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Old 11-03-2008, 10:09 AM   #1
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Thyroid Care and Concerns – Endocrine Balance Issues

First I am reviving an Oldie but Goodie thread series of mine. We will start with the usual as a result of the commonly asked question, ” What is optimal range and HOW do I calculate it?”

Well there is normal and optimal in ANY given hormonal/mineral range in our bodies. My family women are optimal in thryroid hormones in the 65-72% RANGE OF NORMAL. If we fall below 50% we start showing hypothyroid symptoms. If we jump above 80% and then we have hyperthyroid symptoms to fight. In the odd cases we have adrenal issues that split our issues between hyperthyroid and hypothyroid. But my family is genetically dysfunctional that way.

Now let me try and explain this in a manner that is easy to understand, 80% is still NORMAL in range; but it may be too much for someone who is optimal at 65% of range. This their TSH may be LOW normal in range or actually indicate hyperthyroid despite the FT3/Ft4 result being NORMAL.

So let us answer the “What is normal range versus optimal thyroid ranges?” question one more time:
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. By this statistic given various sensitivity calculations that have been refined as the technology in analysis has been refined and the knowledge of scientists and endocrinologists has improved over the year has resulted in the refinement of the .3-10(1960s-1970s.. flee from an MD that states this range.. RUN AS FAST AS YOU CAN TO A NEW MD!), 0.45 – 5.5(late 1980s), .4-4.0 (mid1990s), 0.3 – 3.0 (2002). In 2006 the recommendation shifted again to 0.3-2.5, however this is not widely accepted. HECK the 2002 recommendation is still not common knowledge!

Optimal range in the actual thyroid hormone tests (FT3, FT4) is 50-80% of normal range. Women of child bearing years need to have Fts in the 60-80% range of normal. Women after menopause tend to need slightly lower Ft values in the 40-70% range. (This is just my MFM and 2 Obs 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%

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 T4 and T3 hormone levels and symptoms alone.

So what can happen if your thyroid hormones are not balanced and in the optimal region for you? Well other endocrine issues may arise or malabsorption effects may aggravate your thyroid and body issues.

The main malabsorption issues that occur involve the rarely tested, must be written in minerals and vitamins: Ferritin, B12, D, and Mg.

Remember these threads are a thyroid care and concerns free for all. Share your experiences, ask your questions, and share your knowledge so that we all can learn from each other and understand the mysteries of our endocrine issues better. You know there is more to come...

MG
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Old 11-03-2008, 10:10 AM   #2
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Let us look at Ferritin in detail. It is the main hypothyroid mimic and causes many of us issues. You can have normal iron levels but low Ferritin. A large body of thyroid patients and patients that suffer from acid reflux and treat it with excessive acid reducers have low Ferritin, or storage iron. Ferritin is an iron-storage protein.

Why do we often have low Ferritin? The main reason is hypothyroid and patients on anti-acids have a lowered production of hydrochloric acid in there stomach. If your HCl concentrations are too week or low you have malabsorption of iron.

Being hypothyroid also lowers your body temperature as a result of your body cutting back on red blood cell production. This means less storage houses for your iron and lower ferritin. Additionally, most hypoTs have heavier periods, which causes more iron loss as well. It all adds up.

Why is having low Ferritin a problem? First, though the slide into low Ferritin can be symptomless, it eventually becomes the precursor to being anemic. And once the latter occurs, you can then have symptoms which mimic hypothyroid–depression, achiness, easy fatigue, weakness, faster heartrate, palpitations, loss of sex drive, HAIR LOSS, and/or foggy thinking, etc. In non-tested hypoTs the patient thinks they are not on enough Armour, or Synthroid and that their thyroid supplements are not working.

Excessively low Ferritin can also make it difficult to continue raising your Armour or synthroid! It is important to test this and check your levels periodically. My MD believes in quarterly testing OR when symptoms arise.

