# Test result guidance



## CoolCrisp (Oct 26, 2015)

Hi, I'm new here and although I've been getting some input from another board I'm on, I'd like input from here as well. The other board is geared toward eating low carb but they have medical boards with plenty of people dealing with hyper- or hypothyroidism. They have been very helpful and I'm at that stage where I'm looking everywhere for information!

I've had years of being told my thyroid was normal, but last month went to a new GP and asked for a thyroid panel test. I've had trouble losing weight my entire life and it's only gotten worse since having a hysterectomy a couple years ago. My numbers (Sept. '15):

TSH: *9.470* (range 0.450-4.500 uIU/mL)

T4, Free: *0.98* (range 0.82-1.77 ng/dL)

T3, Free: *2.8* (range 2.0-4.4 pg/mL)

I was told it was "mild hypothyroidism" and began 50mcg. of Synthroid (Levothyroxine). I just began my fifth week today and aside from some mile side effects, the biggest has been I've been very tired. I spoke with my doctor yesterday and I'm going to try taking the med at bedtime instead of the middle of the night as I have been. I go in for my first blood test in a couple of weeks to see if the numbers have been affected with this dosage.

Aside from thin hair and inability to lose weight, I don't have many of the typical hypo symptoms. I am, however, hoping that once my thyroid is working as it should, losing weight might be a little easier. Anything other than gaining despite dieting would be great.

Since I felt fine before, and more tired now, I have no standard to measure how or when I'll "feel better" like I've been told I will. I also know there's many variables since I'm just starting out. Switching meds, doses, etc. But, just curious to see what my numbers look like to you.

Thanks in advance!


----------



## Lovlkn (Dec 20, 2009)

> TSH: *9.470* (range 0.450-4.500 uIU/mL)
> 
> T4, Free: *0.98* (range 0.82-1.77 ng/dL)
> 
> ...


You have hypothyroidism. Did thye run a thyroid ultrasound on you?

Your labs posted indicate you are hypo, without a doubt.

Most on this board feel best with a TSH at 1

FT-4 at mid to 3.4 of range ( depends on when you took your last replacement dose)

FT-3 at mid to 3/4 of range.

Your posted labs are well below those suggested numbers.

If you are still feeling hypo - you should lab, at 4 weeks and ask for an increase.

Be sure to ask for both FT-4 and FT-3 labs to confirm you are converting properly. Do not worry about TSH at this time as it lags up to 6 weeks and as long as the Free tests are in the ranges suggested you are in a good place.

As far as when you take it - does not really matter because of the long 1/2 life. More important is to take 3 hours away from calcium and iron supplements. I take mine in the middle of the night as I have insomnia and wake often, and also take calcium supplements 3 x a day.


----------



## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

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.

Welcome to the board!!

Lovlkn has you covered. Do get labs right now and ask for a small increase to get you over the initial hump. Thereafter, you should lab every 8 weeks and doctor can titrate your med accordingly.

T4 takes 8 weeks to build up in your system. You are in dire need so therefore, it is not building up. You are using it as fast as you can replace it. T4 converts to T3 and FREE T3.

Info on that above.

You really really need to get an ultra-sound of your thyroid.

Have you had any antibodies' tests?


----------



## CoolCrisp (Oct 26, 2015)

CoolCrisp said:


> Hi, I'm new here and although I've been getting some input from another board I'm on, I'd like input from here as well. The other board is geared toward eating low carb but they have medical boards with plenty of people dealing with hyper- or hypothyroidism. They have been very helpful and I'm at that stage where I'm looking everywhere for information!
> 
> I've had years of being told my thyroid was normal, but last month went to a new GP and asked for a thyroid panel test. I've had trouble losing weight my entire life and it's only gotten worse since having a hysterectomy a couple years ago. My numbers (Sept. '15):
> 
> ...





Lovlkn said:


> You have hypothyroidism. Did thye run a thyroid ultrasound on you? *- No, they didn't.*
> 
> Your labs posted indicate you are hypo, without a doubt.
> 
> ...


----------



## CoolCrisp (Oct 26, 2015)

Hi Andros, I tried to multiquote and it didn't work for me. I tried selecting "multiquote" on both, then "multiquote" on Lovlkn, "quote" on yours. I'm sure I'll get it later on.

Anyway, why should they have done an ultrasound? I read if Hashi's is suspected they should, but at this point, it was an initial thyroid test to see if I was hypo or not. I've read about Hashi's and like the hypo symptoms, I don't have those either, except the weight issue.

No antibodies test, either. That's to find out about Hashi's as well?

