dr and I need to know if I ask for an increase in NDT or to add T3? She is the only Dr here in town that will prescribe these medications and I think she is expecting me to guide her some as to the STTM protocol although I'm not sure that is hand's down the authority on this. I've found more useful information in this forum, then I have found there.

I apologize for the length of this. My labs are posted below with ranges.

03/15/17  ( Before Meds)
TSH      1.370            Range 0.450-4.500 uIU/mL
free T3       3.5            Range  2.0-4.4 pg/mL
free T4     1.30            Range     0.82-1.77 ng/dL
RT3           21.5           Range     9.2-24.1 ng/dL
TPO          13              Range      0-34
Thyroglobin AB  <1.0         Range 0.0 to 0.09

Lab results 04/26/17 ( after 6 wks on low dose NDT)
Ranges are same as listed above

TSH = 0.815
free T3 = 3.0
free T4= 1.01
RT3 = 16.4
TPO= 13
Thyroglobulin AB <1.0










14 Responses
649848 tn?1534637300
COMMUNITY LEADER
I think it's only fair to tell you right up front that STTM is a competing site and I'm not a fan of their protocols, otherwise, I'd be posting on their site instead of this one...  :-)

That said, I have to agree that your "before medication" thyroid labs were about as close to perfect as they could get. In view of that other "issues" did they say you have that should be treated?  

You said tests didn't indicate Cushing's, which is adrenal insufficiency and conventional medicine doesn't recognize the commonly noted "adrenal fatigue" or exhaustion.  Can you, please, post the actual test results with reference ranges so we can see what was done?

Can you also post the vitamin/mineral test results you had done, with reference ranges?  There are some vitamin/mineral deficiencies that can cause the debilitating conditions such as you describe.  It's also normal for adrenal hormones to kick in during times of stress; that doesn't mean there's anything drastically wrong with them.

Taking the thyroid medication won't "kill" your own thyroid function, but it can suppress it, which is what it seems to be doing, since your levels have gone down since you began taking the medication.  If you stop taking the medication, your own thyroid should start producing hormones again; however, if you stay on the medication, you'll need higher doses to get your levels up higher.  I'm not sure why you think you'll need more T3, at this point, since desiccated hormones already have a ready supply of T3, but we can go into that later.
2 Comments
Thank you Barb I also am not a fan of STTM I have found a lot of conflicting information there and discovered this site later while I was researching. I am not suggesting they are wrong with much of their information. I just don't particularly care for the manner in which said information is presented.

The reason I thought I might need T3 as a separate medication is because per their instructions I should not be on more than 1.5 grain while addressing the failed conversion they suggested I had due to the RT3 lab result. They said that I should do the saliva cortisol test which I did through Labcorp which they don't approve of. But that's what my insurance covers. The results were
am =low
noon= very high
4 pm = high
midnight=high

I don't know how to provide the graph image provided by labcorp on this site.  

As I understood it, because my RT3 is above 11, I have a conversion issue and the hormones are not getting into my cells. There are numerous issues that can cause this per their site. Adrenals, Iron, liver, vitamin deficiency, inflammation, female hormones.

I was told that because my ferritin is high that my Iron is not low and to not supplement with iron.

I have been supplementing with Zinc and selenium for a few weeks. I've always supplemented with D3. I'm also taking B complex, B12 and Curcumin for inflammation. Vit E, and C and I take a lot of Mag due to heart palps that started a couple yrs ago. I have been using lecithin for liver and will be adding liver supplements next week.

I have all the markers of high inflammation. My C reactive values have ranged from 5 to 38 and they should be less than 3.

I already knew I have the fatty liver that was discovered in a CT scan years ago and I understood that was common for people who are type 2 diabetics and overweight.

My GP ran blood work back on 02/21/17. He only tested TSH and free T4 and whole T3.  Those results are as follows:


T4,Free(Direct) 1.31 Range= 0.82 to 1.77  ng/dL


Triiodothyronine (T3) 121 Range= 71 to 180 ng/dL

Tsh 2.920  Range= 0.450 to 4.500
uIU/mL

I went to a different Dr. on 03/02/17 who ran their Thyroid panel and Iron tests. Some vitamins were ran on this test too.  Results listed below.

Vitamin B12 673 Range =211 to 946
pg/mL
Folate (Folic Acid),
Serum
6.5   Range = >3.0 ng/mL

Iron Bind.Cap.(Tibc) 320  Range= 250 to 450 ug/dL

Uibc 229    Range = 131 to 425
ug/dL

Iron, Serum 91  Range = 27 to 159
ug/dL
Iron Saturation 28  Range= 15 to 55
%

Magnesium, Serum 1.9  Range= 1.6 to 2.3 mg/dL

#note on Magnesium# Just had a RBC Mag test done and that was 6.0 rbc with a range of 4.2 to 6.8 mg/dL

Thyroxine Binding Globulin 19 Range= 13-39 ug/mL

Triiodothyronine (T3)
128 Range= 71-180 ng/dL

Tsh
1.760 Range= 0.450-4.500 uIU/mL
T4,Free(Direct)
1.42 Range= 0.82-1.77 ng/dL

Thyroid Peroxidase (Tpo) Ab
8 Range= 0-34 IU/mL

Ferritin, Serum
232 HIGH Range= 15-150 ng/mL


The first labs my functional doctor ran included the female hormones, testing for Candida, Alk Phos Isoenzyme, think she said this was for liver function. ?? Not sure. That was 03/15/17 and I listed the thyroid results in my original post. Not sure if the other values will be helpful.

