# New Labs please advise????



## Catie516 (Mar 18, 2011)

Hi, had the lab results from 3 weeks ago come in and talked to the new doc (endo).

Thyroxine (T$) Free, Direct, S T4, Free (Direct) : 1.29 (0.82 - 1.77)
TSH 3.150 (.450 - 4.500)
Vitamin D, 15- Hydroxy 41.8 ng/mL: 32.0 - 100.0
T3 83 ng/dL :71-180
TPO Ab <6 IU/mL : 0-34
Testosterone, Free/Tot 314 ng/dL : 193-740
Triiodothyonine (T3) 99 : 71-180

Doc said there was a small nodule, under what they would normally worry or do anything about (ultrasound response - didn't get a copy of the results, darn!)

What would be your views???? Only my second visit to this doc, but wanted to rule out complications of the hypothyroidism.

Thanks much for your help!

I've noticed more carpal tunnel type pains in my wrists, shoulder, bones, rough heels, tiredness and gained 4 pounds in the last 3 weeks - so when she asked if I felt fine at the 50 I said no - so she upped it to 75 mcg or whatever the measurement is.


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## Andros (Aug 26, 2009)

Catie516 said:


> Hi, had the lab results from 3 weeks ago come in and talked to the new doc (endo).
> 
> Thyroxine (T$) Free, Direct, S T4, Free (Direct) : 1.29 (0.82 - 1.77)
> TSH 3.150 (.450 - 4.500)
> ...


Free T3 is below the mid-range (1.25) of the range given by your lab. So I don't view that as being good. No wonder your TSH is so high. Most of us target 1.0 or less for TSH and FREE T3 at about 3/4 (about 2.25 give or take a bit) of the range given by your lab.

Free T3 is your active hormone and no wonder you have carpal tunnel. (peripheral neuropathy, myopathy)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010480/

I urge you to get a copy of the results on that nodule. Even though it is small, you need to know what the radiologist had to say and what the follow-up advice is. It should be written on the report. For example, is the nodule solid, calcified, cystic................................what?? She may not be worried but it's not her nodule. So, you need to know.

And I need to know. LOL!

I am glad she increased your dose. You need it.


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## Catie516 (Mar 18, 2011)

Andros, again, thank you for your help!

I am wondering if I am at the right doc??? The only reason she upped the Synthroid is my saying I wanted it upped (she agreed with me when I said I wanted it upped but it wasn't her telling me to up it first!) - and she didn't say anything at all about the T3!

Is Synthroid able to get me to the lower values of TSH w/o some other med to up the T3????

I will ask for a copy of the ultrasound report. I don't want to be a doc junkie but want to get on the right road as soon as possible w/o burning my insurance co with 2nd and 3rd and 4th opinions!

I am feeling like even though she didn't argue with me when I said I was told by my oncologist NOt to take estrogen,progesterone, testerone supplements b/c of the breast cancer, and that although she was agreeable to up the synthroid, agreed that it needs to be lower values .....but that she should have upped the synthroid herself b/c of the T3!!! She seemed more concerned that the glucose rose to 120 (last blood work had it at 109 and previous at 90 something) than the thyroid stuff including the nodule. I think the majority of her business is diabetes!

Whew - that was hard for me to even THINK much less write or read! You truly are a godsend!

Okay, short question for those weary of the above: am I going in the right direction with a doc who is letting me 'steer' the ship instead of her steering it herself???

Is elevated glucose a symptom of hypo?

Thanks much!!! :hugs:


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## Andros (Aug 26, 2009)

Catie516 said:


> Andros, again, thank you for your help!
> 
> I am wondering if I am at the right doc??? The only reason she upped the Synthroid is my saying I wanted it upped (she agreed with me when I said I wanted it upped but it wasn't her telling me to up it first!) - and she didn't say anything at all about the T3!
> 
> ...


It most certainly can do the job. Many folks convert very well and that TSH comes right down. Heretofore, you were on 50 mcg. and doc just raised you to 75 mcg.. So, in 8 weeks, you should know more by getting labs.

If you agree with my suggested targets of TSH @ 1.0 or less and FREE T3 in the 75% of the range; talk to your doc and get her to agree with this. If she does not, find a doctor who does.

One way or the other, you need to get to where you are going.

And elevated glucose can be a symptom as well as elevated BP, Cholesterol and enlarged red blood cells. A whole bunch of stuff!


