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    Old 03-16-2008, 09:46 AM   #1
    cshaw50
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    Fibromyalgia or Thyroid? Questions

    Hi, I hope this isn't too long for you to read & hope I get some replies, kind of feeling a bit desperate. I'm a 50 y/o female with no signs of menopause yet (darn!).

    Back in 92, 6 months after major surgery, I woke up one day feeling like I had been hit with a truck with the main symptom being brain fog. After many tests I was diagnosed with fibromyalgia. 16 years later, I still feel that way. There are many other issues I have that I won't get into now, but I always had a feeling I had thyroid problems because of family history (mother, aunt, cousin), but my lab results always came back within normal range.

    2 months ago at an ENT appt. a nodule was felt on my thyroid. I had an u/s, thyroid uptake scan & bloodwork done. All of my numbers were in the normal range except for my thyrogobulin, Qn. which is 247. I was diagnosed with multinodular goiter from the scan & u/s.

    I was referred to an endo who put me on 30 mg. of Armour and scheduled an FNA (NOT fun!). I get the results next week.

    I guess my question is - obviously my thyroid isn't normal because of the goiter & nodules, but is it true you can have "within range" blood results and still have a thyroid issue?

    If you've read this much, I sure do appreciate any input any of you may have.

    Last edited by cshaw50; 03-16-2008 at 04:04 PM.

     
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    Old 03-16-2008, 04:00 PM   #2
    midwest1
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    Re: Fibromyalgia or Thyroid? Questions

    Quote:
    Originally Posted by cshaw50 View Post
    ...is it true you can have "within range" blood results and still have a thyroid issue?
    Absolutely! There are two ways to test for low thyroid. Most MDs use only a TSH test for screening, and there is a world of inaccuracy to that test... even though they insist on calling it the gold standard. Ignore them... They're wrong.

    A few really good thyroid docs test the real thyroid hormones, free T4 and free T3. When these are below the middle of their ranges, and/or if thyroid antibodies are present, and there are symptoms, a smart doc knows the patient is probably hypothyroid and will begin treatment.

    With your family history, an autoimmune component is in play. I wouldn't doubt if your labs aren't as "normal" as you've been told.

    Pursue this, not as fibromyalgia, but as untreated hypothyroidism. Good luck!

     
    Old 03-16-2008, 04:48 PM   #3
    mkgb
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    Re: Fibromyalgia or Thyroid? Questions

    YES!

    I was so normal in my TSH it is not funny. But I fought and scratched through 5 MDs until I got treatment. This is even with the knowledge of having Hashimoto's thyroiditis in hand. Most wanted me to wait til my TSH hit X.. well I had every symptom and then some in the book.. and my TSH was 1.6. I was secondary hypothyroid. My pituitary gland was not functioning and calling for my thyroid to increase T4 production. My Fts were in the 5% and 30% range. I could not function at this level. 50 then 75 mcgs of synthroid made all the difference in my health and brain fog and energy and.. I can lose weight again! Do not give up and I am sorry it took a groiter to catch your issue. Now you have that in hand you need some more info to make sure your MDs are on top of things. If not.. well be prepared to doctor shop.

    I have Hashimoto's thyroiditis.. and I bet you do as well. If the FNA does not come back and confirm Hashimoto's by the tissue extracted,, get a TPOAb and TGAb blood test run. If you have it.. any children you have need to know about for their sake and the sake of their children. Hashimoto's is the hypothyroid autoimmune thyroid disorder. It is very common and a nasty bugger to live with. I am 32 and my Hashimoto's was activated with my first pregnancy five years back. It took years to get an MD to listen and test me for the AIs.. then another 7 months of MD shopping to get an MD that listens to me and is willing to treat me.

    Hashimoto's can mascarade as fibro.. many here can tell you that. It causes all the issues.. especially when you drop below 50% of Ft3 and FT4 levels. Get a copy of your lab reports, post them and the ranges here. Normal is not necessarily optimal for you. Just because you are in normal range doesn't mean you are not hypothyroid. We all hate the word "normal" Unless it is in a biopsy report.

    Here are some of those facts, I mentioned.

    Since 2002 the normal TSH range has been .3-3.0 on the A A C E's recommendation. Many Endocrinologists are not up on this.. much less your GPs and FPs. The optimal TSH range is .89-1.1. This is the range of 2000+ males with no thyroid problems in their background that was used to statistically develope the .3 - 3.0 gausian normal curve for TSH.

    Optimal FT3 and Ft4 levels for women of child bearing age is 60-80% of the normal range. This is according to my MFM that I saw a couple of weeks back. Optimal for 85-90% of the population is 50-80% of the normal FT3 and FT4 range. This was determined via many studies of males with no abnormal thyroid histories. Many N A C B recent research studies show if you fall below 25% in the range ypur body doesn't have sufficient thyroid hormone to meet physical needs.

