Need advice on labs , not sure what to do?

[sunny5357]

Any thoughts or advice would be greatly appreciated!

UPDATE:

T4 went up higher and I began having the stomach issues once again and diarrhea. I also have had some rapid heartbeat, up to 120 on occasion so am unable to stop the Propranolol entirely which I would like to do, so I can also stop the Eliquis. But until they are sure I am stable on synthroid and no risk of A-fib my cardiologists want me to take the Propanolol or wean off, but take it heart rate goes up. As long it still goes up they fear A-Fib and risk of stroke so are insistent I stay on it for now.

Thursday 4/25, night I woke up at 4 AM with extremely bad stomach pains, drenched in sweat and had diarrhea. I took immodium and went back to sleep. Woke up around 7 AM with it again, took my Synthroid and went back to sleep. Around 11 AM it began again and this time it was just bright red blood with clear mucous so I called my gastro and then called my cardiologists  because they have me on Eliquis. They said go to ER to rule out a bleed from the Eliquis. ER did cat scan, labs, stool samples etc. but insisted I stay overnight to monitor. I saw the gastro the next day( 8 days ago), no more blood and he cleared me to go home and said it was colitis and IB most likely.

I was on a heart monitor the entire time and they saw no more A-Fib but did catch a couple periods of tachycardia. Not bad but once up to 128 just from walking a few feet to the bathroom. They gave me the propranolol and it went down.

They did run labs on Free T4 and TSH but not T3. Anyway…. the T4 is up since my labs and the TSH is down. T4 is now higher than it has ever been.  They said to call my endocrinologist and let him know T4 was now 1.77 (0.76-1.46) HIGH.

I was released the next day and called the office and spoke with my endo on call Saturday and endo on call said skip Synthroid Sunday and then take 1/2 of 112 Synthroid on Monday and call my regular endo on Monday, which I did. He changed me from 112 to 100 Synthroid based on T4 up and TSH heading downward.. I am due for labs on May 6, tomorrow.  Yesterday and today I am feeling worse…. that cold feeling I had before the Synthroid kicked in is returning, so is the tired, achy feeling, I am tempted to just start back on the 112 before he gets the new labs.

Below is T4 chart from 11/2016 to yesterday:


Chart of T4 since 2016. In January 2019 A-Fib began: REFERENCE RANGE FOR ALL IS (.076-1.46) ALL DONE AT HOSPITAL

11/23/2016- 1.25 (.076-1.46)
3/5/2017- 1.05 (.076-1.46)
2/19/2018-1.25 (.076-1.46)
11/20/2018- 1.38 (.076-1.46)
1/13/2019- 1.46 HIGH (.076-1.46)
2/4/2019- 1.57 HIGH (.076-1.46)
2/19/2019- 1.50 HIGH (.076-1.46)
3/2/2019- 1.51 HIGH (.076-1.46)
3/7/2019- 1.35 (ON PTU)PRIOR TO SURGERY ON 3-13-18 (.076-1.46)

THYROID REMOVED 3/13/2019

3/18/2019- T-4- 1.04 (5 DAYS AFTER SURGERY BEFORE SYNTHROID)
3/19/2019- BEGAN SYNTHROID
3/27-2019- T-4 1.35 (.076-1.46) -9 DAYS AFTER BEGAN SYNTHROID

LABS 4/9/19 @ Quest prior to first visit to endo since surgery:

TSH- 0.27(.40-4.50) LOW
T4 FREE- 1.8 (.08-1.8) ALMOST INTO HIGH RANGE
T3 FREE-2.4(2.3-4.2) NORMAL BUT ALMOST LOW


LABS 4/26/19- @  Hospital:

TSH-0.14 (0.36-3.74) LOW
T4 FREE-1.77 (0.76-1.46) HIGH

Thoughts?

