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Old 04-22-2002, 12:42 PM   #1
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Anyone, including treefrog, artfuld...Thyroid levels six weeks

Hi -

Just got my six week levels. First I have to say this. I just had my gallbladder out on 4-2-02 and then developed post op pneumonia. Lost 8 pounds in a two week period, which is probably due to bein so ill. Still recovering. Doing better.

TSH < 0.01
Free T4 1.3 (0.58-1.64)
T4 13.6 (4.7-13.3)
T3 Uptake 34 (31-39)

Alright, my primary doc wanted to lower my 88mcg synthroid to 75mcg. He thought my weight loss was also due to the 88mcg based on my lab numbers. I dont feel hyper. Then I e mailed my endocrinologist at Vanderbilt University (cause I am in Michigan) He said to stay on the 88mcg and repeat in six weeks. He said my labs could be misleading because I was so ill with the surgery and the pneumonia. he did not explain how the illness can screw up my lab values. Well before I told the endo, I started the 75mcg about five days ago. Within two days I noticed that lumping, swelling feeling in my throat....same thing I had when I was hypo. HMMMM. I know my Free T4 is on the upper end of normal....and pituitary is totally shut off from making the thyroid work. Just want to know if you all think the illness made my numbers this way. Anywhooo, I see my primary doc he is pretty good. He will go along with the endo's decision. He is just nervous about bone loss.

I am also going to get a free t3 along with my next set of labs. I think some of my symptoms of fatigue may not be totally corrected. My last free t3 was on the low end of normal.

any thoughts...thanks

 
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Old 04-22-2002, 09:08 PM   #2
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Oh, judekate. I'm so sorry to hear about your post-op troubles. Stress and illness can definitely affect our thyroid levels.

I think Meep (or maybe bird123) could explain your blood tests best. But, to me, it looks and sounds like you may not be fully metabolizing or absorbing your Synthroid. Good for you for emailing your Endo and noting how the reduced dosage made you feel. Sounds like you have some good physicians, and I think you're right to stay on the 0.88 mg until your health stabilizes and then repeat the blood tests.

If your primary doc is concerned about bone loss, does he have you on calcium/magnesium/Vitamin D? If not, ask him if perhaps this should be added to your regimen.

I think you're right to get a Free T3. Here's a post from the Info Archive that explains some of the different blood tests available:

<B>Thyroxine (T4)</B>: This shows the total amount of the T4. High levels may be due to hyperthyroidism, however technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills or estrogen replacement therapy. A Free T4 (see below) can avoid this interference.

<B>T3 Resin Uptake or Thyroid Uptake</B>: This is a test that confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein! The method of reporting varies from lab to lab. The proper use of the test is to compute the free thyroxine index.

<B>Free Thyroxine Index (FTI or T7)</B>: A mathematical computation allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the blood stream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.

<B>Free T4</B>: This test directly measures the free T4 in the blood rather than estimating it like the FTI. It is a more reliable, but a little more expensive test. Some labs now do the Free T4 routinely rather than the Total T4.

<B>Total T3</B>: This is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent and shorter lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3.

<B>Free T3</B>: This test measures only the portion of thyroid hormone T3 that is "free", that is, not bound to carrier proteins.

<B>Thyroid Stimulating Hormone (TSH)</B>: This protein hormone is secreted by the pituitary gland and regulates the thyroid gland. A high level suggests your thyroid is underactive, and a low level suggests your thyroid is overactive.

May you heal quickly.

 
Old 04-23-2002, 12:14 PM   #3
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Thank you artfuld

Can you give me a hint as to why (by my numbers) you interpret I am not absorbing or metabolizing all my synthroid. Thanks....and I hope meep , bird123 will look at this. Anyone...I appreciate everyones help. Thank you for the archive note. I reference that all the time. I am also one cacium 1200mg and D daily. More luck for me...I just started another course of antibiotics. Pneumonia not resolved. I am sick of being sick

I am on estrogen replacement....would you say the regular T 4 is not an accurate account of my blood levels? Just the free T4. Right??

