# What else should I have done??



## beachy29 (Jul 17, 2011)

Hi all. I was diagnosed with hashi's back in 2008, put on levothyroxine and still don't feel "normal". Like many of you, I have the classic hypo symptoms - extreme fatigue, weight gain, brain fog, etc. I feel like I am in a daze all day. I could sleep all day and have no energy to exercise or socialize after work. I just feel drained all the time. I even got a Dr to prescribe me Armour and I took that for about 6 months without feeling any better. This past year has been worse than before. Besides feeling crappy every day, I have gained 15 pounds (I have been the same weight for years), and had a miscarriage at only 4 weeks. My lab results seem to be different every time I get them done. I feel there is something underlying all these issues since I dont feel better on medication. Here are some of my labs.

*At time of diagnosis 12/08:*
TSH: 10.955 *Range* _(.45-4.5)_
TPOAb: 1,740 _(0-34)_
T4, Free: 061 _(.61-1.76)_

*2/11*
Thyroglobilin: 50.7 _ (.5-55) _ 
TSH: 2.9 _(.45-4.5) _ 
LH: .2 _(2.4-12.6)_
FSH: .4 _(3.5-12.5)_
Prolactin: 25.3 _(4.8-23.3)_
TPOAb: >600 (lab doesn't give higher #) _(0-34)_
T3: 2.7 _ (2.4.4)_

*2/11*
T4, Free: 1.12 (.81-1.77)
Cortisol: 37.5 _(2.3-19.4)_
TSH: 2.59 _(.45-4.5)_
ACTH: 13.4 _(7.2-63.3)_ 
Prolactin: 16 _(4.8-23.3)_

*3/9 Results of Dexamethasone Suppression Test after High Cortisol*
Cortisol: 1.4
ACTH: 1.9

*5/11:*
T4, Free: 1.65 _(.82-1.77)_
T3: 3.6 _(2-4.4)_
TSH: .052 _(.45-4.5)_
Prolactin: 6.3 _(4.8-23.3)_

*7/11:*
Cortisol: 13.4 (None Estab). Did some research on the internet and found that 8am cortisol of this # is slightly low and further testing should be done
Free T3: 3.3 _(2.77-5.27)_
Free T4: .98 _(.79-2.35)_
TSH: 1.08 _(.45-4.68)_
Prolactin: 13.6 _(3-18.6)_
ACTH: 15 _(6-58)_
C-Peptide: 1.4 _(.9-7.1)_
Glucose: 92 (_65-99)_
Vitamin D: 23.1 (_30-100)_

My gynecologist is testing my hormone levels and a glucose intolerance test. Does anyone think it is weird that my cortisol was so high and now it is low? I had an MRI of my Brain to check the pituitary functioning to make sure my adrenals are working properly. That came back fine. Should I have an adrenal saliva test? Any ideas of what to try next? I have a Dr.'s appt coming up so please give any ideas of helpful labs, etc that I can discuss with him. It appears (and feels like) something is not working properly and I want to get to the bottom of it before trying to conceive again. I know many other people are going through the same thing so hopefully we can help each other!


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## Lovlkn (Dec 20, 2009)

Can you please post your lab ranges?


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## Andros (Aug 26, 2009)

beachy29 said:


> Hi all. I was diagnosed with hashi's back in 2008, put on levothyroxine and still don't feel "normal". Like many of you, I have the classic hypo symptoms - extreme fatigue, weight gain, brain fog, etc. I feel like I am in a daze all day. I could sleep all day and have no energy to exercise or socialize after work. I just feel drained all the time. I even got a Dr to prescribe me Armour and I took that for about 6 months without feeling any better. This past year has been worse than before. Besides feeling crappy every day, I have gained 15 pounds (I have been the same weight for years), and had a miscarriage at only 4 weeks. My lab results seem to be different every time I get them done. I feel there is something underlying all these issues since I dont feel better on medication. Here are some of my labs.
> 
> *At time of diagnosis 12/08:*
> TSH: 10.955
> ...


Welcome to the board.

Let me ask you a question right out of the gate.......

Has anyone thought to give you a sonogram at the very least of it w/the better choice being RAIU (radioactive uptake scan?)

You have some numbers that are suspiciously high like the Thyroglobulin and TPO.

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

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419

Cancer needs to be ruled out and I have observed over the years that this is one possible reason patients don't respond to their thyroxine replacement.

When you were on the Levothyroxine, what was your dose? When you were on the Armour, what was your dose? Are you NOT on any thyroxine replacement at this time?

And I need a favor. Could you please re-post the 7-11 lab results with the ranges? Different labs use different ranges.

There are other antibody tests that would be good to have but I personally think RAIU should be at the top of the list.

Also a ferritin test for if your ferritin is in the basement, it impedes the efficacy of your thyroxine replacement.

