# Hi, I'm new here and have some labs to discuss



## Nannysbaby (Oct 26, 2009)

My thyroid history goes back probably 12 years or so. I never knew I had an issue until my dr found nodules. I went through all the tests, nuclear, fine needle, ultrasounds, etc. That was back at the beginning. No cancer! My labs were always "normal." I honestly do not recall if that dr was only measuring TSH or what. I took Levoxyl for about 4 years. I never felt any different on or off the meds. So I stopped taking it.

I have thought for many years that I do have a thyroid issue, but the tests always say I'm normal. I just have not been able to shake the tiredness, dry skin, fuzzy brain, lethargy...it goes on and on. So I did a bit of research on the internet for a dr here in Houston that will prescribe Armour thyroid. I went to her about 2 years ago and she did indeed prescribe it for me. She had me start by taking 2 60mg tabs daily. Within a month I was having heart palpitations, all the time, and her nurse told me to stop taking the Armour. Never heard from the dr again and I stopped seeing her.

I pressed on and kept looking or someone that was in-network with my ppo and prescribed Armour. I found a nice dr in Tomball. I like her and she did prescribe Armour. I told her what happened with the palpitations and she said I must start off very slowly, so I did. I eventually made my way up to 90mgs daily, which is my current dose. No heart palpitations.

She did blood work on May 26, 2009

TSH, 3rd generation 0.76... normal reference range...0.40-4.50
T3, free 288...expected range...230-420
T4, free 1.2...reference range 0.8-1.8
Cortisol 10.4...reference range,...4.0-22... (depending on time of day)
T3, reverse 34...reference range...11-32.

Based on the T3 reverse result she prescribed me the armour thyroid.

I think at first I may have felt somewhat better, at least energy wise. However, I'm back to feeling crummy most of the time.

I recently had a severe allergic reaction to an antiobiotic and they ordered labs which included some of my thyroid ones. It's not the same dr, it was the ER dr that ordered them on October 13, 2009...

T3...34...<35
T4...10.1...<12.5
TSH....01...normal .04

SO, now I'm kind of worried about my TSH and the fact the I still feel crappy. I am planning on going back to the dr that prescribes me the Armour thyroid. But I feel lost.

I also am having an issue with even getting the prescription! Last time I ended up getting 60mgs and splitting the one pill in half. It's not very cool though since they do not split well and some of the pill crumbles off. The pharmacy suggested that they could compound me a T3/T4 pill that they say my dr will approve. I read about that on the internet a bit and it seems that the armour has a bit of something that I need...I am so confused!

It looks like you guys here know your stuff, so I would really, really appreciate any advice/suggestions.

Thank You for reading this very looooooooooooooooooooong post!

BTW-I'm 49 yo woman.


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## Andros (Aug 26, 2009)

Nannysbaby said:


> My thyroid history goes back probably 12 years or so. I never knew I had an issue until my dr found nodules. I went through all the tests, nuclear, fine needle, ultrasounds, etc. That was back at the beginning. No cancer! My labs were always "normal." I honestly do not recall if that dr was only measuring TSH or what. I took Levoxyl for about 4 years. I never felt any different on or off the meds. So I stopped taking it.
> 
> I have thought for many years that I do have a thyroid issue, but the tests always say I'm normal. I just have not been able to shake the tiredness, dry skin, fuzzy brain, lethargy...it goes on and on. So I did a bit of research on the internet for a dr here in Houston that will prescribe Armour thyroid. I went to her about 2 years ago and she did indeed prescribe it for me. She had me start by taking 2 60mg tabs daily. Within a month I was having heart palpitations, all the time, and her nurse told me to stop taking the Armour. Never heard from the dr again and I stopped seeing her.
> 
> ...


Hi and welcome to the board.

I like your doc in Tomball. This is the proper way to titrate Armour. Slow but sure.

After reading your story, I am thinking that you may have low ferritin issues. Ferritin is the protein that stores your iron for cellular uptake. Your hemo can come back fine but the Ferritin can be in the basement. So, I do urge you to get a Ferritin test.

What antibiotic did you have an allergic reaction to?

Your labs in May look wonderful. Did you feel well then? The rT3 is high though.

While the symptoms you describe can be the same for thyroid, they also apply to low ferritin.


