# Which lab tests?



## TBRaysgrl3 (May 28, 2013)

I was just diagnosed with Hashimoto's Thyroiditis a few weeks ago and started on 50 mcg of levothyroxine. Just got the doc's order for my next round of labs in the mail (to be taken at the 1 month mark) and he has only ordered TSH and Free T4 be tested. From reading these boards, it seems like I should ask if he will order Free T3 tested too. My labs that prompted being put on meds had my TSH at 42.82 (0.4-4.5 range) and Free T4 at 0.8 (0.8-1.8 range). So, obviously we are trying to get my TSH down to a normal level. Also, it's worth noting that my symptoms have been waaaaay worse since starting the levothyroxine. What else should I be having tested at this point to make sure I am getting the proper treatment?

This is all still so new to me, so any advice from those experienced in dealing with this disease would be greatly appreciated!


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## sjmjuly (Mar 23, 2012)

Alot of the time you feel worse before you feel better, and it can take WEEKS. There is no quick fix when it comes to your thyroid. I am STILL struggling with meds and I was diagnosed two years ago. 
You should also have your Free T3 tested and what about your antibodies (TPO)? I assume this was already done? If not, you need that too and you should have an ultrasound as well. 
Wow. TSH of 42.82? I would be a walking zombie.


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## joplin1975 (Jul 21, 2011)

Yes, definitely get those antibodies tested. Will you be having an ultrasound?


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## TBRaysgrl3 (May 28, 2013)

I did have the antibodies tested and an ultrasound. That is how the doctor confirmed the Hashimoto's diagnosis, but I don't have those results yet myself (waiting for copies). Besides TSH, FT4 and FT3, are there any other tests I should be getting as part of the routine labs to make sure the meds are working? How long does the whole titration process last for most people? I really don't want to wait months and months, especially as I am starting to have symptoms of an "episode"/flare up ( as I do at least once a year) with numbness and tingling in arms and legs, cramps in my calves, insomnia, etc.. I still have a couple weeks til I see my doc next and have so many questions!

Yes, sjmjuly, I've been taking A LOT of naps (and I never even took naps as a little kid!). My TSH jumped that high, up from 6.0, in just 6 months. But I've felt exhausted every day for the last 4 years, so I'm afraid I'm one of those people who want the meds to start working like yesterday. I'm so glad I found this group because it's nice to finally have people who understand!


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## bigfoot (May 13, 2011)

I think TSH, Free T4, and Free T3 are pretty good for the titration process. If you can bend your doctor's ear, you might ask for Reverse T3 to be tested as well. Reverse T3 blocks the Free T3 from being absorbed and used.

It can take in the neighborhood of 6-8 weeks for T4 medication (levothyroxine) that you are taking today to soak in, so to speak. The half-life of T4 is measured in weeks, while the half-life of T3 is measured in hours and days. But, that being said, with a TSH like yours so high (42... wow!) it is going to take time for your body to adjust. It can be a bit of a roller-coaster in the meantime. Hormones affect people mentally, physically, and emotionally.

Your doc may or may not have a good bedside manner or be a good listener. Hopefully they are. But many docs will act as though problems from thyroid hormones are almost just a myth, or that patients are making it up. I had a weird rash all over my inner arms for a few months. No doc could figure it out. Then I started T4 meds., and just like magic, the rash was gone within days. Sometimes that's how these signs and symptoms will play out.

And do yourself a favor, be sure to get routine lab work and push for additional titration until not only the labs look good, but you also FEEL good. I made the mistake of not knowing anything about thyroid stuff and was initially on a 50 mcg dose of generic levothyroxine for over a year. Whoops.

With the medication that you are taking, you might want to push for brand-name only. Generics tend to come from different manufacturers and can vary in potency by 10%. By taking a brand-name product (Synthroid, Levoxyl, etc.) you can get a little more consistency. Levoxyl is presently under a recall, but is supposed to come back to the market in 2014.

Here's some tips:
* Take your medication at the same time.
* You can take it at night, around bedtime if you like. It is more potent this way. The only reason they tell people to take it in the morning is for compliance.
* Don't take it within a few hours of anything with calcium, including supplements or food.
* Stay away from soy and goitrogenic veggies (broccoli, cabbage, cauliflower, etc.). If you are going to eat them, be sure they are cooked.
* Consider going gluten-free. Gluten can be nasty stuff, and it's in darn near everything.
* If you eat a lot of fiber, you may wind up needing a little more medication because thyroid medication is absorbed in the GI tract. More fiber leads to faster clearance of the meds.

If T4-only medication doesn't do it for you, you might want to ask for adding in a little T3 from Cytomel (synthetic), or switch over to a natural desiccated product that has both T4 and T3 in it (Armour, Nature-throid). But I would try the T4-only medication first and see where that gets you.

Folks here mention wanting to get your TSH to around 1.0 or less, and getting your Free T3 and Free T4 to the ~75% area of their ranges. That's a good long-term goal to work at, but it will take time. Think of it as a journey, not a race, LOL.

hugs6


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## TBRaysgrl3 (May 28, 2013)

Thanks for the tips bigfoot!


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## bigfoot (May 13, 2011)

More than welcome! Honestly, I suspect you will start seeing things moving in a positive direction in sooner than 6-8 weeks. Besides getting and keeping a copy of all your labs, you may wish to keep track of other things, too. I have a spreadsheet where I track changes I notice, weight fluctuations, daily temperatures, and blood pressure / pulse. Taken on their own, they don't account for much, but if you look at a few months' worth of data, you can see upwards or downwards trends, which can give some clues if you are heading in the right direction.

There are varying ideas out there on the temperature-measuring bandwagon. Some docs (Dr. Broda Barnes, I believe) advocated taking a basal temp. immediately upon waking. Others suggest taking a temp. three times a day (9 a.m., 12 noon, 3 p.m.) and averaging them together. The idea is still the same -- if you are consistently seeing readings in the 96.x and low-to-mid 97.x (degrees F) ranges (especially if averaged for the day), it can suggest that you are leaning towards the hypo side of things. Likewise, if you feel all ramped up, your pulse is soaring over 100 bpm just sitting around watching TV, and you feel like you are burning up with high temps., you could be over-medicated or going through a hyper phase.

End result? I think thyroid and hormone management is part art, part science.


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## Andros (Aug 26, 2009)

TBRaysgrl3 said:


> I was just diagnosed with Hashimoto's Thyroiditis a few weeks ago and started on 50 mcg of levothyroxine. Just got the doc's order for my next round of labs in the mail (to be taken at the 1 month mark) and he has only ordered TSH and Free T4 be tested. From reading these boards, it seems like I should ask if he will order Free T3 tested too. My labs that prompted being put on meds had my TSH at 42.82 (0.4-4.5 range) and Free T4 at 0.8 (0.8-1.8 range). So, obviously we are trying to get my TSH down to a normal level. Also, it's worth noting that my symptoms have been waaaaay worse since starting the levothyroxine. What else should I be having tested at this point to make sure I am getting the proper treatment?
> 
> This is all still so new to me, so any advice from those experienced in dealing with this disease would be greatly appreciated!


Somewhere along the line, you do need FREE T3 but it is early in the game here and until that TSH comes way down and the FT4 goes up where it should be, it is not necessary.

Your goal would be to get your FREE T3 at about 75% of the range provided by your lab. So....................as I say, somewhere along the line you will need to get it to know where you are at. FREE T3 is a good "fine tuning" tool.

Here is info and most certainly get the FREE T3 if you would like a current "baseline."

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.


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