# Thyroid Concern - history, lab results, etc.



## LMSchune (May 30, 2013)

Hi all. New to the forum and decided to take the leap. I personally believe I might have some sort of thyroid disorder (something is just not right), but will spell out my history as detailed as possible. So get the reading glasses 

I'm a 24yo female and I feel like I am in relatively good health - get a cold here and there, no major surgeries or accidents, and no major diseases. I was very heavy as a child and through my teens - highest I was 180lbs at 5'6", despite lifelong efforts at getting my weight under control. The summer after my freshman year of college in 2008 I started losing weight out of the blue. Being happy, I went with it and eventually worked my way down to 130lbs and a size 4. I didn't do anything crazy - just lots of cardio and only eating when I was actually hungry, although my diet certainly was not 'clean'; ate carbs, fast food sometimes, sweets, etc. but I just made sure not to overindulge like I did as a child.

I easily maintained that weight until the summer of 2011. About a month after a family vacation in Mexico, I noticed I was gaining weight out of the blue. My response was to really clean up my diet and continue with my cardio and weight training. Didn't do a damn thing, and eventually my weight stabilized around 145-150. This is where I have been for the past two years. Despite every effort on my part, the weight will not drop, and this is pure body fat in my thighs, hips, and stomach. I eat healthy as a general rule, and my activity level is extremely high - I run half marathons, spin, kickbox, step aerobics, Zumba, weight training, pilates, yoga, elliptical, etc. I love being active, and for the amount of exercise that I do (because I enjoy it), dropping weight should not be a problem or so my doctors have told me.

Besides the weight/fat gain:
-Sometimes I get so cold out of the blue that my nail beds will turn purple or blue. At night my feet are often ice cold to the touch (although I don't usually notice). I always have a cardigan or sweater stashed nearby.
-My temperature has always run below 98.6. I'm usually 97.0-98.0, and a temp of 99 is high for me if I'm sick.
-While my hair is thick, the amount of it I lose every day is astounding and gross - combing, in the shower, running my fingers through it
-Sometimes I'm so tired I can barely drag myself out of bed or will need a serious power nap. This hits me completely random sometimes.
-Without coffee, I am often constipated and will go days without a BM. Even with coffee, the constipation can be present.
-I go through periods of severe mood changes, which might be exacerbated due to the weight gain. Never medication for it, because I've only have the mood swings/depressions when I've been unhappy with my weight. In the 2-3 years where I was fit and thin, I was happy.
-These past two years my hands have suddenly become drier than sandpaper, with the tendency to split at the knuckles. Lotioning my hands several times a day has helped some.

After a GP ran standard TSH and insulin resistance bloodwork and basically blew me off with my concerns, I got more in-depth testing on my own:

*12/14/2011*
TSH 1.895 (0.550-4.780 uIU/mL)
Insulin resistance <2.0 (L) (2-32 uU/mL)

*6/15/2012*
TSH 1.690 (0.450-4.50 uIU/ml)
Thyroxine (T4) 8.5 (4.5-120 ug/dL)
T3 Uptake 29 (24-39%)
Free Thyroxine Index 2.5 (1.2-4.9)

*5/29/2013*
TSH 1.5 (0.450-4.50 uIU/ml)
Triiodothyronine Free Serum 2.3 (2.0-4.4 pg/mL)
T4 Free 1.15 (0.82-1.77 ng/dL)

Also got progesterone and estradiol levels in this latest bout of testing, so I will post those if people ask.

I've recently relocated from OH to SC for work and I'm seeing a DO on Monday in case this positions extends over the 1 year initial period, and I plan to discuss all of this with her. My previous MDs have not impressed me with their bedside manner or knowledge, so perhaps she will have some ideas. All I know if that I KNOW when my body feels right. And for the past two years, something has not been right. I KNOW this.

Much gratitute to anyone who reads


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## jenny v (May 6, 2012)

Welcome! Based on your last labs, I'm not surprised you can't lose weight and don't feel good. Both your Free T3 and Free T4 are in the basement and even though your TSH is fairly good, most of us feel better when that number is closer to 1.0. Are you on any kind of thyroid replacement? I think a low starting dose of Synthroid might help you out.

Also, consider asking to have your B12, Vitamin D and ferritin levels checked. Low levels of those can also contribute to your symptoms. Good luck!


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## LMSchune (May 30, 2013)

jenny v said:


> Welcome! Based on your last labs, I'm not surprised you can't lose weight and don't feel good. Both your Free T3 and Free T4 are in the basement and even though your TSH is fairly good, most of us feel better when that number is closer to 1.0. Are you on any kind of thyroid replacement? I think a low starting dose of Synthroid might help you out.
> 
> Also, consider asking to have your B12, Vitamin D and ferritin levels checked. Low levels of those can also contribute to your symptoms. Good luck!


