# Labs...what is going ON?



## kl2010 (May 10, 2010)

It's been a while since I have posted on this forum, but I'm getting frustrated with doctors. I am 19, and have had hashimoto's for 3 years. Recently I have bounced from specialist to specialist because no one can figure out what is wrong with me. Long story short- the last endo had me on 112mcg synthroid and 4 cytomels per day (5mcg each...i think). My t3/t4 were right in range, but TSH was WAYYY low... somewhere around .03 (range 0.5-4.30)

So, my general practitioner knew I was fed up and suggested that I stop taking cytomel to see if my TSH comes up. Here's my latest lab:

TSH (3rd gen) 0.52 (range 0.5-4.30)
T4 (free) 0.8 (range 0.8-1.8) 
T3 (total) 59 (range 76-181)

So basically my TSH jumped from .03 to .52 in 2 months. I'd say it's on it's way up because I feel terrible already. So exhausted, cold, muscle aches, etc. My T4 Just made it to "normal range" and my t3 was low. The nurse practitioner looked over these labs and said "looks good!"

Needless to say, I'm getting sick of doctors dismissing the fact that I am a college student and feeling this way is getting old!

Any thoughts here are helpful. My idea would be to bump up the synthroid? I think my TSH is rising regardless...


----------



## desrtbloom (May 23, 2010)

Hi:

Have you ever had your TSH around 2.0? That is where my endo likes mine to be and I find about 1.8 to 2.0 I feel my best. Also, it might be a matter of increasing your Synthroid up to 125 for three days of the week and four days at 112 mcg. You would be surprised how just that little bump up can make a difference. I was having issues with my T4 and T3 when I was just on 125 mcg daily of Synthroid (I don't take the Cytomel) and my doc increased my Synthroid to 137 mcg Sunday through Friday only and it has made a big difference to my T4 and T3 levels. It also leveled out my TSH because at higher levels I'd go hyper, but at lower levels I would go hypo. This has helped me, so you might talk to your doctor.

I know it is frustrating and it is ever changing as we change and our bodies change. I definitely feel for you.

I wish you the best.

Patti


----------



## Andros (Aug 26, 2009)

kl2010 said:


> It's been a while since I have posted on this forum, but I'm getting frustrated with doctors. I am 19, and have had hashimoto's for 3 years. Recently I have bounced from specialist to specialist because no one can figure out what is wrong with me. Long story short- the last endo had me on 112mcg synthroid and 4 cytomels per day (5mcg each...i think). My t3/t4 were right in range, but TSH was WAYYY low... somewhere around .03 (range 0.5-4.30)
> 
> So, my general practitioner knew I was fed up and suggested that I stop taking cytomel to see if my TSH comes up. Here's my latest lab:
> 
> ...


What's going on is a very good question. Your labs are horrible. Your FT4 is in the basement and so is your TOTAL 3 and why they did not run a FREE T3 is beyond me given the circumstances.

How long have you been off the Cytomel and what thyroxine replacement are you on and how much is the dose per day?

When your TSH was that low, are you saying that you did not feel good at that time?

You cannot be feeling well with labs like that.

Have you had any of these antibodies' tests?

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/

Have you ever had a sonogram of the thyroid or RAIU (radioactive uptake scan?)

Here is info on why FREE T3 labs are important to the assessment of your situation.

http://www.thyroid-info.com/articles/freet3woliner.htm

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid

And finally, how did your diagnosis of Hashimoto's come about?


----------



## kl2010 (May 10, 2010)

Desertbloom- I have never heard of different dosages different days but it sounds interesting!! I will talk to my doctor about that.

Andros- I stopped taking cytomel about 2 months ago, maybe less. Currently I take 112mcg daily at 6am. When my tsh was super low I felt "ok" but not great. Right now I feel about 10x worse!! As for the labs, I'm pretty sure I've had all of them done, I just don't have a copy. My initial diagnosis came in august 2007. I went to the doctors thinking I had mono because I was so tired and so cold (wearing a winter coat poolside!) at that time my tsh was 28 or something.

Thanks for your advice, it's nice to know I'm not too crazy whenbj get upset with labs like this!!


