# Just diagnosed with Hashi's - A Few Questions



## bigfoot

Bit of a long read here, but maybe someone here has been through a similar situation and can point me in the right direction or answer a question or two. Thanks for helping a newbie! (12/2011 - Wow, this thread is starting to really get long. I suppose it is part Q&A and part ongoing log. Good thing, 'cause I won't remember anyway! LOL)

*Backstory*
After a long stretch of fighting another illness and chemo, I recently discovered that I also have (surprise) Hashimoto's. I've already been on 50 MCG of generic Levothyroxine and 5 GM Androgel for hypothyroidism and low testosterone for a year, likely thanks to the chemo. And apparently there was a Vitamin D deficiency a year ago, too.

And so I thought I was out of the woods, so to speak. Things were going pretty well...

Then, about a month ago things really started acting up; tired until the evening, anxiety/depressed, memory trouble, cold all the time, no libido, hot flashes, racing pulse, sore joints, acidy stomach, no energy for hitting the gym three days a week, etc. Went to the primary doc but he thought it was just anxiety issues. Went to another doc for a second opinion and she thought it just might be Hashi's. Low and behold my TPO Ab lab came back positive for it. (Then I discovered that apparently there is family history of this as well as Hashimoto's Toxicosis, so the puzzle pieces started to fall together.)

So after they bumped my dose to 75 MCG of generic Levothyroxine, I felt good for a few days. Then starting feeling crappy again. Doc raised me to 100 MCG of brand-name Synthroid and felt waaay over-medicated. Pulse was racing, along with being constipated one minute and with diarrhea the next, insomnia, ridiculous brain fog, and exhaustion.

*Present*
Finally got in to see an Endocrinologist. He noted the 100 MCG was probably too much for me and we settled on taking 62.5 MCG of generic Levothyroxine. After about a week on that I started being exhausted again, weak, peeing all the time, with trouble getting out of bed, insomnia resulting in 2-3 hours of sleep, a persistent headache, along with the "wired but tired" feeling.

*Questions*
Which brings me to the present day. I have a follow-up with the Endocrinologist in a few days. TSH was already recently tested in April. He's planning to test this time for sodium (Na) levels, along with diabetes insipidus. Is there anything else I should ask for? (Such as B-12 deficiency, Adrenal panel, Cortisol saliva test, Free T3 & T4, etc.)

None of the doctors I have seen seem give much, if any, attention to the T3/T4 series of tests; instead each doctor has been paying more attention to the TSH levels. I heard that ideally for Hashi's your TSH should be in the 1.0-2.0 range. But, I have no idea which is more important, and where T3/T4 levels should be. Does anyone know?

Thanks in advance!

*Thyroid Labs & [Ranges]*
5/2/08 - TSH 3.06 [0.34-4.82], Free T4 0.7 [0.6-1.2]
2/23/09 - TSH 4.74 [Unk. Range]
3/4/09 - Begin Chemo TX
4/16/09 - TSH 2.63 [0.34-4.82]
8/24/09 - TSH 4.10 [Unk. Range]
1/28/10 - TSH 6.82 [0.34-5.60]
1/29/10 - End Chemo TX
2/9/10 - TSH 5.62 [0.34-4.82], Free T4 0.8 [0.6-1.2], Free T3 3.53 [2.4-4.2]
2/10/10 - Begin Levothyroxine 50 MCG
3/23/10 - TSH 1.79 [0.34-4.82], Free T4 0.7 [0.6-1.2]
5/2010 - Begin Androgel 5 GM
8/9/10 - TSH 2.74 [0.34-4.82]
12/1/10 - TSH 2.72 [0.35-5.50]
4/20/11 - TSH 3.17 [0.3-4.0], TPO Ab 253.7 [0.0-60.0], Thyroglobulin Ab 45.0 [0.0-60.0]
6/01/11 - Increase to 62.5 MCG Levothyroxine
6/02/11 - TSH 3.28 [0.3-4.0], Free T4 1.41 [0.84-1.51], Free T3 3.5 [2.3-4.2]
6/6/11 - Begin Vitamins & Supplements per Naturopath
6/21/11 - TSH 3.649 [0.3-4.0], Free T4 1.49 [0.84-1.51], Free T3 4.0 [2.3-4.2]
7/2/11 - Increase to 75 MCG Levoxyl, Increase Androgel to 7.5 GM, Reduce/End Supplements per PCP and Endo.
8/8/11 - TSH 2.71 [0.34-4.82], Free T4 0.88 [0.47-1.23], AM Cortisol 22.1 [3.1-22.4], ACTH 64 [7-69]
8/13/11 - Increase to 88 MCG Levoxyl, Continue Androgel 7.5 GM
9/2/11 - TSH 2.27 [0.34-4.82], Free T4 1.04 [0.47-1.23]
9/8/11 - Begin 2.5/5.0 MCG Cytomel
9/20/11 - End 2.5/5.0 MCG Cytomel
9/21/11 - Begin 100 MCG Levoxyl
9/26/11 - Begin Wellbutrin XL
9/27/11 - TSH 0.15 [0.34-4.82], Free T4 1.85 [0.47-1.23]
10/1/11 - Reduce Levoxyl to 88 MCG
11/7/11 - TSH 2.31 [0.34-4.82], Free T4 0.97 [0.47-1.23]
11/9/11 - Reduce to 5 GM Androgel, Begin RX of 50,000 IU for low Vitamin D
11/29/11 - Thyroid Stimulating Immun. "TSI" 31 (0-139%)
12/2/11 - Begin 20mg of Prednisone for Autoimmune Hep.

*Other Labs & [Ranges]*
8/08/11 - ACTH 64 [7-69], AM Fasting Cortisol 22.1 [3.1-22.4]
9/7/11 - % Sat 27 [20-50%]
9/7/11 - Ferritin 90.0 [26.0-388.0]
9/7/11 - Iron 115 [65-175]
9/7/11 - TIBC 433 [250-450]
9/7/11 - Prolactin 11.9 [2.1-17.7]
9/7/11 - HGB 17.7 [13.9-16.3]
11/4/11 - ANA by ELISA = Positive, ANA IFA = Negative
11/4/11 - IgA 143 [114-339], TTG IgA 3.9 [<=19.9]
11/7/11 - Vitamin D-25 Total 25 [32-100], Vitamin B-12 430 [180-914]

*Testosterone Labs & [Ranges]*
5/04/10 - Total T. 229 [262-1593]
5/05/10 - Begin Testosterone RX 5 gm Androgel
8/02/10 - Total T. 334 [262-1593]
12/1/10 - Total T. 577 [241-827]
4/20/11 - Total T. 543 [300-1080], Free T. 135 [47-244], T % Free 2.5 [1.6-2.9]
6/21/11 - Total T. 489 [300-1080], Free T. 120 [47-244], T % Free 2.5 [1.6-2.9], SHBG 18 [11-80]
6/21/11 - Free Estradiol 0.70 [adults less than 0.45], Estradiol 21 [adults less than 29]
7/13/11 - Increase Androgel to 7.5 gm
9/02/11 - Total T. 709 [300-1080], Free T. 182 [47-244], T % Free 2.6 [1.6-2.9], SHBG 18 [11-80]
11/9/11 - Reduce Androgel to 5 gm

*Current Meds*
88 mcg Brand-Name Levoxyl
5 g Androgel - Low Testosterone
150 mg Wellbutrin XL (switching to 10 mg Celexa)
Daily Men's Multivitamin
Daily Selenium 200mcg
Daily Carlson's Fish Oil 1,600 x 3 Times


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## Andros

bigfoot said:


> Bit of a long read here, but maybe someone here has been through a similar situation and can point me in the right direction or answer a question or two. Thanks for helping a newbie!
> 
> *Backstory*
> After a long stretch of fighting another illness and chemo, I recently discovered that I also have (surprise) Hashimoto's. I've already been on 50 MCG of generic Levothyroxine and 5 GM Androgel for hypothyroidism and low testosterone for a year, likely thanks to the chemo. And apparently there was a Vitamin D deficiency a year ago, too.
> 
> And so I thought I was out of the woods, so to speak. Things were going pretty well...
> 
> Then, about a month ago things really started acting up; tired until the evening, anxiety/depressed, memory trouble, cold all the time, no libido, hot flashes, racing pulse, sore joints, acidy stomach, no energy for hitting the gym three days a week, etc. Went to the primary doc but he thought it was just anxiety issues. Went to another doc for a second opinion and she thought it just might be Hashi's. Low and behold my TPO Ab lab came back positive for it. (Then I discovered that apparently there is family history of this as well as Hashimoto's Toxicosis, so the puzzle pieces started to fall together.)
> 
> So after they bumped my dose to 75 MCG of generic Levothyroxine, I felt good for a few days. Then starting feeling crappy again. Doc raised me to 100 MCG of brand-name Synthroid and felt waaay over-medicated. Pulse was racing, along with being constipated one minute and with diarrhea the next, insomnia, ridiculous brain fog, and exhaustion.
> 
> *Present*
> Finally got in to see an Endocrinologist. He noted the 100 MCG was probably too much for me and we settled on taking 62.5 MCG of generic Levothyroxine. After about a week on that I started being exhausted again, weak, peeing all the time, with trouble getting out of bed, insomnia resulting in 2-3 hours of sleep, a persistent headache, along with the "wired but tired" feeling.
> 
> *Questions*
> Which brings me to the present day. I have a follow-up with the Endocrinologist in a few days. TSH was already recently tested in April. He's planning to test this time for sodium (Na) levels, along with diabetes insipidus. Is there anything else I should ask for? (Such as B-12 deficiency, Adrenal panel, Cortisol saliva test, Free T3 & T4, etc.)
> 
> None of the doctors I have seen seem give much, if any, attention to the T3/T4 series of tests; instead each doctor has been paying more attention to the TSH levels. I heard that ideally for Hashi's your TSH should be in the 1.0-2.0 range. But, I have no idea which is more important, and where T3/T4 levels should be. Does anyone know?
> 
> Thanks in advance!
> 
> *Recent Labs*
> 1/28/10 - TSH 6.82
> 2/9/10 - TSH 5.62, Free T4 0.8, T3 3.53
> 3/23/10 - TSH 1.79, Free T4 0.7
> 12/1/10 - TSH 2.72
> 4/20/11 - TSH 3.17, TPO Ab 253.7, Thyroglobulin Ab 45.0
> 
> *Meds*
> 62.5 MCG Generic Levothyroxine
> 5 GM Androgel
> 2,000 IU Vitamin D


Hi there! Welcome to the board!

You definitely have something going on and I wonder if your doctor has ordered a scan?

Besides the TP(O and the Thyroglobulin Ab, have you had any of these other 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/

Did doc only run the T3 and not the FREE T3 (FT3?)

And for future reference, lab ranges are very helpful as different labs use different ranges.

Do you have a goiter or swollen lymph glands in the neck/clavicle area?

I am sorry that you have had a myriad of health issues.

I do think that your TSH should be a lot lower. When was the last time your doctor increased your Levothyroxine? Are you male or female? That is a low dose of thyroxine.

Most of us feel best w/TSH @ 1.0 or lower and the FREES (FT3 and FT4) @ about 3/4 of the way in the range given by your lab.


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## bigfoot

Hi Andros, thanks for the info and support! I put my responses to your questions in italics below...



Andros said:


> Hi there! Welcome to the board!
> 
> You definitely have something going on and I wonder if your doctor has ordered a scan?
> 
> *Nope.*
> 
> Besides the TP(O and the Thyroglobulin Ab, have you had any of these other tests?
> 
> *Only the TSH, TPO Ab, and Thyroglobulin Ab recently.*
> 
> 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/
> 
> *Thanks!*
> 
> Did doc only run the T3 and not the FREE T3 (FT3?)
> 
> *Back in Feb. 2010 before I started treatment, my Free T3 was 3.53 (range 2.4-4.2 pg/mL) and my Free T4 was 0.8 (range 0.6-1.2 ng/dl), and my TSH was 5.62 (range 0.34-4.82 uIU/ml).*
> 
> And for future reference, lab ranges are very helpful as different labs use different ranges.
> 
> *Will do!*
> 
> Do you have a goiter or swollen lymph glands in the neck/clavicle area?
> 
> *Back of my throat or neck feels a little swollen or puffy. I'll have to ask at this next appointment.*
> 
> I am sorry that you have had a myriad of health issues.
> 
> *Thanks! Hoping to learn lots from the fine folks here!*
> 
> I do think that your TSH should be a lot lower. When was the last time your doctor increased your Levothyroxine? Are you male or female? That is a low dose of thyroxine.
> 
> *Male, 32 years, and I had been taking the 50 MCG of Levothyroxine for about a year straight with no adjustments.*
> 
> Most of us feel best w/TSH @ 1.0 or lower and the FREES (FT3 and FT4) @ about 3/4 of the way in the range given by your lab.
> 
> *In that case, my Free T3 and Free T4 in Feb. 2010 was okay, but my TSH was definitely in the can. And I sure felt it, too. No idea what the Free T3 and Free T4 are presently -- hopefully I can convince the endocrinologist to test them as well next week.*


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## bigfoot

Okay, some notes about my 2nd visit to my endocrinologist today. My main reason for visiting was I could hardly stop urinating over the last week, along with insomnia, a persistent headache, and lump feeling in my throat. I wasn't anticipating returning so soon (only been 2 weeks since 1st appt.). So I used the time to ask a few more questions and try to get more information.

He drew a BMP (basic metabolic panel), calcium & sodium levels, and took some urine to check for diabetes insipidus (so-called "water diabetes"). Also scheduled me up for an MRI of my pituitary gland. He wanted to rule out if that was causing some of my signs & symptoms, or perhaps linking them together. He doesn't think so, but is going to check anyway.

I asked about adrenal insufficiency or adrenal gland problems, but he said unless I was having dark pigmentation of the skin, light-headedness when standing, etc. that it was highly unlikely. He said the sodium levels would help reveal something like that anyway, so no adrenal or cortisol tests for me.

He felt my neck and lymph nodes, but didn't notice anything unusual. However, I have been having a feeling of something swollen in my neck/throat area over this last week that comes & goes. I have no idea what that is from.

For some reason nausea, insomnia, frequent urination, persistent headache, constipation, and low libido are running rampant this past week as well. His only thought was that possibly I was over-medicated on the 75 & 100 MCG, and that my body was slowly correcting itself from that.

I asked about the Free T3 and Free T4. He didn't respond to my Free T3 comment at all. I get the impression (about 99.9%) he is using TSH and Free T4 to manage ongoing treatment. I don't think he touches Free T3 with a ten-foot stick.

He did mention that some of my symptoms seemed to match up to both hypothyroid and hyperthyroid. I asked if it was possible to have swings quickly in either direction with Hashimoto's, but he said no. He also said not all my symptoms could necessarily be attributed to thyroid issues, there may be another issue at play.

In the meantime, I'm still on 62.5 MCG of generic Levothyroxine and will be getting TSH and Free T4 labs drawn in July. I need to call and schedule the MRI for my pituitary, too.

So the end result: a few more diagnostic tests, and more hanging in there & waiting.

:a1Thyroid:


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## Andros

bigfoot said:


> Okay, some notes about my 2nd visit to my endocrinologist today. My main reason for visiting was I could hardly stop urinating over the last week, along with insomnia, a persistent headache, and lump feeling in my throat. I wasn't anticipating returning so soon (only been 2 weeks since 1st appt.). So I used the time to ask a few more questions and try to get more information.
> 
> He drew a BMP (basic metabolic panel), calcium & sodium levels, and took some urine to check for diabetes insipidus (so-called "water diabetes"). Also scheduled me up for an MRI of my pituitary gland. He wanted to rule out if that was causing some of my signs & symptoms, or perhaps linking them together. He doesn't think so, but is going to check anyway.
> 
> I asked about adrenal insufficiency or adrenal gland problems, but he said unless I was having dark pigmentation of the skin, light-headedness when standing, etc. that it was highly unlikely. He said the sodium levels would help reveal something like that anyway, so no adrenal or cortisol tests for me.
> 
> He felt my neck and lymph nodes, but didn't notice anything unusual. However, I have been having a feeling of something swollen in my neck/throat area over this last week that comes & goes. I have no idea what that is from.
> 
> For some reason nausea, insomnia, frequent urination, persistent headache, constipation, and low libido are running rampant this past week as well. His only thought was that possibly I was over-medicated on the 75 & 100 MCG, and that my body was slowly correcting itself from that.
> 
> I asked about the Free T3 and Free T4. He didn't respond to my Free T3 comment at all. I get the impression (about 99.9%) he is using TSH and Free T4 to manage ongoing treatment. I don't think he touches Free T3 with a ten-foot stick.
> 
> He did mention that some of my symptoms seemed to match up to both hypothyroid and hyperthyroid. I asked if it was possible to have swings quickly in either direction with Hashimoto's, but he said no. He also said not all my symptoms could necessarily be attributed to thyroid issues, there may be another issue at play.
> 
> In the meantime, I'm still on 62.5 MCG of generic Levothyroxine and will be getting TSH and Free T4 labs drawn in July. I need to call and schedule the MRI for my pituitary, too.
> 
> So the end result: a few more diagnostic tests, and more hanging in there & waiting.
> 
> :a1Thyroid:


I was just reading your post of one day ago when I saw this. Well, I am not a happy camper and I will tell you why.

Your labs are odd.
copy and paste
Back in Feb. 2010 before I started treatment, my Free T3 was 3.53 (range 2.4-4.2 pg/mL) and my Free T4 was 0.8 (range 0.6-1.2 ng/dl), and my TSH was 5.62 (range 0.34-4.82 uIU/ml).

