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Old 07-23-2011, 09:42 PM   #1
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Please help me interpret these results

I finished treatment over a year ago for breast cancer. I'm currently on Tamoxifen. Something has played havoc with my metabolism. I was overweight at the time of diagnosis. Then I lost weight during chemotherapy, but the weight started to pile on as soon as I finished. I attributed this to regaining my appetite along with going through radiation which left me physically drained. Yet I was still eating and not getting enough exercise. Once radiation was finished I started Tamoxifen, which has weight gain as a known side effect. I gained 25 pounds in the last year, moving into obese territory in January and still the pounds pile on.

On a follow-up visit to my oncologist last month, she included thyroid function in the bloodwork. My TSH level was 5.29. It was 2.40 a year ago. She advised me to have it checked out by my GP. My T3 and T4 levels were within the normal range.

So GP tested again. This was just two weeks later. TSH 6.76. It was a different lab so that may explain the difference. She suggested that I start on a 50mg dose of levothyroxine, but said I could see an endocrinologist first if I wanted.

Saw endo last week. She repeated the tests and included testing for antibodies. TSH 6.62, FT3 2.64, FT4 0.9, TG Ab 734.5, TPO Ab 170. I haven't spoken to endo since results come back, but guessing this would confirm Hashimoto's. Should I be alarmed at such high antibody numbers. I had a really bad upper respiratory tract infection when the last two tests were done. Might that have affected the results?

 
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Old 07-23-2011, 10:21 PM   #2
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Re: Please help me interpret these results

Welcome to the board.

The RT infection likely made no difference in your results.

TSH consistently above 5, anti-thyroid antibodies, and low T4/T3 [even though within range, they're too low for the average healthy person] mean that your thyroid is failing due to Hashimoto's thyroiditis. You don't actually need to see an endo; you're probably better off without seeing one, to be honest. They're the pits at treating thyroid disease. Take that levoT script and run with it. You probably don't yet realize how lucky you were to get an easy diagnosis.

No need to be alarmed at the antibody titers. Not much you can do about them anyway, and the treatment for the resulting hypothyroidism will be the same whether it's caused by antibodies or anything else.

Keep reading this board to learn everything you can about optimal treatment. Our "Thyroid Information" thread is full of such info, and Thyroid for Dummies is a
good primer for the newly diagnosed.

It shouldn't be left up to the MD to decide how much levoT to dole out at his whimsy; it should be all about finding your optimal dose that will restore your well-being. You will need to acquire the tools to help you determine how to get what you need from treatment, because there is no guarantee that you will get it on the first try. HypoT is often not a simple disorder to treat, but MDs are taught that it's always a piece of cake. Not necessarily, so you need to know that going in.

Congratulations on making it through the cancer treatment. Continued good luck with beating that. Hope you'll be feeling better soon.

 
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Old 07-23-2011, 10:35 PM   #3
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Re: Please help me interpret these results

Thanks Midwest. I did see the endo already but haven't spoken to her yet re results of test. I just accessed them online today. She did a physical exam of my thyroid and took a medical history including asking me about autoimmune disease in my family. My mother has rheumatoid arthritis and I was diagnosed with transverse myelitis three years ago.

I only found this forum tonight and will definitely try to educate myself further. I'm interesting in learning if there are lifestyle changes that will help along with the levoT.

I asked endo if I was taking the levoT, should I ease into it gradually and she implied it wouldn't make any difference.

Another concern I have is the cost of medication. I do have health insurance but without Rx coverage. Tamoxifen is the only med I'm currently taking and it's inexpensive. My insurance renews on 1 August and I think I still have the option to add Rx coverage which would be an additional $50/mo. Wondering if I need to do that to cover the levoT.

 
Old 07-24-2011, 10:04 AM   #4
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Re: Please help me interpret these results

Yes... The most common cause of hypothyroidism is autoimmune, so having a family history of those type of diseases is common. Having one AI disease also puts you at risk of another. I myself have AI hypoT and an AI blood disorder.

Generic levoT is cheap. It's usually included on the chain pharmacies' $4-10 a month list. (I don't know what those "bargain" formularies are called, but most stores have them.) The thing is... If you choose to go with a generic, make sure that you get the same manufacturer's generic each time you refill. There are differences between the way each one is absorbed within each individual body, and you don't want that kind of variability.