----------



## Andros (Aug 26, 2009)

kl2010 said:


> Desertbloom- I have never heard of different dosages different days but it sounds interesting!! I will talk to my doctor about that.
> 
> Andros- I stopped taking cytomel about 2 months ago, maybe less. Currently I take 112mcg daily at 6am. When my tsh was super low I felt "ok" but not great. Right now I feel about 10x worse!! As for the labs, I'm pretty sure I've had all of them done, I just don't have a copy. My initial diagnosis came in august 2007. I went to the doctors thinking I had mono because I was so tired and so cold (wearing a winter coat poolside!) at that time my tsh was 28 or something.
> 
> Thanks for your advice, it's nice to know I'm not too crazy whenbj get upset with labs like this!!


Well; one way to get labs like that, especially if you are on this dose of T4 @ 112 mcgs., is that there are binding, blocking and stimulating antibodies at work. I have a suspicion that is why your labs look like that. They are blocking and binding the hormone at the receptor site thus preventing uptake and conversion.

I would like to see you at least get the TSI. Believe it or not, I personally would like to rule in or rule out hyper. I have seen this so many times it is not funny.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

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/

To be upfront with you, you would remember how you got diagnosed with Hashimoto's if it were a really true diagnosis which would involve a sonogram whereupon a lot of nodules were noted (cluster of grapes), very very high TPO and FNA. Nodules and TPO are "suggestive" and often seen in Hashimoto's and FNA (fine needle aspiration) would be conclusive "if" the pathologist identified Hurthle cells indigenous to Hashimoto's.

Also, 2007 was a long time ago. I strongly suggest you get the tests recommended above.

How do you even know if you have cancer or not? You see? The point is, if you cannot get regulated on thyroxine and triiodothyronine replacement; something is afoot.

Most importantly, you are not crazy. I validate you 100%. But, we must get to the bottom of this and as unwell as you feel, you may have to prepare for battle for if you cannot advocate for yourself, you won't get very far withing the medical establishment. Most of us here will vouch for that one.

This hug is for you,


----------



## kl2010 (May 10, 2010)

Andros said:


> Well; one way to get labs like that, especially if you are on this dose of T4 2 112 mcgs., is that there are binding, blocking and stimulating antibodies at work. I have a suspicion that is why your labs look like that. They are blocking and binding the hormone at the receptor site thus preventing uptake and conversion.
> 
> I would like to see you at least get the TSI. Believe it or not, I personally would like to rule in or rule out hyper. I have seen this so many times it is not funny.
> 
> ...


Andros - thanks again for the thorough response. Curious - if it IS hyper, would I still be gaining weight, feeling exhausted, low heart rate? I also have really bad migraines. Also, as far as my Hashi diagnosis, what else could it be if it's not hashi?


----------



## Chromatic (Mar 31, 2011)

kl2010 said:


> Curious - if it IS hyper, would I still be gaining weight, feeling exhausted, low heart rate? I also have really bad migraines. Also, as far as my Hashi diagnosis, what else could it be if it's not hashi?


Well,.. with your results -- even though your TSH is reporting on the lower end of things which in a 'normal' thyroid/brain indicate higher levels of T3,.. thus the suppression of the TSH (Thyroid Stimulating Hormone) -- It is called stimulating for a reason , and it controlled by our brain, particularly the pituitary gland. There is something called the HPA axis,.. which is basically a loop between the brain (hypothalamus) and the thyroid.. regulated via our bloodstream. The pituitary gland detects the levels of thyroid hormone in the blood, and either upregulates or down regulates the TSH hormone. When the thyroid hormone is elevated the brain will lower the 'stimulating hormone' so the levels go back down.. and vice versa.. when the levels are lower it will raise the stimulating hormone in an attempt to tell the thyroid to produce more.

In normal brains and thyroids this 'loop' works great and levels stay in good range and people feel fine.

In your case you have suppression , lately, of the TSH -- which means the T3/T4 should report a bit elevated in many cases.. it at least means that the brain is sensing elevated thyroid hormone in the blood and attempting to control it by lowering the TSH release.

Typical Hyperthyroidism has a low TSH, with high T3 (and T4) .. Which indicates even though the brain is signaling to lower or stop production of the thyroid hormones.. they are being produced anyways -- ie: Hyper thyroidism.

