# Recent labs...need some input :)



## prettynikki5 (Dec 9, 2009)

Here are my recent labs, after the doc reviewed them he said everything looked good, with the exception of my calcium (parathyroids still healing).
My TSH is good now, he said, I told him that I'm haing some hypo symptoms including low energy, some fatigue, pretty moderate mood swings, mild carpal tunnel pain, still some hair loss (heavy shedding), still snoring, not waking up refreshed. He advised we could increase my current dosage of levothroid from 125 mcg to 137mcg. I told him that I agreed to that, that I felt I needed an increase. 
I would just like some opinions on my labs, if the levels look okay, if something seems off...Thank you!!!
Here they are:
Name Standard Range 6/7/2010 8/6/2010 9/28/2010 
TSH----(0.27-4.20)-----5.87----10.68-----3.42 
Name Standard Range 6/7/2010 8/6/2010 9/28/2010 
T4 FREE----(0.9-1.8)----1.2-------1.5--------1.6 
Name Standard Range 9/28/2010 
T3 FREE-----(2.3-4.2)----- 2.7


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## Andros (Aug 26, 2009)

prettynikki5 said:


> Here are my recent labs, after the doc reviewed them he said everything looked good, with the exception of my calcium (parathyroids still healing).
> My TSH is good now, he said, I told him that I'm haing some hypo symptoms including low energy, some fatigue, pretty moderate mood swings, mild carpal tunnel pain, still some hair loss (heavy shedding), still snoring, not waking up refreshed. He advised we could increase my current dosage of levothroid from 125 mcg to 137mcg. I told him that I agreed to that, that I felt I needed an increase.
> I would just like some opinions on my labs, if the levels look okay, if something seems off...Thank you!!!
> Here they are:
> ...


Most of us feel best w/TSH @ 1 or less and FREE T3 about 1/2 way above the mid-range mark of the suggested range. Mid-range on your lab is about 3.2 so you can see you are way below the mid-range. Give it another 8 weeks on the increase, get labs and let's have a look at that point in time. Free T3 is your active hormone from which you derive your energy and healing.

You may not be converting too well but.....................really, it is so soon after surgery. You do need to let your poor body settle. You have been through a lot.


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## Lovlkn (Dec 20, 2009)

I had similar issues with continued fatigue post op and it never resolved until I added Cytomel.

With your FT-4 already in high range I doubt more Levothyroxine is going to make a difference.

If at your next appt you are still experiencing symptoms reduce your Levo back to 125 and add 5mcg of Cytomel.

Other things to check out are your ferritin levels and Vit D levels, B-12 too.


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## prettynikki5 (Dec 9, 2009)

Thank you very very much for your input  I will see what labs look like next time and get the other things checked out as well...
You guys are the very BEST!!!


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## prettynikki5 (Dec 9, 2009)

I just had another set of labs done. My potassium levels are getting lower and lower and my calcium is still too low, hasn't changed at all even though I have been eating plenty of yogurt/cheese/milk and taking my caltrate supplement daily. Doc wants me to start taking Rolcatrol again (VitD) to help with my Calcium levels. 
Here are my latest and greatest:
TSH 2.73 (0.27 - 4.20)
T4 FREE 1.6 (0.9 - 1.8) 
T3 FREE 2.6 (2.3 - 4.2)
POTASSIUM (3.5-5.5) MMOL/L 4.6(10/09) 4.6(11/09) 4.4(06/10) 4.5(8/10) 3.8(9/10) 3.4 (10/10)
I have muscle pain, kind of achey all over, very emotional, and hair still thinning, some fatigue and memory problems. I just generally don't feel that great at all. I am going to work on increasing my calcium and potassium. Any other thoughts? Doc says my levels look good, why don't I 'feel' good...
Thanks a bunch!!!


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## Andros (Aug 26, 2009)

prettynikki5 said:


> I just had another set of labs done. My potassium levels are getting lower and lower and my calcium is still too low, hasn't changed at all even though I have been eating plenty of yogurt/cheese/milk and taking my caltrate supplement daily. Doc wants me to start taking Rolcatrol again (VitD) to help with my Calcium levels.
> Here are my latest and greatest:
> TSH 2.73 (0.27 - 4.20)
> T4 FREE 1.6 (0.9 - 1.8)
> ...


You appear to be undermedicated with your thyroxine replacement. Your Free T3 is in the basement. You must feel exhausted. Your FT3 should be about 1/2 way between mid-range and the top of the range. Ideally, your TSH could be lower as well. You are approaching the top of the range as per AACE which is 0.3 to 3.0.

Your body is not utilizing supplementation while in hypo state. That is my humble opinion. When hypo, everything is slo-mo.


