# Lab results and advice?



## Syferix (Oct 23, 2011)

About a year ago I went to the doctor complaining about fatigue and a multitude of other symptoms. After many tests, they found I had a slight deficiency in b12 and said I may have subclinical hypothyroidism and to come back in a few months for more tests.

Long story short, I ran into financial problems and have only just now gone back for another round of tests that have similar results to the first round.

NSPG-TSH	6.40	(0.50 - 6.00)
NSPG-T4, FREE	0.99	(0.75 - 1.54)

I also had my adrenal gland tested but it is within normal range.

I'm not sure why they didn't test my T3 as well, but I may request it depending on what the doctor says/suggests.

I really think I'm going to push for treatment because of the multitude of symptoms I'm having:
- hunger after eating
- fatigue
- depression
- weight gain 
- irregular periods
- tendency to be cold (though I live in Chicago so we don't have the warmest of climates) 
- brain fog and having a hard time concentrating/organizing my thoughts
- finding myself out of breath doing simple things like climbing a flight of stairs
- dry skin and scalp (could also be climate?)
- nausea, especially in the morning (and no, I'm not pregnant)
- having a hard time waking up in the morning
- tired in the afternoon but more awake at night
- earaches (sometimes, but could also be related to grinding my teeth at night)
- allergies (could be seasonal?)
- queasy, acid-y stomach - I've been taking tums more often recently

I'm 26, female, 5'4" and about 140lbs. I eat pretty healthily and notice most of my symptoms, especially the fatigue, tend to get more noticeable in the winter (though they are still present in the summer). My mom has also been diagnosed with a thyroid problem.

Any advice would be greatly appreciated while I try to sort through everything. Tests I should get done (and economical ways/resources to get them completed as my insurance doesn't cover things), what I should tell my doctor, other things I can try that may help, similar stories/experiences, etc. etc.

Thanks so much!!!


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## lainey (Aug 26, 2010)

That is one of the broadest ranges I have seen for TSH blood work. Typically it goes up to 5.0, but 0.3-3.0 is more commonly recommended.

You are hypo and should be started on thyroid medication with those numbers, especially if you have old labs showing the same.

If money is a concern, you really don't need any other tests to make a diagnosis. T3 is not typically ordered except for specific situations. Antibodies tests are nice but not necessary if your labs are obviously skewed. Both of these add significantly to the cost of thyroid lab work.

A thyroid ultrasound would be worth while. There are certain structures and features that are typical with hypothyroidism, and your gland should be looked at.


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## Andros (Aug 26, 2009)

Syferix said:


> About a year ago I went to the doctor complaining about fatigue and a multitude of other symptoms. After many tests, they found I had a slight deficiency in b12 and said I may have subclinical hypothyroidism and to come back in a few months for more tests.
> 
> Long story short, I ran into financial problems and have only just now gone back for another round of tests that have similar results to the first round.
> 
> ...


I am w/Lainey on this one. Due to financial constraints, I think pushing for treatment and an ultra-sound are in order. Ultra-sound would be the most important thing you could do for yourself to make sure you don't have anything really untoward going on.

Most of us feel best with TSH @ 1.0 or less and the FREES in about 75% of the range given by your lab for these tests.

All the antibodies' tests are nice and they are helpful but they also are expensive. The bottom line is that you need treatment. Lord; I don't think I could walk down to the mailbox if my TSH was that high.

Let us know what you think.


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## Syferix (Oct 23, 2011)

Thank you so much for your advice! It's such a relief to have confirmation that how I feel is not normal.

My doctor has yet to contact me regarding the lab results (they were posted on my online account over the weekend) but when he does I'm really going to push for treatment.

With regards to the ultrasound - is it an expensive procedure? I'll be able to dig into my savings if necessary - nothing more important than your health! I just get nervous regarding tests and lab work, as just to test my TSH and t4 came to $200...

As it is, even though you all recommend the ultrasound, I might hold off for now unless I can convince my insurance to cover it or get financial aid from the hospital or something...


