Test results

[astunally]

Hello  all,
just got my blood results back and would like to k ow what you think as I'm still not that good at reading them
personally Iam feeling very well these days .The person who took y blood said there was really no need for the FT 3 test but I told her do it any way. looks like my B12 is ok to,

Here they are :
FT3.  4.00. Pmol/ml.          Range 2.8 - 7.1

FT4.  12.00 pmol/ml.          Range 12- 22

TSH. 8.50 pmol/ml.            Range 0.27- 4.2 mlU/MI

Vitamin B12.      313.00.     Range 176-1100

Thanks in advance for any input  

Sandra

[goolarra]

How you fell is most important.  You say you are feeling very well.  Do you have hypo symptoms that remain?

All your thyroid tests say that you are still quite hypo.  FT4 is at the bottom of the range, and target for FT4 is midrange (17 on your range).  Target for FT3 is upper half (50+% of range) to upper third of range, and yours is only at 28% of range.


TSH, for what it's worth, is high, also indicating hypo.  Has your doctor commented on your labs yet?  Does he want to increase your meds?  What thyroid meds do you take?

Vitamin B-12 also usually has to be much closer to the top of the range.

[astunally]

Haven't been to see the doctor yet. The only thing that's bothering me at the moment is hot flashes but I put that down to the menopause.
Iam on 50gm Levo only . Do you think I need to increase the dose even though I feel ok?
My last results if you can remember , I was nearing on Hyper . How often do you recommend blood tests? My last ones were about a 2 months ago.
I appreciate your feed back, thank you .  

[goolarra]

Well, as I said, how you feel is the most important thing.  Most people conform to the "midrange for FT4, upper half to third for FT3" rule, but we ALL don't (myself included).  I'm usually quite comfortable with my FT4 not far from where yours is and my FT3 even lower than yours.  So, no, if you feel okay, you don't need to increase the dose.  

When you are actively changing your dose, blood work should be done every 4-6 weeks.  I'd keep that schedule up until I'd had two consistent labs without changing dose.  So, last meds change, labs after 4-6 weeks, labs again after 4-6 weeks, then lengthen that.  If I remember correctly, I think I went to every 3 months, then to every six months.  I still have blood work every six months, but I only see my endo once a year.  If either of us has anything to say to the other after the interim blood work, we talk on the phone.

I'm sorry, I don't remember your previous results.  If you'd like to post them, too, it might be an interesting comparison.

[astunally]

These are my last results , I carried on taking 50gm a day ,


FT4   1.5  ng/dl          range 0.82 - 1.63
FT3    3.92  pg/ml      range 2.1 - 3.8
Results obtained by automated quantitative test ELFA technique by VIDAS instruments.

TSH ELECSYS              0.35 mlU/ML        range 0.27 - 4.2 mlU/ML





Sandra

[goolarra]

Big changes for sure.  You were on 50 mcg before both labs?

[goolarra]

I should also have asked if you have Hashi's.

[astunally]

Yes I was on 50mg for both tests and yes I have recently been told I have. Hashimotos disease . At the beginning of treatment , I felt really bad, but this last month have felt much better, I do get the occasional heart flutter and hot flushes ,but apart from that I feel ok

[astunally]

Would also like to mention my B12 vitamin was 700 last time and I was told it was ok that's why I didn't post but now it's gone down again to 313 range 176-1100 I suppose that  means I should keep on taking supplements for B12

[goolarra]

As you know, early stages of Hashi's can be characterized by swings from hyper to hypo, and it looks like you've just swung...that is unless there were changes in other meds or supplements, diet, how you take your meds, etc.  That was quite a change...how long between the two labs?  

If I were you, I'd definitely want to schedule labs again in 4-6 weeks.  While your FT3 is probably high enough to keep you feeling pretty well at the moment, I'd worry that wouldn't last with your FT4 so low and your TSH high.  If you have labs drawn again soon, you'll be able to see if your levels are stable or if the downward trend is continuing.

