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    Old 04-19-2012, 10:04 AM   #1
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    Change in Labs Question

    This is my first time posting, but I have been reading the board a lot over the last six months.

    I was diagonsed with a "sluggish" thyroid in May 2011 when my TSH got slightly above 4. I started on 50mcg of Levothyroxine until the fall of 2011 when the doctor bumped it up to 75mcg since my TSH was still above 2 and I was continuing to feel unwell.

    Since my PCP was forgetting to schedule follow-up lab appointments (I would have to ask if I should make an appointment) I asked to be referred to an endo. My first appointment with the endo was in January 2012 where my TSH was right at 1.5 and my Ft4 was around 1.0 (range 0.74ng/dL to 1.83ng/dL). My Vit D was in the 20s (range 30-80 ng/mL) so they suggested I bump up my daily dose from 2000 units to 4000 units per day and get retested in April.

    I just got the April results back and my TSH has gone down to 0.356 (range 0.46 to 4.70 uIU/mL) which the nurse said was borderline hyperthyroid but that the doctor didn't want to change dose yet and to come back in 6 weeks for a re-test.

    I asked for a copy of the full results and see that my Vit D has come up into the normal range (37.3 with same range as above) but that my Ft4 is still in the bottom third of the normal range (this time is was 1.12 with the same range as above).

    I definitely do not want to lower my dose of Levo (still feel generally "slow" compared to how I felt in 2008 which is the last time I felt "normal"). Is it strange for my TSH to fall so rapidly from January to April with no change in my dosage and for my Ft4 to stay so constant?? All of my labs from 2011 generally showed a TSH between 1.5 and 2.5 (PCP never did a free T4 test).

    Any thoughts on this and how to convince my endo that I'm not hyper are greatly appreciated. Thank you so much to everyone who has helped me learn more about this crazy process!

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    Old 04-19-2012, 09:08 PM   #2
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    Re: Change in Labs Question

    Welcome to the board. I'm glad you finally stepped up to post.

    TSH is just funny that way. First of all, it isn't meant to be static. In a healthy person, it actually can fluctuate up to 3 full points within the day's circadian cycle. Once you throw exogenous hormone into the mix, it's entirely unpredictable how much TSH a pituitary gland will spit out. That's what makes it such an inaccurate way to dose thyroid hormone. Problem is, most MDs don't see it that way and cling tenaciously to the misguided idea that TSH is the gold standard. They then proceed to treat TSH instead of raising the actual thyroid hormones. The goal should never be to lower TSH; it should be to raise thyroid levels. Big difference.

    You continue to have symptoms because your FT4 has gone essentially unchanged. T4 (and T3) is responsible for them. Endos aren't easy for thyroid patients to get along with. I'm not sure if anything will change their minds once they get the idea that low TSH automatically means "hyper".

    I have to say I'm already impressed by your endo, who seems a cut above the rest. Maybe he's one of the few enlightened ones who will allow you to remain on the higher dose even with a below-range TSH. I really hope so. But... If you have to argue your case, point out how the FT4 is still below mid-range even though TSH has "improved". Point out that the disorder is called "hypothyroidism" because thyroid levels are low... Not "hyperpituitary-ism" because TSH is too high. (Those aren't scientific terms, of course, but you get the idea. LOL)

    Good luck! I hope the board will continue to be of help to you.
    "We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses." Abraham Lincoln

    Old 04-20-2012, 03:17 PM   #3
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    Re: Change in Labs Question

    Have you had your FT3 levels checked? I had a hard time convincing my endo to check FT3, since they are usually higher than FT4 in hypoT cases. However, my FT3 levels are right at the bottom of the range. In cases where conversion of T4-T3 is a problem, taking a T4 only medication can actually aggravate the problem of low T3 levels by increasing levels of RT3. I would suggest asking for FT3 to be checked and possibly requesting adding a T3 med to the mix if it is low compared to your FT4 level.

    Old 05-08-2012, 12:29 PM   #4
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    Question Re: Change in Labs Question

    Some additional (what I think are) weird results to update you all on.

    I happened to have a follow-up appointment with my primary care doc shortly after my endo appointment and went ahead and had them test my TSH and Free T4 again even though the appointments were only about a week apart. I thought it might be interesting to see how much things fluctuated within that one week.

    I finally got the results today and they were not what I anticipated.

    My TSH came back at 0.567 (range 0.46-4.7) but my freeT4 they said was now 1.8 (range 0.74-1.83). That would put me in the very top of the range for freeT4 when only one week ago I was below the midpoint. I know that there could be lab errors on either one, but has anyone else ever had anything like that happen in such a short time span?

    I have noticed that I feel like I have more energy over the past two weeks(especially on the weekends when I now wake up before my husband) but that just seems like a really short time for such a large jump considering no change in any medication.

    Guess I'll see what the endo follow-up results in June show.

    Thanks for the previous replies!

    Old 05-08-2012, 09:57 PM   #5
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    Re: Change in Labs Question

    A possibility.... When had you taken your last dose of Levothyroxine in relation to the time of this blood draw?

    Having blood tests within 8 or 9 hours of your last T4 dose could give a falsely high result. If you had NOT taken your meds within 8 hours prior to these tests, I think a repeat set of labs would be a good idea.

    You could be headed to hyperT due to being over medicated. Please watch for symptoms of this; fast heart rate, nervousness, hands shaking, etc. Or it could have just been a lab error - it does happen.

    Nevertheless, YAY for you - feeling more energy! Please keep us updated on your next lab results.

    Old 05-09-2012, 05:33 AM   #6
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    Smile Re: Change in Labs Question

    Hm, that's a good point. I think the second round of testing was from a morning doctors appointment and I usually take my Levo first thing when I get up. So it was probably only about 2 hours at most between taking it and the lab work. For the endo appointment, that was in the afternoon so there were several more hours in between.

    I'll check to see what the June numbers show. So far not feeling any hyper symptoms which is good. Never knew this could be such a roller coaster but sounds like lots of other people work a long time to figure out the optimal dosage too!

    Old 05-09-2012, 03:31 PM   #7
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    Re: Change in Labs Question

    Please keep us posted. This is getting interesting! And make sure you watch for hyper symptoms. Especially heat intolerance in the summer-- it is an inability to acclimate to the heat on hot days.

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