SO you are flat and smelly too! Join the party. The only thing worse than feeling like a cow patty is feeling like a cow patty tossed into an industrial cyclone fan. The results are messy and FAR from pretty. Do not try this with a wet cow patty at home kids... and I do not mind you using the description at all. This is a little long, but I really need help....PLEASE SOMEBODY....Been a long time lurker.
Well welcome to our thyroid dysfunctional family. It feels better to get it out doesn't it? Little background: dx as postpartum-hypo back in Dec. Have TPOAB. On 100mcg Synthroid, iron, multi-v, b12, calcium w/vit d, fish oil...I don't take Synthroid w/supplements, and I wait an hr until I eat after I take it.
This sounds good, however are you also diagnosed and listed as have Hashimoto's. With TPOAb like yours, you HAVE Hashimoto's and you should be treated as a high risk OB patient accordingly. Did they also test your child's blood for antibodies as well as a base line TSH, Ft3, and Ft4 panel? This should have been done and if it wasn't.. you need to get your pediatrician to do it. Tired upon getting up, but about noon or so I get extremely exhausted and I am that way for the rest of the day, puffy eye lids, no energy, little cholesterol build up under one eye, etc. (that's all I can think of for now).
This can be a sign of under treated thyroid issues, adrenal issues, low ferritin (FERRITIN is not total, iron.. it is labeled ferritin and must be written in not checked off on a standard lab sheet), sleep deprivation, sleep apnea.. etc. It is a good thing that I do see some Ferritin checks down there.. give your MD a pat on the head for me. Been to several health care providers, going back in a few weeks to an endo who I have been to once before. I didn't "click" with her the first time, but figured I would try again. The provider I have been seeing has just told me that she doesn't know what else to do for me.
Ugh! I am sorry that you are having to MD shop. It is the worst part of having a dysfunctional thyroid. You feel like cow flop and have to fight to get someone to believe and listen too you.. THEN when you get one.. they may or may not be willing to treat you. It sucks, vent, get it out.. and then we shall see what we can do. On my latest labs if I did my math correctly, my FT4 is at the 90% of range and FT3 is at about 40.5%. So do you think this could be adrenal or that I may need T3? Looking at my ACTH from June 2008 (listed below), it is a little high, but I don't know if my adrenals are doormat from under treated hypo or what. Please help...I go back in about two weeks, and I need to arm myself with info.
Latest labs (Sept 2008) While on 100 mcg Synthroid
TSH 0.76 (.40-4.50)
Free T4 1.7 (.8-1.8) You are 90% of range here. This is above optimal and can make you feel washed out.
Free T3 307 (230-420) You are at 40.5% here.
This is suboptimal and is showing that you are not converting your T4 to T3 for some reason. Being suboptimal here will cause the facial puffing and physical symptoms you described.
Ferritin 58 (10-154)
This is still a bit low. You want it in the 70-90 range. What supplement are you taking and how much are you taking of it? There are some supplements that absorb better than others.
Iron, Total 115 (40-175) TPO AB 463 (<35)
IGF-1 177 (126-291)
Still have a good strong set of antibodies ripping your thyroid a new one.
(June 2008) Tests done while at 88mcg Synthroid...bumped to 100 mcg July 2008 after these tests
TSH 2.00 (.40-4.50)
Free T4 1.4 (.8-1.8) 60%
Free T3 324 (230-420) 49.5% This is still suboptimal here. Your trending toward needing T3 supplementation.
TPOAB 593 (<35) Another positive hashimoto's. You are not postpartum thyroiditis.. you are HASHIMOTO'S thyroiditis and hypothyroid. *snort* Fight and make sure that is declared in your medical records.. otherwise you can have issues down the road with the PPT only lasts 12-18 months.. you no longer need medication. Just stop and live in hypoT Hashi's Hades! I know some one that was just told that 2 days back. I am riding shot gun on her Friday appointment.. time for some fun. ACTH, Plasma(8am) 28 (5-27)
Cortisol, (8am) 16.7 (4.0-22.0)
Cortisol, 24hr urine 24.6 (4.0-50.0)
Okay from these results you do not appear to have an adrenal issue. For adrenals to be causing the low T3 and high T4 we are seeing Your cortisol levels would be High not mid range. I would say that at the time your adrenals were studied they were doing fine. ACTH fluxes a bit depending on stress and physical demands. You want and ACTH in the 20 range. HOWEVER adrenals should be ruled out and when you go back to your MD have them run another 8 am fasting blood serum cortisol and ACTH just to be sure. If the cortisol and ACTh are HIGH then you need to get your pituitary gland evaluated further. (May 2008)
Vitamin D 41 (20-100)
This is still a bit low. You could benefit from a bit more vit D in your system.
Ferritin 46 (10-154)
This was still low as well.. need more iron.
DHEA (NOT Sulfate) 378 (143-1277)
This is also low. You may benefit for a 10 - 20 mg once a day supplementation of DHEA. My IM tried to treat my adrenals this way first, but DHEA was not needed in my case and did nothing but give me acne.
Okay given the 50% deviation in your Ft3 and FT4 levels of your latest labs and previous adrenal tests I recommend that you get your conversion of T4 to t3 checked out. The best tests in my experience for this are:
TSH, T4, T3, and T3 Uptake.. the uptake is dependent on T4 and T3 results. It tells you how much of your T4 is being bound up and used in different processes. It doesn't tell you HOW the T4 is being used.. just if your body is using it.
RT3.. revere T3 is an isomer of T3 that is inactive. An internal iodine is stripped off the T4 versus a terminal iodine. When this mechanism acts excessively you are left with an inactive non-binding RT3 form that just floats about and doesn't help matters. This behavior requires T3 supplementation.
High cortisol will also suppress the binding and conversion of T4 to t3. This shows in low T3 with respect to T4 and High cortisol levels.
Two out of Three thyroid suffers need some T3 in their supplement regime. It looks like you are one of them. You may need to mix and match Armour and synthroid til you balance out.. OR you may just be able to drop back on your T4 a bit and add cytomel. Either way you still have some medication adjustments to go.
Keep fighting for yourself. You are your best advocate.