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  • Thyroid Antibodies/Normal TSH,T3,T4

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    Old 02-18-2009, 07:10 AM   #1
    herekittykitty
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    Thyroid Antibodies High but with Normal TSH,T3,T4

    I would like some advice on the following lab work I had done because of various symtoms I have been having such as tiredness, hand tremors, cold intolerance, coarse hair, numb arms/hands, eyelids swelling, etc.

    TPO - 97 high (range 0-34)
    Antithyroglobulin Ab - 142 high (range 0-40)

    TSH 1.407 (range 0.45-4.500)
    Triiodothyronine, Free 3.3 (range 2.3-4.2)
    T4, Free 1.18 (range 0.61-1.76) EDITED TO CORRECT RANGE ON THIS

    Cortisol 7.7 (range 4.3-22.4)
    DHEA 37 (range 32-240)

    Doctor says I don't need medication because my thyroid levels are normal. She did say my cortisol and DHEA are low even though they are in normal range. I was also diagnosed with anemia and low ferritin of 2, so I am not sure whether symptoms are from anemia or thyroid??? Any opinions on lab work would be appreciated.

    Last edited by herekittykitty; 02-18-2009 at 09:02 AM. Reason: To correct T4 range

     
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    Old 02-18-2009, 07:40 AM   #2
    Alisonj29
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    I have exactly the same question as you!

     
    Old 02-18-2009, 07:58 AM   #3
    midwest1
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    Re: Thyroid Antibodies High but with Normal TSH,T3,T4

    You have Hashimoto's thyroiditis, based on the strongly positive TPO and Tg antibodies and very low free T4. Your TSH is "normal", and that's likely what your MD based her decision to withold treatment on. But TSH is frequently - if not usually - falsely depressed when antibodies are so high. You're having symptoms because your free T4 is below range .... too low for a human being to squeak by on.

    Treating this now may prevent nodule/goiter formation and will relieve symptoms. Your gland is failing to produce hormone you need. You need to supplement what it can't make. If the MD refuses, you may prefer to start the search for a better doctor, one who knows something about Hashi's and will treat you now.

    Last edited by midwest1; 02-18-2009 at 08:01 AM.

     
    Old 02-18-2009, 08:58 AM   #4
    herekittykitty
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    Midwest,
    I am afraid I posted my T4 incorrectly! It is:

    T4 1.18 (range 0.61-1.76)

    So, it too is in the normal range. So is she correct in that I don't need medication?

    Hi, Alisonj, I hope you can get your answers too!

     
    Old 02-18-2009, 10:03 AM   #5
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    OK... That correction makes a huge difference.

    Both your free T4 and free T3 are exactly mid-range. That doesn't necessarily mean that they are high enough for you, however, or that you wouldn't benefit from supplementing your thyroid hormone now. You might or might not.

    The only endo I saw begins treatment with antibody counts like yours. She says that it can prevent goiter/nodule growth and relieve symptoms. However, she is probably in the minority of endos who think this way. To be honest, you will have trouble finding a mainstream MD who will treat you now. Mind you, I'm not saying you don't need it, because you still could.

    If you have the means to find a holistic-minded professional, like an osteopath, you may have better luck getting a prescription for thyroid hormone. Or if you can find an MD who prescribes Armour thyroid for hypothyroidism, you may have better luck. Armour-prescribers are generally more open-minded about treatment than MDs who favor synthetic meds.

    Wishing you good luck.

     
    Old 02-18-2009, 10:42 AM   #6
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    Re: Thyroid Antibodies High but with Normal TSH,T3,T4

    Okay you have hashimoto's thyroiditis. You will eventually go hypothyroid and may have periods where you feel it now.

    TPO - 97 high (range 0-34)
    Antithyroglobulin Ab - 142 high (range 0-40)

    TSH 1.407 (range 0.45-4.500) Optimal TSH is 0.89-1.1. You are trending hypoT, but not there yet. You are right at that normal prepare to slide into hypoT land stage of hashimoto's. Why? Let's look at your Ft3 and ft4 levels.