No, as the MD I saw for the first test in 2011 blew me off and said I was fine. I'm hoping the DO I see on Monday will look at these labs and suggest I either see an endocrinologist or will put me on a trial of thyroid medication. I've done so much research on my own and have come across many doctors saying that they see women with normal bloodwork but a trial of Synthroid or a generic starts reversing their symptoms.

I will look into the B12, Vit D and ferritin testing. I did a health physical for my new employment and they ran my blood. The things I noticed on that that were on the low end of ranges:

WBC Count 3.6 (3.7-10.6 K/cmm)
Hemoglobin 12.3 (11.0-14.9 g/dL) 
Hematocrit 36.6 (36.0-46.0 %)
Potassium 3.8 (3.5-5.2 mmol/L)
Calcium 8.9 (8.9-10.3 mg/dL)

Thank you!


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## LMSchune (May 30, 2013)

So I went to my appointment with the DO, and aside from the fact that I liked her a lot (great bedside manner, close to my age, LISTENED to me for a change), we had a long discussion about my concerns.

She looked at all of my labs and felt that they are still normal, and did not feel like I needed to be on Synthroid or another generic form, although I did mention my research on normal bloodwork and medication trials for a conclusive answer.

On the physical exam however she did feel that the left part of my thyroid felt "fuller" - in her words. She didn't feel a bump, nodule, growth, etc. but just that it felt "fuller." I am scheduled for an ultrasound tomorrow at 10am to, again, hopefully conclusively rule on whether my thyroid is giving me an issue.

I'm hoping I can get a copy of the ultrasound when its completed, but we'll see what comes of tomorrow.

Anyone else have any comments on my labs?


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## Andros (Aug 26, 2009)

LMSchune said:


> Hi all. New to the forum and decided to take the leap. I personally believe I might have some sort of thyroid disorder (something is just not right), but will spell out my history as detailed as possible. So get the reading glasses
> 
> I'm a 24yo female and I feel like I am in relatively good health - get a cold here and there, no major surgeries or accidents, and no major diseases. I was very heavy as a child and through my teens - highest I was 180lbs at 5'6", despite lifelong efforts at getting my weight under control. The summer after my freshman year of college in 2008 I started losing weight out of the blue. Being happy, I went with it and eventually worked my way down to 130lbs and a size 4. I didn't do anything crazy - just lots of cardio and only eating when I was actually hungry, although my diet certainly was not 'clean'; ate carbs, fast food sometimes, sweets, etc. but I just made sure not to overindulge like I did as a child.
> 
> ...




I vote for hypo. FT3 is in the basement. This is your active hormone.

T3 uptake is low.

Here is info on both of the above.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

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.

T3 Uptake test
http://www.drstandley.com/labvalues_thyroid.shtml (high, hyper---low, hypo)

The T3 uptake explained.
http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm

It would be wise to get an ultra-sound of your thyroid and some of the tests below that you have not yet had.

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and 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/

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

I included the Trab as you could be flipping back and forth. Many of us here have had that experience.


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## LMSchune (May 30, 2013)

^

Thank you for your post.

I remembered that I got thyroid testing my senior year of high school, probably on a whim, and the office mailed me the results:

*4/24/2007*
Free T3 2.9 (2.5-3.9 pg/mL)
Free T4 0.82 (0.61-1.12 ng/dL)
TSH 1.75 (0.49-4.67 uIU/mL)

So the SOP that I'm getting the hint of for the medical community is that, as long as the results are anywhere in the normal range given, it is determined that the thyroid is functioning fine, even if the results are on the very low or very high end of the range? This is what I was getting from the DO I saw, as she does not think I warrant any thyroid medication.

Does anyone on this board have any experience with taking thyroid medication, preferably for a hypo suspicion, without a prescription or under a doctor's supervision? I got the ultrasound done yesterday but was not clear as to whether my DO would call me if the scan showed something abnormal, or if I would just talk to her at my 2 week follow-up. But at the rate I'm going and my frustration level, I'm getting close to the point where I'm willing to risk it and just try a trial of Synthroid on my own if I can obtain it from a viable source.

:confused0024:

Something else that I noticed from this year and from recent bloodwork done for my pre-employment physical, is that my WBC is very low, bordering on abnormal:
*4/24/2007*
4.7 (4.5-11.5)
*5/20/2013*
3.6 on a range of 3.7-10.6.

