preparing for my endo referral in 2 days...

[clareyh]

Hey everyone,

Wondered if anyone can help me in what the important things to stress to the endocrinologist i am seeing this thursday are:

The history of my TSH levels are:

Dec 2008: 7.5
Feb 2009: 5.8
May 2009: 5.7
September 2009: 7.2
October 2009: 5.7

obviously they are not consistant, I have just had my Thyroid antibodies tested and the levels are normal- ruling out anything autoimmune. I have had a full blood work done for which everything else was ok.

I have over the last year suffered from: muscle weakness, tiredness, bad joint pain, extreme coldness in feet hands and nose, have gone from u.k size 4 to u.k size 8 (which doesnt bother me as i have always been too thin!), a very slight numbess in my left leg (and sometimes in my left arm), irregular periods (that are heavier than they used to be), TMJ pain (dont know if this is related or independent from thyroid problems), noticed a lot of hair falls out in the shower and when brushing, brittle nails, dry itchy eyes, vertigo (although i feel this is more related to my TMJ and grinding my teeth in my sleep).

my main worry is that my G.P keeps saying, oh, your not much over the lab range (which upper limit is 5.5) and i get so annoyed as it is still over the threshold, even if 'not by much'. She keeps trying to prescribe me mild forms of an antidepressant for my anxiety, but i keep trying to tell her that I seem so anxious because I have been feeling like this for a YEAR now and no one is doing anything.

I am worried the endo will say the same thing? Does anyone know whether they use more sensitive lab ranges or will maybe trial me on some kind of meds? I am just wondering what to expect really, and if anyone has any advice as to what I can say to insist my case.

thanks in advance for any help anyone can give,

Clare :-)

[clareyh]

I will also mention I am U.K based (and therefore NHS treated) as opposed to U.S.A based.

[goolarra]

Here, in the U. S., the currently accepted range for TSH (as defined by the AACE) is 0.3-3.0.  Unfortunately, most labs and doctors have not caught up with the new range and still use obsolete ranges.  So, by the "new" standards, your TSH is higher yet than you thought.

Do you have the actual numbers for FT3 and FT4 (and their reference ranges)?  I'm willing to bet that one or both is in the low end of the range.  That, coupled with your symptoms, makes you hypo.

Here's an article I wrote a while back because we hear of this scenario so often on the forum.  Disclaimer:  I'm not a doctor, this is my opinion.  I hope it will give you some ideas to help convince your doctor to start you on a trial dose to see if it helps symptoms.

Proper Use of Reference Ranges in Treating Hypothyroidism:  Some Ideas to Discuss with your Doctor

Many hypo patients or undiagnosed hypo patients have an array of hypo symptoms, yet their lab work (free T3, free T4 and TSH) indicate that they are within the reference ranges that doctors erroneously refer to as “normal”.  TSH is often high in the range (or maybe even above the range according to the latest standards of 0.3-3.0 which many labs and doctors still refuse use) and FT3 and/or FT4 are low in their ranges.  Many doctors think that if labs are anywhere within ranges, their job is done...patient is no longer hypo, any remaining symptoms are not thyroid related, patient is fat and lazy.  NOT TRUE.  

Please see illustration below.  Each of us has a personal reference range within the population reference range at which we are euthyroid (neither hypo nor hyper).  A shift in lab values of the individual outside of his or her individual reference range, but still within the population reference range, is not normal for that individual.  Many don't feel well until FT3 and FT4 are in the upper half of the ranges.  After all, the population ranges of FT3 and FT4 are statistically determined distributions of patient results; by definition, approximately half the population will be euthyroid in the top half of the range and approximately half in the bottom.  If you are one of the people whose personal range must be in the top of the ranges, and your doctor won’t treat you or won’t fine-tune your medication when your results are in the bottom of the range, you are left hypo.  Your doctor may tell you your labs are "normal", but they are NOT “normal” for you.

