# Do you medicate or not before blood tests?



## I DClaire

The thyroid hormone replacement equivalent chart was a thyroid epiphany for me yesterday, a flash of insight. I feel like I've been rowing on Lake Armour with one oar!

After my thyroidectomy, no one said anything to me about whether or not to take my medication (Synthroid initially, then later Armour) BEFORE having blood drawn for routine tests. Then, somewhere along the way, I believe my endocrinologist's PA told me to NOT medicate on the mornings when I was going in for lab tests.

Opinions please! Should we medicate the mornings we're having scheduled blood tests or not?

Looking at what appears to be low lab results for T4 Free and T3 Free, it was brought to my attention yesterday that those results are without medication - if I took my Armour prior to blood being drawn, the results would be higher...to the point where I could very well be over-medicated when it comes to my T3 Free test results.

That, coupled with the realization that the amount of Armour I take is equivalent to something like 150-200 mcg Synthroid (when at one time 125 mcg Synthroid was too much), has me struggling to understand exactly what I'm looking at? I've been thinking one thing so long it's hard to consider something else.

I'm also trying to play thyroid sleuth and nurse/physical therapist simultaneously - Mother has fallen again, backwards into an empty bathtub. My one track mind (and failing computer) is moving a bit slow!

I'm just thinking out loud but wouldn't it make more sense to medicate before blood tests or not? I don't know if the half-life of Armour vs. Synthroid is a factor or how any of that plays into test results.


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## joplin1975

I'm not an expert on this and I'll also say I'm on T4 only meds, but...

I think it really depends on when you take your meds and when you get that blood draw...and what kind of meds you take.

For example, I take my synthroid at 5:30am but I usually can't get to the lab until noon-ish. Given the long half life of T4, I can't imagine it makes much sense to wait until 1:00pm to take my meds on the day of my labs.

Now, if you are getting blood drawn first thing in the morning AND are on combo meds, it makes sense to me to wait.


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## Octavia

I get my labs drawn first thing in the morning, and I do NOT take my meds beforehand. (I take Levoxyl and Cytomel.)


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## Andros

I DClaire said:


> The thyroid hormone replacement equivalent chart was a thyroid epiphany for me yesterday, a flash of insight. I feel like I've been rowing on Lake Armour with one oar!
> 
> After my thyroidectomy, no one said anything to me about whether or not to take my medication (Synthroid initially, then later Armour) BEFORE having blood drawn for routine tests. Then, somewhere along the way, I believe my endocrinologist's PA told me to NOT medicate on the mornings when I was going in for lab tests.
> 
> Opinions please! Should we medicate the mornings we're having scheduled blood tests or not?
> 
> Looking at what appears to be low lab results for T4 Free and T3 Free, it was brought to my attention yesterday that those results are without medication - if I took my Armour prior to blood being drawn, the results would be higher...to the point where I could very well be over-medicated when it comes to my T3 Free test results.
> 
> That, coupled with the realization that the amount of Armour I take is equivalent to something like 150-200 mcg Synthroid (when at one time 125 mcg Synthroid was too much), has me struggling to understand exactly what I'm looking at? I've been thinking one thing so long it's hard to consider something else.
> 
> I'm also trying to play thyroid sleuth and nurse/physical therapist simultaneously - Mother has fallen again, backwards into an empty bathtub. My one track mind (and failing computer) is moving a bit slow!
> 
> I'm just thinking out loud but wouldn't it make more sense to medicate before blood tests or not? I don't know if the half-life of Armour vs. Synthroid is a factor or how any of that plays into test results.


The new Armour dissolves very fast and very well which is a good thing. However, that necessitated me taking my Armour after my labs because...........................

Liothyronine (T3)
is almost totally absorbed, 95 percent in 4 hours.
http://www.frx.com/pi/armourthyroid_pi.pdf

And this will really really throw your labs off. My doc knows I now do this and she said it did not matter as long as I always do the same thing which I do.


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## Lovlkn

I never take my labs before my draw and I also try to schedule my draws around the same time - usually 8:30 in the morning.

I have interestingly tested toward the hypo endo of range - might be having a reaction to the gobs of calcium I began taking over a year ago


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## I DClaire

I feel like I'm braindead but I'm bound and determined to somehow get a better grasp on the correlation between testing and dosing of various thyroid hormone replacements. I have never really understood it and I admire those of you who do!

