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Lab Results-I have no clue if they are good or bad
8 weeks ago I was switched from Nature Throid to NP thyroid b/c on the 'new Nature Throid' my TSH went to 6.5 & i felt horrible... I switched to 15mg of NP thyroid but never felt well.. I saw my PCP Aug 1st & she said to raise it but never told me to what so I raised it to 30 mg & felt a bit better but not as good as I wanted--heart palps increased/persisted & I was getting severe anxiety--I raised it again to 45 mg & within days I had severe shortness of breath like my lungs were crushing/bad heart palps & anxiety/panic attacks through the roof..I saw my PCP and she ran tests on 10/18 but the severe shortness of breath was so bad 3 days later I went to the ER(see labs below)...the ER did nothing but tell my it was anxiety & my heart was fine & sent me home..my PCP never got back to me until today(2 weeks later).. her only advice was to switch from NP to Levothyroxine 50 mcg.. I am perplexed b/c in those 2 weeks of hell I reduced my NP thyroid to (1.5 pills)currently taking 22mg (15 mg & 1/2 of a 15mg)...my shortness of breath has gotten better but.. still there.. my lungs still feel like they are a bit crushed.. my labs are below they are from the ER except the last one Vit D taken in August.. the ER did nothing except tell me my labs & heart was fine as I had heart palps too.. (still do but not as bad today) PCP took 2 weeks to get back to me & slapped me up w/ a prescription for 50 mcg of Levo telling me in a message it's not as much of a dose as the NP I'm currently taking.. I'm VERY confused.. why would my shortness of breath be worse when raising the NP thyroid? Is she correct telling me the 50 mcg of Levo isn't as much as the 22 of NP I'm currently taking? Could it be my Iron is too low? Could I be having a reaction to the T3? Am I undermedicated or over medicated? All say my lans are normal but it's def NOT normal having shortness of breath.. I also tested negative for TPI (Graves)... if anyone has ideas please let me know.. my quality of life has drastically diminished and I can barely breath.. catch my breath..
10/21/18 TSH 1.61 (0.30 - 5.00) -- 3 days prior it was .73 (no meds for 24 hrs & was taking 45mg of NP)
RT3 10 (8 - 25)
FT3 2.5 (2.0 - 4.4)
FT4 1.05 (0.80 - 1.80)
IRON: 71 (37 - 145)
FERRITIN: 120 (13 - 400)
B12 791 (232 - 1245)
8/1/18 Vitamin D 35 (30.0 - 80.0)
10/21/18 TSH 1.61 (0.30 - 5.00) -- 3 days prior it was .73 (no meds for 24 hrs & was taking 45mg of NP)
RT3 10 (8 - 25)
FT3 2.5 (2.0 - 4.4)
FT4 1.05 (0.80 - 1.80)
IRON: 71 (37 - 145)
FERRITIN: 120 (13 - 400)
B12 791 (232 - 1245)
8/1/18 Vitamin D 35 (30.0 - 80.0)
This is what I think has happened to you.
Your old dose of 32.5 mg Nature Throid (NT) was quite small (19 mcg T4 plus 4.5 mcg T3). This low dose did not completely suppress your TSH, so your natural thyroid gland was still able to produce thyroid hormones and in total you were getting a good amount of thyroid hormones so that you felt good. If we take a guess, your natural thyroid may have been producing 70 to 80 mcg of T4 daily, which you can see is quite a bit compared to the 19 mcg in the NT.
It appears that the new NT gives very little or no thyroid hormone to people. So now your body had to totally rely on your natural thyroid gland. Your TSH went up to 6.5, so that proves that your natural thyroid gland cannot produce enough thyroid hormone for you. At this point you were clearly hypothyroid and started having a lot of hypo symptoms, including anxiety-panic attacks-palpitations.
When you started low doses (15 & 30 mg) of NP Thyroid (NP), the symptoms that you had might have been carry-over from your hypo condition caused by the NT and not due to the NP meds.
