# Labs for my Mother -- Hypothyroid.



## Chromatic (Mar 31, 2011)

Hey guys,

I just wanted to run some quick labs by on my mother.. she is long diagnosed Hypothyroid and was on Synthroid for a decade, and has been on Dessicated Armour Thyroid (not sure of dose atm,.. will have to ask, but don't think it matters when asking if these labs look 'ok' or not) -- but has been on the Armour Thyroid for at least 4-5 yrs now.

Her TSH is: 1.521 ulu/mL same reference and doctor as me: [.5 - 5.0 ulu/mL ]

While her Free T4 is : 0.58 mg/dL , though the reference is [0.17 - 1.85 mg/dL]

I seem to notice others references for the Free T4 would make this 0.58 considerably low. Is this lab weird..

And further does this look like she is being treated well, any adjustments needed?

This doctor checks TSH and Free T4 -- He is an internal medicine physician.. and while good at being a GP,.. I don't think he is very good at anything specific and takes too many things in a 'general sense'.

In other words I don't think he should be treating her hypothyroidism, but she likes him.

So all I can do is recommend things to her, if I believe anything is at error.

Is it likely this lab just has a larger reference range, or are they testing somehow different than you other guys who have reference ranges above her level?

The lab is "LabCorp" -- which is a huge company (nationwide) has nearly 2000 separate facilities. Is used by government, businesses, and many medical offices/clinics. I would assume some of you have your labs done by them. (I also get the impression they might not be so great.  )

Shouldn't he be testing for more than TSH and T4 for a hypo patient on meds?

That is all.. thank you!


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## Andros (Aug 26, 2009)

Chromatic said:


> Hey guys,
> 
> I just wanted to run some quick labs by on my mother.. she is long diagnosed Hypothyroid and was on Synthroid for a decade, and has been on Dessicated Armour Thyroid (not sure of dose atm,.. will have to ask, but don't think it matters when asking if these labs look 'ok' or not) -- but has been on the Armour Thyroid for at least 4-5 yrs now.
> 
> ...


When taking any form of T3, FT4 is typically lower in the range. This is the way it should be. However, your mother's doctor would do well to run her FT3 every now and again throughout the course of the year.

Most of us find that we feel best when TSH is @ 1.0 or less and FREE T3 at 75% of the range given by the lab used. This does vary from individual to individual. Clinical evaluation is just as important as labs are.

Different labs use different ranges because they use different lab procedures. Aaaaaaaaaaaaargh. I have long thought and would wish that this stuff was universal but not so.

Does your mother have any lingering symptoms or complaints?


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## Chromatic (Mar 31, 2011)

Good information. I'm sure she can request FT3 at next visit, and the rule of thumb for 75% roughly sounds fair.

Is it recommended to have TSH/FT4 and FT3 all run at the same time again for proper comparison due to fluctuation?

As for symptoms: Mainly she needs alot of sleep. So a bit abnormally fatigue, some thinning of hair, dry hair, things of this nature. She isn't complaining, but I can tell she can probably use an adjustment.

As with everything does the thyroid not continually become less efficient as time goes on (age) and slow titration upwards of dosage needed every so often? I wouldn't imagine, logically, that one set dosage would be THE dosage for life, especially when ones thyroid still exists in 'original' state. (IE: No surgery, etc.. ) only natural processes causing the Hypo of course.

Thanks,


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## lainey (Aug 26, 2010)

>>In other words I don't think he should be treating her hypothyroidism, but she likes him.<<

Why not?? We'll start with, he's prescribed her Armour, which a lot of endos won't do.

The only thing he hasn't run that he should is Free T3. When taking medication with T3 in it, this should be measured. She's being treated after being diagnosed 15 years ago, so the antibodies are not particularly useful here.

Some people recommend an annual sonogram for people with thyroid disease.

How old is your mother? There are certain things that are a normal part of aging--certain changes in energy level, hair and skin come as part of the process. Keep in mind, TSH tends to naturally rise as people age, and there is some debate as to what level it should be treated to, as to some extent the higher TSH becomes protective: http://www.natap.org/2009/HIV/122109_01.htm


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## Chromatic (Mar 31, 2011)

lainey said:


> >>In other words I don't think he should be treating her hypothyroidism, but she likes him.<<
> 
> Why not?? We'll start with, he's prescribed her Armour, which a lot of endos won't do.


Hrmm.. I am aware, thank you though.



> The only thing he hasn't run that he should is Free T3. When taking medication with T3 in it, this should be measured. She's being treated after being diagnosed 15 years ago, so the antibodies are not particularly useful here.


