# Please help! Any info is appreciated!!



## Missfl9898 (Oct 6, 2011)

Hi all! I'm new to the board and would like to see if you could shed
Some light on my issues. Ok here we go...I have been a type 1 diabetic for 
Over 24 years. I am very well controlled and am on a pump.
I have always taken good care of myself by healthy eating, although not perfect, and excercising regularly. I have had two healthy children in the 
Past 7 years and of course that can do a number on your body too. Lol
In the past few years I have noticed that regardless of how good I eat and how much I work out I am considering gaining weight. I am 5'8" tall and weigh 155. Last year at this time I weighed 145. And before that I was 135. In order for me to loose any weight I literally have to starve myself. And then as soon as I eat one piece of bread or a bowl of healthy cereal I gain it right back. 
Also my energy levels are just way below normal. I can't run on the treadmll for longer than 10 min at 5.5 without feeling like I'm going to die.
Now granted I do have two kids ages 6 and 7 and work 6 days a week but what I am feeling is not normal. 
I was tested my my endo who said I was fine. I went to my primary doc who said I have seen your labs and your THS levels are normal but your T3 and T4 are low and have been getting lower. He never told me exactly what they were but just put me on Armour 30mg. Without feeling any change a month later after testing my labs again he raised me to 60 my. I recently saw my endo and he flipped out because he said I didn't need it. So here I am...I stopped taking the Armour and I dont know what to do. I am still feeling bad, gaining weight, and don't know what's wrong with me. Any suggestions? Sorry for the VERY long story...


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## Missfl9898 (Oct 6, 2011)

Sorry about the typos. I am using my iPhone to write this and it is making up words.


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## lainey (Aug 26, 2010)

lol damn auto correct!

For the weight, when you have a thyroid problem, low carb diets often work best (okay, and that goes well with diabetes too). Insulin resistance is what becomes a factor here.

That aside, you should get copies of your labs, with ranges.

Autoimmune thyroid problems are extremely common in type 1 diabetics--autoimmune diseases tend to go hand in hand. If your primary doc is saying your frees are low and prescribing replacement, you have a pretty smart primary doc.

Once you have a look at the numbers, you can post them here with ranges so that we can evaluate them a little.

See your primary doc again. Ask him to run the thyroid antibodies. Tell him what happened at the endo's office, and see about getting back on the meds again if your numbers support it.


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## Missfl9898 (Oct 6, 2011)

Lainey,
I will see my primary next week. I a bit in the dark I guess about the levels and will ask if I can get that info, although, I will say that it will be like cracking into Alcatraz as they are not the easiest to work with, but the doc is great. 
My endo took it upon himself to contact my primary and basically "give him a piece of his mind". He contacted me back to let me know that my primary is simply giving me the drug because "he (my primary) thinks it would help me loose weight" which he was livid over. So I asked my endo what his thoughts were and he said that he and my primary just "agreed to disagree". But that really puts me in a bad spot.
I stopped the 60mg Armour two days ago and my sugar levels have risen a bit. I am not a huge carb eater (although I do have carbs), I probably only take about 30g of carbs at each meal tops. 
I have tried the 6 meal a day thing, protein at every meal, etc...nothing really made my metabolism work normally like it should. It's AMAZING. My husband keeps telling me to just eat small meals throughout the day and when I did that, I put on 5 pounds!! I was working out every day and lifting a few days a week. I even had a nutritionist and personal trainer I was working with and they were left scratching their heads.
It's just so frustrating. I know that there is a solution but I can't seem to find it. 
And when you have two docs arguing over it, I am just at a loss. 
I will try and get the levels today and see what I can find out. Thanks for your reply!


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## lainey (Aug 26, 2010)

It is your right to know what your lab numbers are. They're your results.

Don't they tell you your A1c or cholesterol, etc? What should be the big secret about the thyroid numbers?

Maybe it was the Armour that ticked off the endo? The typical treatment is T4 only--something such as Synthroid or Levoxyl. Armour is a combination medication that contains T4 and T3--many endos don't approve of it, as in recent years T4 has become the standard treatment.