When you went to 45 mg NP (29 mcg T4 and 6.8 mcg T3) , then a new effect starts to kick in, which is typical of natural desiccated thyroid. That is, the T3 suppresses your TSH to a low number. If your TSH is quite low, then your natural thyroid gland cannot produce any thyroid hormones - that small amount of NP can shut down your 70 -80 mcg T4 natural production. So now in total you are only getting thyroid hormone from the NP, but it is way too small! The result is that you are getting less thyroid hormone than before and you are even more hypo and the symptoms are worse.
The bottom line is - usually when you take natural desiccated thyroid such as NP you have to take a dose that will fully replace your total thyroid hormone requirement.
What to do? Until you find a doctor who understands all this and can guide you thru it, it might be an idea to try the 50 mcg Levothyroxine that your PCP suggested. The Levo does not suppress your TSH like the NP does, so it allows your natural thyroid gland to produce thyroid hormones so that you get enough in total. It may not be perfect but it may help alleviate a lot of the symptoms you have.
You may find that your heart palps/panic attack/anxiety does not stop right away. They are extremely erratic and can start anytime for no apparent reason. For example it could start one minute after you take your Levo, but that does not mean the Levo caused it. I would agree it is not "in your head". But somehow or another you have to take some thyroid meds to get your thyroid labs up to a good level and then see what happens to all your symptoms.
Your old dose of 32.5 mg Nature Throid (NT) was quite small (19 mcg T4 plus 4.5 mcg T3). This low dose did not completely suppress your TSH, so your natural thyroid gland was still able to produce thyroid hormones and in total you were getting a good amount of thyroid hormones so that you felt good. If we take a guess, your natural thyroid may have been producing 70 to 80 mcg of T4 daily, which you can see is quite a bit compared to the 19 mcg in the NT.
It appears that the new NT gives very little or no thyroid hormone to people. So now your body had to totally rely on your natural thyroid gland. Your TSH went up to 6.5, so that proves that your natural thyroid gland cannot produce enough thyroid hormone for you. At this point you were clearly hypothyroid and started having a lot of hypo symptoms, including anxiety-panic attacks-palpitations.
When you started low doses (15 & 30 mg) of NP Thyroid (NP), the symptoms that you had might have been carry-over from your hypo condition caused by the NT and not due to the NP meds.
When you went to 45 mg NP (29 mcg T4 and 6.8 mcg T3) , then a new effect starts to kick in, which is typical of natural desiccated thyroid. That is, the T3 suppresses your TSH to a low number. If your TSH is quite low, then your natural thyroid gland cannot produce any thyroid hormones - that small amount of NP can shut down your 70 -80 mcg T4 natural production. So now in total you are only getting thyroid hormone from the NP, but it is way too small! The result is that you are getting less thyroid hormone than before and you are even more hypo and the symptoms are worse.
The bottom line is - usually when you take natural desiccated thyroid such as NP you have to take a dose that will fully replace your total thyroid hormone requirement.
What to do? Until you find a doctor who understands all this and can guide you thru it, it might be an idea to try the 50 mcg Levothyroxine that your PCP suggested. The Levo does not suppress your TSH like the NP does, so it allows your natural thyroid gland to produce thyroid hormones so that you get enough in total. It may not be perfect but it may help alleviate a lot of the symptoms you have.
You may find that your heart palps/panic attack/anxiety does not stop right away. They are extremely erratic and can start anytime for no apparent reason. For example it could start one minute after you take your Levo, but that does not mean the Levo caused it. I would agree it is not "in your head". But somehow or another you have to take some thyroid meds to get your thyroid labs up to a good level and then see what happens to all your symptoms.