Good information. Though I think the very point that Free T3 isn't established and hasn't been in well over 6 years is case point in his 'practice' with hypothyroid patients. He , as most, prefers to use Synthetic T4.. which for those that is works for , that is great. So I suppose his TSH, with Thyroxine is as good as it gets.

I also know that Free T3 is the more expensive of the tests mentioned,.. but even so, I would think an annual check if symptoms are present should be done.

No, antibodies wouldn't be particularly useful as a diagnosis isn't being sought, but differentiating between a correlation of symptoms current and "optimal" thyroid function and levels should be performed.



> Some people recommend an annual sonogram for people with thyroid disease.


Sounds reasonable,.. this does not occur either, worth mentioning.



> How old is your mother? There are certain things that are a normal part of aging--certain changes in energy level, hair and skin come as part of the process.


She is 56.

I am quite aware of the aging process and the changes that coincide, I do believe most reasonable people have some fundamental understanding of this concept. However, I can only compare her to her previous self, to her peers, and to others I know her age and older. While in most regards she is in great health.. she is easily fatigued, and moreso requires more sleep than I think she needs. In other words, I think an adjustment of medication may prove to increase her energy levels. Even when she is fully rested she isn't at the level she 'could' be at.

She is a non smoker, non drinker, eats healthy and always has,.. is of healthy BMI, low cholesterol.. there is absolutely nothing bad about her health. Her bone density and cardiovascular health are better than some 30 year olds. Point is she is in remarkable health for her age.

To be more specific -- She is in bed by 7-7:30pm, and takes daily naps of on average 2-4 hours.

I have no problem with the way she wishes to live her life, sleep as much as you want. However, if her thyroid is causing her to sleep away more of her life and further lower the quality of her life when she is awake currently, I simply think it should be investigated.

I also think there is a correlation in her thyroid, fatigue, and her migraines. When I speak to her I see a pattern.

I am well aware you can't blame everything negative away on hypothyroidism, but I do think considering the insidious nature and broad spectrum of symptoms (and arguably the complexity of treating it properly) it warrants proper comprehensive testing and appropriate adjustment of doasge (If symptoms and tests coincide).

Some say even if symptoms are the only marker it allows for dosage 'tinkering'..

I am merely gathering information and learning myself.

Thank you for your help,


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## lainey (Aug 26, 2010)

>>She is 56.<<

>>To be more specific -- She is in bed by 7-7:30pm, and takes daily naps of on average 2-4 hours.<<

I suppose it is no different on the internet than it is in the doctors office. We can only work with the information we are given and go from there. By leaving those 2 tidbits out, my opinion changes completely, you see, because it puts the situation in quite a different light.

So then I would guess that the tests the doctor runs, or dose adjustments to be made would depend on exactly how specific your mother is with her doctor about how she feels and what her symptoms are and how satisfied she herself is with her treatment and life in general.

>>Though I think the very point that Free T3 isn't established and hasn't been in well over 6 years is case point in his 'practice' with hypothyroid patients.<<

Most hypothyroid patients are not that complicated. Considering that T4 therapy is the standard practice, if the patient has TSH and free T4 numbers that fall nicely in the range and they are not complaining, you're right, the free T3 is generally not run and that is because it usually doesn't really need to be. For the same reason, the antibodies generally are not run as a matter of course. Most doctors don't relate symptoms to antibodies, and because the treatment is not for the antibodies themselves but the thyroid disfunction, once the diagnosis is made, they really don't factor into the treatment--it is the same whether you have them or not.

There are a lot of practitioners of all varieties that prescribe T3 medications that don't think to test the free T3 as part of the normal labs. Some of them prescribe T3 meds and then don't understand the way in which that the labs become skewed because of it. It's not that your mother needs to find a doctor that runs this test--she first needs to ask her doctor to do it.

Your mother should share her daily sleep habits, request a free T3 on the blood work and perhaps discuss a slight dose increase with the doctor if that is what she feels that she needs based on the results of the bloodwork. Ferritin and vitamin D should be run, if only because low levels of both cause symptoms that are similar to hypothyroid symptoms. If she has a good relationship with him there won't be any problem accomplishing this.


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## Chromatic (Mar 31, 2011)

I don't anticipate any problems with this. I was merely trying to get a good idea of how to gauge results of labs when they are run.

Because even if he runs every thyroid test there is,.. sometimes the interpretation and action isn't best.

I could easily see an example where an increase needs to be done and it not,.. and so on.