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## Catie516 (Mar 18, 2011)

Also, she didn't mention anything about the Vitamin D. My major concern was to find out if I have hashimotos, cancer or just plain average garden variety hypothyroid! She said I didn't have hashimotos, didn't think the nodule was cancer and didn't know why I had hypo. When I offered 'could it be from radiation and chemo in '95' she said it might be.

Is it normal to NOT know where this comes from and to be okay with not knowing? As you can see from my posts - it seems like I get 'spooked' around the time I go to the doc then I lay low just trying to get on with life! So sorry to annoy if I am annoying anyone!

Thanks much


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## Catie516 (Mar 18, 2011)

Ooops, one more quick question??? The reason I asked about Vit D is that the gp told me to go UP with D (without testing me) however, I take quite a bit of calcium to help my osteoporosis (side effect of chemo) and didn't want to take another supplement (the magnesium in D is horrible for my IBS) unless I had to. The doc was 'rushed' yesterday so I wasn't able to discuss the Vitamin D with her. At this point I am not taking extra D outside my Citrical. Are the values shown on my labs for Vitamin D low or normal???

I had read that Vitamin D is not good for hashimotos - but the doc said I don't have that anyway, so do I just grin and bare it and up the D b/c of my labs or just do as I am w/o upping the D???

How about I turn my computer off so I won't send another message??? I am sooooo sorry for being a pest!


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## Andros (Aug 26, 2009)

Catie516 said:


> Also, she didn't mention anything about the Vitamin D. My major concern was to find out if I have hashimotos, cancer or just plain average garden variety hypothyroid! She said I didn't have hashimotos, didn't think the nodule was cancer and didn't know why I had hypo. When I offered 'could it be from radiation and chemo in '95' she said it might be.
> 
> Is it normal to NOT know where this comes from and to be okay with not knowing? As you can see from my posts - it seems like I get 'spooked' around the time I go to the doc then I lay low just trying to get on with life! So sorry to annoy if I am annoying anyone!
> 
> Thanks much


If you really really want to sort the wheat from the chaff; these antibodies' tests will do that. And it would be a good idea anyway with that nodule to get the Thyroglobulin and Thyroglobulin Ab.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

All of the above are indigenous to genetically inherited autoimmune disease and a few are specific to the thyroid where the others are "suggestive."

This way, you won't have to wonder.


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## Catie516 (Mar 18, 2011)

Andros, okay, thanks so much!!! I thought I was getting those tests you mentioned by asking her for a thyroid panel - I guess I need to specifically ask!!!

So, my game plan (and thank you for getting me to this point) is to:

take my Synthroid 75 mcg from now until my next appt and see how it is working getting my T3 to where it needs to be or closer to it, as well as my TSH at or below 1

Get her to order the labs you suggested

See if she is on the same page as the Free T3 and TSH

If none of the above work, on to the next best doc/endo I can find!!!

At this point I'm not going to worry about adding back the vitamin D.

Thanks again so much!!!


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## Andros (Aug 26, 2009)

Catie516 said:


> Ooops, one more quick question??? The reason I asked about Vit D is that the gp told me to go UP with D (without testing me) however, I take quite a bit of calcium to help my osteoporosis (side effect of chemo) and didn't want to take another supplement (the magnesium in D is horrible for my IBS) unless I had to. The doc was 'rushed' yesterday so I wasn't able to discuss the Vitamin D with her. At this point I am not taking extra D outside my Citrical. Are the values shown on my labs for Vitamin D low or normal???
> 
> I had read that Vitamin D is not good for hashimotos - but the doc said I don't have that anyway, so do I just grin and bare it and up the D b/c of my labs or just do as I am w/o upping the D???
> 
> How about I turn my computer off so I won't send another message??? I am sooooo sorry for being a pest!


Exogenous Vitamin D can trigger antibodies. Why don't you make sure you sit in the sun for about 15 minutes every day when the sun is out? I am outside all the time and my D is good.

Vitamin D
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

Also, I make sure I eat foods high in D.

http://www.healthaliciousness.com/articles/high-vitamin-D-foods.php

You definitely are not a pest to me; that is for sure. If you were, I would have no business doing what I am doing.

I am on a mission!!


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## Catie516 (Mar 18, 2011)

Andros, I'm sitting here and trying to figure out this lab report. I went into the newbie section to bone up more on the labs and what they mean! I am trying to get a grip on T3 and what it means as well...........so remembering yesterday that the doc said I had high Testosterone and wondering if I had included the 2nd page of results and if they had the thyroid panel included.

Actually when the doc said I had HIGH testosterone I was floored and wondered if I'd be growing a mustache soon!!! I told her I was surprised by that and that I was told I was estrogen depleted by my gyn doc (had hysterectomy when I was 37 b/c of big babies)...........high testosterone! Good grief!!!