Biologically/biochemically speaking.. here comes condensed geek speak.., insufficient iron levels may be affecting the first two of three steps of thyroid hormone synthesis by reducing the activity of the enzyme thyroid peroxidase, which is dependent on iron. Iron deficiency, in turn, may also alter thyroid metabolism and reduce the conversion of T4 to T3, besides modifying the binding of T3. Additionally, low iron levels can increase circulating concentrations of TSH.

A delicate balance of iron, in addition to iodine, selenium and zinc, are essential for normal thyroid hormone metabolism and synthesis. If you are having small issues with balance and thyroid levels it may not be the thyroid but the building blocks your thyroid needs.

What’s the solution and treatment? The solution, after you have verified low Ferritin with a blood test (lower than the 50, optimal is 70-90 in range), is to supplement your diet with iron. I recommend Ferrous fumerate because of our bodies ability to absorb it easier. Thus you need less of it and it is easier on the digestive tract.... Also eat foods rich in iron include lean meats, liver, eggs, green leafy vegetables (spinach, collard greens, kale), wheat germ, whole grain breads and cereals, raisins, and molasses.

Ferrous Gluconate may cause fewer symptoms and is milder on stomach. Ferrous Fumerate is often prescribed by doctors as it, too, has fewer side effects, absorbs well, and is easier on the stomach.

Should you take anything with the iron? Yes. It’s recommended to take Vitamin C, which helps absorption of iron. It is that whole acidity thing. Also taking a mineral supplement can assist the absorption, as can B-vitamins. I take a super B complex. A nutritionist may be helpful to you.

Now this same malabsorption effect hits the vit's D and B12 and can effect Magnesium levels as well. So it is always important to test your levels and supplement as necessary. Low vit D can cause joint and bone pain. Low Magnesium hits the bones and the muscles as bad as low K does. Low B12 and B6 can cause migraines, fatigue, and general energy/immune issues. SO please do not forget to write yourself a note to ask your MD to do a basic chemical profile with the special minerals and vits. We need balance. The mechanisms of B12 and vit D are more complex than ferritin, so I am going to leave discussion of it til someone asks for the chemical breakdown.
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Old 11-03-2008, 10:14 AM   #3
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

The endocrine system and balance. The endocrine system is delicate and an intricate system of checks and balances.

For the thyroid you have the HPT(Hypothalamus-Pituitary-Thyroid) loop. Now this is influenced by the outlying HPO(Hypothalamus-Pituitary-Other Gland) Loops. The main HPO loop that influences the HPT directly is the HP-Adrenal loop.

First a summary of the HPT loop:
Your hypothalamus receives a message from you liver that tells it that your T3 needs are being met/not met and thyroid hormone needs to be adjusted (increased/held steady/reduced). The hypothalamus then sends its memo (TRH) to the good old pituitary gland or endocrine over seerer.

The Pit. Then interprets the TRH and tells the Thyroid via TSH to make (more/less/stay steady). If the pituitary gland is working well a TSH around one shows your thyroid is receiving what it needs at the current time. If it is LOW then you tend to have too much thyroid hormone (High T3 is the most common factor). When the TSH is HIGH your thyroid is not meeting your bodies expectations for T3 and T4. NOW NOTE this is the PITUITARIES view of things. NOT the thyroid to SEE what the thyroid is doing you need to look at you ACTIVE thyroid hormones.

The thyroid receives the TSH. The TSH can be affected by many things and thus throw off the system. But that is another topic discussed in weeks 3-4 of my thyroid care and concerns series. The thyroid accepts the TSH demand and acts according to produce T4 and T3 in an approximate 80:20 ratio. In the case of Graves TSI mimic TSH and make the thyroid into a supper T4 and T3 producer. In the case of Hashimoto's, every time TSH calls the thyroid to make T4 and T3 the TPO and TG activate. Upon activation the TPOAb and TGAb go on the warpath and attack and kill off the active thyroid tissue. This results in T4 dumps and can cause temporary hyperactive flares in early Hashimoto's. Eventually these flares will decrease in intensity and the thyroid will be obliterated.

