# Labs make me feel mismanaged



## Snickers (Jan 19, 2013)

I'm a 50 y/o male, 5'10" 240#s (gained 30# in the past year). I've never been to an endocrinologist and have had three different primary care docs in the past 15 years who have done nothing other than test my TSH, T4 &T3, and prespribe me thyroid replacement medication. I have no idea why I have hypothyroidism and have never been tested beyond the basic lab work.

I have symptoms of being hypo like feeling tired all the time and have gained a lot of weight in the past year. I currently take 175mcg of Levothyroxine and recently had the following lab results:

TSH 12.91 (0.30-3.00)
T4, Free 0.92 (0.58-1.84)
T3, Free 2.83 (2.5-3.9)

Could the solution to my fatigue, etc. be as simple as increasing my Levothyroxine? I think I already take a fairly high dose. Are there better thyroid replacement medications I should be considering? Should I go to an endo instead of my GP? Are there other tests I should be asking for?

Any and all thoughts or follow-up questions would be appreciated.


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## Andros (Aug 26, 2009)

Snickers said:


> I'm a 50 y/o male, 5'10" 240#s (gained 30# in the past year). I've never been to an endocrinologist and have had three different primary care docs in the past 15 years who have done nothing other than test my TSH, T4 &T3, and prespribe me thyroid replacement medication. I have no idea why I have hypothyroidism and have never been tested beyond the basic lab work.
> 
> I have symptoms of being hypo like feeling tired all the time and have gained a lot of weight in the past year. I currently take 175mcg of Levothyroxine and recently had the following lab results:
> 
> ...


No wonder! My gosh; it's a miracle you are not comatose w/TSH that high.

3.2 is the mid-range of the range given by your lab for the FREE T3. And by the way; thanks for the ranges.

Most of us feel best with TSH @ 1.0 or less and the FREE T3 at about 75% of the range given by your lab.

So................you do have a situation. I am thinking that you are not converting too well. It would be interesting to get rT3 (reverse T3)run as your FT4 is also low. One reason could be it is not converting to the FREE T3 but to the rT3 instead. There could be antibodies to the receptor site causing this OR you are way undermedicated. I don't believe the latter is the case and I am advising you to find a doctor to put you on natural dessicated thyroid OR add Cytomel (synthetic T3) to your T4 regimen. Your T4 would have to be cut way back and the T3 slowly titrated over a period of weeks or even months.

Here is some info that may be helpful.

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.

Have you had any antibodies' tests or an ultra-sound of your thyroid? You would be very very wise to get an ultra-sound to make sure you do not have cancer. This should be standard procedure.


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## jenny v (May 6, 2012)

Wow, you are very hypo! I'm kind of amazed you can function and get out of bed with a TSH that high. You definitely need an increase in medication but the tests Andros mentions would be helpful, too. My doc kept increasing my Synthroid over the past year to help my symptoms but just T4 alone wasn't doing the job so we've switched to a combo of T4 and T3 to see if that helps. That maybe something you need, too.


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## Lovlkn (Dec 20, 2009)

I will agree that you need a dose increase.

How do you take your Synthroid? Time of day? What supplements or foods do you eat after and how soon after or before? Do you drink at least 6-8 oz of water with the pill?

Your weight indicates a dosage of 183 mcg but everyone is different. Answer the question above and let's see if you are doing something to interfere with absorption.


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## Snickers (Jan 19, 2013)

Thank you for the replies. I have an MD appointment this Wednesday and you've given me hope that I can get back on track. I certainly have a few things to discuss with him. I'm hopeful I get a referral to an endocrinologist.

As for taking my Levothyroxine, I take it first thing in the morning when I get up. Along with it I take 1 baby asprin, 10mg of simvastatin and 50 mg of Losartan... and two cups of coffee to try and wake up. I don't eat food until an hour after I take my meds, which is usually an apple or eggbeaters and salsa.

I failed to mention that like most men my age, I had my testosterone checked a year ago and it was barely on the low end of the lab ranges. My doctor opted not to treat that. Also, here are some other values of my most recent labs:

Vitamin D 21.0 (20.0-49.9)
Sodium 133 (135-145)
ALT 44 (4-43)
Monocyte 8.80 (0-8)
Total Cholesterol 192
HDL 57
LDL 114
Triglyceride 103
PSA 0.870 (0.000-4.000) Yay!

Otherwise, my labs were all unremarkable.

