# Need help with lab results



## karen54 (Sep 14, 2013)

New here and looking for some help.

I was diagnosed with Graves about 5 years ago. Had radioactive pill and then started on Levoxyl. Since Levoxyl recall I was switched to Synthroid, which caused side effects. I was recently switched to Tirosint. Had lab results last week and the results are below:

Tsh - 2.78
T4 total - 10.5
T3 uptake - 26
T4 free, calculated - 2.7
T3 total - 68

My doctor called and said numbers were fine. However, everything I have read indicates my T3 is low. Also, I am experiencing many symptoms including, constant stomach bloating, facial bloating, anxiety, irritability, dry skin, hair loss, constipation and a little bit blah.

I am so confused. Can anyone please help me figure out why I feel this way? Is it the low t3? If so, do I need an increase in medication? Thank you so much!


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## jenny v (May 6, 2012)

Could you please post the ranges for all of those labs? Your TSH is a little high-ish, most of us feel best around 1.0 or so.


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## karen54 (Sep 14, 2013)

Thank you for getting back to me. Here are the reference ranges:

Tsh - 0.40-4.50 
T4 total - 4.5-12.0
T3 uptake - 22-35
T4 free, calculated - 2.7
T3 total - 76-101

My readings again are:

Tsh - 2.78
T4 total - 10.5
T3 uptake - 26
T4 free, calculated - 2.7
T3 total - 68

Two months ago on Synthroid my Tsh was 5.5, so it has come down a bit, since being on Tirosint, which I started about 2 months ago. Thanks again!!


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## Octavia (Aug 1, 2011)

I believe you should talk with your doctor about that low T3. You may need to add Cytomel along with your Tirosint.


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## karen54 (Sep 14, 2013)

Thanks, I thought it was low too. Do you think I also need an increase in Tirosint because of the Tsh being 2.78?


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## Lovlkn (Dec 20, 2009)

Karen,

Do you have any labs prior to your medication change? How did you feel before you began changing medications?


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## Octavia (Aug 1, 2011)

karen54 said:


> Thanks, I thought it was low too. Do you think I also need an increase in Tirosint because of the Tsh being 2.78?


I'd like to reserve judgment on that until we see your Free T4 range, if you have it. Your total T4 is high in the range...wondering if your Free T4 is as well.


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## karen54 (Sep 14, 2013)

I don't have lab results while on Levoxyl. I seem to do better on Levoxyl but it has been recalled. Doctor switched me to Synthroid. I was on Synthroid for 3 months but it didn't seem to be working. Here are my results while on Synthroid:

Tsh - 5.5
T4 total - 9.2
T3 free 2.4

I don't have results for the t4 free. As you can see my numbers have improved on Tirosint but still experiencing symptoms of hypo. With Levoxyl and Synthroid I was taking 75mg 4 x week and 88mg 3x week. I am currently taking 75 mg daily of Tirosint. I am a bit concerned about the elevated tsh and low t3 but doctor says numbers look good. Thanks again for your help!


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## Octavia (Aug 1, 2011)

I'd be more inclined to go after that low Free T3 (by adding Cytomel) than add more Tirosint, given what you've been able to share.


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## karen54 (Sep 14, 2013)

Would my symptoms be consistent with a low t3 reading? I didn't speak with my doctor. The receptionist called and said the doctor wants me to continue with the same dosage and that everything looked good. I don't know why she did not address the low t3. I have a feeling getting her to give me Cytomel is going to a struggle. My blood work was done about 5 1/2 weeks after starting Tirosint. Is it too early to tell if the medication has reached its full effect? I have an appointment with her in December.


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## karen54 (Sep 14, 2013)

Sorry, I also wanted to ask if anxiety is caused by a low t3? I have had a lot of anxiety lately but my doctor said anxiety is related to being hyper. I was both hyper and hypo and had anxiety with both. Is it just me!!!


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## Andros (Aug 26, 2009)

karen54 said:


> Sorry, I also wanted to ask if anxiety is caused by a low t3? I have had a lot of anxiety lately but my doctor said anxiety is related to being hyper. I was both hyper and hypo and had anxiety with both. Is it just me!!!


It can be and I would like to say that "most" of us who no longer have a thyroid do require T3 supplementation.

Your Total 3 is in the basement and that is very bad as Total 3 is comprised of bound, unbound and rT3 hormone. What you need to know is what your FREE T3 is; that would be the unbound available for cellular uptake.

Here is info:

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

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

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.


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## karen54 (Sep 14, 2013)

I really felt like the anxiety was related to my thyroid.  I feel so much better when someone understands. Thanks so much! I will mention it to my doctor at my December appointment. I am so so glad I found this site!!!


