New here and could really use some help

[realtrade]

Hello, I am new here and could really use some advice to wrap my head around all of this. But first my labs so that whoever can answer my questions have something to go on.

First Lab 9/21 blood test
only results that were flagged are listed....all others were considered normal range

AST(SGOT) 65 H IU/L  range 0-40

Cholesterol, Total 220 H mg/dL    range 100-199

Triglycerides 436 H mg/dL    range 0-149

HDL Cholesterol 26L mg/dL    >39

TSH    20.64 uIU/mL       range 0.450- 4.500

Then My Primary asked I run additional test for TSH, Free T4 and T3 on 10/12

TSH 22.6 uIU/mL  range 0.450-4.500

T4, Free Direct   0.96 ng/dL range 0.82-1.77

T3 Free, serum   2.8 pg/mL    range 2.0-4.4

Thyroid Peroxidase (TPO) Ab  1958 H IU/mL    range 0-34

Antithyroglobulin Ab   11425 H IU/mL    range 0-40

Also had a ultrasound of my thyroid on 10/07 and the results were that I have 2  nodules both without calcification.
Dominant nodule measuring 1.5 cm on right and subtle nodule on left measuring 1.1 cm Both nodules were said to be solid and hypoechoic. And a small cyst measuring 2 mm.

So now that we have all that out of the way, I'd like to some question from people that have gone through this or are going through this.

My primary says I may have Hashimoto's. Didn't really discuss treatment since he said I have to go see an endo which I had an appointment with today. Didn't get a good vibe from him. He immediately put me on synthroid (haven't filled prescription yet...one of the questions I have) and wants me to do a FNA(fine needle aspirate). Didn't really answer any questions and sorta ushered me out saying I'll feel better once I'm on synthroid.

I have another appointment with another endo on 12/05. My first choice but didn't have availability till that day.

What questions should I go in there prepared to ask? I feel based on my interweb journeys about hashimoto and hypothyroidism that I would prefer to take Armour just because I'd prefer a natural approach to this. Never been on any medication in my life other that over the counter cold remedies and aspirin.

Would it be better for me to go ahead and wait to be put on armour or go ahead and take the synthroid and see how i feel till my appointment on 12/05 so for about a month and a few day?

I read taking adrenal support (im looking at dessicated adrenal from standard process) might be beneficial. Am also considering taking milk thistle to help with liver. And also thytrophin pmg also by standard process for the thryoid...according to reviews it helps support thyroid. Should I take these?

Why are my triglycerides so high? I don't eat alot of junk food....almost cut that down to 0.I drink occasionally and I do smoke 1-2 mini cigars a day.

I may have follow up questions, but those are the ones weighing on my mind now. Thanks

[gimel]

Your comments prompted me to recall an old post on this whole subject area.  The member was a nurse that was apparently having trouble convincing her doctor that she had low metabolism due to low thyroid levels.  Here is the thread.




pickdaisies |  Apr 18, 2009

I was having some major problems with my metabolism.  I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library.  I, too was going to see doctors who would not help me.  Fortunately, I found a doctor who gave me armour thyroid despite "normal" levels. I brought him a RMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem  I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body.   I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms.  I documented all the thyroid lab work before and after treatment.  I went and had metabolic testing to test my bmr and it measured normal for my age and weight and I was symptom free.  I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face.  The human body is not black and white.






How much clearer could it be?????

[flyingfool]

This is bringing back a VERY old thread.

But - A TSH of 1.75 is a "normal" reading and is just about perfect in the eyes of most Doctors.  So if you are not having any symptoms related to thyroid, you have nothing to worry about or to dig any deeper.

That being said, TSH is really only a screening test.  So if the symptoms you are experiencing don't make sense to what the TSH test result suggests (that you are perfect), then you may have to do a little more investigating to determine if the TSH test is accurate or what else is causing you to have thyroid related symptoms.

