# Back with new labs: feedback?



## McKenna (Jun 23, 2010)

Hi all,

I'm back with some new (weird) labs and could use some feedback. My signature is up to date with Naturethroid dose and my ongoing issues with UCTD. I just started with a new rheumatologist and I'm still in the weird limbo of "almost" lupus, which is why the diagnosis of UCTD. However, the past two months I'm having what I think are thyroid issues again: gaining weight, tired, swollen fingers and eyes, irritable and feeling "blah".

With my UCTD it can be hard to pinpoint what is causing my issues, however my FT4 is low (which I know is not abnormal in someone taking a t3 med) and my FT3 is lower than I would like. I do fast from Naturethroid before bloodwork so my FT3 does not look artificially inflated. My RT3 is flagged as low. ????? And for the first time in 7 years my TPO is not flagged as high! Yay!

The nurse at my doctor's office saw my microscopic TSH and freaked out, lol! She was new and didn't know that TSH can be low in someone taking a T3 med, like Naturethroid. She called me and told me to stop all thyroid meds ASAP and I said, "um...no!". I had to explain to her what TSH was and that I was actually under-medicated for what is good for me.

My plan right now is to ask doctor for a slight increase to 2 Grains of Naturethroid at my visit next week and then lab in a few weeks.

My latest labs:

Free Thyroxine

0.62 NG/DL

Range: 0.76-1.46 NG/DL

Low

Thyroxine (T4)

5.9 UG/DL

Range: 4.8-13.3 UG/DL

Thyroid Stimulating Hormone (TSH)

0.04 UIU/ML

Range: 0.358-3.74 UIU/ML

Low

Free Triiodothyronine (T3) pg/mL

3.08 PG/ML

Range: 2.18-3.98 PG/ML

Thyroid Peroxidase Antibodies

23 IU/mL

Range: <35 IU/mL

Anti-Thyroglobulin Antibody

<20 IU/mL

Range: <40 IU/mL

Reverse Triiodothyronine (T3)

8.1 ng/dL

Range: 9.0-27.0 ng/dL

Low

My ANA has jumped to 1:640 so I'm having other autoimmune things going on too, but I'm trying to figure out what is best based on each individual issue. I'm really thinking a slight increase of Naturethroid might help with the thyroid stuff. I have more testing for the UCTD stuff and an upcoming appointment for those issues. I also have steroids to start if I'm flaring with the UCTD.

Ah....autoimmune disease....the gift that keeps on giving! :sick0025:


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## creepingdeath (Apr 6, 2014)

So this UCTD is some made up disease they use when they can't figure what's wrong with you?

How much do you weigh?

How much desiccated thyroid do you take.

I started on the lowest dose of Armour and increased ever month till I *felt better*.

My doctor and I looked at my labs but where more concerned about how I felt.


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## McKenna (Jun 23, 2010)

No, it's an actual diagnosis that basically means I have some identifying lab results and symptoms of a rheumatologic autoimmune disease, but not enough of any of them for a definite diagnosis. My labs and symptoms are consistent with SLE, Rheumatoid Arthritis and/or Scleroderma. My labs and symptoms "lean" more toward SLE and I'm in a holding pattern of hoping I don't get worse and get the final diagnosis, and managing my health as best as I can to not get worse. (lifestyle management, stay out of the sun, steroid boosts when flaring, anti inflammatories, etc) So far I don't have organ involvement and my complement levels and anti-ds-dna aren't showing a tip in the scale, although the anti-ds-dna is rising. We'll see what the next set of labs show.

I'm now 145 lbs and my dose is on my signature. 1 3/4 gr.

My endo was very adamant about keeping my dose (when I was on Armour) lower than I needed b/c he looked mostlyy at labs. When I fired him and had my family doc take over, he was willing to up my dose until I felt well. I no longer feel well and my labs are showing what I think means I need an increase. My family doc is usually good at going with whatever I say. The thing that messed me up this time was the low RT3, which I don't know what that means. As I wrote above, I am going to ask for an increase to start at my appointment. I just have to figure out some things since Nature Throid is still backordered.


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## Lovlkn (Dec 20, 2009)

Your labs look like they could use a slight increase. Since your TSH is low you likely have stimulating antibodies as your free labs are not hyper


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## jenny v (May 6, 2012)

I would definitely ask for an increase. Your reverse T3 is okay (low isn't bad there) so increasing your NDT should help your Frees rise and you have some room for rT3 to rise and still be okay (just watch that it doesn't go over 11 or so).


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## McKenna (Jun 23, 2010)

Thanks for the feedback! I got my doc to increase my dose by 1/4 grain which brings me to 2 grains. My pharmacist is helping me locate the Naturethroid since some doses are still back ordered.

If anyone is in the same mess with Naturethroid and WP thyroid, RLC Labs (the manufacturer) is back in production again, however they are filling the most popular doses first. My pharmacy ordered 1/2 grain tabs, which was the only dose available to them right now. I will have to take 4 tabs but I split my dose anyway so it's no big deal. I went through the Armour shortage a few years ago and now this one looks like it's coming to a close. It's just a pain!



Lovlkn said:


> Your labs look like they could use a slight increase. Since your TSH is low you likely have stimulating antibodies as your free labs are not hyper


I haven't had a TSI run in years. My TSI fluctuated back then and were elevated, but never flagged as high. But I seem to recall Andros saying that there shouldn't be ANY TSI in the blood. ??? Sometimes my TSH goes even lower, like .01, but I'm never hyper. Do you think there's any benefit to running it since I don't have a thyroid any longer?



jenny v said:


> I would definitely ask for an increase. Your reverse T3 is okay (low isn't bad there) so increasing your NDT should help your Frees rise and you have some room for rT3 to rise and still be okay (just watch that it doesn't go over 11 or so).


