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Old 05-19-2008, 05:34 PM   #1
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Lab interpretation - Postpartum Thyroid problem??

Hi all .. I've read quite a bit on the site and thanks to you I think I (not my doctors!) have figured out my issue! I too have not been feeling myself for the past two months. I am six months post partum currently. My regular doc ran a cbc and to his estimation my thyroid numbers are within range and hence normal. I know now this is not the case. I had my nutritionist also run some blood work which included the thyroid panel and here are my numbers:

TSH 1.77 (Range .35 - 5.50)
Free T4 .9 (Range .9 - 1.8)
Free T3 142 (Range 60 - 181)

These numbers are sub optimal, right? and I am going to make an appointment to see an endocrinologist. My nutritionist is going to give me some thyroid support vitamin and she want to see if my getting more iodine in my diet will correct this .. should I try this first and see what happens or see the endo doc? The brain fog is terrible. Oh .. I have good days and bad days .. is that normal for thyroid disorder?

I also have a mildly elevated sed rate (38 - Range 0-20). Is the elevated ESR related to the thyroid problem?

Thanks for all the info on this site and any and ALL feedback is appreciated.

- Lisa C.

 
Old 05-19-2008, 06:49 PM   #2
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Re: Lab interpretation - Postpartum Thyroid problem??

Did they test you for Hashimoto's per chance? If not just to get a baseline and make sure it didn't activate during pregnancy.. Hashimoto's can cross the placenta and mess with your child. Hence in my opinion it is essential to catch it early.

Now to your results:
Alright your active T4 levels are at 0%.. suboptimal is an understatement.
Your active T3 levels have me perplexed. They are optimal in range 67.7%

This is way out of balance. You need T4.. but if this is due to adrenal insufficiency you need to address the adrenal issue first. Are you on beta-blockers or birth control pills at the moment?

You need ACTH and cortisol and DHEA sulfate... fasting 8 am blood draw is the best.

If you are not on BCs or beta-blockers.. also add Aldosterone and renin.

This will cover the main adrenal-pituitary function loop.

Did you have a lot of bleeding during your delivery. Septic pelvic vein thrombosis maybe? It could cause the pituitary gland to fail or misfunction.. this would effect the adrenals. There is something up with this imbalance and you need an MD that will work with you on it. Finding an adrenal savvy MD on top of thyroid savvy is neigh impossible.

Look to my week 2 thyroid care and concerns post it goes over a lot of the basics and points to many other threads of mine that may be useful to you.

[url]http://www.healthboards.com/boards/showthread.php?t=597479[/url]

MG
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Last edited by mkgbrook; 05-19-2008 at 06:51 PM.

 
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Old 05-19-2008, 07:22 PM   #3
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Re: Lab interpretation - Postpartum Thyroid problem??

What do you mean that it can mess with my child? Should I have him checked for anything? He's only 6 months old. I had a c-section so no, I didn't have a lot of bleeding during delivery. I haven't been tested for Hashimoto's. I know you don't mean to but you're scaring me ... especially about my baby. What should I do??

 
Old 05-20-2008, 06:07 AM   #4
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Re: Lab interpretation - Postpartum Thyroid problem??

Don't be scared. Your child should have had a basic thyroid panel run at birth. If the child had suppressed thyroid function it should have been caught then. It is worth while to ask your pediatrician if they ran a TSH, FT4, Ft3 on your child at birth. They are supposed to, but it is not set in law. My SIL is an OB so I get the latest findings in that regard.

Most issues to the child will arise in the first trimester of a pregnancy. If you have low T4 levels there is an increased chance of cognitive development issues. This is just an increased chance.. not guarantee and your issues appear to have manifested post pregnancy correct?

Well with Hashimoto's it increases your chance of miscarriage.. your have a beautiful healthy baby, so no worries there. It also predisposes you to hypothyroidism.. which causes issues in future for you and any other babies you might have... the main issue with Hashimoto's is it is so had to catch until it has ravaged your system. Thus catching it early and treating it early is better for you and your child and any future children you desire. It is also important because Hashimoto's is very familial dependent. SO if you have it.. your children are at an increased chance of developing it and you should be watchful of the signs. It is not something that is going to wake up and snatch your baby from you. My son is five. He is reading and writing and doing math at a 2nd and 3rd grade level. He is physically one of the strongest and biggest in his class. He does have sleep apnea and is immune deficient in IgA.. which means LOTS of sinus ills, but he is wonderful. My Hashimoto's developed during my pregnancy. So you should not worry. But you need to be aware and know what to look out for...

So what is the text book scenario for the thyroid autoimmune diseases. First, Hashimoto's and Graves Disease are the two thyroid autoimmune diseases. The antibodies from either can cross the placenta and attack the child's thyroid as it develops.. just like it attacks the mother's. Once born the antibodies will slowly purge from the child's system. Issues are normally dramatic and arise from pregnancy long attack on the child's thyroid. Your child arrived safe and sound, if there was an immediate issue they should have detected it at birth. Most issues arise earlier in the pregnancy and can compromise the pregnancy, if they are going to occur. Thus you shouldn't be worried, but if you have Hashimoto's and if it developed while you were pregnant it increases the chance that your child will have it.. because your thyroid antibodies could have transfered into the child making that genetic imprint. What causes Hashimoto's or Graves to wake up and become a pain in the neck. Well they can not pin it down to an exact source, but they know it occurs in times of hormonal flux (puberty, pregnancy, menopause), certain viruses and bacterial infections (mono is the big one), if you have another autoimmune condition, certain medications and radiation and environmental toxins.. etc. you get the picture. Women naturally have more periods of hormonal flux and the Hashimoto's is linked to the X chromosome.. so we get that wonderful predisposition to have it. This doesn't mean you have it. The test will say if you do.. another thing to look at is your family. Does anyone in your family have a thyroid autoimmune disease.. wait a minute most MDs do not want the insurance to flip for two antibody tests.. so look for hypoT or hyperT family members. If you have a mother or grandmothers or sister or aunts with thyroid issues.. it may be an autoimmune issue at work. I have Hashimoto's and I have developed Graves antibodies as well. My mom has Hashi's and Graves.. she is one of 5 sisters. .. all of them have thyroid issues as well. It took 13 years of suffering to get them all diagnosed. So this is your chance to get proactive and have the blood work run. If you have Hashimoto's you can be prepared versus run about like a chicken with your head cut off for five years until you determine what is the issue.. because MDs often will look at the TSH and say your normal.. not the thyroid. I REALLY hate the normal word.