Thanks for the welcome!


----------



## Lovlkn (Dec 20, 2009)

> I was told it was "mild hypothyroidism" and began 50mcg. of Synthroid (Levothyroxine).


You are actually very hypo. 50mcg is most likely going to have to be increased to make a difference.

What type of doctor is currently treating you?

FT-4 and FT-3 are what they run and the only tests you should have when dialing in your replacement dose.

The reason an ultrasound is important is to find out "why" you are hypo. Nodules are often the cause and the ultrasound will reveal if they are normal nodules or cancerous nodules.

As far as taking your dose at bedtime - make sure you are 4 ( not 3) hours from iron or calcium. I would make sure I was at least 3 -4 hours away from food and take the pill with a full 8 oz glass of water.


----------



## CoolCrisp (Oct 26, 2015)

Lovlkn said:


> *You are actually very hypo.* 50mcg is most likely going to have to be increased to make a difference.
> 
> What type of doctor is currently treating you?
> 
> ...


The bolded up there is interesting to me. Which number makes me very hypo? The other board I'm on had the same reaction at being told it was "mild". Naturally, I thought it was the TSH number until I began doing some research. And I'm still a bit dazed and confused!

I'm seeing a GP (I go to church with her). She's treating another good friend and her daughter, have worked with them to get the meds right and they are happy with the results. The time I got the blood test was the first time I'd seen her professionally. I've made a note to ask her about the FT-4 and FT-3 for checking the med dosage.

I take my vitamins midday, so that's good. The pill at bedtime may not turn out to be a good idea! Not that I'm particularly a late eater, but it's too variable. I may stick to taking it in the middle of the night. But, I keep hearing how the Synthroid shouldn't be making me tired. Does this indicate maybe it won't be the best med for me? I just refilled my prescription and am scheduled for blood work tomorrow.

Thanks, I really appreciate all the info. 

*ETA: *Would you mind looking at my sister's numbers? She went to the same doctor as she has the same issues as me (mainly weight gain/inability to lose weight). After all I'm reading, I think she is hypo, but was told "normal". I asked if I could put her numbers here and she agreed.

*Please note, these are my sister's numbers to see what you think:*

TSH: *2.690* (range 0.450-4.500 uIU/mL)

T4, Free: *1.27* (range 0.82-1.77 ng/dL)

T3, Free: *2.9* (range 2.0-4.4 pg/mL)

Thanks you!


----------



## jenny v (May 6, 2012)

I think hypo is running in your family!

You are definitely hypo and your sister is heading in that direction, too. We normally aim for a TSH close to 1.0 and the Frees at the upper end of their ranges. The mid point of your Free T3 range is 3.2 and neither you nor your sister is even close to that. Free T3 is the one that contributes greatly towards metabolism, energy, etc., so your low numbers point to why you've been having some of the issues you've described.


----------



## Lovlkn (Dec 20, 2009)

> Which number makes me very hypo? The other board I'm on had the same reaction at being told it was "mild".





> TSH: *9.470* (range 0.450-4.500 uIU/mL)
> 
> T4, Free: *0.98* (range 0.82-1.77 ng/dL)
> 
> T3, Free: *2.8* (range 2.0-4.4 pg/mL)


This is my opinion - being at the bottom of range to me is being very hypo. Your FT-4 is bottom while your FT-3 is only at 1/4 of range.

The good news is your conversion looks to be working as you are higher in range of FT-3 which is what you "feel". T-4 converts to FT-3.

I take my 1st dose which is Unithroid (T4) sometime between 1:30-3:00 a.m. as I awaken every night and take my 2nd dose ( 1st Cytomel) around 5:30 a.m, 3rd at 1:00p.m and 4th at 6:00 p.m.. As long as you are consistent your labs will make sense and you can adjust appropriately if needed.

My most recent labs were perfect at 3/4 of range for both - I think it was the 1st time ever in 10 years taking replacement they were both where we preach. It's a goal - you will shoot for that goal and adjust according to where you are.

Since I take my meds so early I was feeling a bit keyed up and am in trial of stretching out my Cytomel doses during the day since they only have a 6 hour 1/2 life vs the Unithroid with a 7 day 1/2 life.


----------



## Andros (Aug 26, 2009)

To make sure you don't have cancer. It seems it is on the rise and we would be very irresponsible to you, the poster, to not advise it.

You would be surprised to find out how many that we have advised to this over the years came back to say thank you for saving their life.

It's our duty.

So, dear one, please tell your doctor that you would like to have an ultra-sound of your thyroid. And when you do, be sure to get your own reading of that ultra-sound so you can post it here and you can put it in your file for future reference.