Thanks for the responses!


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## LMSchune (May 30, 2013)

*ANOTHER UPDATE:*

From my ultrasound, left side is clear. On my right, they found a nodule measuring 13 x 10 x 5mm, consisting of both cystic and solid tissue. Because of the combination, the DO is referring me to a general surgeon who will see me and look at it, and decide on whether to monitor it, do a different type of ultrasound, or take an actual biopsy.

Per the DO, it's on the larger side for a nodule and the cystic/solid combination warrants a more thorough look. So hopefully UHC won't **** around approving the next steps, and I'll get further on the road of discovering WTH is wrong with me.


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## joplin1975 (Jul 21, 2011)

Well, I'm glad you are having that checked out. Just be prepared...it's right on the cusp of being the right size for biopsy. They may take a watch and wait approach for a little bit.


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## Andros (Aug 26, 2009)

LMSchune said:


> *ANOTHER UPDATE:*
> 
> From my ultrasound, left side is clear. On my right, they found a nodule measuring 13 x 10 x 5mm, consisting of both cystic and solid tissue. Because of the combination, the DO is referring me to a general surgeon who will see me and look at it, and decide on whether to monitor it, do a different type of ultrasound, or take an actual biopsy.
> 
> Per the DO, it's on the larger side for a nodule and the cystic/solid combination warrants a more thorough look. So hopefully UHC won't **** around approving the next steps, and I'll get further on the road of discovering WTH is wrong with me.


There you go; dang!!! Just think if you had not gotten the ultra-sound. you will have to keep us in the loop on this.

Have they done any antibodies' tests?


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## LMSchune (May 30, 2013)

Andros said:


> There you go; dang!!! Just think if you had not gotten the ultra-sound. you will have to keep us in the loop on this.
> 
> Have they done any antibodies' tests?


Well, the revelations keep coming. I talked to my mom about the going-ons (she's my rock), and an hour later she texted me that her sister, my maternal aunt, has Hashimoto Thyroiditis and has been on Synthroid for years. I had *NO* idea, I thought my family had no history of thyroid problems. Then again, most of my family members would only go for stitches if they cut their hand off with a chainsaw 

I wonder what the DO and gen surg will say when I add this info to the puzzle. With this, I want my DO to order the antibodies tests; I can get them myself but will have to pay $105 out of pocket, when I could hopefully get UHC to cover it.


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## Andros (Aug 26, 2009)

LMSchune said:


> Well, the revelations keep coming. I talked to my mom about the going-ons (she's my rock), and an hour later she texted me that her sister, my maternal aunt, has Hashimoto Thyroiditis and has been on Synthroid for years. I had *NO* idea, I thought my family had no history of thyroid problems. Then again, most of my family members would only go for stitches if they cut their hand off with a chainsaw
> 
> I wonder what the DO and gen surg will say when I add this info to the puzzle. With this, I want my DO to order the antibodies tests; I can get them myself but will have to pay $105 out of pocket, when I could hopefully get UHC to cover it.


If you get them, here is a suggested list:

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and 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/

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583


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## LMSchune (May 30, 2013)

Andros said:


> If you get them, here is a suggested list:
> 
> TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.


Thank you 

Told the DO re: aunt's Hashimoto thyroiditis dx, and she's noted it in my chart and said to follow that up with the general surgeon. I am scheduled to see him next Tuesday in the afternoon, so I will post back with the results of that.

Going to call my auntie and get the history on her diagnosis. Maybe I will find a lot of correlation between my symptoms and what she experienced.


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## LMSchune (May 30, 2013)

So I had the appointment with the surgeon this afternoon. He listened to most of what I had to say and was nice, except he looked at the labs and pronounced that they "looked good." I still refuse to believe that, but that's not priority for me right now. I'll pick that battle back up later.

On the physical exam he said he could feel the nodule seen on the ultrasound, and did his own ultrasound. He said there was a nodule of "indeterminate bordering" (wth that means), and said he doesn't want to do an FNA just yet. He wants me back in 3 months for a re-check.

However, he did order me the thyroid antibody test - the ordering sheet said thyroidglobulin and thyroid antibodies. He also ordered me a chest X-ray, though I don't know why. It was a large medical plaza so I just went downstairs and got those done immediately after the appointment. Hopefully I can get the results by end of this week. He also said something about me possibly seeing an endocrinologist, but didn't go into detail.

Today was one of my bad days - very high fatigue (normally I have borderline fatigue that I can still function with) and very foggy; I had to refer to my notes and folder a lot to answer their questions, and felt awful.

