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Old 09-05-2008, 07:31 AM   #1
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Help needed please

Do you have any suggestions as to why the T4 levels would drop from 22.4 (68.1&#37 to 19.3 (51.1%) or what I could do to bring it back up. I felt better when the levels were higher. I haven’t changed anything that I'm aware off and have consistent with vitamins, minerals, omega, exercise etc. The only thing I've noticed is at times my throat is sore, but not enough to bother me but just enough so that I know it's there. (upper part of throat)

When I mentioned it to my doctor she said, you are still in the normal range. I’ve asked for a referral to Endocrinologist again and she has agreed to make a referral, but the waiting list for an appointment is a year. Is there another specialist that would be helpful? My doctor suggested we try the home sleep apnea test, as the clinic wait time is well over a year. However, she doesn’t think this is the problem, but will rule it out. I also don't think this is the problem, I don't wake up gasping, startled, nothing like that. I’m still having a very difficult time with sleep, waking up repeatly at night and never refreshed in the morning, always tired. I've been taking zopiclone nightly, for the past couple of months and still wake up a few times a night - and this is a good night.


Aug15/08 - 112 mcg
TSH .138 (0.46-4.68)
Free T3 - 5.5 (3.5 -6.5)pmol/l -66.7%
Free T4 19.3 (10.0 - 28.2) pmol/l 51.1%

May 15/08 - 112 mcg
TSH .144 (0.46-4.68)
Free T3 - 5.5 (3.5 -6.5)pmol/l - 66.7%
Free T4 -22.4 (10.0 - 28.2) pmol/l -68.1%


Thanks,
Patti

Last edited by moderator2; 09-10-2008 at 08:31 PM. Reason: to change the title

 
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Old 09-05-2008, 08:02 AM   #2
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Re: Help needed please

Pattie,

I am sure this is open to anyone's advice you were just trying to get a quick answer. But I will give you my opinion since I am puttering about at the moment.

Do you have any suggestions as to why the T4 levels would drop from 22.4 (68.1%) to 19.3 (51.1%) or what I could do to bring it back up.
First some questions to ask yourself. DO you still have your thyroid and do you have Hashimoto's thyroiditis? Are you on any thyroid supplementation? Thyroid hormone production can be affected at many loops in the chain. The only thing that is standing out is that the ft3 level is steady and the FT4 level has dropped. The deviation is 15.6% between your latest Ft4 and FT3 result. This isn't too bad.. but it does hint and a T4 to T3 conversion imbalance. The question is why?


I felt better when the levels were higher.
Optimal range for childbearing females is 60-80% so speakest my MFM. I feel better around 70% in both my Ft3 and Ft4 levels. SO I understand where you are coming from. If I am at 50% I still have hypoT symptoms. I am not saying that if you are not on medication that you should jump on the thyroid supplemental band wagon at this time. That is a permanent step and must be thought over carefully. So refresh my mind on your status.. are you taking thyroid meds and if yes what and how much? Okay.. brain gas. Just noted the 112 mcg by the lab results. It is a blonde day and the Ac is one.. my thoughts float about the room as a result of periodic room cooling. I assume this is 112 mcg of a pure T4 supplement... noted.. and processing.

I haven’t changed anything that I'm aware off and have consistent with vitamins, minerals, omega, exercise etc. It may not be a diet or exercise thing. Our natural thyroid need and output fluctuates over time. Illness and stress have some effect, but over all the ability of our thyroid to output the needed T4 and T3 can change. This is especially true if you are genetically predisposed to be hypoT and still are relying on your thyroid for some of your thyroid hormone. In the case where T3 levels begin to climb higher than T4 levels.. there are two main issues that may be happening.
1) Adrenal fatigue or insufficiency. Low cortisol production will result in over conversion of T4 to T3. Tests for this are the ACTH, ACTH stim test, and Cortisol (blood AND saliva in my opinion). I am not saying this is what you have.. but it can be a factor given the numbers. If it is.. it is mild and early in the process.
2) Poor conversion of T4 to RT3 in the liver. For some reason your liver may have started to improperly convert you T4 into the inactive Reverse T3. Most of these cases the T3 levels are lower than the T4 levels.. this is not your case.

The only thing I've noticed is at times my throat is sore, but not enough to bother me but just enough so that I know it's there. (upper part of throat) The upper part of your throat is indicating a lymph node response to some aggravant. I can not say it is thyroid. It may be viral or allergic in origin. Thyroid pain and interference tends to manifest low in the throat at the junction of the base of the neck and your torso. Inflammation due to my thyroiditis causes issues with my swallowing and gives me a continual aching throb on my right thyroid lobe.. where my little nodule likes to make itself known.

