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    Old 04-03-2004, 06:40 AM   #1
    dbo
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    Can you give me input?

    I have been reading for a few days and decided maybe if I posted I might get a little insight to my questions. The more I have read the more questions I have. Here is a shortened history. Will be glad to expand on anything if need be.

    Sept. 2003, visited my PCP with symptoms of fatigue, insomnia, hot flashes, palpitations, shortness of breath among others that I hadn’t thought anything about until recently. He ordered a complete lab workup with results as following (I will list only those that were H or L and Thyroid):

    Glucose 161 (65-109)
    Potassium 3.0 (3.5-5.5)
    Chloride 94 (96-109)
    AST 45 (0-40)
    ALT 59 (0-40)
    Triglycerides 186 (0-149)
    TSH .484 (.350-5.5)
    Thyroxine (T4) 9.5 (4.5-12.0)
    T3 Uptake 26 (24-39)
    Free Thyroxine Index 2.4 (1.2-4.9)
    Monocytes 3 (4-13)
    A1c 7.0 (4.5-5.7)

    Together we decided to see what exercise and diet would do to blood sugar and recheck in 3 months. Recheck liver in 1 month. Started me on potassium one time day. Blood pressure was also elevated considering it had been controlled for years on meds.

    I knew that loosing weight would help my blood sugar, so after returning home I committed that I would walk 3-5 days a week for at least 30 minutes and would really watch what I ate. Started reading the connection between liver and diabetes.

    The above symptoms kept getting worse. I couldn’t walk 5 minutes and my heart was racing, shortness of breath, chest pains. I was nauseated all the time, if I ate, if I didn’t eat. I had no strength in my arms or legs. But I plugged along.

    One-month liver and potassium recheck:
    AST 35 (0-40)
    ALT 60 (0-40)
    Potassium 3.3 (3.5-5.5)

    Two weeks later Hepatitis panels run:
    All came back negative.
    AST 43 (0-40)
    ALT 63 (0-40)

    After much research I discovered that diet and exercise were the best thing for elevated liver enzymes. Mine were elevated but not to the extreme as many I had read about.

    Three month check: Symptoms were not getting any better, but blood work was looking better.

    AST 34 (0-40)
    ALT 51 (0-40)
    A1c 6.8 (4.5-5.7)
    Potassium 3.4 (3.5-5.5)

    Continued doing what I was and increase potassium to twice a day. Recheck in three months.

    A few weeks before my 3 months, I called PCP with palpitations, shortness of breath, hurting in back & chest and left arm. Went right in and off to CCU for 24 hr. observation.

    Heart enzymes looked good, some irregular heartbeats, was dismissed to go for stress test later that day. After symptoms worsened during test. I was referred to cardiologist.

    He was concerned about the intolerance to exercise (shortness of breath, rapid heart beat), but otherwise a very healthy heart.

    One of his first questions was “Have they checked your thyroid and done a liver ultra sound”? He added Atenolol to control the palpitations.

    After starting this I have been able to increase my walking and we have been eating very healthy. I have lost a total of 12 lbs since just before the holidays.

    I called my PCP, went in for follow up to cardiologist. Still having symptoms, but the palpitations and shortness of breath are better on the new med.

    Lab results: Again only H & L and Thyroid listed
    Glucose 162 (65-99)
    Potassium 3.3 (3.5-5.5)
    Chloride 95 (96-109)
    AST 47 (0-40)
    ALT 79 (0-40)
    TSH .305 (.350-5.5)
    Thyroxine (T4) 9.8 (4.5-12.0)
    T3 Uptake 29 (24-39)
    Free Thyroxine Index 2.8 (1.2-4.9)

    PCP called with:
    1. Continue walking and diet for blood sugar recheck 3 months
    2. Increase potassium to three times a day recheck 3 months
    3. Consider seeing GI for elevated liver enzymes or recheck in 1 month since they are not very high
    4. Slight hyperthyroid, recheck 1-2 weeks


    Presently I am on Lotrel for BP, Vivelle for hormones, Potassium, Maxzide, Prilosec, & Atenolol

    After reading here and other places, I am wondering if my thyroid could have been causing most of my symptoms all along. Any input and questions I should be asking my PCP is very much appreciated.

    Last edited by dbo; 04-15-2004 at 01:01 PM.

     
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    Old 04-03-2004, 06:14 PM   #2
    K9Mom
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    Re: Can you give me input?

    The best tests for evaluating thyroid function are:

    Free T4
    Free T3
    TSH

    Hyperthyroidism can cause elevated liver enzymes along the same lines as yours are elevated.

    Your TSH is ever so slightly out of range...but your actual thyroid hormone levels are still in range....that is why *I* would want the "Free T4" and "Free T3" tests done. These are the best indicators of what your thyroid is doing.

    You might want to request thyroid antibody testing as well (Thyroid Perioxidase (TPO) and Thyroid Stimulating Immunoglobulin (TSI)).

    Your glucose levels are pretty bad....have you been able to get those under better control? Have they given you a blood glucose monitor for home? Diet and exercise plans?
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    Dx Graves 4/99, tx w/Tapazole & Atenolol - Remission 7/03; Relapse 1/06, back on Tapazole, remission & off meds again 11/06.