She then ran more tests on 04/10/17
One test was to look for tumors in the adrenals. It was called a Metanephrines, Frac, Qn, 24-Hr test. She also tested for Celiac disease, dairy allergens, because in the course of 6 wks I lost 40 lbs.
I asked for Zinc, mag, iodine and  D3.
I've listed those results below.

Zinc, Rbc 1242 Range= 822-1571 ug/dL

Iodine, Serum Or Plasma 56.7 Range= 40.0-92.0 ug/L

Vitamin D, 25-Hydroxy
38.7   Range= 30.0-100.0 ng/mL

Cortisol, Serum Lcms
11 ug/dL
Dhea-Sulfate, Lcms
166 ug/dL
No range given

Selenium, Rbc
260 No range given mcg/L


Sorry again for the lengthy post.




One additional note. In April 2016 my TSH was ran by my GP and it was 3.280 same ranges as listed above. Thyroxine (T4), does not say Free T4 so suspect it's a serum value was 7.6. Free T3 was 3.3
649848 tn?1534637300
COMMUNITY LEADER
Okay... where to start here...lol   It's going to be hard to get STTM out of the conversation, but that's what I'd like to do, eventually, since this isn't their site.  I'm not necessarily saying they're "wrong" either, and I'm certainly not going to spend time bad mouthing them.

First off, there's no evidence that you have a conversion issue, since your original, un-medicated Free T4 was right at mid range and your Free T3 was in the upper half of its range.  Both of these are exactly where we, typically, recommend them to be.  Granted, some people recommend Free T3 to be in the upper quarter of its range, but not all of us need to have it that high... I, personally, would be hyper if my Free T3 stayed that high and so would many others. It "is" possible you're one that needs it higher, but not having that high should not be totally debilitating, either.

The rT3 issue is somewhat controversial... A lot of people insist that rT3 is a horrible thing, when in fact, it's actually very natural and is not all bad.  Free T4 is converted into, either, Free T3 or rT3.  Some people believe it's, partially, the body's way of protecting itself from over-conversion of Free T4 to Free T3 - in other words, it can help keep us from going hyper.  It's not the actual rT3 result that's important, it's the FT3:rT3 ratio that counts.  In order to calculate that correctly, both have to be collected at the same blood draw and we have to have the units with which they were measured.  

I'm confused about the LabCorp cortisol test... what about it did the fine folks at STTM not like?  It clearly shows that your cortisol levels were backward, at any rate, so we'll come back to that, after your explanation.

As noted, the actual rT3 result is not so important; it's the FT3:rT3 ratio, explained above.

High ferritin does "not" guarantee adequate iron stores.  I found this out, myself, when my own ferritin level came back high and it was assumed I had high iron, but I didn't.  High ferritin is another indicator of inflammation in the body and as shown by other markers, such as C-reactive protein, you have inflammation...  

I'm going to post this, because MedHelp only lets us make our responses so long and I don't to cut off in the middle of something.  
2 Comments
Thank you again Barb. I appreciate your patience with me. I know looking at my labs is a nightmare.
The reason they won't use Labcorp results is because in their words " we cannot use Labcorp cortisol tests due to the less than signs in the ranges, we have specific math to do for optimal, and without an actual number, it is not possible."
So I understood they could not do the math to figure the levels of cortisol but Labcorp provides a tool which you input the results and it provides the graph which clearly defines your levels in correlation to the normal ranges. It was easy to determine.
I researched the high ferritin, and also saw it was common with diabetes and obesity. But when I looked at the serum level of iron I wasn't sure it was really considered low and was afraid to supplement iron. I was born anemic, and was told I was fine when I was around 8 yrs old. My mother fed me lots of liver and spinach. That was the treatment apparently that long ago.

The Rt3 ratio for before meds was 16.3 and after meds was 18.3. There are several online calculators to put the lab values in to come up with it. I think it was stated that it had to be 20 or over to be "optimal".

I'm not a big fan of these comment boxes because they break up the conversation so much, but I guess we have to deal with them, don't we?  LOL  

I "sort of" understand what you're saying about the LabCorp cortisol results, but why do they have to put into a graph?  Can you just post the results with reference ranges?  A lot of labs use "less than" signs - we deal with those all the time, so I don't know what the big problem is, though I do understand that putting something into a graph would require an actual number.  

The reason high ferritin is common with diabetes and obesity is because inflammation is common with diabetes and obesity.  You have to try to reduce inflammation in order to reduce the ferritin level, along with the CRP level.  

Your iron is not "horrible"; it's actually about 50% of the range, which most doctors would consider just fine and for most people it probably is.  For those of us that might be anemic or thyroid in question, we might want it a bit higher.  Your mother was right to feed you lots of liver (or any type of beef) when you were young, because liver is the best source of iron and vitamin B-12.  The problem with liver and other red meats we buy today is that they have all the chemicals (antibiotics and hormones) added to their food to make them grow faster. These are a major cause of inflammation in the body.

The rT3 ratio should be over 2 or over 20, depending on the units used for the results... at 16 - 18, you're close enough to 20 to say you don't have a problem!!! It may not be what they consider "optimal", but it's not going to be drastic enough to cause dibilitation (is that a word? lol) either.  If your Free T4 and Free T3 levels had been way off in one direction or the other, I'd say you could have had an issue, but they weren't.
649848 tn?1534637300
COMMUNITY LEADER
Okay, I'm back with more questions and some suggestions...

Do you have a recent CRP level - an actual level instead of a range of levels?  Have you ever had a Homocysteine test done?

