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Old 07-13-2008, 06:16 PM   #1
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What to do next?

Had said I was only going to read and no more posts, I know my complaining gets old but...

I too am still in diagnostic heck. All the antibodies for thyroid positive, but I have seen nurse practionioner since Christmas because I don't think Dr. knows what to do next. Took me off of T3 and everything thyroid associated. Wants to see if it will go on its own. Its going alright, but will numbers be accurate with high antibodies? Last results were TSH 1.5, Free t3 3.3, and Free t4 at 1.1. Which from a diagnostic standpoint look good. Best Free t4 been in a while. Last time at .9.

I still hurt all over and eyes feel full of sand. ENT suggested possible Sjogrens.

On 24 hour urine for metanephrines because of panic they were all normal, cortisol saliva levels were low.

Right now I feel I am only surviving with each day something new to add to my list of symtoms. Thinking about starting back on T3 without even calling dr. back. Will see her or nurse on the 24th. Blood sugar levels have been pretty good though. Working hard on diet for that. Trying to take metformin but headaches and stomach problems. Trying low dose for a while. Early morning numbers still a little high.

One thing that is better is muscle twitches that I had so bad for a while. The last week they have been better. Ear buzzing still persistant.

Brain is fried though. I wonder if I will get up and not be able to remember my own name. Easy words that I have to think about to spell and can't remember squat.

I still think TSI adding more to the mix than they are giving it credit for. When they see a short fat woman they automatically think Hypo,Hashi's. But so many of my symptoms scream hyper. Blood work just hasn't caught it if it is there. And hyper/hypo symptoms overlap alot too.

Still wake each morning with that adrenalin rush/pit in stomach/panic AWFUL feeling. Try to set alarm to head it off. If I can get up before it happens I will sometimes miss it. And I know this sounds weird but I seem to be able to hear something in my throat, a cracking, crunching sound.

At least I wasn't so down and out with the T3. My mood was better and had some energy to do some things. I also have a bottle of Armour 30 mg tablets with the low t4 that may be a better choice. She will pretty much let me try anything at this point. Mattie

 
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Old 07-13-2008, 06:39 PM   #2
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Re: What to do next?

Even with out seeing the reference ranges that your lab uses....Free T's look very low.
I think you need to start on Armour thyroid. The hyper symptoms you are feeling are likely due to adrenal insufficiency.

Start off with a very low dose (maybe 1/2 of the 30 mg tablet in the morning and the other half about 6 hours later). Cut the pills in half with a small pair of sizzors or get a pill splitter from the drug store.

Take it sub-lingually (under the tongue). If that is too much (if the Armour makes you feel too hyper). Cut the dose and take 1/4 th twice a day (or 1/4 th of a tablet 3 times a day).

In other words start off on a very low dose that you can tolerate and slowly raise that dose.

Have you had your ferritin level tested?
Low ferritin will make it very hard for you to tolerate Armour.

Also, low B12, same thing. Have both of these tested and compare them to optimal ranges (NOT 'normal ranges'.!

Shoot for both the FREE T's to be in the middle to upper part of the 'normal range'.

Everyone on Armour (when they are on a high enough dose to make the FreeT's optimal) will have a very low TSH.

That is because the FREE T3 in the Armour. This is normal and MUST BE IGNORED. If your doctor sees a very low TSH and thinks you are on too much med.....that is just wrong and a very commom mistake. Its NORMAL for someone on ARMOUR to have a very low TSH.


Two books that helped me make the switch from Synthroid to Armour are...

"From Fatigues to Fantastic" & "Stop The Thyroid Madness".

Both of these books explain why Armour may help you feel so much better, why- what you are feelin may be due to adrenal insufficiency and how to dose Armour Thyroid (and that most doctors don't know how to do that!!).
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25 years feeling worse every year on Synthroid & 13 months feel good on Armour Thyroid.

Last edited by GCC; 07-13-2008 at 06:41 PM. Reason: typos

 
Old 07-13-2008, 06:55 PM   #3
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Re: What to do next?

My TSH stayed in "normal" range even while on Cytomel. 1.2 to 1.7 range. I must not have been taking enough. Will try again. Thanks a lot.
Mattie

 
Old 07-13-2008, 07:37 PM   #4
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Re: What to do next?

Wow Mattie, sounds like you've been through the wringer.

There is a good book by Dr. Theodore Friedman, "The Everything Health Guide to Thyroid Disease". He actually HAS Hashimoto's---so he knows what it's like.