Mid-range on lab range provided for FT3 would be 3.3 Yours is slightly above that. With your TSH high and the FT4 tanked, you would not expect that. You would expect to see the FT3 tanked also.

I suspect that in fact you are hyperthyroid and going through what I call a rebound effect flipping back to hypo and each time you rebound, the hyper gets worse.

What causes labs to look like this when this is taking place are the blocking, binding and stimulating antibodies and autoantibodies. It is the body's attempt to right it's self thus skewing the numbers.

I would not be surprised if you have TSI, Trab, TBII. Not at all surprised.

TSI (thyroid stimulating immunoglobulin)

Trab (Thyroglobulin antibody)

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)

Your doc's answer to you about the Hasmimoto's swings was incorrect.

And because you are male and because you feel a lump in your throat, I do think you should insist on RAIU (radioactive uptake scan.)

men more likely to have cancer than women
http://www.umm.edu/endocrin/thytum.htm

Also, see if this is where you live. You can go and get your own lab tests.

HealthCheckUSA

http://www.healthcheckusa.com/

Wonder why your doc shied away from the FREE T3 subject like that? Very strange, don't you think?

And, if you care to share, I am sure we will all be interested in your lab results and ranges even though the doc did not do much for the thyroid.

And I hope you do not have diabetes.


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## bigfoot

Well, that certainly makes things potentially interesting! Thank you so much for the info -- I will be bringing that up at my next doctor's appointment, if not sooner.

My recent Thyroglobulin AB test (performed along with TPO Ab test) was 45.0 (normal range 0.0-60.0). I have never had a TSI or TSII test performed. Do you know if the Thyroglobulin AB test could be normal, but the TSI and TSII tests abnormal, indicating the hyperthyroidism?

Dunno why he shied away from the Free T3 usefulness, but when I mentioned last time that a parent takes both T4 (Levoxyl) _and_ T3 (Cytomel), his eyes just about rolled back in his head. LOL

I do have an appointment with another endocrinologist in early July. I like to hedge my bets, so I have a backup doc just in case.


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## bigfoot

And thanks for the Health Check USA lab info -- there is one only a few miles from me! I think I will be getting that TSI and TSII test done on my own time, just to satisfy my own nagging curiosity...

EDIT: Just checked out the Health Check USA website and I don't see the TSI or TSII labs listed. So I guess they will have to wait.


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## Andros

bigfoot said:


> Well, that certainly makes things potentially interesting! Thank you so much for the info -- I will be bringing that up at my next doctor's appointment, if not sooner.
> 
> My recent Thyroglobulin AB test (performed along with TPO Ab test) was 45.0 (normal range 0.0-60.0). I have never had a TSI or TSII test performed. Do you know if the Thyroglobulin AB test could be normal, but the TSI and TSII tests abnormal, indicating the hyperthyroidism?
> 
> Dunno why he shied away from the Free T3 usefulness, but when I mentioned last time that a parent takes both T4 (Levoxyl) _and_ T3 (Cytomel), his eyes just about rolled back in his head. LOL
> 
> I do have an appointment with another endocrinologist in early July. I like to hedge my bets, so I have a backup doc just in case.


I am glad you are hedging your bets.

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf (page 430 is of interest)

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

You will come to realize that Trab labs should be negative.

A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm

And these are written out just for you so you can write them down if you wish.

TSI (thyroid stimulating immunoglobulin)

Trab (Thyroglobulin antibody)

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)

All these letters can get confusing and I have to constantly refer to my own notes to get this stuff right. LOL!!

It happens to be a fact that some of us do not convert T4 to T3 very well if at all. Many of us who no longer have a thyroid fit into the latter. If it were not for T3, I would be dead.

There are other reasons as well such as liver disease or antibodies attacking the thyroid receptor sites etc..

I am so discouraged with doctors......................; and even worse, I am scared to death to go to one. Thank God I currently have a wonderful one but this was not always the case and things do change. I live in mortal fear that something will happen to my wonderful doctor as I have already run the gamut in my area.


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## bigfoot

Andros said:


> You will come to realize that Trab labs should be negative.
> 
> A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
> http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm


So if I'm understanding this correctly, my Thyroglobulin AB lab results showing 45.0 (0.0-60.0 range) mean I am POSITIVE for the antibodies?
If so, does this mean that a 0.0 reading would be considered negative, or undetectable, and the ideal situation? (Not to put you on the spot here, I realize every lab company is different in how they relate the data.)

When I asked the endocrinologist if my lab data and current condition / diagnosis put me at a higher risk for developing thyroid cancer, he responded "no".

Many thanks for the clarification and all the time you are spending helping me! Already recently bought a copy of "Thyroid Power" and have a copy of "Stop the Thyroid Madness" on order. There sure is a lot to learn!


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## HashiMess

Hey bigfoot!
As far as I understand it, you are within that normal range, therefore would not be positive. You would have to have a value larger than that end range to qualify as positive.

That being said, can I just say he is taking you for a fool by saying there are no ups and downs in Hashi's!! The shear fact that your thyroid goes in and out of attacks, and therefore in and out of producing its own hormones, will cause you to feel ups and downs. You are on a steady level of T4 in your meds, which helps when you are on the more hypo side of things, but when your thyroid fails to produce its own hormones you may feel more hypo. When your thyroid is actively producing hormones, that along with those in your meds will cause you to feel less hypo/more hyper. It's so hard to find good docs anymore, so I feel for you. Pair that with the difficulty in gaining doctor understanding on something that they have not experienced themselves, and it can make you want to scream. Hopefully you have more sympathy for the women in your lives when they are PMSing!!! 

Hormones really are the drivers of our lives, and when they're funky, you feel funky. It's no fun, and I hope that you find some answers quickly.

BTW, anyone interested in at least giving you an ultrasound to check for nodules? Multiple nodules in Hashi's can be common but apparently when they are more singular they raise alarms. With a feeling of lumpiness in your throat, they should at least check for you.


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## lainey

I would like to suggest that you look into the long term side effects of the chemo drugs that were used to fight your previous illness.

The side effects from chemo are many and myriad--they effect the whole body and differing organs to varying degrees, and usually impact the patient for the rest of their lives.

I am not saying your thyroid couldn't be the problem. I would start with an ultrasound, as RAIU requires you to be off medication for 6 weeks, to investigate the "feeling" in your throat.

I would also suggest a "branded" thyroid medication--some of your problems could be due to an "inadvertent" medication change at the pharmacy--all generics are different from each other, and as you can see thyroid medication has a narrow theraputic index. Slightly different bio-availabilities that come from different manufacturers could have started your problem.


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## bigfoot

Many thanks for the additional info! I am going to ask the 2nd endocrinologist about getting an ultrasound, as well hopefully as getting a TPI, Free T3 & Free T4, and cortisol tests in the future, not just monitoring the TSH level. I am thinking that getting routine labs drawn every 3-4 months might make more sense than every 6 months or more.

You're absolutely right about the chemo drugs -- before I started that treatment regimen I had to practically sign my life away. The disclaimers and liability paperwork was wild! The gastroenterologist I had was very knowledgeable and supportive. She made the case at the end of treatment that it's likely the chemo pushed the thyroid issue out of the woodwork.

Thankfully my generic thyroid meds are the same manufacturer at present time. But I do want to work my way onto a brand name at some point, hopefully when some of the present issues get cleared up. Who knows, maybe even try T3 Armour? (That is, if I can find a doc willing to RX it...) Also thinking about visiting a naturopath MD just to see what they say since they are a little more "outside of the box" thinkers.

I have been tracking my weight, pulse, blood pressure, and temperature in AM & PM over the last week or so (and will continue). My AM temp upon waking up is running around 97.2-97.5 degrees (F) consistently. Also gave up coffee a couple of weeks ago which was _really_ hard to do! I splurge every now and then and get a cup of decaf or have a little soda.

Just received the book "Stop the Thyroid Madness" today. Guess I have some light reading for the weekend, LOL. It seems like every thyroid question that pops into my mind results in an answer generating yet another question.

So much to learn! And the support here is so great! arty0016:


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## lainey

First of all, STTM is not the most credible of sources, IMHO.

Don't get caught up in the idea that your TSH needs to be "properly" at a certain level. Each person functions well at differing TSH levels. TSH levels form a bell curve, with the 50th percentile falling around 1. However, this is not a mandate that you should be treated to a TSH of 1, you should be medicated to that TSH level where you feel well--whether it is above, below, or at 1. The goal is to find where that is.

What we are suggesting with the additional antibodies and free T3 tests is not that you are under treated--not likely, if you had hyper symptoms on such a low dose of T4--but that there may be a hyperthyroid component to your thyroid problem.

Thyroid antibodies come in many forms, both blocking and stimulating. Some people have both sets, and these influence their levels, causing them to shift from hypo to hyper. High T3, or the presence TSI, could indicate that you could be one of these people. What does this mean? It means that, depending on what antibody is dominant, you could have trouble settling on replacement dose, simply because at some times the thyroid is producing hormone due to stimulating antibodies, and at other times it is producing less hormone due to blocking antibodies. The only way to know this is to test for it.

T3 medication works best for people who don't convert the T4 medication well. Once again, if you had hyper symptoms on a slightly higher dose, this is likely not your issue--T3 is the active, more powerful thyroid hormone--but the best way to tell is to measure the free T3.

The bottom line is, you really need to measure at least the free T4 to monitor the thyroid meds, and at the moment see what the free T3 says.

Body temperature is not a good indicator thyroid status. Being a little low in the morning is normal, as is being around 97 degrees.

In addition to the cortisol, you should keep checking your testosterone and vitamin D. Low levels all produce hypo-like symptoms.


----------



## Andros

bigfoot said:


> So if I'm understanding this correctly, my Thyroglobulin AB lab results showing 45.0 (0.0-60.0 range) mean I am POSITIVE for the antibodies?
> If so, does this mean that a 0.0 reading would be considered negative, or undetectable, and the ideal situation? (Not to put you on the spot here, I realize every lab company is different in how they relate the data.)
> 
> When I asked the endocrinologist if my lab data and current condition / diagnosis put me at a higher risk for developing thyroid cancer, he responded "no".
> 
> Many thanks for the clarification and all the time you are spending helping me! Already recently bought a copy of "Thyroid Power" and have a copy of "Stop the Thyroid Madness" on order. There sure is a lot to learn!


You are exactly correct! It is time well spent and thank you! I just love it if I can do something nice for someone.


----------



## bigfoot

You know, I should probably just skip over the doctors and start sending my co-pays to you folks! 

After everything I am reading here it is making me wonder about the hyperthyroid possibility.

One doctor said my TSH was fine at 3.17, another tested for Hashimoto's, another over-medicated me, and yet another isn't sure I even have a big thyroid problem. I can see why there is so much discrepancy between patients, doctors, lab tests, signs & symptoms, and RX dosage.

When I was on 50 MCG of generic Levothyroxine for the better part of a year, things were okay for the most part. As the months wore on, I noticed myself having less energy and becoming more tired. Finally not being able to hit the gym forced me into the doctor's office. A week later I awoke shaking, very anxious, with a fast heart rate, unable to think straight, weak, cold, etc. The doc put me on 20 MG of Citalopram and that made things _so_ much worse. (Ended that after 5 days' time with doctor's permission.)

When they bumped me up to generic 75 MCG it was okay for a couple of days, then things seemed like they went hyper. Fast pulse, nausea, overactive stomach, diarrhea, and walking around in a "fog". (I question whether this was my body getting used to the medication; I only took it for 8 days' time before they changed me to 100 MCG. Wonder if things would be different if I stuck with it.)

When they boosted me to 100 MCG of brand-name Synthroid for a few days (big mistake), it felt like I was a pile of goo. Could hardly keep my eyes open or even form sentences. Didn't drive anywhere. It was all I could do to walk upstairs a couple of times. Basically was a zombie.

Now, on generic 62.5 MCG for 12 days, things have leveled out a little (if you want to call it that, LOL). I still am having nausea, persistent headache, tiredness, anxiety that comes & goes, dry skin has returned a bit, sleeping better, stomach returning to normal. The insomnia and frequent urination came and went.

* Here's my list of tests I intend to ask for:
Free T3
Free T4
TSI
Ultrasound of thyroid
Cortisol / Adrenal
Vitamin D
Vitamin B-12

* Ongoing tests the docs have been pretty good about:
Testosterone
TSH
Liver Function (due to my past history)

If you think it would be better to know my Free T3 at the present moment (versus waiting 1.5 weeks for already written labs), I can get that run sooner at the nearby Health Check USA. I don't know how the time component figures into all of this and whether it makes a huge difference...


----------



## Andros

bigfoot said:


> Many thanks for the additional info! I am going to ask the 2nd endocrinologist about getting an ultrasound, as well hopefully as getting a TPI, Free T3 & Free T4, and cortisol tests in the future, not just monitoring the TSH level. I am thinking that getting routine labs drawn every 3-4 months might make more sense than every 6 months or more.
> 
> You're absolutely right about the chemo drugs -- before I started that treatment regimen I had to practically sign my life away. The disclaimers and liability paperwork was wild! The gastroenterologist I had was very knowledgeable and supportive. She made the case at the end of treatment that it's likely the chemo pushed the thyroid issue out of the woodwork.
> 
> Thankfully my generic thyroid meds are the same manufacturer at present time. But I do want to work my way onto a brand name at some point, hopefully when some of the present issues get cleared up. Who knows, maybe even try T3 Armour? (That is, if I can find a doc willing to RX it...) Also thinking about visiting a naturopath MD just to see what they say since they are a little more "outside of the box" thinkers.
> 
> I have been tracking my weight, pulse, blood pressure, and temperature in AM & PM over the last week or so (and will continue). My AM temp upon waking up is running around 97.2-97.5 degrees (F) consistently. Also gave up coffee a couple of weeks ago which was _really_ hard to do! I splurge every now and then and get a cup of decaf or have a little soda.
> 
> Just received the book "Stop the Thyroid Madness" today. Guess I have some light reading for the weekend, LOL. It seems like every thyroid question that pops into my mind results in an answer generating yet another question.
> 
> So much to learn! And the support here is so great! arty0016:


Thank you for the compliment; I do happen to think we have one of the nicer thryoid boards on the net. Wonderful posters and mods!

I do agree w/Lainey about the chemo pushing the thyroid over the edge and also a sonogram "is" a good place to start.

I am glad my TSH is not 3.7.....................yikes!! We keep mine @ 0.03. Keeping it suppressed like that keeps the antibodies very very quiet. Especially the Lupus ones.

Your list of tests is a good one. Good for you!


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## bigfoot

Well, I called the endocrinologist's office yesterday and asked for my pituitary MRI results. At that point I hadn't heard anything for six business days -- how nice. Anyway, there was nothing in the pituitary gland that showed after a radiologist read the results. The blood/urine lab results I am waiting for in the mail. Assuming normal (that can be dangerous) as they made no mention of them.

This last week I've really noticed my throat/neck getting tight. The sensation comes and goes, but I swear it feels like I'm making a pearl in there! It seems like it's been getting more and more prevalent. I'm guessing this is also related to Hashimoto's, but when I asked the doc last week, he palpated my neck and said everything seemed fine. I can breathe, eat, and drink, it's just at times it feels like there is a lump in your throat and you have to swallow past it. A couple of Advil seems to help with the swelling for a while, but eventually it comes back. Don't wanna be eating those things like Tic-Tacs.

Seems like that darn nausea and headache just won't go away, either. And now I'm tired & winded after just climbing the stairs a few times. C'mon July 1st for the new endocrinologist!

What a way to enjoy your early 30s! LOL arty0006:


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## Andros

bigfoot said:


> And thanks for the Health Check USA lab info -- there is one only a few miles from me! I think I will be getting that TSI and TSII test done on my own time, just to satisfy my own nagging curiosity...
> 
> EDIT: Just checked out the Health Check USA website and I don't see the TSI or TSII labs listed. So I guess they will have to wait.


You might mean TBII on that one.

TSI (thyroid stimulating immunoglobulin)

Trab (Thyroglobulin antibody)

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)

Give them a buzz. See what they have to say over the phone. I am pretty sure many have gotten those test from them.

Many hugs and let us know how you fare w/this.


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## bigfoot

Thanks! I'll have to see what they say...


----------



## Andros

bigfoot said:


> You know, I should probably just skip over the doctors and start sending my co-pays to you folks!
> 
> After everything I am reading here it is making me wonder about the hyperthyroid possibility.
> 
> One doctor said my TSH was fine at 3.17, another tested for Hashimoto's, another over-medicated me, and yet another isn't sure I even have a big thyroid problem. I can see why there is so much discrepancy between patients, doctors, lab tests, signs & symptoms, and RX dosage.
> 
> When I was on 50 MCG of generic Levothyroxine for the better part of a year, things were okay for the most part. As the months wore on, I noticed myself having less energy and becoming more tired. Finally not being able to hit the gym forced me into the doctor's office. A week later I awoke shaking, very anxious, with a fast heart rate, unable to think straight, weak, cold, etc. The doc put me on 20 MG of Citalopram and that made things _so_ much worse. (Ended that after 5 days' time with doctor's permission.)
> 
> When they bumped me up to generic 75 MCG it was okay for a couple of days, then things seemed like they went hyper. Fast pulse, nausea, overactive stomach, diarrhea, and walking around in a "fog". (I question whether this was my body getting used to the medication; I only took it for 8 days' time before they changed me to 100 MCG. Wonder if things would be different if I stuck with it.)
> 
> When they boosted me to 100 MCG of brand-name Synthroid for a few days (big mistake), it felt like I was a pile of goo. Could hardly keep my eyes open or even form sentences. Didn't drive anywhere. It was all I could do to walk upstairs a couple of times. Basically was a zombie.
> 
> Now, on generic 62.5 MCG for 12 days, things have leveled out a little (if you want to call it that, LOL). I still am having nausea, persistent headache, tiredness, anxiety that comes & goes, dry skin has returned a bit, sleeping better, stomach returning to normal. The insomnia and frequent urination came and went.
> 
> * Here's my list of tests I intend to ask for:
> Free T3
> Free T4
> TSI
> Ultrasound of thyroid
> Cortisol / Adrenal
> Vitamin D
> Vitamin B-12
> 
> * Ongoing tests the docs have been pretty good about:
> Testosterone
> TSH
> Liver Function (due to my past history)
> 
> If you think it would be better to know my Free T3 at the present moment (versus waiting 1.5 weeks for already written labs), I can get that run sooner at the nearby Health Check USA. I don't know how the time component figures into all of this and whether it makes a huge difference...


