# New labs



## McKenna (Jun 23, 2010)

I had my last adjustment in January, when my TSH was over 10. These are my latest labs on 90 mgs (1 1/2 grains) Armour.

TSH .087 .45 - 4.5
Free T3 3.4 2.0 - 4.4 This was fasting, no Armour dose that morning
Free T4 .89 .82 - 1.77
TPO 243

Of course the endo was not comfortable with my supressed TSH. He wants it higher and I told him that I feel better than I have in a year and I don't want to lower it. He said we can compromise and he wants me to take 90 mgs for 6 days a week and 60 mgs for one day. I don't have any hyper symptoms other than one or two loose BM's per day and an occasional heart palp, but I'm still on a beta blocker.

My Free T3 was fasting with no Armour dose that morning and it was at 58%, which is above mid range. So I'm sure it's higher after I take my dose, probably closer to top of range, which is good.

My Free T4 is still low, but I know that it is naturally supressed b/c of the T3 in Armour. My question is....how low is the Free T4 supressed? Is this normal for someone on Armour?

My antibodies are still acting up, but lower than January when they were around 297. Endo's comments about it being high were b/c of stress. Well so kidding stress makes it act up, but I'm actually doing well with stress right now. *He* makes me stressed out! LOL! And he gave me the big spiel about staying away from stress even though I told him I'm not under any extra stress right now.

Oh, he also gave me the spiel about how a low TSH can affect my heart (didn't listen to me when I pointed out my actual thyroid number don't reflect hyper) and that I have a greater chance of osteoporosis. I told him I was under cardiac care anyway and not having any problems.

How much is going down to 60 mgs on only one day per week going to affect me? He said he would be comfortable with my TSH near .4 but would even settle for it around .2 or .3. Ugg! And I'm wondering how accurate my TSH level is b/c of the high antibodies, which I'm sure are messing numbers up again.


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## lainey (Aug 26, 2010)

I don't think it's so much of a dose decrease that it would affect you, other than to make your doctor happy so that he leaves your meds alone otherwise.


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## Andros (Aug 26, 2009)

McKenna said:


> I had my last adjustment in January, when my TSH was over 10. These are my latest labs on 90 mgs (1 1/2 grains) Armour.
> 
> TSH .087 .45 - 4.5
> Free T3 3.4 2.0 - 4.4 This was fasting, no Armour dose that morning
> ...


I have to say those labs look really really good. I just hate when a doc is a 
TSH worshipper, don't you?

What affects the heart and osteoporosis in NOT having the FREES in the exact right place for you which is euthyroid (meaning you feel great!)

Oh, my gosh..................what to do, what to do?

My doc keep my TSH @ 0.03. And my Frees are ideal. FT4 is naturally low because it is supposed to be when taking any form of T3 and my FT4 is in 75% of the range given by my lab and believe me, I am not hyper. Not by any stretch of the imagination.

FT4 is naturally lower because of the T3. That is the active hormone. So you don't need as much T4.

I hate this for you; you must let us know how you fare and I hope some others have some helpful input.


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## McKenna (Jun 23, 2010)

The nurse gave me a copy of my labs a few minutes before the doctor came in and as soon as I saw the TSH, I KNEW he was going to give me a hard time.
I did a "pre-emptive" strike as he walked in the door and said "I think I'm finally getting there! I feel better than I have in a year!". LOL! And as he read my labs to me I didn't let him comment but told him that I'm finally feeling better and don't want to decrease my meds. He told me that as my physician...blah, blah, blah.....he had to tell me about the heart effects and osteoporosis and I told him I still don't want to decrease it. Then he said we can compromise and he gave me "60" one day of the week and "90" for 6 days deal. Ugh!!!


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## McKenna (Jun 23, 2010)

New labs taken 6/8/11 (fasting from armour that morning)

TSH .05 .358 - 3.74
Free T 4 .71 .76 - 1.46
Free T 3 3.3 2.0 - 4.4

TPO 185

TPO has gone down from 243 since being gluten free. Yay!! I also eat two Brazil nuts per day for selenium.

Endo freaked out last time when my TSH was .087, I know he's going to lower my dose again, even though my Free T3 is good.

I'm on 90 mg Armour for 6 days and 60 mgs on one day per week.