1 Comments
That makes a lot of sense to me... I actually am going to print this out & present it to my dox.. HOPING it'll give her an idea how to help... I also see a functional med dox on Nov 8th.. and will show him as well.. I'm 10,000% all in for helping myself.. I just don't know how b/c I'm not a dox & can't prescribe.. I feel like my issues aren't too impossible to figure out.. and yes, I do feel like my dose is too low & I have been not treated properly in the last 3 years due to the fact my 3 PCP's & 2 endo's have no clue how to help... I am paying dearly out of pocket for this functional med dox... to the tune of $1000's for tests so he can get to the root cause & treat that... I'm no rocket scientist but, I feel like my adrenals, low iron & stomach issues has A LOT to do w/ what is happening but we'll see what the tests say... now, just to get on the same page as a competent dox & I'll be much better... I'm willing to ut the work in for sure.. no one wants to feel like this... THANK YOU beyond words for commenting/messaging... I will tell you that I am alone.. not just in this but in life... I have no friends & when I say that I mean none.. I have a husband but he's 'tired' of all of it... even when he's home he avoids me like the plague... I have a daughter & son but they are grown & live 15 hours away... so, I've been on this long journey literally by myself... I feel sad.. but, in the small messages & comments here it really makes me even sadder b/c it makes me miss people in general & it takes complete strangers to offer help when you don't know me at all... for some like me, it means the world... how can the wold have billions of people & one person feel so lonely.. it's hard for me to sometimes comprehend.. <3
What was the dose of the old Nature Throid that worked perfectly for you? It would seem reasonable to take the same amount of NP Thyroid, because the old Nature Throid and NP Thyroid contain the same amount of T4 and T3.
1 Comments
I'm on the same dose however, for some reason, I do not react to it well.. I was on a low dose of 16.25 mcg of NT & then it was upped to 32.5 mcg.. the best I've felt in years... I had a lot of the 'old batch' but when I refilled & they gave me the 'new batch'..my TSH went from optimal to 6.5 & all symptoms came back.. it was like there was nothing in them... dox switched me to 15mg of NP & told me to take that & then up it.. since starting it.. & then upping it to 30mg my #'s have been all over the map.. dox told me to raise it again so i upped it to 45mcg & I went to the ER with 4 breaths per/minute.. blood pressure of 180/120.. heart rate was 128 average beats per minute.. I reduced the meds back to (1) 15mg & a half (22mg altogether) & even though I feel a bit better & I have not regulated since.. heart palps/panic attack/anxiety through the roof/shortness of breath have continued but not as drastic as the ER visit (which they told me was nothing but anxiety).... .. I have no idea what they use for the hormone in each one.. (porcine or bovine) but something is different.. they may have the same amounts of T4 & T3 but whatever it is.. my body doesn't like it..
Regarding iron supplements, the best I know of is Vitron C. It contains 64 mg of iron and some Vitamin C to help with absorption and avoiding stomach distress. Other good sources are ferrous sulfate, ferrous fumarate, and ferrous bisglycinate. Either of these should be taken with some Vitamin C.
1 Comments
Thank you.. I will be looking for those.. Thank you!
In your original post you said that you made a switch to NP Thyroid 8 weeks ago. May I ask did you previously have thyroid meds that seemed to work for you (that is you were symptom free)? What was it, what amount, and do you have lab tests for it? If you seemed to be OK before, then it would make sense to try to get back to similar meds again...
1 Comments
Yes, i was on Nature Throid that worked perfectly ... I had enough 'old batch' and was really feeling well.. when I renewed the prescription I got the 'new batch'.. within 4 weeks I could feel a huge change.. my TSH went up to 6.5 & the symptoms returned.. now, just can't seem to get settled on NP thyroid.. it is very frustrating.. worst symptoms is the shortness of breath & panic attacks/high anxiety
If you will tell us your location perhaps we can suggest a doctor that has been recommended by other thyroid patients.
1 Comments
I am in a little town in the Chicago suburbs! thank you!