In my most humble opinion, the most important test there is that TSI!

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


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## bigfoot

:confused0024:

Which would mean, if TSI is present, that I have _hyper_thyroidism. So that brings me to another question -- can you have both hypo AND hyperthyroidism? Or is this considered Graves' Disease? Or is this just a part of Hashimoto's? I guess I'm lost because I associate Hashimoto's with hypothyroidism with some hyper swings, and most of the symptoms I'm having seem to match to hypo. But is there a way to be hyper AND also have Hashi's with an elevated TSH, bringing along the hypo symptoms?

Thanks for helping to clarify! Today is not a great day, pretty nauseated, cold, exhausted, a little anxious, and really tired. Most days the nausea & tiredness clears out a bit by late afternoon / early evening. At this point I would think the higher dose of medication would have taken hold, but it seems like very slow going. Some days feel like two steps forward and one step back.

It's been interesting tracking my vitals over the last month. At this point I've been on 62.5 MCG for 2.5 weeks. My early AM temp upon waking is in the 97.2 - 97.5 degree (F) range. My pulse has been slowly climbing from the 60s to 70s to 80s in the early AM. My blood pressure has been climbing a little, seeming to hold in the 130s/80s. Weight has remained pretty constant, with small daily fluctuations, about 182 lbs.


----------



## Andros

bigfoot said:


> :confused0024:
> 
> Which would mean, if TSI is present, that I have _hyper_thyroidism. So that brings me to another question -- can you have both hypo AND hyperthyroidism? Or is this considered Graves' Disease? Or is this just a part of Hashimoto's? I guess I'm lost because I associate Hashimoto's with hypothyroidism with some hyper swings, and most of the symptoms I'm having seem to match to hypo. But is there a way to be hyper AND also have Hashi's with an elevated TSH, bringing along the hypo symptoms?
> 
> Thanks for helping to clarify! Today is not a great day, pretty nauseated, cold, exhausted, a little anxious, and really tired. Most days the nausea & tiredness clears out a bit by late afternoon / early evening. At this point I would think the higher dose of medication would have taken hold, but it seems like very slow going. Some days feel like two steps forward and one step back.
> 
> It's been interesting tracking my vitals over the last month. At this point I've been on 62.5 MCG for 2.5 weeks. My early AM temp upon waking is in the 97.2 - 97.5 degree (F) range. My pulse has been slowly climbing from the 60s to 70s to 80s in the early AM. My blood pressure has been climbing a little, seeming to hold in the 130s/80s. Weight has remained pretty constant, with small daily fluctuations, about 182 lbs.


If you have any TSI, even if it is below the range, that is "definitive" for hyperthyoid. As to the reason, that's another story. It could be because of cancer, Hashimoto's or Graves'.

Hashimoto's is diagnosed by FNA. If certain Hurthle Cells indigenous to Hashi's are present, then you have Hashi's.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

The criteria for Graves' is clinical. You must exhibit..........goiter, exophthalmos, pretibial myxedema and thyrotoxicosis as per Dr. Robert Graves' of the 1800 era. 3 out of the 4 qualify.

http://www.ncbi.nlm.nih.gov/pubmed/12876418
The above on hyper and cancer was rare in 2003 but not so rare now. Probably due to better diagnostics or poorer environmental factors or both. Wah!

Symptoms do cross over plus the binding, blocking and stimulating antibodies and immunoglobulins give false lab reports and even symptoms. That is why the roller coaster ride.

You see? First TSI goes nuttso; along comes TBII to bind. Hyper, hypo and thus the world turns.


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## bigfoot

Aha, thanks!!

Just walked the dog and my BP is 147 / 86 with a pulse of 96. My God, it feels like I just ran a marathon, phew!


----------



## Andros

bigfoot said:


> Aha, thanks!!
> 
> Just walked the dog and my BP is 147 / 86 with a pulse of 96. My God, it feels like I just ran a marathon, phew!


You are welcome!

Oh, Lordy!! Yep.........................just moving around is a negative but Bowser needs walked. Our dog is always on leash when he is not in the house.

What kind do you have? Sparky is an English Springer Spaniel but he thinks he is one of us!! And we don't mind on little bit!


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## bigfoot

We've got a GSD closing in on 3 years old. Like yours, he also thinks he is "one of us"! You should see him climb up on the couch, he thinks it's his own bed or something, haha. (Meanwhile his own new dog bed sits barely used.) If you even mutter the word "walk" or "ride" he jumps up and is ready to go.

I guess what amazes me is how quickly everything turned upside-down. A couple of months ago I was hitting the gym regularly, walking the dog 2-3 miles a day, on top of everything else. Now I'm lucky if I can work up the steam to walk him a few blocks! (Actually, he might be dragging me instead, LOL.) Oh well, that's enough venting and complaining for one day!

Here's a link to a photo of the pup:


----------



## Andros

bigfoot said:


> We've got a GSD closing in on 3 years old. Like yours, he also thinks he is "one of us"! You should see him climb up on the couch, he thinks it's his own bed or something, haha. (Meanwhile his own new dog bed sits barely used.) If you even mutter the word "walk" or "ride" he jumps up and is ready to go.
> 
> I guess what amazes me is how quickly everything turned upside-down. A couple of months ago I was hitting the gym regularly, walking the dog 2-3 miles a day, on top of everything else. Now I'm lucky if I can work up the steam to walk him a few blocks! (Actually, he might be dragging me instead, LOL.) Oh well, that's enough venting and complaining for one day!
> 
> Here's a link to a photo of the pup:


Oh, he is so so beautiful!! He knows his fur-parent is unwell; you can bet on that! They are so sensitive to our needs, moods and body language.

Don't worry, you and your buddy will be back walking again. That definitely is on the get-well program. That is what I had to do. I could barely walk 1/4 mile after I had my thyroid nuked and now I walk 8 miles a day. Baby steps. You will do this.


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## bigfoot

Thanks for the support, it really does mean a lot! And yes, they really are tuned right in to us.


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## bigfoot

Well, just finally got a call from the endocrinologist. Pituitary MRI last week was fine, and blood & urine labs looked okay (sodium level, calcium level, etc.). He did mention blood glucose was 134, although I wasn't fasting for these morning labs. He also made the comment, "There's nothing in your pituitary to explain the symptoms you're having."

While I'm glad he's investigating new angles, I can't help but feel we're overlooking the obvious thyroid connection to the signs & symptoms, and maybe missing the boat on potential adrenal issues.

Can't wait to see the MRI bill...


----------



## Andros

bigfoot said:


> Well, just finally got a call from the endocrinologist. Pituitary MRI last week was fine, and blood & urine labs looked okay (sodium level, calcium level, etc.). He did mention blood glucose was 134, although I wasn't fasting for these morning labs. He also made the comment, "There's nothing in your pituitary to explain the symptoms you're having."
> 
> While I'm glad he's investigating new angles, I can't help but feel we're overlooking the obvious thyroid connection to the signs & symptoms, and maybe missing the boat on potential adrenal issues.
> 
> Can't wait to see the MRI bill...


That is the part I am wary of; doctors will run all the tests they can. $$$$$$$ even when they already have a really good idea of the diagnosis.

However, it is very reassuring to have ruled out a pituitary adenoma. I will say that. I am glad.


----------



## Andros

bigfoot said:


> Thanks for the support, it really does mean a lot! And yes, they really are tuned right in to us.


You are very welcome. When hubby and I were younger, we had 3 dogs all at one time and all of them house broken as well as trained in advanced obedience, tracking, agility, a little Shutzhund.

We love our canine friends.


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## bigfoot

Off to get my labs shortly... should be TSH, Free T3, Free T4. I'm curious to see what has developed over the last 5-6 weeks. (Edit: Oh, and an A1C test as well.)


----------



## Andros

bigfoot said:


> Off to get my labs shortly... should be TSH, Free T3, Free T4. I'm curious to see what has developed over the last 5-6 weeks.


And so am I!! Hope you drank plenty of water so the veins are supple and engorged.

Good luck!


----------



## bigfoot

Okay, the labs just came in from yesterday. My TSH has increased from 3.17 on 4/20/11 to now 3.28 on 6/1/11. Yet my Free T4 and Free T3 counts are in the upper portion of the range, where I understand they are supposed to be with Hashimoto's (or whatever I've got) for feeling good. So obviously something like Cytomel or Armour isn't likely to help me here, as I already have plenty of T3 available to use, right?

So that brings me to the next question. How in the heck can I get that TSH suppressed? Especially without overdoing it on the Levothyroxine medicine (T4). At this point it's been about 5-6 weeks on some sort of higher dose per docs (72.5 MCG for a week, then 100 MCG for 2 days, then 62.5 MCG steady from there until now.) Would it benefit me to bump back up to 75 MCG of Levothyroxine? (When I initially took the 75 MCG I felt decent for a couple days, the rest were spent with headaches, loose stomach, and other fun side-effects. Maybe I didn't give it enough "break in" time?)

I do also see my blood glucose average and A1C is starting to creep out of the upper-end of normal. This is a red flag to me and I'm in the process of changing some eating habits immediately (less sugars, more fruits & veggies, etc.). Although we do eat relatively healthy, there is always room for improvement. Going to try to work in some gluten-free foods and go from there, too.

My days are still spent feeling sick, nauseated, tired, dry mouth, dry skin, and et al. The headaches come and go, as does the swollen/lumpy throat feeling (although that has gotten somewhat better). All of the poster child Hashi's signs & symptoms, yet my Free T3 and Free T4's are looking great. And yet my TSH keeps climbing. Any ideas? Thanks!

6/1/11 Tests (Range)
-----------------------
TSH 3.28 (0.3-4.0)
Free T4 1.41 (0.84-1.51)
Free T3 3.5 (2.3-4.2)

A1C 5.7 (3.0-5.6) 
Est. Avg. Blood Glucose 117


----------



## Andros

bigfoot said:


> Okay, the labs just came in from yesterday. My TSH has increased from 3.17 on 4/20/11 to now 3.28 on 6/1/11. Yet my Free T4 and Free T3 counts are in the upper 1/4 of the range, where I understand they are supposed to be with Hashimoto's for feeling good. So obviously something like Cytomel or Armour isn't likely to help me here, as I already have plenty of T3 available to use, right?
> 
> So that brings me to the next question. How in the heck can I get that TSH suppressed? Especially without overdoing it on the Levothyroxine medicine (T4). At this point it's been about 5-6 weeks on some sort of higher dose per docs (72.5 MCG for a week, then 100 MCG for 2 days, then 62.5 MCG steady from there until now.) Would it benefit me to bump back up to 75 MCG of Levothyroxine? (When I initially took the 75 MCG I felt decent for a couple days, the rest were spent with headaches, loose stomach, and other fun side-effects. Maybe I didn't give it enough "break in" time?)
> 
> I do also see my blood glucose average and A1C is starting to creep out of the upper-end of normal. This is a red flag to me and I'm in the process of changing some eating habits immediately (less sugars, more fruits & veggies, etc.). Although we do eat relatively healthy, there is always room for improvement. Going to try to work in some gluten-free foods and go from there, too.
> 
> My days are still spent feeling sick, nauseated, tired, dry mouth, dry skin, and et al. The headaches come and go, as does the swollen/lumpy throat feeling (although that has gotten somewhat better). All of the poster child Hashi's signs & symptoms, yet my Free T3 and Free T4's are looking great. And yet my TSH keeps climbing. Any ideas? Thanks!
> 
> 6/1/11 Tests (Range)
> -----------------------
> TSH 3.28 (0.3-4.0)
> Free T4 1.41 (0.84-1.51)
> Free T3 3.5 (2.3-4.2)
> 
> A1C 5.7 (3.0-5.6)
> Est. Avg. Blood Glucose 117


LHM!! {{{{100 MCG for 2 days, then 62.5 MCG steady from there }}}} In my mind, this is exactly the same as being on 75 mcg. 7 days a week.

You are saying that Free T3 and Free T4 are @ 75% of the range given by your lab? Sounds like an antibody is "blocking" the receptor site for TSH. There are binding, blocking and stimulating antibodies, autoantibodies and immunoglobulins.

And what did your doctor have to say about your rising TSH?


----------



## Andros

bigfoot said:


> Okay, the labs just came in from yesterday. My TSH has increased from 3.17 on 4/20/11 to now 3.28 on 6/1/11. Yet my Free T4 and Free T3 counts are in the upper 1/4 of the range, where I understand they are supposed to be with Hashimoto's for feeling good. So obviously something like Cytomel or Armour isn't likely to help me here, as I already have plenty of T3 available to use, right?
> 
> So that brings me to the next question. How in the heck can I get that TSH suppressed? Especially without overdoing it on the Levothyroxine medicine (T4). At this point it's been about 5-6 weeks on some sort of higher dose per docs (72.5 MCG for a week, then 100 MCG for 2 days, then 62.5 MCG steady from there until now.) Would it benefit me to bump back up to 75 MCG of Levothyroxine? (When I initially took the 75 MCG I felt decent for a couple days, the rest were spent with headaches, loose stomach, and other fun side-effects. Maybe I didn't give it enough "break in" time?)
> 
> I do also see my blood glucose average and A1C is starting to creep out of the upper-end of normal. This is a red flag to me and I'm in the process of changing some eating habits immediately (less sugars, more fruits & veggies, etc.). Although we do eat relatively healthy, there is always room for improvement. Going to try to work in some gluten-free foods and go from there, too.
> 
> My days are still spent feeling sick, nauseated, tired, dry mouth, dry skin, and et al. The headaches come and go, as does the swollen/lumpy throat feeling (although that has gotten somewhat better). All of the poster child Hashi's signs & symptoms, yet my Free T3 and Free T4's are looking great. And yet my TSH keeps climbing. Any ideas? Thanks!
> 
> 6/1/11 Tests (Range)
> -----------------------
> TSH 3.28 (0.3-4.0)
> Free T4 1.41 (0.84-1.51)
> Free T3 3.5 (2.3-4.2)
> 
> A1C 5.7 (3.0-5.6)
> Est. Avg. Blood Glucose 117


Refresh my memory. What antibodies' tests have you had done in the past and you have had a sonogram or RAIU?


----------



## bigfoot

At this time, only the following antibodies tests have been done:

4/20/11
Test (Range)
--------------
TPO Ab 253.7 *High* (0.0-60.0)
Thyroglobulin Ab 45.0 (0.0-60.0)

Using this info, my signs & symptoms, and family history, they determined I was likely Hashimoto's. No sonogram, no ultrasound, no RAIU, no FNA -- none of the fun stuff.

Have not heard from the GP doc yet, as they e-mail you copies of the labs first. Hopefully I hear from them today, although I'm not sure what my next steps and/or questions should be. I think asking for the TSI (Thyroid Stimulating Immunoglobulin) test to rule out being _hyper_ would be good, right?

Throwing more fuel on the fire, I have a new job prospect lined up soon and I need to get all of my housekeeping in order, and fast. I have a month or two to work with, at most. When it rains it pours! Next endocrinologist appointment is 7/1/11 (with the doc who hopefully doesn't keep checking his watch, LOL).


----------



## bigfoot

And one more question... if it does turn out to be an antibody blocking the TSH, what are my options for dealing with or suppressing that antibody?


----------



## Andros

bigfoot said:


> At this time, only the following antibodies tests have been done:
> 
> 4/20/11
> Test (Range)
> --------------
> TPO Ab 253.7 *High* (0.0-60.0)
> Thyroglobulin Ab 45.0 (0.0-60.0)
> 
> Using this info, my signs & symptoms, and family history, they determined I was likely Hashimoto's. No sonogram, no ultrasound, no RAIU, no FNA -- none of the fun stuff.
> 
> Have not heard from the GP doc yet, as they e-mail you copies of the labs first. Hopefully I hear from them today, although I'm not sure what my next steps and/or questions should be. I think asking for the TSI (Thyroid Stimulating Immunoglobulin) test to rule out being _hyper_ would be good, right?
> 
> Throwing more fuel on the fire, I have a new job prospect lined up soon and I need to get all of my housekeeping in order, and fast. I have a month or two to work with, at most. When it rains it pours! Next endocrinologist appointment is 7/1/11 (with the doc who hopefully doesn't keep checking his watch, LOL).


Yes; TSI would be very good and so would TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)

TBII inhibits TSI so if you have one, you likely have the other and even if TSI does not show up, you could have TBII as that would mean it is doing it's job.

I will be honest with you. Only FNA can determine Hashimoto's. They look for certain Hurthle Cells indigenous to Hashi's. Anything else is conjecture. Experienced clinical conjecture, yes. But, conjecture none the less.

And you really should have a sonogram at the very least. At the very best RAIU. So many are having thyroid cancer these days it is not funny.