I've seen posts as long as I've been a member here about how some doctors only diagnose/treat based on TSH but T4 Free and T3 Free are critical to getting it right. If a patient, like me, always has blood drawn (same location, same time, same routine as far as not taking morning Armour before test) then exactly what do my results represent?

If I have not had Armour for over 24 hours when blood is drawn, what do my T4 Free, T3 Free and TSH results represent?

If my T4 Free is 0.9 (normal range being 0.8-1.5) and I haven't taken any Armour in over 24 hours, what does that 0.9 represent, what is it measuring?

My test results have since last April been relatively consistent though always a bit low in my view but is my view different from what my doctor sees, does she somehow compensate for the fact that I haven't had any Armour before the blood is drawn? Something about all this totally boggles my mind! It seems like even if blood was drawn after I'd taken my morning Armour, the test results would be subject to wild fluctuation because of the half-life being so limited with Armour.

Then throw into the mix the other conditions and other drugs some of us take. One of the most interesting reports I've read recently was a supplement to U.S. Pharmacist, January 2012, titled "Current Challenges in the Management of Hypothyroidism".

Unless someone taking any thyroid hormone replacement is extraordinarily healthy otherwise and never develops any other health problems or is prescribed other drugs, becomes elderly, etc., this all seems to me like a merry-go-round that never stops. If I get to a good place, then develop anything from common gastritis to a life-threatening condition like heart disease, it just seems to me like this can get awfully complicated.


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## lainey

Labs should be considered a treatment guideline. As for what they represent, they are a measure of approximation at a moment in time, of a variable that is fairly dynamic.

As such, it should be remembered that TSH varies from hour to hour, day to day and season to season. Other medications, general health, other hormone levels and a host of other also factors influence it.

Small variations from test to test are normal and to be expected.

When making comparisons, it is usually most helpful to keep these things in mind, as well as the idea that because of these natural variations people will feel well over a range of numbers, not a precise set of single numbers.

People who take T4 should not have to fast their medication for labs. The levels in the body, over the course of 24 hours, stay relatively stable.

People who take T3 or combination medications are often instructed to fast their medication before labs. This is because the T3, should your doctor measure it, can appear falsely high if it is within a four hour window or so of taking the medication.


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## Octavia

I DClaire said:


> If I get to a good place, then develop anything from common gastritis to a life-threatening condition like heart disease, it just seems to me like this can get awfully complicated.


Then just don't develop those things...it's really that simple. 

I think you're right about the merry-go-round for some people. We already know that thyroid medications (levothyroxine in particular) have a narrow therapeutic range (gotta be pretty precise with them), so it makes sense that for people with very sensitive systems, it would seem like there are a lot of ups and downs, or rounds and rounds.


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## I DClaire

lainey said:


> Labs should be considered a treatment guideline. As for what they represent, they are a measure of approximation at a moment in time, of a variable that is fairly dynamic.
> 
> As such, it should be remembered that TSH varies from hour to hour, day to day and season to season. Other medications, general health, other hormone levels and a host of other also factors influence it.
> 
> Small variations from test to test are normal and to be expected.
> 
> When making comparisons, it is usually most helpful to keep these things in mind, as well as the idea that because of these natural variations people will feel well over a range of numbers, not a precise set of single numbers.
> 
> People who take T4 should not have to fast their medication for labs. The levels in the body, over the course of 24 hours, stay relatively stable.
> 
> People who take T3 or combination medications are often instructed to fast their medication before labs. This is because the T3, should your doctor measure it, can appear falsely high if it is within a four hour window or so of taking the medication.


Good points! Continuing to read the supplement to pharmacists regarding their role in helping hypothyroid patients, I read that of patients treated with levothyroxine, 30% to 60% never reach biochemical euthroidism, that they're either undertreated or overtreated. Colorado did a study of people taking thyroid medication and 60% had normal serum TSH values.

In a large North American study, only 43% of patients over 65 years of age were biochemically euthroid while receiving levothyroxine and it wasn't much better in the U.K. where 37% of patients in this age group were biochemically euthroid. I found a fact that was interesting - in the United Kingdom, the government rewards primary care physicians for taking the time to monitor treatment more closely.

I haven't decided how I'm going to approach my endocrinologist next week. I won't get my latest test results until then BUT I've been doing some serious soul-searching about Armour and seriously considering possibly asking to try Synthroid again OR another levothyroxine. I never thought I'd say that or even think that but after 8 months now of periodically having the fact that I take Armour questioned (and insulted) by a variety of healthcare professionals AND the realization that if or when the times comes that for whatever reason I'm not physically able to defend wanting to be treated with a natural product, it would be possibly more efficient to be taking a drug like Synthroid.