He should have no problem running the test.. they do have a good relationship. Again it wasn't so much about the doctor, but lab results in hypo, specifically hers. Further I didn't think so much of the T3 (learning again) when I made the post.

We have spoken, and she is going to request Free t3 at the next visit. He would probably even allow an increase in the medication if there was something to warrant it. He allows alot if in reason, but of course isn't just going to say sure increase away because you feel like it.

Thing is, a slight increase isn't a dangerous action in this case anyhow.. and that factors into things.

Though, should she have all these tests run again for best results for comparison.. or would just the T3 alone be fine (she will see him in 4 months or so).

She is a little reserved, self conscious of her sleep habits .. so getting her to push that she sleeps an overt amount might be a challenge. She likes to bend the numbers a bit and give excuses here and there to make it seem like she really doesn't sleep that much.

It is her life, but if , as I've said the whole time, a little more medication is needed to make a beneficial difference then great.

When talking about the armour thyroid, she always says how the first time her endocrinologist (a different doctor) put her on it.. she felt so GOOD for two days until she thought it was causing some side effects and went to regular synthroid which doesn't ever seem to do much of anything.. though she takes it compliantly. Then she got put back on the Armour and it never did make her feel that big noticeable difference in mood quality as it did the first time. (She was only on it 2 days the first time).

Of course this could be a brand difference etc.. but she has been through several pharmacies so surely by now the 'quality' would have come to her.

I naturally think that her thyroid levels, TSH, the whole deal was in an entirely different range at that time and whatever dose she took had a different .. perhaps proper effect on her for those few days. Now, many years later,.. the labs are very different, and what worked then really isn't enough now. Little over simplified, but the effect is there.

Thanks,


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## lainey (Aug 26, 2010)

Looking at your mother's present labs there would have been no reason for the doctor to think of an increase unless she were specifically reporting symptoms.

Armour has undergone a reformulation in the recent past, and some people have reported changes in the way they feel or changes in their labs because of it, and have needed dose adjustments.

People often report such a "boost" as your mother had when starting T3 medications, that is the active hormone, and does make a difference for some quickly. It is often transient, however, so she wasn't on Armour long enough the first time to see if that would have been the case for her.

If her appointment is in 4 months, TSH, Free T4 and Free T3 would be appropriate at that time. If she really feels her sleeping patterns are an issue, she should see her doctor sooner. There could be other reasons, such as low ferritin or low vitamin D, that could be contributing to it.


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## Chromatic (Mar 31, 2011)

Well, she isn't reporting symptoms to him.. so that is a good point. But again, this wasn't so much about the doctor than just getting reference ranges of feeling the best. I have a much better understanding of ranges *within* the normal ranges that generally result in the optimal results from this forum. So we will get him to run a TSH, FT4, and FT3 in a few months to get the full picture here. T3 is where it is at, and without that it is fairly impossible to do anything but guess. (And, I do understand your point of view is there is no absolute number to 'live by' ) -- But It is still good to have some points of references that are in a better range than the general references listed from the labs.

You are right with the symptomology.. but it seems doctors, anecdotally, prefer to use test results as their basis without regard to symptoms too often, and then utilize the 'no reported symptoms' as their basis with lack of the 'full picture'. But that is just the way it is... I get it, I really do. I am not naive, I understand medicine and the speed at which things are handled, and the doctor may even have a altruistic , and economic motive for ordering "less" tests in mind. Which is all fine and good.

Again, just really wanted to get a better idea for ideal labs with treatment with t3/t4, and then can go from there.

Her symptoms aren't just destroying or stopping her life.. it isn't urgent to see him today, but it is something that may just need a little bit of tweaking. ie: If t3 is low , etc.. to give age appropriate energy, less irritability, and all the things that go along with levels of T3 that just aren't in the 'optimal/ideal' area.

As for the reformulation -- may or may not have affected her. Though I think a slight increase in dosage may be warranted. Likely talking a very small bump, nothing major. But these things are that delicate, where just a slight shift or tweak can make all the difference. Thank you for the heads up though.

I believe the 'boost' she felt was her initially feeling some 'hyper' symptoms -- mainly the good ones because of the 2.5 day half life and short course. IE: Burst in energy, improved mood and so on (this going from being drastically hypo) -- But being treated with too aggressive of a dose which pushed into the hyper territory for just a few days. No harm done,..

That point is fairly moot now though.

TSH, Free T4, and Free T3 were my thoughts exactly, and perhaps Iron/Ferritin serum, with vitamin D would be a good idea.


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