Thanks again

Judekate

 
Old 04-23-2002, 03:34 PM   #4
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Sorry for being vague. My interpretation was a bit of a guess, based on your symptoms and test results:

Your Free T4 is within "normal" limits, but your TSH suggests that you're hyperthyroid. Without seeing a Free T3 result, it's really just a guess, but I was supposing that your Free T3 might be high and thus causing the low TSH. Because you don't have hyper symptoms (and, in fact, have a return to hypo symptoms when you lower your med dosage), I was thinking that you may be at a good Synthroid dosage, but not fully absorbing the T3 as your Synthroid is metabolized.

But since your last Free T3 was on the low end of normal, I could be way off base. Some of us need our TSH suppressed way below 1.0 in order to feel good, and you may just be one of those people. <B>Meep, you have experience in this area -- what do you think?</B>

Glad to hear that you're on Calcium. Make sure you also take Magnesium (about half as much as your calcium, or 500-600 mg should be about right for you). Magnesium is very important in helping us absorb calcium. To find out what's right for you, take the magnesium in increasing doses until your stools are too soft, and then lower the dose until you stabilize. As with other minerals, citrates and gluconates are easier to absorb than the more inexpensive oxides and carbonates, but if you're not having stomach upset, take whatever type you want.

I agree that the estrogen replacement may lead to some inaccuracies in the Total T4 blood test. Free T4 is best.

 
Old 04-23-2002, 05:26 PM   #5
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Thank you ArtfulD

I may have central hypothyroidism. I have a diagnosed pituitary disease. From what they can tell though the pituitary making TSH is not damaged. My endo doctor wanted to put the thyroid "to sleep" because I have hashi's. Not let the thyroid work. He put me on the 88mcg anticipating in the future my thyroid would die off. Rather than start me on a lower dose, he said we will just put the thyroid to sleep by putting me on a larger dose with anticipation of my thyroid becoming hypo over time. He said that is his theory. It will be interesting to see what the levels are in another 6 weeks. I will say when I was put on that dose bammm, no more swelling in my throat!! That was annoying. Thanks again

 
Old 04-23-2002, 05:27 PM   #6
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Thank you ArtfulD

I may have central hypothyroidism. I have a diagnosed pituitary disease. From what they can tell though the pituitary making TSH is not damaged. My endo doctor wanted to put the thyroid "to sleep" because I have hashi's. Not let the thyroid work. He put me on the 88mcg anticipating in the future my thyroid would die off. Rather than start me on a lower dose, he said we will just put the thyroid to sleep by putting me on a larger dose with anticipation of my thyroid becoming hypo over time. He said that is his theory. It will be interesting to see what the levels are in another 6 weeks. I will say when I was put on that dose bammm, no more swelling in my throat!! That was annoying. Thanks again

 
Old 04-23-2002, 05:33 PM   #7
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by judekate:
<B>
TSH &lt; 0.01
Free T4 1.3 (0.58-1.64)
T4 13.6 (4.7-13.3)
T3 Uptake 34 (31-39)
</B><HR></BLOCKQUOTE>


Well, if your TSH has been slowly going down over the past sevearal months (for example 2.5-1.8-0.7-0.01), one might think about reducing the dose of Synthroid. If you have had stable TSH for a while and got a sudden drop in TSH during the illness (like 2.5-2.7-2.4-0.01) I would rather repeat TSH in a few weeks or even sooner. It can be just a lab error or Euthyroid Sick Syndrome.

Euthyroid Sick Syndrome (sometimes called "low T3 syndrome")is caused by severe illness, trauma, or surgery. In this case the convertion of T4 to T3 is impaired. As a result, large amounts of reverse-T3, an inactive form of thyroid hormone, accumulate. In Euthyroid Sick Syndrome T3 levels are low, but T4 and TSH levels are normal.

