# Any Hashi Lab input would be appreciated



## artms (Jul 23, 2011)

I'm trying to get a better understanding of my labs and would appreciate any input. Better to be informed. In retrospect,I felt great with the values on 9/22/2008. Then they changed the lab values and dropped my dose. The first lab on 88mcg was on 3/15/2011 and I still felt fine but the next one I was feeling terrible.

By 4/29/2011 my T4 values started dropping with the same dosage. I was having weight gain, fatigue and brain fog and told my Dr I thought I was perhaps having trouble converting T4 so I asked for a T3 result as well. With her knowledge I would try taking 100mcg and every fourth day an 88mcg to see if that would help then I retested on 7/15/2011. BTW the day of that particular test was when I had taken 88 mcg.I also requested Vit D test. 
My TSH had dropped and my T4 was also on the low end compared to say 11/1/2010 when I was taking 100 mcg. My Vit d was low. I haven't had a test for antibodies since 2008 and don't know if it matters.

2008

THYROGLOBULIN AB 165.0 0.0-14.4 IU/mL H
TEST INFORMATION: Thyroglobulin Antibody
A value of 14.4 IU/mL or less indicates a negative result
for thyroglobulin antibodies.
ANTI-TPO Ab 0.7 0.0-3.9 IU/mL

THYROID STIMULATING HORMONE

5/23/2008 very hypo symptoms 
4.16 (75 mcg)
0.35-5.5 range

9/22/2008 felt good 
0.54 (88 mcg)
0.35-5.5 range

6/26/2009 hypo symptoms
2.29 (75 mcg
0.35-5.5 range

11/1/2010 felt good
0.33 L (100 mcg)
0.35 - 3.30 **new lab values**

3/15/2011 felt good
0.45 (88 mcg)
0.35 - 3.30 range

4/29/2011 hypo symptoms
0.72 (88 mcg)
0.35 - 3.30 range

7/15/2011 felt better
0.24 L (100 and few 88)
0.35 - 3.30 range

VITAMIN D, 25 HYDROXY 21.6 
Deficiency < 10
Insufficiency 10-29
Sufficiency 30-100
Toxicity > 100

THYROXINE, FREE (FREE T4)

5/23/2008 very hypo symptoms 
1.26 (75 mcg)

9/22/2008 felt good
1.30 (88 mcg)
0.80-1.80 range

6/26/2009 hypo symptoms 
1.14 (75 mcg
0.80-1.80 range

11/1/2010 felt good
1.21 H (100 mcg)
0.60 - 1.20 **new lab values**

3/15/2011 felt good
1.03 (88mcg)
0.60 - 1.20 range

4/29/2011 hypo symptoms
0.90 (88 mcg)
0.60 - 1.20 range

7/15/2011 felt good
0.95 (100 and few 88)
0.60 - 1.20 range

T3 (TRIIODOTHYRONINE)
FREE 2.6 
(2.3 - 4.2) pg/mL range
-----------------------------------

Does anything jump out looking at these values? 
Are there any correlations to think about?
Are these flunctuations due to the Vit D insufficiency or is there something else I should be considering? 
When I get retested what labs should be included that might give a better picture?
What might help me to get my TSH and T4 into a better range?


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## Lovlkn (Dec 20, 2009)

artms,

How do you feel now? You say good?

Did the manufacturer possibly change on your replacement?

You are smack dab in the middle of the range for FT-4 which is good however since your FT-3 is so low I would like to see your labs taking 100mcg daily before asking for Cytomel. Sometimes getting your FT-4 into the upper 3/4 range is all it takes to feel your best.

I wanted to also point out you should never take your replacement before a lab draw. Also try to schedule your lab draws about the same time every time you have them.

It appears your TSH is impacted by your replacement so be sure and dose by FT-4 and FT-3.

Supplementing vit D will most likely give you more energy.


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## artms (Jul 23, 2011)

Lovlkn

I felt ok on my last labs when I was taking mostly 100mcg but my TSH was too low so my Dr ordered 88mcg Synthroid.
I have only been taking 88 mcg for the last four days.

I'm concerned about the dose change because the last time I switched fromm 100 to 88 I felt fine after 1 month (3/15/2011)and horrible at 2 months(4/29/2011).I suspect it took that long to get a reading on 88mcg dose.

I discussed with my Dr dosing by how I feel. She seems to hold strict to normal TSH ranges but has had patients who were in normal ranges and felt awful. She mentioned Armour or Cytomel but we tried mixing doses to see how it would work. It didn't so I'm back to 88mcg and not optomistic.