The way it works with thyroid meds is that most people don't tolerate them if they take them when they really don't need them. If you were tolerating the 90mg of Armour, chances are you probably need it!


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## Missfl9898 (Oct 6, 2011)

Ok so here are my levels...I got them to expedite it over to me via fax...yeah!!!
THS- Value 1.294 Range 0.350-4.50 ulU/mL
T3- Value 87.5 Range 80.0-204.0 ng/dL
T4- Value .78 Range 0.80-1.80 ng/dL

So basically I am normal in my THS, very low side of normal on T3, and below normal on my T4.

I was on the Armour bc my PCP said both my T3 and T4 were low. He said he typically does use Synthroid but in my case he wanted to use the Armour 60mg. Never tried the 90mg. But I am supposed to go back to my PCP on Tuesday. 
I am wondering what the effects are if you are not on the right dosage or if you truly don't need it and take a low dosage amount?

What are your thoughts?


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## lainey (Aug 26, 2010)

Were you taking the medication when those labs were run?

If so, of course your TSH will look normal. Armour has a tendency to yield lower than normal T4 results, while raising T3 values.

Also, thyroid panels often call for "total" numbers (which it looks like you have ). The more accurate measurement is via the free T4 and T3 tests, which measure the unbound hormone in your blood (a variety of things bind thyroid hormone, including the sex hormones and antibodies). You need to have these done.

Your doctor should also run thyroid antibodies tests--thyroid peroxidase (TPO), thyroid stimulating (TSI) and thyroglobulin (TgAb) if he suspects you have a thyroid problem.

Commonly, people would have hyperthyroid symptoms if they are taking thyroid hormone and don't need it. Many people gain weight while hyper, because the increased metabolism causes them to eat more, so the idea that you can use thyroid hormone to lose weight is a little spurious. However, if your metabolism is truly off, becoming euthyroid with treatment will allow a person to lose weight with normal diet and exercise measures.


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## Missfl9898 (Oct 6, 2011)

It looks as though they ordered the following:
TSH
T3
T4 Free

but nothing else was taken. This was done on 9/8/11 so it has been about a month ago and prior to that I was on the 30mg Armour for one month. I am trying to see if I can get the labs I did before I started on Thyroid meds to begin with.

Don't think the meds are making me feel hyper at all. In fact, I am just sluggish and could literally lay down right now and take a nap. I really haven't felt "normal" for awhile. 
The only way that I feel like I can have the energy to last throughout the day is if I take an over the counter metabolism booster which is really bad for you or the drinks you can buy in the gym that give you a boost like Speed Stack and I don't want to do that all the time.


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## Andros (Aug 26, 2009)

Missfl9898 said:


> Hi all! I'm new to the board and would like to see if you could shed
> Some light on my issues. Ok here we go...I have been a type 1 diabetic for
> Over 24 years. I am very well controlled and am on a pump.
> I have always taken good care of myself by healthy eating, although not perfect, and excercising regularly. I have had two healthy children in the
> ...


Welcome!

You are in good hands with "our" Lainey.

We do need to see your most recent labs and the ranges. Your numbers no doubt improved while on the Armour and I can't say the doc too brilliant to take you off of the Armour for that is the very thing that brought you there...................; I am thinking.

Balancing thyroid and diabetes is very very tricky but with a good doc to help, it can be done w/little or no inconvenience.


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## Missfl9898 (Oct 6, 2011)

The above posts shows my most recent levels from my labs which we taken approximately one month ago. My PCP is the one that put me on the Armour but my Endo is the one that wants me to stop. I guess I am just in limbo right now and it is so frustrating. :-(


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## Andros (Aug 26, 2009)

Missfl9898 said:


> The above posts shows my most recent levels from my labs which we taken approximately one month ago. My PCP is the one that put me on the Armour but my Endo is the one that wants me to stop. I guess I am just in limbo right now and it is so frustrating. :-(


I was just looking at your labs. You are in dire need of a higher dose of Armour. You have been undermedicated. And those are Totals. I would hate to see what your FREES look like! Yikes!