How long have you been supplementing with the B-Complex?  I'd expect your vitamin B-12 to be higher than it is if you're taking the B-Complex every day, as most complexes have much more than the recommended daily allowance in them.  I'm wondering if you're getting maximum absorbance of the B-12.  Many of us don't absorb adequately and have to supplement B-12 separately, with a methyl B-12 that's "body ready" so it doesn't have to be converted.  Your B-12 level is not "horrible", but it's not the best either.  Some countries consider levels of 500 or less to be deficient, so level of 673 is barely above deficient, in spite of the range the lab uses.  I have Pernicious Anemia (inability to absorb B-12 via the gut) and I have to keep my level at/near the very top of the range in order to keep symptoms of deficiency at bay.

Additionally, Folate and Folic Acid are not the same thing, even though it says they are.  Again, many of us have to have a body ready Folate... Folate and B-12 work together.  

Did you not have any imaging tests to look for adrenal tumors/adenomas?  The test your doctor did - the Metanephrines, Frac, Qn, 24-Hr test can produce false negatives if the tumor is only producing intermittently.  Imaging, in the form of CT or MRI would be called for. I have bilateral adrenal adenomas, found on imaging, that have yet to be tested.

One can have a food sensitivity, such as gluten or dairy, without actually being allergic; these foods can cause inflammation in some of us when we don't expect it.

Your vitamin D level is way too low... optimal level is 60-80.

How long have you had Type II diabetes?  Do you take medication for it and is it under control?  What's your diet like?

Diabetes and being overweight are a couple of the "causes" of fatty liver.  Some types of fatty liver can be reversed, while others cause permanent damage.  One type, NASH (nonalcoholic steatohepatitis) can cause permanent liver damage. Was this checked as a possible cause for your weight loss?

Were you ever tested for intestinal parasites?  I, recently, went through a bout with H. Pylori, also...

Have you taken a lot of antibiotics in recent years?  Do you take probiotics or digestive enzymes?
3 Comments
The most recent CRP value is 5.53 which was done on 02/21/17. In 2013 is when the CRP was first tested and that was when it was highest around 37 or 38. Its fluctuated so much in many of my lab reports. The 5.53 is the lowest it's ever been.

I've just recently began supplementing with the B Complex. I am taking 2 capsules of Solgar Complex 50 per day. I also have a separate Jarrow Methyl B 12 which I try to take a couple of times per day. It is 1000 mcg. I carry it with me but have found I often forget to take it. Will try to do better with that. I thought my b12 level was normal.

There have been no images of adrenals since 2014 when a CT was performed after my gyn thought there was a mass and they found my adrenals enlarged. But nothing on the report indicated any tumors. I was sent to an Endo who did all the cushings testing. He said I passed all the tests and did not have cushings. He did lots of testing at the time and it was the first time my insulin was tested and he said my blood insulin/insulin resistence was very high. That was no surprise to me because no matter what I did, my blood sugars were always high. I was always needing more and more insulin.

Side note: I had a kidney infection in July 2016 and a CT scan was done at the ER at that time. This was the result.

Non contrast CT of abdomin pelvis
The lung bases are clear. Fatty hepatatic infiltration. Spleen and pancreas appear unremarkable. Bilateral nephrolithiasis with calculi ranging between 2-3 mm  to 8-9 mm involving the lower pole of left kidney. There is no hydroniphrosis. The adrenal glands are unremarkable.The gallbladder appears unremarkable. No free intraperitoneal fluid or air. No pelvic masses. No aggressive osseous lesions.

I've had diabetes since 2004. I take insulin and metformin. Just added in meal time insulin a couple of yrs ago. My last A1C was 8.5, that was done on 02/21/17 but I'm not sure how accurate it was because it was right in the middle of this recent illness and I was eating very little.

I would like to add just prior to this illness I got a cold in mid December. Have not had a cold in 10 yrs which I had always attributed to my high D3 intake which use to show usually in the 58 range. I was surprised to see the more recent drop in that level. The cold lingered well over 3 weeks and on January 10th is when I got very dizzy, feet were freezing and I felt I was going to pass out. I went to the ER the next morning when I did not feel better.  Will continue in a new comment.
Prior to the cold in December I was working on the goal of getting to 20 carbs per day with a high fat, low carb diet. I was having a hard time getting to the 20 carbs and averaged more around the 40 carbs per day mark. But even at 40 carbs per day my blood sugars were improving.

The problem I often run into when I go to the ER or go get labs done is that they always detect a UTI in my reports. Despite me not having any symptoms of a UTI. My gynocologist believes the reason I always show E coli in the urine tests is because of the kidney stones sitting in my kidneys. I have not had a kidney stone since 2002, but did have the kidney infection this past summer. So they always put me on antibiotics, and it never clears the urine tests results. Since January 10th I was put on a round of Macrobid, twice. A round of Ceflen, think thats the name, a round of Levaquin and a Z pack. I'll be honest I did not complete the Levaquin round because when I read of it's dangers I threw out the rest of the pills.

I had just started on Probiotics and D.E. before this illness took hold of me. My appetite is just starting to come back as my body temp is going up but its been hard for me to eat the low carb through this as it seems to upset my stomach and I've been eating more comfort type foods which sit well. Like oatmeal, mashed potatoes etc.

The candida test this functional Dr ordered tested igg, iga, igm antibodies. Would that have also tested for the H Pylori? I've had no parasite testing.