As I said, I'm very comfortable low in the ranges, and you might be as well.  My FT4 has been near the bottom of the range for over a year now, and my FT3 has been below range for almost that long.  I keep waiting for the other shoe to drop and have it all suddenly catch up to me, but it hasn't so far.  All I can say is that my levels seem stable where they are...no further downward trend.  Just monitor yours closely for a while.

Yes, I'd keep on taking B-12 if I were you.  The range in Europe starts at 500, so a change in continent would make you deficient.  LOL  Most people seem to feel better with B-12 quite high in the range.

[astunally]

Thanks for the advice, it is 2 months between labs , I will schedule labs again after 6 weeks . I suppose with Hashimotos we have to keep monitoring as our thyroid will eventual stop working, if I understand correctly.

I'm a bit worried about the B12 , as I read I could have been deficant for a long time without knowing about it. Do you think this could be why my memory is so bad, I can't understand why I am deficant as I should get it in my diet. I will have to research this a bit more.

Thank you again for your valuable advice

[goolarra]

Yes, I think my thyroid has stopped working.  I've been on the same dose for years now.  With Hashi's, your thyroid can die slowly, or it can go like gangbusters.  When it's going downhill very rapidly, you can get hyper periods as those dying cells dump hormone into the bloodstream over a short period of time.  Really, the disease becomes much easier to manage once the thyroid has given up the ghost.

B-12 deficiency can have the same symptoms as thyroid.  However, considering where your thyroid labs are, memory could also be a thyroid issue???  Brain fog/memory problems are just as important symptoms as the physical ones.

Pernicious anemia, the inability to absorb B-12 through the gut, is another autoimmune disease.  Once we have one AI, we're more likely to get a seond than the general population is to get its first.  If your B-12 never went up very high despite oral supplements, you might ask your doctor about PA.  People with PA have to inject B-12.  There are also sublingual preparations and nasal sprays, but they don't seem to be used in this country as much as in others.    

[astunally]

So do you think I need to increase my meds to 75mg or should I carry on with 50mg and retake my labs in 6 weeks?
I will supplement B12 and try and get it higher , do you think if it doesn't get higher after 6 weeks I will need injections, this is so confusing, I'm going to have to read up on everything again. It's really frustrating with bad memory . And I think it would be much easier like you said when the thyroid stops so we can keep our levels in normal range .
Thanks again for your input

[goolarra]

Whether you ask your doctor for an increase or stay at 50 mcg really depends on how you are feeling.  You don't know if the downward trend in your labs is going to continue or if you might have another swing.  So, it's all a little bit of a gamble at this point.  You could also ask your doctor if you might take a smaller increase.  There's no single tablet between 50 and 75, but you can achieve 62.5 by alternating 50/75, by taking half of each (50 and 75) every day or by adding half a 25 to your current 50.

PA is due to the lack of something called "intrinsic factor" in your gut that catalyzes the absorption of B-12.  I'm not sure of the timeframe regarding oral supplements, but you might ask your doctor after 6 weeks if she'd test for PA.  If your serum B-12 levels aren't rising or are rising more slowly than they do in her other patients, it might be time to test for PA.

[astunally]

Hello Barb, just want to up date you , looks like I'm on a downward spiral, feeling so ill these days , I increased my meds slightly , but considering I was felt so well before and now feel very bad it can't be enough.
I will retake blood tests tomorrow and also ask for PA to be taken to know one way or the other if I have it.
If I need an increase of meds , how much can you increase the dose at any one given time, I appreicate your input , so I can discuss with the doctor when I see him .

[astunally]

Just another thing , I was talking with a lady who has had the same illness and she said maybe it would be better to take off the thyroid all together. Not sure I like that idea at all . Any advice ?
Thank you
Sandra

[goolarra]

Would you mind listing your symptoms?  Are they the same as before the increase (and if so, have they gotten worse), or have new ones arisen?

