# Help with first labs after TT



## sunshinie (Sep 8, 2011)

Hi! I'm new to labs....had a TT 9 weeks ago for pap thyroid cancer. Had blood work done a few days ago and got a copy of my results in the mail yesterday. Endo called to say I need to come in on Tuesday to go over everything in person. Of course, I've been researching, and I realize the higher TSH means I'm hypo and Synthroid should be increased (no surprise, considering how I've been feeling), but I'm not sure about the others:

PTH, Calcium, Albumin & T4 Free are all in range
TSH, 3rd gen 8.05 H
T3 Free 2.2 L
Thyroglobulin panel 2.2 L
Thyroglobulin <0.2 L

Any insight would be appreciated! Thank you!


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## Octavia (Aug 1, 2011)

sunshinie, welcome to the forum!

You are correct about the TSH being too high, and they should increase your Synthroid. For post-cancer, the goal is for your TSH to be close to zero ("TSH suppression").

Do you have the ranges for your lab results? That will be helpful as we look at how to interpret them.


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## northernlite (Oct 28, 2010)

High TSH and low FT3 both tell you that you are undermedicated. Get that increase and start to feel better!!


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## webster2 (May 19, 2011)

Hi Sunshine, 
I had a thyroidectomy 9 weeks ago for papillary cancer too. Seems to be the trend, doesn't it?!?! I think few people hit the mark with the correct dose right off. Hope they will increase your dosage, slowly, to get you feeling much better.  Welcome!


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## Andros (Aug 26, 2009)

sunshinie said:


> Hi! I'm new to labs....had a TT 9 weeks ago for pap thyroid cancer. Had blood work done a few days ago and got a copy of my results in the mail yesterday. Endo called to say I need to come in on Tuesday to go over everything in person. Of course, I've been researching, and I realize the higher TSH means I'm hypo and Synthroid should be increased (no surprise, considering how I've been feeling), but I'm not sure about the others:
> 
> PTH, Calcium, Albumin & T4 Free are all in range
> TSH, 3rd gen 8.05 H
> ...


In the future, we sure would appreciate the ranges also as different labs use different ranges.

I am so sorry for what you have been through here but what I do see is that the Thyroglobulin is very very low which is an excellent sign for when cancer is afoot in the thyroid gland, Thryoglobulin can raise sky high which is an indication and Thyroglobulin Ab are in the picture as well.

We are supposed to have small amounts of Thyroglobulin and NO Thyroglobulin AB.

Henceforth, this will be used as a "marker" to detect whether the cancer has come back or not.

How much Synthroid are you on now and when did you start taking it? Yes; you will need more Synthroid for sure.

It is very very important to keep your TSH suppressed now. This also helps to keep the cancer from coming back.

Your Free T3 is your active hormone so somewhere along the line you may end up a candidate for Armour (porcine T4/T3) or Cytomel (Synthetic T3) if it turns out you are not converting well.

And frankly, most of us w/o a thyroid do not convert well.

Here is some info for you.

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.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.htm

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

I know the above is a lot to read but I do sense that you are interested in knowing this stuff.

How is the incision site doing and aside from being really hypo, are you hanging in there?


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## sunshinie (Sep 8, 2011)

Thanks so much for the prompt responses! I really appreciate each of them. 

They started me on 100mcg, which is what I'm currently on. I take 1800 mg calcium throughout the day as well - and am careful to wait 4 hrs before/after Snythroid. I'm happy to know I just need an increase in Synthroid and *should* be feeling better soon!

Here are the #'s with ranges included (Siemens chemiluminescent method):

PTH, Calcium, Albumin & T4 Free are all in range
PTH, intact parathyroid hormone 12 - range 10-65 pg/mL
TSH, 3rd gen 8.05 H - Range: .40-4.5
T3 Free 2.2 L - Range: 2.3-4.2 pg/mL
Thyroglobulin <0.2 L - Range: 2.0-35.0 ng/mL
(specifically, I wasn't sure what low in this area means? I'm guessing that's good?)

I've read a bit about Armour; is that something the Endo would bring up based on labs, or something I should question? Thanks again everyone!!


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## Andros (Aug 26, 2009)

sunshinie said:


> Thanks so much for the prompt responses! I really appreciate each of them.
> 
> They started me on 100mcg, which is what I'm currently on. I take 1800 mg calcium throughout the day as well - and am careful to wait 4 hrs before/after Snythroid. I'm happy to know I just need an increase in Synthroid and *should* be feeling better soon!
> 
> ...