SO to effectively evaluate your HPT loop you need to test your TSH and your FT3 an FT4 levels. Given that autoimmune thyroid issues are tricky and love to make things difficult you should also periodically test for TPOAb, TGAb, and TSI. You can have both Graves and Hashimoto's.

I think that in such cases one usually manifest before the other and then the secondary AI may be your bodies attempt to cancel out the effects of the first. Just a theory of mine and some friends.. not a fact.

If you do have Hashi's and Graves You will have shifts in dominance as the conditions progress. In the end your Hashimoto's will win and your thyroid will be killed off. In the mean time how you are treated depends on you and your MD. Try and find that special MD for You. I am working on the Adrenal system loop and impact post now. It will take a while. The adrenal system is.. complex to say the least. So keep your eyes open for my next rant/lecture.

I hope that you all find this helpful and that it may answer some of the whys and question about what is going on in our bodies. Understanding your body and what it is telling you is the first step to reaching that Optimal state we are all striving for!

So what do you all think? Questions and comments? How are your MDs testing you?
MG
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Last edited by mkgbrook; 11-03-2008 at 10:47 AM.

 
Old 11-03-2008, 02:24 PM   #4
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

I don't suppose you could dumb down the math equation for me? I'm afraid I don't understand how to plug my own numbers in there. Of course, I took 4 years of Algebra 1 in High School and failed all 4 times. It's no great surprise I don't get it. My latest numbers are as follows:
TSH: 3.11 (0.30-5.00)
FT4: 1.19 (0.71-1.85)
FT3: 3.02 (2.30-4.20)

 
Old 11-03-2008, 03:21 PM   #5
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Thanks MG-
I have had low ferritin, raised it up , and fell back down, and am now in the process of raising it up.
I just wanted to add that it is not easy/fast to raise your ferritin with iron supplements. You will probably be at this project at least several months or longer. And, it is best to be supervised and tested by your dr and not have this a DIY project.
Also supplements can be hard on the stomach as MG indicated. So , you have to see what you can tolerate. For me this is with ferrous sulfate and ferrous fumerate as well-both cause stomach upset.
Also it seems alot of drs don't even get motivated to supplement until you are way low-and then it is even more of a difficult project. Best not to get too low and watch it periodically, if you are a person with this issue.
And, it will likely mess up your synthroid dose. In my case even when taken 8-12 hrs. from synthroid --still my tsh was affected and I had to raise my dose of synthroid. And, remember to lower when you get off the supplements.
And, a good doc should rule out other causes of low ferritin and may suggest a colonoscopy to rule out internal bleeding. Or, blood tests and possible endoscopy to rule out celiac which would affect absorption of nutrients.
Just thought I would add my ferritin experience to the mix.

Last edited by osteoblast; 11-03-2008 at 03:22 PM.

 
Old 11-03-2008, 04:05 PM   #6
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Osteo,

Thank-you for your Ferritin insight. It was well said and informative. You are right that anytime you start a supplement regime you should:
1) KNOW you need the supplement by testing your levels first.
2) TRY dietary adjustment and a multivitamin first.
3) TEST in 8 weeks time if you have no change or were on a multivitamin when you tested deficient, then add additional supplementation and test every 8 weeks until you level off.
4) TOO much of a good thing can be toxic when you are talking minerals like Fe and Mg. SO go easy.

MANY good points there, THANK-YOU!

Kittyroo;

I don't suppose you could dumb down the math equation for me? I'm afraid I don't understand how to plug my own numbers in there. Of course, I took 4 years of Algebra 1 in High School and failed all 4 times. It's no great surprise I don't get it. My latest numbers are as follows: I bet you are very creative. My mom is as well. We can not all be mathmatically minded. I have to work at it. Let me show you through repetition.
Using 2002 recommended A A C E ranges for TSH:
TSH: 3.11 (0.30-3.00)
[3.11 - 0.30] divided by [ 3.00 - 0.30 ] multiplied by 100 = % of normal range.
[2.81] divided by [2.7] multiplied by 100 = 104% of normal. This would be an indicator of being hypothyroid.