I do not know what liver test would have tested for my weight loss. The Dr I see now did that Alk Phos Isoenzyme and she told me that was testing my liver function. That test was done back on 03/15 and it shows in normal ranges and on my last appt she did not comment on it. Aside from urine lab reports CBC etc I'm not aware of any other liver tests that were done.
Now I'm concerned this is not a thyroid issue at all and I don't know what else to do to get diagnosed. As I mentioned in my original post, the medication has helped to semi stabalize me but I still don't feel normal at all. My anxiety through all of this has been through the roof as I could not even drive for 2 months because I kept feeling like I was going to pass out and that would follow with a major panic attack. I have a history of panic attacks but honestly had not had one in years. Many years and now I was having several panic attacks per day.  The last few days I've been feeling some of that coldness in my feet again and that scares me. I have an appt at the end of the month with a neurologist to test for diabetic neuropathy. I can't get into the Cardiologist until August to test for leg circulation issues. I was trying to rule out all the scary stuff but in this town our dr choices are so limited it's exhausting. Would upping my NDT dose hurt me at this point?  I go back to the Dr on Friday and not sure if I should tell her I need to stop the NDT or what I should do.
649848 tn?1534637300
COMMUNITY LEADER
Can you tell me what was going on in 2013 that might have caused a CRP of 37 or 38?  Was your diabetes out of control, did you have another illness or did you weigh more?

Your B-12 is "normal"; it's just not optimal.  As with everything, there's a difference. The Jarrow methyl B-12 is an excellent supplement and if taken regularly, should bring our levels up nicely, provided you absorb adequately, which it seems you do.

Since you're diabetic and you take insulin, I might not be surprised at high insulin levels, depending on when you had a dose of insulin in relation to the blood draw.  

Your CT scan in July 2016 showed nephrolithiasis, which is the formation of kidney stones.  Unless you've passed them, they're still in your kidneys.  Who is doing your urine tests?  Are you seeing a urologist or is it your gyn?  There's a reason the infection is not clearing and that really needs to be resolved, not just have them keep throwing antibiotics at you.  I can't say I blame you for not taking the Levaquin.  It's supposed to be an antibiotic of last resort and doctors have begun using it as a first defense, so I don't think it works like it's supposed to in a lot of cases.

It's important to remember that antibiotics not only kill the bad bacteria, they kill the beneficial ones, as well.   Every time we take a round of antibiotics we need to make sure we take probiotics at the same time and afterwards to replace the good bacteria. Along with supplements, it's important to eat foods with live cultures, such as yogurt, sauerkraut, kimchi, kombucha, kefir, etc.  I eat these foods on a daily basis to make sure I get plenty of good bacteria.  I'm a firm believer that the gut microbiome is one of the most important organs in the body.

I guess for a low carb diet, I'd rather see oatmeal than potatoes... at least, oatmeal is a whole grain, so you're getting fiber with it and it takes longer to break down, so it's not going to spike your blood sugar.  Mashed potatoes, on the other hand, will spike the blood sugar and increase the demand for insulin very quickly.  

No, the tests your doctor did won't tell if you have H. Pylori or any other parasite.  Those have to be tested specifically, by name. Besides, testing antibodies won't tell whether you have an active infection.  If the tests are positive, it could mean you have an active infection or that you had one in the past.  If you don't have one now, it's pointless to treat for it.  The best ways to test for H. Pylori are via a stool sample, endoscopy or breath sample...

I'm not convinced your problem is totally thyroid related, either, which is why I'm asking so many questions.  Your before medication thyroid labs are too good to cause one to be as ill as you were.

I'm more concerned about your diabetes than I am your thyroid.  High blood sugar and/or insulin resistance can cause many symptoms that can mimic those of hypothyroidism and you still have those odd cortisol levels that we haven't addressed.

The inflammation in your body that could be caused from out of control blood sugar could have caused cortisol levels to be out of control, as well.  Add anxiety and panic attacks to the mix and it's easy to understand how you could have been so ill.

Is the coldness in your feet the same as you had when you had the cold in Dec?  That could be related to you diabetes, also.

How are your blood pressure and cholesterol levels?  Have you actually been diagnosed with Metabolic Syndrome/Syndrome X?
20202111 tn?1492379275
I'm going to try to respond without using the comment box. I did not realize you had responded so many hours ago because I didn't see a new post showing up on "My posts" section. My apologies, I have read a lot on this site but clearly did not know how to use it properly. Give me a bit to gather my responses to your questions. I am very appreciative of your help.
20202111 tn?1492379275
I am responding to your comment up above which I have cut and pasted here. My response is under your comment.


I'm not a big fan of these comment boxes because they break up the conversation so much, but I guess we have to deal with them, don't we?  LOL  

I "sort of" understand what you're saying about the LabCorp cortisol results, but why do they have to put into a graph?  Can you just post the results with reference ranges?  A lot of labs use "less than" signs - we deal with those all the time, so I don't know what the big problem is, though I do understand that putting something into a graph would require an actual number.  

The reason high ferritin is common with diabetes and obesity is because inflammation is common with diabetes and obesity.  You have to try to reduce inflammation in order to reduce the ferritin level, along with the CRP level.  

Your iron is not "horrible"; it's actually about 50% of the range, which most doctors would consider just fine and for most people it probably is.  For those of us that might be anemic or thyroid in question, we might want it a bit higher.  Your mother was right to feed you lots of liver (or any type of beef) when you were young, because liver is the best source of iron and vitamin B-12.  The problem with liver and other red meats we buy today is that they have all the chemicals (antibiotics and hormones) added to their food to make them grow faster. These are a major cause of inflammation in the body.

