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New Labs... Confused


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Old 01-14-2010, 07:54 AM   #1
Paseo
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New Labs... Confused

Ok, these are the results of my labs from 1/7/10:

TSH 2.04 (0.4-4.50)
Free T4 1.3 (0.8-1.8)
Free T3 305 (230-420)
Reverse T3 31 (11-32)
TG <20 (<20)
TPO <10 (<35)
ANA Neg
DHEA 239 (110-370)

Ok, so my TSH was 4.541 on 12/22/09 and is now 2.04. Could this be due to Hashi flare ups? My Reverse T3 seems pretty high and my Free T3 could be higher.

Really confused now about all this. Still really cold and fatigued.

 
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Old 01-14-2010, 10:42 AM   #2
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Re: New Labs... Confused

Sorry to bump this, but I just got back from my doctor's appt and now I'm really confused. He dismissed the high normal RT3 and dismissed the RT3 to FT3 ratio of 9.84 which should be closer to 19+, right? Also, the ultrasound did find a small follicular adenoma in the isthmus measuring 3mm x 5mm. Also, the right lobe was 5x1.3x1.3 (seems a bit large on the first number) and 4.3x1.4x1.3 on the left.

This doc seems to think that it is some sort of drug interaction between my omeprazole and my fexofenadine. I am not convinced since I have been on the omeprazole for about 5 years and I have been on the fexofenadine on and off for the last 2 years for allergies.

Since I didn't have a high antibody count he says that I can't possibly be having flare ups associated with Hashimoto's.

I don't know where to go from here. He wants me to go off my omeprazole and fexofenadine for a week to see if I improve and see him next Thursday. I'm not opposed to that idea by itself, but I don't think it will do any good.

Any suggestions on where I should go from here would be great. Especially from javelina, midwest, etc.

Thanks everyone!

 
Old 01-14-2010, 02:57 PM   #3
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Re: New Labs... Confused

Hi Paseo, I can't answer all of the questions but I can start you off with some answers. A TSH of 2.04 falls well within the NEW guidelines put out by the AACE of 0.3-3.0. I know that MY Endo and my GP like to see the TSH around 1. Your FT4 is at 50% of the range and your FT3 is 39.47% of the range. I know from Javelina and Midwest that it is best to be in the upper half of the range. I think it would be difficult to find a doctor to prescribe thyroid meds with that TSH and negative antibodies. Why don't you try what the doctor has recommended and see how you are feeling. Just be sure to go into it with an open mind instead of a negative feeling. The mind is a powerful tool! If you try "his experiment" and it fails, he may be more open to further investigation.

About the size of the thyroid.....I believe normal size to be (3-4cm H x 1-1.5cm W x 1cm D). The difference between your right and left lobe is only 0.7cm (7mm) and that is only .27 or 1/4 of an inch. Just my 2 cents......

 
Old 01-14-2010, 03:13 PM   #4
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Re: New Labs... Confused

Do you have any suggestions on the higher RT3? It seems to me that this is awful high. Also, why would I be having these "swings" and just two weeks ago have a TSH of 4.541? I am not "negative" about trying his suggestion. I simply don't see how after over 5 and 2 years of being on these medications that "poof" they just start to interact. The experiment is fine with me though because I don't like taking medication. This isn't about taking medication. This is about me being able to feel like I should. Being foggy in the head, cold in a 74 degree house, exhausted, fatigued, nauseous, dry heaving, etc etc etc is not how I should feel. Sorry if I seem a bit discouraged, but it is not fun living like this and I wish I had lab results that stayed steady. I can't do anything about my TSH going up and down at will. If I would have gotten my FT3 and FT4 done like I wanted to when my TSH was 4.541 a doc may have treated me, but now they won't because it's a couple weeks later. The only thing I have stopped doing is working out. While I feel a bit better I don't feel well by far. I exercised today for 30 min at an 8 mph pace and I felt good from the endorphins. Low and behold about 1 hour later I feel like crap again so I am assuming there is some sort of connection here. Again, I apologize if I seem to be attacking you personally, but please know that I am not. I don't want to be hypothyroid, but if I'm not what the heck is going on with me?

 
Old 01-14-2010, 03:28 PM   #5
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Re: New Labs... Confused

I know how frustrating it is to have seemingly normal labs with raging hypo symptoms. I also never had positive antibodies and I had a completely normal U/S despite a considerable amount of thyroid pain. Your thyroid actually has a nodule on it and this is an indication that something's up with the thryoid. The good news is that you don't have anything really big and scary growing on there.

