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Old 07-26-2012, 04:29 AM   #1
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New lab results help please with Free T4 numbers!!!

It was suggested I add my symptoms.

Before anti thyroid meds:

goiter
hair loss
IBS symptoms
anxiety
palpitations
ache muscles and joints
forgetfulness
weight gain a few years ago (wasn't sure why)
last pregnancy I only gained 9 lbs.
Dizzy spells
feeling cold
lower heart rate
irritable
I go back and forth between feeling hyper like I can't sit still to being exhausted.
I've dealt with minor depression issues


Since taking anti thyroid meds:

Nothing has changed much except that I feel warm and am warm to the touch. I gained 4 lbs in 2 weeks!!! I don't need to gain that is for sure!!
I may have experienced improvements from the above list but not enough for me to say I feel better. I've only been on the meds for roughly 2 weeks.

My first set of blood tests was taken on July 10th. They were:

FT4 0.6 (0.6-1.5)
FT3 3.8 (1.5-3.5)
TSH 0.058 (0.400-4.400)

I went back for a follow up on July 24th and my labs are as follows:

FT4 0.5 (0.6-1.5)
FT3 2.7 (1.5-3.5)
TSH 3.677 (0.400-4.200)

Why is my FT4 getting lower?

I'm currently taking 10 mg of methimazole twice a day. He also prescribed 25 mg of Atenolol which I stopped taking because it makes me very sleepy and groggy! I don't go back to the doctor until the beginning of September but he may adjust my meds due to the latest blood results. I should know today. My main question is how is the FT4 so low???

Last edited by Missy1227; 07-26-2012 at 12:08 PM.

 
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Old 07-26-2012, 05:19 AM   #2
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Re: New lab results help please with Free T4 numbers!!!

Your FT4 is so low because you were taking methimazole and didn't need it.

As I mentioned when you first started it, anti-thyroid drugs such as methimazole are only supposed to be taken if the FT4 level is above-range.

When people have labs such as you did (in-range FT4 level and over-range FT3 level), a thyroid-savvy doctor will Rx a beta-blocker only (such as Atenolol).

In fact, instead of methimazole, your doctor should have prescribed some T4 thyroid hormone replacement such as Synthroid since your FT4 level was at the bottom end of the range. (most healthy people have FT4 levels near the high end of the range)

The fact that your TSH is near the high end of the range (and much higher than the 1.0-1.5 level a healthy person would have) tells us that your pituitary is screaming at your thyroid, trying to get it to produce more hormone that is needed by every cell in the body for proper function.

Your doctor clearly doesn't know what he/she is doing - sorry.
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Old 07-26-2012, 05:38 AM   #3
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Re: New lab results help please with Free T4 numbers!!!

This is all so frustrating! I'm anxious now to see what he comes back with for me to do. He said he waivered back and forth on weather he should give me meds. I don't understand why so many doctors don't know what they are doing??? Should I have sucked it up and taken the beta blocker. I felt horrible!! . I didn't understand from your previous post thT he shouldn't have prescribed the methimazole. From my understanding the beta blockers help with symptoms but not the actual hormone. Am I wrong? I wonder if any of my numbers suggest a pituitary problem or maybe I have a doctor who doesn't know what he is doing.

 
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Old 07-26-2012, 05:50 AM   #4
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Re: New lab results help please with Free T4 numbers!!!

I just got a call from the doctor and he is decreasing the methimazole from 10 mg twice daily to once daily? What do I do? I'm not sure if I should see someone different or what. I don't go back until early September.

 
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Old 07-26-2012, 06:22 AM   #5
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Re: New lab results help please with Free T4 numbers!!!

Unfortunately, many doctors look at pituitary hormone TSH to judge thyroid status.

Your doctor saw your earlier level and declared you hyper.

Yes, your elevated FreeT3 level was probably to blame for your symptoms but, as I mentioned already, methimazole acts to lower the thyroid hormone levels - both of them.

Your FreeT4 level was already insanely low. The only way to lower a too-high FreeT3 level is to take a beta-blocker.

Not only does the beta-blocker help with symptoms, it actually interferes with thyroid hormone metabolism so can effectively lower a too-high FreeT3 level.

The other threads on here illustrate just how clueless many doctors can be with thyroid care.

Your numbers do not indicate a pituitary problem. TSH is a pituitary hormone. The fact that it was so low when your FreeT3 thyroid hormone level was over-range shows that your pituitary gland was slowing down its production of thyroid stimulating hormone in its attempts to get that FreeT3 level lower.

Now that your TSH is higher, your pituitary gland obviously recognizes that your FreeT4/T3 levels are too low for your body's needs.

You need to find another doctor pronto.

Maybe your GP can help.