Reference ranges of test results do not imply that everyone is going to be well as long as they are anywhere in the ranges.  The ranges are broad (e.g. 0.6-2.0 for FT4).  If your personal FT4 reference range was 1.6-1.8 when your thyroid was functioning properly, does it really make any logical sense at all that now that you are on replacement hormones, you should feel comfortable with an FT4 of 1.0?  No, it doesn't.  We all have a set point that is optimal for us...doctors should be finding it and adjusting medication to it.

If labs are within ranges, it's time for fine-tuning (or initiating a low dose trial)...increasing meds slightly if hypo symptoms are still present.  This will move FT3 and FT4 up in the range and alleviate symptoms…that’s the goal.  The ranges define the universe in which we can freely adjust medication; its entire breadth from lower limit to upper should be used for this purpose.  The patient will still be in the reference ranges, but he or she will no longer be symptomatic.  

Illustration:
                                                 Personal
                Current                      Reference
                  Level                          Range
0.6               1.0                       [1.6……1.8]          2.0
|-----------------Population Reference Range-------------------|

With an FT4 of 1.0, patient is still hypo according to his/her personal reference range.

[clareyh]

wow, thanks!! that is really helpful. I will pop into my doctors tomorrow and see if they can give me my other results, as i only know my TSH levels.

i am so scared the endo says no to trialing me on meds as i feel so horrid!

Thanks so much for your reply, much appreciated!

:)

[clareyh]

Well I saw the endo today..

I dont quite know all results as it is all so confusing but I know that:

TSH- 5.5-7.8
T4: 11-14 ...not sure what this means!

Anyway they said it was borderline and may not be causing my symptoms but as I was so sure they have put me on thyroxine 25mg for 6 weeks, then I go back for more tests and a review.

I feel like this will never end!

[goolarra]

What;s the range on your T4?  And is it total T4 or free T4?  Your TSH is 7.8?  Is that correct?

I think it's excellent that they started you on a low dose - some doctors are just impossible to convince.  You have to be patient...thyroid stuff cannot be rushed.  It takes six weeks for the meds to reach a stable level in your body, so you just have to wait that long between each meds adjustment.

[clareyh]

he was a bit hazy on T4, i got the impression it is a bit high, but not by much.

my TSH is too high in my eyes, their range go up to 4.5 and the endo thinks its not high enough to cause my problems. All I can do is try the low dose trial and see how it goes.

Thanks again for all your help, it was very useful :)

[gimel]

Goolarra gave you some very worthwhile info to absorb and discuss with your doctor.  I know the medical system works differently with the NHS in the UK, but there are a couple of things you should emphasize with your doctor.  First is the changed reference range TSH also mentioned above.  Another is that TSH is a pituitary hormone that is affected by many variables, and studies have shown that it does not correlate very well at all with hypo symptoms.  The thyroid test that has been shown to correlate best with hypo symptoms is the free T3 test (FT3).  

Another important thing to keep in mind is that the reference ranges for FT3 and FT4 have never been adjusted like was done for TSH, where the data base was purged of  those patients that were suspect of being hypo or hyper.   If this were done for FT3 and FT4, their reference ranges would move upward and narrow significantly.  I believe this is the basic reason why, as Goolarra recommends, that FT3 and FT4 test results in the lower end of the range need to be increased with medication in order to alleviate symptoms.  Symptom relief should be all important.

[Otto44$]

You seem to be very knowledgeable about thyroid disease. I was just diagnosed with Hashi's. Thyroid disease is a very hard disease to understand. I was wondering if all Hashi patients usually have high TPO's Tgab's? or if it means something else also if you have a autoimmune disease? not sure of the relation to one another, after reading that some people have normal TPO's & Tgab's, and some are high as mine but both have thyroid disease. Please help me in understanding. From my understanding the true test for Hashi's according to my PCP, are the antibodies, TPO & Tgab, is this true? From what I've read, it's not just the antibodies that make that determination. Another question I've is, not sure when I should be put on something for Hashi's?  Here are my most recent results:

3/24/2012-TSH 0.236,           range: 0.350-4.940
                 Free T4 1.00        range: T4-0.70-1.48

4/16/2012-  Anti-Microsomal 599 IU/ml also known as the TPO  range: 0-34
                   Thyroglobulin Ab <20 IU/ml                                      range: 0-40