The rT3 ratio should be over 2 or over 20, depending on the units used for the results... at 16 - 18, you're close enough to 20 to say you don't have a problem!!! It may not be what they consider "optimal", but it's not going to be drastic enough to cause dibilitation (is that a word? lol) either.  If your Free T4 and Free T3 levels had been way off in one direction or the other, I'd say you could have had an issue, but they weren't.
6 hrs Report

The Labcorp saliva cortisol report I rec'd did not include the ranges. They do have it on their website. That's where I also found the fill in graph to enter the values to see the peaks and valleys of the test results. I will go back to their website and find the ranges and post them along with the results after I complete my responses to you.

When I first thought I had an iron issue, I purchased some Solgar iron tabs and then was told not to supplement because of the ferritin. Would it hurt to supplement now being that the ferritin does not seem to be an issue? It might help with the coldness I am feeling. I will follow up on your question about the cold feet below my next cut and paste of your last comment.


20202111 tn?1492379275
Cut and paste of your last comment and my response below. I hope this isn't making this more confusing LOL, but I agree with you that it breaks up the conversation when using the comment box.

Can you tell me what was going on in 2013 that might have caused a CRP of 37 or 38?  Was your diabetes out of control, did you have another illness or did you weigh more?

Your B-12 is "normal"; it's just not optimal.  As with everything, there's a difference. The Jarrow methyl B-12 is an excellent supplement and if taken regularly, should bring our levels up nicely, provided you absorb adequately, which it seems you do.

Since you're diabetic and you take insulin, I might not be surprised at high insulin levels, depending on when you had a dose of insulin in relation to the blood draw.  

Your CT scan in July 2016 showed nephrolithiasis, which is the formation of kidney stones.  Unless you've passed them, they're still in your kidneys.  Who is doing your urine tests?  Are you seeing a urologist or is it your gyn?  There's a reason the infection is not clearing and that really needs to be resolved, not just have them keep throwing antibiotics at you.  I can't say I blame you for not taking the Levaquin.  It's supposed to be an antibiotic of last resort and doctors have begun using it as a first defense, so I don't think it works like it's supposed to in a lot of cases.

It's important to remember that antibiotics not only kill the bad bacteria, they kill the beneficial ones, as well.   Every time we take a round of antibiotics we need to make sure we take probiotics at the same time and afterwards to replace the good bacteria. Along with supplements, it's important to eat foods with live cultures, such as yogurt, sauerkraut, kimchi, kombucha, kefir, etc.  I eat these foods on a daily basis to make sure I get plenty of good bacteria.  I'm a firm believer that the gut microbiome is one of the most important organs in the body.

I guess for a low carb diet, I'd rather see oatmeal than potatoes... at least, oatmeal is a whole grain, so you're getting fiber with it and it takes longer to break down, so it's not going to spike your blood sugar.  Mashed potatoes, on the other hand, will spike the blood sugar and increase the demand for insulin very quickly.  

No, the tests your doctor did won't tell if you have H. Pylori or any other parasite.  Those have to be tested specifically, by name. Besides, testing antibodies won't tell whether you have an active infection.  If the tests are positive, it could mean you have an active infection or that you had one in the past.  If you don't have one now, it's pointless to treat for it.  The best ways to test for H. Pylori are via a stool sample, endoscopy or breath sample...

I'm not convinced your problem is totally thyroid related, either, which is why I'm asking so many questions.  Your before medication thyroid labs are too good to cause one to be as ill as you were.

I'm more concerned about your diabetes than I am your thyroid.  High blood sugar and/or insulin resistance can cause many symptoms that can mimic those of hypothyroidism and you still have those odd cortisol levels that we haven't addressed.

The inflammation in your body that could be caused from out of control blood sugar could have caused cortisol levels to be out of control, as well.  Add anxiety and panic attacks to the mix and it's easy to understand how you could have been so ill.

Is the coldness in your feet the same as you had when you had the cold in Dec?  That could be related to you diabetes, also.

How are your blood pressure and cholesterol levels?  Have you actually been diagnosed with Metabolic Syndrome/Syndrome X


My response to your questions above.

In 2013 I had just started my new job after being laid off and I hurt all over and was just exhausted by day's end. It was like my whole body was in pain all the time.  I've never been a bastion of energy but this was really troubling me especially being new on my job. I have had a painful right leg since 2001 when I had taken a statin drug that caused lots of muscle pain in my thighs. I took a lot of CoQ10 at the time to try to replace what the statin took from my muscles. It got better but I never regained strength in my legs as I had before the statin. Then I had a fall in the parking lot at the hospital I worked at which tore up my knee in the right leg. So for years I've had a lot of trouble with that one leg. Lots of swelling when I walked too much or stood too long etc. I went to see the same functional Dr I am seeing now and she did a lot of labwork testing for RA etc..and she called me when the tests came back and told me about this C Reactive test result that was extremely high. Being that she was not covered on my health insurance now she suggested I find a new primary who could run the necessary tests to investigate what was causing it to be so high. So I found a primary and he ran a ton of blood labs and the only thing he prescribed for me was baby aspirin and he then told me he believed I had fibromyalgia. For that he gave me a script for Cymbalta. Since the Lipitor situation I have been very untrusting of prescription meds and have informed any Dr. I go to that I will not take newly released medications and/or any statin drug. Needless to say this has caused issue with some Drs. I understand their side of it to a degree but the damage from the Lipitor changed my life in many ways and lesson learned on this end that I simply don't trust most conventional doctors. When I was given the Lipitor my total cholesteral was 201. 1 point above their cut off. I was given a bag of samples and the old, stupid me took them without ever researching or questioning it.

