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  • I'd like to understand my lab results...

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    Old 10-02-2008, 09:32 AM   #1
    imtupp
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    I'd like to understand my lab results...

    Hello All,

    I've had diagnosed Graves' for about 6 years. Was treated with 10millicures RAI in early '03. Took a real long time to feel NORMAL and get the proper dosage for me. I've really learned a lot about the disease and feel I'm proactive in my care. But there is so much to learn.

    I'm impressed with your knowledge and would really appreciate if you could give me your imput on my labs, and help me to understand how you calculate the percentage of the values.

    Labs @ 09/08/08
    TSH 0.54 [ 0.2-5.00mU/L ]
    FT4 17.3 [ 8.0-23.0pmol/L ]
    T3total 1.7 [ 0.9-2.8nmol/L ]

    Since my last labs my TSH has increased from 0.33 to 0.54
    My FT4 has moved from 16.8 to 17.3
    My T3 total remained the same.

    I thank you in advance for helping me to totally understand this,
    tup

    Last edited by moderator2; 10-05-2008 at 04:45 PM. Reason: Please do not title threads to specific members. Post openly to all readers.

     
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    Old 10-02-2008, 10:20 AM   #2
    mkgb
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    Re: I'd like to understand

    Any and all will help if they can. I actually have posted some threads that may help you with the calculations and general knowledge. I am not a Graves guru. I have Graves antibodies, but my Hashimoto's has beaten my thyroid to Hades and back so there is not much left to work with and antagonize.
    General calcs and hypothyroid issue discussion explained here:
    [url]http://www.healthboards.com/boards/showthread.php?t=597479[/url]

    So let's summarize your case and clear up some questions I have. I like the WHOLE picture in front of me.
    Point 1) You went with an RAI versus the antithyroid drugs.
    Point 2) Now you are having trouble supplementing your thyroid with a thyroid supplement.
    Point 3) How do you calculate your percentage in normal range and what does it mean?

    Questions for clarification:
    1) Did you have a thyroidectomy (TT)? If you still have your thyroid, have they performed a follow up uptake scan to make sure that your thyroid is dead and not traumatized? My Aunt B1.. I have four aunts with thyroid issues and my mom. Had Graves and Hashimoto's as well. Her Graves was much more virulant than mine. She had an RAI.. it just ticked her thyroid off.. had a second to try and kill the remaining portion.. that failed again... then she had a TT. Things got better and she was able to stablize and medicate herself after that. I have another Aunt N that is pure Graves and has successfully treated Graves with anti-thyroid drugs for near 15 years, but she has to manage symptoms with beta-blockers and L-carnitine supplementation.

    Thyroid Care and Concerns Around the World - Part 7 - TT or RAI
    [url]http://www.healthboards.com/boards/showthread.php?t=610550[/url]

    2) You are on a T4 only supplement? Or are you on a T4/T3 combination? What dosage are you on? Are you on any vitamin/hormone supplement regimes? How and when do you take them?

    3) What symptoms are you fighting? How old are you? Have you enter menopause?

    4) How are your salivary glands? Everything clear up from the RAI? Were you tested for Hashimoto's by chance? Just curious?

    But to your numbers:
    Labs @ 09/08/08
    TSH 0.54 [ 0.2-5.00mU/L ]
    This is a little on the hyperT side, unless you are taking a T3 supplement as well.
    FT4 17.3 [ 8.0-23.0pmol/L ] You are at 52% in range here. Method: [your value-lower limit]/[upper limit - lower limit]*100 = % This is not bad. Optimal if you are post meno or in the process of meno. Not optimal if you are of child bearing years.

