# My Latest Labs - just checking in



## Serenia (Sep 27, 2011)

OK this is me just checking in with my latest results.

These are last weeks blood test results - I had my appointment today.

TSH - 2.89 (0.4 - 5.5)
FT3 - 4.3 (3.8 - 6.0)
FT4 - 7.5 (7.5 - 16)

For the record I feel absolutely great - I never once had that blah unwell feeling (in the last 3 months) that I was having trouble with last year - see some of my previous posts

My new doctor (the old doctor dumped his thyroid patients and went back to diabetes and high cholesterol patients) told me at the last appt in December to switch to 5 mg Tapazole (methamazole or thiamazole as it now seems to be called) alternating with 2.5 mg Tapazole every day for the last 6 weeks - so I have been doing that since the beginning of February.

As of today I am now going to 2.5 mg Tapazole every day for the next 3 months so I feel good about that.

I do currently have edema in my lower legs and I am losing weight again - so it is possible that the Hyperthoridism is becoming active again. Am currently taking a water pill for the edema.

I was planning to ask some hard questions for the new doctor today but she was running late and we had to be fast. But she does depend on the TSH although she also doses on the symptoms as well since she is the one who suggested that I be weaned off the Tapazole at a much slower rate that the first doctor was doing when I first met her briefly 3 months ago.

My December labs were as follows (for comparison)

TSH - 1.39 (0.40 - 5.50)
FT3 - 4.7 (3.8 - 6.0)
FT4 - 9.7 (7.5 - 16.0)

My TSH in October 2011 (for the record) was rising - ( < 0.08 ) and in August 2011 it was suppressed ( <0.010 )


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## Andros (Aug 26, 2009)

Serenia said:


> OK this is me just checking in with my latest results.
> 
> These are last weeks blood test results - I had my appointment today.
> 
> ...


Sounds like pretibial myxedema is setting in but your numbers certainly look good and I am glad you are feeling good.

Is your doctor checking your liver enzymes about every couple of months?


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## Serenia (Sep 27, 2011)

Myxedema - that does not sound good.

Wikipedia article on Myxedema doesnt sound so good either.

Mortality rate of 30-40 percent??

Caused by CHF amongst others. And yes I do have CHF. My TSI has always been high - on the few occasions it has been tested. It was last tested on my October labs, was not on my December or March labs but it is ticked off on my next labs to be tested - in June.

(from Wikipedia for Myxedema)
Most experts agree that a large intravenous bolus of levothyroxine should be administered (200 to 400 mcg), followed by daily doses of 50 to 100 mcg, based on the patient's weight and comorbidities. Other experts advocate the use of triiodothyronine (T3) or a combination of both T3 and T4. In addition to thyroid replacement therapy, it is important to detect coexisting adrenal insufficiency and treat patients with stress-dose steroids to avoid precipitating adrenal crisis.

(me again)
Previously when my TSI was tested I was above range. I probably still am outside the normal range meaning the antibodies are ravaging my insides. 

I have not taken ANY hormone at all in the entire 2 years since I was diagnosed. Perhaps I should start taking some now??

I took the water pill for 10 days - my legs went down. I was told to stop taking the water pill when my legs went down so I did. Within 3 days my legs have swelled back up again. I will be making another appointment with the family doctor. My last labs were 2 weeks ago including liver. I haven't been called in by the doctor so I assume that my results are OK.

Mind you I probably am also still eating too much salt - too much worcestershire sauce. I guess I need to cut out the worcestershire sauce completely - pity coz I really love that.

We do try to cut down on salt - but the pasta still has salt added when cooking - there are 2 others in this family and we cant afford to cook my pasta separate from everyone else. We eat low salt tuna and I dont add salt to my rice when I am cooking that.

ETA - treatment

The term myxedema refers to the thickened, nonpitting edematous changes to the soft tissues of patients in a markedly hypothyroid state. Myxedema coma, a rare, life-threatening condition, occurs late in the progression of hypothyroidism. The condition is seen typically in elderly women and is often precipitated by infection, medication, environmental exposure, or other metabolic-related stresses. Because rapid confirmatory laboratory tests are often unavailable, the diagnosis may be made on clinical grounds with treatment started promptly.

Treatment of myxedema coma requires potentially toxic doses of thyroid hormone, and mortality rates exceeding 20% have been reported even with optimum therapy.

http://emedicine.medscape.com/article/768053-overview

What is the best treatment for Myxedema when one has CHF and Graves disease?

Should I be taking some T3 and/or T4 hormone to regulate my hormones?

Thanks.


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## Andros (Aug 26, 2009)

Serenia said:


> Myxedema - that does not sound good.
> 
> Wikipedia article on Myxedema doesnt sound so good either.
> 
> ...