Now as far as what and how TSH is and how it works read on:

TSH is a pituitary hormone. TSH is a three letter acryonom that stands for Thyroid Stimulating Hormone.  TSH is essentially a thermostat or signaling hormone.  

here is how it is "supposed" to work.:

The pituitary gland in your brain "tests" the blood level of thyroid.  If the pituitary senses too little thyroid hormone.  THe pituitary will produce more TSH.  This is the hormone that the thyroid gland in the base of your neck recognizes. When TSH is called for, the thyroid gland produces thyroid hormones.  So the lower your pituitary senses the blood level of thyroid, the more TSH it will produce. Which tells your thyroid gland to crank up and start producing more thyroid hormone.  Conversely, if the pituitary senses too high of thyroid in your blood, the pituitary will reduce the TSH produced which signals your thyroid gland to produce less thyroid hormone.

Thus TSH is basically like a thermostat in your house, sensing the temperature in the house, and if cold, send a signal for the furnace to kick on.  When the thermostat senses that it is getting too warm, it sends a signal to shut the furnace off.

Hope this helps!

[Jvshady1]

Sorry.. I am new here. On this test.. I do not understand what the results mean.

Component

Standard Range TSH 0.450 - 4.500 uIU/mL

Your Value 1.730

Can anyone tell me?

Thanks

[Jvshady1]

Component

Standard Range TSH 0.450 - 4.500 uIU/mL

Your Value 1.730

[flyingfool]

I think I did see that thread with that women who had the 50% metabolism rate.  I'd also love to see what her FT4 and FT3 levels are at!

I 100% believe this to be true that it is low metabolism.  Or at least a significant contributing factor.  The fact that my wife's Ft3's re still below even mid range MUST be a contributing factor.

When we met in college my wife was about 150 pounds.  maybe less.  After 3 kids and Hypo.  She now weighs 50 pounds more than that.  And nothing she does can get her to lose more than about 10 lbs. And then if she even smells a cookie or something let alone actually eat it. She gains weight.

She has tried Jenny Craig and most recently weight watchers.  On WW she was EXTREMELY strict on the diet and was walking 3 miles in the morning and 4 miles at night.  And she lost I think 12 lbs after about 4 weeks. And NOTHING more even though continuing strict for at least another 3 or 4 weeks.  Finally she got tired of the routine for no further gain and gave up.  I can hardly blame her.

I just really wonder what would be possible if her FT3 was up a little bit.  Or then start looking into other issues like adrenal fatigue or something.  But have to take this one step at a time.

[Barb135]

I knew what you were doing --- just had to give you a bit of a hard time, because I've been trying so hard and you didn't even have to try........... lol

[gimel]

No, no, no bragging.  LOL   The weight loss was just the outcome.  I didn't even think of it as an accomplishment, since I didn't do anything except get my meds and my Free T3 levels correct.  I just thought it might be of interest to some of our members who have doctors that tell them that a test result that is anywhere in the range is adequate and "normal".  

[Barb135]

Brag, brag, brag.  LOL  

The most annoying lingering symptom I've had is the weight issue; even when my FT3 was up to 3.7 (2.3-4.2;) and FT4 was 1.8 (0.8-1.8), I wasn't losing, unless I really worked at it.  I'm currently at 3.1 for FT3 and still working the weight issue.

[gimel]

I also meant to mention that I have had some experience in this area as well.  When Armour thyroid was no longer available, i had to switch my meds around.  I did not do a good job of it and got back into being hypo again.  Along with other hypo symptoms, I gained about 18 pounds in a relatively short time.

After Armour became available once again, I switched back and after some tweaking my Free T3 is now 3.9 (range 2.3 - 4.2) and my Free T4 is .84 (range .60 - 1.50), and I feel best ever.  I have also been very pleasantly surprised that with no other changes in diet or exercise level, over a period of 6 months, I have lost 17 pounds and my weight has now seemingly leveled out at my previous level.    It only makes sense to me that if your metabolism is increased, and your diet and exercise levels don't change, then you should lose weight until you hit a new equilibrium representing your  diet/exercise/metabolism.