Thanks! I will recheck in February and make sure he runs the RT3 again.


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## Lovlkn (Dec 20, 2009)

I had TBII antibodies run. Was high positive. That's the test and result I use to explain my lack of TSH


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## McKenna (Jun 23, 2010)

Lovlkn said:


> I had TBII antibodies run. Was high positive. That's the test and result I use to explain my lack of TSH


Good to know, thanks!


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## creepingdeath (Apr 6, 2014)

My ANA tests are higher than yours and I was never diagnosed with anything else but autoimmune thyroiditis. HASHIMOTO'S
Even my double DNA test was somewhat high but no diagnoses of Lupus......
I also have vitiligo another autoimmune disease that requires no blood test because it can be seen on your skin.

What are the symptoms that lean your diagnoses towards SLE?


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## McKenna (Jun 23, 2010)

creepingdeath said:


> My ANA tests are higher than yours and I was never diagnosed with anything else but autoimmune thyroiditis. HASHIMOTO'S
> Even my double DNA test was somewhat high but no diagnoses of Lupus......
> I also have vitiligo another autoimmune disease that requires no blood test because it can be seen on your skin.
> 
> What are the symptoms that lean your diagnoses towards SLE?


My experience and conversations with my care team (2 rheumatologists, gastroenterologist, dermatologist and family doc) have given me the following understanding. Take it with a grain of salt as everyone is different and I'm not trying to give medical advice. This is only what my experience has been.

SLE and other autoimmune rheumatoid diseases, are definitely not diagnosed by the presence of a positive ANA only. Positive ANA is usually a hallmark of SLE, but not the only criteria for diagnosis. It can be present in other diseases (like Hashi's, but there is no set staining pattern specific for Hashi's per my rheumatologist) or cancer, and can be present in healthy people, but usually not at a high titre and sometimes without a specific staining pattern or a speckled pattern, which seems to be the most common.

ANA also fluctuates and doctors usually don't test it frequently after the initial positive result, but they monitor other labs and symptoms as protocol to see if means something or not. Most of the tests revolve around inflammation markers and organ assessment. My doctors do not believe my ANA is from the Hashi's.

My primary symptoms right now are low grade fevers, mouth sores, severe fatigue, joint pain and swelling, muscle pain, headaches, rash from sunlight, livedo reticularis not caused by cold temps.

SLE is not easy to diagnose and usually takes a while. It also can mimic other diseases, which is why doctors don't jump to the SLE diagnosis. (its called the disease of many faces) It also presents differently in different people and is very individual. My rheumatologist told me from the beginning that it was a "mixed connective tissue disease" based on my symptoms and labs. A lot of the rheumatological autoimmune diseases share the same genetic make up and it can take a while to sort out. Right now my diagnosis is undifferentiated connective tissue disease but it could change.

Initially I was on plaquenil but had an allergic reaction to it and now cannot take any antimalarial. I also did a course of methotrexae but had to stop because it caused liver enzyme issues. It helped a lot with pain and fatigue. I do short term steroid boosts when I flare, which help, but steroids in general are very harsh.

If you are concerned that you have something other than Hashi's, I hope you can get a referral to a rheumatologist.


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## Lovlkn (Dec 20, 2009)

My ANA were high as well. I never developed SLE like symptoms, although when hypo my joints ached severely..

Hashitoxicosis is the only DX I have received. Thankful for that knowing an individual can have more than one autoimmune issue.


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## McKenna (Jun 23, 2010)

Back again with new labs. I had my doc check my levels because I started with the extreme tiredness, weight gain and I can't lose a pound.

Here are my results. I'm going to ask for an increase next week at my appointment. Any suggestions on how much to go up? I don't know if I should start small and go higher after I lab again, or try for a little higher. I think the last time I went up it was by 1/4 grain.

I'm currently on 2 grains of Naturethroid.

Free Thyroxine 0.72 NG/DL 0.76-1.46 NG/DL *Low*

Free Triiodothyronine (T3) pg/mL 1.87 PG/ML 2.18-3.98 PG/ML *Low*

Thyroid Stimulating Hormone (TSH) 0.12 UIU/ML 0.358-3.74 UIU/ML *Low*

Triiodothyronine (T3) Uptake 34.0 % 30.0-39.0 %

TIA!!


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## Lovlkn (Dec 20, 2009)

Do you keep a log of your labs and med dosages?

I find mine invaluable when adjusting doses.

Wish I could help with the NDT dosing but I'm on synthetic and always have been.


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## McKenna (Jun 23, 2010)

Lovlkn said:


> Do you keep a log of your labs and med dosages?
> 
> I find mine invaluable when adjusting doses.
> 
> Wish I could help with the NDT dosing but I'm on synthetic and always have been.


I do keep logs of the labs and dosages. I've never been this high on the Naturethroid (or any natural thyroid med) and I don't know what's going on with it. I've also never been so low on both my FT3 and FT4 at the same time. When I adjust up, I usually go by 1/4 grain at a time but I'm wondering if I should stick with that or try a 1/2 grain up. This is new territory for me, lol!

Thanks for the reply!


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## Lovlkn (Dec 20, 2009)

> I've never been this high on the Naturethroid (or any natural thyroid med) and I don't know what's going on with it.


Dose variations in the Naturethyroid? Without a thyroid isn't that about the only thing that it could be?


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## McKenna (Jun 23, 2010)

Thanks for the feedback. I had my appointment and we are going up slowly, by 1/4 grain. I'll lab in 4 weeks again.

My doc believes the omeperazole I started is interfering with the absorption of the naturethroid. He has seen other instances where it could interfere because it changes the ph of the stomach.


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## Lovlkn (Dec 20, 2009)

Makes sense.


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