Oh well. Guess I'll just have to wait :confused0031:


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## LMSchune (May 30, 2013)

Well ladies and gents, I believe I FINALLY have an answer.

The general surgeon called me at 5pm yesterday as I was driving home from work, and notified me that my TPO Ab was extremely high. It's autoimmune.

I just about started crying. I was not going crazy, there is something medically wrong with me. I'm ****ED that it has taken 2+ years to diagnose me, but I'm not going to focus on that. The gen surg recommended that I start with an endocrinologist and go from there. Definitely the plan, but likely not until after July 1 when my new insurance kicks in and I can skate around the pre-exis condition.

6/20/2013
Antithyroglobulin Ab: 33 (0-40)
Thyroglobulin, Qn.: 30 (0.5-55)

Antithyroglobulin Ab: 28 (0-40)
*Thyroid Peroxidase Ab: 248 (0-34)*

Doctor did say something like Graves, but it's got to be Hashi's - same as my aunts, and my symptoms are all Hashi's.

Thank you EVERYONE who has posted and given me their opinion, it has helped me so much! Looks like I will be a FF on this board.


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## Andros (Aug 26, 2009)

LMSchune said:


> So I had the appointment with the surgeon this afternoon. He listened to most of what I had to say and was nice, except he looked at the labs and pronounced that they "looked good." I still refuse to believe that, but that's not priority for me right now. I'll pick that battle back up later.
> 
> On the physical exam he said he could feel the nodule seen on the ultrasound, and did his own ultrasound. He said there was a nodule of "indeterminate bordering" (wth that means), and said he doesn't want to do an FNA just yet. He wants me back in 3 months for a re-check.
> 
> ...


Thyroid tissue can become sub-sternal. This guy knows what he is doing; humble opinion. I think you are in good hands here.


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## Andros (Aug 26, 2009)

LMSchune said:


> Well ladies and gents, I believe I FINALLY have an answer.
> 
> The general surgeon called me at 5pm yesterday as I was driving home from work, and notified me that my TPO Ab was extremely high. It's autoimmune.
> 
> ...


Do not neglect this situation; make sure you keep the 3 month schedule w/ the surgeon. Indeterminate and a few other things such as the TPO, Thyroglobulin and Thyroglobulin Ab dictate that.

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/


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## LMSchune (May 30, 2013)

Andros said:


> Do not neglect this situation; make sure you keep the 3 month schedule w/ the surgeon. Indeterminate and a few other things such as the TPO, Thyroglobulin and Thyroglobulin Ab dictate that.
> 
> Substances not found in normal serum (scroll down to autoantibodies)
> http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/


Oh, I am definitely going to stay on top of this. I have no idea what an endo will want to do, but you can be damn sure I'm going to push for a treatment trial. Unfortunately I do not have a huge selection of endos to choose from, but the GS has two he has worked with before.

I just really need to wait until July 1 to make sure I'm totally clear of the clause in my insurance. I should be okay diagnostic wise because technically I enrolled in my plan June 14th.


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## Andros (Aug 26, 2009)

LMSchune said:


> Oh, I am definitely going to stay on top of this. I have no idea what an endo will want to do, but you can be damn sure I'm going to push for a treatment trial. Unfortunately I do not have a huge selection of endos to choose from, but the GS has two he has worked with before.
> 
> I just really need to wait until July 1 to make sure I'm totally clear of the clause in my insurance. I should be okay diagnostic wise because technically I enrolled in my plan June 14th.


Well; keep us in the loop! And I hope your insurance is a slam dunk!


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## LMSchune (May 30, 2013)

Andros said:


> Well; keep us in the loop! And I hope your insurance is a slam dunk!


Definitely. If I go on medication, which is my ultimate hope, I'm sure I'll be on here still pestering you wonderful folks. And trying to give encouragement to those who are struggling like I am/was. I would never wish these past 2 years on anybody 

Additionally, my mother is going to get a full comprehensive bloodwork because now that she understands more about the immune disease, Hashi's, Graves, etc. she is suspicious of her own. She's dealt with similar symptoms for years and it was always blamed on her low Ferritin. I gave her a list of tests and to make sure her doctor orders them - Free T4, Free T3, TPO Ab, Thyroglobulin, Antithyrogloblin Ab, etc.

I really wonder how much this could run in my maternal family. My maternal grandmother died 6 years ago this July 4th, but she had a host of complications and issues mostly stemming from bad tobacco use.

hugs3


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## LMSchune (May 30, 2013)

*sigh*

Still waiting for an appointment with the endo. The explanation to the wait is that the referral has been sent, but the doctor has to review it and sign off (basically saying she'll accept me as a patient) before her staff can schedule me.