    Triiodothyronine, Free 3.3 (range 2.3-4.2) Optimal is 50-80% of normal range. you are at 52.6% of normal range here. This is right at the bottom of optimal range, supplementation at this time may push you hyperthyroid. Mds want to hold off until there isn't a danger of the hyperT silde. I had to wait until my ft4 and Ft3 levels were 5% and 10% of normal range.. I would have benefited when i dropped to 30% of normal... but I didn't have a good MD to work with at that time.

    T4, Free 1.18 (range 0.61-1.76) You are 40.8 % of normal range here. You are beginning to drop in T4 into suboptimal range. But you are still close to that 50-80% window.

    Getting thyroid meds at this time will be HARD.

    What you need to do is keep up with the TSH and Ft testing. Every 3 months minimum. In the mean time work on getting your ferritin up. Low ferritin can give hypothyroid symptoms. You want a ferritin in the 70-100 range depending on your laboratory range. Ferrous fumarate is one of the best forms of iron you can take. iron sulfate is not good absorption wise... or on your digestive track. You also should try adding 10-20 mg of DHEA to your regime. If you have too much DHEA it will show in the manifestation of acne and excess hair growth on the face.. so start slow at 10 and work up in 5 mg increments.. IF supplementing the DHEA does nothing for your fatigue... then cotisol supplementation may be warranted.

    I also recommend you get your B12 levels checked. Low or suboptimal B12 levels effect your adrenal function and fatigue as well.

    I have Hashimoto's and Graves and hypoadrenalism and reactive hypoglycemia and IR and PCOS and.. well i have to supplement my ferritin, B12, D, K, Ca, Mg daily. My combination of issues has result in what my MDs call metabolic malabsorption effects. All in all it is treatable, you just become a pill popper.

    Early on Hashimoto's stinks. I know I was in your boat 1.5 years ago. Now i am on 100 mcgs of T4, 20 mg of hydrocortisone for my adrenal and thyroid. My T4 will continue to increase as my thyroid is systematically destroyed. Last uptake showed that I was about 20% functional thyroid wise. This matches the body weight calculations that I should need 137 mcg of T4 to meet my needs. We shall see when the time comes.

    Welcome to our thyroid dysfunctional family. You are not alone and we will help where we can.
    MG

    Cortisol 7.7 (range 4.3-22.4)
    DHEA 37 (range 32-240)
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    Old 02-18-2009, 12:42 PM   #7
    wipedout
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    Talking Re: Thyroid Antibodies/Normal TSH,T3,T4

    Dear Herekittykitty,

    Not sure what you mean by thyroid antibodies, but my new MD tested me for something I had never heard of before: "Reverse T3" which measured my body's production of a substance that was blocking my production of T3. I had forever been on Synthroid which is what most doctors prescribe today or at least its generic. But Synthroid only provides T4 and not T3 which is the more powerful of the two. Your body then has to manufacture its own T3 from the T4, but mine was blocking that process. Yet my TSH was always normal.

    I am furious that I have been so mismanaged by the medical buffoons for so many years!!

    I did some reading about Armour thyroid and about assessing one's degree of hypothyroidism by using basal temperature measurement (the first temperature taken in the morning before you get up or move around much). Normal basal temperature should be 97 degrees (taken in armpit) or higher. Mine tended to be around 94 degrees which meant I was quite hypothyroid.

    Forget about using TSH to determine whether you are hypothyroid - it just doesn't work much of the time and yet that is the measurement that the medical buffoons usually do use. My TSH was always normal so they always told me I was fine thyroid-wise even though I was hypersensitive to cold, extremely weak and fatigued, off-balance, with twitching, hoarseness, thinning hair, and thickened skin (all symptoms of being hypothyroid).