When I mentioned it to my doctor she said, you are still in the normal range. I’ve asked for a referral to Endocrinologist again and she has agreed to make a referral, but the waiting list for an appointment is a year.
Do not put all your eggs in the Endo's basket. They may not be helpful. So far I am batting zero on good thyroid managing Endos.

Is there another specialist that would be helpful? My doctor suggested we try the home sleep apnea test, as the clinic wait time is well over a year. Sleep hygiene and habits can affect your thyroid repair and work cycle. It is a known and documented fact. This said the only way to tell if you have one of more than 80 sleep disorders is to have a CERTIFIED sleep lab testing. The home tests appear to only test for hypopnea or OBSTRUCTIVE sleep apnea. there are many flavors of apneas. I have one.. my husband has another, and my son has both of ours. Sleep apnea does trend in families by the way.

I also don't think this is the problem, I don't wake up gasping, startled, nothing like that. I’m still having a very difficult time with sleep, waking up repeatly at night and never refreshed in the morning, always tired.
THE GASPING AND CHOKING ARE NOT NECESSARY. Waking up more than once a night every night is a major indicator of sleep apnea. Snoring is not necessary for sleep apnea either. You should have a study done given your sleep issues.

I've been taking zopiclone nightly, for the past couple of months and still wake up a few times a night - and this is a good night.
Sleep apnea.. ESPECIALLY obstructive sleep apnea is aggravated by sleep meds. You should get off of them until you rule sleep apnea out. Sleep meds prevent you from waking up as your body needs to do to an apnea event. Prescription sleep meds should only be prescribed after consultation with a sleep specialist and a sleep study has been performed. This is my personal opinion and the opinion of my sleep specialist who is a pulmonologist, internal medicine, and neurological sleep specialist.

The main issue I see here is that you Ft3 and T4 levels have fallen out of balance. This can be an indicator of adrenal issues, illness, poor sleep.. the list goes on.. I need a few answers before I can speculate further. Given your T4 supplement regime and an assumption that you still have your thyroid.. I think you might want to get your ACTH and Cortisol levels checked out. You may just have a cold or virus, but if a week goes by and the symptoms persist. I would get my adrenals checked out. Worse comes to worse.. you know how well they are behaving.

Aug15/08 - 112 mcg
TSH .138 (0.46-4.68)
Free T3 - 5.5 (3.5 -6.5)pmol/l -66.7%
Free T4 19.3 (10.0 - 28.2) pmol/l 51.1%

These labs look GREAT. They are optimal in range and balanced. These are the levels that my mom and her four sisters love to exist at... I would too if I could keep my Ft3 and Ft4 levels balanced.
May 15/08 - 112 mcg
TSH .144 (0.46-4.68)
Free T3 - 5.5 (3.5 -6.5)pmol/l - 66.7%
Free T4 -22.4 (10.0 - 28.2) pmol/l -68.1%

I wish I could have helped more.
MG
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If we learn by our mistakes, I am working on one hell of an education.

Last edited by moderator2; 09-10-2008 at 08:32 PM.

 
Old 09-09-2008, 09:14 AM   #3
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patti101 HB User
Re: Help needed please

MG - you are funny brain gas.
You were so quick to answer, I had to do some reading before I could respond.
Yes, I still have my thyroid not sure but I don't think I have Hashimoto's thyroiditis. You suggested that I have cortisol levels tested, I've requested from my doctor twice before that she test cortisol levels and both times she's said, she doesn't know if she would know how to read the levels. I'm assuming that she has never ordered the ACTH or the cortisol blood or urine test. In fact I looked at the laboratory requisition and these tests are not on the preprinted sheet - the doctor must have to fill in which test they want. Salvia testing is not done here. This is why I requested the Endo appointment, hoping at least he could order and read the results, however this will be over a year away. I'm hoping on my next appointment to doctor I can convince her to order tests and perhaps the forum could help with results?

I've just received confirmation, my appointment for the Obstructive sleep disorder is Oct 6/2008 (this will be the at home sleep test - level 3 whatever this means) For the in clinic study this is over a year waiting list.

My doctor was concerned with my chronic insomnia, (which has been going on for over a year now) and that it would cause health problems. We tried different prescriptions, but nothing worked and I have very good sleep hygiene habits. The zopiclone allows me to sleep for approximalety 5 hours most times, without it I only sleep 2 - 3 hours before awakening and trying to go back to sleep is so hard. I'm tired of counting backward from 100 - so coming off this is not an option as long as I have to go to work.

I was thinking of bumping up from 112 mg to 125 daily of synthroid to see if this would help, I'm extremely tired by late afternoon and early evening and by the time I go to bed at my normal time, I have trouble getting to sleep.

Thanks,

Patti

Last edited by moderator2; 09-10-2008 at 08:32 PM.

 
Old 09-09-2008, 10:49 AM   #4
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Re: Help needed please

MG - you are funny brain gas. Must be because i am a strawberry blonde. Otherwise it would be just plain air up there..

