# New Labs for Hashi before I see endo...what do you think



## artms (Jul 23, 2011)

I was helped here a lot earlier and managed to get on Armour. I've been really happy with it and will be seeing an Endo in two weeks. I became too much for my GP. 
I just got labs back for when I see her and to my surprise my TSH is lower than it's ever been and my T4 and T3 are lower as well. Just getting worse. Seems I am taking higher doses and getting lower T4 and T3. I did make sure I didn't get my blood drawn at least 8 hours after taking my meds and the Tsh was still low. What gives? 
TSH .15 (.35- 3.30)
T4 .61 (.56-1.64)
T3 2.6 (2.3-4.2)

When my GP was happy was when she dropped my dose and I went into a horrible tailspin.These were my labs then
TSH .54
T4 .83
T3 2.8
I do think I'm not converting T4 but I don't like taking too much meds because I get too hot and my hair falls out. Too little meds and I'm befuddled and my metabolism tanks.

This will be my first meeting with the endo so I just wanted to run it by you and see what you might think and any suggestions for my discussion with the Endo.


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## Andros (Aug 26, 2009)

artms said:


> I was helped here a lot earlier and managed to get on Armour. I've been really happy with it and will be seeing an Endo in two weeks. I became too much for my GP.
> I just got labs back for when I see her and to my surprise my TSH is lower than it's ever been and my T4 and T3 are lower as well. Just getting worse. Seems I am taking higher doses and getting lower T4 and T3. I did make sure I didn't get my blood drawn at least 8 hours after taking my meds and the Tsh was still low. What gives?
> TSH .15 (.35- 3.30)
> T4 .61 (.56-1.64)
> ...


You are currently undermedicated. When taking any form of T3, one expects the TSH to go down (that's what we want), also the T4 and FT4 go down and the med has to be titrated upward by small increments every 8 weeks until the FREE T3 is above the mid-range and the patient feels well.

Sadly, your doctor is not doing the FREES although the range included looks like it might be for the FT3 but you have T3 listed.

In any case, that is way low. It should be above the mid-range of 3.2 of the range provided if indeed we have the correct range for FREE T3 instead of T3.

Please read the links provided.

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

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


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## artms (Jul 23, 2011)

Just a quick note. 
Those are FT3 and FT4.I'm taking Armour 60mg in the early am and another 15 late morning. I was taking 30mg late morning but was hot and losing hair so I cut back on my own. I know the T3 is low...but I'm a little confused about the TSH being so low. 
If I just took a straight supplement of T3 like Cytomel and a lower dose of Armour would that give me a more in range Tsh and a higher T3 ? I'm concerned because it seems over time I'm requiring higher dosage to get a good T3 and T4 and it seems to be happening all in the last year like whatever it is is progressing rather quickly. I've been taking meds for 10 years and suddenly it's become more problematic. Physiologically is it just lack of conversion, just typical of Hashi's or what?


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## Andros (Aug 26, 2009)

artms said:


> Just a quick note.
> Those are FT3 and FT4.I'm taking Armour 60mg in the early am and another 15 late morning. I was taking 30mg late morning but was hot and losing hair so I cut back on my own. I know the T3 is low...but I'm a little confused about the TSH being so low.
> If I just took a straight supplement of T3 like Cytomel and a lower dose of Armour would that give me a more in range Tsh and a higher T3 or would the T3 still drop my TSH?


Seriously, you would not want to concoct a cocktail like that. TSH is no longer relevant in regards to the titration process and getting your FREE T3 where it should be.

The FREES are the big concern. I hope you read those links that I have provided.

Don't know why you cut back on your Armour. Did you confer w/your doctor about this? I believe you have done a disservice to yourself by doing so.

I am a 68 year old woman and I take 3 1/2 grains of Armour per day.