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## lavender (Jul 13, 2010)

I have had low calcium levels since my thyroidectomy 8/5. I was initially taking very high doses of Citracal. Several docs told me that was the best calcium supplement because Caltrate is harder to absorb. I was literally taking 16-20 Citracal a day and still feeling low calcium symptoms.

Endo put me on calcitriol (Vit D similar to Rocatrol) for a month, but I was still taking 12-16 Citracal and dealing with low calcium symptoms. I stopped taking itbecause my insurance refused to cover it and also because the endo said it was no longer necessary. Last appointment with him, he basically threw up his arms when I tried to discuss calcium issues with him, saying he did not care how much citracal I took.

Then, I spoke with my chiropractor, and although I would rather get medical advice from an MD, she was the only person able to really help me out. I had vitamin D tested (by my endo), and it was at the bottom of the range (while on Calcitriol). She suggested I take Vitamin D and Magnesium, that I would not be able to absorb the Vitamin D without Magnesium.

I started the Vitamin D (5000iu) and magnesium (235mg) that day, and immediately cut my citracal dose in half. Within a week, I was able to take 4-5 a day with few low calcium symptoms. Now, I am taking 4 a day, and I do not feel the low calcium symptoms any more. I ran what I was doing past my PCP, and she agreed that I needed the magnesium and D to absorb calcium.
It's been about a month since my calcium levels were checked, but I am honestly not worried. I no longer find myself craving milk and dairy products. I was going through about a gallon of milk a week. 
I read something a few days ago that magnesium actually helps restore parathyroid functioning. Rocatrol/Calcitriol can suppress it. I feel better with the OTC Vit D, but you might want to run this by your doc. 
If the Rocatrol and Calcium are not working for you, it might be worth looking into a Magnesium supplement. I am taking Reacted Magnesium from Ortho Molecular Products. Chiro said it is easier to absorb. I initially bought it at her office, but just ordered more on-line because it was cheaper to buy a several month supply at once. 
Hope this helps, Calcium issues were very frustrating to me until I got this figured out.


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## prettynikki5 (Dec 9, 2009)

Andros said:


> You appear to be undermedicated with your thyroxine replacement. Your Free T3 is in the basement. You must feel exhausted. Your FT3 should be about 1/2 way between mid-range and the top of the range. Ideally, your TSH could be lower as well. You are approaching the top of the range as per AACE which is 0.3 to 3.0.
> 
> Your body is not utilizing supplementation while in hypo state. That is my humble opinion. When hypo, everything is slo-mo.


Hi there Andros, I always pray you chime in 
You give the bestest advice.
Should I keep increasing my T4 meds or perhaps try adding in some T3 at this point? I am pondering something like armour....i noticed that my FT3 has decreased a hair, not going up at all. That makes sense that if I am hypo I can't absorb supplements effectively and heal. Would adding the T3 take me past this hypo state in your opinion or would I need more T4 regardless?
Thank you!!


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## Andros (Aug 26, 2009)

prettynikki5 said:


> Hi there Andros, I always pray you chime in
> You give the bestest advice.
> Should I keep increasing my T4 meds or perhaps try adding in some T3 at this point? I am pondering something like armour....i noticed that my FT3 has decreased a hair, not going up at all. That makes sense that if I am hypo I can't absorb supplements effectively and heal. Would adding the T3 take me past this hypo state in your opinion or would I need more T4 regardless?
> Thank you!!


Which T4 are you taking and how much daily?


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## prettynikki5 (Dec 9, 2009)

Andros said:


> Which T4 are you taking and how much daily?


Levothroid @ 137mcg daily


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## Andros (Aug 26, 2009)

prettynikki5 said:


> Levothroid @ 137mcg daily


I think you could benefit greatly with a little nudge in the right direction w/some T3. The body cannot heal nor can the brain work effectively w/o sufficient T3.

You are on a pretty good dose of Levothyroid and I do think to keep on raising the T4 is unconscionable in that somewhere along the line you would think the doctor may wonder why??

So, have a chat w/ your doc. My very experienced recommendation is to start on 2.5 mcg. of Cytomel. Doc can Rx the 5 mcg. which is the smallest and you can split it. I would stay on 2.5 mcg. for about 2 weeks to see how that goes, then go up the 5 mcg. per day and get labs in about 6 weeks to 8 weeks.

Get a pill splitter.


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## prettynikki5 (Dec 9, 2009)

lavender said:


> I have had low calcium levels since my thyroidectomy 8/5. I was initially taking very high doses of Citracal. Several docs told me that was the best calcium supplement because Caltrate is harder to absorb. I was literally taking 16-20 Citracal a day and still feeling low calcium symptoms.
> 
> Endo put me on calcitriol (Vit D similar to Rocatrol) for a month, but I was still taking 12-16 Citracal and dealing with low calcium symptoms. I stopped taking itbecause my insurance refused to cover it and also because the endo said it was no longer necessary. Last appointment with him, he basically threw up his arms when I tried to discuss calcium issues with him, saying he did not care how much citracal I took.
> 
> ...