Low is very good on the thyroglobulin. Yes, indeed; you understand correctly.
Now...............since you are on 100 mcgs. of Synthroid already and if your labs have not improved i.e. the TSH (H) and the FREE T3 (L, very low), I would suspect that you would do better on Armour.

Here is info.

http://www.frx.com/pi/armourthyroid_pi.pdf

You would have to start on a low dose (about 1/2 grain, 30 mgs.), get labs every 8 weeks and get increase by 1/4 grain (15 mgs.) and do this every 8 weeks until you feel tip top.

Then quarterly labs and adjustment if needed about every 3 months.

It is worth it to do this slowly; it ensures a very high success rate.

Thank you soooooooooooooooooooooo much for adding in the ranges. They are most helpful.


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## sunshinie (Sep 8, 2011)

Thanks again! You've been so helpful!

Other than the hypo symptoms that are making me miserable, I'm doing very well! I had a left thyroidectomy in May, that came back showing pap carcinoma (original biopsy results showed a follicular neoplasm, but couldn't determine whether it was cancer or not). Second, completion surgery with neck dissection was on July 25, and that went very well also. I was a little worried about the incision, having two surgeries in such a short period of time, but it looks great! We decided not to do RAI right now since everything looks so good - but the option is always there if we need to explore it in the future, so that makes me feel good.

I will be good as new as soon as they regulate my meds better. I'm tired of being tired.

I've been reading through posts here and it's comforting in a way to know there are so many others going through the same thing.


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## Andros (Aug 26, 2009)

sunshinie said:


> Thanks again! You've been so helpful!
> 
> Other than the hypo symptoms that are making me miserable, I'm doing very well! I had a left thyroidectomy in May, that came back showing pap carcinoma (original biopsy results showed a follicular neoplasm, but couldn't determine whether it was cancer or not). Second, completion surgery with neck dissection was on July 25, and that went very well also. I was a little worried about the incision, having two surgeries in such a short period of time, but it looks great! We decided not to do RAI right now since everything looks so good - but the option is always there if we need to explore it in the future, so that makes me feel good.
> 
> ...


It is good we have folks here with whom you can share experiences, information and commiseration! However, I am perpetually startled and concerned that we do in fact have so many w/cancer.

That worries me a lot.


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## sunshinie (Sep 8, 2011)

Hi! I just wanted to follow-up and post how my appt went: My endo increased Synthroid from 100 mcg to 150; she said I should start feeling better in a few weeks, with a noticeable improvement in 5-6 weeks.

I asked her about Armour; she said she doesn't prescribe it, mainly because it's difficult to get a true reading of what's going on with your bloodwork since there are such high & low spikes throughout the day. She said most patients she knows who are on it, swear by it; but feels it makes her job of monitoring and controlling things more guesswork. It was an interesting conversation. I will certainly bring it up again in the future if I feel Synthroid alone is working as it should - so thanks for the information!


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## Andros (Aug 26, 2009)

sunshinie said:


> Hi! I'm new to labs....had a TT 9 weeks ago for pap thyroid cancer. Had blood work done a few days ago and got a copy of my results in the mail yesterday. Endo called to say I need to come in on Tuesday to go over everything in person. Of course, I've been researching, and I realize the higher TSH means I'm hypo and Synthroid should be increased (no surprise, considering how I've been feeling), but I'm not sure about the others:
> 
> PTH, Calcium, Albumin & T4 Free are all in range
> TSH, 3rd gen 8.05 H
> ...


Having survived cancer, you always want the Thyroglobulin to be low low. So you are good in that department. Thyroglobulin will now be used as a marker to make sure you are cancer free.

You know doubt need an increase in Synthroid. How much are you on now? I am sure doc will slowly titrate you upward about every 8 weeks until you feel good and with cancer, the TSH has to be suppressed.

Actually, your numbers while not just right yet.....................look good for just 9 weeks out.

Small amounts of thyroglobulin are normal in those with normal thyroid function. If thyroglobulin concentrations are initially elevated in a person with thyroid cancer, then it is likely that thyroglobulin can be used as a tumor marker. Thyroglobulin levels should be undetectable or very low after the surgical removal of the thyroid (thyroidectomy) and/or after subsequent radioactive iodine treatments. If levels are still detectable, there may be normal or cancerous thyroid tissue remaining in the person's body, indicating the need for additional treatment.

http://labtestsonline.org/understanding/analytes/thyroglobulin/tab/test

How are you feeling? How is the incision site?


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