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Old 09-15-2008, 07:48 PM   #1
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Exclamation Cow patty right here...PLEASE HELP ME

Ok, so I borrowed MG's saying about being a cow patty, hope that's ok...Best way to describe me. This is a little long, but I really need help....PLEASE SOMEBODY....Been a long time lurker. Little background: dx as postpartum-hypo back in Dec. Have TPOAB. On 100mcg Synthroid, iron, multi-v, b12, calcium w/vit d, fish oil...I don't take Synthroid w/supplements, and I wait an hr until I eat after I take it. Tired upon getting up, but about noon or so I get extremely exhausted and I am that way for the rest of the day, puffy eye lids, no energy, little cholesterol build up under one eye, etc. (that's all I can think of for now). Been to several healthcare providers, going back in a few weeks to an endo who I have been to once before. I didn't "click" with her the first time, but figured I would try again. The provider I have been seeing has just told me that she doesn't know what else to do for me.

On my latest labs if I did my math correctly, my FT4 is at the 90% of range and FT3 is at about 40.5%. So do you think this could be adrenal or that I may need T3? Looking at my ACTH from June 2008 (listed below), it is a little high, but I don't know if my adrenals are dormat from undertreated hypo or what. Please help...I go back in about two weeks, and I need to arm myself with info.

Latest labs (Sept 2008) While on 100 mcg Synthroid

TSH 0.76 (.40-4.50)
Free T4 1.7 (.8-1.8)
Free T3 307 (230-420)
Ferritin 58 (10-154)
Iron, Total 115 (40-175)
TPO AB 463 (<35)
IGF-1 177 (126-291)

(June 2008) Tests done while at 88mcg Synthroid...bumped to 100 mcg July 2008 after these tests
TSH 2.00 (.40-4.50)
Free T4 1.4 (.8-1.8)
Free T3 324 (230-420)
TPOAB 593 (<35)
IGF-1 356 (126-291)
ACTH, Plasma(8am) 28 (5-27)
Cortisol, (8am) 16.7 (4.0-22.0)
Cortisol, 24hr urine 24.6 (4.0-50.0)
Creatinine, Urine 1.38 (.63-2.5)

(May 2008)
Vitamin D 41 (20-100)
Folate, Serum 17.3 (>5.4)
Iron, Total 109 (40-175)
TIBC 387 (250-450)
% Saturation 28 (15-50)
Ferritin 46 (10-154)
DHEA (NOT Sulfate) 378 (143-1277)

Last edited by one2wonder; 09-16-2008 at 08:39 PM. Reason: sp

 
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Old 09-16-2008, 08:03 PM   #2
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Exclamation Re: Cow patty right here...PLEASE HELP ME

Anybody? Please....help me...I'm begging....

Last edited by one2wonder; 09-16-2008 at 08:41 PM.

 
Old 09-17-2008, 05:30 AM   #3
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Cool Re: Cow patty right here...please help me

Hi one2wonder welcome - I saw this yesterday, & didn't know WHAT to say sorry

Quote:
my FT4 is at the 90&#37; of range and FT3 is at about 40.5%.
I'm not expert, but from what I've read here (i believe) your T4 & T3's shouldn't be that far apart.
It could be adrenal issues. <~ don't know enough to continue commenting

Your T3 are low, so why doesn't Dr add a bit of Cytomel?

Last edited by Suey77; 09-17-2008 at 05:30 AM.

 
Old 09-17-2008, 07:04 AM   #4
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Re: Cow patty right here...please help me

sorry, my brain starts to shut down when i look at numbers!

i too wonder if it might be adrenals. that runs so parallel to thyroid problems it seems.

perhaps an easy saliva test is in order?

either that, or though your T numbers look pretty decent, perhaps it is not where YOU need to be. i wonder if your doc would bump up your meds a bit if you would feel better, or like sue said, maybe a tad of a t3 supplement.

Last edited by scoot; 09-17-2008 at 07:06 AM.

 
Old 09-17-2008, 08:07 AM   #5
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Re: Cow patty right here...PLEASE HELP ME

SO you are flat and smelly too! Join the party. The only thing worse than feeling like a cow patty is feeling like a cow patty tossed into an industrial cyclone fan. The results are messy and FAR from pretty. Do not try this with a wet cow patty at home kids... and I do not mind you using the description at all.

This is a little long, but I really need help....PLEASE SOMEBODY....Been a long time lurker.
Well welcome to our thyroid dysfunctional family. It feels better to get it out doesn't it?