I may sound like I've been drinking the Kool-Aid but several facts I've read this week have left me not quite so confident with my choice to try Armour. Desiccated thyroid contains (as I understand all this) T4 and T3 but the balance of T4 and T3 in non-human animals is not the same as that in humans...plus the amounts of T4 and T3 can vary in every batch of desiccated thyroid. I've been majorly hung-up on wanting a "natural" drug and the binders certainly aren't natural.

I just don't know what to do BUT somehow, someway, I've got to get this settled. I love you guys to death but I don't want to eternally be upset and confused and honestly just not settled in my mind why I can't find the right answers.


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## lainey

> I may sound like I've been drinking the Kool-Aid but several facts I've read this week have left me not quite so confident with my choice to try Armour. Desiccated thyroid contains (as I understand all this) T4 and T3 but the balance of T4 and T3 in non-human animals is not the same as that in humans...plus the amounts of T4 and T3 can vary in every batch of desiccated thyroid. I've been majorly hung-up on wanting a "natural" drug and the binders certainly aren't natural.


"Natural" in this case is an adjective that describes the source most often used as "existing in or produced by nature : not artificial <natural turf> <natural curiosities>".

However, people don't like the medication Premarin, because it is made from the urine of pregnant mares, and somehow that source is more romantic than the thyroids of the pigs that Armour is made from--but, it is no less natural in its source. Yet, as you have noted, some people prefer the "unnatural" ratio of T4/T3 found in the medication made from thyroids of another animal as opposed to the more "natural" ratio that people themselves will most of the time produce when they take synthetic T4 on its own.

We have attached the word "natural" to many things which are not, because the word arouses people's sympathies, and implies that somehow it is "better" than something "synthetic" or man made. This is not always the case.


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## I DClaire

lainey said:


> "Natural" in this case is an adjective that describes the source most often used as "existing in or produced by nature : not artificial <natural turf> <natural curiosities>".
> 
> However, people don't like the medication Premarin, because it is made from the urine of pregnant mares, and somehow that source is more romantic than the thyroids of the pigs that Armour is made from--but, it is no less natural in its source. Yet, as you have noted, some people prefer the "unnatural" ratio of T4/T3 found in the medication made from thyroids of another animal as opposed to the more "natural" ratio that people themselves will most of the time produce when they take synthetic T4 on its own.
> 
> We have attached the word "natural" to many things which are not, because the word arouses people's sympathies, and implies that somehow it is "better" than something "synthetic" or man made. This is not always the case.


I've thought a lot about Premarin in the last few months. I'd bet the farm (no pun intended) that the two doctors who have given me such a hard time about Armour never give any thought to where Premarin comes from. I don't know what the most popular estrogen replacements are today but 20-25 years ago half the women I knew were taking Premarin!

It truly is pretty remarkable what it takes to treat thyroid disease patients. Virtually every illness or physical condition I can think of seems to have more dependable testing and while sometimes some drugs don't work and have to be tweaked or replaced, I've personally never realized what so many thyroid patients go through until I was diagnosed myself.

This morning I was reading about another angle - adherence. I never realized how many thyroid patients don't take their medications seriously. The report I was reading stated that 22% to 82% of patients don't take their medications for a variety of reasons - from forgetfulness to not being able to afford them. Some people choose to suffer with thyroid symptoms over suffering from side effects symptoms. THEN, the physician sees test results based on faulty adherence to taking the drugs and may very well increase the dosage unnecessarily.


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## StormFinch

I object to premarin because of the way it's made: http://www.aspca.org/fight-animal-cruelty/equine-cruelty/premarin.aspx Yes, pigs are killed, but they would be slaughtered whether we used their thyroids or not. And at least they aren't kept like catheterized concentration camp victims for 20+ years.


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## lainey

> Yes, pigs are killed, but they would be slaughtered whether we used their thyroids or not.


And I suppose the conditions in the slaughter houses are more humane, as are the lives of any animal headed to slaughter to begin with.....it must be all right because we eat bacon but not mare-steaks.

Not to argue, but this is exactly the "natural" selectivity I was referring to--where "natural" becomes a selective, emotionally based position, not a logical one.

In theory, vegetarians must take "unnatural" thyroid preparations.....