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## Nannysbaby (Oct 26, 2009)

Andros said:


> Hi and welcome to the board.
> 
> I like your doc in Tomball. This is the proper way to titrate Armour. Slow but sure.
> 
> ...


My labs in May were before I started again on Armour for the second time. I felt lousy then! The dr put me on the Armour based on that rT3 result.

I'm sure she will do the ferritin test if I ask.

I had the reaction to Azythromycin, known as the Z-Pack. They tell me that is a very unusual med to be allergic to...leave it to me :confused0031:


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## Andros (Aug 26, 2009)

Nannysbaby said:


> My labs in May were before I started again on Armour for the second time. I felt lousy then! The dr put me on the Armour based on that rT3 result.
> 
> I'm sure she will do the ferritin test if I ask.
> 
> I had the reaction to Azythromycin, known as the Z-Pack. They tell me that is a very unusual med to be allergic to...leave it to me :confused0031:


That is a shame about your bout with the medication. It does say in the prescribing information that allergic reaction is while not common, possible. You know how they word these things.

How are you feeling now?

I meant to say that the "thing" about low ferritin is that it also impedes the efficacy of your thyroxine replacement. Ferritin should be 50 to 100 and the closer to 100, the better.

That may be why rT3 is so high. I will be anxious to hear the results of your ferritin test.


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## Nannysbaby (Oct 26, 2009)

So I ended up in the hospital over the weekend. I have been having a new racing feeling in my heart since the anaphylaxis, that was not PVC's. Started experiencing shortness of breath and chest pain. They did all the usual tests...thallium stress test, echocardiogram. The good news is that my heart muscle is fine. However, I do have a sinus arrhythmia now. They call it premature atrial contractions or PAC's. I knew it felt different than the PVC's. Apparently they are not life threatening, which I am quite relieved to hear.

My cardiologist asked an endocrinologist to consult. My TSH is basically nothing and she told me I was hyper-thyroid. I'm pretty sure she thinks that the Armour is causing my heart issue, but I am not really that convinced considering that I have been on the Armour for 6 months now with no palpitations whatsoever. Not only that, these new palpitations, the PAC's, are completely different that those PVC's that I had a while back when the first dr put me on 120mgs armour too quickly. They feel completely different and now I know that they come from different sections of the heart.

She ordered a thyroid ultrasound and, not surprisingly, I have 10 nodules of various sizes, which is kind of un-nerving. I had FNA done probably 10 years ago and there was no cancer, so I hope that is still the case.

She told me that I could lower my dosage to 60mgs but then told me to stop all together. I'm quite confused. I called to make an appt with her this morning and they gave me Nov 17. I feel like I should lower my dose instead of just stopping cold turkey considering that I didn't have these symptoms until after the anaphylaxis and the predinosone injection and 7 day prednisone therapy. I asked them about this and the doctor is going to call me back. She did tell me that the prednisone would mess up my test results.

Another strange thing is that my blood pressure is low. 91/55 at certain times. This is not normal for me. I have been running 120/80 or slightly higher since starting the Armour 6 months ago.

Has anyone had similar results and experiences? I would appreciate any input.

Here are my new labs...

Free T4----1.1----reference range 0.9-1.8
TSH----<0.01----reference rage 0.35-5.50
T4----8.4----reference range 4.5-11.4

BTW-this endo is one that the Texas Thyroid group recommends, so I think she will be good. I'm just confused.


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## Andros (Aug 26, 2009)

Nannysbaby said:


> So I ended up in the hospital over the weekend. I have been having a new racing feeling in my heart since the anaphylaxis, that was not PVC's. Started experiencing shortness of breath and chest pain. They did all the usual tests...thallium stress test, echocardiogram. The good news is that my heart muscle is fine. However, I do have a sinus arrhythmia now. They call it premature atrial contractions or PAC's. I knew it felt different than the PVC's. Apparently they are not life threatening, which I am quite relieved to hear.
> 
> My cardiologist asked an endocrinologist to consult. My TSH is basically nothing and she told me I was hyper-thyroid. I'm pretty sure she thinks that the Armour is causing my heart issue, but I am not really that convinced considering that I have been on the Armour for 6 months now with no palpitations whatsoever. Not only that, these new palpitations, the PAC's, are completely different that those PVC's that I had a while back when the first dr put me on 120mgs armour too quickly. They feel completely different and now I know that they come from different sections of the heart.
> 
> ...