[gimel]

Higher levels of FT4, even within the reference range have been shown to cause atrial fibrillation.   I personally experienced some strange palpitations when taking a large dose of T4.   Note the following links.

https://www.endocrinologyadvisor.com/home/topics/thyroid/high-free-t4-levels-within-reference-range-associated-with-atrial-fibrillation/

https://www.medscape.com/viewarticle/904785

Since it is the TISSUE T3 EFFECT that determines your thyroid status, it is important to get your Free T3 high enough to relieve hypothyroid symptoms.  Trying to achieve adequate FT3 levels by taking enough T4 med to raise your FT4 to high end of range is not the most effective approach.   Many hypothyroid patients have had better results from taking  some T3 med adequate to get FT3 into the upper third of its range, along with taking enough T4 to get it to mid-range.   Another alternative is to switch to  a desiccated type containing both T4 and T3.

I also recently found this study that you will also find interesting.

https://www.entdoctorlevine.com/wp-content/uploads/2016/07/Optimal-Metabolism.pdf

[telus2]

I hope freeT3 lab is included for May 6. A full set of labs is required to really see what is going on. I'd go for total T4 and total T3 as well if there is any way to swing it.

Your freeT4 is high, but I don't think it is so high to worry about. If you are taking synthroid only, your fT4 needs to be high in order to get a reasonable amount of fT3. Your doctor should be more concerned about fT3 than fT4, because it is T3 that is the active hormone that would make you hyper.

With your fT4 at 1.77, a typical synthroid user would have fT3 around 3.3 which would put you pretty much at the middle of the fT3 range and it would be reasonable to stay at 112 synthroid. If your fT3 turns out to be significantly higher than that, then that could point to something unusual going on. It is unusual that your TSH is as low as 0.14 when on 112 synthroid, so I'd ask the endo if there is any way that you could still be having lingering effects from the surgery, such as do you still have a piece of thyroid gland producing thyroid hormone.

I'd sure have a serious discussion with the cardiologist about the appropriateness of staying on Eliquis when you have had a bleeding problem. I'd ask about the beta blocker too - my cardiologist told me that Metoprolol had the least effect on thyroid hormones compared to other beta blockers.

[sunny5357]

Thank you. I had labs today,  TSH, Free T4, free T3 and Vit D. I should have the results Wednesday. I felt like i was going back to feeling hypo on the 100 so today went back to 112 without even asking the doctor.  My surgery was done by 2 of the top thyroid surgeons in the country, so I doubt they left some but anything is possible. A cat scan for something else did show lumpy thyroid nodules after the surgery but the surgeon said it was scar tissue that it had not even had time to heal since it was close to after the surgery. I thought T4 was what made you hyper. My T3 was never out of normal range before it was removed, but when the T4 went out of normal range the A-fib began

[sunny5357]

New labs:

VIT D -28 ( REF RANGE (30-100)
TSH-0.76 (.40-4.40)
FREE T4- 1.7 (.08-1.8)
FREE T3- 2.6 (2.3-4.2)

[sunny5357]

I took med 100 of Synthroid before the blood draw I took it around 8 AM, got draw around 2:45 PM. When the T4 was out out of range before this draw, I had IBS. Bad stomach ache and diarrhea.  That is when he dropped  Synthroid down from 112 mcg to 100 mcg. After he got the results today he still wants me to stay on 100 then 1/2 of 100 each Sunday.  Main symptoms are still my stomach, it just hurts a lot, very little appetite, have lost about 9 pounds since the surgery on 3/13. Sometimes the smell of food is enough to turn my stomach and for some reason I want cold foods more than hot foods. Weird. Body aches and pains are horrendous. That is my main complaint. However, I was diagnosed  with Fibromyalgia 25 years ago but only had a couple major flare ups over  25 year period. My vision at times seems weak, I feel tired and weak but sleeping well at night. My sleep pattern has not changed at all and I never sleep in the day or feel sleepy, just tired. Sometimes I feel like I can't concentrate as well, brain fog.  I am usually very sharp with a great memory, I feel at times  I am struggling.