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## artms (Jul 23, 2011)

For some reason the Dr Lam article wouldn't load correctly but the T3/T4 article was interesting. I cut back because I was way too hot all the time and I was having a lot of hair loss. Unfortunately I couldn't get in to see this endo referral for three months and my GP confessed she really didn't know what to do with me so she was no help. She gave me the prescription which I was grateful for and said for me to go by how I felt. I just went by symptoms. I decided not to do labs in the interim and just get the lab before I went to see the Endo because every time I would get a lab before my GP would screw around with my dose . OMG if she had seen this Tsh at .15 she would have dropped my dose even more than she did before and I would be a frickin zombie. So while I shouldn't have been doing dosing on my own dealing with my Dr was a nightmare so I have just sort of managed to get by till I see the endo. I hope she's good. The Armour has been great and the only thing that got me was the body overheating and all the hair in the sink. Maybe that's just the new normal. 
It just seems to me if I'm not converting T4 then I should focus on the T3 but what do I know. It'll really suck if this Endo goes by Tsh alone.


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## Andros (Aug 26, 2009)

artms said:


> For some reason the Dr Lam article wouldn't load correctly but the T3/T4 article was interesting. I cut back because I was way too hot all the time and I was having a lot of hair loss. Unfortunately I couldn't get in to see this endo referral for three months and my GP confessed she really didn't know what to do with me so she was no help. She gave me the prescription which I was grateful for and said for me to go by how I felt. I just went by symptoms. I decided not to do labs in the interim and just get the lab before I went to see the Endo because every time I would get a lab before my GP would screw around with my dose . OMG if she had seen this Tsh at .15 she would have dropped my dose even more than she did before and I would be a frickin zombie. So while I shouldn't have been doing dosing on my own dealing with my Dr was a nightmare so I have just sort of managed to get by till I see the endo. I hope she's good. The Armour has been great and the only thing that got me was the body overheating and all the hair in the sink. Maybe that's just the new normal.
> It just seems to me if I'm not converting T4 then I should focus on the T3 but what do I know. It'll really suck if this Endo goes by Tsh alone.


When first starting Armour, you do go through some hormonal changes. For example, I did not sweat....................ever. When I started Armour, I broke a sweat. I had been going to the gym and working out really hard. No sweat.


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## artms (Jul 23, 2011)

OK so i saw her. It was interesting. She is a professor at the medical school. Here's how it went.My TSH was .15 and she warned me of the risks to a menopausal woman to bone density and heart. The interesting thing is I don't have hyper symptoms so I don't know if you have to have symptoms to actually have damage. She said she only does TSH because FreeT4 and FreeT3 are unreliable for a combo medicine like Armour. She thought it odd that I was taking a large dose of Vit D and it wasn't raising my levels much. Maybe i had an absorption issue.I was splitting my dose and she said that was like taking meds for a boost like drinking coffee. I told her I was fine on 100mcg Synthroid but when my TSH was .33 instead of .35 they dropped me to 88 and I tanked. I told her I can't tolerate that.She said I have to separate the TSH from the symptoms. Get the TSH low normal and then figure out the next layer...pituitary, adrenal whatever. I was frustrated that she didn't do frees. 
In retrospect I'm not sure how my gp and I came up with 90mg Armour as a dose for me till I saw the endo .Probably me being pushy. Now I think that dose was high if I did well at 100mcg Synthroid and the conversion is 60 mg Armour. 
So I was probably taking too much Armour and the endo knew it but here's the kicker. With a low TSH and probably too high a dose this is what she wants me to do. Take all 90mg early in the morning. Take my Vit D. Get a test at 6 weeks and another at 12 and see her. She said if my TSH is good fantastic. If not she would step me down 15 at a time. I asked her if she would be tempted to drop the dose at the 6 week lab and she said no. We'll see what it is in 12. So I took all 90 and my hair started falling out,I had palpitations ,overheating and tanking in the afternoon. I then became a non-compliant patient. I'm not sure how it'll work out with this Endo so I figure I'll do what I think will work for me and see what the labs are. From my experience it just get complicated sometimes trying to work it out with a dr. Fortunately for me i came to her on too much meds so I don't have to go through weeks of being hypo while she figures it out. I'll probably get independent testing . So I tried splitting it and that didn't help. I dropped my dose by 15 and started taking D and Selenium and multivitamin. I know I'm low in D and probably selenium. I'm thinking as I get those better the meds will come into line. 
Depending on how it goes I may tell her what I'm doing but I'm being cautious and don't want to be held hostage my TSH and undermedication. Anyone have a thought as to what her game plan may be? I just don't think that with her it was worth it to fight over tsh, splitting doses, free t4 and t3 and all the rest. But it surprised me she didn't drop the dose when as it turns out even i feel better on less. My hair stopped falling out immediately and my pulse and BP are good and I have a sense of well being. I feel a little bad about not going along with her but oh well. There were too many things about her that we were not on the same page about but how weird that she didn't drop my dose then and there. Your thoughts?