Little background: dx as postpartum-hypo back in Dec. Have TPOAB. On 100mcg Synthroid, iron, multi-v, b12, calcium w/vit d, fish oil...I don't take Synthroid w/supplements, and I wait an hr until I eat after I take it.

This sounds good, however are you also diagnosed and listed as have Hashimoto's. With TPOAb like yours, you HAVE Hashimoto's and you should be treated as a high risk OB patient accordingly. Did they also test your child's blood for antibodies as well as a base line TSH, Ft3, and Ft4 panel? This should have been done and if it wasn't.. you need to get your pediatrician to do it.

Tired upon getting up, but about noon or so I get extremely exhausted and I am that way for the rest of the day, puffy eye lids, no energy, little cholesterol build up under one eye, etc. (that's all I can think of for now). This can be a sign of under treated thyroid issues, adrenal issues, low ferritin (FERRITIN is not total, iron.. it is labeled ferritin and must be written in not checked off on a standard lab sheet), sleep deprivation, sleep apnea.. etc. It is a good thing that I do see some Ferritin checks down there.. give your MD a pat on the head for me.

Been to several health care providers, going back in a few weeks to an endo who I have been to once before. I didn't "click" with her the first time, but figured I would try again. The provider I have been seeing has just told me that she doesn't know what else to do for me.

Ugh! I am sorry that you are having to MD shop. It is the worst part of having a dysfunctional thyroid. You feel like cow flop and have to fight to get someone to believe and listen too you.. THEN when you get one.. they may or may not be willing to treat you. It sucks, vent, get it out.. and then we shall see what we can do.

On my latest labs if I did my math correctly, my FT4 is at the 90&#37; of range and FT3 is at about 40.5%. So do you think this could be adrenal or that I may need T3? Looking at my ACTH from June 2008 (listed below), it is a little high, but I don't know if my adrenals are doormat from under treated hypo or what. Please help...I go back in about two weeks, and I need to arm myself with info.

Latest labs (Sept 2008) While on 100 mcg Synthroid
TSH 0.76 (.40-4.50)

Free T4 1.7 (.8-1.8) You are 90% of range here. This is above optimal and can make you feel washed out.
Free T3 307 (230-420) You are at 40.5% here.
This is suboptimal and is showing that you are not converting your T4 to T3 for some reason. Being suboptimal here will cause the facial puffing and physical symptoms you described.
Ferritin 58 (10-154)
This is still a bit low. You want it in the 70-90 range. What supplement are you taking and how much are you taking of it? There are some supplements that absorb better than others.
Iron, Total 115 (40-175)
TPO AB 463 (<35)
IGF-1 177 (126-291)
Still have a good strong set of antibodies ripping your thyroid a new one.

(June 2008) Tests done while at 88mcg Synthroid...bumped to 100 mcg July 2008 after these tests
TSH 2.00 (.40-4.50)
Free T4 1.4 (.8-1.8) 60%
Free T3 324 (230-420) 49.5% This is still suboptimal here. Your trending toward needing T3 supplementation.

TPOAB 593 (<35) Another positive hashimoto's. You are not postpartum thyroiditis.. you are HASHIMOTO'S thyroiditis and hypothyroid. *snort* Fight and make sure that is declared in your medical records.. otherwise you can have issues down the road with the PPT only lasts 12-18 months.. you no longer need medication. Just stop and live in hypoT Hashi's Hades! I know some one that was just told that 2 days back. I am riding shot gun on her Friday appointment.. time for some fun.

ACTH, Plasma(8am) 28 (5-27)
Cortisol, (8am) 16.7 (4.0-22.0)
Cortisol, 24hr urine 24.6 (4.0-50.0)


Okay from these results you do not appear to have an adrenal issue. For adrenals to be causing the low T3 and high T4 we are seeing Your cortisol levels would be High not mid range. I would say that at the time your adrenals were studied they were doing fine. ACTH fluxes a bit depending on stress and physical demands. You want and ACTH in the 20 range. HOWEVER adrenals should be ruled out and when you go back to your MD have them run another 8 am fasting blood serum cortisol and ACTH just to be sure. If the cortisol and ACTh are HIGH then you need to get your pituitary gland evaluated further.

(May 2008)
Vitamin D 41 (20-100)
This is still a bit low. You could benefit from a bit more vit D in your system.
Ferritin 46 (10-154)
This was still low as well.. need more iron.
DHEA (NOT Sulfate) 378 (143-1277)
This is also low. You may benefit for a 10 - 20 mg once a day supplementation of DHEA. My IM tried to treat my adrenals this way first, but DHEA was not needed in my case and did nothing but give me acne.