I truly hope I can find some help to deal with this fatigue and weight gain. Thank you to all in the community who give me hope.


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## Alli (Sep 14, 2012)

In addition to what everyone said above in regard to the Thyroid stuff, Your vitamin D is low "normal" which doesn't mean it's in YOUR optimal range!! Repeat this phrase over & over "optimal range for YOU (me)!" Ask your doctor if those borderline levels are optimal range for YOU(me)!! Also keep in mind that those range levels are for HEALTHY non symptomatic individuals, if you are feeling exhausted (TSH of 12.91!!) or crummy all the time you are not feeling healthy, and those are symptoms! Therefore a barely in range level may NOT be optimal for you and could be the cause of your problems (ask about the testosterone again)!

Back to the Vitamin D...
When did you have this labwork done? 
Do you get 30 min of daily exposure to the sun? 
Is it winter/do you live where there is winter? 
For the Vitamin D did they run 25-OH Vitamin D? or the 1,25 (OH)2 vitamin D? 
25-OH Vitamin D is the best way to check for Vitamin D Deficiency

*Vitamin D deficiency has been linked to weight issues, I have seen first hand how low vitamin D can cause you to have problems losing weight. It really frustrated me how I had a very difficult time losing weight the previous 3 winters of actively trying to lose weight (2-3 hours of workouts a day + healthy diet). Then summer 2012 I lost 25lbs in 2 months eating not so great food, not working out as much, but spending the entire summer outside (3x as much as usual).. hmmmm?!?! Interesting huh? 
*Low D can make you EXHAUSTED (I think your TSH is doing a fine job of that, but low Vitamin D could be adding to it). If it is low enough it can make you barely able to get out of bed in the morning. 
*A whole slew of other issues can arise from Low D (if you re-test and it comes back low it might not be a bad idea for you to research Low vitamin D)

In my opinion (I'm not a Dr, listen to your Dr.), your Vitamin D seem way too low & not an optimal level. If it were me, I would ask for the 25-OH Vitamin D test to be run again if it was run back in the summer months or early fall (when your Vitamin D level would be higher). I went from being able to do 2-3 hour workouts back in September/October to not being able to work out at all, just walking up a flight of stairs leaves me exhausted.. My Vitamin D is less than 1/2 of what it was in September & back in September it was not what I consider an optimal level for me (at the time I was unaware, I thought I had thyroid cancer, so vitamin D was least of my worries).

Did they by any chance run a CBC? How was your Iron? 
HGB (hemoglobin)
HCT (hematocrit) 
MCV (means corpuscular volume) measure of the blood cell size 
MCH (means corpuscular hemoglobin) how much hemoglobin per blood cell 
Low of those could contribute to being tired as well. I think the TSH is the main cause, but Low Iron could make it even worse & it's fairly easy enough to fix.

The more I am researching Vitamin D the more I'm seeing these 3 together: Low D + Low Iron = Thyroid problem! Hashimoto's & Graves are thyroid autoimmune disorders... In recent years (the last 5) it has been discovered & published that Low Vitamin D can cause a person to develop autoimmune disorders just having low Vitamin D puts one at higher risk of developing an autoimmune disorder (nice huh? NOT!). Vitamin D, Low Iron/Anemia & Thyroid conditions are grossly under-diagnosed, misdiagnosed & under treated. If you have all 3 (not sure of your iron level) and aren't being treated you will feel poorly... Add in the low Testosterone issue and I'm surprised you are able to move at all!

I would do as Andros suggested and get those Antibodies run as well as ask for the Ultrasound. 
Antibodies:
TPO-Ab Thyroid Peroxidase Antibody (tests for Hashimotos & Graves)
TgAb Thyroglobulin Antibody (tests for Hashimotos & thyroid cancer)
TRAb Thyroid Stimulating Hormone Receptor Antibody (tests for Graves)
You may have to push to get these run, try to get your MD to run them BEFORE they send you off to the Endocrinologist.

I know this is a lot of info. I bet with your TSH as high as it is you must have really bad brain fog  which makes this whole thing more difficult for you (the most unfair part of thyroid stuff). Keep being an advocate for yourself... go in Wed with a list of questions for your Dr along with those labs (with notes next to them).. Ask him why Low/Barely in range Testosterone should be acceptable for you?

Wishing you a quick journey to health & wellness!! You CAN/WILL feel better again! The people here are AWESOME with any Thyroid questions you might have, I know I would have been lost without this resource!