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## karen54 (Sep 14, 2013)

I have an appointment with my doctor in December. However, I want to call her and ask about my low T3 number. I am tired of feeling so bloated and other symptoms. Honestly, I am afraid to call her. This is the first time I was able to get a copy of my results. I don't believe she knows I have the results. I have been just going on what she tells me, which is "your numbers look good". I am a thin woman and I am getting frustrated at her reference to that! She will ask if I am gaining weight. I know that will be an issue. My clothes are getting tight on me but not really putting on weight. Maybe just bloated. My jeans do not fit me anymore. It doesn't make sense. Can someone please help me? Should I call her? I really am afraid!! Thanks for listening!


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## joplin1975 (Jul 21, 2011)

I'm surrounded by folks in the medical field and while I always think it's good to call your doctor with questions, if it's more than a "yes, no, or go to the ER" type question, your best bet is to call the office and ask for an appointment to discuss the issues.

First, at the risk of sounding crass, physicians don't get paid for phone calls. If you want someone's attention, do it in a setting where they will get reimbursed. Secondly, you'll likely want the results in front of you, so you both can see the same thing. Thirdly, I'd bring in reputable research/articles/etc that note why your free t3 should be higher.

Finally, you are paying your doctor. Never, ever be afraid of him or her!


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## karen54 (Sep 14, 2013)

Thank you for your reply. You made an excellent point about making an appointment rather than a phone call. Ok, now I just have to work on my courage! Thanks again!


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## JenneyCat (Aug 11, 2013)

Hi Karen - just wanted to tell you that anxiety is one of the symptoms I suffer from as well. I mentioned it to my endo who said it's not usually a symptom of being hypo (which I am), but I know that it only started when all of this began, and that symptoms can cross over.

I do not know my Free T3 as I just had it drawn for the first time today, so it will be interesting to see if it's low and if that correlates for me. Sorry I don't have a scientific answer for you, just wanted to reach out and show you some support  I would not wish anxiety on my worst enemy!


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## karen54 (Sep 14, 2013)

Just want to ask something else. Everyone is taking about the free T3 test. The only T3 test my doctor ordered was the T3 total, which was low 68. Reference range is 76-181. Would that cause bloating? My face and stomach is where I notice it the most. I feel so full even after just water! My husband was shocked when I showed him my stomach last night. Of course, he laughed! I look pregnant. I'm 54 so that's definitely not the case!


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## karen54 (Sep 14, 2013)

Thank you everyone for helping me gain the courage to see my doctor yesterday! I explained all of my symptoms and asked if I needed an increase in medication. I was told that my lab work looks fine and my tsh is perfect 2.78. She said my number was right in the middle and no need for increase. No matter how many times I kept going back to my thyroid, she kept on insisting something else is wrong. She is giving me a cortisol 24 hour urine test to test for Cushings. I don't believe that is the reason for my symptoms but she is starting to make me nervous. She insisted it is not my thyroid and truly believes there is another medical reason for facial and stomach bloating along with other symptoms. I am so confused at this point. Can someone please help me! I really don't know what to do now. She is insisting that I get a physical done and recommended a doctor. My concern is that this new doctor will want to run a lot of tests when it may be due to my thyroid. I am feeling frustrated and a bit worried! Thanks for listening!!


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## StormFinch (Nov 16, 2012)

The way I see it, you have two choices. A) If insurance will cover it go ahead and see the other doctor and run the tests. It won't hurt to rule out other things and once they come back clean your first doctor will have no more excuses. The second doctor may also have better insight when it comes to your thyroid numbers. B) Fire the first doctor and find someone who is better versed in thyroid disorders. They don't necessarily need to be an endo. Here is a good group of resources for finding someone; http://hypothyroidmom.com/top-10-resources-to-find-a-great-thyroid-doctor-in-2013/ One of our most common sayings around here is that you've got to kiss a lot of frogs. Don't give up until you find someone who will listen and knows the value of the Frees.


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## karen54 (Sep 14, 2013)

Thank you so much for that information! I did find a doctor who is relatively close to me on that list. I just looked at the next blood work she ordered for 6 months from now and this is what is written t4/ t3u/ tsh,ultra/ t3,total. She is an endo and I can't understand why she is not testing the free numbers. I am still trying to understand what all these numbers mean. Wouldn't a specialist know what numbers to run? Do you think that is reason enough to look for another doctor? Sorry, but I feel at a standstill. Thanks so much.


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## StormFinch (Nov 16, 2012)

It's a long read, but this may give you some insight; http://nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/ (Note: although I am impressed with Dr. Holtorf's views and knowledge, his clinic does not have the best of reviews and I have never visited it personally.)

If it were me, yeah, I'd definitely be looking for another doctor.