Hubba about the job though. There are many out there that wished that they had a job.!! Good for you!


----------



## bigfoot

Thanks Andros! When I talk to the doc I will press for the TSI and TBII tests. Understand about the Hashimoto's -- sounds like I have many of the puzzle pieces, just not sure exactly _what_ the puzzle is. When I see the new endocrinologist I'll be pushing for FNA, ultrasound/sonogram, and try to rule out cancer as well as hyperthyroidism.

Yep, lost my job last year after my chemo, so my fingers are crossed that this pans out. Been a looong few years. Not willing to pass this one by due to being sick with something else a year later. Thanks for the well wishes!

Once I hear from the doc I'll chime back in here with any info... as always, thanks for the support & info!


----------



## bigfoot

Well, urgent care doc e-mailed me and said yesterday's thyroid labs look "normal" and that endocrinologist will probably keep an eye on the A1C / blood glucose in the future, since it was elevated.

Tried calling Health Check USA today to see if they can run the TSI and TBII tests. There was no answer, so I'll try again tomorrow.

I think if I can't get the TSI and TBII tests on my own now, I'll wait until I see the new endocrinologist on 7/1/11 and ask him then. I'll keep taking my 62.5 MCG of Levothyroxine in the meantime, and cross my fingers that things improve a bit. My AM nausea has been slightly less this last couple of days and a tiny bit more energy, so here's hoping for improvements!

Hate to say it, but without the input of that new endocrinologist I am kinda left in limbo land.
:confused0031:


----------



## bigfoot

Quick update... finally decided to go see a local naturopath MD today. What a super nice guy who spent over an hour going over my long-winded story with me. I got sent home with a goody bag of vitamins and supplements (potassium, magnesium, selenium, et al.), and am beginning a trial run of IV therapy tomorrow.

Before I was even able to finish my epic description of the last 3+ years, he was already talking about things he had in mind to help. Having never been to a naturopath before, I wasn't quite sure what to expect, but it was exciting. Here in Oregon, they are fully-licensed doctors who can also prescribe medications, order lab tests, etc. My thyroid is a little swollen ("+1" on the scale) but he didn't feel any lumps or nodules.

His take on everything? I am suffering from an autoimmune thyroid disease, although it isn't 100% clear exactly which one. He has treated patients with Hashimoto's, etc. in the past. He feels that my chemo and associated illnesses over the last few years have shot my adrenals, my vitamin levels, and so on. I asked about running additional tests (TSI, TBII, Cortisol saliva test, etc.) but he is taking the approach of boosting me back up before we even consider more tests or changing anything else.

Hopefully this new course of treatment brings out some good stuff! The naturopath doc thinks I'll start seeing changes within days after the IV therapy. Plus, this gives me something to work at before seeing the new endocrinologist on July 1st. I couldn't stand the idea of just sitting here and popping my T4, playing the waiting game, LOL.

I'll check back in as things hopefully happen...

arty0006:


----------



## lainey

Not to burst your bubble, but a word to the wise:

Be wary of anyone selling their own "cocktail" of supplements.


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## bigfoot

Appreciate the heads up! Yeah, the skeptic in me is a little wary. Still, this doc seems very knowledgeable. He wasn't pushing the sales pitch much, just suggested it might be a good idea. I'm willing to give it a try once or twice, if no results, well then forget the rest. He is pretty adamant that within a few days of this first treatment I'll be feeling better. By how much (if any) remains to be seen...


----------



## CA-Lynn

Sorry, I'm always wary of naturopaths. I don't get good vibes about his "treatment."

And IV therapy???? What's in the IV?


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## bigfoot

Well, the more I think about it, the more my gut reaction says to cancel the IV therapy. (And did so this morning.)

I don't know if I want to overload my body with anything at this point.


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## bigfoot

Update: Saw the naturopath doc again yesterday and he's added another supplement (Phyto-ADR for adrenals) as well as asked me to eat 1/2-1 cup of "groats" (raw oats) daily. These are soaked for 24 hours, then ground up in a blender and eaten.

[When I research the effects of oats and thyroid conditions, I come across a ton of conflicting information. Some point to the increased fiber as being a benefit and the oats have good immune properties, while others point to the oats reducing the effectiveness of levothyroxine medication absorption or increasing inflammation from the gluten. I'll be floating that question back to the doc...]

Overall, I would say things have improved slightly since beginning the various supplements and vitamins a couple of weeks ago. I also attribute that to being on an increased dose of Levo for coming up on 8 weeks now. Still have plenty of crappy days, but they are reduced somewhat. Hopefully everything is working hand-in-hand. The naturopath doc ordered up a bunch of labs (including adrenals, TSH, Free T3 & Free T4, etc.), so it will be interesting to see what, if anything, has changed lately.

Next week I have the new endocrinologist appointment. I will be asking for his opinion, as well as for the TSI, TBII, and ultrasound tests. Depending on everything, I'm thinking of asking to add some T3 to the mix.


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## hamilton

Hi BigFoot,
Your antibody range is good as upto 60 is normal. Mine was 1300! And they stop counting at that point so it could be higher. Have a 'heavy metals' lab test done which is done with hari samples. You ll be surprised with the results. High levels in copper for example can trigger of hashimotos and adrenal fatigue. Hashimotos and adrenal fatigue go hand in hand so have the adrenals checked asap. Endocrinologists dont know half the story so see someone who knows more about hashi's which i know is hard to find. Heavy metals test are not standard practice so if you dont ask they wont suggest it either. This test is thorough and pin points your levels and diet to follow. Worth a try!


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## bigfoot

hamilton said:


> Hi BigFoot,
> Your antibody range is good as upto 60 is normal. Mine was 1300!


Holy smokes -- that is a pretty high number! I'm noticing that my various labs are pretty small potatoes compared to some of the folks here on the forum. Knowing how I feel with mine, I can't even imagine how some other people are feeling.

I'll ask the naturopath about the heavy metal testing the next time I see him. If the adrenal labs from this go-around come back positive, we discussed trying to do the 24-hour saliva cortisol test. I guess insurance can be picky about that one.


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## HeidiBR

Different labs have different ranges for normal for the antibodies, so unless you know the range, you can't say it was normal or abnormal. My lab uses up to 30 for normal.


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## Andros

bigfoot said:


> Update: Saw the naturopath doc again yesterday and he's added another supplement (Phyto-ADR for adrenals) as well as asked me to eat 1/2-1 cup of "groats" (raw oats) daily. These are soaked for 24 hours, then ground up in a blender and eaten.
> 
> [When I research the effects of oats and thyroid conditions, I come across a ton of conflicting information. Some point to the increased fiber as being a benefit and the oats have good immune properties, while others point to the oats reducing the effectiveness of levothyroxine medication absorption or increasing inflammation from the gluten. I'll be floating that question back to the doc...]
> 
> Overall, I would say things have improved slightly since beginning the various supplements and vitamins a couple of weeks ago. I also attribute that to being on an increased dose of Levo for coming up on 8 weeks now. Still have plenty of crappy days, but they are reduced somewhat. Hopefully everything is working hand-in-hand. The naturopath doc ordered up a bunch of labs (including adrenals, TSH, Free T3 & Free T4, etc.), so it will be interesting to see what, if anything, has changed lately.
> 
> Next week I have the new endocrinologist appointment. I will be asking for his opinion, as well as for the TSI, TBII, and ultrasound tests. Depending on everything, I'm thinking of asking to add some T3 to the mix.


Hmmmmmmmmmmmmmmm; I think overall this is a fairly improved report. You sound optimistic also and that is over half the battle. Attitude, attitude!

Whatever helps, do it. I am all for it. As you know, the errant thyroid does a number on all our body parts so it's break it done into grids time.

Good for you and keep us informed.


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## bigfoot

Thanks guys and gals!

Well, as usual, things never fail to surprise me -- after a decent period of days, I now feel downright awful. The typical stuff: no energy, anxious/depressed, still peeing plenty, tired, weak/fatigued, some nausea, sore joints & muscles, and just feeling overall sick. (It's a good thing they don't charge for this roller coaster ride. :tongue0013

Friday morning with the new endo can't come soon enough! Boy, I hope he has his coffee that morning. Hah!


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## bigfoot

Oh, I should add my game plan and see what you guys think. I found that writing this stuff down: a) keeps me from forgetting, and b) keeps me on task at the doctor's office.

**Tests:*
TSI (Thyroid Stimulating Immunoglobulin) = Rule out Hyperthyroidism / Graves
Saliva 24hr. Cortisol = Rule out Adrenal problem
Thyroid Ultrasound = Rule out Nodules / Cancer

**Goals:*
Get Free T3 & Free T4 in upper portion of range (>75%) and maintain.
Keep TSH suppressed as much as possible to keep antibodies low.
Take supplements (multi-vitamin, selenium, etc.) to keep antibodies low.
Monitor Low Testosterone; maintain optimal values.
No dosing by TSH only; include Free T3/T4 and signs & symptoms, too.

**Ideas:*
If Cortisol / Adrenals are low, try adding HC.
If TSI positive for Hyperthyroidism, discuss removal / ablate of thyroid.
If TSI negative for Hyperthyroidism, discuss adding T3 med (Cytomel, Armour).
Slight increase in Androgel to get above 50% range. (5 GM vs. 7.5 GM packets).
Switch from generic Levothyroxine to brand-name Levoxyl.

**Concerns:*
Free T3 and Free T4 have increased from over a year ago - yet TSH rising. Add T3?
A1C and blood glucose elevated at 5.7 value. Monitor over time.
Blood pressure rising over time.
Other multiple signs & symptoms affecting daily life (nausea, low libido, fatigue, etc.).


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## Andros

bigfoot said:


> Oh, I should add my game plan and see what you guys think. I found that writing this stuff down: a) keeps me from forgetting, and b) keeps me on task at the doctor's office.
> 
> **Tests:*
> TSI (Thyroid Stimulating Immunoglobulin) = Rule out Hyperthyroidism / Graves
> Saliva 24hr. Cortisol = Rule out Adrenal problem
> Thyroid Ultrasound = Rule out Nodules / Cancer
> 
> **Goals:*
> Get Free T3 & Free T4 in upper portion of range (>75%) and maintain.
> Keep TSH suppressed as much as possible to keep antibodies low.
> Take supplements (multi-vitamin, selenium, etc.) to keep antibodies low.
> Monitor Low Testosterone; maintain optimal values.
> No dosing by TSH only; include Free T3/T4 and signs & symptoms, too.
> 
> **Ideas:*
> If Cortisol / Adrenals are low, try adding HC.
> If TSI positive for Hyperthyroidism, discuss removal / ablate of thyroid.
> If TSI negative for Hyperthyroidism, discuss adding T3 med (Cytomel, Armour).
> Slight increase in Androgel to get above 50% range. (5 GM vs. 7.5 GM packets).
> Switch from generic Levothyroxine to brand-name Levoxyl.
> 
> **Concerns:*
> Free T3 and Free T4 have increased from over a year ago - yet TSH rising. Add T3?
> A1C and blood glucose elevated at 5.7 value. Monitor over time.
> Blood pressure rising over time.
> Other multiple signs & symptoms affecting daily life (nausea, low libido, fatigue, etc.).


Good list. Do remember that even though the Frees are going up, the blocking and binding antibodies and interfere with the TSH going down.

And "negative" for TSI means none. You should not have one drop of TSI.

Good luck and let us know. You have my full attention!


----------



## bigfoot

Okay, well chalk one up for the naturopath doc. Holy smokes! I just spoke with him to get an idea of my labs from last week on 6/21/11. They haven't all come back yet, but here's what has:

TSH 3.649 [0.3-4.0]
Free T4 1.49 [0.84-1.51]
Free T3 4.0 [2.3-4.2]

What is remarkable is that I am still taking 62.5 MCG of generic Levothyroxine, and have only been taking the supplements / vitamins since 6/6/11. Thanks to all that, my Free T4 and Free T3 have increased to near the top end of the range in the course of only two weeks. (Looks like no need for any sort of T3 addition to my regimen. If anything, the naturopath said the thyroid meds might need to be lowered slightly.)

Something I am trying to wrap my head around is why on earth my TSH is still increasing. _It has jumped recently from 3.17 to 3.28 to now 3.64._ Egads. How in the heck am I going to get this down and suppressed? Hopefully the endocrinologist has some ideas in a couple of days, I have been feeling awful lately and now that tells part of the story why. (The naturopath said with most folks, he doesn't like to see a TSH above 2.0 -- of course, my story is complicated, LOL.)

Oh, and my triglycerides are now 389! My gosh -- no more sugar or high glycemic foods for me. That is crazy. We're still waiting on other labs such as estrogen, as he said this might be messing with my low testosterone treatment and hormone levels, causing some symptoms. Still, I've gotta believe that ever-climbing TSH means my antibodies are climbing, giving me some symptoms, too.


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## bigfoot

Andros said:


> Good luck and let us know. You have my full attention!


Will do. I know I've said it before, but honestly, I can't thank you and everyone here enough!!

hugs3


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## bigfoot

_Update:_ Just saw the new endocrinologist this morning. A really nice guy who took plenty of time to go over my history and explain things. He seems to know a lot about Hashimoto's. He is the first doctor who's acknowledged that the TSH should definitely be lower, he's aiming for somewhere around 2.0 for me to start with. He's also the first who's said that things can be a little rocky at first, as your body adjusts to the changes in thyroid medicine.

Game plan for right now is to bump up from generic 62.5 MCG to brand-name 75 MCG of Levothyroxine. He doesn't really think I'm on a high enough dose currently. Back in 8 weeks for more labs and another office visit, and I can call in if needed in the meantime. Also got me set up with a internal medicine PCP in the same office, which is nice.

As far as labs go, he's more committed to TSH and T4, not having much interest in working with Free T3/T4. (I suppose that's okay for me, as I do know I convert over.) As far as medicines go, I mentioned Cytomel, and he has an open mind about trying that in the future if I'm interested. At least he didn't roll his eyes like the last endocrinologist!

His feelings on naturopathic medicine are mixed -- he mentioned the studies about Selenium, and said taking that is fine, along with a daily multivitamin. The rest he wasn't so sure about as far as benefits vs. cost, but left that up to me.

Overall, I think I got a great doc. Someone who is willing to work with me at getting things resolved and can listen. Hallelujah!


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## Andros

bigfoot said:


> _Update:_ Just saw the new endocrinologist this morning. A really nice guy who took plenty of time to go over my history and explain things. He seems to know a lot about Hashimoto's. He is the first doctor who's acknowledged that the TSH should definitely be lower, he's aiming for somewhere around 2.0 for me to start with. He's also the first who's said that things can be a little rocky at first, as your body adjusts to the changes in thyroid medicine.
> 
> Game plan for right now is to bump up from generic 62.5 MCG to brand-name 75 MCG of Levothyroxine. He doesn't really think I'm on a high enough dose currently. Back in 8 weeks for more labs and another office visit, and I can call in if needed in the meantime. Also got me set up with a internal medicine PCP in the same office, which is nice.
> 
> As far as labs go, he's more committed to TSH and T4, not having much interest in working with Free T3/T4. (I suppose that's okay for me, as I do know I convert over.) As far as medicines go, I mentioned Cytomel, and he has an open mind about trying that in the future if I'm interested. At least he didn't roll his eyes like the last endocrinologist!
> 
> His feelings on naturopathic medicine are mixed -- he mentioned the studies about Selenium, and said taking that is fine, along with a daily multivitamin. The rest he wasn't so sure about as far as benefits vs. cost, but left that up to me.
> 
> Overall, I think I got a great doc. Someone who is willing to work with me at getting things resolved and can listen. Hallelujah!


You know what? I think you hit pay dirt. And somewhere along the line if you need fine-tuning of your thyroxine replaceent, you can pay out of pocket for your FREE T3 and FREE T4.

Let's just see how it goes. And I approve of the name brand. Generic cannot be the same as per patent law. You can only get one patent on one thing. LOL!

I'll bet you are of good cheer today? I know I am having heard such good news.


----------



## webster2

bigfoot said:


> _Update:_ Just saw the new endocrinologist this morning. A really nice guy who took plenty of time to go over my history and explain things. He seems to know a lot about Hashimoto's. He is the first doctor who's acknowledged that the TSH should definitely be lower, he's aiming for somewhere around 2.0 for me to start with. He's also the first who's said that things can be a little rocky at first, as your body adjusts to the changes in thyroid medicine.
> 
> Game plan for right now is to bump up from generic 62.5 MCG to brand-name 75 MCG of Levothyroxine. He doesn't really think I'm on a high enough dose currently. Back in 8 weeks for more labs and another office visit, and I can call in if needed in the meantime. Also got me set up with a internal medicine PCP in the same office, which is nice.
> 
> As far as labs go, he's more committed to TSH and T4, not having much interest in working with Free T3/T4. (I suppose that's okay for me, as I do know I convert over.) As far as medicines go, I mentioned Cytomel, and he has an open mind about trying that in the future if I'm interested. At least he didn't roll his eyes like the last endocrinologist!
> 
> His feelings on naturopathic medicine are mixed -- he mentioned the studies about Selenium, and said taking that is fine, along with a daily multivitamin. The rest he wasn't so sure about as far as benefits vs. cost, but left that up to me.
> 
> Overall, I think I got a great doc. Someone who is willing to work with me at getting things resolved and can listen. Hallelujah!


I am so glad you got a good one that will listen, and get you on a path to feeling better!


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## bigfoot

Thanks!! Yes, it's definitely a great feeling to have a doc that listens and wants what's best for you. I can now breathe a sigh of relief and let someone else help run things, taking some of the weight off my shoulders. I'll give that 75 MCG another shot and see what happens, hopefully it drops the ol' TSH.