    T3total 1.7 [ 0.9-2.8nmol/L ] UGH! COME ON. Sorry mad at your Canadian MDs that WON'T ORDER A FT3! *grumble* *sigh* This is 42% of range and suboptimal. Method: [your value-lower limit]/[upper limit - lower limit]*100 = %. The issue here is that your T3 has a 20% source of error and you can not trust the value. You really need an FT3 run to know exactly where your levels are... however a symptom list can narrow it down to your T3 is actually higher or lower than the Total value. TSI naturally suppressed the TSH. There is an interference mechanism at work. SO you will naturally run a bit lower on this. You need to keep an eye on your FTs and symptoms. They matter the most.

    Since my last labs my TSH has increased from 0.33 to 0.54
    My FT4 has moved from 16.8 to 17.3
    This would be lower in range than above.

    Depending on your age and symptoms I may recommend pursuit of adrenal and T4 conversion testing. You may benefit from a touch of T3 supplementation or adrenal treatment. Once again. I can only say that for someone that is not in menopause your Ft4 is a smidge low. Your T3 is an approximate reading that needs to be clarified with an FT3. If the Ft3 is lower or the same as the T3 then an increase in meds and exploration as to why your actual T3 is lower than your T4 is warranted in my opinion. Depending on your symptoms adrenal testing may be a good idea as well.

    Has your MD been keeping up with your Ferritin, vit D/B12 levels? No? You should get those tested as well. Hope you found this helpful.

    MG
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    Last edited by moderator2; 10-05-2008 at 04:44 PM.

     
    Old 10-05-2008, 04:33 PM   #3
    imtupp
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    Re: I'd like to understand

    Hi MK, sorry it took me so long to get back with the info, but now I've got it gathered, so here goes.

    1. No surgery

    2. RAI Jan'03

    3. Over the years a couple ANA tests were done that all came back negative, other than that no follow up.

    4. Currently on .088mg Synthroid, taken 7 a.m.ish along with meds for depression, as psychaitrist said it would be alright. Have just recently changed as Wellbutrin Xl was added to the meds I already take.

    5. I did research T3/T4 Protocal as I am @ my wits end as far as this depression is concerned. Everything I read suggests a little T3 could possibly help with depression. Psychaitrist didn't seem to want to go that route and suggested seeing an endo.

    6. I am 45 turning 46 in 2 weeks.

    7. I have not been tested for Hashi's.

    8. Initial diagnosis had my TSH @< 0.02 with range then being [.40-5.00]and my FT4 @ 29.2 with range then being [7.6-18] It has taken til now to reach only 0.54 except when endo forced me hypo by not medicating me for 6 months after treatment and my TSH went to 24.49. Chatting with other support groups, I have come to believe RAI suppresses the TSH.

    9.Ferritan(which is what?) has been taken a few times over the years,
    Feburary '04...59...[20-300]
    August'04...52
    April '06...49
    October '06...41

    10.Can you tell me what Microsomal AB is? Mine was @ 1:6400

    11. Salivary glands... very dry if I'm understanding you.

    I understand a lot about Graves', however, I still don't get this optimal/suboptimal, and how it is calculated. I tried to follow your formula but got stuck @ *100 =%. I have tracked my symptoms over the years and I am feeling pretty good actually right now other than the depression. I just really want to stay proactive with this, so understandind is essential.

    I still struggle with;
    1. Constipation
    2. Dry mouth really bad(may be induced by meds???)
    3. My resting H/R is between 74-88.
    4. Depression (I have sooo many symptoms here I no longer know what is what.

    Another thing I was curious about was C3 & C4. What is it? In April'06 these tests were done:
    C3...0.9...[0.8-2.0]
    C4...0.24...[0.10-0.50]...and what Does it mean?

    Thanking you in advance for sharing your knowledge;
    tup

    Last edited by moderator2; 10-05-2008 at 04:44 PM.

     
    Old 10-05-2008, 11:49 PM   #4
    Meep
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    Re: I'd like to understand

    Your ferritin was lower than where most women feel helathy, when those labs were done. If you are still experienceing symptoms that might be a place to look at as well. Ideally, you would probalby feel better above 70.