I've felt better in the last three weeks than I have in a year!

My liver enzymes are still climbing. I don't drink at all and occasionally take motrin or tylenol for headaches, which are more frequent. ??? H ave no clue why my liver enzymes are still going up. My family doc knows about it and thinks it could be due to my thyroid numbers being off. ??

My AM glucose is 100 (70 -99). I think this is the second time it's been elevated while fasting. I'm hoping I'm not developing a sugar issue. Since being gluten free, I'm eating way less carbs and sweets.

Andros, I need your advice again my friend!! :hugs:


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## lavender (Jul 13, 2010)

The strange thing is that all your levels went down, TSH, Free T3 and Free T4, which would make raising your TSH seem like a loosing battle to me

UGH! I hate the idea of lowering a dose when you're feeling well. My doc lowered mine at my request, and it ended up being a big mistake!

Armour is so short acting that I hate the idea of taking one dose one day and a different dose another when 30 mg can make a big difference. Are you feeling differently on the day you take 60 mg?

One thought, They do make a 15 mg Armour tablet. Any chance you could talk the doc into prescribing that and alternating between 75 mg and 90 mg?


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## Andros (Aug 26, 2009)

McKenna said:


> New labs taken 6/8/11 (fasting from armour that morning)
> 
> TSH .05 .358 - 3.74
> Free T 4 .71 .76 - 1.46
> ...


Fight him tooth and nail on lowering the Armour again. Tell him, "What do you think got me feeling good in the first place? Why would you want to mess w/that?"

What did you eat the night before your fasting glucose? I made the mistake of having some dried cranberries around 7 PM the eve of my fasting glucose and my glucose went to 105!! Eeeeeeeeeeeeeeeeeeeeeeeeeeks!! I have a friend who is a dietician and she told me dried fruit(sugar) takes about 72 hours to get out of your system.She said, "Don't do that again!" LOL!! My glucose is usually in the low 90's though (IR?)

In what way does your family doc think your thyroid numbers are off? I personally think you have some wiggle room and should be allowed to go up 1/4 grain.

Good news about the TPO!! Hey, Rome was not built in a day!


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## McKenna (Jun 23, 2010)

Hi Ladies,

I worked quite a bit this week and haven't been able to get on. Today is my endo appointment and I have myself all worked up about it. I'm very nervous b/c we do not have a great relationship at all! I need a new endo but I'm so afraid a new one will take me off Armour.

I feel better now than I have in over a year. I have been back to hiking, biking, swimming and going non-stop. Compared to last year at this time when I felt and thought I might be dying, this is a huge improvement! I plan on telling him that! There are still some kinks I need to get right, my legs are still stiff, especially in the AM, my weight won't budge no matter how active I am or how little I eat. I'm not eating many carbs now b/c of being gluten free and hardly any sweets. GF cookies are expensive and don't taste the same, lol! I'm at the upper end of a normal weight for my height, but I just want to fit into my clothes again. It's more about being cheap and not wanting to buy a new wardrobe (lol) than how I look with a few extra pounds.

I also think I have some wiggle room in adjusting my dose, but he's a TSH worshipper and I know he will flip out when he sees that low number. He'll give me the same lecture about osteoporosis and cardiac problems.



> The strange thing is that all your levels went down, TSH, Free T3 and Free T4, which would make raising your TSH seem like a loosing battle to me


Good point Lavender! I'm going to use that today.
Any thoughts on why my TSH went down, instead of up? I don't think TSH is an accurate measure for me at all.



> Armour is so short acting that I hate the idea of taking one dose one day and a different dose another when 30 mg can make a big difference. Are you feeling differently on the day you take 60 mg?


Sometimes I do. In the beginning it was awful on a Saturday. Mostly I felt mental symptoms and extra tired, Irritable, depressed. Now I think I'm ok with it but feel a little more "blah" on Saturday and Sunday mornings.



> One thought, They do make a 15 mg Armour tablet. Any chance you could talk the doc into prescribing that and alternating between 75 mg and 90 mg?


Alternating days? Monday 90, Tuesday 75, Wed 90 and so on?



> What did you eat the night before your fasting glucose? I made the mistake of having some dried cranberries around 7 PM the eve of my fasting glucose and my glucose went to 105!!