FT4: 1.19 (0.71-1.85)
[1.19 - 0.71] divided by [1.85 - 0.71] multiplied by 100 = % of normal range.
[0.48] / [1.14] * 100 = 42.1% of normal range.

FT3: 3.02 (2.30-4.20)
[3.02 - 2.3] / [4.2 - 2.3] = % of normal range.
[0.72] / [1.9] = 37.89%

Now with brackets you always do the math in the brackets first. In this case it is subtraction. Then divide the two bracketed numbers and finally multiply by 100 to turn it into percent form. I can not make it any simpler than that... did it help?

MG
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Old 11-03-2008, 06:45 PM   #7
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Thanks a bunch!! That totally helped. I am a hairdresser, BTW. So creative, yes. Math, not so much.

 
Old 11-03-2008, 07:51 PM   #8
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HPA Loop - Endocrine Balance Effects

Since Adrenal testing is becoming a hot topic in regards to thyroid dysfunctional patients here is my take on the HPO(Adrenal loop).. Brace yourselves! This has some really confusing words. Don't try and read them a loud. Think of them as letter pictures.

Would you believe that your Cholesterol levels are tied to your adrenal function?
Well they are, triglycerides are also affected by your adrenal glands. YEAH, another surprise. How does this tie in with the thyroid? Well bear with me....
Definition: Triglycerides are fats carried in the blood from the food we eat. Most of the fats we consume are in triglyceride form. (Restraining myself from a biodiesel tangent)
What is the difference between triglycerides and cholesterol?
Well they are both fatty substances known as lipids. Yeah, geek speak, SORRY! BUT triglycerides are fats; cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver that is an essential part of cell walls and nerves. Yes, cholesterol does have a purpose other than to cause heart attacks... Triglycerides are quick storage fuels but given excess in diet OR in estrogen(produced by adrenals) the excess calories from alcohol or sugar is converted into triglycerides as well and stored in fat cells in... DRUM ROLL the hypoT Tummy Tub. This is why in many hypoTs or people with estrogen dominance fat first builds up in the tummy. It also explains why ab fat is much harder to regulate for estrogen high females. Blame it on Hormones ladies. You are justified.

Oh, back to Cholesterol and your adrenal system.. Here is the link:

Cholesterol is converted to Pregnenolone.
Pregnenolone then under goes a dual conversion to form two products:
Progesterone and 17 – HydroxyPregnenolone

Progesterone then under goes a dual conversion of its own to create the two important cortisol and aldosterone synthesis chains through the formation of
1) deoxycorticosterone -> corticosterone -> aldosterone
AND
2) 17-hydroxyprogesterone ->11-deoxycortisol -> cortisol

17 – HydroxyPregnenolone can be converted into 17-Hydroxyprogesterone and thus undergo transition to Cortisol, but the dominant chain of synthesis is conversion from 17 – HydroxyPregnenolone to DHEA which in turn is used to make Testosterone AND Estrogens.

Yeah scary huh.. too much CHEMISTRY!
SO what does our body tell us?
Well Cholesterol and Triglycerides do have a purpose. Sometimes bad Cholesterol is simply your diet, but unless you test your adrenal function can you be SURE? In others high triglycerides are a sign on a more serious dysfunction. PCOS, insulin resistance, hypoadrenalism are just a few of these disorders. If there is a back log of cholesterol or triglycerides then it is only wise in my opinion to find the source of that back log. Wouldn't it be wise to make sure that your cholesterol factory is working efficiently? The main hormones in that mass above to check are cortisol, pregnenolone, progesterone, testosterone, and estrogens. These are commonly montiored and evaluated in an ACTH stimulation test. You have to see how your adrenal reacts under stress to catch a synthesis error. This holds for males and females. Both have estrogen and testosterone. The sexes just differ in ratios of the sex hormones. Females should have more estrogen and males more testosterone. However there are optimal levels for both. One side effect of high estrogen levels (conditions: estrogen dominance / PCOS / Insulin Res.) is that estrogen in excess takes excess alcohol or sugar levels and converts them into triglycerides which are stored in fat cells in the hypoT Tummy Tub first and throughout the rest of the body as well. To fight this we have to eat well and try and avoid EXCESS! This is VERY important for for those that have ED(estrogen Dominance) / PCOS / IR.