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## Snickers (Jan 19, 2013)

Where have you people been all my life? :sad0049: I've been suffering alone with thyroid problems for more than 15 years. I was shocked to see your reference to mental fog. I have frequently experienced that for years and referred to it as having a sense of brain fog. It's particularly troublesome for me given the nature of my job. I'm general manager and part owner of a company with 600 employees. I'm always on-stage and have to be a positive, high-profile leader to the people I work with. I can't tell you how many times I've been completely debilitated with "brain fog" when I've had an important meeting or have been working on projects.

As for the vitamin D issue. I live in Central California, but I'm in the office all day long = not much sun exposure. My labs were just recently done on January 17 and the Vitamin D was 25OH. Other lab values from my CBC were as follows:

Platelet count 188 (150-400)
RBC 4.79 (4.70-6.10) - Now I see, borderline line too
Hemoglobin 14.6 (14.0-18.0) - Again, borderline line too
Hematocrit 44 (42-52) - And again, borderline line too
MCV 91.9 (80-94)
MCH 30.6 (28-32)
MCHC 33.2 (31.5-35.3)
RDW 13.1 (12-15)
Testosterone, Free and Total listed as pending work "Status: Transport Scheduled" - I'm eager to get the results of this too, as is my wife. I have the libido of a corpse.

My MD appointment this Wednesday is with a new primary care doctor. I've only seen him for our initial meeting when he ordered these most recent labs. I am hopeful he will get me back on track. I certainly will be asking for the tests you folks have recomended.

It's my 50th birthday next Sunday (1/27) and I'm starting to feel like I'm 150. Just a year ago I weighed 30 pounds less and felt fantastic. All your words of encouragement give me hope I can get back there again.


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## lainey (Aug 26, 2010)

Everyone is full of detailed advice, but in my humble opinion, tons of antibodies tests, which are generally used to make a diagnosis, are a moot point. You have been treated for many years, but many doctors take the labs defacto, and assume a patient's needs will not change, when in fact they may.

The TSH of 12+ says it all really, symptoms included, you are not on enough T4. Before you start discussing needing to add T3, or moving to natural thyroid--



> Just a year ago I weighed 30 pounds less and felt fantastic.


Obviously your T4 medication was working for you, as you took it for many years and felt well. Start with adjusting the dose upward--don't look at how "high" it is--everyone metabolizes differently, and your needs do change, even over time, and going over 200mcg is not unreasonable. Just because your past dose worked, does not mean you would never need more--perhaps you had some residual thyroid function that has since disappeared.

Look at the testosterone results carefully when you get them--most young men are high in the range, and the levels naturally decline with age. If you fall low in the range here, as you said you did on the first go-round--low level supplementation may improve your fitness, libido and energy level. Keep in mind also, the progesterones tend to free thyroid hormone in the blood (estrogens bind it--women on starting birth control, for example, often need thyroid meds adjusted because of this) so if your sex hormone levels are shifting, your thyroid levels will change somewhat as well.

It is a good idea for persons diagnosed with thyroid problems to have ultrasounds periodically, as their potential for nodules and other structural problems is higher.

You are definitely mis-managed. Good luck with the new doc!

PS. A tip on the cholesterol meds--those work best if taken at night, before bed, when the liver produces most of its cholesterol. Many BP meds also have fatigue as a side effect. I take my little cocktail of cholesterol/BP meds around 9 pm for that reason.


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## smelliebellie (Oct 14, 2012)

snickers, 
i noticed you lived in central california. I could recommend good doctors for you. Feel free to send me a private message and good luck with the new doctor


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## Andros (Aug 26, 2009)

Snickers said:



> Thank you for the replies. I have an MD appointment this Wednesday and you've given me hope that I can get back on track. I certainly have a few things to discuss with him. I'm hopeful I get a referral to an endocrinologist.
> 
> As for taking my Levothyroxine, I take it first thing in the morning when I get up. Along with it I take 1 baby asprin, 10mg of simvastatin and 50 mg of Losartan... and two cups of coffee to try and wake up. I don't eat food until an hour after I take my meds, which is usually an apple or eggbeaters and salsa.
> 
> ...


Salicyte (aspirin) is a goitrogen meaning that it will interfere w/ the efficacy of your thyroxine replacement. Try to take that at some other time during the day or night at least 4 hours away from your Synthroid.

You might be better off letting the MD treat you. Most endocrinolgists focus on diabetes.


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