I should have said pretibial myxedema!!! LHM (Lord have mercy) One word can make a huge huge difference.

If you think you do have pretibial myxedema, please call your doctor and go armed with info.

http://en.wikipedia.org/wiki/Pretibial_myxedema

Here are images.......
http://www.google.com/search?q=pret...HOoyutweqr-y3Bg&ved=0CEMQsAQ&biw=1024&bih=638

http://jcem.endojournals.org/content/87/2/438.full

The only thing that worked for me re the pretibial myxedema was to get rid of the thyroid. Everyone is different; you may respond to a different therapy.

Anyway, sadly whether myxedema or pretibial myxedema.................both are serious.


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## Andros (Aug 26, 2009)

Serenia said:


> Myxedema - that does not sound good.
> 
> Wikipedia article on Myxedema doesnt sound so good either.
> 
> ...


Okay...................we now know I should have said pretibial myxedema. And you would not want to take thyroxine replacement. That is for myxedema only. I am apologize profusely for the error.


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## Andros (Aug 26, 2009)

Serenia said:


> Myxedema - that does not sound good.
> 
> Wikipedia article on Myxedema doesnt sound so good either.
> 
> ...


Are you under the care of a cardiologist/pulmonologist for your congestive heart failure?


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## Serenia (Sep 27, 2011)

Andros said:


> Are you under the care of a cardiologist/pulmonologist for your congestive heart failure?


Yes, but I have only seen him once a year. Last appointment was June last year and he said I was doing fine. Next appointment is July 4, this year - 2012.

(Canada Day is July 1st here in Canada - we do not celebrate the US Independence Day )

Right now my heart is fine - no palpitations. no fast beating, no arrythmia.

Those pictures do look nasty.

My thyroid is NOT enlarged. and so far all the edema is restricted to my lower legs - around my feet and ankles.

I have made an appointment to see my family doctor tomorrow to get the results of the last lot of labs done 2 weeks ago, and for a consultation on my edema.

I will mention the possibility of Pretibial Myxedema as a complication of Graves disease.

Thank you for your responses.


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## Serenia (Sep 27, 2011)

Andros said:


> The only thing that worked for me re the pretibial myxedema was to get rid of the thyroid. Everyone is different; you may respond to a different therapy.


I MAY respond to a different therapy, or I may not.

So if I need to have surgery then I need to have a thyroidectomy surgery - to prevent the Pretibial Myxedema. Thats the only way I will agree to have ny thyroid removed,. OF course that does mean I have to take hormone for the rest of my life. But I'd rather do that and live to a good age - 90 if I am really lucky - than die before I turn 60. I am not even 50 yet.

You did not have thyroidectomy - you had RAI - 3 times.

Did that really help your prebitial myxedema?

Were you diagnosed with prebitial myxedema?


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## Andros (Aug 26, 2009)

Serenia said:


> I MAY respond to a different therapy, or I may not.
> 
> So if I need to have surgery then I need to have a thyroidectomy surgery - to prevent the Pretibial Myxedema. Thats the only way I will agree to have ny thyroid removed,. OF course that does mean I have to take hormone for the rest of my life. But I'd rather do that and live to a good age - 90 if I am really lucky - than die before I turn 60. I am not even 50 yet.
> 
> ...


I know; I would have preferred surgery but what did I know at the time? Nadda, that's what.

Amd I definitely had pretibial myxedema. Elephant legs. Everytime I look at my "sharp" ankles, I "remember" how awful that was.

If you run your finger down the tibia bone and you feel bumps, you surely have it. The tibia is a fairly smooth bone.

And oh, yes...................................I am perfectly normal. I never have edema. I am 69 now. But again, surgery would be what I would chose if I could do it over.

Let us know what your doctor has to say about the pretibial myxedema.


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## Serenia (Sep 27, 2011)

OK well I did go back and see the doctor about my swollen ankles. I have been on HYDROCHLOROTHIAZIDE (water pill) ever since.

Most of the time my ankles are staying slim and shapely. But if I drink too much water, or dont do enough exercise, they swell up.

I did ask about the myxedema, and the doctor said that was only for Uncontrolled hypothyroidism, and my hyperthyroidism is now under control. So no, he doesn't think I have myxedema.

My next endo appointment is in June.


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## Andros (Aug 26, 2009)

Serenia said:


> OK well I did go back and see the doctor about my swollen ankles. I have been on HYDROCHLOROTHIAZIDE (water pill) ever since.
> 
> Most of the time my ankles are staying slim and shapely. But if I drink too much water, or dont do enough exercise, they swell up.
> 
> ...


How controlled is it? Could we see your latest lab results and the ranges?

How do you feel?

Not drinking water causes the body to hold water. It is an inverse relationship.


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