One other thing I suggest is to get tested for cortisol. The best test is a saliva cortisol (free cortisol) panel of 4 tests at different times of day. Most doctor s will only order a morning serum cortisol (total cortisol), which is not nearly as revealing. If that is the case with your doctor you could order online a kit for saliva cortisol testing and send it in your self. Cost is about $145.
Cortisol levels should be verified as optimal even before starting on thyroid med. High levels can counteract the effect of thyroid hormone. Also, it is reported that levels that are too low can sometimes cause reactions to starting or raising T3 type meds. If you want to read about this, here is a good link.
https://blog.udemy.com/low-cortisol/
Cortisol levels should be verified as optimal even before starting on thyroid med. High levels can counteract the effect of thyroid hormone. Also, it is reported that levels that are too low can sometimes cause reactions to starting or raising T3 type meds. If you want to read about this, here is a good link.
https://blog.udemy.com/low-cortisol/
2 Comments
Thank you! I've asked my PCP about the cortisol test.. actually asked all 3 but none will comply.. likely will have to pay out of pocket.. just need a dox after that willing to do something about it.. so, today I'm searching for a new PCP.. it's a bit frustrating but.. will get this figured out I hope :).. I do appreciate all the very kind responses.. I'm open to all ideas.. :)
Hoping this new Functional med dox can get me the cortisol test.... either way I'll still have to pay out of pocket...
There is too much chopping and changing dosages in a short amount of time. Here is an excerpt from Tired Thyroid - Why You Should Wait 6 Weeks between Dose Changes...
"Of course, we all want to be on our optimal dose NOW, and when told that we have to wait 6 weeks between dose changes, many of us groan. Is there a valid medical reason behind the wait? Yes there is, and it has to do with the feedback between the different thyroid hormones, TSH, the deiodinase enzymes that perform conversion, etc. When you change your dose, TSH and all the conversion enzymes shift around until thyroid levels reach a new equilibrium. That takes time, and sometimes it takes more than 6 weeks."
"While bloodwork within a few weeks will show the immediate effect, the long-term effect may be different. Therefore, it’s not advisable to make dosing decisions after only a few weeks on a new dose. In my case, I switched from 112 mcg levothyroxine one day to 1.5 grains of Armour Thyroid the next. After 6 weeks, my FT3 lab was at 161% of the reference range, and my TSH was almost at the top of the reference range. With time, at that same dose, FT3 dropped into range and the TSH became suppressed. I went from not supplementing any T3 one day to taking 13.5 mcg T3 the next, and my “factory” was very confused."
"Of course, we all want to be on our optimal dose NOW, and when told that we have to wait 6 weeks between dose changes, many of us groan. Is there a valid medical reason behind the wait? Yes there is, and it has to do with the feedback between the different thyroid hormones, TSH, the deiodinase enzymes that perform conversion, etc. When you change your dose, TSH and all the conversion enzymes shift around until thyroid levels reach a new equilibrium. That takes time, and sometimes it takes more than 6 weeks."
"While bloodwork within a few weeks will show the immediate effect, the long-term effect may be different. Therefore, it’s not advisable to make dosing decisions after only a few weeks on a new dose. In my case, I switched from 112 mcg levothyroxine one day to 1.5 grains of Armour Thyroid the next. After 6 weeks, my FT3 lab was at 161% of the reference range, and my TSH was almost at the top of the reference range. With time, at that same dose, FT3 dropped into range and the TSH became suppressed. I went from not supplementing any T3 one day to taking 13.5 mcg T3 the next, and my “factory” was very confused."
1 Comments
Thank you for responding... yes, that makes perfect sense.. I have yet to find a dox who is willing to tell/help me w/ this.. I seem to have no choice but to do it all myself... which makes the anxiety worse b/c I'm def not a dox.. :( I'm flailing & failing at this
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Your labs indicate that you're quite hypo and definitely need more thyroid hormone medication. Most of us find that we feel best if Free T4 is about mid range and yours is only at 25% of its range. We also find it best to maintain Free T3 in the upper half to upper third of its range; yours is only at 21% of its range.