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

And as suggested by Lainey; antibodies' tests are certainly called for.

This is my little list:

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

I would run back to the PCP. And I do mean run.


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## Missfl9898 (Oct 6, 2011)

Andros, I appreciate your response!! I have an appt on Tuesday next week so hopefully we can see where I am at that point and do more labs. It's just so weird how my Endo hasn't seen any of this or said anything about it. Although his main concern is just controlling my diabetes really. As far as I can see that is what he cares about and I will say has done a wonderful job on that front thus far. 
I know that the doc did order the T4 free but the T3 is just totals it seems. But my T4 Free was below normal. 
Overall I was taking 30mg first because my PCP said my THS was in the normal range (low side) before we started any meds. Then he put me on the 60mg one month later which is the labs I just posted above. So really the labs only reflect the 30mg in my system for 1 month. Hopefully my labs will show a change when I go back Tuesday and then if it is not raising he will probably put me on 90 mg. 
Although my Endo told me that I am NOT hypo and that he doesn't agree with it at all. He said my PCP told him that he agreed but I needed it to help "loose weight" so that's why he rx'd it to me. 
I can't believe how it could be so obvious that I have been complaining about fatigue, weight gain, and feeling overall miserable, and when my levels are tested no one thinks I have hypothyroidism??? 
Regardless, I am hoping to get some sort of handle on this when I go back on Tuesday and ask for some more in depth lab work. 
Thanks!


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## lainey (Aug 26, 2010)

Actually, it's not so unusual to find endo docs that are well versed in diabetes, but not so knowledgeable about thyroid.

There's no reason why you can't let the GP treat you for a thyroid problem.

Your free T4 is going to be below range on a med like Armour. That is the way a medication with T3 in it works. Hopefully the doc understands that (he probably may have because he did increase the dose). It was probably low normal to start with--when you go, try to get those original, before you started medication, results. However, they must run the free T3 to dose Armour properly, so you'll have to see if you can get the GP to do it.

And the antibodies. Get those done. If you have them, chances are you have more of a problem than the endo thinks.

More labs next week are really only valid if you have been ON or OFF of thyroid meds for at least 4 weeks prior, preferably 6 -8 weeks. It takes a long time for T4 hormone to build up in your system and a long time for it to leave it, so you are still "under the influence" so to speak if you have only stopped the meds recently.


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## Missfl9898 (Oct 6, 2011)

Thanks Lainey. I noticed that my doc didn't order a T3 Free and wondered why so I am hoping that he can do another one when I go on Tuesday but you're right he wanted to run labs every 8 weeks so that would be a bit premature as I just had them ran at the beginning of Sept. I will let you know what they say though. Thanks for your advice Lainey!


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## Andros (Aug 26, 2009)

Missfl9898 said:


> Andros, I appreciate your response!! I have an appt on Tuesday next week so hopefully we can see where I am at that point and do more labs. It's just so weird how my Endo hasn't seen any of this or said anything about it. Although his main concern is just controlling my diabetes really. As far as I can see that is what he cares about and I will say has done a wonderful job on that front thus far.
> I know that the doc did order the T4 free but the T3 is just totals it seems. But my T4 Free was below normal.
> Overall I was taking 30mg first because my PCP said my THS was in the normal range (low side) before we started any meds. Then he put me on the 60mg one month later which is the labs I just posted above. So really the labs only reflect the 30mg in my system for 1 month. Hopefully my labs will show a change when I go back Tuesday and then if it is not raising he will probably put me on 90 mg.
> Although my Endo told me that I am NOT hypo and that he doesn't agree with it at all. He said my PCP told him that he agreed but I needed it to help "loose weight" so that's why he rx'd it to me.
> ...


We appreciate having you join us here! Hopefully, Tuesday you will get some further testing and get to the bottom of this.