Now how do the adrenal glands affect your thyroid hormone levels directly? It affects thyroid hormone conversion in the liver. Cortisol is a stopper on the T4 to T3 conversion signal. If you do not have enough cortisol in your system your T4 to T3 conversion runs unchecked and you over convert your T4 into T3. If you have too much cortisol in your system then your T4 to T3 conversion is suppressed. The key in adrenal hormones as well as any other is BALANCE. To be able to effectively note your balance you need to follow your Free T3 and Free T4 levels. There is TOO much error in the total T3 and T4 tests to effectively determine adrenal dysfunctional trends. Now there is another issue that mimics high cortisol production. This is poor conversion of T4 to Reverse T3. SO if you have low T3 levels and high T4 levels you need to test your adrenals as well as Reverse T3 levels.

Low cortisol and low aldosterone is one indicator of hypoadrenalism. The extreme form of hypoadrenalism is Addison's disease. High cortisol and high aldosterone is one indicator of hyperadrenalism. The extreme form of hyperadrenalism is Cushing's/Conn's disease. You can have primary and secondary forms of both of these issues. Primary is where the gland itself is responsible. Secondary is where a pituitary gland dysfunction is responsible. It is only reasonable, given that the thyroid and adrenal glands are both triggered/queued by the hypothalamus-pituitary loop that dysfunction in one may lead to the other. The best way to tell if such has occurred is to follow your thyroid hormone levels.. NOT TSH and to look at your adrenal hormones and triggers if an imbalance is detected.

The more I study and look into this system the more import following the actual thyroid hormone levels appears to be. We must fight for TSH as well as FT3 and FT4 level monitoring. DO not settle for second best AND DO follow your own LABS! ALWAYS get a copy of your lab work so that you can research it at your leisure. In most cases a self-addressed envelope with a request for a photo copy of the lab report to be mailed to you is sufficient to get this done in a timely fashion. If your detect an imbalance in your FT3 and FT4 levels you then need to then move to the next step. That is minimal adrenal testing: ACTH, cortisol, DHEA. If you have symptoms of insulin resistance of PCOS get a full hormonal panel run.

So once again in these endocrine glands, you have a checks and balance loop system where the hypothalamus registers the cortisol and aldosterone levels and then it sends CRH and ADH to the pituitary to trigger the production of ACTH which tells the adrenal glands to make more or less cortisol and aldosterone according to demand. Stress, illness, nutritional balance, and hormonal imbalance effect adrenal hormone release and production. And just as with the individual parts of the system, the key to a perfect endocrine system is balance. All systems are dependent on the other. When there is a disruption in function it CAN effect the other systems directly or indirectly. The best we can do is follow our own labs and always request thorough evaluation of imbalances. We deserve the best of care and we have to be willing to fight for the care we deserve.

MG
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Old 11-03-2008, 07:54 PM   #9
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Re: Thyroid Care and Concerns - Endocrine Balance Effects

I am working up a write up on PCOS, hypoglycemia, and insulin resistance testing and effects next. Keep an eye out for it.

MG
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Old 11-04-2008, 01:18 AM   #10
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Hi, MG, thanks for all your input. That quite summed up the facts of hypoT!

I am considering having a hair analysis for minerals and heavy mental elments. But some others think it is not as reliable as blood tests (blood tests for minerals are limited, less than 10 kinds of minerals as far as I know) What is your thougt? I remember Audrey B on this forum also had had it tested..

I am also thinking of test for bone density, but worried about the radiation of X rays!