5/16/2012-TSH 0.693
                  Free T4 0.98-        range: T4-0.70-1.48
                  Free T3 3.74-        range: T3-1.70-3.71

7/5/2012-TSH 1.307 uIU/mL
                Free T4 1.04 ng/dl
                

Ultrasound report:

The right lobe measures 4.1 x 1.5x1.5 cm. The left lobe measures 3.8 x 1.6 x 1.3 cm. Heterogeneous thyroid parenchymal echotexture without evidence of a discrete nodule. My understanding is that if my ultrasound was normal, there would be no concern of thyroid cancer and no reason for a thyroid scan.

Thank you for taking the time in viewing my post.

[goolarra]

Almost all of us with Hashi's have elevated antibodies (yes, your doctor is right...it's the true test).  Some of us are TPOab positive, some TGab positive, and some both.  Hashi's is an autoimmune disease.  Once you have one autoimmune to are more likely to develop a second than the general population is to get their first.  Hashi's is the most prevalent cause of hypo in the developed world, but there are other forms of thyroiditis (usually temporary) in which antibodies are not elevated.  

"From what I've read, it's not just the antibodies that make that determination."  I don't know what you are referring to.  Please clarify.

Your U/S report indicates that your have nodules, which is also indicative of Hashi's.  I don't see any concern for thyroid cancer, but I'm also in no way an imaging expert.  A clear U/S indicates no further imaging is required.

Your FT4s are a little on the low side, but considering you're not on meds, not much of a concern.  You only have one FT3 (FT3 should be tested every time FT4 and TSH are), but that one is actually high (over range).  So, I wouldn't suspect you'd be having any hypo symptoms yet???

Whe to start meds is a controversial subject.  Some doctors want to wait until labs go out of range and/or symptoms appear.  Others want to start earlier to avoid the worst of the symptoms.  

Initial stages of Hashi's can be characterized by swings from hyper to hypo, so medicating at that stage can be tricky.  

It can take years or even decades for antibodies to do enough damage to cause symptoms, and sometimes symptoms never do appear.  On the other hand, the degeneration can be swift.  

[Otto44$]

Thanks for the quick response. I've been on edge trying to understand all of this.

From what I've read, it's not just the antibodies that make that determination."  I don't know what you are referring to.  Please clarify.

Per my PCP, he told me that I definitely have Hashi's because of having the TPO antibodies.

I've always had alot of medical issue's, sinuses, kidney, type 2 diabetes, high cholesterol, triyglycerides, ect.now liver, ect. now knowing I have a autoimmune disorder or disease. I'm realizing why I've always had have so many health issue's. Anyhow, from the research I've done, if understanding correctly. That people with high TPO antibodies, but all other thyroid level's are good, doesn't necessarily mean you've Hashi's, that PCP should be ruling out other diseases before assuming it's Hashi's that's causing the high antibodies.

Ultrasound-Per report and Dr. Mark Lupo, I don't have any nodules or a goiter at this time. What are you seeing on that report that indicates nodules?

I've only had that one blood test for the FT3 test, at my request after leaning it should be tested. My PCP at the time I requested, didn't think the FT 3 had any play in Hashi's. However, because I was persistent in order that lab test, he did. I will be requesting the FT 3/4 and TSH to be added to my every 3 month lab order. I go every 3 months for type 2 diabetes, high cholesterol, trig. my PCP is very thorough, but sometimes they think they're also specialist as you can see from what I mentioned above about his thought on the FT3. Is there any other test I should be having done? Is it possible if not hashi's, the antibodies will go down? one of my concerns is not treating the antibodies.

Whe to start meds is a controversial subject.  Some doctors want to wait until labs go out of range and/or symptoms appear.  Others want to start earlier to avoid the worst of the symptoms.

That's just what my PCP said, is that he waits till the TSH level goes off the chart & me not understanding why they'd wait till symptoms get worse is very puzzling.. Maybe, I'm missing something.