I can't remember what I ate the night before, but it might have been something sweet. It was before my "time of the month" and I know I had some chocolate that week. LOL!



> In what way does your family doc think your thyroid numbers are off? I personally think you have some wiggle room and should be allowed to go up 1/4 grain.


My family doc is not treating my hypo, but my family doc did blood work on me a few months ago and my liver enzymes were up. He said that until my thyroid numbers get right, it could be messing up my other systems so he didn't want to do anything about my enzymes until we get my thyroid numbers under control. My endo ordered this round of tests and added the liver enzymes based on my family docs labs. Now my enzymes are up even higher. Any thoughts on it?



> Good news about the TPO!! Hey, Rome was not built in a day!


I'm shocked at how much it came down! I had my surgery last October and my TPO went up in stead of down. Then it crawled down only a few points. But since I went gluten free it really went down a lot. I also eat two brazil nuts a day for selenium.

I read about Hashi's and gluten free and decided to try it. In the beginning it was difficult but now it's second nature. I went GF the beginning of April, and about three weeks after that is when I really started to feel much better.

I will update you ladies after my appointment. Thanks for your input!! :hugs:


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## Andros (Aug 26, 2009)

McKenna said:


> Hi Ladies,
> 
> I worked quite a bit this week and haven't been able to get on. Today is my endo appointment and I have myself all worked up about it. I'm very nervous b/c we do not have a great relationship at all! I need a new endo but I'm so afraid a new one will take me off Armour.
> 
> ...


I personally will be looking forward to your lab results and ranges. As previously discussed, I believe you have "wiggle room" for increase in Armour and you will NOT lose weight until you are euthyroid meaning that the numbers are in the right place for you.

For most of us, that means TSH @ 1.0 or less and FREE T3 @ about 75% of the range given by your lab.


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## lavender (Jul 13, 2010)

McKenna said:


> Hi Ladies,
> 
> Good point Lavender! I'm going to use that today.
> Any thoughts on why my TSH went down, instead of up? I don't think TSH is an accurate measure for me at all.
> ...


I can totally relate to your fear of seeing a doc who will take you off Armour even though you don't like the one you have. I seem to be having a lot of problems, which may or may not be thyroid related and my doc seems totally incompetent to treat me. I'm just afraid to loose her and get told to go back on synthroid and anti-depressants.

It sounds like you are really making some good progress. I hope it continues for you. My thyroid antibodies are gone since surgery, so whatever my issue is, it may be different antibodies, but at least I got my TPO and thyroglobulin down! I'm going to take what I am hearing about your level of activity and keep hoping that I can get there myself! There is so much that I miss being able to do!

I really can't say much on why your TSH is moving in the opposite direction. My TSH has been from .5 to 29 to 23 to 4 over the past few months with no good explanation. I really wish docs would just throw away the TSH test for us altogether!

I would definitely tell the doc how you are feeling on the days when you are on a lower dose. Let him know it is not acceptable and a further decrease will have you feeling worse. I personally think not enough thyroid replacement is hard on our heart and bones, but docs seem so afraid. It's almost harder to get a script for some fricking thyroid meds than to get narcotics! LOL!

What you said about alternating days is exactly what I meant.

Sending you good energy for your appointment today. I hope all goes well.


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## McKenna (Jun 23, 2010)

Back from my endo appt and good news....he DID NOT lower my meds. Thank God! But it was a fight. A friendly fight, though. LOL!

I headed him off by telling him how much better I've felt as soon as he walked in the door. He immediately went into my TSH being .05 and risk of osteo, etc. I said but there has to be other ways to monitor osteo if he was concerned. I pointed out that even though TSH went down when he lowered me last time, my frees did too and that I really don't want to go back wards.

I also reminded him that he told me before that despite labs, he said he looks at a person's symptoms. Then we got into a discussion on how T3 supresses T4 and TSH. He wanted to put me on 90 for 5 days and 60 for two but finally agreed to not do anything and re test me in 3 months. He made me promise to call him if I feel the slightest heart palp or other hyper symptoms.

He is concerned about my liver enzymes and said we will test again in 3 months but there could be the possibility of autoimmune hepatitis. Depending on the next round of tests, we'll see where we go with that.