After researching the Fibromyalgia diagnosis and Cymbalta, I was convinced I was just given that diagnosis because it was the latest unrecognized condition out there that Drs used for when they didn't know what you had. Yes, I am that much of a pessimist on this topic.
I quit taking the Cymbalta and in time I got better and did not ache as much. I always ache but not to that degree. I'm fat, have muscle and leg issues, so I expect to have some pain and discomfort.
20202111 tn?1492379275
Continued response to above.
There is only one Urology group in our town and they have tons of lawsuits, so I don't use them. My gynocologist runs urine tests and so does my primary. My gynocologist did suggest some powerful IV antibiotics to try to resolve the E coli but when I asked her if the stones were still in the kidney and would still produce the E Coli test results what good was using these dangerous IV Antbiotics if the stones still remained? One good urine test and then back to the same results? She didn't have an answer. I usually take D Mannose to keep any kidney infections at bay. It's a supplement and I may have not been taking it as much as I needed to last summer when I got the kidney infection. My coworker was out with breast cancer and I was doing the work for both of us so last year was extremely stressful.
Early in December I contacted a liason with my health insurance company to try to allow me to go to a Urology group outside our local network in a town about an hour away. The only other option that was covered was 3 hours away which is near impossible for me to do. Unfortunately I got sick shortly thereafter and have not been able to get back with her on what we can do.

Regarding the cold feet and cold intolerance in general. I've never and I do mean NEVER have been cold a day in my life. I'm always the person whining about how hot it is here in Florida and the humidity kills me. Run the A/C night and day. Now I'm running the heat when it's a mere 78 degrees outside. Had it on today because I was so cold. I had the maintenance dept at work shut off the A/C to our office. It's gotten much better as my body temp has risen, but not entirely out of the woods. My temp is now up to an avg of 97.7ish.
I had the cold mid December and had a lingering cough and congestion but was almost over it when on January 9th I came home from work, got super dizzy sitting at the computer and went to lay down, then my feet were freezing. Had chills, cold sweats, then hot sweats and shivering. Went to the ER the following morning. They said I was fine, but that dang E Coli came out and they put me on antibiotics and sent me home. Things just got progressively worse as time went on. I made the appt with the neurologist to test for neuropathy but I really don't have the other symptoms related to it. No skin color changes or pain, just coldness.
20202111 tn?1492379275
I usually do all I can to avoid antibiotics, but through all of this I was desperate for anything that would help. I think the multiple antibiotics probably made things worse.

I agree mashed potatoes are bad, but I was not eating at all, everything I ate went right through me. My thought was I had to get regular nutrition in me somehow someway to get my metabolism better.

I have been diagnosed by several drs with Syndrome X. When I was first diagnosed with diabetes I was put on blood pressure meds to protect my kidneys. Been on them ever since. With the medication my blood pressure is generally good unless I'm in the ER and then it sky rockets. lol  Cholesterol is high but I won't take a statin so not sure what I can do about that. The diabetes has never really been in control. My A1C at diagnosis was 14, the lowest I ever had it was at 7.5. When I'm well I eat very little. I usually eat 2 meals a day, and very rarely eat in the evenings. I took great effort to prepare my own meals with whole foods and no processed junk.  I hate taking the insulin, but take it because it's more tried and true. Won't do the Victoza type medications. I did try it once and my sugars were actually higher so I quickly gave it up.

I was reading about parathyroid earlier today and wondered if that might be a factor here. I went back and checked my calcium levels over the past couple of years and the ranges were 9.5 to 9.9. All within normal limits but on high end. I urinate a lot in the evenings, but not as much during the day.

My biggest question is why did I suddenly feel better taking the thyroid medication? Not 100 percent better but could actually function where I could not function before taking it. I worry about the levels dropping now...I'm so confused.  I'm so sorry for all the lengthy details. I just don't want to miss something that might have value in this mystery. Thank you again Barb.

649848 tn?1534637300
COMMUNITY LEADER
Side note:  You're welcome to use the comment boxes if it's easier for you; it's perfectly okay. I don't have a problem with you using them.  It's also not necessary to copy/paste my comments into your replies.  I'll try to keep my comments in the same order as yours and we should be okay, though I'm going to stray off course, now and give a bit of my own opinion, if you don't mind...

Don't be sorry for the details... we can't figure out what's going on without them.

I see so many things in your account of what happened that, when combined, could have brought you to where you are today, starting with the statin drug in 2001...  Statin drugs are known to cause muscle problems in susceptible people and they are also linked to increased risk of type II diabetes.  Some studies have shown that they increase insulin resistance and also can cause the body to produce less insulin.

Do you have any idea what your thyroid status might have been at that time?  High cholesterol is a symptom of hypothyroidism, though it has other causes, as well.  Also, were you overweight at that time?

Did you ever look into getting the right knee repaired after you fell and injured it?  

Inflammation from the muscle damage caused by the statins, along with inflammation from the knee injury could easily have increased your CRP level, at the time.

I do agree with you that for a long time, Fibromyalgia was a "catch all" condition that got blamed for everything doctors couldn't or didn't want to take the time to explain any other way.  Many doctors did, and some still do, believe that Fibromyalgia is, actually, untreated hypothyroidism... In addition, may doctors also believe that if they can't/don't want to find a problem, they can always solve everything with an anti-depressant. Cymbalta and others have become "go-to's" in the medical world.