    Anyway, my suggestion: Find a doctor who is willing to prescribe Armour Thyroid (a type of natural thyroid supplement). Doesn't matter whether he is an endocrinologist or not - just make sure he has a good reputation as an MD and knows what he is doing. None of the local university endocrinologists that I consulted would even consider using basal temperature or Armour. Needless to say they didn't get my business.

    Actually, I have found it is a good idea to avoid university settings altogether when pursuing medical answers. They often have such high opinions of themselves as "being on the cutting edge" but all my experiences with university physicians leads me to the opinion that they certainly are NOT. They are, however, interested in getting their students some experience. . .

    So, start taking your basal temperature first thing in the morning when you wake up before you get out of bed. Don't move around much. Have all your supplies - thermometer, flashlight, eyeglasses (if needed) - ready so you won't have to do any physical work to take your temperature. The more you move around before you take your temperature, the more your temperature will rise and it will not be a true basal temperature. Put the thermometer under your arm and then have your arm come down over it so it is snug. If your temperature is under 97 degrees, you are likely hypothyroid no matter what other tests say. If it is 94-95 degrees like mine was you surely are!!

    I am starting to feel SO MUCH BETTER on Armour Thyroid (made from natural dessicated thyroid and containing both T3 and T4 - unlike Synthroid which only contains the weaker T4).

    A good book about thyroid issues is: Hypothyroidism: The Unsuspected Illness by Broda O. Barnes, M.D. and Lawrence Galton.

    Good luck to you.

     
    Old 02-18-2009, 11:57 PM   #8
    Eeps
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    I have hashimoto's too. When my Dr first tested my hormone levels I was just a tiny bit low, so he decide to retest them and the hormones came back normal. He then tested for the antibodies. That's when he dx me.

    The thing about hashimoto's is that one can fluctuate between low, high and normal in pretty short amounts of time.

    So he started treatment with a very very low dose of levoxil, the plan being that my thyroid, which was still able to make most of the time, would slow production if I was on meds, and would simply be more stable if it slowed itself down.

     
    Old 02-19-2009, 05:11 AM   #9
    herekittykitty
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    This may be a totally off the wall question, but can your body stop attacking the thyroid? I'm thinking that maybe when I get some other issues resolved (like the anemia and low ferritin), things may calm down and some of the other issues, like Hashimoto's, will go away? Has anyone ever heard of a complete remission of this?

     
    Old 02-19-2009, 07:44 AM   #10
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    Once your Immune system has decide the thyroid is a foreign body and dangerous.. it will not cease to destroy it at every opportunity. Of the .. me, mom, Aunt B1, Aunt B2, Aunt R, GG E1, GGA S.. over seven hashimoto's sufferers in my family the only way to stop the antibody production is to take the thyroid out of the loop. You can do this by RAI destruction.. Not recommended, total thyroidectomy.. preferred in my family, or wait and let your antibodies do it for you. When the antibodies have destroyed all of your thyroid tissue and there is nothing left to chew on.. they will settle down.

    Ferritin sulfate is a bad choice to get your iron up. It is the most common prescribed, but absorption wise only 20% is taken up in your digestive track.. the rest goes out the back end and normally gives you black stool and constipation. Ferrous fumarate has a higher absorption rate so you can take 35-40 mg to every 200 mg of ferrous sulfate. Also ferrous fumarate is milder on the stomach. If you call and ask your MD I am sure they will say go for the fumarate it won't hurt you. The ferrous sulfate prescription is reflex for them.

    MG
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    Last edited by mkgb; 02-19-2009 at 11:15 AM.

     
    Old 02-19-2009, 11:17 AM   #11
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    The back door trots. Ugh! That can be an irritation factor of all the added iron. What supplements are you taking and how are you taking them. Adding vit C with your iron pills will improve absorption.. and in some stomach upset.. such as reflux. But you get more iron in your blood. I know the pregnancy iron sulfate really irritated me.

    i hope that you get something that works for you soon.
    MG
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    Old 02-20-2009, 06:15 AM   #12
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    Re: Thyroid Antibodies High but with Normal TSH,T3,T4

    corvelia;

    I'm new to this but this reply suggests you are very familiar with all the ranges! My endo has diagnosed me with hypo but my results look normal:

    I am familiar with the statistical analysis of thyroid blood work and data; however, each lab has a different range and thus I can't make any concrete advice on your specific data. I can hypothesize a bit.

    thyroxine 9.3
    This is redundant and not relevant given you have an FT4. There is over 20% error in this test result.. so I won't bother saying more about it.

