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  • New thyroid blood draw results; What now?

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    Old 02-11-2009, 04:28 PM   #1
    Montanan
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    New thyroid blood draw results; What now?

    Hello All,
    I posted in December when I learned that I had Hashimotos and Hashitoxicosis. At that time, my Free T4 was 2.4. I never knew my TSH. My Free T3 was 6.4.
    I called my endo's nurse a few days ago and she told me that my TSH is okay and my Free T4 is now .04. I asked what my Free T3 was and she said that the endo doesn't pay attention to those stats. She said that my file was on the doctor's desk and they would call, that was two days ago so they must really be studying my file! ( just kidding) She also said I had some TPO but it was not high.
    I guess that I wanted to get advice about how others think this should go before I do hear back from his office. Is it time to get medicated? Thanks for any advice!

     
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    Old 02-12-2009, 08:46 AM   #2
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    Re: New thyroid blood draw results; What now?

    If your FT4 level was 0.04.. you DEFINITELY need medication.

    Get a copy of the lab sheet. Your nurse may have told you the wrong values over the phone. The Ft3 matters. If this Endo doesn'te recognize that fact.. well you most likely need to shop for a new one.

    It is hard to give advice with out the laboratory RANGE as well as the value.
    MG
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    Old 02-12-2009, 11:34 AM   #3
    Montanan
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    Re: New thyroid blood draw results; What now?

    Hello mk,
    I just got some of my labs in the mail with reference ranges:
    My TSH is 4.04 ( 0.34-5.76) with this note from doctor: "Recommend rechecking level in 3 months to make sure things are back to normal and permanent low thyroid state has not developed."
    T4 Free 0.4 ( 0.8 - 1.9) Note from doctor, "low level confirms resolving episode of thyroiditis."
    TPA 5.76 ( 0.00- 5.60) Note from doctor, " Positive antibodies against thyroid. Confirms Hashimoto's thyroiditis. High rish for developing low thyroid function in future."
    Nothing in there on Free T3.

    I am totally bummed because I just went through the Hashitoxicosis which is not something I want to repeat again. Being hyperthyroid is not nice and I would like to avoid going there again. My interpretation of his notes are: let's wait and see what happens. I feel like a lab rat.

    MK, what would you do? Thanks!

     
    Old 02-17-2009, 09:53 AM   #4
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    Re: New thyroid blood draw results; What now?

    Given your TSH higher than the A A C E recommended 2.5 upper limit of 2006 for NON Hashimoto's patients and definitely higher than the 2.0 upper limit recommended for Hashimoto's sufferers in 2006. Your LOW FT4 result and positive Hashimoto's antibodies.. I would fight for medication. Before you medicate you need to figure out where your Ft3 levels are and if there is an adrenal issue possibly in the works.

    I think that you need thyroid medication. It will cut down on the Hashitoxicosis flares and make you feel better. It changed my out look on things.

    MG
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    Old 02-18-2009, 06:12 AM   #5
    Montanan
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    Re: New thyroid blood draw results; What now?

    Thanks MK,
    Your comments echo my gut feelings. I am going to push for medication. I have never really been "sick" before and I have definitely never pushed a doctor to give me medication so this will be out of my comfort zone. Thanks for the support and advice!

     
    Old 02-18-2009, 10:03 AM   #6
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    Re: New thyroid blood draw results; What now?

    Remember to ask for the Ft3 testing before starting your medication regime. If you have an adrenal issue you can detect it early by an imbalance in your T4 to T3 conversion. Adrenal issues if they are present need to be addressed before going full steam into thyroid treatment. Treating the thyroid with out treating the adrenals if there is an issue can cause some NASTY side effects. Normally hyperT in one of the two main thyroid hormone levels.

    MG
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    Old 02-19-2009, 06:14 AM   #7
    Montanan
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    Re: New thyroid blood draw results; What now?

    Hi MG,
    I am not sure that I follow you. Can you tell me specifically what to look for that would indicate an adrenal issue?
    "Normally hyperT in one of the two main thyroid hormone levels." Does this mean that either the Free t3 or Free t4 would be in the hyper level? Are those the two main thyroid levels?
    I called my endo's nurse yesterday to ask the doctor to go on medication and if he says no, to get an explanation for why. I haven't heard back.
    This site really helps and mk, you have educated me greatly. I had no idea about the levels you described in your comments. I also didn't know there are possible adrenal issues. I don't even know what your adrenals are. Of course, I was hardly aware of the thyroid until recently.
    All the best and thanks so much for your help!

     
    Old 02-19-2009, 07:54 AM   #8
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    Re: New thyroid blood draw results; What now?

    Okay I will break it down. When your Ft4 and Ft3 levels are out of balance an adrenal issue or conversion issue is suspect.

    What do I mean by out of balance? First calculate your Ft3 and FT4 percentages. Then look at the deviation.

    IF your Ft3 and Ft4 are more than 10% apart then there is an imbalance. If the imbalance is 15% it may be low ferritin, vit D, or B12 in origin... if it is 20-40% then you need to look at your adrenals and thyroid hormone conversion factors.

    Now depending on which hormone is high T4 or T3.. you can narrow things down:

    1) IF your Ft4 levels are higher than your FT3 levels, then you have two main issues that can be the cause.. hyperadrenalism (High cortisol/DHEA/aldosterone) or High RT3/low T3 Uptake.