You "do" sound like you have thyroid issues and it is not at all surprising as most of us have more than one autoimmune issue to deal with. Sad but true.

Antibodies' tests with reveal what is truly going on.

Let us have an update when you can!


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## Missfl9898 (Oct 6, 2011)

Well I just left my PCPs office and I got my July labs from him. The results were as follows:
Thyroid profile:
T4 5.7. 5.0-12.5
T3 uptake 30.9. 22.5-37%
free thyroxine. 1.8. 1.0-3.9

Thread antibodies
TPO. Ab 42.7. 0-60
Thtroglubin. <30.0. 0-60.0
THS. 1.971. .350-4.5
Test methodology is 3rd generation
T3. 76.3. 80-204.0

This report was done on July 7th. At this point I had taken NO medication whatsoever.

My PCP said he wanted to switch me to synthroid and rechecky labs in December at that point and make changes as necessary.

Thoughts??


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## Andros (Aug 26, 2009)

Missfl9898 said:


> Well I just left my PCPs office and I got my July labs from him. The results were as follows:
> Thyroid profile:
> T4 5.7. 5.0-12.5
> T3 uptake 30.9. 22.5-37%
> ...


You are in dire need of "something" that is for sure. If you were not on any med when these tests were run, I am surprised you can even function................at all. Your FREE T4 (free thyroxine) is in th basement, TOTAL 3 in the basement and that is very very bad as Total 3 is bound, unbound and rT3 (reverse) hormone. Since the unbound (FREE T3) is your active hormone and it's anybody's guess as to where that might be as far as a lab test is concerned, you are one very tired and sick little puppie. Yup! That is for sure!

You do have TPO which is suggestive of many things but often found in thyroid disease.

That test on Thyroglobulin; is that straight Thyroglobulin or Thyroglobulin Ab? It makes a huge difference in my thinking.

Here is info:

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)


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## lainey (Aug 26, 2010)

Your numbers for T3 and T4, including the low levels of antibodies, DO support a low dose trial of thyroid medication considering you were also complaining of symptoms.

Granted, your TSH was not very high, but that is not the only factor here.

I'm wondering about the endo now being so vehement that you didn't need meds. I suspect that if the PCP wants to switch you to synthroid, that the "agree to disagree" was over the Armour.

Have the PCP measure the free T4 and Free T3. Bringing those up in the range with thyroid replacement medication should help you to feel better.


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## Missfl9898 (Oct 6, 2011)

Yes actually he changed me to Synthroid today too. He said he also questions me having a "Central Thyroid" issue. I have no idea what that means but he said that it was doing some research and found that in cases where someone may have a relatively low TSH (but still in the "normal" range) with low T3 and T4 levels, that it could indicate a Central Thyroid issue. 
Anybody know anything about this?
He was very upset with the fact that the Endo called him up and basically chewed him out for doing what he was doing. We basically felt that some Endos feel like if the PCP is encroaching about "their" territory they get defensive, even though they would have done the same thing with the patient if given the same set of circumstances! 
Gotta love the ego's of some docs!
Regardless, my PCP said that we will continue the same treatment until Dec and then run more labs at that time to see where we are then. 
I agreed and overall feel very confident in my PCP that we will get to a resolution here. 
I am very curious about the Central Thyroid thing though. Will probably try to do some research on it to see what I can find out too. 
Thanks!
** Also I think the Thyroglubin test was a regular test and not AB (I don't see the term AB anywhere on the test results). The TPO was TPO AB.


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## Andros (Aug 26, 2009)

Missfl9898 said:


> Yes actually he changed me to Synthroid today too. He said he also questions me having a "Central Thyroid" issue. I have no idea what that means but he said that it was doing some research and found that in cases where someone may have a relatively low TSH (but still in the "normal" range) with low T3 and T4 levels, that it could indicate a Central Thyroid issue.
> Anybody know anything about this?
> He was very upset with the fact that the Endo called him up and basically chewed him out for doing what he was doing. We basically felt that some Endos feel like if the PCP is encroaching about "their" territory they get defensive, even though they would have done the same thing with the patient if given the same set of circumstances!
> Gotta love the ego's of some docs!
> ...