Synthroid is the most expensive brand name on the market. It's hard to say what the cash price would be in every part of the country. When I was prescribed it in 2003, a lower dose of 50-75 mcgs was around $35-40 a month, if I remember right. My insurer paid all but the deductible - perhaps $15 - I just don't remember. It's moot anyway. Insurances and prices vary so widely. Since it is considered a maintenance medicine, most insurers will give you a 90-day option that will save money.

Less expensive brand names are Levoxyl and Unithroid. (I think one named Levothroid has been discontinued.) If money is a big issue, it would be better to go with one of these than Synthroid. And one of these would probably be better than a no-name generic, for quality purposes.

Shop prices at local stores before signing up for the prescription coverage. You should be able to get some kind of levo for less than $50 a month.

 
Old 07-24-2011, 04:39 PM   #5
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Re: Please help me interpret these results

Thanks Midwest. I see Costco has Levoxyl at a lower price than Synthroid and a generic lower again.

Is there such a thing as a blend of T3 and T4? How commonly do people take both instead of T4 on its own?

Have you any suggestions on questions for the endo? who will probably call me tomorrow to follow-up on the blood test.

 
Old 07-24-2011, 09:57 PM   #6
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Re: Please help me interpret these results

There is such a thing as T4/T3 combinations. There used to be a synthetic version called Thyrolar, but I'm pretty certain it has been discontinued. There are several choices of natural combinations made from porcine thyroid glands. This is the type of med I take myself, and I do well with it. The naturals are often the most cost effective of the thyroid meds. I pay about $36 for a 100 day supply (cash price because it isn't in my insurer's formulary).

There is also a synthetic form of T3 only called Cytomel, generally prescribed in combination with a synthetic T4. This technique, from what I've seen discussed on this board, can be an expensive proposition, because Cytomel isn't inexpensive and there's the added cost of a second script for the T4. But when that's the best treatment that works for a patient, the cost should really be an afterthought. Can't put a price on feeling well, after all.

Only a minority of doctors will prescribe any med that contains T3. It's even rarer for an endo to prescribe it. Most have been trained that T3 meds are never needed, which can't be further from the truth, but the myth persists. If you are a person who ultimately needs T3 to feel your best, it will be well worth the effort to locate an MD willing and skilled in prescribing it.

There's a great list of questions to ask of a new doctor that can be found in our "Thyroid Information" sticky thread. Here's the URL to it that you'll have to copy and paste into your browser window:
http://www.healthboards.com/boards/showthread.php?t=106126
Scroll to post #19, written by Meep and titled "Questions to ask a potential doctor". Great advice is found there.

I hope you'll let us know how the discussion goes. Wishing you the best of luck!

Last edited by midwest1; 07-24-2011 at 09:59 PM.

 
Old 08-04-2011, 08:54 AM   #7
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Re: Please help me interpret these results

I'm late in updating this.

When I didn't hear from the endocrinologist, I called and asked her to call me. She called me back and said "your results look OK." I asked if I should be concerned about the high antibody levels and she said she often sees much higher. So what should I do? Her answer was along the lines of whatever you think yourself. You can take levothyroxine now or you can wait and see what happens. It was not a very satisfactory conversation and I was no wiser than before I went to see her.

I asked her if I did start to take the levo-t, what levels she would like to see. She said I could follow up with my GP in about six weeks. She obviously sees thyroid issues (or someone at my stage) as something that should be dealt with by the GP.

She did mail me an Rx for 50 mcg levothyroxine. I haven't filled it yet. I've spoken to a friend who was diagnosed with Hashimoto's a couple of years ago. She was torn between going the conventional route (taking levothyroxine) or using alternative/complementary treatment. She went with the latter and has been very successful.

Does anyone here use a complementary approach to hypothryroidism?

 
Old 08-04-2011, 02:08 PM   #8
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Re: Please help me interpret these results

After 3 clueless endos, I gave up hope that any endo stood a chance of medicating me properly. I think the endo did you a favor by referring you back to your GP.

"Whole body" doctors seem to "get thyroid" much better.

I am not familiar with alternative/complementary treatment for hypothyroidism.

Levothyroxine is, after all, a thyroid hormone replacement. Maybe your friend took Armour which is a natural replacement med since it's made from porcine thyroid?
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