In the case of Hashimoto's it is nasty because it will attack any thyroid it can get access too. Hashimoto's pregnancies normally require an increased dosage of thyroid medication 25-50% more than when you are not pregnant... You should also get targeted ultrasounds of the babies thyroid in womb to make sure they are not developing a goiter.. ONCE again this would/should have been noticed at birth, if Hashimoto's was at work from the onset and you didn't have sufficient T4 levels. You mention nothing of that, so NO WORRIES there. The worry is in the future, the horrid question mother's ask themselves.. "If I have it, will my baby develop it?" You never know.

In the case of Graves it stimulates the thyroid and increases the chance that you and the child are hyperthyroid. It can cause preeclampsia and all sorts of nasty things to you. It does effect the baby as well, but Graves shouldn't be an issue for you. However just for general information, it is possible to have both Graves and Hashimoto's develop.

Thus in my opinion given my family history of thyroid autoimmune issues and the fact that Hashimoto's exists in 12.6% of the population, but only 2 % are diagnosed early with it. I recommend to any woman that has developed postpartum thyroid issues or thyroid issues during pregnancy be tested for the Hashimoto's and/or Graves antibodies.. just to be sure. Most MDs will not bother with the test, they look at the TSH, if you are lucky and do not look at the actual thyroid hormone levels. They treat the now and do not look to the future. But I believe it is better to be prepared and know all that you can. The Hashimoto's antibody tests are quite accurate and only take a little blood. In 85-90% of Hashimoto's patients, it will catch the issue. There is a 15% chance of getting a false negative, but IF you have Hashimoto's it makes you a high risk candidate for future pregnancies and you will need to follow special care. You will also be aware of the fact your body is attacking your thyroid and that it will kill it off one day. This will allow you to look for the signs of hypoT in yourself and those about you. There is an 80% chance that a daughter will manifest hashimoto's if you have it and a 20% chance a son will manifest it. All we can do and do do in my son's case is draw blood yearly and test his TSH, Ft3, Ft4 and thyroid antibodies as part of his physical. This allows us to have a running baseline of his normal thyroid function and will catch Hashi's or Graves, if they rear their ugly head in the future.

So it is most important for you to get tested, so that you know and can take proactive treatment and care measures for you and yours. I hope that I didn't make things worse... with all this. I am just trying to stress that there is no immediate danger to your child, you are more at risk for issues at this time than your child. If I were you and my MD had bothered to run my TSH and levels during my pregnancy to catch a thyroid issues. Knowing my family history and the dominance of Hashimoto's, I would ask my OB or GP to run the following blood tests:
TPOAb and TGAb.

You have the rest. If these come back positive you have added ammo to get you to an Endo that is good with adrenal/pituitary/thyroid issues. You will want to research the Endos. DO not settle for one Endo just because they are close. If they specialize in diabetes they may not be as current or familiar with thyroid issues. You want a thyroid expert. I do think you need to be medicated. That T4 level is way too low. But you need to make sure that your adrenal/pituitary loop isn't out of whack as well. If you medicate with your imbalance it may throw you hyperT in T3 while you wallow hypoT in T4. It sucks living half hyper and half hypo. I do it on a daily basis and wouldn't wish it on anyone.

MG
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Last edited by mkgbrook; 05-20-2008 at 06:14 AM.

 
Old 05-20-2008, 06:37 AM   #5
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Re: Lab interpretation - Postpartum Thyroid problem??

MG .. thank you so much. You really are a wonderful support to all of these people and now me! I can't imagine how much time you spend getting back to everybody on these boards!

I like my GP so I'm going to work with him as well ..

Also, any thoughts on my elevated sed rate (38)? Can this be elevated due to thyroid problems and these levels being out of whack? My GP has been trying to identify the source of this elevation for several years now. I usually do not have symptoms so we have just been "keeping our eye on it". It has stayed the same level for two years but I would really like to know why it's elevated and am VERY hopefully that this new discovery regarding my thyroid is pointing to the source.

Thanks again .. can't thank you enough.

- Lisa C

Last edited by moderator2; 05-20-2008 at 11:54 AM. Reason: disallowed website - please read the posting rules

 
Old 05-20-2008, 06:44 AM   #6
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Re: Lab interpretation - Postpartum Thyroid problem??

An elevated sed rate doesn't tell you much. It can be the sign of an infection.. or inflammation.. inparticular MANY Hashimoto's thyroiditis patients have an elevated sed rate.

One reliable source of information that is postable is thyroidmanager.org. This is a site which supports all its findings with medical and academic journal references and it keeps up with the latest trends. I am not sure of the site you posted, but can vouch for this one.

MG
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