Thank youvery much for all of this helpful information, I am going to try it  I will let you know how it workd for me.


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## prettynikki5 (Dec 9, 2009)

Andros said:


> I think you could benefit greatly with a little nudge in the right direction w/some T3. The body cannot heal nor can the brain work effectively w/o sufficient T3.
> 
> You are on a pretty good dose of Levothyroid and I do think to keep on raising the T4 is unconscionable in that somewhere along the line you would think the doctor may wonder why??
> 
> ...


I was emailing with him today and he said that alot of my symptoms could be due to low calcium and he wants me to take the rolcaltrol first and then think about adding in T3, he stated he didn't want to change too many things at once.


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## Andros (Aug 26, 2009)

prettynikki5 said:


> I was emailing with him today and he said that alot of my symptoms could be due to low calcium and he wants me to take the rolcaltrol first and then think about adding in T3, he stated he didn't want to change too many things at once.


Did you ask him why he did not think that the fact that your FT3 is in the basement should not be addressed forthwith?

Grrrrrrrrrrrrrrrrrr!!

What is your thinking on this? Are you pleased with his comment?


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## prettynikki5 (Dec 9, 2009)

Andros said:


> Did you ask him why he did not think that the fact that your FT3 is in the basement should not be addressed forthwith?
> 
> Grrrrrrrrrrrrrrrrrr!!
> 
> What is your thinking on this? Are you pleased with his comment?


I did go back and tell him that I prefer to add the T3 now, this is his response:

"Your T3 level is not in the basement, it is normal. Adding T3 might help a little bit With fatigue, but will not make a difference for your calcium. Over-the-counter vitamin D is different than Calcitriol. calcitriol is synthetic vitamin D that helps absorb calcium in patients who do not have parathyroid such in your case. Having a low calcium might be giving some of your problems and is not good for your bones on the long run. I will send in a new prescription if you don't have refills on it. Hold off T3 for now, it is not the answer."

What do you think?


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## lavender (Jul 13, 2010)

have you had PTH and Calcium Levels tested? I do not see these labs here. Are your parathyroids gone or just not functioning well after surgery?

Here is a link on hypoparathyroidism:
http://www.nlm.nih.gov/medlineplus/ency/article/000385.htm
Mayo clinic site looks good too.

Low calcium can cause long term probs, and I had symptoms when mine was low that helped me distinguish it from thyroid symptoms. I would get a headache in the front of my forehead, dizziness, muscle cramps, trouble concentrating. Tingling in fingers and lips is common, but is not my first symptom. Some of the symptoms do overlap and it can be confusing.

Calcitriol is different from OTC VitD because OTC vitD has to be processed by the parathyroid. If your parathyroid is not working, you will not absorb OTC Vitamin D no matter how much you take. Calcitriol is vitD in an active state that does not have to be processed by your parathyroid.

I am not trying to say that your thyroid replacement is correct, but treating the parathyroid issue will help as well.


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## prettynikki5 (Dec 9, 2009)

lavender said:


> have you had PTH and Calcium Levels tested? I do not see these labs here. Are your parathyroids gone or just not functioning well after surgery?
> 
> Here is a link on hypoparathyroidism:
> http://www.nlm.nih.gov/medlineplus/ency/article/000385.htm
> ...


I have 3 of 4 parathyroids still intact after surgery, the others were bruised, so they are still healing, hopefully they will work again sometime soon. So, it is good to know the difference between the OTC and Calitriol and why I need it, thank you for explaining that to me  
My symptoms right now:lots of muscle aches in my arms, legs and back, it even hurts laying in bed in some positions for the last week or so...my fingertips feel kind of 'numb' and tingly and my teeth have become super duper sensitve, I feel confused at times, headaches, my hair is thinning pretty bad, and I am so emotional. My hands and feet freeze most of the time. I get really uncomfortable if I stay in one position too long, i.e. crossing my legs at my desk at work or just sitting at my desk, my back hurts.


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## lavender (Jul 13, 2010)

I have been in the same boat as far as you concerning parathyroids. 3 of 4 intact, but bruised after surgery.

I thought it would never get better and had given up on useful conversation with my endo about it until about 3 weeks ago. Adding the magnesium really helped. And I just listened to my body as far as taking as many calcium supplements as it needed. Now that my calcium feels stable, I feel like I can tease out the rest of my symptoms and address my thyroid levels.