Hugs,


----------



## Andros (Aug 26, 2009)

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

You can look this stuff up here and more.........
http://www.labtestsonline.org/
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

Her FREE T3 is in the very low range also and I am sure she is feeling tired and gaining weight no matter what she does.

You "both" need the above tests and an ultra-sound. And don't rule out hyper because symptoms can and do cross over. Example: Many of us hyperthyroid patients gained weight. Lots of it.


----------



## CoolCrisp (Oct 26, 2015)

Thanks for all the info, I appreciate it. I'll be going in this afternoon for the first blood test after beginning the Synthroid. I'll make sure that she's testing FT3 and FT4. I'll ask her about the ultrasound and the antibodies.

I appreciate and understand the cancer concerns. Someone close to me had thyroid cancer recently. She's been guiding me on doctor suggestions, too. I think it just runs in the family on my dad's side (he's hyper). I found out when visiting a cousin (ironically, while waiting to get the results on my initial test) that she is teeters on being hypo. She is my dad's niece.

I passed along your opinions to my sister on her numbers. Unfortunately, I don't think she's going to push the doctor right now as she doesn't think it will do any good and I'm only going to push her so much. Like me, she doesn't have the typical symptoms aside from the inability to lose weight no matter what she does. Maybe "if" I can begin losing some weight down the road, it'll motivate her to speak up. She usually doesn't have that problem! I'm usually the one to acquiese to whatever a doctor says. I'm already prepared to tell my doctor that SHE may fire ME if I come across as knowing more than her.

I've never so anxious to get a blood test and put the results here. And I hate needles!


----------



## CoolCrisp (Oct 26, 2015)

Got the results back. The med worked quicker than I thought it would. The nurse called, but said the doctor said my numbers look good. I have a feeling y'all would prefer to see the FT-3 come up since it didn't change, maybe the FT-4 up a bit more, and the TSH go down. She'd like me to stay on the Synthroid but let her know if the tiredness doesn't subside. It has a wee bit, but I'm also getting hit by the seasonal allergies and that always me feel "off" anyway.

What will help the numbers shift in a better direction? Higher Synthroid dose? I hope so, I wouldn't have a problem asking her for 25mcg more.

Second test results (10/15):

TSH: *3.880* (range 0.450-4.500 uIU/mL)

T4, Free: *1.39* (range 0.82-1.77 ng/dL)

T3, Free: *2.8* (range 2.0-4.4 pg/mL)

Initial test results (9/15):

TSH: *9.470* (range 0.450-4.500 uIU/mL)

T4, Free: *0.98* (range 0.82-1.77 ng/dL)

T3, Free: *2.8* (range 2.0-4.4 pg/mL)


----------



## Andros (Aug 26, 2009)

I hope and pray that your doctor is open minded and amenable to doing the necessary tests.

Unfortunately, you need to focus on yourself right now. Do that and when you are up and running, see what you can do to help your sis. If your cup is empty, you can't offer much help to anybody.

Let us know the outcome of your doctor's visit.

Hugs,


----------



## CoolCrisp (Oct 26, 2015)

Wow, I can't believe it's been a year since I've been here! Got on meds, got busy with the holidays, etc. and boom. Thought I'd just add to this thread instead of starting a new one.

I am still learning about this process. I thought I was taking branded meds until just recently. I've been on Levothyroxine since September 2015. Started out at .50 and have only been upped to .75 during that time and that was earlier this year. Went to see an endo who added Cytomel (the Lio- one, also generic), first at 5mcg. a day, then a month later upped it to twice a day. That was in July. I was supposed to get blood work in September, turned around twice and now it's November. I'm going to see my original doctor (GP) tomorrow.

The endo thought he felt something on my thyroid, did an ultrasound on my second visit and found nothing. I don't know if I'll go back to him because my sister went at the same time and he only tested her TSH. He was fine with her numbers which I'm sure were still roughly what they were above. My GP knows of him and said he only tests TSH and I thought she's surely mistaken - he's an endo!

Aside from being extremely tired once beginning the Levo last year, I've seen no changes. Well, my eyebrows do seem a little more filled in. No weight loss to speak of (I eat lower carb and do IF which has led to a teeny weeny couple of pounds gone). I honestly feel no change.

I've recently began hearing about "functional doctors". I found one locally that does promote lower carb eating which I like, and she does treat thyroid issues. FD's are supposed to treat the person, not the numbers. The big drawback is insurance doesn't cover anything. Not sure if they'd even cover the labs.

So, long story short - have any of you tried them?


----------