Typically, meds increases are done in increments of 12.5-25 mcg per increase.  Blood is drawn 4-5 weeks after the increase and results and symptoms are reevaluated to see if a further increase is necessary.

Thyroidectomy (TT) is seldom recommended for Hashi's unless there are extenuating circumstances, e.g. inflammation is causing breathing and/or swallowing problems.  TT is sometimes recommended, too, when swings from hyper to hypo make stabilization almost impossible.  Usually, the unstable period with swings from hypo to hyper occurs early in the disease and is short-lived.  As more and more of the thyroid dies, treatment becomes easier.  However, levels still have to be monitored regularly since demand for hormones changes over time and with lifestyle changes.  Personally, I'd consider surgery a last resort.  An alternative to TT is RAI, which chemically "kills" the thyroid.  It's less invasive, but radiation and a brief quarantine is involved.

For the moment, I think you should see what these labs say.  If your FT3 and FT4 continue the downward trend, an increase might be all you need.    

[astunally]

Thanks Barb, I have cold intolerance again along with hot flushes very frustrating, aches and pains, swelling in my hands, in the joints, slight puffy face, and my chest itches very much these days ( this is new) bad head aches also new, and very tried these days . Altogether I feel awful. I will post my results as soon as I get them , it been about 5 weeks now since the last ones .
Sandra

[astunally]

Plus some numbness on the side of my face ans soreness , it gone now , but I couldnt understand it, and sometimes  pains in my chest mostly on my left hand side. All my joints seem to ache , especially when getting up in the morning .

[goolarra]

Barb and I are two different people!  LOL  I'm "goolarra".

Joint pain can be caused by both over- and undermedication.  Headaches are more typically hyper.  I guess we'll just have to wait and see what your labs have to say.

Five weeks is plenty of time...you could have your lab draw at any time now.  When my doctor was actively adjusting my meds, I'd have labs after four weeks and see him at five.  

[astunally]

Sorry Goolarra, put it down to brain fog , lol :) Funny but I just had the name Barb on my mind .

Thanks again for your input I really do appreciate it.
Will take the test on Saturday, and post the results when I get them ,
Sandra

[astunally]

Hello again Goolarra,
Just got my blood results back , to me they look ok , not sure really, the lady who took my blod told me once I got it under control I will only need to do the TSH every 3 months, I was not in the mood to argue with her :( .

Any way, I feel awful, tried, but can't sleep because I ache all over in my joints, my feet are a bit swollen, my hands hurt and are swollen as well. So much for feeling great over a month ago!
I get a flutter in my heart more then before as well.

My blood results;

T3 FREE   4.20             RANGE 2.8 - 7.1
T4 FREE   15.3             RANGE 12 - 22
TSH           3.64            RANGE 0.27 - 4.2



VITAMIN B12        608.00   RANGE    176 - 1100

I await your kind advice as the docotr is on holiday and I can't get an appointment for at least 2 weeks .
all my best
Sandra

[astunally]

I have been taking 62.50 mg of levo for the last 6 weeks .

[goolarra]

Your labs look "ok", but not great, and there certainly is room for improvement (and an increase).

FT4 is at 33% of range, and the rule of thumb for FT4 is 50%.  So you have a way to go there.  

FT3 is also at 33% of range, and many of us find that FT3 has to be in the upper half of the range before all hypo symptoms are relieved.

It's hard to draw any conclusions about how well you convert until FT4 is close to midrange.  Right now, your balance of FT4 to FT3 isn't bad (technically FT3 should be a higher percent of its range than FT4 is of its, and yours are equal).  However, with FT4 still below 50%, I'd give that some time and see how it falls out.

If I were you, I think I'd ask my doctor for a modest increase...perhaps to 75 mcg.  Your TSH is a little high compared to the range that was recommended over 10 years ago by AACE (0.3-3.0).  Everything points to your needing more meds.  

[astunally]

Thank you very much for your reply, thats also what i was thinking concedering I feel so bad at the moment , much appreicated
Sandra