[Barb135]

I agree with goolarra that your wife would do better with a small amount of a T3 med, rather than the dessicated at this point, because she doesn't need that much and would have more control over both medications.

I'm on generic T3 and I get my script for 90 days at a time, with a co-pay of only a few dollars.  

I hope you  have better luck with your new HMO/doctors.

[gimel]

If you did not happen to notice this previous post, I think you may find it as interesting as I did.  The member, who is taking thyroid meds,  was unable to lose weight, even when on a strict diet.  She finally got her doctor to test her metabolic rate and found it to be about half of normal for her.  But I'll bet that whatever thyroid tests they were doing for her were within the "normal" range.

http://www.medhelp.org/posts/Thyroid-Disorders/Under-active-thyroid--synthroid-not-helping/show/1617280

I have follow up with a PM to her to see if she will post her thyroid test results and reference ranges, so that we can all see just how "normal" the results are.  

[flyingfool]

Thanks.

That is exactly what I thought.  She needs more T3.  My main thought was the decision between going with 2nd medicine Cytomel with a 2nd co-pay etc or switching to a single natural dissected.  But as you say her FT4 is about right and only need a bit of a boost in FT3.  So adding a small dose of Cytomel may be the best route.

her symptoms are significantly less than they were but still lingering.  The problem is that these lingering symptoms are not really bothersome enough for my wife to want to really get aggressive and take action.  They are more annoyances than debilitating if you know what I mean. She is the type of person who just deals with things like annoyances.

She always wants to lose weight. And I keep telling her that she needs to get her Thyroid meds tweaked before she will have much luck with that.  And she knows she's tried everything in the past with little results.  So I keep hoping that this will be the incentive she needs to get her meds and her Thyroid levels in the sweet spot.

You can bring the horse to water....but you can't make them drink!

[goolarra]

Well, you know the spiel...midrange for FT4, upper half to third for FT3.  

However, bear in mind also that that doesn't work for all of us.  Her labs do look like she'd benefit from a little T3 if she has lingering symptoms.  Her FT3 isn't that far off, so I'd probably tend to go the synthetic route so you have more control over it and can manipulate the two separately.  More importantly, so you can start off low and work up on T3 if necessary.

I hope you have better luck with your new plan.  At least you'll have these labs to bring into the new doctor to start the discussion.  

[flyingfool]

Thanks,  Not to hijack this thread but...

My wifes labs show her to be slightly below mid range on FT4 and BELOW mid range on FT3.  Not anywhere near the upper 1/3 of the range.

Specifically:
TSH 0.789 (0.45-4.5)
FT4 1.24 (0.82-1.77)
FT3 2.9 (2.0 - 4.4)

She is currently taking 125 mcg Levo once per day in the morning.

I'm thinking it would be good to add either some Cytomel or switch to natural dissected to get some T3 into the mix.  Her current Dr will not change a thing. The retest from the upping of the levo ONLY did TSH and since it is below 1.0 won't do a thing. The only reason why we have the FT4 and FT3 numbers is that we went and paid for the test out of pocket.  We are now in the process of changing HMO's and thus new Dr's.  This will start January 1.  We'll see how we do with a new Dr.

What is your thoughts on this?

[goolarra]

I don't know a lot about T2 and T1...I did a quick search and found a lot of talk about T2 on body building sites...probably not the most reputable information available.  From what I gather, T2 contributes to the functioning of the thyroid itself.  So if you've had a TT or Hashi's has destroyed all or most of your thyroid function, it may be a bit of a moot point.  

Some people ONLY seem to do well on desiccated.  Pure conjecture on my part, but maybe some of the trace hormones and other substances play a part in that.  Unfortunately, I don't think anyone has linked T2 and T1 to any specifics.  

It's just a matter of experimenting, researching and finding what's best for you.

[Barb135]

The number behind the "T" indicates the number of iodine molecules.  

[flyingfool]

Gloolarra makes excellent points!  That is why I like this forum.  I seem to learn something every time I visit.