I know I've read alot about the endocrinologist don't really take interest in thyroid disease, more interesting in diabetes, but I did request to see one. I go in Oct. to one I found, and she specializes in I can't remember now, but whatever part of the thyroid that begins with a P cancer. Therefore, hoping she has more interest in the thyroid.

initial stages of Hashi's can be characterized by swings from hyper to hypo, so medicating at that stage can be tricky.  

When I thought back to when my TSH level was low and receiving the call from the dr. with concern. I do recall I had lost a patch of hair in the front on the left side of my head, like receding. Well, I had asked my hairdresser about it, she thought it was a vitamin deficiency. Therefore, she recommended to take Centrum. Well, needless to say, luckily it did grow back. I then realized there were times that I would've heart palpatation's, fatigued ect. Just thought it was nothing serious when they stopped. Could that because my TSH level was low at the time?

[goolarra]

TPOab and TGab can be slightly elevated with other autoimmune diseases.  I've been frustrated in my reading in that "slightly" never seems to be defined.  Your result is pretty high, though, so I doubt you'd be considered "borderline" in any way.  As I said, Hashi's can move very slowly, and you can have antibodies for a very long time before they do enough damage to cause either symptoms or out of range labs.

As I mentioned, imaging is not my forte, so please don't quote me on my comments!  "Heterogeneous thyroid parenchymal echotexture without evidence of a discrete nodule."  "Heterogeneous" is what made me think of nodules, though, you're right, nodules aren't apecifically indicated.  A discrete nodule is often indicative of thyroid cancer (one nodule is worse news than many), and you don't have a discreet nodule, which is good.  Imaging is not my thing.  Some of our members are very good with imaging, so if you wanted to start a new thread, someone with a lot more knowledge will comment.

"one of my concerns is not treating the antibodies."  There is no proven way to treat the antibodies.  Many people claim to have protocols that treat the antibodies, but none has been proven in a large scale study of a heterogeneous population.  Two of the more popular theories involve selenium and a gluten free diet.

Once we have antibodies, we have them for life.  They can go down, and in fact, they vary wildly even intraday, but they're always there.

"That's just what my PCP said, is that he waits till the TSH level goes off the chart..."  No, doesn't make sense to me, either.  First off, TSH is the least important of the tests (FT3, FT4 and TSH).  Any doctor who thinks TSH is the gold standard in thyroid diagnosis and treatment is not a good thyroid doctor.  What makes a lot more sense is to say, "Wait until symptoms appear or FT3 and FT4 drop, whichever comes first."  FT4 below midrange and FT3 below upper half to third of range is where many people start having symptoms.  There's no reason to wait until either of those is below range...most of us are in hypo hell by then.

You're probably referring to papillary cancer.  And, yes, that might indicate she has more interest in the thyroid than some endos.  However, be aware that some doctors take "specializing" to a higher level.  Perhaps ALL she wants to treat is papillary cancer.  I think it's always worthwhile to do a telephone interview with a prospective doctor (probably through a nurse).  With a couple of pertinent questions you can weed out some not worth the time and money of seeing.  What thyroid tests do they regularly order for their hypo patients?  You know the answers you want to hear to those.  What meds are they open to prescribing (T4, synthetic T3/T4 combos, desiccated)?  Even just those two questions will give you a pretty good idea of where they're coming from.  When I was endo shopping, I wrote up a questionnaire and emailed or faxed it to all the endos in the area.

Keep in mind that your TSH level causes no symptoms.  TSH is nothing but a messenger from your pituitary to your thyroid to tell it to produce thyroid hormone.  TSH level should reflect FT3 and FT4 levels, i.e. when TSH levl is low, FT3 and FT4 should be high and vice versa.  That's in a perfect world.  If your TSH level was low, and that ACCURATELY reflected your FT3 and/or FT4 being high, then it could cause palps and fatigue.  However, those are both symptoms that can "cross over" and be symptoms of either hypo or hyper.

