Hashi craziness

[paularose]

I had my appt May 23 & my Dr did increase my Synthroid again from 80 to 100mcg. We made a follow up appt for June 30th & I called to request another blood work order so I will have the new results in hand when I get there. I am STILL no better. This is so frustrating. I figure he will increase  it again. I feel the cytomel needs increased also. It is currently at 5mg 2 times a day, but as you said gotta raise T4 first & see where T3 falls after that. I may need to change Drs. I am beginning to wonder how many Hashi patients he has. He is an integrative Dr. which I thought would help me. I am gonna give him one more shot. This takes SO LONG, while the patient stays ill :(  I guess I need to know my numbers. So I need to know where I am with:
Free T3
Free T4
TPO Antabodies
TSH ?
I order to mange my tbyroid. Do both Free T3&4 need to be st 60% of the range & TPO antibodies need to be as close to 1 as possible?  Sorry if I have repeated myself I am trying to get this all down.

Thanks, Paula
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Kenneth N. Woliner, MD
Jun 09, 2014
Paula,

Thanks for the questions. I just got from speaking at Gena Lee Nolin's Thyroid Awareness seminar, and your questions sound a lot like the ones I got when I was in Scottsdale.

You DO NOT need to get the Thyroid Antibodies to zero. Yes, adding selenium does decrease their numbers, but the main thing is getting your symptoms under control, AND QUICKLY. I agree with brittle patients, ones that easily get side effects to changes in medication, one has to "start low, go slow", but why do so many doctors "take a year and a day" to get their patients feeling better?  In my practice, following an old textbook from the American Medical Association's drug evaluation committee, I change my patients' thyroid dosing every two weeks (if they can tolerate it), so they can better sooner.

I agree that patients have to "be patient", but at some point in time, you might switch doctors, just as you alluded to in your post above.
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11 Comments Post a Comment


paularose  
Jun 09, 2014
Well I wish I could find a Dr in my area that will work with me on this. They all just want  to treat Thyroid as it has always been treated. So upsetting. I did make an appointment with one that
Reply


paularose  
Jun 09, 2014
One that I got his information fromThyroid Sexy.
Reply


paularose  
Jun 11, 2014
Oh & and thank you for answering my question. Is there any way of becoming a patient on line?  Have one in person visit then being treated by Skype or FT by one of MedHelp drs????
Reply


Barb135  
Jun 11, 2014
To: paularose
The doctors who participate on the expert forums have private practices and volunteer their time, here.  You should contact Dr Woliner, directly, if you're interested in becoming one of his private patients.  His contact information is on the home page of this forum.
Reply


Kenneth N. Woliner, MD
Jun 22, 2014
To: paularose
Paularose,

Barb is correct. We do have private practices. I much prefer to see patients in person, but I have patients from all around the world, and many of them do telephone, VOIP, Skype consultations. As long as I don't prescribe controlled substances (e.g., narcotics), the Florida Board of Medicine allows doctors to practice telemedicine.
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paularose  
Jun 30, 2014
Free T3            2.8-5.3          4.3
Free T4.           78-2.19.         84
T3.                   97.0-1.69.     154
TSH.               0.465-468.0.   0.971
FSH.                  2.0-11.6.       8.4
I also have some hormone testing coming back & MTHFR.



Reply


thomthod  
Jul 03, 2014
To: paularose
I will have my blood drawn today for the MTHFR!

Reply


paularose  
Jul 03, 2014
I finally got the reverse T3 reference range 9.0-27.0 /12.8
I am positive for the A1298c Heterozygous.
The only hormone test result back is the estradiol that says 98 with no ref range.
Still waiting on other hormone test ordered.

