# 1st Timer - Lab Results, Postpartum



## Alw1977 (Aug 6, 2012)

I'm new around here. I got the call yesterday (Congrats! It's hypothyroidism!) after visiting my OB complaining of: extreme fatigue, waking up tired no matter how much sleep I got, inability to lose weight, depressed mood, no libido. It's worthwhile to note I had a baby 10 months ago - my second.

I have been unable to lose any weight since about 8 weeks post-partum. I am still 25 lbs over my normal weight and I feel just awful. Thankfully, my doc didn't just pat me on the head and say "there, there." He ran a simple blood test, and I'm glad he did.

I started on 50mcg of synthyroid this AM. Here are my lab results:

TSH: 4.94 (range 0.40 - 4.50)
Free T4: 0.9 ng/dL (range 0.8 - 1.8)
Free T3: 2.7 pg/mL (range 2.3 - 4.2)

Anyone know anything about postpartum thyroiditis? I understand it's common to have elevated TSH and low Free T4 with that condition. I'm wondering if that's my issue since this appeared after childbirth (I was tested throughout my pregnancy and don't think any problems came up).

I see an endocrinologist next week and hope to learn more. I plan to make a pretty comprehensive list of questions for her. How long until I start to get some relief from the fatigue? This is really affecting my quality of life in a bad way - I'm not the mother, wife or employee I need and want to be.


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## Andros (Aug 26, 2009)

Alw1977 said:


> I'm new around here. I got the call yesterday (Congrats! It's hypothyroidism!) after visiting my OB complaining of: extreme fatigue, waking up tired no matter how much sleep I got, inability to lose weight, depressed mood, no libido. It's worthwhile to note I had a baby 10 months ago - my second.
> 
> I have been unable to lose any weight since about 8 weeks post-partum. I am still 25 lbs over my normal weight and I feel just awful. Thankfully, my doc didn't just pat me on the head and say "there, there." He ran a simple blood test, and I'm glad he did.
> 
> ...


Oh, you are hypo. That FREE T3 is in the basement. This is your unbound and active hormone which is available for cellular uptake.

It would seem 10 months is more than ample time for your body to set it's self to rights.

Glad you are seeing an endo.


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## Alw1977 (Aug 6, 2012)

I am so puzzled. I understand that *most* people report not feeling well with Free T3 in the lower ranges of normal, like I have. So why is my level considered normal? Shouldn't those ranges be adjusted? Or, would it be okay in someone who doesn't also have high TSH and a sluggish thyroid?

I look forward to having this discussion with my doctor. My OB put me on the synthroid b/c of TSH, but said (according to him) my other levels were normal. I'll be curious to hear what the endo says.

Are there any articles online that discuss this low-normal free T3 phenomenon?


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## Andros (Aug 26, 2009)

Alw1977 said:


> I am so puzzled. I understand that *most* people report not feeling well with Free T3 in the lower ranges of normal, like I have. So why is my level considered normal? Shouldn't those ranges be adjusted? Or, would it be okay in someone who doesn't also have high TSH and a sluggish thyroid?
> 
> I look forward to having this discussion with my doctor. My OB put me on the synthroid b/c of TSH, but said (according to him) my other levels were normal. I'll be curious to hear what the endo says.
> 
> Are there any articles online that discuss this low-normal free T3 phenomenon?


A range is a range is a range etc.. I am of the humble opinion that it's only purpose as per cohorts is to detect movement either up or down.

By not treating your low FT3, quite frankly, you are being sand bagged.

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
FREE T3 explained by Woliner
http://thyroid.about.com/cs/testsforthyroid/a/freet3.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.

http://jnm.snmjournals.org/content/27/11/1702.full.pdf


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## Alw1977 (Aug 6, 2012)

Thank you for your response. I have learned that two of the most highly recommend endos/physicians in GA for thyroid issues (according to Mary Shoman's site) are quite close to my home. I plan to make an appointment with one of them tomorrow - apparently it's a 4-6 week wait, but I'll make do until then with the endo I've been referred to by my OB. I've felt bad for 10 months already, what's another 2?

Last question - my labs didn't run a complete thyroid panel (Just TSH, Free t3 and free t4) but did run a Hemoglobin A1c. It came back as 5.6%. Anything <5.7 is "decreased risk for diabetes" and 5.7-6.0 is "increased risk for diabetes." I'm not super comfortable with that number either, though it could be a function of the extra weight I'm carrying (5'5'', 160 lbs, normally 135lbs).


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## adenure (May 7, 2012)

Hi!

Postpartum thyroiditis can start at anytime up until a year after child birth. The usual turn of events is that around 2 mo. post partum, a mom experiences hyperthyroidism (hyper symptoms: palpitations, insomnia, weight loss, diarrhea, anxiety). Then at about 6 mo. post partum, the thyroid levels normal out again, OR the thyroid levels go hypo for a period of time. Sometimes, the hypo stage won't go away and a woman has to take Synthroid for a long time or for life.

I read a lot about this because I was diagnosed with Graves Disease after my 4th baby was born. There was a thought it could be post partum thyroiditis (the hyper stage since its onset was about 2 mo. postpartum), but antibody levels and an uptake scan confirmed Graves Disease.

