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Old 01-25-2012, 01:56 PM   #1
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Question What is Reflex T4 on labs?

I am going back to see my endocrinologist six weeks after total thyroidectomy and having my first labs since then. Endo is testing me for TSH with reflex T4. Can someone please explain "reflex T4"?

For some background, my endo has previously run my "frees" at different points in my treatment, and I believe he is waiting to see the outcome of this test, my first since removing my thyroid, and then decide if I need more extensive labs. I actually feel GOOD, I'm happy to say. If I felt bad, I think I'd be telling my endo I want a full panel run. But at this point, I'll go with the plain vanilla TSH testing to get a baseline, but not really sure what the Reflex T4 is...thanks for reading.
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Old 01-25-2012, 04:37 PM   #2
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Re: What is Reflex T4 on labs?

Here's the answer I wrote on your previous thread --
( [url]http://www.healthboards.com/boards/thyroid-disorders/886960-can-someone-explain-reverse-t4.html[/url] )

"TSH with reflex to FT4" means that the lab will test only your TSH. If it comes back out of range, only then will the FT4 be measured. This is NOT the best way to monitor thyroid levels.
[Additionally...] This is bad approach for someone with Graves' disease, because your TSI antibodies can quash TSH and make it especially inaccurate. Even if you're feeling great, I would demand at least a FT4 measurement in order to know what level makes you feel great.

Last edited by midwest1; 01-25-2012 at 04:38 PM.

 
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Old 01-25-2012, 06:52 PM   #3
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Re: What is Reflex T4 on labs?

Quote:
Originally Posted by midwest1 View Post
Here's the answer I wrote on your previous thread --
( [url]http://www.healthboards.com/boards/thyroid-disorders/886960-can-someone-explain-reverse-t4.html[/url] )

"TSH with reflex to FT4" means that the lab will test only your TSH. If it comes back out of range, only then will the FT4 be measured. This is NOT the best way to monitor thyroid levels.
[Additionally...] This is bad approach for someone with Graves' disease, because your TSI antibodies can quash TSH and make it especially inaccurate. Even if you're feeling great, I would demand at least a FT4 measurement in order to know what level makes you feel great.
Ok, I have a hard time understanding all this, please help me to understand: first, if my thyroid has been removed, am I still considered to have Graves? And if so, what is gained by thyroid removal? And, how do TSI antibodies come in to play when you're without a thyroid compared to when you HAVE a thyroid? Thanks for helping me understand this
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Old 01-25-2012, 10:52 PM   #4
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Re: What is Reflex T4 on labs?

Yes, you still have Graves', which is an autoimmune disease that causes hyperthyroidism. Hyperthroidism is a condition involving excessive thyroid hormone levels. They can be thought of as two different conditions that don't necessarily always co-exist. Today you have Graves', but you are (symptomatically, at least) no longer hyperthyroid.

I'm unsure how long TSI Abs are present following surgery. Sammy has personally dealt with Graves'. Maybe she'll see this and offer more help than I can.

 
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Old 01-26-2012, 03:17 AM   #5
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Re: What is Reflex T4 on labs?

I can only second what Midwest said. As such you still have Graves, hyperthyroid is a result of that. Since you no longer have your thyroid, you're TSI can no longer stimulate the thyroid which caused the hyperT. Yet now it's a matter of supplementing your thyroid properly (very well possible the dosage you are taking is the correct one, only time will tell)
TSI antibodies can falsely suppress TSH (for months), so your TSH is not a good indication of where you are. Your TSH might still be suppressed, while your FT4 levels (which is the actual level and the one you feel) might start dropping. Since you're feelign good, at this point it might exactly be where it should be, all the more reason why you want to know the level that is making you feel good.

Glad you're recovery is going well. Keep taking care of yourself.

Last edited by lisa789; 01-26-2012 at 03:18 AM.

 
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Old 01-26-2012, 05:11 AM   #6
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Re: What is Reflex T4 on labs?