He didn't run any tests today, as this was my first appointment, and it happened to be his first day working at this new office. In the meantime he's getting other past records/labs and going to look them over to see if there's anything that was missed or needs attention next time.

I asked some other questions, so I'll summarize here. I'm sure this is no surprise to anyone, but it's always interesting to see how docs respond to questions.

Q: What's with the throat swelling coming and going?
A: That can be from the Hashimoto's.

Q: Can a high fiber diet reduce effectiveness of thyroid meds?
A: Yes.

Q: Okay to take thyroid meds at night?
A: Yes, some studies on that. Take 2 hours or more past food, at same time each night.

Q: Do thyroid meds vary in potency?
A: Yes, they are allowed to have a 10% margin.

When I asked about potentially needing something for mood while going through the thyroid adjustment process, he unequivocally said, "No, I don't prescribe those. I would want you to see a psych or PCP." (Wow, someone who isn't handing pills out like crazy? Who actually wants patients to see a specialist? Amazing!)

Okay, enough of me blabbering... LOL :anim_32:


----------



## bigfoot

Well, it's been a few weeks now and I thought I'd throw out a quick update on things...

I've been on the 75 MCG dose of Levoxyl for three weeks now. The first week was pretty good, and I seemed to have more energy. From the second week onwards things have been dragging and moving at what could be optimistically described as a snail's pace. Some days are okay, some days are a step backwards; joint aches, tired, weak, "emo", dizzy/light-headed, etc. (Preaching to the choir here, I know. LOL)

In the meantime I have seen a new PCP who happens to be an internist practicing in the same office as my new endo doc. He also seems very knowledgable, willing to listen, and wants to tackle things. One result of that visit is he bumped up my Androgel to 7.5 GM daily, from 5.0 GM daily. As much as I hate to be dependent on medications, there wasn't much point in treating the low testosterone only halfway.

I go back to the PCP in a couple of weeks and he is going to draw TSH, FT4, and check my adrenals (after I asked about them). And about a month after that I see the new endo for an 8-week follow-up. So things are slowly starting to get pulled together.

I've throttled back on many of the supplements at both the endo and PCP's urging, although ultimately they left it up to me. Still taking fish oil, a good daily multivitamin, and one Selenium (200mcg). My throat hasn't been swollen in weeks and I've been sleeping like a rock. We've been making a conscious effort to eat healthier and I've been able to walk quite a bit more. So that shows me I'm slowly getting a little more energy back.

Oh, and we did a little trout fishing over the weekend. Three lines in the water and we still got skunked! Can't have it all...

Okay, enough blabbering from my end.


----------



## bigfoot

Semi-Quick Update:

Saw my primary care internist doc this morning. Here are the recent lab results from 8/8/11:

TSH 2.71 [0.34-4.82]
FT4 0.88 [0.47-1.23]
Cortisol 22.1 [3.1-22.4] (Morning, Fasting)
ACTH 64 [7-69]

My original concern was that my adrenal glands were possibly over/under-active. Looks like they are okay based on the Cortisol/ACTH test. So that kinda rules out adrenal problems.

Interestingly, my TSH has dropped down from 3.64 to 2.71 at roughly the five-six week mark on 75 MCG of Levoxyl. Yet I still feel tired out, fatigued, dry skin, anxious/depressed, some nausea, dizziness every now & then, etc. Things are better versus months ago, but I don't think they are optimal.

My primary care doc suggested boosting up to 88 MCG of Levoxyl and seeing if that helped. I got a chance to walk by my endo's office and he agreed, it wouldn't hurt to try 88 MCG. (So happy to finally have doctors that are knowledgeable and agreeable!)

We also discussed boosting testosterone replacement up from 7.5 GM to 10 GM. I held off for now, as I was recently boosted from 5 GM to 7.5 GM about a month ago. Figured if the past is any indication, I should do slow & steady dose increases of any sort of medication.

Final discussion with the PCP was if I was depressed or anxious. I said that yes I am, but I really link it more to the thyroid problems, as an increase in dosage of T4 really seems to help wipe all of that out. Also the frustration factor of trying to get better. He suggested we try the increase in Levoxyl first and see how that goes. But if I'm interested later on, he recommended trying Wellbutrin for a short time for the anxiety & depression. (Apparently going through chemo can bring some of this on.) He said Wellbutrin has fewer side-effects.


----------



## Andros

bigfoot said:


> Semi-Quick Update:
> 
> Saw my primary care internist doc this morning. Here are the recent lab results from 8/8/11:
> 
> TSH 2.71 [0.34-4.82]
> FT4 0.88 [0.47-1.23]
> Cortisol 22.1 [3.1-22.4] (Morning, Fasting)
> ACTH 64 [7-69]
> 
> My original concern was that my adrenal glands were possibly over/under-active. Looks like they are okay based on the Cortisol/ACTH test. So that kinda rules out adrenal problems.
> 
> Interestingly, my TSH has dropped down from 3.64 to 2.71 at roughly the five-six week mark on 75 MCG of Levoxyl. Yet I still feel tired out, fatigued, dry skin, anxious/depressed, some nausea, dizziness every now & then, etc. Things are better versus months ago, but I don't think they are optimal.
> 
> My primary care doc suggested boosting up to 88 MCG of Levoxyl and seeing if that helped. I got a chance to walk by my endo's office and he agreed, it wouldn't hurt to try 88 MCG. (So happy to finally have doctors that are knowledgeable and agreeable!)
> 
> We also discussed boosting testosterone replacement up from 7.5 GM to 10 GM. I held off for now, as I was recently boosted from 5 GM to 7.5 GM about a month ago. Figured if the past is any indication, I should do slow & steady dose increases of any sort of medication.
> 
> Final discussion with the PCP was if I was depressed or anxious. I said that yes I am, but I really link it more to the thyroid problems, as an increase in dosage of T4 really seems to help wipe all of that out. Also the frustration factor of trying to get better. He suggested we try the increase in Levoxyl first and see how that goes. But if I'm interested later on, he recommended trying Wellbutrin for a short time for the anxiety & depression. (Apparently going through chemo can bring some of this on.) He said Wellbutrin has fewer side-effects.


All in all that is a very good report. Will be anxious to see how you do on the 88 mcg.. I am confident that this is a step in the right direction. Most of us feel best w/TSH @ 1.0 or less.

It will be better to see your FT4 just a bit higher as it is just a weensy bit above the mid-range as provided by your lab.

You are wise to hold off on an increase in testosterone as chances are very very strong that getting stabilized w/your thyroid will set that to rights.

And hopefully the limbic system in the brain will also respond in kind. You may find this of interest.

http://www.ncbi.nlm.nih.gov/pubmed/14677082


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## bigfoot

Thanks! Yeah, I am hoping that the increase in Levoxyl will cause other improvements to follow suit. So glad to see that TSH start heading down for once! Maybe that increase will boost the FT4 past the mid-range, too.

That is an interesting article, thanks for passing it along! I figure if I am still having trouble getting everything to fall in line in a month or two, I may try the Wellbutrin angle. It's hard to put your pride aside, although at this point I'm willing to try anything that works. (Just a little cautious after a week of Citalopram made me bedridden, sick, and dizzy.)


----------



## Andros

bigfoot said:


> Thanks! Yeah, I am hoping that the increase in Levoxyl will cause other improvements to follow suit. So glad to see that TSH start heading down for once! Maybe that increase will boost the FT4 past the mid-range, too.
> 
> That is an interesting article, thanks for passing it along! I figure if I am still having trouble getting everything to fall in line in a month or two, I may try the Wellbutrin angle. It's hard to put your pride aside, although at this point I'm willing to try anything that works. (Just a little cautious after a week of Citalopram made me bedridden, sick, and dizzy.)


I would be a little more than cautious quite frankly; but that is me. Antidepressants definitely have their place but it is my personal belief that they should only be Rx'd by a psychiatrist. Too many hands are in the pot when it comes to antidepressants and they can be very dangerous.

So, I am glad you are making inquiry and giving it a "lot" of thought.


----------



## bigfoot

Thanks Andros -- it really does help to see others' input on the matter. In the back of my mind I have the nagging question of whether or not I've really been dealing with thyroid issues all along for years -- rather than mask them, I want to get to the source of the problem this time around.

I think the AD's/anxiety meds definitely have their place, but I'm not so sure that's what I need right now. The catch is the wild road this thyroid stuff sends you down -- you wind up questioning yourself and your judgement along the way. I know I was happy to have them prior to chemo when I was a walking medical mystery, but now that we have another physical issue to focus on, I'd really rather go after that.

:anim_32:


----------



## Andros

bigfoot said:


> Thanks Andros -- it really does help to see others' input on the matter. In the back of my mind I have the nagging question of whether or not I've really been dealing with thyroid issues all along for years -- rather than mask them, I want to get to the source of the problem this time around.
> 
> I think the AD's/anxiety meds definitely have their place, but I'm not so sure that's what I need right now. The catch is the wild road this thyroid stuff sends you down -- you wind up questioning yourself and your judgement along the way. I know I was happy to have them prior to chemo when I was a walking medical mystery, but now that we have another physical issue to focus on, I'd really rather go after that.
> 
> :anim_32:


Since you mentioned judgement; believe me, Anti'd's do just that. There is always a caveat to everything we do. Action, reaction. Sigh and double sigh.

I mean, you could just be too happy! Sometimes that is a very bad thing especially if you are playing craps. Ha, ha!


----------



## bigfoot

Yeah, I'd hate to be in Vegas pumping money into the dollar slots, all the while losing and thinking, "Hey, this is grrreat! What fun!" LOL


----------



## Enigma

bigfoot-

Your TSH still seems high...my doc wants mine around 2.0 or lower (I am a female, not sure if that makes a difference, not sure of your gender!). I felt horrible on levoxyl (worse than on generic). I have been taking Armour for 5 days so far and it is so much better than T4 alone- my depressive thinking has become MUCH better, my body is not as anxious, my mind is able to think through anxious thoughts and get over them rather than stuck... it really is amazing. Family members have even said how much better I sound. Even my chronic aches have improved and almost gone away... I feel like my brain must have been starved for whatever Armour is giving me. And I am completely off of Effexor for over a month as well as Prozac!! I will never go back to those drugs!! If you haven't tried Armour or another of the dessicated thyroid pills, I would highly recommend that before taking another AD.
*
As for Wellbutrin... stay FAR, FAR away!!!!!!!!! *I had a horrible reaction to it- I *was* the black box warning on ADs... I was ready to check myself into a psych ward, no kidding, and I am NOT like that. It was horrible. Please, please, consider anything else besides Wellbutrin. My doc that I switched to after that horrible experience told me he never Rx's Wellbutrin for people with anxiety - that in his experience it makes it so much worse. He couldn't believe my previous doc had given it to me. *Please, be very careful if you start it.* Be ready to stop it right away, because the symptoms only get worse. Especially since you reacted as you did to Celexa- be careful.

PM me if you want to ask me any other questions about Wellbutrin and my experiences. I will gladly share them with you because I don't want anyone else to go through what I had to!!!


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## Andros

bigfoot said:


> Yeah, I'd hate to be in Vegas pumping money into the dollar slots, all the while losing and thinking, "Hey, this is grrreat! What fun!" LOL


ROLF!! Yowza!


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## bigfoot

Enigma -- thanks! That is really good info to know. I remember the doc who treated me with chemo looking at a chart of various AD's. Celexa/Citalopram was supposed to be pretty darn good for anxiety. Interestingly, I took that for nearly two years straight (granted, a low dose of 10-20mg) and didn't really have any problems with it. It did help with the anxiety/depression, although over time that seemed to wane a little bit.

Then I went off it under my doc's care and I got a lot of my energy back. When things started to tank again a few months later, doc wanted me to try going back on it. It was then that I felt so horrible, exhausted, and sick. (Maybe my body was trying to tell me something.) This is also right around when my TSH was climbing and they DX'd me with Hashi's.

My new endo is willing to try something like Cytomel down the road if I'm still having trouble. Didn't ask about Armour, as I want to keep that feather in my cap for now, so to speak. (Would like to build up a rapport first.) Honestly, after seeing some of my FT3 labs, I think I convert pretty darn well from FT4 to FT3, maybe even a little _too_ efficiently. Not sure if Cytomel or Armour would really be a help there or not. We all are certainly our own cases; yet so many docs want to treat us in the same way!

I think you're right, the key is getting that TSH down to 2.0 and below. My endo has mentioned this as well, so thankfully he's on the same page. I don't know if there is a gender-specific ideal level (I'm male). My fingers are crossed that starting the 88 MCG will drop me down to below 2.0 and I should be feeling good. (Right now I'm basically back at the level I was at when I first started complaining about signs & symptoms to my old doc at the beginning of the year.)

:anim_32:


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## Andros

bigfoot said:


> Enigma -- thanks! That is really good info to know. I remember the doc who treated me with chemo looking at a chart of various AD's. Celexa/Citalopram was supposed to be pretty darn good for anxiety. Interestingly, I took that for nearly two years straight (granted, a low dose of 10-20mg) and didn't really have any problems with it. It did help with the anxiety/depression, although over time that seemed to wane a little bit.
> 
> Then I went off it under my doc's care and I got a lot of my energy back. When things started to tank again a few months later, doc wanted me to try going back on it. It was then that I felt so horrible, exhausted, and sick. (Maybe my body was trying to tell me something.) This is also right around when my TSH was climbing and they DX'd me with Hashi's.
> 
> My new endo is willing to try something like Cytomel down the road if I'm still having trouble. Didn't ask about Armour, as I want to keep that feather in my cap for now, so to speak. (Would like to build up a rapport first.) Honestly, after seeing some of my FT3 labs, I think I convert pretty darn well from FT4 to FT3, maybe even a little _too_ efficiently. Not sure if Cytomel or Armour would really be a help there or not. We all are certainly our own cases; yet so many docs want to treat us in the same way!
> 
> I think you're right, the key is getting that TSH down to 2.0 and below. My endo has mentioned this as well, so thankfully he's on the same page. I don't know if there is a gender-specific ideal level (I'm male). My fingers are crossed that starting the 88 MCG will drop me down to below 2.0 and I should be feeling good. (Right now I'm basically back at the level I was at when I first started complaining about signs & symptoms to my old doc at the beginning of the year.)
> 
> :anim_32:


My doctor suggests Passionflower for anxiety.

http://www.webmd.com/vitamins-suppl...ientId=871&activeIngredientName=PASSIONFLOWER

Please do read all side-effects and contraindications though.


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## northernlite

Bigfoot -

My plan is similar to yours, I am try to see if my body will make this work on T4 alone. Adding T3 or a combo medication would be a second step if I don't feel well enough on T4 alone. Been at it since November and what I have learned is most of my other symptoms are gone at a TSH = 2 but I still have fatigue and moodiness. At just below 1.0 I feel great. Keep them raising your T4 until you get there and see how you feel.

I am due for blood work on the 24th and am feeling pretty good on my increase to 75 mcg of Levoxyl. Curious what my numbers look like. 88 is a pretty low dose for a man just as 75 is for a woman but I am a newly diagnosed Hashi and probably have a thyroid that is still producing some T4.


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## bigfoot

Glad you're feeling good on 75 MCG! Progress is progress, no matter how incremental.

Sometimes I have to take a step back and think about how I was doing even a couple of months ago. It was all I could do to walk a few blocks with the dog, now I'm up to over a mile. Same goes something mundane like grocery shopping -- you'd walk in the store and your head would start to spin and feel anxious/overwhelmed. I still get some of that at times, but it's far, far less.

hugs3


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## Enigma

bigfoot said:


> Same goes something mundane like grocery shopping -- you'd walk in the store and your head would start to spin and feel anxious/overwhelmed. I still get some of that at times, but it's far, far less.


You felt that way, too?!?! I thought it was just me!! I'd get so overwhelmed and just exhausted going into the store, let alone when I got home!! Now it is soo much better!! I made my first "solo" shopping trip the other day- and didn't even feel overwhelmed or exhausted after! And it's SOOO much better on Armour!! It took my brain so long to wrap around having to do something or how to do it, that the actual process never got done. I felt like i had this huge barrier to get over in my brain and i'd just get so frustrated. But it is so much better now!! I hope everything works out for you.

I wonder if trying just a tiny bit of synthetic T3 might be worth it? You could regulate the amount better than with Armour and i think you'd know relatively quickly (in relation to T4 time frame) whether it works or not... i know your FT3 is up there in normal range, but I wonder if something is skewing the test results and you actually aren't where they say you are? Given how much better I feel on Armour I would never try anything without T3 again. It's amazing the difference. I just wonder if it would be worth you trying a bit of the synthetic to determine if it is something that would improve your symptoms?


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## bigfoot

Enigma said:


> but I wonder if something is skewing the test results and you actually aren't where they say you are?


Very good question! Funny you mentioned that. In fact, I was browsing the Androgel side effects earlier today just to make sure I wasn't overlooking something, and listed right in the fine print is... the fact that Androgel can skew thyroid lab test results! How about that! Definitely going to be asking my endo doc in a month or so about that statement.


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## Andros

bigfoot said:


> Very good question! Funny you mentioned that. In fact, I was browsing the Androgel side effects earlier today just to make sure I wasn't overlooking something, and listed right in the fine print is... the fact that Androgel can skew thyroid lab test results! How about that! Definitely going to be asking my endo doc in a month or so about that statement.


How about that? Certainly worth considering and doing further research on it.