Since you FT3 is high, I'd recommend having TSI (thyroid stimulating immunoglobulin) tested.  TSI is the definitive test for Graves'.  In Graves', TPOab can be somewhat (again undefined) elevated.  Also, though very rare, some people do have both Graves' and Hashi's.  If you want to cover all the bases, you might also ask for B-12, D, iron and ferritin.  Deficiencies in those often seem to accompany thyroid problems, and some are necessary for the metabolism of thyroid hormones.

  

[Otto44$]

TPOab and TGab can be slightly elevated with other autoimmune diseases.  I've been frustrated in my reading in that "slightly" never seems to be defined.

My understanding is having antibodies is a autoimmune disease & there could be 101 reason as to what they're, unfortunately there's no one bloodtest to determine what's or what causes the disease.

Hashi's can move very slowly, and you can have antibodies for a very long time before they do enough damage to cause either symptoms or out of range labs.

Probably because of me just learning about antibodies and Hasi's. I was saying, that I'm thinking that I've probably always had a autoimmune disease, with all of the medical issue's I'm having and now it's starting to attack the thyroid, because I've never had a issue with my TSH, T4 level's and the PCP has been monitoring for yrs. now. It's just recently, that I'm having problems.

In no way was I trying to be critical of your knowledge of my ultrasound result. Was just sharing Dr. Lupo's comment. I'm truly sorry, if I gave you that impression.

What thyroid tests do they regularly order for their hypo patients?  You know the answers you want to hear to those.  What meds are they open to prescribing (T4, synthetic T3/T4 combos, desiccated)?

Thanks for that advice. I would've never of thought of that and it's getting very costly with all these test, co-pays, medicine's ect. I will definitely take your advice and call for a phone interview. However, I'm not that knowledgeable with this disease to know what to ask, other than the questions you've provided above. Is there anything else I should ask? should the answers to, what thyroid test do they do regulary be, TSH, FT3, FT4, TSI? is that all of them? (T4, synthetic T3/T4 combos, desiccated)?
are the answers i would want to what medicine's they use?

If you want to cover all the bases, you might also ask for B-12, D, iron and ferritin.  Deficiencies in those often seem to accompany thyroid problems, and some are necessary for the metabolism of thyroid hormones.

I will have my PCP order labtest for B-12, iron, ferritin & is that Vitamin D?

I would really like to thank you for all of your help in assisting me in learning about this disease. I am in great appreciation.

[goolarra]

No, it is not known what causes the immune system to go haywire and start attacking body parts as though they were foreign protein.  However, you can't have a generalized "autoimmune disease".  There are many different autoimmune diseases, but they all involve different antibodies.  Thyroid antibodies attack the thyroid and nothing else.  Once we have one autoimmune disease, we are more prone to getting another.  No one knows if that's due to genetic predisposition, if there's a cause and effect relationship or if it simply has to do with the fact that our immune systems are malfunctioning.  TPOab cannot attack your liver or your intestines, it can only attack your thyroid.

What are your other medical issues?  You might be surprised to learn that many of them could be thyroid-related.  I had symptoms that I never thought could possibly be due to thyroid, but they went away once I was on meds.  Every cell in your body needs thyroid hormone, so if you are deficient, you can develop a whole list of problems in different parts of your body.

I never thought you were criticizing.  I felt that I really shouldn't have commented on the U/S results because I don't know a lot about imaging.  I just wanted to let you know that I might not be the best person to listen to regarding imaging.  No offense was taken.

TSH, FT3 and FT4 should be done every time you have thyroid blood work.  If a TSI comes back negative, you don't have to repeat it unless there are new developments that indicate retesting.  So, that's a one time test, unless it's positive.

Ideally, doctors should be open to using whichever of those meds helps the patient.  Practically speaking, doctors usually fall into three camps...those who only use T4 meds (stay away from them), those who use synthetic T4 alone and synthetic T3/T4 combinations, and doctors who use dessicated.  It can be hard in some areas to find a doctor who uses desiccated.  For example, I live in a small medical market, and my endo does not use it.  I wish he did...because of other health issues, I can't use desiccated, so it's not a personal concern...but I think they should all be open to using what's best for the patient.  However, I like everything else about my endo, and if it weren't for him, I'd be travelling 150 miles to find another.  So, I compromised (had to) on that issue.