Many of your symptoms sound like low calcium to me. Numb tingly fingertips is a definite sign of low calcium. I suspect your teeth hurting has to do with muscle contractions from low calcium. My surgeon tapped on the side of my face at one point, noticed a twitch and said my calcium was low. Muscle aches, headaches, confusion all come with low calcium and have gotten better for me over the past few weeks.

I suspect you will feel better once your calcium level gets up there, but this may not fix everything if your thyroid levels are too low. It may be that the doc wants to change one thing at a time. I don't know. Can't figure docs out half the time. Would like to fire all of mine except that I need them right now and I know no one will be perfect.

Is your doc checking your calcium level at all? Mine was getting checked pretty regularly for a while. I found that I feel much better on the higher side of normal. Also, my doc has monitored my parathyroid hormone-PTH. Keeping track could help you see if your levels are getting better and how you feel.

What calcium supplement are you taking? Some are more easily absorbed than others. And they all must be taken 4 hours away from your synthroid because of absorption issues.


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## prettynikki5 (Dec 9, 2009)

lavender said:


> I have been in the same boat as far as you concerning parathyroids. 3 of 4 intact, but bruised after surgery.
> 
> I thought it would never get better and had given up on useful conversation with my endo about it until about 3 weeks ago. Adding the magnesium really helped. And I just listened to my body as far as taking as many calcium supplements as it needed. Now that my calcium feels stable, I feel like I can tease out the rest of my symptoms and address my thyroid levels.
> 
> ...


I am currently taking Caltrate 600mg 2x per day. Once around lunchtime ( I take my thyroid meds in the early am) and again at dinner. 
The doc checks my calcium every 6 weeks or so, but not the PTH, I didn't know that they could test the parathyroids, what does that test tell about them? If they are starting to function again or not? My current calcium level is at 7.8 (8.4 - 10.5). 
Thank you so much again, for sharing all your information with me, the support and help is so nice to have, I really appreciate it!


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## lavender (Jul 13, 2010)

I would be in the ER getting IV calcium with your calcium level because I could not function when mine was that low. So, I am not surprised you are not feeling well. Sounds to me like you need more calcium, especially if it is not going up with the Rocalcitrol. Magnesium could help your body absorb what you are taking better, but you might want to ask your doc about taking more calcium until your levels get up to at least normal.

I took as much as I needed until my body felt better because this was recommended by the on-call surgeon the weekend after my surgery (when I was in the ER). I also found that Citracal is more easily absorbed by the body than Caltrate. Don't buy the generic forms of calcium. I usually think the brand names are just overpriced, but I found that it really does make a difference in how your body absorbs what you are taking.

PTH tests your parathyroid hormone level and is an indicator of how well your parathyroids are working or if they are working at all. It will let you know if they are getting better or worse. My endocrinologist has been monitoring mine to see if my parathyroids are coming back. Usually they do in like 3-4 months, sometimes a year from what I have read.

I have seen some info about investigational research involving supplementing parathyroid hormone in people with hypoparathyroidism, but you have to have the condition for a year to qualify for the study. This site is very critical of inexperienced surgeons, and you can't change what has already happened now. So, be prepared if you choose to read it. I found some helpful info there. 
http://parathyroid.com/hypoparathyroidism.htm

There is also a hypoparathyroidism association, but you have to pay to join the association before you can post on their list serve, which makes me suspicious. The association seems to be linked with the doctor above, and their website is currently down.


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## prettynikki5 (Dec 9, 2009)

lavender said:


> I would be in the ER getting IV calcium with your calcium level because I could not function when mine was that low. So, I am not surprised you are not feeling well. Sounds to me like you need more calcium, especially if it is not going up with the Rocalcitrol. Magnesium could help your body absorb what you are taking better, but you might want to ask your doc about taking more calcium until your levels get up to at least normal.
> 
> I took as much as I needed until my body felt better because this was recommended by the on-call surgeon the weekend after my surgery (when I was in the ER). I also found that Citracal is more easily absorbed by the body than Caltrate. Don't buy the generic forms of calcium. I usually think the brand names are just overpriced, but I found that it really does make a difference in how your body absorbs what you are taking.
> 
> ...


Hey there!
I took your advice and started taking the Citrical. I am feeling better. Altogether, it feels like all of my symptoms are improving. I am still on the Calcitriol, I am taking one pill daily, if I take more than that I get VERY dehydrated. I am also taking 3 of the Citrical per day, sometimes 4, where before I was taking only 2 of the Caltrate per day. I will be anxious to see how improved my levels are when I go back for labs 
Thanks a BUNCH!!!:hugs:


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## lavender (Jul 13, 2010)

Glad to hear you are feeling better! Hope your labs continue to improve.


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