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Old 06-02-2008, 06:15 AM   #1
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Some advice on blood results would be wonderful at this point!

Hi everyone-I'm new to these boards so please bear with me

I went to my GP's 12 weeks ago for help with dry eyes, particularly my right eye which appeared to be slightly asymmetrical to the left. To his credit, the GP asked me lots of questions of a symptomatic nature, to which I informed him of severe fatigue partcularly mid afternoon (you could set your watch by it), intolerannce to cold, emotional blunting, aching joints (mainly wrists for me), never feeling rested, very little motivation at all and the worst thing for me (I am a psychotherapist), cognitive issues such as really poor concentration, memory problems and difficulty speaking when particularly tired (like having cotton wool in my mouth).

My GP requested bloods, which were (?)antibody profile and TSH, which came back as negative (antibodies) and TSH 2.88 (ref. 0.3-5.5). He told me this was fine but would send me to an edocrinologist anyway as I also had a goitre, and also referred me to an Opthamologist.

Endo guy acknowledged the goitre, saw I had a bulging right eye, looked at the symptoms and agreed that they were all signs of hypothyroidism but wouldn't treat it as my bloods were ok. "I am not concerned by these results" is what he said.

He requested an ultrasound and more bloods along with free T3 & Free T4.

Ultrasound showed a multinodular goitre with one of the nodules measuring 4.5cm, optho guy acknowledged the bulging eye, said it was related to thyroid eye disease and prescribed.......eye drops with the assurance that if I started to lose my sight that I could get back in touch (forgive me if I sound facetious).

Latest bloods show (taken at 3.30pm):

TSH 2.45 (0.3-5.5)
Free T3 4.4 (2.6-5.7)
Free T4 18.7 (11-20)

Now my concern is that because everything is within range, I am going to be in some eternal battle with Endo Guy as he is refusing to treat the symptoms and is only looking at the bloods.

I would like an impartial opinion before I consider going private as these symptoms are causing a real problem in my functioning right now.


Many thanks

Paul

p.s. I have a family history of hypothyroidism all on my mothers side.

 
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Old 06-02-2008, 06:30 AM   #2
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Re: Some advice on blood results would be wonderful at this point!

First you need to get the antibody tests run. Both!! for Graves and Hashimoto's, it is possible to have both conditions. You might also find a neuro-opthamologist near you and go around the Endo. Endos are not the be all treaters of thyroids. Most are not equiped to handle it unless it is a straight forward condition. You toss eye issues into the mix and you need to see if there is anything going on in the spinal fluid as far as antibody attack and too much fluid pressure.
Hashimoto's Antibody codes: TPOAb and TGAb
Graves: TSI and TRAb

TSH 2.45 (0.3-5.5) These lab standards are out of date. In 2002 the new range was recommended as 0.3-3.0 with the understanding revision was underconsideration. In 2006 the A A C E and N A C B revised the TSH range to 0.3-2.5 as being normal if no antibodies were present, but 0.3-2.0 is normal for Hashimoto's patients. So by the new standards I would say you are hypoT or well on your way to being hyperT.

Let's see where you are in range.. optimal for a woman of child bearing years is 60-80% of normal.. post-meno 45-70% of normal is optimal.

Free T3 4.4 (2.6-5.7) You are at 58% here. This is near optimal and makes me wonder what is up.

Free T4 18.7 (11-20) You are at 85% here. Humm.. this is a bit high.

Something is off. You are imbalanced in your Fts. Your T3 levels are lower than your T4 levels. This could be hyperadrenalism or an increased tendancy to produce rT3 versus T3.

Additional testing here to rule out these issues would be:
Basic adrenal and pituitary function:
ACTH, DHEA Sulfate, and cortisol (8 am Fasting blood serum tests)
Saliva 24 hour cortisol test
Thyroid Comprehensive:
Antibodies listed above, T3 Uptake, and reverse T3.

You should also get your Ferritin, Vit B12, and vit D checked as well. Some times it is the minerals in our body imparing the thyroid and liver conversion and function loop. Being low in either of these can cause you to feel very hypoT. The symptoms over lap. Many hypoTs are also low in one or more of these as well.

I hope this helps, if the MD will not work with you.. go around them. Do not settle if you do not feel right. We all deserve optimal care.

MG
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Old 06-02-2008, 06:35 AM   #3
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Re: Some advice on blood results would be wonderful at this point!

Oops, Just noted the UK origin. You are really going to be in for a fight. They do not recognize the need for antibody testing even though 12.6% of the population have TPOAb in their system. Also their TSH ranges have not altered in accordance to the United States standards.

I would definitely get on a list to see a neurologist/neuro-opthamologist if you can. Stress the thyroid factor. If you can get thyroid eye disease confirmed they will treat you.

I no you are not a woman as well. Men have a broader optimal range I wanted to recheck on. Men fall into the normal range of 50-80% beign optimal for them. As you get older your hormone demand should decrease.

It is going to be a rough ride and we will help where we can. Look up my thyroid care and concerns thread.. week 2. It has a lot of journal referenced material that might help you get the upper hand.

MG
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Old 06-02-2008, 07:37 AM   #4
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Re: Some advice on blood results would be wonderful at this point!

Thanks for your reply, some very useful info in that.