10 months isn't enough time for a body to right itself postpartum. The first 3 months, our bodies' hormone levels (all of them) are all over the place. In general, my endo. said it takes a year for thyroid hormones to right themselves if it's postpartum thyroiditis.

http://jcem.endojournals.org/content/87/9/4042.full

Alexis


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## Alw1977 (Aug 6, 2012)

Thank you Alexis. I believe it's possible I had the "hyper" phase post-pregnancy. Around 4 months PP, my hair starting falling out in big clumps. It happened after both of my births. I especially lost it at the temples - had large bald spots, almost like male pattern baldness. I attributed it to "hormones," as hair loss can be common post-partum. I could have had anxiety, insomnia, etc... hard to know because having a new baby is stressful and you're not really right at that point anyway, as you well know.

I do recall with my first child that I couldn't lose weight until 11 months PP. I didn't think to go to the dr because I thought my fatigue was just (i) having a baby, and (ii) working full time in a stressful career. I suspect I had postpartum thyroiditis after my first child. I got pregnant again 14 months PP, so obviously the issue righted itself.

I remain hopeful that is my issue - I'm going to proceed with seeing a Mary Shamon-recommended endo/PCP for a second opinion and perhaps more lab work. This sucks.


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## Andros (Aug 26, 2009)

Alw1977 said:


> Thank you for your response. I have learned that two of the most highly recommend endos/physicians in GA for thyroid issues (according to Mary Shoman's site) are quite close to my home. I plan to make an appointment with one of them tomorrow - apparently it's a 4-6 week wait, but I'll make do until then with the endo I've been referred to by my OB. I've felt bad for 10 months already, what's another 2?
> 
> Last question - my labs didn't run a complete thyroid panel (Just TSH, Free t3 and free t4) but did run a Hemoglobin A1c. It came back as 5.6%. Anything <5.7 is "decreased risk for diabetes" and 5.7-6.0 is "increased risk for diabetes." I'm not super comfortable with that number either, though it could be a function of the extra weight I'm carrying (5'5'', 160 lbs, normally 135lbs).


Hook up with these people; they will point you to the right doctor.
http://health.groups.yahoo.com/group/Georgia_Thyroid_Groups/

And don't leave us. Inquiring minds want to know how you are doing.


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## Andros (Aug 26, 2009)

Alw1977 said:


> Thank you for your response. I have learned that two of the most highly recommend endos/physicians in GA for thyroid issues (according to Mary Shoman's site) are quite close to my home. I plan to make an appointment with one of them tomorrow - apparently it's a 4-6 week wait, but I'll make do until then with the endo I've been referred to by my OB. I've felt bad for 10 months already, what's another 2?
> 
> Last question - my labs didn't run a complete thyroid panel (Just TSH, Free t3 and free t4) but did run a Hemoglobin A1c. It came back as 5.6%. Anything <5.7 is "decreased risk for diabetes" and 5.7-6.0 is "increased risk for diabetes." I'm not super comfortable with that number either, though it could be a function of the extra weight I'm carrying (5'5'', 160 lbs, normally 135lbs).


Well, the A1c is "up" there, that is for sure and other illness' can cause an increase in glucose and BP through no fault of your own. I do believe the A1c test can be infallible at times. Personal opinion, of course.


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## Lovlkn (Dec 20, 2009)

I developed Graves disease and also hashimoto's post 2 miscarriages and possibly after my firstborn. Lost all my pregnancy weight both times after 4 weeks, I got pregnant 13 months after my first and noticed my wide eye look in pictures which makes me think I developed it after or during my initial pregnancies. I was not officially diagnosed for 7 years, my kids were 7 and 9. My gyno (not the one that delivered my kids) finally listened to me and ran some tests - my GP told me for many years I needed to go onto depression meds and kept me in a supply of Ambien.

Alw1977 - consider yourself lucky that you are already on treatment.

The ranges you reference are just that ranges - very few if anybody feel well at low range. Mid to 3/4 range is your goal. Never dose by TSH - your endo likely will as will 90% of the doctors you see. Be proactive - insist on them running your FT-4 and FT-3 everytime and only base dose adjustments on those 2 numbers. Get hard copies of your lab results everytime, keep a log of doses, lab results and ranges and symptoms.

I went a tad hypo this Spring and my Glucose and cholesterol both went up so hopefully your issues are just thyroid related.


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## Alw1977 (Aug 6, 2012)

Lovlkn - thank you for the advice. I have already started a "lab results" notebook with hard copies of my bloodwork so far. I do count myself lucky - my OB does actually listen to symptoms and admitted "it sounds like thyroid" even though he was also concerned it could be my mood/depression rearing its head.

I have already scheduled appointments with three endos/PCP to discuss management of my condition. The first is next Monday and the other two are in September. The latest one is the most promising - a PCP known for being very aggressive with management of thyroid issues. He doses based on symptoms and FT3 and FT4, from reviews I've found about him.

On a positive note, now that I know something is physically wrong I somehow feel better about the whole situation. I went to a very tough 90 minute yoga class last night and felt very energized after. I believe daily exercise is going to be a requirement from here on out.


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