Sometimes severe illness causes "low T4 syndrome". In this case TSH decreases early in severe illness, sometimes to less than 0.1 mu U/ml. By definition, it may be caused by decreased thyroid-binding globulin (TBG), inhibition of T4 binding to TBG, or suppressed TSH secretion. Laboratory tests will return to baseline once the underlying illness resolves.

High doses of glucocorticoids (like Solumedrol or Prednisone)can also decrease TSH.

In any case, TSH is best interpreted when free T4 and free T3 levels are known. In secondary hypothyroidism (TSH deficiency in pituitary) TSH can be low in spite of adequite thyroid replacement.

Also, oral contraceptives or estrogen therapy elevate thyroid-binding globulin (TBG), raising total (bound+unbound) T3/T4. In this case the free (unbound) T3/T4 will stay the same, but bound T3/T4 will go up. So, if you take oral contraceptives, you should rather check free T3/T4 instead of total T3/T4 to avoid false results.

 
Old 04-23-2002, 09:53 PM   #8
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

I will concur with Bird on this. Though your Total T4 was above range, your Free T4 was still in range. Since this is the active, useable T4 that is available to be converted to T3 by your tissues and is still well within range, this is likely why you aren't really experiencing any hyper symptoms, and is probably why your endo chose not to lower your dose.

Still with your Total T4 being that high, it would be wise to watch your levels and symptoms carefully if you plan to follow your endo's advice.<p>[This message has been edited by Meep (edited 04-24-2002).]

 
Old 04-23-2002, 10:08 PM   #9
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Bird,

I agree with you on most points (especially on Free T3/T4 vs Total T3/T4), but have a question. You wrote: <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Also, oral contraceptives or estrogen therapy elevate thyroid-binding globulin (TBG), raising total (bound+unbound) T3/T4. In this case the free (unbound) T3/T4 will stay the same, but bound T3/T4 will go up. So, if you take oral contraceptives, you should rather check free T3/T4 instead of total T3/T4 to avoid false results.<HR></BLOCKQUOTE>

That may be true in some cases, but I have also seen cases where the Total levels went up while the Free levels went down. Theoretically, this would be more common. Here is my understanding of what happens due to increased levels of thyroid binding proteins:

Naturally, the Total level rises as the TBG and albumin bind up more and more hormone. This leaves an already lower Free level to start with, initially, and as the body uses what free hormone is left available the Free levels are depleted.

I would also add that in many people, excessive soy consumption causes an increase in TBG as well.

I know that despite our different backgrounds and differing opinions on some subjects, that you are quite knowledgeable and I therefore value your input. What do you think?<p>[This message has been edited by Meep (edited 04-24-2002).]

 
Old 04-24-2002, 07:42 AM   #10
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

You are all awesome. Thank you. I will get a free t3 along with it. I see my Primary doctor tomorrow. I cannot thank you enough. I will write to all of you again with results. One more thing. Where should a free T3 be theoretically??? IF the free T4 is in the middle range like mine is that where the free t3 should be also. My last free T3 was on the very low end of the range like two tenths of a point before going down below normal. IF the free T4 is in the middle mid upper the free T3 in the same general range? I do not feel hyper. In fact I have some problems with fatigue on exertion and my heart rate climbs into the 100's (adrenal problem ruled out) could that be from a lack of T3 or a T3 conversion problem?? Hope that is clear. I want to take info back to my doctors....you all have been a huge help!

Thank you

Judekate

 
Old 04-24-2002, 08:24 AM   #11
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Judekate, most people I have talked to feel better when their Free T3 and Free T4 are both in the middle of the range or higher and in similar parts of the range. They tend to be symptomatic when one or the other is low, despite normal TSH.

Since yout T4 levels look good, if you find that your T3 levels are low, there are things you can do to improve conversion.

Make sure you are getting plenty of selenium in your diet without exceeding 200mcg a day. Selenium is an essential part of the enzyme that breaks the extra Iodine from T4 making it T3.