Yes, that's vitamin D.

You're very welcome.  

[Otto44$]

I do understand that one can't have a generalized autoimmune disease, as I stated above. I also am aware that my liver issue has nothing to do with the thyroid. Now, I'm understanding what you're saying that high TPO's are an autoimmune disease in the thryoid alone. That there are antibodies for each organ in our body. I was just recently on the expert forum by a Dr. after giving him all my liver blood test and sharing my ultrasound report, that It sounds like NASH or autoimmune hepatitis C. Hoping not hepatitis C. I was saying, oh boy here we go possibly another autoimmune disease.

You might be surprised to learn that many of them could be thyroid-related.  I had symptoms that I never thought could possibly be due to thyroid, but they went away once I was on meds.  Every cell in your body needs thyroid hormone, so if you are deficient, you can develop a whole list of problems in different parts of your body.

So, as long as my lab reports don't state High or Low for my T3/4, then I'm ok not taking med's? TSH level doesn't matter as long as my T3/4 are within range? as for me having high TPO's, that just confirms that I've an autoimmune disease, and no med's needed? just making sure I'm getting a better understanding.

I was born with a extra left kidney that stopped functioning when I was 8, A cyst in the right Kidney, high liver enzymes, diabetes, high cholesterol, high trig. menopause at 32, that's when my health started going down hill.

So, I would want to find a Dr. that uses,  synthetic T4 alone and synthetic T3/T4 combinations, and doctors who use dessicated? you mention that you also have other medical issue's and wish your Dr. uses dessicated. If dessicated is a drug, what do you mean he dosen't use it? it should be your choice if it's a drug that can be called in. Not sure what any of these medicines are, but will do research.

From my understanding, when it comes to Thyroid Disease, people that have it actually have more knowledge than the Dr.'s. That's a scary thought.

You're the greatest! you've helped me so so much! and I'm sorry that I through so many questions at you, just desperate for answer's.

[Otto44$]

I just found this interesting link, thought I'd share with you, let me know what you think.

http://bestpractice.bmj.com/best-practice/monograph/1121.html  It's very interesting check it out.

For some reason, it doesn't show if a TSH & FT4 are within normal range, T3 is high.

[goolarra]

"So, as long as my lab reports don't state High or Low for my T3/4, then I'm ok not taking med's? TSH level doesn't matter as long as my T3/4 are within range? as for me having high TPO's, that just confirms that I've an autoimmune disease, and no med's needed? just making sure I'm getting a better understanding."

Not exactly.  FT3 and FT4 ranges are very flawed for a number of reasons.  As a result many people find they still have hypo symptoms until FT4 is around midrange and FT3 is upper half to upper third of range.  Just being "in range" is seldom good enough.  TSH can be influenced by many variables other than thyroid hormone levels, so you have to look at all three test results, and if the TSH isn't suported by the other two numbers, you have to dismiss it.  There is no treatment for antibodies at this time, so, yes,. they do just confirm autoimmune disease.

Your thyroid produces T4 and a little of the T3 your body uses.  Most of the T3, however, comes from conversion of T4 to T3, and a lot of conversion takes place in the liver and kidneys (red flag), though there are conversion sites throughout the body.  The current therapy of choice is usually T4 only meds.  The theory being that the body will convert that T4 in the meds to T3 just as it would your natural T4 from your thyroid.  T4 (a kind of "storage" form of the thyroid hormones) has to be converted to T3 (the "active" form) because T3 is the only form your cells can use.  However, once on meds, some people find that conversion slows down, and even though their FT4 can be quite high, they still feel hypo because their FT3 remains low.  These people have to add a med with T3 in it to their T4 meds to feel well.  If the doctor isn't testing T3 or won't use T3 meds, then the person often ends up mistreated and still symptomatic.

Desiccated is desiccated porcine thyroid (Armout thyroid, NatureThroid, ERFA, etc.).  It is literally the dried thyroid of a pig, who has a thyroid similar to ours.  It's been around for over 100 years as a thyroid treatment, and some people do well only on it, but when the synthetics were introduce in the 1960's, it went out of favor with claim (unwarranted, I belive) of inconsistency in the amount of hormone contained.  So, a new generation of doctors was trained to use synthetics only, and desiccated still suffers from what was probably a very successful campaingn on the part of the manufacturers of synthetics to discredit their competition.