All of the symptoms you've had an apply to either hyper or hypo... I had them when I was very hypo, as well.
When you took the NP did you take it all in one dose or did you split it into 2 doses during the day?
You said you tested negative for TPI... I'm not sure what that is... TSI is the definitive test for Graves Disease and I'd question why you were tested for Graves when you have hypothyroidism, since Graves is associated with hyperthyroidism, unless your hypothyroidism is due to thyroidectomy.
Tests for Hashimoto's, which is associated with hypothyroidism are TPOab (Thyroid Peroxidase Antibodies) and TgAb (Thyroglobulin Antibodies). Do you know if you were tested for either of those? You would need them both, since they're both markers for Hashimoto's; some of us have one or the other and some have them both. Not testing for them both could result in misdiagnosis.
Although your Ferritin is plenty high, your actual iron level is on the low side. Ferritin can be elevated when inflammation is present. Inflammation can be caused by hypothyroidism and/or a Hashimoto's flare.
If you have Hashimoto's, you would need periodic increases in medication to keep up with the constant destruction of your thyroid gland.
Your vitamin D is also too low. It should be, at least 50, but some sources recommend higher than that...
Your B-12 is adequate, but I, personally, have to keep mine at the top of the range (the range my lab uses is 200-1100) in order to keep symptoms of deficiency from appearing.
It doesn't appear that your PCP is too knowledgeable in the use of thyroid hormones or hypothyroid symptoms. Is she willing to accept suggestions for better treatment?
All of the symptoms you've had an apply to either hyper or hypo... I had them when I was very hypo, as well.
When you took the NP did you take it all in one dose or did you split it into 2 doses during the day?
You said you tested negative for TPI... I'm not sure what that is... TSI is the definitive test for Graves Disease and I'd question why you were tested for Graves when you have hypothyroidism, since Graves is associated with hyperthyroidism, unless your hypothyroidism is due to thyroidectomy.
Tests for Hashimoto's, which is associated with hypothyroidism are TPOab (Thyroid Peroxidase Antibodies) and TgAb (Thyroglobulin Antibodies). Do you know if you were tested for either of those? You would need them both, since they're both markers for Hashimoto's; some of us have one or the other and some have them both. Not testing for them both could result in misdiagnosis.
Although your Ferritin is plenty high, your actual iron level is on the low side. Ferritin can be elevated when inflammation is present. Inflammation can be caused by hypothyroidism and/or a Hashimoto's flare.
If you have Hashimoto's, you would need periodic increases in medication to keep up with the constant destruction of your thyroid gland.
Your vitamin D is also too low. It should be, at least 50, but some sources recommend higher than that...
Your B-12 is adequate, but I, personally, have to keep mine at the top of the range (the range my lab uses is 200-1100) in order to keep symptoms of deficiency from appearing.
It doesn't appear that your PCP is too knowledgeable in the use of thyroid hormones or hypothyroid symptoms. Is she willing to accept suggestions for better treatment?
6 Comments
Hi-Thank you for responding.. Yes, my antibodies are quite high..TPOab was 4998 (yes, that # is correct) & was diagnosed w/ Hashimotos in 2015.. the TPI was actually (TSI) I type too fast.. my PCP is very slow & sadly doesn't seem to care.. she's actually my 3rd PCP since b/c the others told me it was all in my head & to see a psychologist.. it took her 2 weeks just to get back to me & that was after 2 messages & 2 calls the the call center (no direct access to the office)... my only problem is.. is that when I raise my dose on NDT the heart palps/anxiety & especially shortness of breath get MUCH worse.. also, I have no idea what iron to take.. there are so many on store shelves.. I don't want junk iron.. I want better quality.. I also am gluten/dairy/soy/oil/grain free for 1.5 years.. I drink only water for liquids.. and I didn't split the NP dose.. all your help is much appreciated!