    2) IF your Ft3 levels are higher than your FT4 levels, then you are over converting your T4 for some reason. The most common case for this is hypoadrenalism. This can be temporary and due to low B12, Ferritin and vit D with a side order of adrenal fatigue OR it can be the result of adrenal burn out OR the result of autoimmune adrenal destruction.

    SO to be able to tell if you have something going on in addition to the thyroid or that is aggravating the thyroid you always need to have the TSH, Ft4, and Ft3 run. Getting just a TSH and FT4 is like only buying a skirt with out having a matching top. You leave yourself exposed and don't cover your bases.

    Did that help or was it too technical?

    MG
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    Old 02-24-2009, 06:39 AM   #9
    Montanan
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    Re: New thyroid blood draw results; What now?

    Hi MG,
    I so appreciate your help and sharing your knowledge. I do understand what you are saying and will try to put it to use at least with questions I can pose.
    I have been asking my endocrinologist questions and getting responses via his nurse. I have also been checking up on my endocrinologist by asking friends in the medical community about his reputation. I guess he has a stellar reputation for knowing his "stuff." That is relevant because I don't agree with how he is handling my case.
    I called to see if I can start on medication to avoid another bout with hashitoxicosis. My theory is that the pituitary gland will sense the hormone and then not stimulate the thyroid to produce more. The doctor said that you can not prevent hashitoxicosis with medication. The only option would be surgery.
    I asked how long I have to be hypo to be medicated. He said that I need to go higher with my TSH and the nurse said that he only goes by TSH. I am at 4.04 now with the 0.34 - 5.76 ref. range. My free T4 was already below the ref range at .04 with the 0.8-1.9 ref range. The nurse said he only medicates using TSH ranges............
    If he didn't have a great rep, I would be more inclined to "shop around" for another doctor.
    So, I was told to wait and test my blood levels again in May..............
    UGH!!!!
    So, that is where I stand today...I welcome your input.
    All the best to you MG and my fellow thyroid dysfunction friends.

     
    Old 02-24-2009, 06:57 AM   #10
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    Re: New thyroid blood draw results; What now?

    I went through four MDon't Endos with great reps. They had great reputations.. but not as thyroid MDs.. as diabetes MDS. Most of the feed back comes from treatment of diabetes not thyroid issues.

    Your TSH is too high. You should be on thyroid supplementation NOW. Not years form now. The longer you are left with subnormal Fts the more systems will suffer. You need to be tested for central hypothyroidism and adrenal complications. However given the ruling of the American Association of Endocrinologists in 2002 saying normal TSH is 0.3-3.0. You have a case to argue with this sterling MD. It is nice he has a good rep.. but that doesn't mean he is handling you properly. In many cases an MD has a good rep because patients do not speak out against them or fill out the MD reports. Have you asked your MD friends your MDs reputation with thyroid treatment specifically? Or as an Endo as a whole. When I target my MDs and family MDs to find me a THYROID specialist they all come up blank. They can tell me such and such is good with diabetes.

    Waiting til MAY is barbaric. Don't. TEST every 4-6 weeks minimum!

    MG
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    Old 02-24-2009, 11:45 AM   #11
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    Re: New thyroid blood draw results; What now?

    Yes! My endo was mostly a "sugar doc" not a thyroid specialist, that's for sure...

     
    Old 02-25-2009, 07:11 AM   #12
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    Re: New thyroid blood draw results; What now?

    Hello MG and Graves Girl!

    Wow - your input, as usual, is valuable. I would never have thought to differentiate between an endo gaining their reputation treating diabetes or thyroid issues. But, that makes a lot of sense.
    Is there a good accreditation that a "more qualified" thyroid doc should have that I could search? Like some sort of national board certification for thyroid specifically?

    Again, thanks for all the good information!

     
    Old 02-25-2009, 07:18 AM   #13
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    Re: New thyroid blood draw results; What now?

    If there was a thyroid board accreditation above and beyond the ATA and A A C E.. I would have found it. I lurk on the academic hospital research pages and look for Endos that are doing research on thyroids and AI conditions. They are VERY rare. The big drive is in diabetes.

    MG
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    Old 02-25-2009, 01:55 PM   #14
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    Re: New thyroid blood draw results; What now?

    Montanan, I have a similar situation. I like my new MD better than any of the others I have seen but as knowledgeable as he is, he seems to go by the lab values...end of discussion. My TSH was above the upper limits of normal and when I followed up with this new MD two weeks later, it was down to 1.4. He felt inflammation of the thyroid along with nodules...but it gets better...I had a thyroid US which he said was unremarkable. I am more than happy to accept a case of thyroiditis, be it viral or whatever, that resolved, please just acknowledge the fact you felt one thing and by the time I had the US it resolved. These MDs just read everything as a lab value, and that is pretty much how it goes. Mine did ask me to follow-up with repeat labs in a month since the TSH swung so much. I am not looking to be put on meds, I am just looking for an explanation of what is going on. I think we are both in limbo.

     
    Old 03-05-2009, 08:41 AM   #15
    Montanan
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    Re: New thyroid blood draw results; What now?

    Hi Sparkie, MG and Thyroid problem friends,
    Because of an MD friend who made a call, I am going to meet with my internal medicine doc later this month after another blood draw. MG, that means not waiting 3 months for any follow up. Hallelujah! How do you all feel about having your case managed by your internal med doc? I will still see the endo in June, when he has his first opening!
    All the best to you all!

     
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