Doesn't our natural Thyroid when working properly also produce T1's and T2's in addition to T4 and T3? Pure synthetics would not give you those T1 & T2's if your Thyroid is no longer working or working properly.  I have not yet researched what the T1 and T2 specific hormones do.  But if your body produces them, they must be needed for something.

[goolarra]

I agree that 137 mcg is a fairly high starting dose.  However, you are young, probably have not been hypo for very long since it was discovered on routine testing, so iif you have no other health problems (especially heart arrhythmia), you might be okay with it.  If it makes you nervous to start that high or you have a history of sensitivity to meds in general, you might want to ask your doctor about starting at half that (once a day), giving it a few weeks for your body to get used to having the hormones available again, then increasing as tolerated.

I don't know that it's fair to say that dessicated is the "better" route to go.  Some people do well on T4-only meds, some on synthetic T3/T4 combos, and some just seem to need dessicated.  Those people who will tell you that dessicated (or any other single approach) is the best way to go for everyone are the people whose writing is probably best avoided as biased.

Dessicated is no more inconsistent than any other thyroid meds.  Dessicated has a T4:T3 ratio of between 4 and 5:1.  Our thyroids, when functioning properly produce only about 20:1, so that's a lot of T3 in dessicated.  For some of us, that's a tremendous advantage, for others, it's too much.

Although dessicated is often referred to as "natural" thyroid, that might not be as true as it seems on first look.  T4 only meds keep the natural conversion process in place, and that's important since it encourages fluctuating levels due to bodily demands.  Of course, IF you don't convert well, then this becomes less of an issue.

The upshot of it all is "one hypo's heaven is another hypo's...".  What works for you might not work for me.  We all have to find what's best for us.

Regarding addressing your other tests that were out of line...I'd stabilize thyroid hormones before trying ANY of that.  You may find that little to none of it will be an issue once thyroid hormones are stabilized.  Work on that one first, then move on to any remaining problems one at a time.

Good luck with it all...I wouldn't cancel my appointment with the doctor behind Door #2...your first endo didn't sound very impressive.

[flyingfool]

My wife has been on increasing Levo medication for well over 10 years and her level now is only at 125mcg.  So a starting dosage of 137 seems odd to me.

At the VERY least I would do as Barb says and at least cut the pill in half and take it twice a day. Even half of that dosage is larger than most people start dosage.

Are you sure it is 137 mcg and not 37 mcg?

Clearly you are having some sort of reaction to the medication and you should call in to tell your Dr.  And also tell him that you've done some research and even go onto the medication website and see if they have recommended starting dosages etc.  If all your research says that the dosage your Dr started you out on is unusual.  You need to point that out. And also you may want to consider a different Dr if he was "hurried" and told you to take this dosage.

Sure Hashi's can be treated.  But as Barb135 said, the Dr has to know how to do it. And that is not as easy as it sounds to find such a Dr.

The more I read the more I'm starting to think that natural dissected Thyroid is the better route to go.  But some Dr.s absolutely refuse to prescribe the stuff.  They cite the inconsistency of dosages.  But when you study, you will find more recalls and more variation of synthetic thyroid meds than with natural Dissected. So the main claim by most Dr.s not to use natural thyroid is based on a totally false assumption!

[Barb135]

The main reason people still have trouble after getting on medications is because most doctors don't really know how to treat hypothyroidism/Hashi's.  Your endo starting you on such a high dosage is one example.

You haven't been on the medication long enough for it to really have an effect, but the fact that you feel worse, now, could be caused from the too high dosage, plus your body needs time to adjust to having hormones its been without; or you could be reacting to the binders/fillers in the medication.

Are you splitting the tablets or taking the whole thing?

[realtrade]

Thanks again Barb and Flyingfool. I started taking my synthroid yesterday. Not feeling that much different, I know it takes time for it to get working. But my left knee and left elbow joints are feeling weird. Hard to describe...not really painful but different, and it seems to take place about an hour after i take my 1 pill...and last the whole day, then no weird sensation this morning, then took my med again...and am feeling it again. Never really had joint issues since I'm only 30 fairly active.