You can read the first five or so chapters on-line for free---just do a search for his name---and you'll find the site. One of the great things about this book---is that it goes beyond just thyroid disease---he also touches on other diseases that are often associated with thyroid like Cushings, pituitary disease, and more.

Good luck with everything, I hope you get some answers real soon.

 
Old 07-14-2008, 04:35 AM   #5
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Re: What to do next?

Thanks, me too. Everyday has become a struggle. I am seeing an endo who has discussed removing it because of nodules, but they are not big enough yet. You know how it is with referrals, health insurance, etc. I have never been depressed but lately I think I am, not because of anything emotional, but waking up everyday struggling with this mess.
Thanks Mattie

 
Old 07-14-2008, 07:56 AM   #6
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Re: What to do next?

Quote:
Originally Posted by mattie75 View Post
Thanks, me too. Everyday has become a struggle. I am seeing an endo who has discussed removing it because of nodules, but they are not big enough yet. You know how it is with referrals, health insurance, etc. I have never been depressed but lately I think I am, not because of anything emotional, but waking up everyday struggling with this mess.
Thanks Mattie
Mattie assuming a standard range set of 230-420 for the Ft3 and .8-1.8 for the Ft4.. you would be at 30% of normal in T4 and 54% or normal in T4. This shows that you have a T4 T3 imbalance and that you are over converting your T4 to T3. Has your MD put you on treatment for your adrenal insufficiency? That will make a BIG difference with the depression, fatigue, and mental alertness. I also think you need at least a token dosage of T4. Given the higher T3 than T4.. YOU do not in my opinion need T3 in any form or fashion. If you take T3 you could throw yourself into T3 toxicosis while still being hypoT due to your low T4 levels.

I am there with you but my imbalance is a bit larger in spread. I have FT4 at 10% with a Ft3 and 54%. Talk about feeling like a tossed cow patty sliding down the wall.. EEWWW! It is not an easy thing to fight with and always feel free to gripe and complain. It helps to know you are not alone.

MG
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Last edited by mkgbrook; 07-14-2008 at 07:56 AM.

 
Old 07-14-2008, 06:40 PM   #7
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Re: What to do next?

Yeah a couple of weeks ago my ft4 was .9 it is up from there. Question if anyone reads and knows, since I sometimes have to take inderal for the hyper palps and all could that be throwing off my adrenals? It really adds to the depressed feelings, I don't take much just when the antibodies go wild on me. I will probably start a little synthroid to see what happens. I have learned over the last year trial and error and adjust to the symptom of the week. My poor insurance company is probably wondering why so many thyroid tests? MG how did you FNA biopsy come out? I haven't had time to read too many posts.
Mattei

 
Old 07-14-2008, 10:00 PM   #8
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Re: What to do next?

Just an idea---you may want to check in with your insurance company and see if you can get a case manager.
Sometimes it helps to get someone who can help you cut through the hogwash...

 
Old 07-15-2008, 06:15 AM   #9
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Re: What to do next?

Mattie,

I was told to wait on the FNA. My node was still under 1 cm.. just an 8 mm sphere now.. and even though I am at an increased risk for cancer (family history age and such) the inflammation and scarring from the Hashimoto's would make an FNA of my 8 mm nodule difficult. So I am too wait and come back in another 6 months for another ultrasound.. OR get an Endocrinologist to order the FNA. Otherwise my ENT prefers to wait until my antibodies come down and my inflammation is reduced. UGH! I was not pleased and was really to chew up a few things and spit them out, but he is a good MD and I get to go to a GI MD about the swallowing and stuff. SO while my thyroid shouldn't be impacting my air way and eating.. something is... so back to the rule it out and leave the thyroid as the source tactic again.

T4 medication can interact with inderal.. or propanol..
The main interactions known with levothyroxine occur with:
* antacids that contain aluminum
* anticonvulsants (e.g., carbamazepine, phenytoin)
* anti-diabetes medications
* beta-blockers (e.g., metoprolol, propranolol)
* cholestyramine
* diet pills
* digoxin
* estrogens
* ferrous sulfate
* ketamine
* sucralfate
* sympathomimetic medications (e.g., amphetamines)
* theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
* tricyclic antidepressants (e.g., amitriptyline, imipramine)
* warfarin
Now what is the actual interaction and effect? In many cases it is an interference in the absorption of one or the other medication. In the case of beta-blockers... Well beta-blockers are know to reduce conversion of T4 to T3. So you can drive your self more hypoT in T3 periodically by large applications of a beta-blocker.

MG
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