Okay, so you have Hashimoto's, which isn't surprising. It's also not surprising that your PCP is pretty slow and doesn't get back to you. That could be because she isn't a thyroid doctor and really doesn't have a clue as to what to do...
When taking a medication with T3, most of us find that splitting it into more than one dose is best. T3 is fast acting and if we take the dose all at once we get the full effect with a very short period, which could be what's giving you the shortness of breath and other symptoms. If you split the dose, you'll keep the T3 level spread over the course of the day instead of getting it all at once so it shouldn't hit you so hard. That would allow you to increase your dosage more steadily.
When taking a medication with T3, one can, typically, increase every couple of weeks, whereas it takes T4 medications 4-6 weeks to reach full potential.
It's fine that you're gluten, dairy and grain free, but oil free? Some oils, such as coconut and olive oil are very good for you...those, along with avocados, nuts, seeds, etc are the fats/oils you'd want in a healthy diet, unless, of course, you're allergic/sensitive to them.
You're right that there are a lot of iron supplements on the market... admittedly, I'm not an expert on iron supplements. gimel is much more knowledgeable about iron supplements than I am; I just know that you want to make sure you get one that's non-constipating. I'm sure he will be willing to tell you what type is best.
When taking a medication with T3, most of us find that splitting it into more than one dose is best. T3 is fast acting and if we take the dose all at once we get the full effect with a very short period, which could be what's giving you the shortness of breath and other symptoms. If you split the dose, you'll keep the T3 level spread over the course of the day instead of getting it all at once so it shouldn't hit you so hard. That would allow you to increase your dosage more steadily.
When taking a medication with T3, one can, typically, increase every couple of weeks, whereas it takes T4 medications 4-6 weeks to reach full potential.
It's fine that you're gluten, dairy and grain free, but oil free? Some oils, such as coconut and olive oil are very good for you...those, along with avocados, nuts, seeds, etc are the fats/oils you'd want in a healthy diet, unless, of course, you're allergic/sensitive to them.
You're right that there are a lot of iron supplements on the market... admittedly, I'm not an expert on iron supplements. gimel is much more knowledgeable about iron supplements than I am; I just know that you want to make sure you get one that's non-constipating. I'm sure he will be willing to tell you what type is best.
I forgot to mention that I'm pretty much gluten, dairy and sugar-free also and coconut and almond milk/yogurt are great substitutes for dairy... I've never eaten soy, so didn't have to eliminate that from my diet...
I have terrible digestive problems which I'm sure goes hand in hand w/ the disease.. I have a very hard time processing oils but if I do have to cook or use any I do use coconut oil which seems to be Ok.. my stomach is extraordinarily sensitive.. I also have a tendency to break out on a rash... I can def split the dose.. take one 15mg in the a.m. and one later in the day to see if that works... hoping someone will get back to me on the iron.. I also had 8 vials of blood taken this a.m... just starting with a functional med dox on Nov 8 but wanted a huge panel of tests first... unfortunately, he doesn't prescribe meds.. but he's the only one in my area that wasn't backlogged until after Christmas... do have an appointment w/ an integrative dox Dec 28.. she prescribes so if I can make it from now until then.. I should be OK.. (I hope).. just wanna be able to enjoy the holidays a bit... I only just turned 50 & I shouldn't be feeling this way... I do appreciate all the help..
Do you still have your gall bladder? Once we've had that removed, we often have a hard time processing fats.
Have you tried taking digestive enzymes when you eat? They help with digestive process so everything gets digested the way it should be. There are some very good ones on the market and definitely worth a try.
Have you tried taking digestive enzymes when you eat? They help with digestive process so everything gets digested the way it should be. There are some very good ones on the market and definitely worth a try.
I still have my gallbladder... and have tried digestive enzymes once & it made my stomach feel much worse but willing to give it a try again... :)
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