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Old 02-22-2012, 06:24 PM   #1
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New Labs: thoughts?

I just got my latest labs, and I'm changing docs because my doc's office is totally unresponsive to my continued extremely disruptive symptoms. While I saw brief improvement, and the intense exhaustion is slightly better some of the time, along with the brain fog (although neither are entirely gone), I don't feel like I can function.

I realize things are still pretty early, since I've been on Synthroid less than 2 months, and I think it would help if I got my T3 tested, which my new doc will do, but I'd love any feedback on my test results. From the little I understand it looks like my levels have improved, but they're still in the borderline "subclinical" range on the TSH. Is there still room to improve the Total T4 and Free T4? If I get too far to the upper range of those numbers am I likely to have more hyper symptoms?

New labs, Feb 10th:
T4 Free: 1.29 reference range: 0.89-1.76
T4 Total: 8.4 reference range: 4.5-12.5
TSH: 3.010 reference range: 0.380-3.790

Previous Labs, Jan 4th:
T4 Free: 1.04 reference range: 0.89-1.76
T4 Total: 7.6 reference range: 4.5-12.5
TSH: 5.660 reference range: 0.380-3.790

 
Old 02-23-2012, 03:20 AM   #2
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Re: New Labs: thoughts?

Quote:
Originally Posted by thefourthmairi View Post
From the little I understand it looks like my levels have improved, but they're still in the borderline "subclinical" range on the TSH. Is there still room to improve the Total T4 and Free T4? If I get too far to the upper range of those numbers am I likely to have more hyper symptoms?
Yes there is room to improve your FT4 (total T4 is inaccrate so I wouldn't look at it that much), your TSH could certainly be lower.

When you're on the right dose you shouldn't have noticeable symptoms, some little easily tolerable things maybe, but being symptom free should be the aim. With small dose adjustments every 6-8 weeks it's easier to find the right dose without overshooting your goal or staying too long on too low a dose.

Last edited by FinnMaid; 02-23-2012 at 03:49 AM.

 
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Old 02-23-2012, 06:27 AM   #3
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Re: New Labs: thoughts?

Thanks FinnMaid, I really appreciate the reassurance. I'm trying to study and learn as much as I can right now. I can tolerate a lot of smaller symptoms, but the energy levels are kind of a deal breaker.

 
Old 02-23-2012, 07:08 AM   #4
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Re: New Labs: thoughts?

Quote:
Originally Posted by thefourthmairi View Post
Is there still room to improve the Total T4 and Free T4? If I get too far to the upper range of those numbers am I likely to have more hyper symptoms?

New labs, Feb 10th:
T4 Free: 1.29 reference range: 0.89-1.76
T4 Total: 8.4 reference range: 4.5-12.5
TSH: 3.010 reference range: 0.380-3.790

Previous Labs, Jan 4th:
T4 Free: 1.04 reference range: 0.89-1.76
T4 Total: 7.6 reference range: 4.5-12.5
TSH: 5.660 reference range: 0.380-3.790
As FinnMaid mentioned, the Total T4 is pretty useless - not only does it measure available hormone (FreeT4) but, hormone that is bound to proteins and not usable by the body.

TSH is a pituitary hormone so, cannot be relied upon to judge thyroid status and definitely not for dosing purposes.

Based upon your lab's ranges, most healthy people would have a FreeT4 level anywhere from 1.4 - 1.6 (or higher).

My lab's ranges are the same as yours and I found that I need my FreeT4 level to be at least 1.7 for me to be symptom-free. I even feel good with it slightly over-range.

I suggest that you aim your FreeT4 level towards the "most commonly comfortable" levels of 1.4 - 1.6.

Then, if you are still dealing with hypo symptoms, it would be appropriate to ask your doctor for a small dose increase (or more).

And, most definitely, you should get a FreeT3 test done....it can only help.
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Old 02-23-2012, 08:20 AM   #5
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Re: New Labs: thoughts?

Thank you Sammy! You're just amazing, especially with how supportive you are for everyone on this board! I feel a lot better about (gently) challenging what I perceive as misinformation from my old doc now. I don't feel like I need a huge increase, but I do feel like something needs to change so I can function. The first thing I asked about when looking for a new doc was those T3 levels! New doc "always" tests T3 levels, and the patient who referred me reference Reverse T3, which makes me think my Free T3 should be tested next...Now to wait 3 more weeks to meet the new doc!

 
Old 02-23-2012, 08:50 AM   #6
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Re: New Labs: thoughts?

Happy to help and, thanks for your kind words.

I forgot to mention something - even though TSH is not a reliable indicator, the fact that yours is > 2 is an indication that your FreeT4 level (and possibly FreeT3 level) is way too low for your body's needs.

People who are optimally medicated on levothyroxine have TSH 1.0 or lower. But, more importantly, they will have FreeT4/T3 levels as I mentioned earlier.

You get better information with a FreeT3 test than a Reverse T3 test. Reverse T3 is a calculation and basically tells you whether or not your FreeT3 level is adequate. Since there is a way to measure the FreeT3 level, there's no need for any other type of T3 testing.

For whatever it's worth, when the patient's FreeT4 level is below mid-range (such as yours), a thyroid-savvy doctor will usually order a 25mcg dose increase. Once the FreeT4 level is above mid-range, 12.5mcg dose increases are more appropriate.

Of course, if the doctor and/or patient want to be conservative, 12.5mcg dose increases are OK....it will just take a little longer to optimize levels.

Best of luck to you with the new doctor - please keep us posted!
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Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 02-23-2012 at 09:17 AM.

 
Old 02-23-2012, 12:45 PM   #7
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Re: New Labs: thoughts?

Sammy, I seriously think there's been at least a couple days where you've kept me from feeling like I'm truly losing my mind, and I'm sure I'm not the only one here who feels that way. You've managed to do a lot of good with some really miserable experiences. Thank you.

Your latest addition leaves me a bit more confident about what I thought I understood (but doubted thanks to lab reference ranges) about the new TSH ranges and subclinical TSH levels. This is very good! Thank you oodles!

 
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