By the way, even many years later, I still cannot enjoy going to a mall or anything where there is a lot of activity. For me, it seems to be a negative reaction visually. I just get spaced out. A lot of noise and a lot of movement (activity) just puts me in a tither.


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## bigfoot

Checking back in:

I'm just about up to 3 weeks on the 88 MCG. Had additional TSH/Free T4 labs drawn today. Another appointment with the endo next week. In the meantime I dropped by his office but he was busy, so I left a message with the assistant asking about trying out some Cytomel.

The first week of 88 MCG wasn't too bad, more energy, but I did have a little dizziness. The second week seemed to level a bit. And then this last week has been a little rough. Cold at times, motility up and down, "emo", brain fog, and the like. I figure if anything, a small amount of Cytomel might help with the cognitive and mood stuff. (I'd rather try that first before something like Wellbutrin.)

Should know more next week after seeing the endo... :anim_32:


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## Andros

bigfoot said:


> Checking back in:
> 
> I'm just about up to 3 weeks on the 88 MCG. Had additional TSH/Free T4 labs drawn today. Another appointment with the endo next week. In the meantime I dropped by his office but he was busy, so I left a message with the assistant asking about trying out some Cytomel.
> 
> The first week of 88 MCG wasn't too bad, more energy, but I did have a little dizziness. The second week seemed to level a bit. And then this last week has been a little rough. Cold at times, motility up and down, "emo", brain fog, and the like. I figure if anything, a small amount of Cytomel might help with the cognitive and mood stuff. (I'd rather try that first before something like Wellbutrin.)
> 
> Should know more next week after seeing the endo... :anim_32:


What was the result of your last FT3 lab and would you be kind enough to include the range and also how long ago was it taken?

You might like to read the entire article:

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://www.drlam.com/articles/hypothyroidism.asp?page=3


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## bigfoot

Sure! My only Free T3 labs:

2/9/10 FT3 3.53 [2.4-4.2]
6/2/11 FT3 3.5 [2.3-4.2]
6/21/11 FT3 4.0 [2.3-4.2]

I am starting to think something is skewing the lab numbers with my FT3 tests. And possibly for FT4, too. Either the Androgel I am also taking, or else those pesky binding / blocking / stimulating antibodies & immunoglobulins, or else the estrogen component.

I have my doubts that the endo will start me on Cytomel before seeing him next week, but I thought it might be worth a try and at least get the ball rolling.


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## bigfoot

Running Update:

Saw the Endocrinologist today for follow-up and to see what my recent labs on 9/2/11 were. My TSH has decreased slightly to 2.27 [0.34-4.82] and my Free T4 has increased slightly to 1.04 [0.47-1.23]. He palpated my thyroid and it seemed a little less swollen than last time.

I talked to the doc about trying Cytomel and he agreed. We are going to start with 5 MCG for a two week trial and see how it goes. At the end of the two weeks I'm supposed to check back in with him and swing by the office to have my pulse reviewed (it was 105 in the office today). He's a little concerned about the high pulse, so we are going to watch it closely.

I'm pretty happy that my TSH continues to decline, although it has been a rocky few weeks since starting the 88 MCG Levoxyl. Some good days, some worse. We all know how that goes! Also happy that my FT4 has finally started to climb out of the basement.

Unfortunately, I'm essentially a pre-diabetic now. My Glucose was 185 [74-106], although I wasn't fasting and had orange juice and a small breakfast beforehand. Still, this is tracking with previous fasting Glucose labs in the 120s and an A1C of 5.7. Need to kick the exercise into gear and really watch my food intake.

My Triglycerides are now 403 [30-150]! This is up from the 380-390 I had a few months ago. The endo suggested taking fish oil three times a day at 2,000mg each time. So I will be doing shooters of Carlson's liquid fish oil now I guess! A little worrisome, but again, hopefully eating better and exercising more will make an impact.

Total Testosterone is now up to 709 [300-1080]. This is more good news! We discussed the issue and it would mean taking a couple of months off from Androgel to try and figure out the root cause of low testosterone. My original doc never did this, so there is an unknown "why" factor. At this point I'm reluctant to do so, as he even mentioned it would bring down my energy level and libido. We might try doing this in the future when my thyroid issues are a little better controlled.

Potassium was a little low at 3.2 [3.5-5.1]. Oh and the doc is running an Iron test along with a few other labs (Prolactin, etc.) that were drawn today after the visit. Didn't have to even ask! Nice to have a good doc...

Okay, end of update!


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## bigfoot

Well, the moment of truth this morning. I sat and looked at the Liothyronine (Cytomel) bottle and finally took the plunge. I couldn't bring myself to take all 5 MCG right off the bat, so I tried to split it, and would up with probably 3.5 MCG that I took. I guess I'm a little nervous knowing this stuff is so potent!

Should know in a few hours if it's working.


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## Andros

bigfoot said:


> Well, the moment of truth this morning. I sat and looked at the Liothyronine (Cytomel) bottle and finally took the plunge. I couldn't bring myself to take all 5 MCG right off the bat, so I tried to split it, and would up with probably 3.5 MCG that I took. I guess I'm a little nervous knowing this stuff is so potent!
> 
> Should know in a few hours if it's working.


You will know in a few hours. And I am sure it will be favorable. Stay active; that helps.

Do you have a pill splitter? Cytomel tabs are teeny tiny so a pill splitter helps.

You know I am very interested in how you fare with this so will you please let us know?


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## bigfoot

Ordered up a pill splitter just to have one on hand. Labs from yesterday came back today; I got a call with the results (detailed copies in mail). Potassium, PSA, Iron Panel, Prolactin, and blood count were all normal. Woohoo!

So far, so good today. I got some laundry done, vacuumed both upstairs / downstairs, and ran errands & grabbed lunch. I would say it's a success. Pulse hasn't been bad at all today (in the mid-80s). Didn't have to "think" about things if that makes sense -- just go and do them. Seem to have more energy.

We shall see what tomorrow brings... arty0006:


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## Andros

bigfoot said:


> Ordered up a pill splitter just to have one on hand. Labs from yesterday came back today; I got a call with the results (detailed copies in mail). Potassium, PSA, Iron Panel, Prolactin, and blood count were all normal. Woohoo!
> 
> So far, so good today. I got some laundry done, vacuumed both upstairs / downstairs, and ran errands & grabbed lunch. I would say it's a success. Pulse hasn't been bad at all today (in the mid-80s). Didn't have to "think" about things if that makes sense -- just go and do them. Seem to have more energy.
> 
> We shall see what tomorrow brings... arty0006:


I would say you are typical in that most of us who are T3 deprived do in fact feel better in a matter of hours.

Very glad to hear this!!


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## bigfoot

Hmm... well it's been 5 days on the 5 MCG of Cytomel now. The first couple of days were okay, with slightly better energy and mood. But now after a few days I'm feeling pretty exhausted all day and the brain fog has returned somewhat, along with a persistent headache. Another bonus: light-headed, dizzy, and spaced out this evening.

The recent lab details came back from last week. Unless I'm missing something, the results look okay.

*Other Labs & [Ranges]*
9/7/11 - % Sat 27 [20-50%]
9/7/11 - Ferritin 90.0 [26.0-388.0]
9/7/11 - Iron 115 [65-175]
9/7/11 - TIBC 433 [250-450]
9/7/11 - Prolactin 11.9 [2.1-17.7]

So after all of this, I am confused. I was under the impression that T3 is very short-acting, with a peak measured in days. Perhaps after these 5 days the 5 MCG of Cytomel is too much for me? (Maybe I only need half at 2.5 MCG?) Or perhaps I don't really need it at all and I am converting enough T4 to T3 on my own?

Or perhaps this is just a "down" point in the process of my body getting adjusted? Argh, I am stumped! What the heck do I do next?

:confused0033:


----------



## Andros

bigfoot said:


> Hmm... well it's been 5 days on the 5 MCG of Cytomel now. The first couple of days were okay, with slightly better energy and mood. But now after a few days I'm feeling pretty exhausted all day and the brain fog has returned somewhat, along with a persistent headache. Another bonus: light-headed, dizzy, and spaced out this evening.
> 
> The recent lab details came back from last week. Unless I'm missing something, the results look okay.
> 
> *Other Labs & [Ranges]*
> 9/7/11 - Ferritin 90.0 [26.0-388.0]
> 9/7/11 - Iron 115 [65-175]
> 9/7/11 - TIBC 433 [250-450]
> 9/7/11 - Prolactin 11.9 [2.1-17.7]
> 
> So after all of this, I am confused. I was under the impression that T3 is very short-acting, with a peak measured in days. Perhaps after these 5 days the 5 MCG of Cytomel is too much for me? (Maybe I only need half at 2.5 MCG?) Or perhaps I don't really need it at all and I am converting enough T4 to T3 on my own?
> 
> Or perhaps this is just a "down" point in the process of my body getting adjusted? Argh, I am stumped! What the heck do I do next?
> 
> :confused0033:


I found this to be extreeeeeeeeeeeeeeeeeeemly interesting.

Can my ferritin look great, but my iron levels are not? Do I need other iron labs done along with ferritin? You betcha. Because as mentioned above, ferritin can look optimal, yet your other iron labs reveal you have poor iron levels. Why would the ferritin look good when the others don't? Because ferritin can rise in the presence of inflammation (very common), infection or even cancer. TIBC will also tend to go high in the presence of low iron. Inflammation of any kind is especially common with some thyroid patients and needs to be discovered and treated. Ferritin rises to counter the normal binding of tissue iron due to the infection or inflammation. The total lab profiles you should request include:

Ferritin
Serum iron
TIBC
% Saturation.

And this:

Are men different than women in their iron lab results? Yes. Men normally have higher levels of ferritin than women without having an infection. It's common to see healthy men with a ferritin over 100.

It would be good to go to the link and read the whole article, I am thinking!

http://www.stopthethyroidmadness.com/ferritin/#


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## Andros

Andros said:


> I found this to be extreeeeeeeeeeeeeeeeeeemly interesting.
> 
> Can my ferritin look great, but my iron levels are not? Do I need other iron labs done along with ferritin? You betcha. Because as mentioned above, ferritin can look optimal, yet your other iron labs reveal you have poor iron levels. Why would the ferritin look good when the others don't? Because ferritin can rise in the presence of inflammation (very common), infection or even cancer. TIBC will also tend to go high in the presence of low iron. Inflammation of any kind is especially common with some thyroid patients and needs to be discovered and treated. Ferritin rises to counter the normal binding of tissue iron due to the infection or inflammation. The total lab profiles you should request include:
> 
> Ferritin
> Serum iron
> TIBC
> % Saturation.
> 
> And this:
> 
> Are men different than women in their iron lab results? Yes. Men normally have higher levels of ferritin than women without having an infection. It's common to see healthy men with a ferritin over 100.
> 
> It would be good to go to the link and read the whole article, I am thinking!
> 
> http://www.stopthethyroidmadness.com/ferritin/#


Hang in there w/ the Cytomel and if you have any doubts; go get a FREE T3 test! But make sure you don't get the blood draw right after you take your Cytomel. Take your Cytomel after the test. That is my recommendation based on experience.


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## bigfoot

One more lab from 9/7/11, this one (Hemoglobin) came back high:
HGB 17.7 [13.9-16.3]

So I did a quick Google search:

"Causes of an elevated hemoglobin count may include:

Living at high altitudes- Because the higher the altitude is, the lower oxygen level is in the air- body is producing more hemoglobin to bind as much oxygen as it is possible! 
Smoking- Several studies done in the past with smokers volunteers have proven that great percentage of the smokers have the elevated hemoglobin level, although the mechanism is still unknown. Some experts believe that it could be because of low level of "pure" oxygen in the smoker's lungs! So, this could be an adoptive mechanism on low oxygen levels! 
Dehydration - Dehydration produces falsely high hemoglobin which disappears when proper fluid balance is restored.

The symptoms and possible complications 
Although much of the clinical focus has been on anemia as a condition where there is lack of hemoglobin, there are also problems at the high end. 
The most notable consequence is increased blood viscosity. 
Several studies have proven that the relation between hemoglobin and blood viscosity is linear when the hematocrit is <0.50 (equivalent to a hemoglobin value of 160 g/L). Above this hemoglobin concentration, the relation becomes exponential, which means that a small increase in hemoglobin or hematocrit results in a large increase in viscosity. Once hemoglobin concentrations reach 180 g/L, the blood viscosity reaches a level that impairs microcirculation and an inadequate amount of oxygen is transported to tissues, similar to the situation with severe anemia. 
Symptoms 
Peripheral cyanosis and impaired mental function resulting from compromised cerebral blood circulation are the two most common symptoms of elevated hemoglobin! Additionally, because of the poor blood flow, the risk of thrombo-embolism increases significantly. 
Treatment 
Because the high hemoglobin couldn't be considered as a special disorder it could be only treated as a symptom of some other underlying disease. That's why- treating the underlying disease will probably lower the hemoglobin level!"


----------



## Andros

bigfoot said:


> One more lab from 9/7/11, this one (Hemoglobin) came back high:
> HGB 17.7 [13.9-16.3]
> 
> So I did a quick Google search:
> 
> "Causes of an elevated hemoglobin count may include:
> 
> Living at high altitudes- Because the higher the altitude is, the lower oxygen level is in the air- body is producing more hemoglobin to bind as much oxygen as it is possible!
> Smoking- Several studies done in the past with smokers volunteers have proven that great percentage of the smokers have the elevated hemoglobin level, although the mechanism is still unknown. Some experts believe that it could be because of low level of "pure" oxygen in the smoker's lungs! So, this could be an adoptive mechanism on low oxygen levels!
> Dehydration - Dehydration produces falsely high hemoglobin which disappears when proper fluid balance is restored.
> 
> The symptoms and possible complications
> Although much of the clinical focus has been on anemia as a condition where there is lack of hemoglobin, there are also problems at the high end.
> The most notable consequence is increased blood viscosity.
> Several studies have proven that the relation between hemoglobin and blood viscosity is linear when the hematocrit is <0.50 (equivalent to a hemoglobin value of 160 g/L). Above this hemoglobin concentration, the relation becomes exponential, which means that a small increase in hemoglobin or hematocrit results in a large increase in viscosity. Once hemoglobin concentrations reach 180 g/L, the blood viscosity reaches a level that impairs microcirculation and an inadequate amount of oxygen is transported to tissues, similar to the situation with severe anemia.
> Symptoms
> Peripheral cyanosis and impaired mental function resulting from compromised cerebral blood circulation are the two most common symptoms of elevated hemoglobin! Additionally, because of the poor blood flow, the risk of thrombo-embolism increases significantly.
> Treatment
> Because the high hemoglobin couldn't be considered as a special disorder it could be only treated as a symptom of some other underlying disease. That's why- treating the underlying disease will probably lower the hemoglobin level!"


Aha; how about that symptoms list? Which cause do you think applies to you? Dehydration perhaps?

Did you get a chance to look up possible underlying diseases yet?


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## bigfoot

Also, you were looking for % Saturation with the iron tests; I found that on the lab results:
9/7/11 - % Sat 27 [20-50%]

The doc's notes on the lab results mention that there is "...no evidence of hyperprolactemia or hemochromatosis."

Thanks for the link to that iron article! So what I take from all of this is that:

a) My iron / ferritin / % saturation / TIBC are within range, but not optimal.
b) This can affect conversion of T4 to T3.
c) This can produce symptoms like dizziness, fatigue, weakness, and headaches.
d) The TIBC being near the high end of the normal range likely indicates inflammation.
e) My elevated Hemoglobin level could be related any of the following things (although I don't smoke)...

Found another link with more info on Mayo's site:

"High hemoglobin count may occur because:

Your red blood cell production increases to compensate for low blood oxygen levels due to poor heart or lung function
Your kidneys release too much of a protein (erythropoietin, or EPO) that enhances red blood cell production
You've taken drugs that stimulate red blood cell production
You have a bone marrow dysfunction that results in an increased production of red blood cells
Your red blood cell production increases to compensate for a limited oxygen supply in higher altitudes
Specific disorders or other factors that may cause high hemoglobin count include:

Congenital heart disease
COPD
Dehydration
Emphysema
EPO doping (injections of erythropoietin (EPO) to enhance athletic performance)
Heart failure
Kidney cancer
Liver cancer
Living at a high altitude, where there's less oxygen in the air
Other types of heart disease
Other types of lung disease
Polycythemia vera
Smoking, which may result in low blood oxygen levels"


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## bigfoot

Andros said:


> Aha; how about that symptoms list? Which cause do you think applies to you? Dehydration perhaps?
> 
> Did you get a chance to look up possible underlying diseases yet?


I'm thinking dehydration possibly, although I have been trying to drink plenty of water. However, it was the hottest day of the year that day at around 100 degrees, LOL. That is probably the most likely explanation.

But having a previous history of liver disease nags me with the question of liver function tests, which have been slightly elevated lately. (Although nothing compared to how they were pre-chemo, with ALT and ASTs in the 400s+.) This could be from the liver itself or possibly from a medication; something like Androgel which says it can elevate liver labs. Thankfully I've got a line on a local gastroenterologist and need to call and make an appt. anyway for my checkup.

The heart disease angle sounds interesting, as there is some family history of that, and my cholesterol and triglyceride levels have been way off lately. Could be from Hashi's, a medication side-effect (again, Androgel), or an underlying condition.

And as far as the iron goes, it looks like there is a little room for improvement there. Perhaps eating more cereal, spinach, and buying a small cast-iron fry pan for eggs?

Oh, and I got about two hours of sleep last night for some reason. Usually take my T4 at night before bed and haven't had a problem sleeping. Cracked open a refill bottle of Levoxyl 88 and I was wired up all night. Dunno what that was all about.