These are the suggestions I have to offer re finding a thyroid-savvy doctor:

1. networking
2. check the Top Thyroid Doctors site for a listing in your area
3. ask local pharmacists (not the counter help) for names of doctors that prescribe either Armour or Cytomel. Doctors that Rx either of these tend to be more thyroid-savvy
4. contact the Broda Barnes Foundation and pay ~$18 to get an information packet that includes a list of doctors in your state who follow Dr. Barnes' ideology (Dr. Barnes was the author of "Hypothyroidism - An Unsuspected Illness" and was lightyears ahead of his time)
5. find a doctor that prescribes bioidentical hormones either by checking websites or contacting compounding pharmacies (they are likely to have names of doctors that prescribe Armour which usually means they're more thyroid-savvy)

Idea #1 worked for me....the other ideas have worked for others. I hope one works for you.
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Old 07-26-2012, 06:33 AM   #6
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Re: New lab results help please with Free T4 numbers!!!

I have a suggestion on what to discuss with your doctor.....it's called Block and Replace Therapy.

Basically the patient takes an anti-thyroid drug such as methimazole which, as you've already experienced, lowers both the FT4 and FT3 thyroid hormone levels.

In addition to the ATD, the patient will take some T4 thyroid hormone replacement (common one is Synthroid) to prevent hypothyroidism (too-low FT4 levels).

BRT will help keep an "errant" FT3 level in line but, keep the FT4 level at a more appropriate place within the range.

If he doesn't agree to this, I'm back to my earlier advice about finding another doctor.
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Old 07-26-2012, 06:36 AM   #7
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Re: New lab results help please with Free T4 numbers!!!

This isn't my thread, but I just wanted to say... Sammy, you're awesome. This thread has been incredibly informative in just a few posts.

 
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Old 07-26-2012, 06:43 AM   #8
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Re: New lab results help please with Free T4 numbers!!!

Thank you. I'll see what happens!

 
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Old 07-26-2012, 11:30 AM   #9
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Re: New lab results help please with Free T4 numbers!!!

You know, Missy

If you are comfortable doing so, it might not be a bad idea to share the symptoms you were dealing with before starting methimazole.

And, it might not be a bad idea to share any new symptoms that developed since you've been taking it.

Thyroid treatment should be based upon symptoms with labs to back up the decision.

The types of symptoms you had *should* have guided your doctor more appropriately but, it seems he was confused by your labs.
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Old 07-27-2012, 05:54 AM   #10
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Re: New lab results help please with Free T4 numbers!!!

Quote:
Originally Posted by sammy64 View Post
I have a suggestion on what to discuss with your doctor.....it's called Block and Replace Therapy.

Basically the patient takes an anti-thyroid drug such as methimazole which, as you've already experienced, lowers both the FT4 and FT3 thyroid hormone levels.

In addition to the ATD, the patient will take some T4 thyroid hormone replacement (common one is Synthroid) to prevent hypothyroidism (too-low FT4 levels).

BRT will help keep an "errant" FT3 level in line but, keep the FT4 level at a more appropriate place within the range.

If he doesn't agree to this, I'm back to my earlier advice about finding another doctor.
I wrote my doctor yesterday and this is the reply I got back:


Hi Mrs. ******** There are several different types of hyperthyroidism. The most common one is graves disease which would be to block t4 and hence one would find an elevated t4. . Unfortunately you have a much less common type of hyperthyroidism called t3 toxicosis. In this situation the t4 is low and the free t3 Is elevated. Your labs are where I expected them to be. Your most recent t3 was normal because of the methimazole. Although we still get a t4 in t3 toxicosis the t 3 is better indicator of the stability of your overall overactivity. The atenolol is generally used as a adjunct to help with symptoms. Unfortunately one of the most common adverse effects of the atenolol is fatigue. At this point I do not believe the atenolol will offer much more benefit than the methimazole alone will.I do not recommend restarting the atenolol. It is important to stop medications which have undesired effects. My reasoning for giving you the atenolol first was to attempt to block overactive symptoms.while awaiting the original thyroid blood tests (from me) . You have an extremely mild overactivity but unfortunately the symptoms do not always match the laboratory findings. I asked the staff to contact you earlier today to decrease the methimazole to 1 tablet a day. Swings in thyroid function can make people feel badly and the symptoms you are experiencing are expected. I expect that once we are able to achieve thyroid levels at a steady state you will begin to feel normal (better) Please feel free to ask questions at any time as I am always happy to answer them. Hope this helps

Last edited by Missy1227; 07-27-2012 at 05:56 AM.

 
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Old 07-27-2012, 06:06 AM   #11
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Re: New lab results help please with Free T4 numbers!!!

Missy, I'm not sure if you posted this already, but were you prescribed Methimazole as a precursor to thyroidectomy, or as medicine-only treatment plan? My doctor wrote me a script yesterday (which I am not filling) for 5 mg tablets though I'm not sure if it's once or twice a day because I can't read her handwriting. But she had said that it was to prepare me for surgery (which is why I'm not taking it yet).

Either way, please keep us posted. It sounds as if you and I have very similar issues. My lab results except for TSH are all in the normal range or very close, but I don't have symptoms - certainly none that are any sort of problem for me, which is why I'm hesitant to have my whole freaking thyroid out. It also sounds like you are a few steps further down the treatment path than I am, so it's a huge help to me to read about your experience. Maybe we'll each learn something that would be useful to the other. I will keep posting as well. This is a journey that I will be taking for the rest of my life - might as well chronicle it.