    T3 uptake 27
    This is a bit low. This test is a measure of how much of your thyroxine is being taken up to convert into the more active T3 component. This may indicate that your T3 levels are out of balance and low with regards to your T4 levels... HOWEVER with out a FT3 result and range I can not say for sure. You need a FT3 test run.

    T4 free( direct) 1.23
    This test has a 2.5-5% source of error to it and is the most accurate measure of T4 thyroid hormone to date. You always want the Free T3 and Free T4 tests when you get your levels checked. Some standard ranges are 0.61 - 1.76, 0.8 - 1.8, and more. If the 0.8-1.8 is your lab range your Ft4 levels would be 43% of normal range. This is not bad, but it is suboptimal. Depending on your Ft3 level you may be hypothyroid.

    TSH baseline 1.584 rising to 13.8 after hormone injection and returning to 11.8 after one hour.

    I am confused here. Did your MD do some form of pituitary TSH stimulation test? Optimal TSH is between 0.89-1.1. Your 1.584 is trending hypoT but not definitive by textbook standards. What exactly was done here with hormone stimulation?

    Glucose T T 84, 152, 204, 212, 197 so glucose impaired ( which is part of hypo)
    This is high. This is not hypoglycemia which I am more familiar with, it may be considered diabetic behavior it certainly falls into hyperglycemia territiory. Blood sugar issues are not necessary a hypothyroid thing. However many do have an issue with their metabolic rates that are untreated hypoT.

    Low Vit D This is more common in hypoadrenal patients than hypothyroid patients. I really thinnk you need additional testing and that what you have here is still to questionable for a clear diagnosis.

    Added thyroid testing I recommend:
    FT3, TPOAb, and TGAb

    Adrenal testing: For best results the data should be collected near 8 am in a fasting stress free state. Also being off birth control pills or estrogen hormone supplements for 4 weeks allows for optimum test conditions. Now those tests for diagnosing fatigue:
    ACTH and cortisol blood serum.
    Cortisol 24 hour rhythm test, Saliva
    DHEA-s

    Additional malabsorption factors to test given symptoms:

    thinning hair, fatigue nail problems, peripheral neuropathy
    Also, goiter and thyroid adenoma with calcifications ( biopsy inconclusive)


    Ferritin - you want to be 40-60% of normal range. 30 or 40 something on a range of 20-180 won't cut it. You would still be slightly anemic and need iron supplementation. When your ferritin is low/suboptimal it can result in hair loss, fatigue and more.

    B12 - This can effect energy and nail strenght, growth, and condition. This level along with B6 and Mg can effect neurological function and result in neuropathy. You should test this level given you low vit D result.

    Also test your Mg levels.

    It is highly probably that you have Hashimoto's and some form of adrenal dysfunction going on. You need to lock it down with additional testing. Also given the goiter, calcifications, and questionable biopsy of your thyroid are they going to remove it? I would think that a PT if not a TT would be warranted here. You should get a second opinion from a good thyroid specialized ENT on the thyroid adenoma and physiology. Don't wait.

    So in summary, you may be subclinical hypothyroid, BUT I would need to see additional thyroid blood work (TSH, Ft4, FT3, TPOAb, TGAb values AND ranges) to be sure. Your fatigue may be due to metabolic malabsorption of a multitude of minerals and vitamins. You need to check on the other hypothyroid mimics: B12, Ferritin, and Mg given your symptoms.