Then I looked at the labs on the T3 and they were different than on page 1 - wondered why I would have two T3 results...................THEN I looked at the other info on page 2 (a smaller amount of results) and realized that I had a 61 year old MALE report - HIS T3 is 99 (range 71-180) and mine is 83 (71-180)..............do you think I should find him and tell him about this site???

What a hoot!!!! And, no, the glucose of 120 (65-99) is still mine (darn!)

I am at peace with docs making mistakes, even nurses, but could they please make them with someone else??? (and none of us!!!)


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## Andros (Aug 26, 2009)

Catie516 said:


> Andros, I'm sitting here and trying to figure out this lab report. I went into the newbie section to bone up more on the labs and what they mean! I am trying to get a grip on T3 and what it means as well...........so remembering yesterday that the doc said I had high Testosterone and wondering if I had included the 2nd page of results and if they had the thyroid panel included.
> 
> Actually when the doc said I had HIGH testosterone I was floored and wondered if I'd be growing a mustache soon!!! I told her I was surprised by that and that I was told I was estrogen depleted by my gyn doc (had hysterectomy when I was 37 b/c of big babies)...........high testosterone! Good grief!!!
> 
> ...


OMG!!! Geez; I wonder if the gentleman even got his lab results?

Okay.

Thyroid 101 coming up.

Total (T3, T4) means exactly that. TOTAL T4 is bound and unbound hormone, T3 is bound and unbound plus rT3. So.....................it would be anybodies' guess as to how much unbound hormone you have when they do the totals. The unbound hormone is your active hormone.

FREE T3 and FREE T4 is unbound hormone only which is available for cellular uptake. Your FREE T3 is your active hormone.

Free T3 is often referred to as Triiodothyronine

Here is some "stuff!"

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid

http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

Free T3 etc. 
http://www.thyroid-info.com/articles/freet3woliner.htm

Then you have your T3 uptake which is not T3 at all but is protein. Sometimes it is helpful if the numbers are startling.


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## Catie516 (Mar 18, 2011)

Andros, knowing that I might have skewed the lab results by quickly typing them yesterday, I decided to do a complete (my labs this time, not HIS - poor guy!)

Complete Metabolic Panel (14) 
Glucose Serum	120	mg/dl	65-99

Bun 11	mg/dl	8-27

Creatinine, Serum	0.73	mg/dl	.057-1.00

eGFR 88	ml/min/1.73	>59

BUN/Creatinine Ratio 15 11-26

Sodium, Serum 139	mmol/L	135-145

Potassium, Serum 4.2	mmol/L	3.5-5/2

Chloride, Serum 103	mmol/L	97-108

Carbon Dioxide Total 25	mmol/L	20-32

Calcuim, Serum 9.7	mg/dl	8.6-10.2

Protein, Total Serum 6.7	g/dl	6.-8.5

Albumin, Serum	4.2	g/dl	3.6-4.8

Globulin, total	2.5	g/dl	1.5-4.5

A/G Ratio	1.7 1.1-2.5

Bilirubin Total	0.4	mg/dl	0.0-1.2

Alkaline Phosphatase, S	86	IU/L	25-165

AST (SGOT)	29	IU/L	0-40

ALT (SGPT)	24	IU/L	0-40

Thyroxine (T4) Free, Direct, S 
T4, Free (Direct)	1.29	ng/dl	0.82-177

TSH 
TSH	3.15	uiu/ml	0.450-4.5

Vitamin D, 25-Hydroxy 
Vitmain D, 25 Hydroxy	41.8	ng/ml	32.0-100.00
"Recent studies consider the lower limit of 32.0 ng/ml to be the threshold for optimal health.

Triiodothyronine (T3) 83	ng/dl	71-180

Thyroid Peroxidase (TPO) Ab <6	iU/mL	0-34

When I asked her to run my thyroid panel it seems like it was not done??? The metabolic panel was 'complete'???? Is this just endo procedure or did I miss the boat in asking for the complete Thyroid panel?

So it seems that we don't know if my T3 is out of whack at this point????

I raised 4 kids, have started and run several business ventures, but feel like a dunce regarding thyroid!!!!

Does this lab suggest any other thyroid abnormalities? In light of the fact the doc thought I had the testosterone of a 61 year old male and that the thyroid panel doesn't seem to be here - I'm a little skeptical at this point. However I don't think the Synthroid 75 mcg is a wrong path, so will go that route and hope for the best - no, make that PRAY for the best (smile).