It sounds like you got a good going over but I am sorry you ended up in the ER over the weekend. THAT is not fun.

If she thinks it's the Armour, I wonder why she did not run a Free T3 lab test? That would have been conclusive; I would think.

To be honest w/ you, I do think you should go down to the 60 mg. for the time being but at this point you will never really know if the PACS stop, was it the medicine you were on and had a reaction to or was it too much Armour? That is why I think the Free T3 test would have been very helpful.

This is a possible cause of hypotension.............

Severe allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergic reaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.

I think you need time to recover and reassess.

Very upset about all the nodules. Do you think she will call for FNA (fine needle aspiration?)


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## Nannysbaby (Oct 26, 2009)

Andros said:


> It sounds like you got a good going over but I am sorry you ended up in the ER over the weekend. THAT is not fun.
> 
> If she thinks it's the Armour, I wonder why she did not run a Free T3 lab test? That would have been conclusive; I would think.
> 
> ...


Yes, I am pretty sure she will request the FNA. I am going to ask for it anyway. No need to worry that much.

They did call back today and told me to discontinue the Armour completely. I guess I need to listen to them. She told me 10 days before it is out of my system. That will be on November 8th since I have not taken it since Thursday last week. It's a waiting game to see it the PAC's go away.

I would think that if I had been hyperthyroid from the Armour that I would have lost some weight and that the PAC's would have been happening all along. Oh well, I probably will never know for certain.


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## Nannysbaby (Oct 26, 2009)

Ok my mind is spinning here. What is the difference between hypoechoic and isoechoic nodules? I have both.


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## Andros (Aug 26, 2009)

Nannysbaby said:


> Ok my mind is spinning here. What is the difference between hypoechoic and isoechoic nodules? I have both.


Holy cats!

hypoechoic
Imaging adjective Relating to an abnormal ↓ in echoes by ultrasonography, due to a pathologic change in tissue density

isoechoic
returning waves of normal amplitude in ultrasonography

So, you do have irregularities as evidenced by the hypoechoic nodules.. I am sure she will want to do FNA (fine needle aspiration.)

I am just so glad that you have a good doctor and are recieving the proper tests and medical intervention here.


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## Nannysbaby (Oct 26, 2009)

I saw my new endo yesterday. The same one I had seen in the hospital. My FNA is scheduled for next Tuesday at 10am. She is checking everthing imaginable, they took 11 vials of blood yesterday and I am here in the office today doing a 5 hour glucose/insulin test. I am also doing a 24 hour urine catch, which I think is for cortisol.

Frankly, I can't remember everything she told me, it was a lot. She did tell that me she thinks my issues with the tiredness, fuzziness, etc could be insulin/diabetes related because the symptoms are the similar to low thyroid issues. She knows that the last dr prescribed me Armour based on the reverse T3 only, which, in her opinion was wrong. That said, I do like her.

I'm worried about the FNA, but that's expected. I am really just hoping for some answers. For now it is still a waiting game. I haven't taken the Armour since Oct 29. I am still having palpitations and my cardiologist has me on an extremely low dose of beta blocker, 12.5 mgs. It helps.


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## Andros (Aug 26, 2009)

Nannysbaby said:


> I saw my new endo yesterday. The same one I had seen in the hospital. My FNA is scheduled for next Tuesday at 10am. She is checking everthing imaginable, they took 11 vials of blood yesterday and I am here in the office today doing a 5 hour glucose/insulin test. I am also doing a 24 hour urine catch, which I think is for cortisol.
> 
> Frankly, I can't remember everything she told me, it was a lot. She did tell that me she thinks my issues with the tiredness, fuzziness, etc could be insulin/diabetes related because the symptoms are the similar to low thyroid issues. She knows that the last dr prescribed me Armour based on the reverse T3 only, which, in her opinion was wrong. That said, I do like her.
> 
> I'm worried about the FNA, but that's expected. I am really just hoping for some answers. For now it is still a waiting game. I haven't taken the Armour since Oct 29. I am still having palpitations and my cardiologist has me on an extremely low dose of beta blocker, 12.5 mgs. It helps.


I am so glad to hear from you and you sound like you are feeling a teensy bit better?