    On the T3, Total T3 is not as accurate as a Free T3, but I feel that it is accurate enough to reveal a pattern. Yours is lower than optimal for most people, AND you are taking a T4 only med. What can you do?

    Get thee hence to a healthfood store and start on some Selenium or ensure that you are taking a vitamin supplement that has Selenium. 100mcg a day will ensure that you are providing your body with the raw materials to properly convert T4 to T3. This is helpful to many patients on a T4 med.

    Another thing to look at while you are there is Magnesium. Some of the sypmtoms of magnesium deficiency are constipation, heart palpitations, "Being uptight", restlessness and numerous other things. A web search on magnesium deficiency symptoms might be enlightening.
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    Old 10-06-2008, 06:30 AM   #5
    mkgb
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    Re: I'd like to understand

    Ferritin is your capacity to store iron. Think of it as your iron reserves. For women we need a minimum of 70.. but 90 is preferred. When you fall below 70 your body will mimic hypoT symptoms. One of the biggies is hair loss and texture changes alongside fatigue.

    Meeps suggestion about selenium is sound. He also made a good point about your ferritin. You should check your multivitamin. If you are not taking one. Get one that contains ferrous fumarate to help boost your ferritin and selenium to help with your T4 to T3 conversion.

    You are getting close to menopausal age. As a result you are most likely going to optimize in the 50-60% range of normal for both T4 and T3. I am betting you need a smidge of T3. However in Canada, getting T3 is harder. I know some MDs prescribe it in various Ontario regions, but I think you have to go private to get it.

    I also think that you need to get a follow up RAI uptake scan run. If you have any functioning thyroid tissue left your Graves can still be kicking your tail with it. Many people need more than one to completely kill off their thyroid. In many cases a TT is a cleaner way to part with your thyroid. No radiation side effects and you know it is gone. Downside? Your standard surgery complications and parathyroid damage.

    ANA is a standard AI antibody test that indicates anything from MS, Lupus, to RA. It is a generic you have an autoimmune disorder. It doesn't necessary go hand in hand with Hashimoto's/Graves.

    The Microsomal AB is the OLD less accurate test for Hashimoto's. The more accurate tests are TPOAb and TGAb.

    The Graves antibody tests are TSI and TRAb.

    Salivary glands... very dry if I'm understanding you.
    This is a side effect of the RAI. It often damages/impairs your salivary glands. Many never recover full salivary gland function. Sounds like your RAI got you there if you are still dealing with the dry mouth.

    I understand a lot about Graves', however, I still don't get this optimal/suboptimal, and how it is calculated. I tried to follow your formula but got stuck @ *100 =%.

    Is it the splat ' * '? * is computer programer language for multiplication. You have to multiply that determined bisection ratio by 100 to get percentage wise where you are in normal range.

    I have tracked my symptoms over the years and I am feeling pretty good actually right now other than the depression. I just really want to stay proactive with this, so understandind is essential.
    I still struggle with;
    1. Constipation
    2. Dry mouth really bad(may be induced by meds???)
    3. My resting H/R is between 74-88.
    4. Depression (I have sooo many symptoms here I no longer know what is what.


    I think you are dealing with hypothyroid depression and that you are on a suboptimal dosing regime. I think that the dry mouth is a salivary gland side effect casualty of your RAI. I think that you need an FT3 run and that you may need some T3 supplementation. Over all I think that your TSI if you have them are surpressing your TSH. It is also possible that the RAI has damaged the pituitary gland.. but I find that doubtful. TSI and other thyroid antibodies like TPOAb have been identified to suppress TSH output. Also I really thing a thyroid uptake scan would be a good test, just to make sure that the RAI worked completely.

    In the mean time the best you can do is supplement the Ferritin and make sure you have a well balanced vitamin regime with selenium in it. Do not take your vitamins with your thyroid meds. Alwas take them 4 hours after or eight hours before.

    MG
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