Thanks for any information you can give. I am wondering about adding the NDT.
Reply


paularose  
Jul 03, 2014
Hello!  Is anyone on here? Was wondering what ya think about my new numbers?  Just anxious lol again!
Reply


paularose  
Jul 11, 2014
To: Hashimoto's Craziness
Ok I have all my numbers & hoping someone will take a look at this with me and give me some advise:

Reverse T3=8.2
Range 9.0-27.0

Thyroid Peroxidase= 53.5
Range 0.0-9.0

T3 Free=4.3
Range 2.8-5.3

T4 Free=.085
Range 0.78-2.19

T3=153.0
Range 97.0-169.0

TSH=0.971
Range 0.465-4.680

Testosterone Female Total & Free=13.5
Range 0.6-3.8/I have a pellet in not sure what dosage of pellet

Sex Hormone Binding=33
Range 30-135

Testosterone=80
Range 9-55

Estradiol=98
Mid Cycle Phase 95-433

Progesterone=<0.05
Range ?

Estrone=Not sure how to read
Range

FSH=8.4
Mid Cycle Peak 5.1-23.4

DHEA=53
Range 26-200

Potassium=3.8
Range 3.6-5.1

Mthfr A1298C/Heterozygous
C665T not back yet
A1286C not back yet


TSH Receptor Antibody=<0.90
Range 20.0
Range <2.8

Methylmalonic Acid, Serum=0.11
Range 0.00-0.40

Vitamin B12=943 Taking sublingual tablets
239-931

PTH intact=44.4
Range 7.5-53.5

Vitamin A Retinol= 0.58
0.30-1.20
Retinol Palmit=<0.02
Range 0.00-0.10

Vitamin D25 Hydroxy=60.6
Range ?

That is about it.  I still feel like crap & I am gluten free, no dairy & no fruit.
The Doctor told me that I have no problem with my thyroid numbers & I need to see a supplement specialist because he is not versed in gene mutations.  He did put me on Homocysetine Supreme & 5 MTHF.

I also take cod liver oil, Vit E, Mag. Gly, Zinc, Selenium, Vit D & Bataine HCI Pepsin.

My prescription meds are Synthroid 100mg just increased to 125 I asked for 112 cause I thought that would be a big jump? Cytomel 5mg 2 a day
Zenpep, Lisinipril 5mg, Lyrica 50mg 3 a day & Tramadol 50mg 3 a day

Thanks, Paula

[goolarra]

I'm so glad you found a doctor who listens.  You're on your way!  

[paularose]

I seen the Dr. Wed. & was impressed as he listened to everything I had to say & said if you felt best on the armour then let's go back to the armour & work on the correct dosing for you. When I was on it before I don't believe I ever had enough. He wrote me a script for 90mg & said we will check my free t3&4, antibodies & TSH but we will dose by symptoms & watch numbers. He said the numbers can get a little crazy when changing so you cannot go solely on the numbers, they are just a guide. I was on 60mg previously, so I am excited to see how it goes. He also wanted me to be on B12 injections weekly for the gene mutation & said he wanted to check into a few things & would get more into other supplements then. Maybe I will be feeling better soon!!

Thanks, Paula

[paularose]

Thanks all if this info is so helpful. The pellets are estrogen & testosterone pellets as I had a hysterectomy & thought I needed some replacement if those. I was due to gave more placed & because I had no improvement we ordered the hormone tests. I wanted tested b4 we started but was told no. Oh well I am not going to get more pellets & just work on the thyroid/Hashi's & if we get rinse numbers right then I think those should come in line by the sounds of the above info. This has really been helpful.
Yes I did mess up the free T4 #s. I have been on the 100 of Synthroid for 8 wks. He gave me that script for the 125. I was gonna wait to fill it as I see the new Dr that us recommended by the Thyroid ž Sexy ppl this Wed.
I am excited. Hopefully I will be in my way to feeling better!!!

Sincerest Regards, Paula  

[paularose]

Thanks all if this info is so helpful. The pellets are estrogen & testosterone pellets as I had a hysterectomy & thought I needed some replacement if those. I was due to gave more placed & because I had no improvement we ordered the hormone tests. I wanted tested b4 we started but was told no. Oh well I am not going to get more pellets & just work on the thyroid/Hashi's & if we get rinse numbers right then I think those should come in line by the sounds of the above info. This has really been helpful.
Yes I did mess up the free T4 #s. I have been on the 100 of Synthroid for 8 wks. He gave me that script for the 125. I was gonna wait to fill it as I see the new Dr that us recommended by the Thyroid ž Sexy ppl this Wed.
I am excited. Hopefully I will be in my way to feeling better!!!