    Also given the fatigue and low Uptake a baseline investigation of your adrenal function would be helpful: ACTH, Cortisol (fasting 8 am blood serum), DHEA-s and a rhythm cortisol saliva study. The saliva test can wait until the blood serum test results come back. Many MDs do not like to run this test because they are not familiar with interpretation of the results.

    I do feel something is up. You should also investigate the blood sugar issue some more as well. Check for insulin resistance with an IGF blood serum test. Look at you insulin levels. Test for the diabetic AI antibodies.. anti-GAD I believe.

    I hope this was kinda helpful and that you get to the bottom of your issue soon. What treatment plan/drugs has your MD started you on?
    How are you taking them and in what concentration?
    Are you addressing your low vit D? How?
    Are you taking a standard multivitamin?
    Is there a history of thyroid dysfunction in your family?

    Many other things can give insight into your thyroid health and risks. Welcome to our thyroid dysfunctional family.

    MG
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    Old 02-20-2009, 10:03 AM   #13
    corvelia
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    Wow! Thanks for taking so much time to answer my query. My endo has put me on Synthroid, high dose Vit D and given me a blood testing kit for the diabetes. I am to go back for another US scan in a month. My sister and mother are hypo but they are overwight ( I am 5'6 and weigh 135 pounds). I also exercise a lot and eat a healthy diet- so this is all a mystery to me! You are right though, I need to ask for more tests.
    Thanks again. I'll keep you posted about the US.

     
    Old 02-20-2009, 11:09 AM   #14
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    Quote:
    Originally Posted by corvelia View Post
    Wow! Thanks for taking so much time to answer my query. My endo has put me on Synthroid, high dose Vit D and given me a blood testing kit for the diabetes. I am to go back for another US scan in a month. My sister and mother are hypo but they are overwight ( I am 5'6 and weigh 135 pounds). I also exercise a lot and eat a healthy diet- so this is all a mystery to me! You are right though, I need to ask for more tests.
    Thanks again. I'll keep you posted about the US.
    I am known for being wordy. Over weight is a symptom of resulting from long term hypoT.. hypoT doesn't happen just because you like fried twinkies. I do not know why people like fired twinkies.. but back to point. Given the family history you definitely need to check on the Hashimoto's and Graves antibodies. When you have that dominant a trend it is most likely AI in origin. Also if your mother and sister are eating reasonably and are moderately active there is no reason other than under treatment of their hypothyroidism or lack of treatment for a different issue for them to retain the excess weight.

    I have been battling my weight for five years. Even weight lifting doing cardio and martial arts on a daily basis under the eye of a personal trainer that giggles and watching every scrap of food I haven't been able to lose the weight. Now I am finally losing it given a boost in T4 and treatment of my insulin resistance. It takes time and it takes staying on top of your own care and management. It would be interesting to see what dose of meds you mom and sis are on and what TSH and Ft4 and Ft3 level their MD considers fine.

    MG
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    Last edited by mkgb; 02-20-2009 at 11:15 AM.

     
    Old 02-20-2009, 11:51 AM   #15
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    Re: Thyroid Antibodies/Normal TSH,T3,T4

    hi, i also have hashi's and it's been on roller coaster ride. what you have to do is find someone who will give you meds. believe me, it sure helped. i was on the verge of insanity when i wasn't on meds. and it was a shocker how synthroid was just magic. everyone has different affects but it really helped me alot. i started on 50 mcgs and then went up to 100mcgs. i was feeling fine at 100 but "lab" suggested that i was being overmedicated. So...they put me at 75 mcgs and i've been here for like a year and a half now. i still get some symptoms here and there but I am thankful that i don't feel cuckoo like i did before. I also have anemia, which I have taken MG's advice and am taking the fumerate instead of sulfate. i do notice that when i'm feeling weak, esp. during those monthly times, i take it and i feel much better.

    so i wish you luck to finding the proper care for yourself. this board is very helpful to try to give you the proper advice. go into the doctor's office knowing what it is that you are talking about and i'm sure that you will find someone who will listen.

     
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