Yes, I still have my thyroid not sure but I don't think I have Hashimoto's thyroiditis.
They would know if you did if you have ever had your antibodies (TPOAb and TGAb) OR a thyroid nodule biopsy done.

You suggested that I have cortisol levels tested, I've requested from my doctor twice before that she test cortisol levels and both times she's said, she doesn't know if she would know how to read the levels. I'm assuming that she has never ordered the ACTH or the cortisol blood or urine test.
The ACTH and cortisol blood tests are standard and easy to run. This your MD should be will ing to do the urine/saliva cortisol tests require graphical interpolation. You have to be able to plot points and connect the dots with a ruler. That seems to be above some MDs. *grunt*

In fact I looked at the laboratory requisition and these tests are not on the preprinted sheet - the doctor must have to fill in which test they want. Salvia testing is not done here. Even down here in the USA we have to make them rwrite in that darn Spit test. You could always look in the big purple book that the lab techs use to determine the color of vial to store/ship the blood and stuff in. i wouldn't be surprised if you had to go to an out of house facility for the saliva test.

This is why I requested the Endo appointment, hoping at least he could order and read the results, however this will be over a year away.
We have 3 - 6 months waits down here as well. If you get in under a months time.. in my opinion and experience it is most likely a bad Endo.. OR a new one that hasn't got a large patient load yet.

I'm hoping on my next appointment to doctor I can convince her to order tests and perhaps the forum could help with results?
Don't tell her you are going to check with a forum on it. Instead tell her that you would like to have the information while you are feeling poorly now to send to the Endo for your file and consultation. Since it is going to take a year she might be able to consult with the Endo in the interim.

I've just received confirmation, my appointment for the Obstructive sleep disorder is Oct 6/2008 (this will be the at home sleep test - level 3 whatever this means) For the in clinic study this is over a year waiting list.
If this is like the six studies I have done.. four my son has done.. and two my husband has had done... then I suspect this is going to be a test that has you sleep with a respiratory and heart monitor on as well as an O2 sensor. This will be able to tell the sleep specialist if you have obstructive sleep apnea or one of the other oxygen deprivation apnea disorders. It will not be able to monitor central apnea or seizure based sleep disorders that show up in a brain sleep wave EKG monitoring session. The EKG monitoring and sleep walking and restless leg and all sorts of other disorders is determined by watching and monitoring you in a controlled facility while hooked up to a spiffy computer.

My doctor was concerned with my chronic insomnia, (which has been going on for over a year now) and that it would cause health problems. We tried different prescriptions, but nothing worked and I have very good sleep hygiene habits. The zopiclone allows me to sleep for approximalety 5 hours most times, without it I only sleep 2 - 3 hours before awakening and trying to go back to sleep is so hard. I'm tired of counting backward from 100 - so coming off this is not an option as long as I have to go to work. The chronic insomnia is a defense against bad sleep apnea.. and a few other sleep disorders. It is often a side effect of a more serious sleep disorder. I think that this sleep study of yours may be revealing. Good thing about sleep apnea.. it can be treated with a CPAP, VPAP, or BiPAP while you sleep.. or in some cases surgically corrected. I did the surgery.. but it just decreased the severity of my sleep apnea. It did not cure it.

I was thinking of bumping up from 112 mg to 125 daily of synthroid to see if this would help, I'm extremely tired by late afternoon and early evening and by the time I go to bed at my normal time, I have trouble getting to sleep.

You can ask to see if a trial dose of OTC pregnenolone might help in case you have adrenal fatigue. This converts into aldosterone and cortisol in your body. It is the parent of cortisol and aldosterone. You only need like 4-8 mg a day to supplement biological requirements. Most supplements are sold in 10 - 20 mg tablets. you will want to cut them down to size if your GP says go for it. However.. if you are going to get further adrenal testing you will need to come of the pregnenolone for 2-4 weeks for the tests to be valid.
Also taking pregnenolone too late in the day will aggravate your insomnia. Why does this have to be so complicated? Human biochemistry is just such a pain. Before adding a supplement like this always run it by your MD. Don't take my word for it. With out knowing your cortisol/ACTH levels.. you can not know if you actually need the steriodal substance, but a 2-4 week trial at a low dose shouldn't hurt you. However I do not know your COMPLETE medical history.. your GP would be better able to gauge if you could benefit from the pregnenolone or not.

Your welcome.. i am glad that I could help. I wish you didn't have to wait so long to get the treatment you deserve.

MG
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Last edited by moderator2; 09-10-2008 at 08:32 PM.

 
Old 09-10-2008, 03:04 PM   #5
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patti101 HB User
Thanks to MG

Just want to send a big "thank you" - you are terrific. I'm going to book appointment with GP tomorrow and discuss issues with her.

Patti

 
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