Thanks also for the reference section, however, as I have a tendency to do in most situations, I prefer to be forearmed and tend to read up on things before I have to discuss them.

I was already prepared for the Endo's response about the bloods as I knew about the disparate reference ranges from health authority to health authority and as a consequence went in armed with literature a plenty (an Australian study showing standard populations and their tsh readings, the new guidelines for narrowing the tsh ref. range and an article from the Lancet recommending a rethink on treating blood results alone as well as questioning the validity of the current ref ranges. These I presented to him twice. His response?

"I will see you in 8 weeks time. Try not to read too much on the internet".

 
Old 06-02-2008, 07:51 AM   #5
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Re: Some advice on blood results would be wonderful at this point!

I am there with you. I do not bother with Endos anymore. Mine couldn't get past the TSH being SOOOO normal. Mean while, my brain and eyes were under attack, my adrenal glands were killed off and I was suffering hypoT rampage of my system. I have an Internal medicine specialist that with my guidance has finally found my autoimmune polyendocrine syndrome type II and my neurologists and neuro-opthamologist determined the Hashimoto's encephalopathy.. my cardiologist determined my heart was under attack from my thyroid as well.. the Endo shot him down. Told him it wasn't possible. Well I have the tests to back me up and i doubt it would still change her mind.

Many times antibodies and symptoms go out of whack before you catch the Fts below mid range. These levels can flux and cause many issues. We do have an active group of UK ladies. Owen was here as well for a time. You might want to start a new post. Possible hypoT male in the UK needs assistance... Be prepared for a flood of well wishers. I wish that the world standards went with the most recent findings. Unfortunately, textbooks our MDs are taught out of are years behind the research articles and then when you get down to it.. many MDs dismiss the memos recommending range changes, just because labs doing the testing have issues changing the accepted range guidelines. All too often the TSH range is wrong because they haven't updated their computer software. *sigh*

The link to my week 2 post is:
[url]http://www.healthboards.com/boards/showthread.php?t=597479[/url]

I need to get off my duff and start working on week 8.. I let week 7 slide by. I was lazy and sick with my son's latest stomach bug.

MG
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Old 06-03-2008, 04:03 AM   #6
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Re: Some advice on blood results would be wonderful at this point!

Just another question if I may:

How should you interpret the relationship between free T3 & free T4?

You mentioned my fT3 being just within the optimal range yet the fT4 was raised.

Are the two results supposed to have a comparable % e.g. fT3 58%, fT4 58%-ish?

I suppose what I'm asking, is what should the relationship be between the two?

Hope I'm making sense

Paul

Last edited by Sunraged; 06-03-2008 at 04:03 AM.

 
Old 06-03-2008, 07:02 AM   #7
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Re: Some advice on blood results would be wonderful at this point!

For your thyroid hormones to be balanced Ft3 and Ft4 levels in harmony so to speak.. they would be with in 5-10% of each other. Perfect would have them identical at 58 and 58 like you said. But because both the Ft3 and Ft4 tests have a 2.5-5% standard deviation in analysis techniques you have to allow for a 5-10% difference in the Ft3 and Ft4 percentages.. make sense?

MG
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Last edited by mkgbrook; 06-03-2008 at 07:02 AM.

 
Old 06-03-2008, 01:59 PM   #8
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Re: Some advice on blood results would be wonderful at this point!

Makes perfect sense now-thanks for that

Paul.

 
Old 06-06-2008, 02:18 AM   #9
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Re: Some advice on blood results would be wonderful at this point!

Ok, an update:

Went to the GP's to get him to feed back my blood results and things didn't get off to a particularly good start when he said he couldn't get access to the results as they were requested by the hospital (I had phoned the previous week and the GP receptionist gave me the results after much difficulty accessing the "new system").

So, based on the blood results from my first GP visit 12 weeks ago (just TSH which was 2.88 (0.3-5.5), he informed me that in his opinion, my symptoms are not thyroid related (walks like a duck, quacks like a duck....), lots of people have goitres, thyroid eye disease can occur when there is nothing wrong with the thryroid and you can not have symptoms of hypo/hyperthyroidism before your bloods are deranged.

When told that my Endo had said that you can get these symptoms before your bloods show dysfunctional thyroid, he shifted about in his chair and said that he used to work in endocrinology and in his experience it doesn't happen. (let's consider the anecdotal evidence above the science shall we?).

In conclusion, he said that he felt there was nothing wrong with my thyroid, the eye disease although classed as thyroid eye disease is nothing to do with a faulty thyroid, and the goitre is having no bearing on my thyroid function.

Amusingly, he asked me if I was depressed, to which I said "no", and he then proceeded to ask me about whether I was happy at home, at work etc.. I informed him that I am a Psychotherapist and in a better position to assess my mental state than he (at this point I was a little annoyed so forgive the Diva moment)

And so it seems, I can add myself to the long list of people who will have to endure months of blank faces and unsympathetic ears until a) my right eye shuts down altogether, and b) I start forgetting my own name.

Happy days.

 
Old 06-07-2008, 02:10 PM   #10
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Re: Some advice on blood results would be wonderful at this point!

hey paul,
If you can't get help from any doctors you can always self treat. Ive been on other forums where many people have been self treating with armour and they are doing great. so keep searching

 
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