My endo and many others won't used desiccated.  They think it's inconsistent and harder to regulate.  I can't take it because I have a heart arrhythmia, but, as you say they should use whatever can be called in to help a patient.  Depending on where you are, though, how big a medical market you're in, it can be very difficult to find a doctor who will prescribe desiccated.  On principle, I wish my endo used it; in practicality, I can't take it, and I live in a very small market, so it was a relatively easy compromise.

It is scary.  In these days, with the internet, you can learn a whole lot in a short time, and you don't even have to have access to a good medical library.  I think it's pretty easy to bypass most PCP's knowledge of thyroid in a week.  Granted, we don't have the breadth of knowledge about all disease they do, but we can get pretty good in our one little tiny corner.

I have to run at the moment, so I can't read your link right now, but I'll follow it later.  Thanks.    

[goolarra]

I just looked at the link. It's fairly unusual to have TSH and FT4 within range and FT3 high, which is probably why they don't mention it.  It's especially unusual to have FT4 a little on the low side and FT3 high.

You could have more than one thing going on.  The antibodies could be keeping your FT4 down (by destroying thyroid tissue), and since you have had both liver and kidney issues, there may be a metabolic disorder causing excess conversion of T4 to T3  It could also indicate a swing from hyper to hypo...your FT4 had gone down, but FT3 was still high due to previously high FT4.

Since your U/S found no discreet nodule, we can rule out a toxic nodule (also called a toxic adenoma), which can sometimes cause higher FT3 levels.

[Otto44$]

Good afternoon. I feel like I know you personally now. Just wanted to share with you, that I've spoken on facebook, her personal page last night. Anyways, she's a Dr. in Australia and has books out on how to control Thyroid, Liver disease ect. it appears from the research I've done, that your liver actually is the main role play in one's life. I really never knew that. Anyhow, I'm starting her juicing with veggies, fruits & herb 8 wk. diet plan. I'm glad that I did speak with her on fb last night, because she informed me with Hashi's not to eat, raw green veggies. I'm sharing her response with you,

Hi Tammy,
Due to the hashimotos I would not suggest this particular juice daily. Try a mixture of different fruit and vegetable varieties such as carrot, celery, beets, lettuce, green beans, ginger, apple, pineapple, zucchini etc...its about juicing the rainbow to increase your anti-oxidant content in your juices. You must avoid eating or juicing a large amount of raw goitrogens vegetables such as cabbage, brussels sprouts, cauliflower, broccoli, spinach, kale. These foods are 100% recommended lightly cooked instead. Did you read the thyroid book or the liver cleansing book?

I really haven't been much in contributing to others that have Thryoid Disease, because of just learning myself. So it makes me feel good when I'm able to. I'm gonna try this diet & will let you know my outcome once I've completed & receive lab test.

[goolarra]

It does get that way, doesn't it?  I've made a lot of friends here.

Liver is very important...it removes all the toxins from your body.  However, there are people who will tell you that thyroid is actually more important since every cell in your body depends on it.  I guess it's just a matter of what you focus on or what your health considerations make you focus on.  

Goitrogens can cause an already inflamed thyroid to become more inflamed.  Cooking destroys the goitrogens.  Many of us haven't changed our diets at all to accomodate our Hashi's.  My recommendation is that you should do anything that makes you feel better, but if it doesn't make you feel better, you can pretty much ignore it.  I eat many of those regularly and they never bother me at all.  Those are some very "good for you" veggies.  If they don't cause distress or make your thyroid swell, you might benefit from the nutrition they offer more than your thyroid benefits from avoiding them.

When are you supposed to re-test?

[Otto44$]

Stupid me never realized how important our livers are, or would've changed my eating habits a long time ago. I never was a bad eater, but didn't eat many veggies or fruits. Oh well, hoping it works and heals my sick liver. I'm more scared about my liver at this time. I'll work on my thyroid next.