So thanks for your prayers and well wishes. Maybe once he sees me doing well with a supressed TSH, he will let me updose next time.

Lavender, what dose are you on now?

I do have a lot more energy and am more active, but I push myself a lot too. Physically my body is beat from the past year but I'm hoping that changes. The biggest thing for me is the desire to do things again. I actually want to get out and hike or go places, even if my body isn't fully cooperating. And I'm not completely exhausted at the end of the day and falling asleep at 7 pm. I can stay up later and sleep pretty well.

What are your thoughts on dosing Armour twice per day? I know Dr. Mercola and other recommend it. I'm wondering if I try it if I will feel a little more "awake" in the afternoon. And didn't you try night time dosing before?


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## lavender (Jul 13, 2010)

Oh, good news about your dose. Bad news about your liver. I hope it heals. I know many with significant liver damage who have recovered.

I am taking 120 mg. I was on 90 mg for a while, and my TSH went to 29! I get more labs run next week, so we will see how it looks then. I'm still exhausted most days, but dealing with a lot of heart palps today. My doc was willing to keep me on 120 with a TSH of .6, but I was worried about the heart palps, and went down, and I just bottomed out. My heart palps have never gone away no matter what my dose, except for a while right after surgery. My doc keeps talking about sending me to a cardiologist, and I think I'm going to push her to just do it finally when I see her.

I know how you feel about being anxious to get out and recover. I was hiking right before my TSH shot up to 29. So, I am so confused. I think I need to take things more slow and steady, but it's hard when it's summer and I have been cooped up sick for so long.

I tired taking my Armour at night, that was how I was taking it when my TSH was 29. I can't remember exactly when I went back to an AM dose, but my TSH only dropped to 23 on a 105 dose in the morning. I have thought about twice a day dosing, but I take so much calcium and iron throughout the day that it feels impossible to time it all right unless I were to stay up taking pills 24 hours a day!


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## McKenna (Jun 23, 2010)

I would say to go get a cardiac workup. I have had MVP forever and last year my heart palps were out of control. I went on atenolol and I'm still on it. Maybe a beta blocker will help?

Are you still having parathoid issues?? My goodness! I just had my calcium level done and it's 9. I stopped all my vitamins and supplements and I'm trying to take things slowly.

I may try twice per day dosing, but not quite yet. Even with the eating factor it can still be a pain to do it at the right times.



> but it's hard when it's summer and I have been cooped up sick for so long.


I know what you mean. I missed the entire summer last year, and the fall, and Christmas....etc. It feels like it takes FOREVER sometimes just to see a little improvement.

We will get there, though! :hugs:


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## lavender (Jul 13, 2010)

I was on a really high dose of propranolol before my surgery that did not seem to help much, but that's because my thyroid was so out of control. It's possible that all those months of untreated hyperthyroid did a number on my heart, and I probably would feel better knowing for sure. Now if I can only get my doc to actually write the referral instead of talking about it.

The parathyroid issues seemed to calm down once I started taking Magnesium. I take a lot of supplements every day between calcium magnesium iron and now a multi-vitamin. trying to stay on top of the timing can be challenging.

I am interested in hearing how you do with twice a day dosing.


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## McKenna (Jun 23, 2010)

Newest labs taken 9/12/11 (Fasting Armour that morning)

TSH .04 (.358 - 3.74)
FT4 .75 (.76 - 1.46)
FT3 3.2 (2.0 - 4.4)

He did not run antibodies this time, but I'm hoping they are still going down.

Good news....my liver enzymes are going down! Finally after a whole year! I will talk to him more about his thoughts on an autoimmune attack on my liver.

Any thoughts on this? My OSMO,CAL has been low with the past two blood tests. I don't have a clue what it is or what it could mean.

OSMO,CAL 278 (280 - 300 MOSM/KG)

It was exactly the same last time in June.

Well, I'll be gearing myself up for the endo to tell me at my appointment next Tuesday that he wants to lower my Armour again. Sigh..... It was a fight last time to not let him touch my dose but now it's gone down another point. I need some ammunition ladies!

I have been feeling really good lately. Dare I even say it! I have had some of those arm and legs pains and stiffness at times and still have those weird blotches on my trunk. And I can't seem to lose weight. I guess I won't be getting my increase this time either.