As Hopalong says, your free T labs are low in range and this can account for your symptoms. Free T3 really needs to be much higher, up into the top third of range for most of us. And the TSH is too high for you. Also an RT3 ratio of 10 is very low. I imagine you've probably got high cortisol levels and early adrenal fatigue going on that's contributing to this. At this point I'm not sure if regular hormone replacement with both T3 and T4 will work or not, but I would give it a try to see if things improve. Otherwise you may need some T3-only therapy to get rid of the high RT3. Most docs won't agree with this and I'm not sure why they even bother to run RT3 testing because they won't do anything about it anyway. The test is more for your information than theirs I guess.

Your choice is to do what your doc says about d/c ing the meds you are on and if (and when) this doesn't help hope he'll listen to you about thryoid hormone replacement or you can seek another doc who understands. It's can be a very difficult road to find good docs who understand these labs results are not a "one size fits all" situation and who realize that your symptoms are indicitive of hypothyroidism.

Hanginthere and keep fighting for good treatment, it's actually the only choice you really have

Last edited by javelina; 01-14-2010 at 03:29 PM.

 
Old 01-14-2010, 03:46 PM   #6
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Re: New Labs... Confused

So, could I still have Hashimoto's going on with no antibodies? Would that account for a change of TSH from 4.541 to 2.04 in two weeks? From what I am reading this could be from a swing from hyper to hypo or vice versa? I still have "hyper" symptoms off and on but they are few and far between now. I was at work last night and was cold and then all of a sudden my face felt flush and I was hot and then that night I couldn't sleep well.

Could adrenal fatigue itself cause all this to happen? I mean, if I have adrenal fatigue and get treatment for that would it affect my thyroid?

 
Old 01-14-2010, 04:03 PM   #7
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Re: New Labs... Confused

I think AF could be a big player here as well as an underfunctioning thryoid. Your low Free T levels indicate you don't have enough hormones but the high RT3 levels indicate you have some adrenal fatigue going on as well. Did you ever get your ferritin vitamin D and B12 levels tested? They have to be pretty good to be able to handle treatment for any of these issues.
As far as the antibodies, it's possible you may be one of the 15-20% who have false negative readings. Hard to say, many feel like their thyroid disorders are autoimmune despite negative antibody labs. I would retest from time time just to see if the antibodies finally become apparant.
With the fluctuating TSH, I just think that TSH is a lousy lab and try to not spend too much time worrying about it. It's a pituitary response and its correlation to actual metabolic function seems to be largely hit or miss a lot of the time. I only focus on it when it is high because this is sometimes the only thing doctors will sit up and take notice of and high TSH has been shown to lead to many severe health consequences. But just because it's low or "lowish" does not mean that we are not hypo and need treatment too. The fact that it's going up and down for you (and you've been doing labs at the same time of day under the same circumstances haven't you?) does seem to point to an autoimmune etiology though.

 
Old 01-14-2010, 04:10 PM   #8
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Re: New Labs... Confused

Yeah, both tests were done in the morning. The first at 8 am and the second at 8:45 am. Vit D was 42, Ferritin was over 100, and B12 was pretty high because I was supplementing, but stopped a couple weeks before the test. Don't really know how I got Vit D up to 42 though. My multi has only 400 iu, but I do drink a lot of milk especially when I work out.

I ordered the 24-hour cortisol saliva test from Canary Club and will hopefully get some answers from that. After that I will treat the adrenals if needed and go from there. I have an email out to another doc in my area. He is actually closer and specializes in hormones. I just would hate to go to him and have him sing the same tune as this last doc.

 
Old 01-16-2010, 06:33 AM   #9
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Re: New Labs... Confused

I think it is a good idea to do the 24-hour cortisol. I too was a bit of an adrenal skeptic and would dismiss the idea, until I did the 24-hour test. I had 2/4 readings below or at the lower limits of normal and the new MD I took this to acted on it. Personally, I don't like the term adrenal fatigue. If an MD tests more than cortisol and digs deeper and other adrenal studies fall at or below lower limits of normal, it would be adrenal insufficiency, that is a true medical diagnosis. She did an aldosterone, the range is 4.0-31, I was 4.8. Another interesting finding was HGH, range 0.03-10, I was 0.09.

After at least 4-5 solid months of dealing with this, I started to see a turnaround just in the last few days. My body temp has been over 98, although it still drops at night. I was able to easily tolerate an hour on the EFX and noticed I did it faster and still remained comfortable. I was also able to tolerate more reps with weight lifting without feeling uncomfortable. My appetite has picked up, I no longer have the mild nausea. If this pattern continues, I may even attempt a run on Sunday! I had a glass of wine Thursday with no aftermath. I am curious what time of day you run....AM or PM. Cortisol is highest in the AM and then dramatically decreases throughout the day.