I'm very new at looking at these labs but I'm looking for correlations. I think over time I am requiring more Synthroid to get me into a good T4 range but it also puts me into a hyper range and my T3 still low. It seems like that has been a trend over the last few years. 
Is that just the nature of the disease?

Thanks for the good advice regarding lab draws
In light of that information it's likely I have not had a really accurate reading of my results because of the way I took them and the inconsistency. I never knew. Thanks for the tips.

Couple questions.

Why should I not take meds the day of my labs? 
I usually take meds early in the morning. If I skip that dose the day of the lab is there a best time of the day to test am or pm?


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## Andros (Aug 26, 2009)

artms said:


> I'm trying to get a better understanding of my labs and would appreciate any input. Better to be informed. In retrospect,I felt great with the values on 9/22/2008. Then they changed the lab values and dropped my dose. The first lab on 88mcg was on 3/15/2011 and I still felt fine but the next one I was feeling terrible.
> 
> By 4/29/2011 my T4 values started dropping with the same dosage. I was having weight gain, fatigue and brain fog and told my Dr I thought I was perhaps having trouble converting T4 so I asked for a T3 result as well. With her knowledge I would try taking 100mcg and every fourth day an 88mcg to see if that would help then I retested on 7/15/2011. BTW the day of that particular test was when I had taken 88 mcg.I also requested Vit D test.
> My TSH had dropped and my T4 was also on the low end compared to say 11/1/2010 when I was taking 100 mcg. My Vit d was low. I haven't had a test for antibodies since 2008 and don't know if it matters.
> ...


Yes; your one Free T3 (Triiodothyronine) lab test results are too low. 3.2 would be about mid-range of the range provided by your lab. It is below that. Most if not all of us feel best w/FT3 at about 3/4 of that range given by your lab. Put another way, about 1/2 way above the mid-range.

FT3 is your active hormone.

Here is some info.

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid

http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

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

You could stand some tweaking of your thyroxine replacement. An increase should show improvement. Your doc appears to be titrating based on your TSH; this is not a good thing.


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## Lovlkn (Dec 20, 2009)

> I discussed with my Dr dosing by how I feel. She seems to hold strict to normal TSH ranges but has had patients who were in normal ranges and felt awful. She mentioned Armour or Cytomel but we tried mixing doses to see how it would work. It didn't so I'm back to 88mcg and not optomistic.
> 
> I'm very new at looking at these labs but I'm looking for correlations. I think over time I am requiring more Synthroid to get me into a good T4 range but it also puts me into a hyper range and my T3 still low. It seems like that has been a trend over the last few years.
> Is that just the nature of the disease?


It's time to find a new doctor and you may have to visit a few until you find one who will dose your replacement based on FT-4 and FT-3 because you most likely have some stimulating antibody production going on which is suppressing you TSH when you are actually still hypo based on your FT-3.

I had the same issues and found a doctor (#3) who doses me by my Free T-4 and Free T-3. They are out there you just have to look until you find one. I gave up on endo's and tried 2 GP's who worked with me for about 18 months each before the TSH thing forced them to cut my doses. The current DO I see now ignores TSH and doses me by my "free's"



> Couple questions.
> 
> Why should I not take meds the day of my labs?
> I usually take meds early in the morning. If I skip that dose the day of the lab is there a best time of the day to test am or pm?


Take your meds after your lab draw. You can skew your lab draw if you take it before. It's a pain and may be closer to a meal than you would like but you just need to do it for the one day. I try to scheule my labs in the morning before I eat so I can take my morning dose as close to usual as possible.

Based on your current labs my opinion is that you should be taking at minimum 100mcg of replacement daily.


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## artms (Jul 23, 2011)

If I were to check my antibodies level and it were elevated, would that be responsible for a low TSH? Should it always be monitored as well?

Is there a URL link with more info? 
I have had my labs done at all times of the day. The last one which had the lowest TSH reading was in the morning after I took my meds. I rarely do it in the morning and was surprised how low it was.

If antibodies skew the TSH are you still at risk for side effects if you continue at that dosage?


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## Andros (Aug 26, 2009)

artms said:


> If I were to check my antibodies level and it were elevated, would that be responsible for a low TSH? Should it always be monitored as well?
> 
> Is there a URL link with more info?
> I have had my labs done at all times of the day. The last one which had the lowest TSH reading was in the morning after I took my meds. I rarely do it in the morning and was surprised how low it was.
> ...


Keeping TSH suppressed keeps antibodies quiet. There are all sorts of antibodies, autoantibodies and immunoglobulins that are binding, blocking and stimulating.