That is good on the Thyroglobulin then. You should have a little.

And I think your PCP knows what he is doing. I am very relieved to hear all this.

Central hypothyroidism refers to thyroid hormone deficiency due to a disorder of the pituitary, hypothalamus, or hypothalamic-pituitary portal circulation. 
http://www.uptodate.com/contents/central-hypothyroidism

I don't think the above applies; do you?


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## lainey (Aug 26, 2010)

Basically for the central hypothyroidism, the PCP would have to scan and test the pituitary to see if it is working properly or if there is a tumor.

An endo would be the one to investigate this, but if the PCP is motivated to look into it , let him go after it. It sounds like he has your interests in mind, and is looking at the whole problem, which is to your advantage. We all need a doc like that in our corner.

The bottom line would be that he would treat you to the free T4 and T3 values, not the the TSH. If he's reading up, he will figure it out.

What dose of synthroid did he put you on? Hopefully you will be seeing some results from it soon.


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## Missfl9898 (Oct 6, 2011)

lainey said:


> Basically for the central hypothyroidism, the PCP would have to scan and test the pituitary to see if it is working properly or if there is a tumor.
> 
> An endo would be the one to investigate this, but if the PCP is motivated to look into it , let him go after it. It sounds like he has your interests in mind, and is looking at the whole problem, which is to your advantage. We all need a doc like that in our corner.
> 
> ...


He put me on Synthroid 50mg (I don't know if it is measured in mg's but it's 50) lol
I am assuming it is equivalent to the 60mg of Armour? Right?


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## lainey (Aug 26, 2010)

One grain (60mcg) of Armour contains about 38mcg of T4 and 9mcg of T3.

The 50mcg dose of Synthroid is slightly higher in T4, but your body is then responsible for the conversion of T3. T3 is the active form of thyroid hormone that is used by your cells.

Because Armour has the T3 in it, and at a higher ratio than is found in the body, many people get an instant "boost" from it that they do not get from the slower acting T4 only medications.

Overall, what matters with thyroid medications is time. It takes time for sufficient T4 to build up in your cells to replace what is being used compared to what was lost---T4 is stored. As a result, you generally need to take a specific dose for at least 6 to 8 weeks before you can expect to measure an affect through lab work. For the same reason, it often takes patients a period longer than that to have symptom relief, considering that your starting dose isn't typically where you stay--usually it is increased until your numbers fall into place in the range and symptoms are relieved.

It's a process


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## Missfl9898 (Oct 6, 2011)

Oh ok. Thanks for that insight. I have heard that you may have hair loss on Synthroid as well as weight gain. I hope that this isn't the case as I have lost a couple of pounds so far and I have long thin hair so I really dont want to have it falling out! I guess you have to give it a shot to see what works best for you.


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## lainey (Aug 26, 2010)

People sometimes do report those as side effects of T4 medications.

The problem is that people who are hypothyroid are often low on iron and vitamin D to name a few deficiencies, both of which contribute to hair loss. Sometimes people have a very low appetite when they are hypo, and gain weight because the increased metabolism "wakes up" their sense of hunger and they start eating again.

Personally, my experience with the drug has been the opposite on both counts.


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## Andros (Aug 26, 2009)

Missfl9898 said:


> Oh ok. Thanks for that insight. I have heard that you may have hair loss on Synthroid as well as weight gain. I hope that this isn't the case as I have lost a couple of pounds so far and I have long thin hair so I really dont want to have it falling out! I guess you have to give it a shot to see what works best for you.


Aside from iron and Vit. D; you might consider adding a few grams of Omega III. I like Carlson's as it is cold water fish. I take 3 G a day. 2G of fish oil and 1G of Omega VI derived from Currant Seed as it has an extra enzyme that others do not.


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