 
Old 01-16-2010, 02:21 PM   #10
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Re: New Labs... Confused

I generally do (did) my workouts at about 9 am. I usually have to wait about an hour and a half after I eat to workout or I feel extremely nauseous. Lately, I have noticed that I can do some working out in the early afternoon or so, but most mornings lately I am extremely lethargic when I wake up. I had a friend of mine suggest that maybe I have some sort of sleep disorder. I did break my nose when I was 18 and didn't like how the doctor put my nose back. I do snore and wake up alot at night sometimes for no reason at all. I don't know if I stop breathing or not. I am looking into doing a sleep study just to rule that out as a possible factor.

 
Old 01-16-2010, 03:14 PM   #11
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Re: New Labs... Confused

Paseo, sleep disorders are pretty common when we are hypo. I underwent several sleep studies and have found I have sleep apnea. It turned out to be mostly central apneas, which did not respond well to CPAP treatment. I am pretty certain these sleeping problems are connected to my thyroid and adrenal issues and will resolve once they are corrected.

 
Old 01-22-2010, 09:32 AM   #12
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Update

Ok, so I couldn't make it to my doctor's appt yesterday due to having sick kids. So I did a phone consult and talked with his assistant. She was very open to my ideas and listened to everything I had to say. She and the doctor were both unaware of the FT3 to RT3 ratio. I thought this strange considering the fact that he is a naturopath.

Anyway, I told her that I had been off my meds for a week and have not noticed a change. They want to test my adrenals (which I already did and sent back BEFORE they ordered the test) and I should get the results back soon. She also talked about testing my neurotransmitters. She said she would send me some information on that.

As for the ratio. With the help of javelina, I was directed to a website which uses a variation of the one used here. You have to convert both FT3 and RT3 into the same measurements and then divide RT3 into FT3. If you get a number below 2 then treatment with T3 should be initiated. This is a variation to the 20 used here by moving decimal places, but they are the same concept. Anyway, using this method I am 0.98! Way below 2!!

I am actually making more RT3 than I am FT3! No wonder I am having such a hard time!

So, I don't know if they are going to consider this or not. She told me that when FT3 is within normal range and RT3 are within normal range then they don't initiate treatment. Which is so funny to me because that RT3 is a 31 on a max scale of 32. That is way to close for comfort to me especially with FT3 at 39% of scale.

Sorry to ramble, but I feel I am making progress at the same time not making progress!

Ok, waiting for cortisol test. May test neurotransmitters. Also talked about doing a gluten free diet for shiggles. Oh, I have been on testosterone patches for 2 weeks. Libido seems to be better and don't seem as sore. Will switch to shots in 2 weeks.

 
Old 01-22-2010, 10:09 AM   #13
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Re: New Labs... Confused

Good for you that your doc is willing to listen. Thyroid hormone resistance is far more common than most realize and a major reason why we are hypo as well a unable to get good results from hormone replacement. The ratio FT3 is a far more accurate way to determine the level of RT3, instead of an abitrary range assigned to the test. Like TSH, FT3 and FT4, many test ranges are not accurate for many of us.

Did you post your RT3 and FT3 levels at one time? I'm curious what they are and how you came to the .9 calculation. That's really quite low. Mine got as low as 10 (or 1.0).

 
Old 01-22-2010, 10:22 AM   #14
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Re: New Labs... Confused

Thanks for the reply!

Actually not on replacement yet. I'm hoping that this will wake them up to my needing it and hopefully T3 only because I don't think I need anymore T4 converting to RT3!

Here were my labs posted earlier:

Free T3 305 (230-420)
Reverse T3 31 (11-32)

Based on one of the websites you directed me to you simply convert both into the same measurements. In this can I simply converted the Reverse T3 into the same measurement as FT3 which gave me 305/310=0.98. This is simply a variation on the same calculation you use. The only difference is a decimal place. If I were to use your calculation it would come up to be 9.84 where higher than 20 is what I have found to be optimal. With the calculation I found, anything 2.0 and greater is optimal.

 
Old 01-22-2010, 11:21 AM   #15
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Re: New Labs... Confused

Yes, that's correct. I'm used to ranges for FT3 and RT3 that are different but the ratio is what's important. You're definitely converting your T4 to RT3 at a very high rate. This is often from high or low cortisol levels so the results of your cortisol test should be interesting.

 
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