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## bigfoot

Checking back in with a Cytomel update...

I've been on the Cytomel for 11 days now. The first five days I took the 5 MCG but that seemed pretty strong for me. So I dropped it down to 2.5 MCG for the remainder of the time, hoping to alleviate a few of the symptoms. I seem to be tolerating that okay, but I am still getting these persistent headaches pretty much all day. Also, the dizziness, nausea, tiredness, anxiety/depression, and brain fog are all still there. Some nights I seem to sleep okay, others it's toss-and-turn. On the other hand, the skin inflammation has dropped off, eyes are less red, and throat is less tight, so those are good things.

Has anyone else experienced this when starting Cytomel? I'm wondering if I would do better with just a straight increase in T4 from 88 to 100 MCG? Is it possible the Cytomel has lowered my body's T4 levels? (Perhaps my body converts T4 to T3 just fine right now and what I really need is more T4?)

Thanks in advance for any insight!


----------



## Andros

bigfoot said:


> I'm thinking dehydration possibly, although I have been trying to drink plenty of water. However, it was the hottest day of the year that day at around 100 degrees, LOL. That is probably the most likely explanation.
> 
> But having a previous history of liver disease nags me with the question of liver function tests, which have been slightly elevated lately. (Although nothing compared to how they were pre-chemo, with ALT and ASTs in the 400s+.) This could be from the liver itself or possibly from a medication; something like Androgel which says it can elevate liver labs. Thankfully I've got a line on a local gastroenterologist and need to call and make an appt. anyway for my checkup.
> 
> The heart disease angle sounds interesting, as there is some family history of that, and my cholesterol and triglyceride levels have been way off lately. Could be from Hashi's, a medication side-effect (again, Androgel), or an underlying condition.
> 
> And as far as the iron goes, it looks like there is a little room for improvement there. Perhaps eating more cereal, spinach, and buying a small cast-iron fry pan for eggs?
> 
> Oh, and I got about two hours of sleep last night for some reason. Usually take my T4 at night before bed and haven't had a problem sleeping. Cracked open a refill bottle of Levoxyl 88 and I was wired up all night. Dunno what that was all about.


Are you still on the Cytomel as well?

Cast iron cookware is where it's at. Good idea; get a couple items.

I do think dehydration is the most likely culprit. 100° can do a number on a person and it is insideous.

A lot of pharmaceuticals are hard on the liver so I do suggest you look up everything you are required to take and see what is what.


----------



## bigfoot

Yep, still on the Cytomel. Endo has me trying it for two weeks' time. I'm supposed to go in this week and check in with him to see how things are going. To be honest, I'm not so sure the Cytomel is the big boost I envisioned it being.

At this moment I'm on:
88 MCG Levoxyl
5 MCG Cytomel (taking 2.5 MCG)
7.5 GM Androgel

I know from reading that the Androgel can spike liver function. My cholesterol levels and triglycerides are out of control -- if I understand correctly, that can partially be from Hashi's/thyroid, right?


----------



## peacesells560

bigfoot said:


> My cholesterol levels and triglycerides are out of control -- if I understand correctly, that can partially be from Hashi's/thyroid, right?


Yup. I've had Total Cholesterol levels over 200 since age 15 because of this.


----------



## Gwen1

Hi Bigfoot, I don't know a whole lot, that's why I'm reading posts right now.
Anyway I wanted to just make a comment. You have mentioned several times that maybe your T3 is just fine. It seems you are still in a process of getting your Levoxyl at the right dosage. Maybe you still need to increase that to get to the right level. After all, the TSH is not yet at an optimal level yet, right? -Gwen


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## bigfoot

Actually, I think you're right-on with that statement!

:anim_32:


----------



## Andros

bigfoot said:


> Checking back in with a Cytomel update...
> 
> I've been on the Cytomel for 11 days now. The first five days I took the 5 MCG but that seemed pretty strong for me. So I dropped it down to 2.5 MCG for the remainder of the time, hoping to alleviate a few of the symptoms. I seem to be tolerating that okay, but I am still getting these persistent headaches pretty much all day. Also, the dizziness, nausea, tiredness, anxiety/depression, and brain fog are all still there. Some nights I seem to sleep okay, others it's toss-and-turn. On the other hand, the skin inflammation has dropped off, eyes are less red, and throat is less tight, so those are good things.
> 
> Has anyone else experienced this when starting Cytomel? I'm wondering if I would do better with just a straight increase in T4 from 88 to 100 MCG? Is it possible the Cytomel has lowered my body's T4 levels? (Perhaps my body converts T4 to T3 just fine right now and what I really need is more T4?)
> 
> Thanks in advance for any insight!


When taking any form of T3, it is normal to have a lower FT4. You only need a little T4 for deodination and conversion to T3 to become biologically active.


----------



## bigfoot

Well, had to go in today to see the endo for the two week check on Cytomel. Pulse wasn't bad at all (72) but boy I was super-nervous just getting over to the doc's office. Explained the bad anxiety, headaches, trouble sleeping, etc. and he said I could stop taking it. We're gonna try bumping up from 88 MCG Levoxyl to 100 MCG in place of the Cytomel. He explained that Cytomel can be very stimulating -- but that we could shelve the idea for now and maybe try again down the road.

I also asked about taking Wellbutrin (haven't started yet) and he said that it can also be pretty stimulating, giving some people trouble sleeping, etc. Just said to keep tabs on it.

This process is certainly a test of one's patience and others' understanding.


----------



## Andros

bigfoot said:


> Well, had to go in today to see the endo for the two week check on Cytomel. Pulse wasn't bad at all (72) but boy I was super-nervous just getting over to the doc's office. Explained the bad anxiety, headaches, trouble sleeping, etc. and he said I could stop taking it. We're gonna try bumping up from 88 MCG Levoxyl to 100 MCG in place of the Cytomel. He explained that Cytomel can be very stimulating -- but that we could shelve the idea for now and maybe try again down the road.
> 
> I also asked about taking Wellbutrin (haven't started yet) and he said that it can also be pretty stimulating, giving some people trouble sleeping, etc. Just said to keep tabs on it.
> 
> This process is certainly a test of one's patience and others' understanding.


Did your doc do labs?


----------



## bigfoot

No, unfortunately. But I have a physical appointment with my PCP next week and plan on asking about them (along with any others he might want).


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## Andros

bigfoot said:


> No, unfortunately. But I have a physical appointment with my PCP next week and plan on asking about them (along with any others he might want).


Well good. I hope you can share them when you get them.


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## bigfoot

Yes, will do that for sure. Today's meeting with the endo was more like a two minute talk in the hallway than an appt. Added bonus: no co-pay.


----------



## bigfoot

Well, had my physical this morning with the PCP. Nothing can ever be simple, right? LOL Apparently, I have my share of things going on:

1) Recent blood tests indicate being pre-diabetic or diabetic. Doc took an A1C lab and wants me to check blood glucose with a meter and see him again in two weeks.

2) Blood pressure is high. I seem to hover around the 135/85 area with some as low as 120s and some as high as 160s. Doc is concerned, was ready to give me BP medicine, but I am holding off for now at least in the short-term.

3) Low testosterone is being addressed with the 7.5GM Androgel. We don't have a reason "why" it is low, will look into that later per endo's interest.

4) He's concerned I may have sleep apnea. I had a sleep study a few years ago that came back *mostly* okay, and a pulse oximeter test earlier this year that was fine. But I do snore and have really funky breathing sounds at night. So we are doing another sleep study.

5) Thyroid is being addressed by a recent increase to 100 MCG Levoxyl from the endocrinologist. Had the PCP take a TSH and Free T4 lab today to check the progress of things.

6) Tried taking the Wellbutrin XL 300mg yesterday. Was pretty burned out. It was okay at first, but this morning my pulse was 120 in the doc's office and it felt like I was on speed. We are going to reduce to 150mg and try that.

7) Appt. with gastroenterologist to check up on liver disease post-chemo.

8) And, of course... it was time for a flu shot! 

He spent a great deal of time with me and is an excellent doc. His impression (and mine, too) is that we are dealing with a variety of issues that can be causing the fatigue, lack of energy, etc. It's really impossible to know how much is from the thyroid and how much is from other causes. I'd like to think that once the thyroid is straightened out the other pieces will fall into place, but that might not be completely realistic.

Anyhow, that's my laundry list for the day! LOL


----------



## Andros

bigfoot said:


> Well, had my physical this morning with the PCP. Nothing can ever be simple, right? LOL Apparently, I have my share of things going on:
> 
> 1) Recent blood tests indicate being pre-diabetic or diabetic. Doc took an A1C lab and wants me to check blood glucose with a meter and see him again in two weeks.
> 
> 2) Blood pressure is high. I seem to hover around the 135/85 area with some as low as 120s and some as high as 160s. Doc is concerned, was ready to give me BP medicine, but I am holding off for now at least in the short-term.
> 
> 3) Low testosterone is being addressed with the 7.5GM Androgel. We don't have a reason "why" it is low, will look into that later per endo's interest.
> 
> 4) He's concerned I may have sleep apnea. I had a sleep study a few years ago that came back *mostly* okay, and a pulse oximeter test earlier this year that was fine. But I do snore and have really funky breathing sounds at night. So we are doing another sleep study.
> 
> 5) Thyroid is being addressed by a recent increase to 100 MCG Levoxyl from the endocrinologist. Had the PCP take a TSH and Free T4 lab today to check the progress of things.
> 
> 6) Tried taking the Wellbutrin XL 300mg yesterday. Was pretty burned out. It was okay at first, but this morning my pulse was 120 in the doc's office and it felt like I was on speed. We are going to reduce to 150mg and try that.
> 
> 7) Appt. with gastroenterologist to check up on liver disease post-chemo.
> 
> 8) And, of course... it was time for a flu shot!
> 
> He spent a great deal of time with me and is an excellent doc. His impression (and mine, too) is that we are dealing with a variety of issues that can be causing the fatigue, lack of energy, etc. It's really impossible to know how much is from the thyroid and how much is from other causes. I'd like to think that once the thyroid is straightened out the other pieces will fall into place, but that might not be completely realistic.
> 
> Anyhow, that's my laundry list for the day! LOL


Yowza!! That is just too much! I will say this, get that glucose under control and you probably will get the BP under control. So, you are wise to stave of more meds at this time.

Glad you got the flu shot; I got mine last Weds..

The pituitary gland sends messages to the testes to produce testosterone. When taking thyroxine, the pituitary has a tendency to slowly shut down.

What do you think of that theory?

Here is my layperson's opinion.


----------



## bigfoot

Yeah, I just couldn't stomach adding another medicine to the mix right now. Three potent ones are enough to start with!

I think your theory has a lot going for it. Thankfully my pituitary MRI came back normal, but I'm sure that doesn't completely address its level of functionality. Prolactin tests are okay, too. A quick search turned up this info from NIH:

"The cause of hypogonadism may be "primary" or "central." In primary hypogonadism, the ovaries or testes themselves do not function properly. Some causes of primary hypogonadism include:

*Certain autoimmune disorders
*Genetic and developmental disorders
*Infection
*Liver and kidney disease
*Radiation
*Surgery"

Well, I can check off two of those right off the bat (Hashi's and liver disease), and possibly a third (kidney/diabetes).


----------



## bigfoot

*Holy smokes!* I just got a call from the PCP who ran my recent labs the other day. He still is pretty committed to the older TSH range, but I have mentioned that my endo says Hashi's patients do better with a lower TSH. Even so, apparently I have overshot my TSH and Free T4 target by a bit! (See bold below...) The funny part is I don't really feel hyper and don't have boundless energy or anything. It's only been about 10 days at 100 MCG.

8/8/11 - TSH 2.71 [0.34-4.82], Free T4 0.88 [0.47-1.23]
8/13/11 - Increase to 88 MCG Levoxyl
9/2/11 - TSH 2.27 [0.34-4.82], Free T4 1.04 [0.47-1.23]
9/8/11 - Begin 2.5/5.0 MCG Cytomel
9/20/11 - End 2.5/5.0 MCG Cytomel
9/21/11 - Begin 100 MCG Levoxyl
*9/27/11 - TSH 0.15 [0.34-4.82], Free T4 1.85 [0.47-1.23]*

So my PCP said I could try alternating between 100 MCG and 88 MCG Levoxyl. Wonder if this might explain why I have been a little more anxious/depressed this last week or so for no reason, with a fast pulse at times and higher blood pressure than usual.

Thoughts? arty0006:


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## lainey

That free T4 is way over the mark and likely explains that high pulse and HBP reading in the office.

I don't think alternating is going to do it to bring that down, I would back off at least to the 88 mcg daily, maybe even all the way back to 75 mcg. Why? I see you had labs on the increase to the 88 a mere 3 weeks after you started, and then added more meds. That isn't really enough time for it to build up in your system.

Where does the androgel fit in to that time frame? The progesterones cause more thyroid hormone to become available in the blood stream by unbinding it....you may have needed to wait until that settled a bit before increasing your T4 dose.


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## bigfoot

The Androgel was upped from 5 gm to 7.5 gm in early July.

A bit after I posted that, I heard back from my endo, after leaving him a message. He was also a little surprised how sensitive I was to the change and how quickly it took hold. He also suggested backing off to 88 mcg Levoxyl and re-checking in a couple months when I see him again.

I know I have been pressing for changes probably a little too quickly. Unfortunately (well, fortunately), I have a new job lined up. Been trying to get everything in order before then.


----------



## lainey

Here's the thing: the high T4 is going to be responsible for fatigue and anxiety too.

Why the Wellbutrin again?

As for the "pre-diabetes" check out the website "Blood Sugar 101". It will give you a lot of information on glucose metabolism, diagnosing and monitoring all phases of diabetes, etc. Most docs don't start treating this until A1c of 6.5.....so between the meter and offering you BP meds (usually to diagnose HBP you should have at least 2 readings over 140/90 at two separate sittings, or a 24 hour monitor showing the same), maybe the doc is a little prescription happy?

Not that I don't think you shouldn't be treated for problems, but these are lifetime issues, and if you can alter them yourself without adding meds to the mix your doc should give you the opportunity to do so. I have similar issues, and am treated for one, so this is only my personal experience talking.

For both of these, you are better off waiting until your hormones settle and taking data readings for a few months to see where things are going. Both are improved initially with diet and exercise (and weight loss--I don't know if you need to lose any).


----------



## Andros

bigfoot said:


> *Holy smokes!* I just got a call from the PCP who ran my recent labs the other day. He still is pretty committed to the older TSH range, but I have mentioned that my endo says Hashi's patients do better with a lower TSH. Even so, apparently I have overshot my TSH and Free T4 target by a bit! (See bold below...) The funny part is I don't really feel hyper and don't have boundless energy or anything. It's only been about 10 days at 100 MCG.
> 
> 8/8/11 - TSH 2.71 [0.34-4.82], Free T4 0.88 [0.47-1.23]
> 8/13/11 - Increase to 88 MCG Levoxyl
> 9/2/11 - TSH 2.27 [0.34-4.82], Free T4 1.04 [0.47-1.23]
> 9/8/11 - Begin 2.5/5.0 MCG Cytomel
> 9/20/11 - End 2.5/5.0 MCG Cytomel
> 9/21/11 - Begin 100 MCG Levoxyl
> *9/27/11 - TSH 0.15 [0.34-4.82], Free T4 1.85 [0.47-1.23]*
> 
> So my PCP said I could try alternating between 100 MCG and 88 MCG Levoxyl. Wonder if this might explain why I have been a little more anxious/depressed this last week or so for no reason, with a fast pulse at times and higher blood pressure than usual.
> 
> Thoughts? arty0006:


I think you got labs too soon after stopping the Cytomel; that's what I think. The half-life is about 72 hours. Then there would be a lag time for the numbers to catch up.

Humble opinion.


----------



## bigfoot

lainey said:


> Here's the thing: the high T4 is going to be responsible for fatigue and anxiety too.
> 
> Why the Wellbutrin again?
> 
> As for the "pre-diabetes" check out the website "Blood Sugar 101". It will give you a lot of information on glucose metabolism, diagnosing and monitoring all phases of diabetes, etc. Most docs don't start treating this until A1c of 6.5.....so between the meter and offering you BP meds (usually to diagnose HBP you should have at least 2 readings over 140/90 at two separate sittings, or a 24 hour monitor showing the same), maybe the doc is a little prescription happy?
> 
> Not that I don't think you shouldn't be treated for problems, but these are lifetime issues, and if you can alter them yourself without adding meds to the mix your doc should give you the opportunity to do so. I have similar issues, and am treated for one, so this is only my personal experience talking.
> 
> For both of these, you are better off waiting until your hormones settle and taking data readings for a few months to see where things are going. Both are improved initially with diet and exercise (and weight loss--I don't know if you need to lose any).


My A1C actually dropped from 5.7 (back around May) to 5.5 (present). Blood glucose (AM, before meal) has been from 95-105, with 103 this morning. I agree, my PCP is a little prescription-happy. Which is why I asked the other day to hold off on the blood pressure medication. Totally agree -- I'd like to get everything in order with diet and exercise if possible.

As far as weight loss, I am hovering between 180-182, but am 5'10". It would be nice to lose about 5-7 pounds, but I don't want to go nuts. So I wouldn't consider weight a huge factor.

The Wellbutrin was for depression/anxiety, and was from the PCP. In a way I agree with him on this, it has been several years of dealing with various illnesses and my body was getting tired and stressed from it. At the same time, there really is no way to know how much of it is caused by my body itself, the thyroid issues, the testosterone/hormone issues, etc. I do feel better after a week on it, and if anything it is helping to smooth out the speedbumps from the thyroid med transitions. So that is a good thing, at least for right now.