Ferritin http://www.thewayup.com/newsletters/081504.htm


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## beachy29 (Jul 17, 2011)

I posted my lab ranges along side my lab results. I have had a thyroid ultrasound on a yearly basis. The Dr. states that there are some nodules but nothing to worry about due to their small size. No doctor has suggested a sonogram or RAIU. I was only on Armour for about 3 months over summer 2010 before moving and unable to find Dr would prescribe it. I do not have my labs available from when I was on Armour. I was on 1 grain. When on Levothyroxine I was always taking .88 or .75. I seem to flip flop between the 2 based on my labs. I have been on .75 for the past 3 months now. I have heard the optimum level for T4 and T4 is in the 50-80% range of normal. When these numbers get into optimal level, then my TSH goes down into hyper and my meds are adjusted. Is this commom? Also, the Dr. didn't seem to worried about my TPOAb and just stated that they would always be there because of Hashimotos. My current Endo, who is Directr of our hospital Endo Dept, said that when I came in in Feb 2011 for the 1st time, he had never seen lab results like that. He said that when one # went up the other should go down (I think he was talking about T3 & T4). He blamed this on the Armour and kep retesting me until he was satisfied my levels were "normal." Thanks for your replies.

Also wanted to add that my Gynocolegist thinks I have PCOS based on my irregular long cycles, miscarrigage in 6/11, and hormone levels I have from 2/11. He is sending me for current, more extensive, testing. Doesn't it seem that this, along with my thyroid, is indicative that something isn't firing correctly? (hypothalamus, pituitary?)


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## Andros (Aug 26, 2009)

beachy29 said:


> I posted my lab ranges along side my lab results. I have had a thyroid ultrasound on a yearly basis. The Dr. states that there are some nodules but nothing to worry about due to their small size. No doctor has suggested a sonogram or RAIU. I was only on Armour for about 3 months over summer 2010 before moving and unable to find Dr would prescribe it. I do not have my labs available from when I was on Armour. I was on 1 grain. When on Levothyroxine I was always taking .88 or .75. I seem to flip flop between the 2 based on my labs. I have been on .75 for the past 3 months now. I have heard the optimum level for T4 and T4 is in the 50-80% range of normal. When these numbers get into optimal level, then my TSH goes down into hyper and my meds are adjusted. Is this commom? Also, the Dr. didn't seem to worried about my TPOAb and just stated that they would always be there because of Hashimotos. My current Endo, who is Directr of our hospital Endo Dept, said that when I came in in Feb 2011 for the 1st time, he had never seen lab results like that. He said that when one # went up the other should go down (I think he was talking about T3 & T4). He blamed this on the Armour and kep retesting me until he was satisfied my levels were "normal." Thanks for your replies.


You are a sweetie! Thank you so much for doing that. Both the FREE T3 and FREE T4 are below the range. The one that is really important is the FT3 which is your active hormone. You cannot have much energy where it is at and I'll bet you are really symptomatic also?

Yes; as a previous poster has pointed out, TSH is diagnostic and in now way is useful when it comes to titrating meds. Doc should be titrating based on your FREE T3 which should be in the 75% area of the range given by your lab. FREE T4 is also very important and really both of them should be considered together.

Example: If FT3 is high and FT4 is low, we need to know if the patient is on T3 because that naturally keeps the FT4 low which is normal and natural.

If FT4 is high and FT3 is low; we might want to know why and could assume until proven otherwise that the patient is not converting as he/she should. This would warrant further testing.

And so on. At a certain point, TSH is no longer relevant. There are exceptions, of course. For example if it should suddenly sky-rocket.

Then there is the clinical evaluation which should play a huge role in this. Is the patient feeling better or worse. Does she/he appear lethargic, lackluster and w/o enthusiasm? Edema, weight gain and so on. OR is my patient responding to treatment and getting on w/his/her life?

If your doctor does not consider all this, I would say it is time to go doctor shopping.

Based on your 7/11 labs, I feel you are undermedicated. Let's see what others have to say!


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## beachy29 (Jul 17, 2011)

Thanks Ando. Yes, I noticed that my T3 & T4 are both low (although "within range"), so I am going to talk to the Dr about adjusting my meds. My next appointment is with a new Endo. I felt that my old Endo did not take the time with me, sent me to get labs, and saw me again every 4 months. Hopefully this doc will be better.

I still have some Armour left over from my previous prescription and have considered taking it again, but I am hesitant to take it without a Dr. recommending it. I don't think I have ever had optimal T4 & T3 levels. I'm also concerned about my other hormones, cortisol, etc., fluctuating or being irregular as well. I have added a Vitamin D supplement daily since my Viamin D was low. Hopefully, that will help me feel a bit better.

Andos, what other Antibody tests do you think would be good to have done?


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## Lovlkn (Dec 20, 2009)

"normal" - most doctors have not a clue how to treat a patient on thyroid replacement which is quite frightening, especially to those of us taking replacement.

Can you add your replacement doses to your labs?

Be careful with your naturopath as she is completely wrong in her statement


> the majority of Armour is still T4.


.

I want to ask you a question - when did you feel best? On Armour, on Levothyroxine .75 or .88?

At this point it comes down to when you felt best, on Armour or on the higher dose of Levo. Some people feel better taking Armour, some taking levothyroxine and some supplementing Cytomel with Levo. It's what works best for you that matters.

Armour has a higher concentration of T-3 so it is likely you may begin running too high a FT-3 because taking the levo has raised your FT-3 into a decent range although it should be higher, be sure and re-test in 6-8 weeks. 
Don't worry about your TSH for now -it's diagnostic.

Your current labs


> 7/11:
> Cortisol: 13.4 (None Estab). Did some research on the internet and found that 8am cortisol of this # is slightly low and further testing should be done
> Free T3: 3.3 (2.77-5.27)
> Free T4: .98 (.79-2.35)
> ...


Your low D should also be addressed. I take 5,000 IU daily as well as spend time in the sun daily.


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