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## karen54 (Sep 14, 2013)

I am so grateful for this forum! I was hoping someone can help me figure out what this means. My endo will not address my complaints, all of which are hypo. She said numbers were "perfect." Well, from all the educated people on this board my numbers are not. After being tired of being tired I decided to go to an urgent care for a second opinion. The doctor did increase my medication from 75mg daily of Tirosint to 75mg 5 x week and 88mg 2 x week. I felt like crying that someone finally listened to me. Before Levoxyl recall I was taking 75mg 4 x week and 88mg 
3 x week. I hope this is the answer but I do know my t3 is very low. At least this is a start! She also wants me to have an ultrasound of my thyroid. My question is, I had the radioactive pill about 5 years ago so I guess I do not have a thyroid anymore. Why would I go for an ultrasound if there is not a thyroid left? Does anyone know why she would request this? I am glad this doctor took an interest but I'm just a little confused.

Thanks everyone for all your previous advice. It's with the advice here I gained the courage to go for a second opinion!


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## jenny v (May 6, 2012)

I am not an expert on RAI (the radioactive pill), but from what I've heard it kills off your thyroid from functioning, but the gland itself is still there (it just doesn't do anything). However, I've seen posters on this board who had to take more than one dose of RAI because their thyroids started kicking back on again. I think it's a good idea to have the ultrasound if only to see what's going on in there for a baseline.


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## Andros (Aug 26, 2009)

karen54 said:


> I am so grateful for this forum! I was hoping someone can help me figure out what this means. My endo will not address my complaints, all of which are hypo. She said numbers were "perfect." Well, from all the educated people on this board my numbers are not. After being tired of being tired I decided to go to an urgent care for a second opinion. The doctor did increase my medication from 75mg daily of Tirosint to 75mg 5 x week and 88mg 2 x week. I felt like crying that someone finally listened to me. Before Levoxyl recall I was taking 75mg 4 x week and 88mg
> 3 x week. I hope this is the answer but I do know my t3 is very low. At least this is a start! She also wants me to have an ultrasound of my thyroid. My question is, I had the radioactive pill about 5 years ago so I guess I do not have a thyroid anymore. Why would I go for an ultrasound if there is not a thyroid left? Does anyone know why she would request this? I am glad this doctor took an interest but I'm just a little confused.
> 
> Thanks everyone for all your previous advice. It's with the advice here I gained the courage to go for a second opinion!


Your thyroid may be growing back; I had to have RAI 3 times so get that ultrasound and do let us know!

Being validated can make a person weepy; I know it did me!!!


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## karen54 (Sep 14, 2013)

I will definitely go for the ultrasound. I can't imagine having to have RAI 3 times! Andros, it sounds like you have been through a lot. Hopefully, you are where you need to be now. I will call and schedule my appointment. I do hope to have good results to report. Thanks so much again!!


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## karen54 (Sep 14, 2013)

I am a little freaked out and am hoping someone can help! I did go for my thyroid ultrasound. I just received a call asking me to come in to speak with the doctor about the results. The only thing the woman would tell me is that it was abnormal and they found something. I have no idea what it means. Since I had the pill to destroy my thyroid I thought there was nothing there. I do know, because of this forum, that there is still the gland itself left. I know this is premature to ask but I am hoping someone might have a little more understanding of what it could mean. Thanks again for everyone's help. Oh, as much as I hate to admit it, I do smoke. I really plan to be an ex-smoker soon!


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## Andros (Aug 26, 2009)

karen54 said:


> I am a little freaked out and am hoping someone can help! I did go for my thyroid ultrasound. I just received a call asking me to come in to speak with the doctor about the results. The only thing the woman would tell me is that it was abnormal and they found something. I have no idea what it means. Since I had the pill to destroy my thyroid I thought there was nothing there. I do know, because of this forum, that there is still the gland itself left. I know this is premature to ask but I am hoping someone might have a little more understanding of what it could mean. Thanks again for everyone's help. Oh, as much as I hate to admit it, I do smoke. I really plan to be an ex-smoker soon!


Boy......................I am glad you did get an ultra-sound. If you did not have RAIU or ultra-sound previous to the RAI; yes........................they may have seen something. Especially if some of the gland did shrivel.

Now..................do not be distressed. If there is something that has to be addressed, let's all be glad they see it so something can be done.

Saying a big prayer for you right now this minute.

Are you going in today to speak to the doc?


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## karen54 (Sep 14, 2013)

Andros, thanks so much for getting back to me and your kind words. I am going to see my doctor tomorrow. I do remember having the RAIU scans done before the RAI. That was about 5 years ago. Why is that something you wanted to know? Does that mean anything?


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## JenneyCat (Aug 11, 2013)

best of luck Karen - please let us know what they say!!


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