Thanks again. you have no idea how helpful you've been (and patient!).

It appears patients are so much in a 'quick revolving door' when they finally see the doc that so many questions or concerns are left unaided!!!


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## Andros (Aug 26, 2009)

Catie516 said:


> Andros, okay, thanks so much!!! I thought I was getting those tests you mentioned by asking her for a thyroid panel - I guess I need to specifically ask!!!
> 
> So, my game plan (and thank you for getting me to this point) is to:
> 
> ...


You are very welcome and together, we may have devised a most sensible and operable plan. Now let's hope the doctor agrees.


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## lainey (Aug 26, 2010)

A couple of things.

You have the results for a standard thyroid panel. The antibodies are not part of it, they have to be requested individually usually. The doc doesn't need to run the antibodies unless a diagnosis is being made. If your numbers were hypo with out running them, the doc may assume they are there--they are really of most help in diagnosing people for whom TSH tests fall into the normal range. At that point, if they are present, they might elect to treat.

The presence or absence of antibodies does not affect the course of treatment--ie, you take the same drug if you have them or if you don't, as long as your thyroid is malfunctioning. So as to your question of "where did this come from?" it matters to your treatment very little from the doctor's perspective--it's here, they treat it. If you ask for these tests, it is for your information only, it really doesn't affect the outcome of your diagnosis much (you're still hypo) or the medication you take (it's still T4). It is not uncommon for thyroid dysfunction to be the result of cancer treatment. From your history, the doctor may not have felt a need to go any further than that.

>>I am wondering if I am at the right doc??? The only reason she upped the Synthroid is my saying I wanted it upped (she agreed with me when I said I wanted it upped but it wasn't her telling me to up it first!) - and she didn't say anything at all about the T3!<<

Most docs don't run the free T3 (and you didn't get that--"Triiodothyronine (T3) 83	ng/dl	71-180"--it looks like you have a total, which really isn't revealing) for their patients on T4 meds--they often don't feel it is material to the patient's treatment. In your case, your labs are in range, so your doc isn't going to volunteer to increase your meds unless you are complaining of symptoms.

If the vitamin D is at that level with the Citrical, you probably don't need to add more. This is a stored vitamin, and too much can be toxic. You are at a decent level now, you just want to keep it there.

Lastly, re: the glucose. Was it a fasting number? If it was not a fasting number, don't worry too much--any food you had shortly before the test can do that to the number. If it was a fasting number, and A1c should be part of your lab work the next time. The A1c gives the average of your blood glucose of a 3 month period prior to the test, and is considered a most accurate picture of the status of your glucose metabolism. In the meantime, anything that you can do to modify your carb intake and increase your exercise level will have a good impact on that.


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## Andros (Aug 26, 2009)

Catie516 said:


> Andros, knowing that I might have skewed the lab results by quickly typing them yesterday, I decided to do a complete (my labs this time, not HIS - poor guy!)
> 
> Complete Metabolic Panel (14)
> Glucose Serum	120	mg/dl	65-99
> ...


Oh, your FREE T3 is below the mid-range. Mid-range of your lab range given would be 1.25. Most of us here would consider that to be very low. You have to be lagging around. You cannot have much energy.

Your doc did run the normal thyroid panel plus one antibody.

TSH, FREE T3, FREE T4 are considered the normal panel. You got lucky he did the FREES.

Most would run the TSH, T4 and T3 (totals)


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## Catie516 (Mar 18, 2011)

Thanks, Andros about the sitting in the sun, however my dermatologist says I have to have SPF 50 or higher sunscreen b/c my family history of melanoma, and other skin cancers (dad had 3, I've had basal and squamish, brothers have had the same as me)(red headed, fair skin, geen eyes). Will Vitamin D get through the sunscreen???

I actually think I'm getting enough with the Citrical with D.

Have a great weekend!


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## Andros (Aug 26, 2009)

Catie516 said:


> Andros, knowing that I might have skewed the lab results by quickly typing them yesterday, I decided to do a complete (my labs this time, not HIS - poor guy!)
> 
> Complete Metabolic Panel (14)
> Glucose Serum	120	mg/dl	65-99
> ...


If not for Lainey, I would have never noticed that the ranges are the same for the T3 and the Triiodothyroinine (http://en.wikipedia.org/wiki/Triiodothyronine) so something is very very wrong here.

For that reason, I must pretty much cancel my opinion which has to be in error due to this mistake.

Can you please check your labs and when you do; only post your TSH, FREE T4 and FREE T3 ( Triiodothyroinine ) with the ranges so that I and others can reassess?


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