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## lainey (Aug 26, 2010)

The ultrasound would probably be around $300. You should ask. There are 2 parts usually--the ultrasound itself, and the radiologist that reads it and writes the report.

You might be able to negotiate with the lab regarding the price, or do the labs through an online resource . Talk to the doctor about it--they may be able to help you on that one. Different labs also charge different prices. For a thyroid panel and BMP I have had my blood work submitted for about $800 from one lab while others submit it for closer to $300. The lab actually gets paid quite a bit less than that by insurance--why shouldn't you lobby for a discount too?


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## Andros (Aug 26, 2009)

Syferix said:


> Thank you so much for your advice! It's such a relief to have confirmation that how I feel is not normal.
> 
> My doctor has yet to contact me regarding the lab results (they were posted on my online account over the weekend) but when he does I'm really going to push for treatment.
> 
> ...


OMG!! You should have never had to pay that for those 2 labs.

See if you have this in your area..

HealthCheckUSA

http://www.healthcheckusa.com/

And see if you have a clinic in your area..............

find a clinic near you
http://findahealthcenter.hrsa.gov/Search_HCC.aspx (they might do ultra-sound if you can find one)


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## Syferix (Oct 23, 2011)

Thanks so much for that healthcheckusa site! There's a few places near me and the test is only $60!? I feel so ripped off! I had a feeling the lab work was a bit overpriced but by that much?! I'll be sure to get my lab work done through this site from now on, that's for sure!

Any resources on good & affordable doctors in the chicago-land area? I'm pretty sure a consult with my doctor to discuss my results is going to be $200 in itself.... If not, well, at least I'm saving on my lab work.

Also, with regards to medicine... I've read a combination of t4 and t3 replacement tends to work better than just one or the other. What are the different kinds? Brand name vs generic?? Any resources with regards to type of medicine would be awesome as well!

Thanks so much to everyone. I'll be sure to be around this forum for a while as I try to educate myself on this as much as possible.


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## lainey (Aug 26, 2010)

A vast majority of patients do very well on T4 only medication. A patient should really titrate their dose properly on T4 medication before they "assume" that a combination medication would be better. Keep in mind, your thyroid does produce primarily T4, with most of the T3 being converted from that by the cells. A person with a thyroid often does retain some residual function, and they will feel quite well on T4 replacement.

T4 medications are generally inexpensive as a brand name, and even less so if you are willing to try a generic. Branded medications tend to be more consistent and reliable for dosing, with is very critical for some people. Combination medications and T3 medications are more expensive. Additionally, patients who are taking T3 medications are best monitored by having their free T3 measured (expensive test), as these medications distort the TSH and free T4 results. The doctor who prescribes these may have to be a specialist (endo) depending on the attitudes of the doctors in your area.

If money is a concern, a knowledgeable general practice doctor or internist (lower cost office visit) can handle your condition and prescribe the necessary medication. Many thyroid patients are well treated that way. 
Start there and see how you do.


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## Andros (Aug 26, 2009)

Syferix said:


> Thanks so much for that healthcheckusa site! There's a few places near me and the test is only $60!? I feel so ripped off! I had a feeling the lab work was a bit overpriced but by that much?! I'll be sure to get my lab work done through this site from now on, that's for sure!
> 
> Any resources on good & affordable doctors in the chicago-land area? I'm pretty sure a consult with my doctor to discuss my results is going to be $200 in itself.... If not, well, at least I'm saving on my lab work.
> 
> ...


When it comes to thyroid replacement Rx, I am a huge proponent of brand name for best results. By patent law, a generic cannot be the same as the name brand.

What will work best for you is something that you will have to experiment with. Many do well w/T4 only. Most of the folks that don't convert too well are usually those of us who have had complete thyroid removal and we do better on T4/T3 combo. Usually dessicated porcine thyroid.

You will have to play that by ear!


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## Syferix (Oct 23, 2011)

Thanks so much for all the info everyone!!

My doctor's yet to call me about the results, even when I left a message. Hopefully I hear from him soon and can get started on some medicine. My symptoms seem to be getting worse as today I can hardly keep my eyes open I'm so tired!

I'll keep you all posted on it all and again, thank you so much for the info and resources!