A cholesterol level of 201 is not a reason to prescribe a statin, but of course in 2001, they thought it was.  I had a doctor who insisted that I was going to die if I didn't take Crestor, at one time.  I refused and he got very upset... I eventually left him because I got tired of being yelled at about it. To this day, I have refused to take statin drugs, but I do a lot of other things in an effort to keep my cholesterol within normal limits.  Did you try anything else to bring your levels down?  Are they normal now?

A gynocologist is not qualified to determine urological issues, unless she's been trained specifically in the urological field and apparently, yours hasn't been.  It's not true that simply having kidney stones will cause you to have an E-coli show up in your urine all the time.  I have kidney stones and my urine doesn't show E-Coli unless that's the type of infection I have.   It would be well worth your effort to get a good urologist.  Once you've gone through the initial screening, you don't have to see them very often.  This is another possible source of inflammation.  

Cold feet/hands and cold intolerance are symptoms of hypothyroidism, but they can also be caused by other things... I've just learned that the hard way.

I think you'd know if you had neuropathy, as you'd have burning, tingling, numbness, etc in your extremities.  I have peripheral neuropathy caused from long standing B-12 deficiency and it feels like my feet are wrapped in hot coals all the time, but that's not the only pain I have.  

What do you do to try to bring your cholesterol levels down?  What blood pressure medication(s) are you on?  Have you ever had a complete heart work up?

"When I'm well I eat very little. I usually eat 2 meals a day, and very rarely eat in the evenings."  You should be eating 3 meals and small snacks throughout the day to keep your blood sugar levels stable... it could help reduce the amount of insulin you need.

"I took great effort to prepare my own meals with whole foods and no processed junk"   You "took" great pleasure... does that mean you no longer do this?  

The thyroid medicine might have given you more energy, but that doesn't necessarily mean that's what you need to make you well.  Your pre-medication levels didn't indicate hypo,  and you have a lot of things going on that could cause the same symptoms.  

Metabolic Syndrome, by itself, can cause a multitude of symptoms that can be very debilitating... I know because I have it, too.

I'm not a doctor and I can't tell you what to do, so I'm not saying you should/shouldn't stop the thyroid med, but if it were me, I'd try to take steps to get all the other issues under control - blood sugar, blood pressure, cholesterol, weight - and see if that helps.  

Diet and exercise is very important and no matter how much thyroid medication you take, if you have other things wrong, you aren't going to get well.

We still have that cortisol issue to work on... stress/anxiety is another biggy, along with diet and exercise when it comes to inflammation.
20202111 tn?1492379275
Honestly, I don't know what my thyroid status was back then. I was overweight back then, but not to the degree I am now. I found once I became diabetic, the weight would not budge and when insulin was added it only got worse. I've felt like I've been trapped in this vicious circle by trying to keep blood sugars in range required more insulin, the more insulin I took, the more weight I gained, the more weight I gained, the less I could move. The less I moved, the less chance of losing weight.

I did see an orthapedic when I injured my knee and they wanted to do surgery to clear the miniscus, unsure of spelling but it was going to require 6 wks recovery that I could not do. I had just gone through a divorce and bankruptcy and was working 7 days a week, 12 hr shifts for 3 years straight to try to keep from losing my house. In hindsight, I should have made better decisions during that time in my life. My priorities were on everything but me. Dealt with a lot of guilt with the bankruptcy and was trying to do the right thing by maintaining my commitment to paying my mortgage. I was a loan officer and lost my career because my husband filed bankruptcy during our divorce, that's why I had to work so many hours, my wages went from $20 an hr to $7 per hr over night. I only filed my bankruptcy after I lost my job and had no other choice.

My cholesterol is still high and over the years I've attempted various supplements with no success. 2 yrs ago I started having heart palps that came out of no where. It hit me on a holiday weekend, so after researching I thought my electrolytes might be off and I got some slo-mag at the drugstore and it helped. I went to my GP first thing that Monday morning and they did an EKG, blood labs and I wore a holter monitor. They said there was nothing wrong. I was not convinced and I followed up with a Cardiologist and continue to do so. They did many tests too and have said I am okay, no immediate threats. I was referred to a lipid specialist but when I called their office, their protocol is to put the patient on statins which I refuse to do, although they ensured me it was safe. Sorry, I just have no faith in that approach, so I took a pass on that referral. I continue to take mag supplements to keep the palps away.

I can't imagine feet being hot all the time. That has to be miserable. I think I will take this iron supplement to see if the coldness might improve. I'll have my iron tested in a few weeks to see if it goes up a bit.

I will also check back into getting a urologist to see what can be done about the stones.

I take Losartan 100mg for blood pressure.

I do still use whole foods and unprocessed products, but just haven't had the appetite or energy through this illness to go to the lengths I was doing prior. I was very engrossed in trying all sorts of low carb recipes and using the weekends to prepare everything for the weekend ahead. Right now I'm lucky if I get a load of laundry done and get a trip to the grocery store in on the weekend. I've made a lot of homemade soup throughout this illness and take left overs into work. It hits the spot and warms me up. I have been eating small frequent meals now and will continue to do so to try to keep the blood sugar stable.
I also spend a good majority of my weekend trying to get as much rest as possible because it seems that by the time Thursday hits, I feel like I can't go one step further. Fridays are even worse. I'm focusing on getting better sleep as I was often lacking in that dept and hoping that will maybe help the cortisol issue.