Good for you on the 5 hour glucose test and excellent about the FNA. When is the FNA scheduled? Not to worry, it will be over before you know it. Be brave as this is quite necessary.

I will be anxious to learn about the glucose and the FNA. Glad you are on a beta-blocker also.

Sending hugs,


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## Nannysbaby (Oct 26, 2009)

I _am_ feeling somewhat better since I started the beta blocker. The FNA is Tuesday, November 24. They told me 48 hours for the biopsy results...which puts us on the holiday...So I am guessing they will let me know the Monday after. Blah, I don't want to wait. I'm trying to be optimistic about it, because I don't need any violins playing for me. :anim_03:


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## Nannysbaby (Oct 26, 2009)

Okay my mind is spinning again. I have been reading here on these boards and thinking about the 10 nodules in my thyroid. Only 2 of them are large enough to be examined with FNA. Let's say the 2 are fine, who is to say the other 8 are fine too? Is that when I will need an isotope scan? Or where to go from there?

Let's say the two are not fine. What then?

When I asked the doctor about possible surgery she said there would be no need to leave any part of the thyroid. I assume she was talking about if there was cancer. Under what circumstances would total removal vs partial removal be better/worse?

I realize that some of my questions may not ever need to be answered depending on my FNA results. I just really feel like I need to be informed. I trust the information I am reading here and want to know more.

Thank you!


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## Andros (Aug 26, 2009)

Nannysbaby said:


> Okay my mind is spinning again. I have been reading here on these boards and thinking about the 10 nodules in my thyroid. Only 2 of them are large enough to be examined with FNA. Let's say the 2 are fine, who is to say the other 8 are fine too? Is that when I will need an isotope scan? Or where to go from there?
> 
> Let's say the two are not fine. What then?
> 
> ...


Hi, Nannysbaby! The best thing to do is take one day at a time here. You are right though about the other nodules. I think a radioactive uptake scan would be good; very good in fact.

Also, if you leave part of the thyroid behind, it can and will grow back. Something to consider also.


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## Nannysbaby (Oct 26, 2009)

I had the FNA today. Sooooooo glad that is over with! 4 needles per nodule plus 5 or 6 for numbing. Now I have a bruised neck and a lump that feels like an egg. Just glad it's over.

I did get back the results from my 5 hour glucose tolerance test...

Fasting...*112*<100 normal...impaired fasting 100-125...diabetes >OR=126
1 hour...183
2 hours...*202*<140 normal...140-199 impaired tolerance...>200 diabetes
3 hours...143
4 hours...83
5 hours...66
(I do not have reference ranges for the other hours)

Insulin response to glucose
time 1...4 (fasting)<17
time 2...29 (8-112)
time 3...51 (5-55)
time 4...29 (3-20)
time 5...11 <15
time 6...8 <8

Based on the fasting result and the 2 hour result the dr says diabetes and is prescribing Januvia.

I am confused because I would have thought the test might be redone to confirm the diagnosis. I didn't actually speak to the doctor, just the nurse and I have an appointment on Dec 15 to see the dr so maybe that is what she will do.

Do diabetes and thyroid have anything to do with each other?

I will probably not get the results of the FNA until Tuesday next week. It's going to be a long week.


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## Andros (Aug 26, 2009)

Nannysbaby said:


> I had the FNA today. Sooooooo glad that is over with! 4 needles per nodule plus 5 or 6 for numbing. Now I have a bruised neck and a lump that feels like an egg. Just glad it's over.
> 
> I did get back the results from my 5 hour glucose tolerance test...
> 
> ...


Yep; as we suspected. I am sorry but the good news is that you can get this on track.

Sometimes these things are interelated. We will have to see your progress by labs for both the thyroid and the diabetes.

Did you start on the Januvia yet?

Anxious to know the results of your FNA and I know you are as well.

Hang in there; everthing is going to be okay. Just follow doctor's instructions to a T.

Sending hugs....


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## Nannysbaby (Oct 26, 2009)

Nodule one is negative for malignancy

Nodule two is non diagnostic due to insufficient cellularity.

So...I am having a 2nd FNA on December 17 at a different hospital.

I am relieved and do believe that nodule 2 is probably negative also. Here is what the description of nodule 2 states...

The specimen consists predominately of blood. Few groups of bland follicullar cells (some obscured by blood) and rare colloid suggest a hyperplastic nodule. However, sufficient material is not present for a definitive diagnosis.