You present with low TSH AND low T3/T4. -- So it is a bit more confusing, add in the medication and it becomes really hard to accurately depict what is going on without some uptake tests and just more specific things (or time and monitoring of the levels.. )

To your direct question, after all of that general fundamental explanation that you probably already knew  --

No matter what is going on -- if your Thyroid levels are low -- in which yours are -- you will experience the Fatigue, Weight gain, Bradycardia, and so on because these things, these metabolic processes are regulated specifically by the level of Thyroid hormone in the serum blood.

So until those levels are into proper range (which seems to be about roughly 75% of the reference range for optimal results) you will feel the negative effects.

The medication can downregulate the TSH, as can the antibodies as was mentioned -- which of course will keep the T3/T4 low.

So yes, even being technically hyper in diagnosis -- you can 'temporarily' be hypo as you are with your T3/T4 levels -- and have hypo symptoms. This can quickly change though.. and the the levels change which change your symptoms.

So what you are feeling , while miserable, is completely par for the course. Though you are just in the middle of getting things under control -- more testing is needed, and I hope your doctor and labs really paint the appropriate picture sooner than later, so you can get the right level of treatment (and appropriate treatment) so you can not only stop feeling sick but feel good again!

Keep us informed..


----------



## Andros (Aug 26, 2009)

kl2010 said:


> Andros - thanks again for the thorough response. Curious - if it IS hyper, would I still be gaining weight, feeling exhausted, low heart rate? I also have really bad migraines. Also, as far as my Hashi diagnosis, what else could it be if it's not hashi?


Oh, yes...................nothing is carved in stone here. Symptoms do cross over.

I and many others here have gained weigh while hyper and the reason a person is exhausted is because even at rest, your metabolism is racing in high gear leaving the person utterly exhausted.

What is your heart rate? One never knows; as i say, "Nothing is carved in stone."

What about your blood pressure?


----------



## kl2010 (May 10, 2010)

It's been a while, and I finally went to see the new doctor. Any advice on the new labs would be appreciated. I have not changed any dosages (still on 112mcg synthroid)

Total T4 - 6.9 (range 4.5-12.0)
Free T4 Index - 2.3 (range 1.4-3.8)
T3 Uptake - 34 (range 22-35)
TSH 3rd Generation PENDING

BUN - 6 (range 7-20)
Albumin/Globulin Ratio - 2.4 (range 1.0-2.1)

Any insight would be very appreciated! I still feel exhauseted, and have gained 25 lbs.


----------



## Andros (Aug 26, 2009)

kl2010 said:


> It's been a while, and I finally went to see the new doctor. Any advice on the new labs would be appreciated. I have not changed any dosages (still on 112mcg synthroid)
> 
> Total T4 - 6.9 (range 4.5-12.0)
> Free T4 Index - 2.3 (range 1.4-3.8)
> ...


Well....................2.6 is mid-range of the range given for your Free T4 and that is very low. One would hope to see it somewhere above the mid-range.

It is interesting to also note that your Total 4 is exceedingly low. It makes me wonder what your FREE T3 might have been like had they run that test and then of course w/o TSH, I don't really have a clue.

Why is TSH pending? It would have been helpful.

More importantly, what has your new doctor had to say?


----------



## kl2010 (May 10, 2010)

OK....so now my TSH is .22 (range .50 to 4.30) and my thyroid peroxidase antibodies are 273 (should be under 35)

MCH is also slightly elevated

Any suggestions now??


----------



## Andros (Aug 26, 2009)

kl2010 said:


> OK....so now my TSH is .22 (range .50 to 4.30) and my thyroid peroxidase antibodies are 273 (should be under 35)
> 
> MCH is also slightly elevated
> 
> Any suggestions now??


Somehow, we need to see a FREE T3 test as w/o it I cannot tell if your FREE T4 is converting to FREE T3 at a rapid rate. It looks like it might be but it has to be confirmed.

If my suspicions are right on, I would say hyper.

This test is highly advisable.....

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Really there are other important antibodies' tests as well and at the very least a sonogram.

So, just for starters. FREE T3 (not T3) and TSI. Please note, you should have absolutely no TSI so if you get the test, we need the results in hand. They could say normal which could mean anything.


----------