     
    Old 04-03-2004, 08:29 PM   #3
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    Re: Can you give me input?

    Hi,
    I agree you really need the free tests and thyroid antibody testing. Your high blood sugar can be reflective of the fact that your thyroid is out of whack, and it may not get into better range until you get your thyroid under control.

    The thyroid controls the rate of function of EVERY cell and gland in the body, so yes, all those symptoms could very well be caused by your thyroid.

    Please get the free tests done, they are the actual thyroid hormones your body has available for use, the TSH a lot of times is a very poor indicator of actual thyroid function. The free thyroxine index and the T3 uptake do not really tell how your thyroid is functioning, I don't know why drs don't do the free tests to begin with.

    Keep us posted on what you find out.

     
    Old 04-03-2004, 10:43 PM   #4
    ldolson
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    Re: Can you give me input?

    Have they tested the calcium in your blood to see if maybe you have overactive parathyroid glands? I have blamed many of my symptoms on my thyroid and just this past week was in for an ultrasound to find a "calcification" in my thyroid that didn't actually exist. Instead, the doctor found very enlarged parathyroid glands and after doing some research on these critters, I have come to realize that some of my issues can be blamed on them. Fatigue, insomnia, weakness, high blood pressure, mental confusion, irritability, bone pain.... all because the parathyroid sucks all of the calcium out of your system. Just a thought... maybe something to look into.

    Good luck!!
    Denice

     
    Old 04-05-2004, 08:11 AM   #5
    dbo
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    Re: Can you give me input?

    Thank you K9Mom, dea4 & Denice. I am scheduled for recheck next week and will most certainly request the Free T4, Free T3 & Antibody, also asking about the calcium in the blood. Since the TSH is slightly out of range and the actual thyroid hormone levels are in range, is this a good sign that I might not actually be having thyroid problems?

    As for the glucose levels, I am monitoring these at home, and with increased excercise and diet, my A1c is looking better and my PCP feels some of this increase in levels is due to something else, just have not figured it out yet.

    I almost hate to admit this, but I was almost excited when we thought my thyroid might be causing some of my symptoms. Atleast then I can treat it and hopefully the liver enzymes and glucose levels, along with some of the other symptoms would return to normal.

    Again thank you for your time.

     
    Old 04-15-2004, 12:57 PM   #6
    dbo
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    Re: Can you give me input? UPDATE

    As suggested here I asked for FT3, FT4 and Thyroid Antibody. Here is what I got and the results:

    Test/Result/Limits
    Thyroxine (T4) Free, Direct, S
    T4, Free (Direct) 0.83 0.61 - 1.76
    TSH 0.627 0.350 - 5.500
    Triiodothyronine, Free, Serum 3.0 2.3 - 4.2

    Per the nurse, dr said thyroid is normal. If I continue to have problems I can come in to see him!!!

    Opinions and advice are more than welcome.

     
    Old 04-15-2004, 01:33 PM   #7
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    Re: Can you give me input? UPDATE

    Quote:
    Originally Posted by dbo
    As suggested here I asked for FT3, FT4 and Thyroid Antibody. Here is what I got and the results:

    Test/Result/Limits
    Thyroxine (T4) Free, Direct, S
    T4, Free (Direct) 0.83 0.61 - 1.76
    TSH 0.627 0.350 - 5.500
    Triiodothyronine, Free, Serum 3.0 2.3 - 4.2

    Per the nurse, dr said thyroid is normal. If I continue to have problems I can come in to see him!!!

    Opinions and advice are more than welcome.
    Normal? Maybe in "normal range", but that doesn't mean its normal for you.
    Your FT4 is too low, mid range is 1.185, you are at 0.83, your FT3 is at 3.0, mid range is 3.25, so you are low on both of those, you should be mid to upper in the range.

    This dr is not helping you any.

     
    Old 04-15-2004, 03:58 PM   #8
    dbo
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    Re: Can you give me input?

    dea4, thank you for you input. Since I am not getting anywhere with my PCP on this, would you recommend seeing an endo or is it too early for this? OR should I find another PCP within our network at this stage?

    dea4, I really appreciate you taking the time to help me.

     
    Old 04-15-2004, 04:21 PM   #9
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    Re: Can you give me input?

    Its never to early to see an endo, however, it depends on the dr, some endo's are very good, some PCP's are good, it depends on how much they really know about thyroid and the treatment. On average a reg dr has about 30 minutes training on thyroid disorders, most do not know how to read the test results, I think your dr falls in this category. Some however do more extensive training so they know more.
    So, if I were you I would call drs (endo's and PCP's) and ask questions, ask if they check Free T3 and Free T4 or just go by TSH, ask if they treat by symptoms or just by lab work and also what meds they prescribe for thyroid. The dr with the right answers is the one you want to see, that would be the one that checks the Free numbers, treats by symptoms and not lab sheet and it would be great if they will precribe the natural meds, if they say Synthroid only, pass them by.

    Hope this helps you, I hope you can find a good dr soon.

     
    Old 04-15-2004, 09:31 PM   #10
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    Re: Can you give me input?

    Just popping in to say I agree you should find another doctor. Dea4's suggestions about how to go about that are excellent.
    Wishing you the best!

     
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