Last time I found my CO2 in blood is too low (too much "acid" in diet?? or it is the common phenomina of hypoT?) I am thinking having it tested or PH values to trace periodically.

And for the tests, do you think we should stop taking the supplements 1 day before the tests? I heard that 24 hours of fasting is good for tests. Since taking different minerals/vitamins, would it interfere the accurate result? (I am thinking stopping taking iron/magnesium..etc 1 day before testing them)

Best Wishes,

Jenny

 
Old 11-04-2008, 07:53 AM   #11
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

I am a chemist and I worked in a synthetic inorganic lab making quad bonded heavy metal complexes. My reaction catalysts were carcinogenic mutagens. When I got married I did a carrier change so I could safely have children. I tested myself for MANY metals. More than 10. It was all done via blood. My blood had to be sent off to California and New Jersey, but I got a 20 some odd panel run. I came back clean.

It is rare for a person to have excess metals in there system other than the common ones taken in supplements. Call your water quality board and get a report of what is in your water. This information is public access. High CO2 can be a sign of low Na and K in your system. WHere is your Cl level? What are your K and Na levels? These are processed and controlled by aldosterone.. one of those adrenal outputs.

MG
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Old 11-05-2008, 10:41 AM   #12
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

On a personal note my Great Aunt just passed on Monday night. She was 93. She lived a long life despite Graves and Diabetes. She had four children, many grandchildren and great grand children. She maintained self sufficiency until last year. Take note of this and strive for it. See it as a good thing and an example to live by.. I do. She died peacefully and did not suffer long. We are all glad to have had her in our lives for so long. I hope to be a plague to my family for just as long.

Also a family friend successfully made it through heart surgery and is doing well. So there is another positive note for you out there. Good things happen. My little nephew TSH had his first ear tubes put in and they were in time to spare hearing damage.. one more plus for the little fighter for a 6 mo premie.

Any prayers you want to send out to those recovering and suffering now in bulk is appreciated. I pray for the masses when those close to me are suffering. Just part of my philosophy, I might as well ask for a big favor if I am going to ask for one at all.

I have ceased to pray for my thyroid issues to be taken away. I do not think it will work. I see it as a trial for us to follow the you will get help if you help yourself adage. SOOO Now I help myself by harassing my MDs like my border collie does everyone with his ball. YOU GOT TO THROW THE BALL! If you don't.. well your not in the game.

Thanks for letting me spill a bit. I may be out of touch due to funeral travel for a few days. But I felt a bit blue and needed an out. I also think my thyroid levels have took a dive. Well you all know how that goes. I am really wanting a nap.

MG
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Last edited by mkgbrook; 11-05-2008 at 10:43 AM.

 
Old 11-05-2008, 12:38 PM   #13
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

MG-Your aunt lived a long life and I hope she is in a place of peace and joy. Sounds like you have a wonderful extended family and loving friends to whom you are well connected. During this time when you are coping with alot , I wish you the best Do take a load off and get that nap. You deserve it-you have been doing that extra mile for us as you always do. So take it easy and I hope that your thyroid decides to be cooperative.

 
Old 11-07-2008, 07:24 PM   #14
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Quote:
Originally Posted by mkgbrook View Post
High CO2 can be a sign of low Na and K in your system. WHere is your Cl level? What are your K and Na levels? These are processed and controlled by aldosterone.. one of those adrenal outputs.

MG
Hi, MG....Following is my Na,K, and Cl levels.

K 4.22 (3.5-5.3)
Na 141 (135-148)
Cl 105 (96-108)

I think I had soy bean related drinkings which is rich in K before, but now I know that soy destroies the thyroid, so I stop having it...my K level is a little bit low, right? Actually I guess that I don't take much alkaline food that made my CO2 level low...not sure for it..

 
Old 11-08-2008, 12:21 PM   #15
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Re: Thyroid Care and Concerns – Endocrine Balance Issues

Your K is not too bad. It is 40% in range. You could add some K to your diet, but you do not need excessive supplementation.

MG
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