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## Andros (Aug 26, 2009)

McKenna said:


> Newest labs taken 9/12/11 (Fasting Armour that morning)
> 
> TSH .04 (.358 - 3.74)
> FT4 .75 (.76 - 1.46)
> ...


You have wiggle room w/the FREE T3. Since that was w/o Armour (you are such a good girl), I would say only go up by 1/4 grain. Ideally, FT3 should be about 75% of the range provided by your lab. Right now, you are smack dab in the middle.

Your argument is going to have to be, "If I am feeling so well, why do you want to lower my Armour?" Isn't this the goal; that I should feel well?

And then tell him/her you want to get "weller" by adding another 1/4 grain. LOL!!

Arm yourself with info:

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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## McKenna (Jun 23, 2010)

> Your argument is going to have to be, "If I am feeling so well, why do you want to lower my Armour?" Isn't this the goal; that I should feel well?


Oh yes, that was part of my arguement last time.

I'm also going to point out that my FT4 is still low and not even in range and my FT3 went down a bit.

Honestly, I would just be happy if he lets me go up a bit on my Saturday dose. He flipped back in March when my TSH was .08 and lowered it one day a week, Saturday. I know it makes him nervous but honestly...I feel so much better than 6 months ago.


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## Andros (Aug 26, 2009)

McKenna said:


> Oh yes, that was part of my arguement last time.
> 
> I'm also going to point out that my FT4 is still low and not even in range and my FT3 went down a bit.
> 
> Honestly, I would just be happy if he lets me go up a bit on my Saturday dose. He flipped back in March when my TSH was .08 and lowered it one day a week, Saturday. I know it makes him nervous but honestly...I feel so much better than 6 months ago.


FT4 is supposed to be low when taking T3; this is not a concern nor is the TSH at this point. Focus on the FT3.

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


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## McKenna (Jun 23, 2010)

Andros,

Endo appointment today. He let me go again...sort of...
He hates my TSH so supressed and wants me to lower my dose on two days a week now. (I currently take 90 for 6 days and 60 for one) Believe me, I argued everything! He finally relented and said to try it and if I feel more tired then I can go back to my usual dose. I may humor him and try it this weekend, but I will most likely go back to my usual dose.

He really pushed the osteo angle again. I need some studies to show him that people on Armour have a higher chance to go on to develop osteo.

My liver enzymes going down was a great thing. He still thinks I have some sort of autoimmune attack on my liver but he also wants to do a three hour glucose test b/c he's suspecting some insulin issues. I go back in 6 weeks to have the test and go over the results with him.

So, all in all not a bad appointment. He's giving me say in my treatment and letting me decide where I feel better, which is good. I'm not happy about more testing though.


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## Andros (Aug 26, 2009)

McKenna said:


> Andros,
> 
> Endo appointment today. He let me go again...sort of...
> He hates my TSH so supressed and wants me to lower my dose on two days a week now. (I currently take 90 for 6 days and 60 for one) Believe me, I argued everything! He finally relented and said to try it and if I feel more tired then I can go back to my usual dose. I may humor him and try it this weekend, but I will most likely go back to my usual dose.
> ...


It really does not matter what the thyroid replacement is. The single thing that prevents osteo is NOT being euthyroid. That is achieved by the doctor carefully adjusting and titrating whatever med it is until the patient is totally well and the numbers are where they should be for that particular patient.

For most of us, that is TSH @ 1.0 or less and the FREE T3 @ about 75% of the range given by your lab.

I am glad to hear that your doc is listening to you and involving you in the decision-making process. This is very good!

Don't know why your doc would hate a suppressed TSH? Does he ever say?


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## McKenna (Jun 23, 2010)

> Don't know why your doc would hate a suppressed TSH? Does he ever say?


He says that the lower the TSH the higher liklihood of developing osteo and cardiac issues. I told him there are other ways of monitoring these without just going ahead and lowering my dose in a "what if" situation.


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## McKenna (Jun 23, 2010)

Labs taken Monday 10/24

Endo wanted labs and a 3 hour glucose test b/c he suspects something is strange with my blood sugar, which my labs seem to confirm. I had been very tired, but sometimes keyed up, anxious and confused. I don't know how to read the sugar related labs and we're still waiting on the C peptide to come in.