Make sure you are not starving yourself of carbohydrates. While a high protein/low carb diet has its advantages, you still need some carbohydrates in your diet or you will not convert well.

If those things do not help, then adding T3 may be what you need.

Your symptoms indicate possible hyper, but also over or under activity of the adrenals can cause these symptoms, too. How was an adrenal problem ruled out? what kind of testing was done and what were your results?

Many people who are low-normal or even normal on the adrenal tests that most doctors are comfortable with have symptoms of adrenal problems and benefit from low-dose supplementation of adrenal hormones. These tests only really see black and white. They reveal extreme adrenal failure or overactivity, but not the more subtle imbalances that aren't life-threatening, but still cause symptoms.

Granted, since your Total T4 is high, perhaps you are bordering on hyper and I would look into lowering that a little first and getting your T3 up, but if that doesn't resolve your symptoms, a more aggressive approach to the adrenal testing may be warranted.

 
Old 04-24-2002, 07:31 PM   #12
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

Hi meep -

I had an ACTH stim test. cortisol baseline was 18 and rose to 28. I also had an insulin tolerance test. My baseline 9 am cortisol was I think 12 and it rose to 22 when my blood sugar dropped below 40. They say that when the cortisol rises above 20 when the blood sugar drops below 40 that is a normal response. Dropping blood sugars that low is dangerous and if the cortisol rises in response to stress from that .... this indicates the pituitary and adrenals are working. I may talk to my doctors about a small dose of cortisone. That is what they replace when you are cortisol deficient or the adrenals are not working great. I am so frustrated. So yes I had two stimulation test. Also I take selenium. I take 60mcgs. I know it is working. It gives me hot flushes when I take it. Any other advice? <p>[This message has been edited by judekate (edited 04-24-2002).]

 
Old 04-24-2002, 10:44 PM   #13
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Meep:
[B]Naturally, the Total level rises as the TBG and albumin bind up more and more hormone. This leaves an already lower Free level to start with, initially, and as the body uses what free hormone is left available the Free levels are depleted.

I would also add that in many people, excessive soy consumption causes an increase in TBG as well.[B]<HR></BLOCKQUOTE>

By the book, "..the increase in TBG that results from the high estrogen levels elevate the total serum T4 but not the free serum T4.." However, this might be true for the people with normal thyroid function. In people with hypothyroidism, I think, you may be right, elevated TBG could cause decrease in free T4. I haven't heard about excessive soy consumption and TBG. Pregnancy can also elevate TGB.

 
Old 04-24-2002, 10:45 PM   #14
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Meep:
[B]Naturally, the Total level rises as the TBG and albumin bind up more and more hormone. This leaves an already lower Free level to start with, initially, and as the body uses what free hormone is left available the Free levels are depleted.

I would also add that in many people, excessive soy consumption causes an increase in TBG as well.[B]<HR></BLOCKQUOTE>

By the book, "..the increase in TBG that results from the high estrogen levels elevate the total serum T4 but not the free serum T4.." However, this might be true for the people with normal thyroid function. In people with hypothyroidism, I think, you may be right, elevated TBG could cause decrease in free T4. I haven't heard about excessive soy consumption and TBG. Pregnancy can also elevate TGB.

 
Old 04-25-2002, 01:05 PM   #15
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Re: Anyone, including treefrog, artfuld...Thyroid levels six weeks

By the book, "..the increase in TBG that results from the high estrogen levels elevate the total serum T4 but not the free serum T4..."

Thanks, that's interesting. It is not that patern I would have expected, but it is definitely more complicated than just a few hormones would suggest. Do you have a source I could explore for more information?

Have you looked at <A HREF="http://www.thyroidmanager.org" TARGET=_blank>www.thyroidmanager.org</A> ? It is a fascinatingly detailed, up to date and well-cited thyroid text book. You might find it a good addition to your current sources.

 
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