Okay given the 50% deviation in your Ft3 and FT4 levels of your latest labs and previous adrenal tests I recommend that you get your conversion of T4 to t3 checked out. The best tests in my experience for this are:

TSH, T4, T3, and T3 Uptake.. the uptake is dependent on T4 and T3 results. It tells you how much of your T4 is being bound up and used in different processes. It doesn't tell you HOW the T4 is being used.. just if your body is using it.

RT3.. revere T3 is an isomer of T3 that is inactive. An internal iodine is stripped off the T4 versus a terminal iodine. When this mechanism acts excessively you are left with an inactive non-binding RT3 form that just floats about and doesn't help matters. This behavior requires T3 supplementation.

High cortisol will also suppress the binding and conversion of T4 to t3. This shows in low T3 with respect to T4 and High cortisol levels.

Two out of Three thyroid suffers need some T3 in their supplement regime. It looks like you are one of them. You may need to mix and match Armour and synthroid til you balance out.. OR you may just be able to drop back on your T4 a bit and add cytomel. Either way you still have some medication adjustments to go.

Keep fighting for yourself. You are your best advocate.
MG
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Last edited by mkgbrook; 09-17-2008 at 08:13 AM.

 
Old 09-17-2008, 08:36 AM   #6
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Re: Cow patty right here...please help me

Thanks for the replies. I am supposed to go next week back to an endo who I had gone to once in May. I didn't originally go back to her b/c I kind of felt discouraged when I had asked her about T4-T3 conversion she flatly said, "well that's rare." She then had said maybe I had something polyglandular going on.

I left her very upset and ended going to a nurse who did the ACTH and Cortisol testing upon my request and had also bumped my Synthroid from 88-100mcg in July. The nurse informed me the other day that she felt that she doesn't know enough about endocrine issues to help me further. That was when I made the appt back with the endo to try her again. I am just worried she will be unwilling to look at T4-T3 conversion based on her previous statement.

I do know of a more of a holistic-type doctor who used to be a pharmacist and then became an md that prescribes Armour. I heard he will also presribe Cytomel too. I am a little hesitant about his practice b/c he has a store attached to his practice where he sells his own supplements he developed. It kind of makes me feel there is a conflict of interest there and the whole thing just doesn't sit right with me...I feel like he should either be a doc or do the store thing. I dunno if it is just me too, but the Armour thing kind of freaks me out a little having come from a pig, but if it looks like a T4/T3 thing, I would be willing to try Cytomel and if it didn't work, the Armour.

WHY is this so DIFFICULT to get managed correctly?

 
Old 09-17-2008, 08:45 AM   #7
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Re: Cow patty right here...please help me

Well I like to think of Armour as efficient use of product. The cows and pigs are going to be eaten anyway.. why not process and extract and purify the natural hormone using one more piece and making less waste. They do not dry it and grind it up and say here chug this. The chemist in me, KNOWS there is a lot more to it.

Many Holistic MDs sell their own supplements so they know what ratios are in them.. also with his pharmacy background he is tailoring his meds to the patients. I wouldn't dismiss him out of hand, because he does have a pharmaceutical background.. an MD with out a pharm. D selling supplements DOES bother me. I tend to as for an ingredient and composition list tell them to give me the script and research and price check the item. You can see this MD and see what he has to say. It is worth a shot. The polyglandular reference your endo made was most likely referring to your pituitary/adrenal interaction with your thyroid. She might be okay especially after she sees your latest results. Then again she may grunt and say you are fine.. just looking at the TSH.

You need some one willing to work with you on a 6 week basis so you can optimize quickly and efficiently.

MG
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Last edited by mkgbrook; 09-17-2008 at 08:46 AM.

 
Old 09-17-2008, 08:51 AM   #8
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Re: Cow patty right here...please help me

I forgot to add... to answer MG's questions on your reply:

So you lean towards conversion issues? I went to the nurse's office yesterday with a note begging to have at least the reverse T3 checked as well as adrenal antibodies, renine, reverse t3, and my female hormones so the results would be in before I went to the endo. The nurse's office called back yesterday afternoon and said no-go, to have the endo check it. I DUNNO IF SHE WILL BE WILLING TO...dangit. Yes, it feels a lot better to get it out, especially to people who "get it." I had asked the ped to check my child's thyroid previously based on my stuff, and he said that it was checked at birth and fine. I think I better push testing. I actually asked for the Ferritin to be run based on what I had read here. I am taking Ferrous Sulfate with either a Vitamin C tab or Cranberry Juice (not cocktail...straight juice). What was the other type of iron that absorbs better? I just got what the pharmacist had suggested.

