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First Labs Since TT & RAI - Help, please! :)


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Old 09-10-2008, 03:39 PM   #1
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First Labs Since TT & RAI - Help, please! :)

So - here are my numbers:

Free T4 .93 (range .58 - 1.64)
Free T3 4.0 (range 2.3 - 4.2)
TSH .06 (range .34 - 5.60)

Thyroglobulin / Anti-Thyroglobulin <0.1 (range 0 - 35)
Anti Thyroglobulin 6 (range <4)

Notes: Up until the morning of the blood draw, I wa taking 125mcg Levothyroxine, and 50 mcg Cytomel daily (I didn't take Cytomel the morning of the blood draw btw). My endo said I was on way too much Cytomel, and to drop it out completely as it will skew the lab results and that all I need is T4. I sort of questioned her on this point because of all that I've read on this board.

However, I have to say I REALLY like her, and she's been very proactive with me, so I'm following her directions at this point in time. Since dropping the Cytomel last Thursday, I have been feeling increasingly tired Am I in for more tired??

She had said at my appt last Thursday that she anticipated I would need to go up to 137 mcg of Levo, but the lab results I got today have a handwritten note to stay on my current dose. It's been 5 weeks since I've started on the Levo (and back on Cytomel) since RAI. Does it take longer to build up in your system??

THANKS in advance for all the help

Last edited by moderator2; 09-10-2008 at 08:22 PM. Reason: to change the title

 
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Old 09-10-2008, 06:47 PM   #2
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Re: First Labs Since TT & RAI - Help please:)

It is always good to get as many opinions as possible. Access, Midwest, Finnmaid and many other veterans are great sounding boards as well. Each has a different set of personal experiences to draw from... and we have new blood about all the time. There is no telling what they may have to share. But then again anyone on this forum knows all threads are fair game. My philosophy is the more the merrier. I just wish their weren't as many sick with thyroid issues.

To the meat of your post. Your levels. The theory/calculation is simple:
Yanking out of one of my previous threads... [url]http://www.healthboards.com/boards/showthread.php?t=597479[/url]

Optimal thyroid hormone levels are 50-80% of normal range. This statistic comes from the N A C B where they determined 85 – 90 % of non-dysfunctional thyroid MALES had TSH levels between 0.89-1.1 and FT levels in the 50-80% range of normal. Now women have a few additional issues as a result of our fluxuating biochemistry. Women have two main phases after puberty.. child bearing years and menopause/post menopausal years. Women of child bearing years with an intent to have children.. need to have Fts in the 60-80% range of normal. This is an optimal thyroid state to promote fertility. Women after menopause tend to need slightly lower Ft values in the 40-70% range. (This is just my MFM, 1 Endo, 2 Obs, and 1 IM's knowledge on this.. trying to dig up a public access postable journal article on this information)

Many MDs do not know how to determine where you are in the normal range. So here is the formula you need to know and come to love.

Given the following format:
Free T or Total T value (lower limit - upper limit)
0.85 (0.8-1.8)
Your percentage is calculated as follows:
[Your FT value - lower limit]/[upper limit - lower limit]*100 = %
[0.85 - 0.8]/[1.8-0.8]*100 = 5%

Now using your numbers
Free T4 .93 (range .58 - 1.64)

[.93-.58]/[1.64-.58]*100 = 33% of the normal range. This is suboptimal and could use a boost. It is not hyperT in range what so ever. But the T3 levels drive you hyperT the quickest.. so moving on!
Free T3 4.0 (range 2.3 - 4.2)

[4-2.3]/[4.2-2.3]*100 = 89.5% of normal range. Whee! Yeah too much T3. Are you needing to keep your TSH supressed due to post op cancer treatment if so you would be better served balancing your Ft4 and FT3 levels in my opinion. Right now you have PLENTY of T3 in your system.. Actually too much... so I concur with your Endo.
TSH .06 (range .34 - 5.60)
Look at what a nice pituitary gland you have it is telling you that you have Plenty of T3 in your system.