As Heidi has implied, no doubt you have an antibody blocking the TSH receptor site. Most likely that would be TSHR (thyroid stimulating hormone receptor antibody.) Not positive it is TSHR; just speculating here.

http://www.mayomedicallaboratories.com/test-catalog/Overview/81797

You may find the above interesting; it is complex and there are many alias'!

This is also interesting reading and mind you, I do not understand every single thing but I am good at "gleaning" what I want to know! LOL!!

http://jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-17-293.pdf


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## Andros (Aug 26, 2009)

Andros said:


> Yes; your one Free T3 (Triiodothyronine) lab test results are too low. 3.2 would be about mid-range of the range provided by your lab. It is below that. Most if not all of us feel best w/FT3 at about 3/4 of that range given by your lab. Put another way, about 1/2 way above the mid-range.
> 
> FT3 is your active hormone.
> 
> ...


Also, don't you think that it would be wise to have those Thyroglobulin Ab done again?

Have you ever had a sonogram done of the thyroid?


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## Lovlkn (Dec 20, 2009)

artms said:


> If I were to check my antibodies level and it were elevated, would that be responsible for a low TSH? Should it always be monitored as well? *I doubt that your current doctor would believe and treat you even if you had the stimulating antibody test done. I had a TBII test and scored 22 with <20 being range- it worked for about 12 months then the doc went back to dosing on TSH alone*
> 
> Is there a URL link with more info?
> I have had my labs done at all times of the day. The last one which had the lowest TSH reading was in the morning after I took my meds. I rarely do it in the morning and was surprised how low it was. *I don't have any like, just my experiences and those experiences of others. I have taken my meds previous to tests and THS was skewed lower but now my TSH is non existent and I avoid it as not to skew the FT-4 or FT-3 tests*
> ...


I posted in bold above.


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## artms (Jul 23, 2011)

Great information..Are the following labs the ones I should get and are there any others you can think of? I don't know the exact names of some of the test....especially any that would shoe why I have a dropping T3.
It sounds like the next tests I should have are 
TSH,
FT4, 
FT3, 
antibodies, 
a test for binding is it TSHr or whatever the name of it 
Vitamin D level, perhaps calcium and cortisol, blood panel

Am I right that I may in the end be looking at a T3 added and vitamin replacement? If so would I be looking at cytomel or Armour.
I'm happy to be understanding this a little more. Who knows, I may wind up ok, time will tell but I won't know for a while. Once I become befuddled and exausted I'll know.

I did find a few great links so when I get time to go back through I'll post them. Some of the info was a bit wonky but valuable.


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## Andros (Aug 26, 2009)

artms said:


> Great information..Are the following labs the ones I should get and are there any others you can think of? I don't know the exact names of some of the test....especially any that would shoe why I have a dropping T3.
> It sounds like the next tests I should have are
> TSH,
> FT4,
> ...


Yes; I believe your thinking is correct and adding T3 may be in the near future. You simply must get that FT3 up there otherwise you cannot function.

Your selection is good on the tests. Sometimes you have to check the lab sheet as the doctor will mark the wrong thing for the FREE T3 and FREE T4 even though they say they will. This is to save insurance companies the money.

It's a great life if you don't give up!


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## artms (Jul 23, 2011)

What are the all the test names for antibodies and binding. TBII? TSHr?
You know I had that conversation with my Dr about treating according to symptoms. She changed my dosage and never asked me about how I felt. Guess that in itself says a lot. I don't know if a Dr in a group os required to follow that protocol despit the T4/T3 levels.


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## Andros (Aug 26, 2009)

artms said:


> What are the all the test names for antibodies and binding. TBII? TSHr?
> You know I had that conversation with my Dr about treating according to symptoms. She changed my dosage and never asked me about how I felt. Guess that in itself says a lot. I don't know if a Dr in a group os required to follow that protocol despit the T4/T3 levels.


TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

And the TSHR

You can look this stuff up here and more.........
http://www.labtestsonline.org/

Ask you how you feel, touch you? Are you kidding? That would be too human!

One step at a time here but yes; you could have a very hard time getting put on Armour or getting Cytomel as an adjunct to your thyroxine.


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## artms (Jul 23, 2011)

Ignorant no more. I'm on it !!


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## Andros (Aug 26, 2009)

artms said:


> Ignorant no more. I'm on it !!


Isn't it wonderful when the lightbulb comes on? I just love it. I love learning things. It is so wonderful and I am glad you love learning too.

It truly is the only way to dig out. Knowledge is power!


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