And I guess she's taking her sweet time


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## Andros (Aug 26, 2009)

LMSchune said:


> *sigh*
> 
> Still waiting for an appointment with the endo. The explanation to the wait is that the referral has been sent, but the doctor has to review it and sign off (basically saying she'll accept me as a patient) before her staff can schedule me.
> 
> And I guess she's taking her sweet time


Geez! Always some kind of stall. I am sorry. I am about as anxious as you are to get to the bottom of this.

Let us know when things get crackin'!


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## debster (Jul 3, 2013)

I just read your story from the beginning, and it sounds so similar to mine. We're even the same age.

I'm new to all of this as well, and I'm just starting the fight to get my hypo symptoms recognized, even though my numbers are within the reference range, but within the lowest percentile. So, this is a hello! I'm cheering you on!


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## LMSchune (May 30, 2013)

debster said:


> I just read your story from the beginning, and it sounds so similar to mine. We're even the same age.
> 
> I'm new to all of this as well, and I'm just starting the fight to get my hypo symptoms recognized, even though my numbers are within the reference range, but within the lowest percentile. So, this is a hello! I'm cheering you on!


Welcome to h-e-double hockey sticks, lol.

Still no call from the endo's office. I _really_ am trying to be patient and I don't want to call directly just yet, since I know that can irritate some doctors and their staff. Definitely don't want to be pre-labeled as a 'problem' patient before I even see her, but I have a feeling even when I do I might have a fight on my hands


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## LMSchune (May 30, 2013)

Sigh...

My mother decided to go to her GP to get in-depth thyroid testing done, since she has many similar symptoms as me. Also given that her sister has Hashi's and her grandmother reportedly had a goiter, adding in my TPO Ab result, we felt it was a good idea. I gave my mother a specific list of ALL the thyroid tests and ALL the antibodies tests she needed to specifically ask for.

Her results were posted online over the weekend, and this is what they said:

TSH 1.140 (0.4-4.40)
Free T4 0.78 (0.8-1.80)
Free T3 2.62 (2.3-4.2)
Ferritin 5.0 (10-291)
Anti-Thyroglobulin Ab <20 (<40)
Anti-Microsomal Ab 13.4 (<35)

Where is the TPO Ab? There could have been a chance my mother didn't give her doctor the list of the tests, but she says she did. Which means doctor didn't listen and did the tests she wanted.

Then she tells my mother that with her history of low ferritin and iron, it's probably past time she see an hematologist. No mention of doing thyroid replacement or seeing an endo. Am I an idiot for seeing these results and thinking the low ferritin is likely a cause of a her underproducing thyroid, NOT the other way around? T3 is basement and T4 is under the range.

I'm not clear on why doctor's insist on treating the symptoms instead of the cause.


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## LMSchune (May 30, 2013)

Update:

Good news - I have an appointment with the endo. Bad news - it's not until August 13th. She wants me to have fresh lab work and an ultrasound done one week before she sees me.

I'm debating calling back her scheduler and asking if I can be put on a cancellation list. Her office is almost next door to mine on the medical center property, but getting the pre-appointment work done might be tough.

Oy vey. I want to do a half marathon October 20, and I've already paid for the race. My 8 week training schedule would put me to start August 26th.


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## LMSchune (May 30, 2013)

So to give a quick update:

http://thyroidboards.com/forums/topic/9767-pituitary-related-hypothyroidismcentral-hypothyroidism-anyone-here/

I had my follow up with the PA mentioned here ^.

My LH and FSH were all within normal range for my cycle, so I'm okay with ruling out hypopituitarism. Now for the regular thyroid labs -

*10/11/2013; 12.5 mcg of Levothyroxine*

TSH 0.969 (0.45-4.5)

FT4 1.26 (0.82-1.77)

FT3 2.0 (2.0-4.4)

*11/22/2013 (exactly 6 weeks later)*

FT4 1.31 (0.89-1.76)

TT4 8.95 (4.5-12.5)

FT3 2.8 (1.8-4.2) *IIRC, best it's ever been

*TT3 88 (84-172) *PA says this needs to be increased*

rT3 16 (8-25)

My cortisol levels show very minor adrenal fatigue, and PA is not concerned enough with that to treat it.

So I am switching over to NatureThroid 1/4 grain. I was hoping for a bigger dose, such as 1/2 grain but PA didn't want to shock my system too fast. So I start taking it tomorrow. Hoping this will help. As of now, the only improvement I've seen on Levo is regular BMs, but they are weeeeeeeird looking.


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