Your results are not bad. Your T4 levels need to come up about 30% and your T3 levels need to drop 20-30%.. then you will be balanced in the 60-70% region of normal and your system should be happy right now. You are hypoT/suboptimal in T4.. this will affect your brain and cognitive abilities the most.. while you are hyperT in T3.. this is going to hit your body temp, digestion, heart, all things physical.. etc. You are riding a fence and dangling your toes in both the hypo and hyper ponds. I have been there and done that... it sucks.

Thyroglobulin / Anti-Thyroglobulin <0.1 (range 0 - 35)
Anti Thyroglobulin 6 (range <4)
You have TGAb present which indicates you still have Hashimoto's running about.. but with out the thyroid tissue to play in.. all should go easier there.

Optimal care is when your TSH is around 1 on a T4 supplement alone with Ft's are in the 50-80% range of normal. T3 supplementation such as cytomel or Armour results in TSH suppression and as a result you must gauge thyroid supplementation on your actual T4 and T3 hormone levels and symptoms alone.

Now my take on this:
Up until the morning of the blood draw, I wa taking 125mcg Levothyroxine, and 50 mcg Cytomel daily (I didn't take Cytomel the morning of the blood draw btw). My endo said I was on way too much Cytomel, and to drop it out completely as it will skew the lab results and that all I need is T4. I sort of questioned her on this point because of all that I've read on this board.

You need to up your T4. Boost it to 150 mcgs to boost your T4 levels into optimal range. This is my opinion of course going on your 33% actual T4 levels and the fact that there is only a 2.5-5% error in these results.

Now what to do with the cytomel... humm I wouldn't cut it out cold turkey. You are not that far out of range in T3. You were 89.5% of normal range.. this is not out of range and only 10% above optimal range. By this I think you need the cytomel. You may not need 50.. maybe you only need 25.. but I still think you may need it. How are you adrenals holdiong up? Is your cortisol production up to snuff? Are you over converting T4 to T3? That is something else you need to make sure your MD is checking on. So I would ask if you could cut back to 25 cytomel. You were not hypert in your FT levels.. only your TSH was low. This is to be expected.. you are on a T3 supplement and were slightly above optimal range.

However, I have to say I REALLY like her, and she's been very proactive with me, so I'm following her directions at this point in time. Since dropping the Cytomel last Thursday, I have been feeling increasingly tired Am I in for more tired??
It takes 2 weeks for the Cytomel to completely get out of your system You are in for more tired and right now you are probably down to 50-25% of your previous cytomel levels retained in your system. I am betting you are full out hypoT now.. but your TSH will not reflect it. That is just a side effect of the TSH supression by your T3 supplement.

Hope this helps. Your Endo maybe watching that TSH closer than you think. She still may be good.. but you may have to push her to consider your FT levels more heavily. SO that is my Chemist's.. non-MD opinion on your results.

MG
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Last edited by moderator2; 09-10-2008 at 08:21 PM.

 
Old 09-10-2008, 10:48 PM   #3
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Re: First Labs Since TT & RAI - Help, please! :)

Thanks MG! And, sorry for my goofing up about addressing the thread to just you..............don't ever mean to exclude anyone. My apologies all around. I'm pretty tired right now, so will re-read your wonderful response in the morning with my big mug of coffee

But, thanks to you and all the great people on the board!

 
Old 09-11-2008, 08:53 AM   #4
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Re: First Labs Since TT & RAI - Help, please! :)

Since you had thyroid cancer, the reason your doctor tested your Thyroglobulin (and the tg antibodies) was not for hashimotos. Your doctor is using that to see if it's a good tumor marker for you, and see if all the thyroid tissue has been all destroyed.

In my case, it's a good tumor marker for me (had high tg before the RAI, and no antibodies), so my endo. tests it once every year or so to see if I have a recurrence---it would theoretically go up before a tumor shows up in scans.

 
Old 09-11-2008, 12:46 PM   #5
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Re: First Labs Since TT & RAI - Help, please! :)

Thanks Reece. My endo did explain that about the antibodies for me, but I appreciate your pointing that out. Unfortunately for me, since I do have the antibodies, it won't be an accurate marker for me Oh well.

I've got a call into her office today to ask about going up on the levothyroxine or continue to take some Cytomel because I feel pretty awful (ie fatigued) right now. This is beyond what coffee can cure LOL! ***snort***

 
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