As far as dosage is high....I didn't really argue because he didn't even want to talk about different medications or treatment possibilities, like I said earlier it wasn't my first choice of endo, but it was the one without having me wait for 1 1/2 months. He basically said in a hurried fashion that I'm giving you this dosage based on your weight. I am 5'9 and weigh 175lbs. I work out for about an 45 mins a day and watch what I eat. Endo said I'll be dropping weight like hot cakes once the meds fully kick in. I used to be 150lbs. I was expecting to get a clean bill of health when i went in for my checkup for 1st time in 11 yrs. I don't really feel sick, except for the feeling cold if my wife lowers the thermostat to below 77, i just thought i was a person who likes to be warm, and I thought me not losing weight even with diet and exercise was because I wasn't working out hard enough. Mild depression i also just chalked up to that's how I'm supposed to feel. I have been reading up on hashi's and hypo and found out irritability is also  one symptom and my wife pointed out that one right away. Kinda scared in the sense since I've been reading about this condition it seems that alot of people are struggling even after being on meds. When my primary first said I may have hashi , he told me that its no big deal and its easily treatable not curable...but a simple fix. Then why are so many people still struggling and is this what I have to look forward to? I am beginning to think i may have been better off not knowing.

[flyingfool]

Also, some have reported that once you start taking Thyroid meds, the nodules are reduced.  

I forgot to mention that yes starting out at 137 mcg is a high starting dose. It is not terribly surprising for people to be at this rate or even higher.  But usually they start out or not much more than about 50 mcg.

And based upon your FT4 and Ft3 levels seems higher than I would expect you might need even as a final dose.  but everyone is different and I'm not a Doctor so what do I know???

[Barb135]

Yes, 137 mcg is a high starting dose.  It's normally best to start lower and work your way up over a period of time, in order to avoid adverse reactions.  I was started at 25 mcg for 2 weeks, then up to 50 mcg for another 4 weeks, then tested, then up to 75 mcg, etc........  Since your prescription is for 137 mcg, you could split the pills in 1/2 and try that for a couple weeks, just to make sure you aren't going to react; though you should be aware that some people have worse symptoms following the beginning of medication.  That's not the medication causing it, it's your body getting used to having  hormones it hasn't had for a while.

*DO* make sure you get retested every 6 weeks, until your levels have stabilized and symptoms are alleviated.  This will be an adjustment process for you and will require a lot of patience to get things right again.  

Taking it slow and steady will mean it takes longer to feel better, but you get there with a lot less hassles or ups and downs.

Don't worry; you did list the sample results perfectly.  Many labs refer to Free T4 as T4, free, direct (sometimes, you may also see it, especially on this forum) as simply FT4.  Likewise, triiothyronine free, serum is the same as Free T3, which you  may see listed on lab reports as Free T3, T3 free (or particularly on this forum you will see it often as FT3).......

In regards to the FNA, I would hope that some others will chime, because as I said, that's not really in my area of expertise, but I think you'd be safe to wait until you see the other endo in Dec and get his opinion on that, since FNA is usually done on nodules > 2 cm.  

BTW -- I don't think you have to worry about them hitting your jugular; I'm sure they would do an ultra sound guided FNA, and won't even come close........ lol

[realtrade]

Thank you as well flyingfool. Quick follow-up questions, is the 137mcg dosage high for being put on it first time?

I am not a doctor but I play one on tv...always wanted to say that sorry, but seriously since i am not a medical professional I wrote the lab results as they appeared on paper...are those free t3 t4 or did I confuse them...it says T4 free, direct on the paper...is that the right one...it also says triiothyonine free, serum, is that the right one also.

And is a FNA neccessary since like barb said its under 2 cm....some people say its painful others say its not. I'm not so much worried about pain or scared of a needle by any means, but I am worried since its going into my neck. Don't want the endo hitting my jugular or anything.