I'm glad that Dr. Cabot, informed me that raw Goitrogens can cause a inflamed thryoid. I'll have to do more research on what veggies are considered goitrogens, to avoid them raw.

I'm changing my diet for the liver. I never new that certain foods could affect the thyroid.

I have my thyroid testing with all other lab test every 3 months. Just went in July, so I go again in October.

just looked at the link. It's fairly unusual to have TSH and FT4 within range and FT3 high, which is probably why they don't mention it.  It's especially unusual to have FT4 a little on the low side and FT3 high.

You could have more than one thing going on.  The antibodies could be keeping your FT4 down (by destroying thyroid tissue), and since you have had both liver and kidney issues, there may be a metabolic disorder causing excess conversion of T4 to T3  It could also indicate a swing from hyper to hypo...your FT4 had gone down, but FT3 was still high due to previously high FT4.

Since your U/S found no discreet nodule, we can rule out a toxic nodule (also called a toxic adenoma), which can sometimes cause higher FT3 levels.

I'm now worried about why the T3 is high and T4 is low if it shouldn't be. I don't see the Endocrinologist until Oct. I still have to call & do the phone interview you suggested.

[goolarra]

I'm a little worried about your FT3 level, too.  I don't understand why they didn't test it in July when it was above range in May.  They should have followed up on that.  

You might want to do some reading on T3 toxicosis and Hashimoto's toxicosis.  As antobodies attack the thyroid and cells die, they sometimes "dump" thyroid hormone into the bloodstream, causing FT3 levels to rise.  T3 toxicosis can be a serious condition.  Your TSH went up from May to July with little change in your FT4.  That could mean that your FT3 went down also, which would be good.  But that's a leap of faith I'd like to see confirmed with actual FT3 numbers.

I'd just encourage you to stay on top of thyroid at the same time you work on your liver issues.  

[Otto44$]

Oh boy, now I'm real scared. I didn't understand the what the level's meant, or I could've had my PCP retest. My PCP probably doesn't know as much about Thyroid Disease as he would like. Because he actually tried to tell me, when I was informed on the forum to have my FT3 checked, that that doesn't matter. I insisted in him checking it. When I requested to be referred to a Endocrinologist, he said, you know alot of Endo's. don't really know as much as they claim about Thyroid's. I didn't really respond, just thought. Well, you obviously don't understand it either, it thinking the FT 3 test doesn't matter.

I will definitely do my research & call his office demanding to have all test retested before Oct.

Oh I misspoke, I will definitely, stay on top of what I am learning on the thyroid.

This is so much for me to take in, all these health issue's at once and not knowing which way to go anymore.

So, what is the best readings for FT4, FT3 & TSH?

I wonder if this is why I'm getting alot of headaches, aches, pains, ect
You know I was told yrs. ago that it was the lipitor I was on, that was making affecting my memory (Side effect of lipitor is memory loss) it's probably my thyroid disease, probably have had it for a long time.

[Otto44$]

Sorry, forgot to add, maybe that's why I've having issue's with my liver now, because of toxins releasing. OMG! I don't know if it's better to not know anything about my health & just live the rest of my life happy vs. knowing & trying to control.

[Otto44$]

Sorry for so many different post, but wanted to share with you, what I just sent to my PCP in testing  regarding my thyroid:

I've been doing research about Hashi's, in which I was diagnosed with. I noticed that my lab test results in May showed that my FT3 was over the range,(it appears that's not good) FT 4 was on the lower end of the range. Anyhow, not sure why having Hashi's, my FT3 was repeated again in July. In my research, having Hashi's, TSH, FT3 & FT4 levels should always be tested at the same time. Therefore, I would like the following tested concerning my thyroid disease:

TSH
Free T3/T4
TSI-to rule out graves also
Vitamin D
Ferritin
B-12
Iron

My PCP has given me access to my chart thru portal. He'll probably wish he never did that, lol!

Ok, I'm gonna go check my sugar & watch a show called Dallas.

You've a good night & I'll probably ttyt