Quote:
Originally Posted by lisa789 View Post
I can only second what Midwest said. As such you still have Graves, hyperthyroid is a result of that. Since you no longer have your thyroid, you're TSI can no longer stimulate the thyroid which caused the hyperT. Yet now it's a matter of supplementing your thyroid properly (very well possible the dosage you are taking is the correct one, only time will tell)
TSI antibodies can falsely suppress TSH (for months), so your TSH is not a good indication of where you are. Your TSH might still be suppressed, while your FT4 levels (which is the actual level and the one you feel) might start dropping. Since you're feelign good, at this point it might exactly be where it should be, all the more reason why you want to know the level that is making you feel good.

Glad you're recovery is going well. Keep taking care of yourself.
Thank you Midwest & Lisa. I will give my endo a call and see if he will send me a script for FT4 at this point--do I need FT3 as well at this point? Not sure how much resistance I might get for asking for more labs then originally written....
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Old 01-26-2012, 05:14 AM   #7
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Re: What is Reflex T4 on labs?

if you can have the FT3 that would be great and sure useful, but you should at least have the FT4 done.

 
Old 01-26-2012, 06:02 AM   #8
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Re: What is Reflex T4 on labs?

Quote:
Originally Posted by Chihuahuacat View Post
do I need FT3 as well at this point? Not sure how much resistance I might get for asking for more labs then originally written....
I most definitely think you should get a FreeT3 test done as well.

You say you are feeling good - it's VERY important for your future well-being to know what your FreeT4*and* FreeT3 levels are at this point.

This way, if you develop issues in the future, you will have a goal re optimal levels. Optimal levels are quite individual-specific and, if they are maintained, the patient will be free from thyroid symptoms.

And, I can only agree with what's been said thus far. The fact that you had your thyroid removed does not mean you no longer have Graves'. You've "just" removed the object of the antibody attack.

Your antibody levels should lower over time but, as long as you still have them, those antibodies will falsely lower TSH.

That is why it is crucial to monitor your actual thyroid hormone levels (FreeT4 and FreeT3).

Not only do we need adequate stores of T4 (measured by the FreeT4 level) but, we need to make sure that our bodies are converting that T4 into T3, the active hormone.

This most especially applies for people taking T4 meds such as Synthroid.

Since 20% of conversion happens in the thyroid, a person without a thyroid needs to make sure the other parts of the body are compensating for this....this would be confirmed with a FreeT3 level.

If conversion isn't adequate, the patient will have hypo symptoms. Labs could show a "good" FreeT4 level but, a lagging FreeT3 level. This can be remedied by the addition of a T3 med such as Cytomel.

You shouldn't be getting resistance when asking for tests that have been deemed necessary by the US National Institute of Health.

Even "Thyroid for Dummies" (written by an endo) indicates how important FreeT4 and FreeT3 testing is.

If you do get resistance, you just might want to seek care from another doctor.....your well-being is highly dependent on a doctor that knows how to medicate properly and running the right tests is the first step.

Please keep us posted.
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Old 01-26-2012, 09:32 AM   #9
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Re: What is Reflex T4 on labs?

Quote:
Originally Posted by sammy64 View Post
>>I most definitely think you should get a FreeT3 test done as well.

You say you are feeling good - it's VERY important for your future well-being to know what your FreeT4*and* FreeT3 levels are at this point.

This way, if you develop issues in the future, you will have a goal re optimal levels. Optimal levels are quite individual-specific and, if they are maintained, the patient will be free from thyroid symptoms.<<
Sammy, excellent easy to understand advice. I have even read Thyroid for Dummies, but got it as library book--need my own copy because I've obviously forgotten what it said... I put a call into the doc today and requested a script for FT3 & FT4. They have not been uncooperative in the past, I hope to see a script shortly. Thank you for your help, and to everyone who chimed in here with Graves/TT/antibodies knowledge--it was VERY helpful!
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Old 02-02-2012, 07:48 AM   #10
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Re: What is Reflex T4 on labs?

Update: I called my endo's office last week, spoke with one of the gals there, and explained I would like a script for FT4 and FT3. As it turns out, I received my script yesterday and,yes, the FT4 is on there, as well as Total T3 (not free) and TSH. Sigh. Not sure why he didn't write up FT3, if maybe the gal didn't understand what I wanted, or what, but I will talk to my endo when I see him next week. As it stands now, I am getting my FT4 lab done and I'm happy about that. And, since I feel pretty well, I'm not overly anxious about my FT3s (thought I would have liked a baseline...) Anyway, just wanted to update all you kind people.
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