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## Andros (Aug 26, 2009)

Syferix said:


> Thanks so much for all the info everyone!!
> 
> My doctor's yet to call me about the results, even when I left a message. Hopefully I hear from him soon and can get started on some medicine. My symptoms seem to be getting worse as today I can hardly keep my eyes open I'm so tired!
> 
> I'll keep you all posted on it all and again, thank you so much for the info and resources!


We will all love to see results and ranges when you get them! Thanx for the update!


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## Syferix (Oct 23, 2011)

Doctor called today and prescribed Levothyroxine 0.025mg (25mcg). I ended up getting a generic as he said so long as I stick with the same manufacturer, I should be fine. The manufacturer of mine is Lannett.

He said that since my t4 is normal, my thyroid is making some of it, hence the low dose. He also said that ideally my TSH should be around 2.5 not the 6.4 that it is.

I'll be starting my first dose tomorrow morning and keep you all posted on how things go!

Few questions though: What type of over the counter medicines interact with this? Ibuprophen? Allergy medicine like clairtin? Cold and Sinus medicines?

Secondly, what about foods? Coffee? And what is considered high-fiber foods? And how much of a concern of having walnuts is?


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## Syferix (Oct 23, 2011)

So I got new labs done on 12/21/11:

TSH 5.63 0.450-4.500 uIU/mL
Free T4 1.24 0.82-1.77 ng/dL

My doctor doubled my doseage and I'm now on .5 micrograms of a generic of synthroid.

HOWEVER, I've been feeling all my symptoms again. When I was on the .25 for the first month or so I was feeling amazing! Tons of energy and a normal sleep schedule etc. etc.

Now, I'm so exhausted I can barely get out of bed and I daresay it's worse than before I started my thyroid medicine at all! The worst part of it is I have another two months before I can get my labs done again.

Is this a normal part of the process? I would think doubling my dose would have a positive effect, not a negative one! Any advice or info on this would be very appreciated. I'm curious if I should call and discuss this with my doctor, though I fear he won't want to change my dose until I hit the 3mo mark and get my tests done...

Also, I still haven't gotten my period while being on this medicine. Is this something I should be concerned about or will it work itself out eventually? Should I call my gynecologist or doctor to discuss?


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## Andros (Aug 26, 2009)

Syferix said:


> So I got new labs done on 12/21/11:
> 
> TSH 5.63 0.450-4.500 uIU/mL
> Free T4 1.24 0.82-1.77 ng/dL
> ...


Firstly a look at the generic Synthroid. Secondly, how is your ferritin? Low ferritin can impede the efficacy of your thyroxine replacement.

Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)

Thirdly, I am wondering why your doctor is not interested in getting your TSH down around 1.0 to 2.0 so that you feel better.

And has your doctor ever run the FREE T3 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=2#diagnosis: standard laboratory test

You are in a very bad place and it would appear your doctor intends to keep you there.

The above is humble opinion only!


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## Syferix (Oct 23, 2011)

My doctor said the generics are just as good, and I know my manufacturer hasn't changed... The only thing that changed is the dose.

My doctor _does_ want my TSH lower, hence the larger dose, but from my understanding this needs to be done slowly?

I'll check my iron, or maybe just start taking supplements because that could be a factor.

And I think got my free t3 tested a while ago but this current lab I think I only got free t4. I get my labs through Healthcheckusa so next round I'll be sure to get free t3 as well.

I might call my doctor this week and see if there's anything else I can do. Thankfully my boss at work is very understanding of the matter so she doesn't mind if I'm a few minutes late from being so sluggish in the morning!


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## Andros (Aug 26, 2009)

Syferix said:


> My doctor said the generics are just as good, and I know my manufacturer hasn't changed... The only thing that changed is the dose.
> 
> My doctor _does_ want my TSH lower, hence the larger dose, but from my understanding this needs to be done slowly?
> 
> ...


You are correct; labs every 8 weeks and then titration of med as indicated until you feel well (euthyroid.)

Let us know; it is no fun to feel sluggish every day. 
We can all identify w/that!


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