 
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Old 07-27-2012, 06:41 AM   #12
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Re: New lab results help please with Free T4 numbers!!!

Princesca- I just lost everything I wrote some how . No my doctor did not prescribe me the methimazole for future surgery. So far no surgery has been mentioned I've had an ultrasound and ct without contrast. He ordered another ultrasound that I'll do in about a month. The reason I'm not sure but the first one I got was done by my physicians office. He said we will eventually biopsy it but he doesn't like to biopsy when the thyroid is hyper because it can give false positives for cancer. It's a waiting game at this point and I'm not a very patient person! Lol. He did however order the ct scan without contrast because he said something about not being able to do RAI for six weeks if he did the contrast.

Good luck with everything and hopefully along the way we'll find some support with one another. I felt very alone until I found this message board. It's not uncommon in our family to have thyroid issues except that my Dad and his sister are both hypo and get bloodwork done once or twice a year and they are good. Of course it had to be me that gets a more complicated thyroid :/. I do however have thyroid antibodies and the hope is that my body is going to eventually kill my thyroid and then it will be much easier to treat

 
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Old 07-27-2012, 06:54 AM   #13
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Re: New lab results help please with Free T4 numbers!!!

Missy

Sorry but, it doesn't seem like your doctor understands how the meds she's prescribing actually work.

Unfortunately, this is all-too-common.

I'm sure you noted from my signature that I started my thyroid disease journey with Graves'. I found my first-ever thyroid forum shortly after my hyperthyroidism was discovered during my annual physical. I've been participating on multiple thyroid forums for the past 5+ years and have researched extensively.

There's a great online course about hyperthyroidism called "Hyperthyroid Disorders". If you read the anti-thyroid drug section of the conventional treatment options chapter, you will see that anti-thyroid drugs such as methimazole should be prescribed so the FreeT4 level is maintained in the upper part of the range, regardless of TSH.....that's not happening with you.

Yes, you could have T3 Thyrotoxicosis which is a form of Graves' and that is treated with either beta-blockers or BRT.

The author of the course is a thyroid expert and she maintains a Q&A Forum on her website. You might find her advice to be helpful.

edited to add....for whatever reason, the course doesn't seem to be accessible right now. The author of the course is the same person who wrote "Graves' Disease - A Practical Guide"....you just might want to read the book.
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Old 07-27-2012, 06:58 AM   #14
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Re: New lab results help please with Free T4 numbers!!!

Quote:
Originally Posted by sammy64 View Post
Missy

Sorry but, it doesn't seem like your doctor understands how the meds she's prescribing actually work.

Unfortunately, this is all-too-common.

I'm sure you noted from my signature that I started my thyroid disease journey with Graves'. I found my first-ever thyroid forum shortly after my hyperthyroidism was discovered during my annual physical. I've been participating on multiple thyroid forums for the past 5+ years and have researched extensively.

There's a great online course about hyperthyroidism called "Hyperthyroid Disorders". If you read the anti-thyroid drug section of the conventional treatment options chapter, you will see that anti-thyroid drugs such as methimazole should be prescribed so the FreeT4 level is maintained in the upper part of the range, regardless of TSH.....that's not happening with you.

Yes, you could have T3 Thyrotoxicosis which is a form of Graves' and that is treated with either beta-blockers or BRT.

The author of the course is a thyroid expert and she maintains a Q&A Forum on her website. You might find her advice to be helpful.

I seen this coming. I was thinking why isn't it important to this doctor to get my ft4 at a better level? Grrrrr. I don't know what to do! It takes forever to get a appointment with any endocrinologists in my area. I wasn't supposed to have even been seen yet as my first appointment was scheduled for Sept.6th. I had been seeing a gastroenologist and when I mentioned to him that I had found out I have an enlarged thyroid he asked who I was referred to and he would get me seen sooner, which he did!

Thank you again Sammy! I'm trying to educate myself

 
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Old 07-27-2012, 07:09 AM   #15
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Re: New lab results help please with Free T4 numbers!!!

"Non-endos" are usually better at diagnosing/treating thyroid disease (sad reality but, true).

I apologize if this is a repeat but, these are the suggestions I have to offer re finding a thyroid-savvy doctor:

1. networking
2. check the Top Thyroid Doctors site for a listing in your area
3. ask local pharmacists (not the counter help) for names of doctors that prescribe either Armour or Cytomel. Doctors that Rx either of these tend to be more thyroid-savvy
4. contact the Broda Barnes Foundation and pay ~$18 to get an information packet that includes a list of doctors in your state who follow Dr. Barnes' ideology (Dr. Barnes was the author of "Hypothyroidism - An Unsuspected Illness" and was lightyears ahead of his time)
5. find a doctor that prescribes bioidentical hormones either by checking websites or contacting compounding pharmacies (they are likely to have names of doctors that prescribe Armour which usually means they're more thyroid-savvy)

Idea #1 worked for me....the other ideas have worked for others. I hope one works for you.
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