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## StormFinch

You're really going to compare the 15 or so minutes it takes to run a pig through a slaughterhouse to the 20+/- years that those mares stand in the same place day after day forcibly pregnant and catherterized? I live in farm country, know what the whole farm to table process is about, have raised my own individual animals. I would hope that the raising and slaughtering process was as humane as possible but know that's not always the case, we as a race can't even be good to our own. I do try to choose free range as much as I can, but know that even that isn't always guaranteed thanks to our flimsy oversight process. Right or wrong, as an omnivore I help contribute to the industry while accepting the reality of it. I can also tell you though that were I faced with the choice between the slaughterhouse or the life a premarin mare lives, I'd take the pig's path every time.

I'll also freely admit that part of my view on the whole situation includes which animal group I'm more empathetic towards. A herd of pigs will eat you just as soon as look at you. It's common knowledge in the pig farming community that if you lose consciousness around a pig herd you will be their next meal long before you can come to. Wild herds aren't any better because they're a menace to both the land and other animal populations. So am I biased towards horses? You bet I am.

As far as synthetics go, I don't have a single problem with them, and have taken levothyroxine, several different brands, a number of times myself. The problem is, I feel like complete garbage on synthetics, both T4 and T3. Something in the formulations, T3 especially, make me feel like I have a mild case of the flu. I really don't give a flying frack whether either medication is natural or as fake as a starlet's assets, I only care whether or not it works the way I need it to.


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## lainey

I use pigs vs. horses because it creates exactly the sympathetic response that you gave, and illustrates the point of how the word "natural" generates more of an emotional response than a logical one exactly. Twist around the wording a little bit, and people get very defensive.

Like it's okay to use mice and rats for research because we don't like them as much as we do bunnies and kitties. No matter which organism has the more similar genetic make up for what ever it is we happen to be testing.



> I've been majorly hung-up on wanting a "natural" drug


This is the part of the OP's post that got me started, because the "natural" part of the description of dessicated thyroid is more of a marketing ploy, a description to encourage people to think about it in a certain way.

The OP's "hang up" seems to concern the fact that she does not really feel better on this "natural" treatment, in spite of its rave reviews. When trying to reconcile these things with self, sometimes it helps to have someone point out that in this case, the description is subjective, as is the response. It's okay to have something not work for you, even if it is "natural".

A very vast majority of thyroid patients do very well on synthetic medications, with a smaller population doing well on dessicated thyroid products. There is an even smaller number who never do well on any thyroid replacement--at which point they should consider other sources for their problem.


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## I DClaire

The relationship between non-human animals and medical and cosmetic industries bothers me on many different levels. Not far from my house is a sanctuary for monkeys who have been used for scientific research, some for 20 years or more, who miraculously are given a chance to live out part of their lives in total freedom.

StormFinch, you were talking about what pigs are capable of. We have a friend who is a sheriff's deputy, I'm guessing 6' 2" tall, in good health (thank goodness) who was attacked by a wild boar. This man was hospitalized for weeks and came very close to losing an arm!

As someone who loves animals so much, I wish we lived in a world where no defenseless creature ever had to suffer. I used to be deeply involved with a breed specific dog rescue, not just locally but nationally and internationally, and it's a hard situation to get involved with and maintain one's sanity. My husband believes much of that is why I came so close to a nervous breakdown which may have played into nearly destroying my own health.

If I stay with Armour, the next time my internist pops off about "that stuff you take", I'm going to look him in the eye and ask him what he thinks about Premarin?


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## Abcdefg

I have some anecdotal evidence:

2 tests ago: took meds, waited an hour, had blood drawn.

TSH: 0.36

Last test (1 week later), no meds, blood drawn at roughly same time of day.

TSH 0.94
ft3 4.1 (range 4.0-7.8)
ft4 17 (range 11-22)

Based on those numbers, my doc upped me to a higher dosage. I was considerably more suppressed in tsh with having the first test. But normally I don't take meds before blood draws, that time I had it done after a GP visit because she asked me to.

I think it affects your tsh level, but has little to do with the other numbers.


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## lainey

@Abcdefg

Your labs could easily have varied like that, with meds or without.

What type of meds are you on?

The ones of concern are meds containing T3. The do peak at about 4 hours, and labs can vary considerably for free T3 values because of it.


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## Abcdefg

lainey said:


> @Abcdefg
> 
> Your labs could easily have varied like that, with meds or without.
> 
> What type of meds are you on?
> 
> The ones of concern are meds containing T3. The do peak at about 4 hours, and labs can vary considerably for free T3 values because of it.


Synthroid only. Was 150mcg, now on 175


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