For nodule 1 the descrition states...

Hyperplastic nodule

Here are a few of the highlights of my blood test results...

Parathyroid hormone...*6* (10-65) 
Calcium...9 (8.6-10.2) 
Vitamin D...*22* (20-100) dr wants me to bring this up to >32
TSH, 3rd generation... .89 (.40-4.70) 
Free T4... 1.0 (0.8-1.8)
Free T3... 256 (230-420)
Thyroid Perioxidase Antibodies...<10 (<35)
Thyroglobulin antibodies...<20 (<20)
Thyroglobulin...*39.7 *(2.0-35)
ACTH, plasma...13 (5-27)
Cortisol total, LC/MS/MS...9.3 (4.6-20.6am 1.8-13.6pm)

The 24 hour urine test...

Epinephrine...*results are below reportable range for this analyte, which is 
3UG/L*
Norepinephrine...25 (15-100)
Calculated total (E+NE)...*25* (26-121)
Cortisol, free 24 hr urine LC/MS/MS total volume...900
Cortisol, free, urine...11.6 (4-50)

I highlighted in bold the things that are not within ther normal limits as well as the vitamin D which considered normal but the dr wants me to get my number up to what is stated.

All things considered, I am feeling pretty happy! Any thoughts?

Thanks!


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## Andros (Aug 26, 2009)

Nannysbaby said:


> Nodule one is negative for malignancy
> 
> Nodule two is non diagnostic due to insufficient cellularity.
> 
> ...


Good to hear from you and good to hear the first FNA is negative. Very very good news. Will be standing by to hear about the other FNA on 12/17/09. Hoping and praying that it too is negative.

Did doc comment on your low parathyroid hormone?

Here is a little matrix.........

http://www.labtestsonline.org/understanding/analytes/pth/test.html

Scroll down, it is near the bottom of the page.


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## Nannysbaby (Oct 26, 2009)

She did talk to me about the low PTH and noted that my calcium levels were excellent. She is having me supplement with 5000mgs of Vitamin D since my level was 22, which is technically normal, but as you can see at the lower end. Ideally she wants my Vitamin D >32. She explained that this would also help me absorb calcium better.

I looked at the matrix but don't see a line with "_low_ PTH, _normal _calcium" which is where I fit in.

Is this something that I should inquire more about with the endo?

Thank you!


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## Andros (Aug 26, 2009)

Nannysbaby said:


> She did talk to me about the low PTH and noted that my calcium levels were excellent. She is having me supplement with 5000mgs of Vitamin D since my level was 22, which is technically normal, but as you can see at the lower end. Ideally she wants my Vitamin D >32. She explained that this would also help me absorb calcium better.
> 
> I looked at the matrix but don't see a line with "_low_ PTH, _normal _calcium" which is where I fit in.
> 
> ...


No......see how it goes. She sounds like she is on top of the situation. I will be very very intereste in your next labs whenever that might be and I know you will also.

Let me know how the Vitamin D therapy goes!

How are you feeling right now?


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## Nannysbaby (Oct 26, 2009)

Thank you for asking. Honestly, I'm feeling overwhelmed by the diabetes diagnosis. Started taking 500mg Metformin ER twice daily and am adjusting to the side affects. Taking an extensive nutrition class the next 3 Monday evenings. I am hopeful that will get me on track with diet and exercise adjustments and give me some much needed confidence!


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## Andros (Aug 26, 2009)

Nannysbaby said:


> Thank you for asking. Honestly, I'm feeling overwhelmed by the diabetes diagnosis. Started taking 500mg Metformin ER twice daily and am adjusting to the side affects. Taking an extensive nutrition class the next 3 Monday evenings. I am hopeful that will get me on track with diet and exercise adjustments and give me some much needed confidence!


Good to hear from you. Don't fret; it may seem daunting right now but w/ the classes and support, you will get a handle on all this.

Hope you feel better soon and I just know that you are the "Little Engine That Could!":anim_63:


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## Nannysbaby (Oct 26, 2009)

Second biopsy results back...negative for cancer!


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## Andros (Aug 26, 2009)

Nannysbaby said:


> Second biopsy results back...negative for cancer!


That is totally awesome; what a great start to the New Year!! Hubba, hubba!

How is the diabetes management coming along?


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