    Most people.. 90% of the population need Ft levels in the 50-80% range to feel NORMAL. Most MDs look at the Fts and if you are not out of the range you are good. Many do not look close enough. So do not settle for minimal treatment.. fight for optimal treatment. Optimal treatment will be when you have a TSH ~1 and FT3 and FT4 levels with in 10% of each other and in the 50 - 80% range. Where is your optimal range? It is in that 50 - 80% region where your symptoms are negligible.

    Welcome to the family. Vent, gripe, ask questions, and share your successes. The more here the better we can all be from the added experience. Good luck and keep looking.

    Sincerely,'
    MG

    P.S. You are on Armour.. your TSH will be suppressed and should be ignored. You need to monitor your thyroid health by the FTs alone. Fight to get into optimal range for your FT3 and Ft4 levels.
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    Last edited by mkgb; 03-16-2008 at 04:50 PM.

     
    Old 03-16-2008, 06:49 PM   #4
    cshaw50
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    Re: Fibromyalgia or Thyroid? Questions

    Wow! Thank you both so much for your replies! I do have test results but there are no percentages given. I guess I may have to do some math. OK, this is what I have so far (forgive me for not abbreviating, I am not too good with the lingo...yet): Antithyroglobulin Ab <20; T4 Free, Direct 1.16; TSH 1.040; Thyroid Peroxidase (TPO) Ab <10; Triiodothyronine, Free, Serum 3.1; Thyroglobulin, Qn. 247.0. BTW, it looks like "Siemens (DPC) ICMA Methodology" is what the lab bases their ranges on.

    Interestingly enough, the doctor who performed the FNA (different from my endo) mentioned Hashimoto's but I was in such a state I can't remember in what capacity.

    I must admit my eyes are glazing over with the terminology, abbreviations and numbers, but I will study very hard (as much as my inability to concentrate allows, lol).

    This bloodwork was ordered by the endo, who, although it was my first visit to any endo, I was very impressed with. The fact that I didn't get a "there, there, dear" pat on the head type of response when I told him about my fibro was a good sign. I was also impressed that he was so willing to put me on Armour even before these blood results were in. I do have to say that I feel no different with it yet (been on it for 3 weeks only) but now I understand that this is just the beginning of a process.

    I am afraid at this point to get my hopes up too high, but boy, to even have a bit of hope that even though I've suffered for so long, there [I]may[I] be an answer is astounding to me!

    You have no idea how much your replies mean to me. I have tears in my eyes and for the first time in 16 years I feel like someone "gets" me. Thank you SO much, again.

     
    Old 03-16-2008, 08:32 PM   #5
    mkgb
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    Re: Fibromyalgia or Thyroid? Questions

    Antithyroglobulin Ab <20 = TGAb This is a 65-75% positive indicator of Hashimoto's.. however 35-25% of Hashimoto's sufferers test false negative by this test.

    T4 Free, Direct 1.16 = FT4 Normal range given info you gave is (.61-.8) - (1.76-1.8) - It depends on the instrumentation and calibration methods.. etc. Assuming the range is .8 - 1.8.. here is how you calculate your percentages:
    [actual value (1.16) - lower limit value (.8)]/[upper limit value (1.8) - lower limit value (.8)]*100 = 36% This is below optimal. I had symptoms out the waz when my levels were in the 40% range.

    Are your blood results here before or after Armour was given?


    TSH 1.040
    Well it isn't 3rd generation but if this is while on Armour.. it is suppressed and not worht much. Looks good though.

    Thyroid Peroxidase (TPO) Ab <10: = TPOAb.. Okay this is the best blood test for Hashi's out there.. but there is a 10-20% chance of a false negative result depending on analysis method employed.

    Triiodothyronine, Free, Serum = FT3 3.1 normal range is 2.3 - 4.2.. Using the formula above... you are at 42%.

    This looks high to me. and you said as much earlier. Thyroglobulin, Qn. 247.0. It is an indicator of all those nodes and lumps in your thyroid. I am glad that you got an FNA. Let us know what the results are... my mother had to have half her thyroid out because the FNA was questionable. She had Hashimoto's and Graves disease. My family is riddle with thyroid AI's. It is genetic and 80% dominant in females.. the dominance in males varies. My mother is one of five sisters. Each one of her sisters have thyroid dysfunction and her mom and aunt and her grandmother and great aunt... It does run in the family.