I did ask this functional medicine dr about testing my PTH and she said it wasn't necessary but I don't remember why. I'll ask her about that again on Friday. I'm contemplating maybe trying another go with an Endo, but we have so few here and I doubt I'd be able to get an appt before the end of the year. I'm thinking they might investigate some of my other issues in more depth than this functional doctor. I've also considered seeing an ENT because the functional med dr said on my exam on 03/15, she did feel some swelling on the lymph nodes around my neck, but not necessarily on the thyroid, but she never expanded on that. I attribute a lot of the anxiety and stress I'm feeling to having to do so much of this hard work myself. I fully believe I have to be my own advocate but it's exhausting that one has to push the medical providers to do their jobs. I take a lot of pride in my work and I wouldn't have a job if my customers had to tell me how to do it. If that makes any sense. lol  It's just one of those things that stresses me out and I'm trying to not let these little things get the best of me. Easier said then done!

I appreciate all of your feedback, its opened my eyes to the bigger picture. I just hope I have some strength to make the positive changes I need to hopefully feel normal again.
649848 tn?1534637300
COMMUNITY LEADER
Insulin is known as "the fat storage hormone", so the higher our levels get, the more fat we store.  That's why it's so important to take care not to spike the blood glucose levels.  You'd have had insulin resistance long before you were diagnosed with Type II diabetes...

I understand about the knee issue when the injury happened. Marital issues and/or divorce is a tough thing to deal with, so of course, that would have added more stress to the mix.  We do what we feel is best at the time and that's what you did... hindsight is always 20/20, right?  :-)  It is what it is, so we be kind to ourselves and move on.

What supplements have you tried to help bring down your cholesterol?  Red yeast rice is supposed to help.  Omega 3 fatty acids also help.  

You said you followed up with a cardiologist and "there are no immediate threats" - does that mean you have some type of heart condition?  I've just learned that any type of heart condition, threat or not, is a threat... lol   Many of them can also cause symptoms we'd never dream of, because women experience heart symptoms differently from men and many doctors (including cardiologists) miss them... I totally agree with you about the lipid specialist - I didn't know there was such a thing, but I'd not go for statin drugs, either so their whole concept would be lost on me, as well... lol

Actually, my feet aren't hot all the time... they're usually freezing because I don't get enough blood circulation.  It's the neuropathy that gives the sensation of hot coals.  The colder my feet get, the more painful it is and sometimes it feels like there are nails in the hot coals... it's hard to explain and probably even harder to understand.

You're taking a very high dose of Losartan... is your blood pressure under control?  Have you ever researched side effects of Losartan?

Here's just a few:

"Common losartan side effects may include:

    cold or flu symptoms such as stuffy nose, sneezing, sore throat, fever;
    dry cough;
    muscle cramps;
    pain in your legs or back;
    stomach pain, diarrhea;
    headache, dizziness;
    tired feeling; or.
    sleep problems (insomnia)."
https://www.drugs.com/sfx/losartan-side-effects.html

I was on only 20 mg Losartan for a couple of years and had side effects, including weight gain; I talked my doctor into letting me get off it and I lost several pounds quite quickly, even though weight gain is one of the less common side effects.

The homemade soups are good and it's good that you can make them ahead to take to work.  Make sure you're getting plenty of healthy fats in the form of avocados, olive and coconut oils, grass fed butter, etc.  The fat will help keep your blood sugar more stable.  It will also help reduce the need for carbs.  Adding plenty of fresh veggies, so you get the fiber is also necessary, along with lean protein.  

Have you ever tried going gluten free?  Many people are sensitive to gluten, even though they don't have celiac.  I find that if I stop eating bread, crackers, and other things with wheat flour, I don't have near the stomach issues, plus I tend to lose weight and my blood glucose levels are lower - I've averted Type II diabetes by doing this.  2 yrs ago, I managed to lose 26 lbs in less than 3 months, but then I slacked off and started eating a lot of bread, etc again... I gained back about 12 of those 26 lbs and I've had a horrible time losing, but I've almost done it.  Once I get another pound off, I can start working on the next 20 pounds I have to lose!!  If I accomplish that, I'll be where my doctor says I need to be...

Good sleep is necessary, but so is exercise.  I know it's hard after you've worked all day (been there, done that), but if you can force yourself to go for a 10 - 15 minute walk when you get home or do that much of some type of exercise, you'll feel a lot better and will sleep a lot better, as well. I gradually worked up to 30 minutes/day, then 45... Now, I walk for an hour, at least 4 days/week, plus do other stretching exercises that was prescribed via physical therapy last year. That's another of those things I learned the hard way.  Exercise helps to reduce inflammation and helps keep bones strong.  

I'm not sure that testing PTH will do you any good.  Your calcium levels are in the normal range, so there's no evidence that you have hyperparathyroidism.  

I'm too lazy to go back and look, though - I remember that your vitamin D was very low... are you supplementing that?  

Why do you think you need an endo?  Who manages your diabetes right now?  Many endo's specialize in diabetes and are not good thyroid doctors.  I'd be pretty safe in saying that any endo you'd go to would tell you to stop taking the thyroid medication because you don't need it.  

You should ask your Functional Medicine doctor to explain what she meant about the lymph nodes.  If you have a problem, that's one more source of inflammation...

Always remember - any place you have swelling, pain, soreness or any type of malfunction, you have inflammation.  All of this combines to make you feel sick, stressed, anxious, tired... It all has to be sorted out and you have to make lifestyle changes in order to eliminate the inflammation so you'll feel better.
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