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## bigfoot (May 13, 2011)

Tough call. After months of trying to find the right level (and still trying) on Levoxyl, I have learned you can't go just by symptoms. My humble opinion: the signs & symptoms tell you *something* is wrong, the labs tell you in *what direction*.

My endo also doesn't believe in FT4 or FT3, just TSH. My PCP tests TSH and FT4. My naturopath wanted to ignore TSH and look at FT4 and FT3 only. I don't think there are many doctors out there who are willing to look beyond TSH. At the same time, my humble opinion again, I think they are all useful when looking at the big picture. I had an instance recently where on 100mcg Levoxyl my TSH was 0.15 (not too bad at first glance, right?), but my FT4 was 1.85 (skyrocketed hyper!). Granted, everyone's case is different and unique.

If this doc is willing to look at possible pituitary and adrenal issues, that's friggin' awesome. I had a pituitary MRI but only a single adrenal lab test. Beyond that my docs have dismissed it, despite it being a few tenths of a point from being high. Adrenals must seem like some sort of voodoo science to docs.

The vitamins and supplements... be careful, add one at a time, see how your body reacts. I was taking Selenium every morning with the idea that it would definitely be helpful. Then I realized that the Selenium was making me really out of it and spaced out, worse than usual. The Vitamin D -- my doc also prescribed a high-dose regimen for a few months (50K IU a week). I started taking that and it seemed like everything flared up a bit, but perhaps that's just my imagination.

If you have found a level of medication that works for you, and you feel great and have the energy like you used to, maybe you can convince the doc of this. So much of this is trial-and-error anyways. If you stumble on the answer before them, so be it. But once you start being non-compliant, as you noted, I think docs are hesitant (and rightfully so) to deal with you. Fine line to walk...

hugs3


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## Andros (Aug 26, 2009)

artms said:


> OK so i saw her. It was interesting. She is a professor at the medical school. Here's how it went.My TSH was .15 and she warned me of the risks to a menopausal woman to bone density and heart. The interesting thing is I don't have hyper symptoms so I don't know if you have to have symptoms to actually have damage. She said she only does TSH because FreeT4 and FreeT3 are unreliable for a combo medicine like Armour. She thought it odd that I was taking a large dose of Vit D and it wasn't raising my levels much. Maybe i had an absorption issue.I was splitting my dose and she said that was like taking meds for a boost like drinking coffee. I told her I was fine on 100mcg Synthroid but when my TSH was .33 instead of .35 they dropped me to 88 and I tanked. I told her I can't tolerate that.She said I have to separate the TSH from the symptoms. Get the TSH low normal and then figure out the next layer...pituitary, adrenal whatever. I was frustrated that she didn't do frees.
> In retrospect I'm not sure how my gp and I came up with 90mg Armour as a dose for me till I saw the endo .Probably me being pushy. Now I think that dose was high if I did well at 100mcg Synthroid and the conversion is 60 mg Armour.
> So I was probably taking too much Armour and the endo knew it but here's the kicker. With a low TSH and probably too high a dose this is what she wants me to do. Take all 90mg early in the morning. Take my Vit D. Get a test at 6 weeks and another at 12 and see her. She said if my TSH is good fantastic. If not she would step me down 15 at a time. I asked her if she would be tempted to drop the dose at the 6 week lab and she said no. We'll see what it is in 12. So I took all 90 and my hair started falling out,I had palpitations ,overheating and tanking in the afternoon. I then became a non-compliant patient. I'm not sure how it'll work out with this Endo so I figure I'll do what I think will work for me and see what the labs are. From my experience it just get complicated sometimes trying to work it out with a dr. Fortunately for me i came to her on too much meds so I don't have to go through weeks of being hypo while she figures it out. I'll probably get independent testing . So I tried splitting it and that didn't help. I dropped my dose by 15 and started taking D and Selenium and multivitamin. I know I'm low in D and probably selenium. I'm thinking as I get those better the meds will come into line.
> Depending on how it goes I may tell her what I'm doing but I'm being cautious and don't want to be held hostage my TSH and undermedication. Anyone have a thought as to what her game plan may be? I just don't think that with her it was worth it to fight over tsh, splitting doses, free t4 and t3 and all the rest. But it surprised me she didn't drop the dose when as it turns out even i feel better on less. My hair stopped falling out immediately and my pulse and BP are good and I have a sense of well being. I feel a little bad about not going along with her but oh well. There were too many things about her that we were not on the same page about but how weird that she didn't drop my dose then and there. Your thoughts?