First, my thyroid labs. He wanted me to lower my Sunday dose but told me that if it was too much, to go back up. I tried it one Sunday and then went back up. Now I'm wondering if my FT3 is too high? These labs were fasting Armour:
TSH .04 .40 - 4.00
FT4 .8 .8 - 1.8
FT3 4.1 1.8 - 4.2

Now...the Glucose. I had a 3 hr test.

Glucose 0 minutes 97 70 - 108
Glucose 60 minutes 84 (L) 90 - 158
Glucose 120 minutes 92 65 - 139
Glucose 180 minutes 48 (L) 70 - 108

Insulin: The only range given is for the 0 minutes. Does the range stay the same for all times??

Insulin 0 minutes 6.7 (L) 9.3 - 29.1
Insulin 60 minutes 40.9
Insulin 120 minutes 35.5
Insulin 180 minutes 13.1

C peptide results are not in, but they were taken every hour.

Am I hypoglycemic with the low glucose levels? I got EXTREMELY tired about one hour or so after I drank the sugar solution. So much so that I had my kids make sure I stayed awake b/c I felt like I was going to fall asleep sitting on the couch.

The good news is that my liver enzymes have stayed down. The ALT is within range and the AST is only 3 points above the range. Much, much better when they were in the hundreds!

Opinions? Advice? Can anyone decipher these glucose labs?


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## Andros (Aug 26, 2009)

McKenna said:


> Labs taken Monday 10/24
> 
> Endo wanted labs and a 3 hour glucose test b/c he suspects something is strange with my blood sugar, which my labs seem to confirm. I had been very tired, but sometimes keyed up, anxious and confused. I don't know how to read the sugar related labs and we're still waiting on the C peptide to come in.
> 
> ...


Your labs look good. FT3 fluctuates throughout the day not to mention that if you took it before your labs, the peak time is 4 hours.

You feel good, right? If you do, this is the main criteria. Bottom line.

Sorry; glucose tests not my field of expertise.


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## McKenna (Jun 23, 2010)

Thanks Andros. I was fasting from Armour that morning. You don't think the FT3 is too high at almost the top of range?


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## Andros (Aug 26, 2009)

McKenna said:


> Thanks Andros. I was fasting from Armour that morning. You don't think the FT3 is too high at almost the top of range?


My doctor doesn't and I don't. As long as you are presenting w/hyper symptoms clinically. As I mentioned, these numbers do fluctuate.

You did right to fast from it for the "new one" absorbs really fast. And I do mean fast. I think we talked about this before.

Huggles,


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## lainey (Aug 26, 2010)

I'm no expert but it looks like reactive hypoglycemia

http://www.mayoclinic.com/health/reactive-hypoglycemia/AN00934

The key to managing this is to avoid the post meal dip by having frequent, lower carb meals instead of larger meals to stabilize your blood sugar.

With your borderline high T3, your elevated metabolism could be contributing to the problem.

I would get some labs without fasting the Armour. When you do that, you aren't getting a true picture of what is going on shortly after you take the meds. At these levels, you could very well be over on the T3.

It will be interesting to see what the endo says.


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## McKenna (Jun 23, 2010)

Thanks Lainey,



> With your borderline high T3, your elevated metabolism could be contributing to the problem.


Interesting....

Wouldn't I be overly hungry if my metabolism is high? Or lose weight? Neither of which have happened, in fact I'm rarely very hungry.

I'm very interested in what the endo has to say. My appointment is next week so we'll see.


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## lainey (Aug 26, 2010)

Basically what happens in reactive hypoglycemia is that the pancreas over-produces insulin in response to a carb load, causing a faster and deeper post meal dip than normal. Hunger is controlled by a separate hormone, ghrelin, and the interesting thing about that is that it is often suppressed in the presence of higher levels of insulin. The body does not then respond in the normal way to hypoglycemia-ie, increased hunger.

Faster processing does not necessarily mean increased hunger. Likewise, weight loss also would not necessarily be a given. You numbers aren't out of range hyper, just nearly so. Everyone assumes that if they are hyper they will automatically lose weight--again not necessarily so.


> I had been very tired, but sometimes keyed up, anxious and confused.


These could very easily be from the excess of T3.

Just postulating.


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