Sincerest Regards, Paula  

[goolarra]

Best of luck...one of these has to be the charm!  Let me know how it goes.

[paularose]

Well you confirmed what I though!  I don't know how he thought I would get better!  I think her refered me out because we didn't agree & he did not like me telling him where I thought my numbers should be. I gave him his LAST chance at that appt. We just could not hit it off!  I was hoping I had found someone to help & build a relationship of working together.  Can you say FIRED!  So THANK YOU for understanding!  I have an appointment at yet another Dr. this week!  At least this one is recommended by tbe Thyroid Sexy folks & he is in my insurance net work for a change!  Oh my WISH ME LUCK!  If I had all tbe money I have spent on this crazy illness & my 12yrs if hell back, I would be a NEW woman for sure but no sense in crying over spilled milk!  am typing this as I lay in bed at 1:37 in the afternoon on a beautiful day outside ... SAD huh, and my hubby tries to understand but he is aggravated that I am in bed all the time :(  

[goolarra]

Thanks...helps a lot!

FT3 is at 60% of range, which is good.  However some people have to have it a little higher, and there is plenty of room there for a tweak.

FT4 is still very low.  It's at 5% of range, and as you know, 50% is the guideline for FT4.  (I'm assuming your FT4 is 0.85 rather than .085???)  How long ago were you increase to 100 mcg?

I don't know a lot about MTHFR, but I think many variants are possible.

Vitamin A is in range.  I don't know enough about A to interpret the finer points of where in range is ideal.  Same for DHEA.

I don't think your numbers are "fine".  Your FT4 is way too low.  That means that at times of peak demand, there is nothing there to convert to T3.  Thyroid test ranges are very flawed for a number of reasons, and the whole bottom half of the range should probably be considered hypo.  

And how, exactly, does your doctor think you are going to fix the "root cause" of Hashi's???  I'm being a bit facetious here because there is no "cure" for Hashi' s (which is the root cause of your hypothyroidism).  All we can do is treat the resultant hypothyroidism.  I don't tend to have a high opinion of any doctor who is satisfied with 5% of range when the patient still has symptoms.  

[Red_Star]

Your testosterone is elevated from those labs. Not sure what you mean by pellets? But anyway, you might find this of interest...

Milwaukee Thyroid - 6 Patterns Of Hypothyroidism..

"Pattern 4: Over Conversion

Pattern 4 is the opposite of pattern 3. The thyroid and pituitary are again working properly, but this time there is too much T4 converted to T3 (remember roughly 20% of T4 is converted into reverse T3 which is inactive and excreted). High levels of testosterone is the cause which also has the added effect of decreasing the amount of thyroid binding globulin (TBG: the taxi that carries the thyroid hormones).

The high levels of T3 in conjunction with low TBG causes cells to become resistant to T3. They close the doors and do not allow anymore T3 into the cells. TSH levels will be normal even though the patient is showing signs of hypothyroidism

This pattern is similar to insulin resistance. In fact, patients with thyroid over conversion often also present with insulin resistance and polycystic ovary syndrome (PCOS) which is also caused by increased testosterone levels. Managing blood sugar is extremely important. Since there is already to much T3, prescription thyroid medication will not help in this pattern."

[paularose]

I guess my main question is my free t3 & 4. I think my free t3 is optimal now but my free T4 is still low?

Can you have both the a1296c & a1286c gene mutation?

Vitamin A looks low?

Dhea low?

Doctor told my thyroid numbers are fine & that we have to fix root cause before we fix thyroid. If the root cause is fixed the thyroid won't he out if whack. I feel terrible. Hope that is more clear lol  

[goolarra]

I read your other thread (part of it), which I believe is identical to this one, and quite frankly find it confusing.  Perhaps you could pare it down to 1) current labs that you are questioning, and 2) your current basic question.  

[paularose]

Hello I have posted in 2 forums now. No help?  I am not un-grateful just curious for answers.

Thanks, p