Don't really know what to say here. Except that I personally am a huge proponent of running the FREE T4 and FREE T3 as these are the "unbound" hormones available for cellular uptake.

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


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## artms (Jul 23, 2011)

The frees were a big deal to me too.I was surprised half way through the appt that she said she only did TSH and that she wouldn't do frees.That seemed an important piece of the puzzle. She said it was not done specifically with me taking Armour and that it's unreliable in that it shifts constantly throughout the day.On the other hand she didn't seem opposed to Armour and when I asked her how would she know if i had enough T3 or even if i was converting, she was confident I had enough and she may be right. I'll probably look around anyway for a Dr that does those labs and doses according to symptoms and I'll get labs on my own at 6 weeks to see what the frees are. I do think that to a certain degree, in my case, Armour vs Synthroid is apples and oranges in that I felt hypo on a lower dose of Synthroid but perhaps won't on Armour because of the T4 and T3. I'm really happy to be on it. BTW something that i ran into in researching all this, something I didn't know and makes everything a little more complicated for us trying to get it right, is that you can feel fatigued and have hair falling out when you're hypo AND when you're hyper. So you can think you need a higher dose to get rid of the hypo symptoms when you may actually have hypo symptoms because you're on too high a dose. Of course it's all really complicated but who knew?


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## Andros (Aug 26, 2009)

artms said:


> The frees were a big deal to me too.I was surprised half way through the appt that she said she only did TSH and that she wouldn't do frees.That seemed an important piece of the puzzle. She said it was not done specifically with me taking Armour and that it's unreliable in that it shifts constantly throughout the day.On the other hand she didn't seem opposed to Armour and when I asked her how would she know if i had enough T3 or even if i was converting, she was confident I had enough and she may be right. I'll probably look around anyway for a Dr that does those labs and doses according to symptoms and I'll get labs on my own at 6 weeks to see what the frees are. I do think that to a certain degree, in my case, Armour vs Synthroid is apples and oranges in that I felt hypo on a lower dose of Synthroid but perhaps won't on Armour because of the T4 and T3. I'm really happy to be on it. BTW something that i ran into in researching all this, something I didn't know and makes everything a little more complicated for us trying to get it right, is that you can feel fatigued and have hair falling out when you're hypo AND when you're hyper. So you can think you need a higher dose to get rid of the hypo symptoms when you may actually have hypo symptoms because you're on too high a dose. Of course it's all really complicated but who knew?


Right you are about the symptoms; they can and do cross over. Nothing is carved in stone as we each react so differently.

Precisely why these labs are so so important.

And your doctor is just full of it and I say that with a smile on my face. TSH fluctuates during the 24 hour cycle also. As a matter of fact, TSH is diurnal reaching it's peak around 2 AM for most persons.

And if you are taking T3 in any form, be aware of the fact that it peaks in 4 hours after ingestion.


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