 
Old 09-17-2008, 08:57 AM   #9
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Re: Cow patty right here...please help me

Ferrous Sulfate is not absorbed well in the stomach.. you have to take 3x the amount of Ferrous sulfate to get the same absorption that can be achieved using Ferrous fumarate or ferrous oxalate. I recommend changing to a fumarate supplement. That is just basic chemistry there.

I do think it is a conversion issue. Maybe your nurse can recommend an Internal medicine MD that prescribes Armour and cytomel for your primary physician. I can see how a FNP would be hesitant to treat you.. but I do not know why she is hesitant to test you. There may be an issue with her permissions. She may not be able to order some of the more specialized tests given insurance policy.

MG
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Old 09-17-2008, 09:11 AM   #10
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Re: Cow patty right here...please help me

MG, do you think I should keep the endo appt. and see what she says? Should I make an appt at the holistic md for a few days after the endo appt just in case? I called the holistic md and he is booked until November but the nurse sees all new patients and she treats as the md does according to receptionist and they do prescribe Cytomel to those who need it. Also, he is on the website that says which docs prescribe Armour.

 
Old 09-17-2008, 09:11 AM   #11
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Re: Cow patty right here...please help me

MG, do you think I should keep the endo appt. and see what she says? Should I make an appt at the holistic md for a few days after the endo appt just in case? I called the holistic md and he is booked until November but the nurse sees all new patients and she treats as the md does according to receptionist and they do prescribe Cytomel to those who need it. Also, he is on the website that says which docs prescribe Armour.

 
Old 09-17-2008, 09:13 AM   #12
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Re: Cow patty right here...please help me

Are those types of iron ok on the stomach?

 
Old 09-17-2008, 09:27 AM   #13
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Re: Cow patty right here...please help me

All iron will give you issues if you take too much of it. The beauty of the fumarate/oxalate formulations is that you can take less of them and still get the same amount of iron in your system.. or a bit more without the added constipation and dark stool side effects having to take 3x as much iron sulfate generates.

As to appointment plans. I would give your Endo one more shot. Get a copy of your records and labs while you are in her office. Tell her you want to try T3 supplementation. Feel her out and see how she responds.

I do think it wouldn't hurt to make an appointment with the DO.. you can always cancel it if the appointment with the Endo goes well or meet the DO if the Endo bombs. I have been through two Endos, two IMs, an Allergist, ENT, two GPs, 2 Obs.. you get the picture. It takes time to assemble the right group of MDs. Good luck. Hopefully we can help you in your search. Sometimes if you start a new thread.. looking for a thyroid savvy MD in X, Y.. HELP! You might get a hit. I have helped others this way and most of my good MDs have come to me via word of mouth.

MG
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Last edited by mkgbrook; 09-17-2008 at 09:28 AM.

 
Old 09-17-2008, 03:29 PM   #14
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Re: Cow patty right here...please help me

The endo has never run labs on me. (See the labs listed earlier in this post) After the first (and only) appt I had with her, I took her lab orders and ended up having the nurse in my fam prac office run them (plus a few other I thought needed done). I was orig dx last Dec with labs from fp.

Ok, so I got more info about the holistic doctor. The "store" that is attached to his practice doesn't just sell things he has developed, it also sells stuff from others that has been developed and has a compounding pharmacy, but they don't take scripts from other docs. He is an MD and board certified gyno and board certified in holistic meds.

I called the receptionist there and explained my dilemma about the endo and said that I didn't know what to do. She said that there is an opening tomorrow with their nurse for a new patient consult appt. I took that and figured I will go from there. I won't cancel the endo appt just yet til I see what happens tomorrow. I couldn't believe they had an appt that fast. I went and got the new patient papers. In it there was a pamphelet about this doc. One thing that stood out to me is something that said "when it comes to hormone therapy, one size does NOT fit all."

Last edited by one2wonder; 09-17-2008 at 05:24 PM. Reason: s

 
Old 09-17-2008, 05:15 PM   #15
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Cool Re: Cow patty right here...please help me

iron

My ferritin was 33 late July. So I started taking PRE-NATAL vitamin's. The iron in them is like 157% needed. (eating Cream-0-wheat every day as its 60% of daily iron too) Had no probs. Then a few weeks ago I decided to start FERRIS SULFATE. (reg iron) After 2 weeks, I'm having trouble doing #2 So I'm back to the PRE-NATALS. If you read them they have all the vitamins we THY patients get low on.

Did labs a week ago that will tells us how my regime is working
Sue

 
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