    By your TPOAb and TGAb... you don't scream Hashimoto's.. but if it has been attacking the thyroid for 15 years... it may have run its course and the antibodies may have leveled off. Then there is the whole false negative thing. Given a FT4 at 36% and Ft3 at 42%.. you appear to be balanced.. your FTs are with in 10% of each other. This suggests your T4 to T3 conversion in your liver is good and that supplementation should be your fix.

    Let me know if these results are pre or post Armour. I also have a few other questions for you.
    What time of day did you have your blood drawn?

    If you were taking Armour.. did you take before your blood was drawn?

    If you did take Armour before your blood was drawn, how long before the blood draw did you take Armour?

    Okay, I think I have rattled on enough for now. Hope this is helping.
    MG
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    Old 03-17-2008, 05:13 AM   #6
    cshaw50
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    Re: Fibromyalgia or Thyroid? Questions

    This was done before being prescribed the Armour, and blood was drawn in the mid-afternoon, probably around 3:30 PM.

    Thanks, MG!

     
    Old 03-17-2008, 05:38 AM   #7
    mkgb
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    Re: Fibromyalgia or Thyroid? Questions

    Okay in the future.. you want your blood drawn as close to 8 am as possible, before taking your meds. If you take meds and then have your blood drawn your results may be artificially biased by the initial T4/T3 hormone flooding your system. So if you have later MD appointments. Get them to right you a blood work request and get it done as early as you can at the preferred laboratory.

    Also did the MD go over supplementation administration regimes with you? Any vitamins or minerals you take need to be taken 4 hours after your thyroid medication.. or 8 hours prior to taking your thyroid medication. Beta blockers, decondestants, anti-histamines, and proton blocking acid reducers are fine to take with your Armour.. Tums and mineral based ant-acids are not safe to take with your Armour.. they will interfere with the absorption of your Armour making it less effective. So the general rule of thumb is take your thyroid meds 8 hours after or 4 hours before taking your vitamins and make sure you take it first thing in the morning on an empty stomach. Also try and wait an hour after taking your thyroid meds to eat or drink anything of any substance.

    Good luck and keep us posted.
    MG
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    Old 03-17-2008, 02:47 PM   #8
    cshaw50
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    Re: Fibromyalgia or Thyroid? Questions

    I was told to take this 1/2 hour before eating, but nothing about drinking. Now I feel stupid for having coffee about 15 minutes after the pill. Thanks for that heads up, I guess I took the Dr.'s instructions too literally. The only other medicine I take regularly is 12.5 mg of elavil for my fibromyalgia, and it does help me sleep.

    I'll keep everything you've said in mind. They draw blood right there at the office, so should I just not take the Armour the day of my appointment? I am already scheduled for the afternoon.

     
    Old 03-17-2008, 04:50 PM   #9
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    Re: Fibromyalgia or Thyroid? Questions

    I have coffee immediately after my Armour. It's ok, especially if it's black or lightened with non-dairy creamer.

    If your MD tests your FT4 and FT3, don't take your Armour until after the blood draw. It will temporarily spike these levels and make them appear higher than they are on average. When I go for my testing, I take my Armour tablet with me and swallow it after the blood draw. And IMO, it doesn't matter what time of day you have your blood drawn now that you're in treatment. A knowledgable MD knows that TSH doesn't matter with Armour anyway, and for the other levels, timing isn't critical... except for spacing the blood draw at least 6 hours apart from medication time.

    Last edited by midwest1; 03-17-2008 at 04:50 PM.

     
    Old 03-18-2008, 10:18 AM   #10
    cshaw50
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    Re: Fibromyalgia or Thyroid? Questions

    Great info, thanks.

    Just as an aside & funny story (now), I'm sure all of you on Armour know how tiny those beige pills are. At least mine are. Well, I have a very feisty tortie cat named Kloee. She knows no fear and does what she wants. I had just gotten the new Rx for Armour and left it on the counter at night so I'd remember to take it every morning. I have no kids at home anymore, and had flipped the lid of the pill bottle upside down as to make it non-childproof. Late in the evening, I heard Kloee playing with something, but paid no mind. Next morning I reach for the pill bottle and no bottle! Only the cap! I called my DH and he said he had thrown an empty pill bottle away that she had been playing with. I had 27 pills in there!

    She had not eaten any (ever try to make a cat take a pill?), and I could only find 3 pills. I have been on the floor with a flashlight, vacuuming & searching through the contents, you name it. There are 24 Armour pills somewhere in my house. I have beige tile & carpeting almost throughout the house. Talk about embarassed at the pharmacy! The pharmacy tech didn't even blink when I told her. I guess this happens quite often.

    Anyway, I hope this made someone smile today. Finally I can laugh about it.

     
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