----------



## bigfoot

Andros said:


> I think you got labs too soon after stopping the Cytomel; that's what I think. The half-life is about 72 hours. Then there would be a lag time for the numbers to catch up.
> 
> Humble opinion.


I also agree with this -- I can see the Cytomel having lowered my TSH. But wouldn't I notice a corresponding decrease in FT4 levels, having taken the T3 meds?


----------



## lainey

The effect of the cytomel would be to lower the free T4 while you were taking it (it would also lower TSH), and raise the free T3 (which was not measured). Consider then, how HIGH the free T4 is. Given the short half life I don't really think it is a factor at that low dose a week later for labs. That said, you need to stick with one dose for a period that is long enough (4 weeks minimum, 6-8 is better) to really see what is going on.

For glucose, those are fine numbers actually. It's nice that you have a meter to keep track--if you use it as a tool, you can fine tune your diet to take out foods that spike you (that would be over 140 2 hours post prandial, if you even get that high) and the A1c will drop even closer to 5%. Typically those are high glycemic index or high carb foods--watch the "sugar free" variety, as sugar alcohols used to make it "sugar free" can raise your BG just the same. Walking for 20 minutes after a big meal has the same effect.

As for the Wellbutrin--I agree that there are a combination of factors affecting your mental health, and that adding a medication can make it better faster. There is a school of thought, however, that these should be prescribed by a psychiatrist--there are several classes that all act differently, and response is individual. This type of doctor sometimes has a better idea of which meds will work better in different environments--ie, people with thyroid problems, etc. It's just a thought.

Yes, you do want to feel your best in all areas.


----------



## Andros

bigfoot said:


> I also agree with this -- I can see the Cytomel having lowered my TSH. But wouldn't I notice a corresponding decrease in FT4 levels, having taken the T3 meds?


Perhaps but it depends on how long it takes the T3 to start suppressing the FT4. There always is a lag time between the TSH and the FREES.

That is why most docs (who run the Frees) like patients to lab every 8 weeks; not 6 or 7 or 5 or whatever.


----------



## bigfoot

Well, it's been two weeks in from the drop of 100 mcg to 88 mcg Levoxyl. This was in response to my TSH being low at 0.15 and the FT4 being 1.85 on 9/27/11.

The other day and this evening I noticed a weird symptom (on top of the usual Hashi's stuff); a really nervous, almost like racing, panic feeling in my chest and thoughts. From out of nowhere, and without really anything to stress out about. Then it fades away. My pulse hasn't been bad (70s-80s bpm), although my blood pressure has been high today at 145/83 this morning, and 143/86 tonight. No pain or anything like that.

I am scratching my head over this one. I know I've had some anxiety in the past, especially before getting the thyroid addressed. This seems to be at a level higher than that. But at the moment I am taking Wellbutrin XL 150 mg, so I would assume that *should* be helping things.

This leaves me wondering -- is it from my TSH being too low and FT4 too high recently, pushing me hyper (even though it's been two weeks now)? Or is it something like TSI (never tested) rearing its head? Or something else entirely? Very strange. Thankfully I do have a sleep study scheduled for this Sunday night, so if it is heart-related I would imagine it would show up.

Curious if anyone has any theories...


----------



## Andros

bigfoot said:


> Well, it's been two weeks in from the drop of 100 mcg to 88 mcg Levoxyl. This was in response to my TSH being low at 0.15 and the FT4 being 1.85 on 9/27/11.
> 
> The other day and this evening I noticed a weird symptom (on top of the usual Hashi's stuff); a really nervous, almost like racing, panic feeling in my chest and thoughts. From out of nowhere, and without really anything to stress out about. Then it fades away. My pulse hasn't been bad (70s-80s bpm), although my blood pressure has been high today at 145/83 this morning, and 143/86 tonight. No pain or anything like that.
> 
> I am scratching my head over this one. I know I've had some anxiety in the past, especially before getting the thyroid addressed. This seems to be at a level higher than that. But at the moment I am taking Wellbutrin XL 150 mg, so I would assume that *should* be helping things.
> 
> This leaves me wondering -- is it from my TSH being too low and FT4 too high recently, pushing me hyper (even though it's been two weeks now)? Or is it something like TSI (never tested) rearing its head? Or something else entirely? Very strange. Thankfully I do have a sleep study scheduled for this Sunday night, so if it is heart-related I would imagine it would show up.
> 
> Curious if anyone has any theories...


The FREE T3 test would be most helpful in this case. The Wellbutrin "should" be helping; right you are.


----------



## bigfoot

Thanks Andros! I think I will ask my PCP for that and a TSI test next week, just to cover all the bases.

In the meantime I discovered an excellent article about anxiety (and other issues) and how they relate to the endocrine system:

http://www.drrichardhall.com/anxiety.htm

A few excerpts really caught my eye:

"Hall et al in a study of medically induced anxiety disorder found thyroid disorders, i.e., hyper- and hypothyroidism and thyroiditis, to be the most frequent medical conditions misdiagnosed as primary anxiety disorder."

"In a study of patients with Hashimoto's thyroiditis, anxiety was a prominent initial symptom at the time that the condition was diagnosed. It was often associated with a lability of mood, withdrawal from normal duties due to perplexity, and in severe cases, generalized agitation, disorientation, and persecutory delusions as well as extreme restlessness."

"The anxiety associated with significant hypothyroidism usually resolves within days to months following the initiation of treatment. The clinician must remember that the central nervous system effects of profound hypothyroidism may not fully clear for two to twelve months after successful treatment. Sleep and growth hormone production during sleep have been shown to be disturbed for weeks to months following the replacement of thyroid hormone. Return of these functions to normal seems to be related to the cessation of the anxiety states that these patients experience.34 Kales et al have shown that patients' improvement parallels restoration of their normal sleep patterns, and, in fact, note that the return of a normal sleep pattern is an excellent predictor of treatment outcome."


----------



## Andros

bigfoot said:


> Thanks Andros! I think I will ask my PCP for that and a TSI test next week, just to cover all the bases.
> 
> In the meantime I discovered an excellent article about anxiety (and other issues) and how they relate to the endocrine system:
> 
> http://www.drrichardhall.com/anxiety.htm
> 
> A few excerpts really caught my eye:
> 
> "Hall et al in a study of medically induced anxiety disorder found thyroid disorders, i.e., hyper- and hypothyroidism and thyroiditis, to be the most frequent medical conditions misdiagnosed as primary anxiety disorder."
> 
> "In a study of patients with Hashimoto's thyroiditis, anxiety was a prominent initial symptom at the time that the condition was diagnosed. It was often associated with a lability of mood, withdrawal from normal duties due to perplexity, and in severe cases, generalized agitation, disorientation, and persecutory delusions as well as extreme restlessness."
> 
> "The anxiety associated with significant hypothyroidism usually resolves within days to months following the initiation of treatment. The clinician must remember that the central nervous system effects of profound hypothyroidism may not fully clear for two to twelve months after successful treatment. Sleep and growth hormone production during sleep have been shown to be disturbed for weeks to months following the replacement of thyroid hormone. Return of these functions to normal seems to be related to the cessation of the anxiety states that these patients experience.34 Kales et al have shown that patients' improvement parallels restoration of their normal sleep patterns, and, in fact, note that the return of a normal sleep pattern is an excellent predictor of treatment outcome."


I love this link and have bookmarked it. Have read other articles by Dr. Hall. He is excellent and knows his stuff.

Further proof that we are not all crazy; right? LOL!!!

Hyper is equally as bad and can cause severe psychosis and anxiety.

I personally would love it if you got the TSI (thryoid stimulating immunoglobulin.) And the FREE T3, of course!

Read post # 5; from the get go, I have suspected that you are hyperthyroid with waxing and waning.

http://www.thyroidboards.com/showthread.php?t=3190


----------



## bigfoot

I remember you posting that -- it certainly deserves to be investigated, thanks for reminding me! The trick will be convincing the doc of the TSI test. But he is on board with getting me healed up, so it may be no big deal.


----------



## Andros

bigfoot said:


> I remember you posting that -- it certainly deserves to be investigated, thanks for reminding me! The trick will be convincing the doc of the TSI test. But he is on board with getting me healed up, so it may be no big deal.


It should not be a big deal; it should be standard procedure. Boy, what a life!


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## bigfoot

Got back from the sleep study this morning. (They really should call them a "non-sleep study" LOL.) Sounds like my legs move a bit during the night, potentially keeping me from REM sleep. Won't know much more until the sleep doc does his review/report and forwards it to my doc.

If anyone has done one of these before, you know what I mean. It's like a cross between a bad hotel room, hospital room, and jail cell. However, this time I was smart and brought my own pillow! :tongue0013:

Now off to find a real bed!


----------



## Andros

bigfoot said:


> Got back from the sleep study this morning. (They really should call them a "non-sleep study" LOL.) Sounds like my legs move a bit during the night, potentially keeping me from REM sleep. Won't know much more until the sleep doc does his review/report and forwards it to my doc.
> 
> If anyone has done one of these before, you know what I mean. It's like a cross between a bad hotel room, hospital room, and jail cell. However, this time I was smart and brought my own pillow! :tongue0013:
> 
> Now off to find a real bed!


Yikes!!! Get some Zzzzzzzzzzzzzzzzzzzzzzzzzzzz's!


----------



## bigfoot

Had a quick follow-up with the PCP this morning. Unfortunately, the sleep study results were not back yet. So there wasn't a whole lot to go over. I asked about the TSI test but the PCP wasn't comfortable running that; wanted me to ask the endo (who I see in a few weeks) for it. I was able to get a Vitamin D, Vitamin B-12, and cholesterol test incorporated into the next set of labs, as I was low on Vitamin D last year and B-12 was in lower end of range. I'll be curious to see if the daily fish oil regimen, better diet, and more exercise have helped my triglycerides (also if the better thyroid numbers have helped to reduce it).


----------



## Andros

bigfoot said:


> Had a quick follow-up with the PCP this morning. Unfortunately, the sleep study results were not back yet. So there wasn't a whole lot to go over. I asked about the TSI test but the PCP wasn't comfortable running that; wanted me to ask the endo (who I see in a few weeks) for it. I was able to get a Vitamin D, Vitamin B-12, and cholesterol test incorporated into the next set of labs, as I was low on Vitamin D last year and B-12 was in lower end of range. I'll be curious to see if the daily fish oil regimen, better diet, and more exercise have helped my triglycerides (also if the better thyroid numbers have helped to reduce it).


All that will help the triglycerides along with oodles of olive oil. My Trigycerides are 48; believe that or not. We use only olive oil on and in everything. Baked potato w/olive oil, salt and pepper is to die for. You could add a squeeze of lemon as well. No butter, no margerine or any other oil or fat will be found in our house. Period.

How much fish oil are you taking?

I will be interested to see if the endo will run the TSI. What's up with that. Why should it be so hard to get that test? Goodness!


----------



## bigfoot

Wow, those are some awesome triglyceride numbers! Mine are about ten times that. The irony is we ate pretty well before all of this -- my wife likes to cook/bake, we have a small garden, buy fresh veggies from the farmers market, use lean meat, eat fresh meals if out, etc. (Sure, there is the occasional Five Guy's burger or Chipotle burrito, LOL.) We do, however, use butter (sparingly) and Land o' Lakes spread. Salt is sea salt, pepper is freshly ground. Oil is usually of the olive oil variety. But I am a sucker and have to put some spread and perhaps a little grated cheese on my baked potato!

The endo has me taking fish oil three times daily with meals. I am using the Carlson's liquid version you recommended, which is 1,600mg of Omega 3's. I thought he might think that was too much, but he is fine with it. Here is a link to the kind we have been buying.

Yeah, I am not sure about that TSI test. Hopefully the endo will be interested in running it...


----------



## bigfoot

Had my appointment with the new gastroenterologist this morning. Super-nice guy and excellent doc. Woohoo!

I mentioned everything that's been going on lately and when I said something about Celiac or gluten problems he said he was thinking the same thing. In addition to liver labs to check my previous liver disease status, he put in a gluten blood test and ANA test. Should have results of these labs next week sometime.

What is interesting is there is such a thing as "autoimmune hepatitis". He mentioned and is checking for that as well, as it could be giving me some of the troubles I have been experiencing. Fortunately, there is a treatment for it.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001291/

Follow-up appointments next week with the endocrinologist and PCP. Should know more about the sleep study results then, too.


----------



## Andros

bigfoot said:


> Had my appointment with the new gastroenterologist this morning. Super-nice guy and excellent doc. Woohoo!
> 
> I mentioned everything that's been going on lately and when I said something about Celiac or gluten problems he said he was thinking the same thing. In addition to liver labs to check my previous liver disease status, he put in a gluten blood test and ANA test. Should have results of these labs next week sometime.
> 
> What is interesting is there is such a thing as "autoimmune hepatitis". He mentioned and is checking for that as well, as it could be giving me some of the troubles I have been experiencing. Fortunately, there is a treatment for it.
> 
> http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001291/
> 
> Follow-up appointments next week with the endocrinologist and PCP. Should know more about the sleep study results then, too.


You turn up some good research papers!! This is "most" interesting. We don't have a chance in hell, do we? Egads!!!

I won't be surprised if you are advised to go on a gluten-free diet. You know that many of us are and it surely has made a difference in how we feel.










Let us know when your test results come in. Worthy of note; "You do sound a lot better than when you first joined the board!" Progress is being made, that is for sure!


----------



## bigfoot

Thanks Andros! Yes, there definitely has been some improvement versus starting down this path back in April. Maybe not as quick as I would have liked, but I'll take what I can get! Some things seem better, others worse, but the gastroenterologist made the nice comment this morning that, "I think things really will resolve and get better over time." Excellent doc, smart and kind, too.

I sat here for a few minutes this morning and jotted notes down and did a little research. It's really amazing how many things are all intertwined together. Like you mentioned, I really won't be surprised if the gluten lab comes back positive. Heck, even if the autoimmune hepatitis does, too. According to the gastro. doc, thyroid issues can cause some see-sawing of liver labs (AST/ALT).

You should have seen the gastroenterology office this morning. The place looks like a bank inside! No joke -- they have about 6-7 "tellers" that check you in/out, take your co-pay, and the doc comes out to get you himself! I said I'd never had a doctor come out to get me from the waiting room, he joked they were "saving on overhead".

The wonderful people here, yourself included, have been such a huge help to me. So much easier to advocate and explain things with the right info. I can't thank you enough!


----------



## bigfoot

Saw the endo and the PCP this morning. Had a list of questions for both so I wouldn't forget anything!

I asked the endo about the TSI test. He rather quickly said no, I don't need it, as I am hypothyroid. I also asked whether I needed an ultrasound at all -- again, no. Finally I asked about re-testing my TPO Ab and Thyroglobulin Ab levels that were last tested in April by an urgent care doc. Again, endo said no, that it makes no difference.

One interesting thing -- my Vitamin D-25 test (that I asked my PCP to run as it was low last year) came back, no surprise, as low. So the endo saw this and prescribed me 50,000 IU pills of Vitamin D to take for 12 weeks, followed by taking 2,000 IU of Vitamin D each day after that treatment.

I had been taking low testosterone treatment of 7.5 gm Androgel daily. I mentioned being very anxious and irritable lately, endo thought we should reduce back down to 5 gm daily to avoid "roid rage" (LOL).

As far as my TSH and FT4 levels, they have both changed quite a bit since reducing from 100 mcg of Levoxyl to 88 mcg (it's been six weeks). Endo thought these new levels were fine, and that it isn't likely my thyroid/Hashi's giving me trouble lately. He also added that TSH values are logarithmic, not linear. He palpated my thyroid and didn't feel any swelling or nodules.

The PCP and I discussed changing from Wellbutrin XL over to Citalopram (Celexa). Hopefully that helps some of the anxiety, too.

My recent TSH and FT4 test from 11/7/11 came back (on 88 mcg Levoxyl):
TSH 2.31 (0.34-4.82)
FT4 0.97 (0.47-1.23)

Also, my Vitamin D-25 and Vitamin B-12 test from 11/7/11 came back:
Vitamin D-25 Total Level 25 (32-100)
Vitamin B-12 430 (180-914)

Thoughts?


----------



## Negative101

bigfoot said:


> Saw the endo and the PCP this morning. Had a list of questions for both so I wouldn't forget anything!
> 
> I asked the endo about the TSI test. He rather quickly said no, I don't need it, as I am hypothyroid. I also asked whether I needed an ultrasound at all -- again, no. Finally I asked about re-testing my TPO Ab and Thyroglobulin Ab levels that were last tested in April by an urgent care doc. Again, endo said no, that it makes no difference.
> 
> One interesting thing -- my Vitamin D-25 test (that I asked my PCP to run as it was low last year) came back, no surprise, as low. So the endo saw this and prescribed me 50,000 IU pills of Vitamin D to take for 12 weeks, followed by taking 2,000 IU of Vitamin D each day after that treatment.
> 
> I had been taking low testosterone treatment of 7.5 gm Androgel daily. I mentioned being very anxious and irritable lately, endo thought we should reduce back down to 5 gm daily to avoid "roid rage" (LOL).
> 
> As far as my TSH and FT4 levels, they have both changed quite a bit since reducing from 100 mcg of Levoxyl to 88 mcg (it's been six weeks). Endo thought these new levels were fine, and that it isn't likely my thyroid/Hashi's giving me trouble lately. He also added that TSH values are logarithmic, not linear. He palpated my thyroid and didn't feel any swelling or nodules.
> 
> The PCP and I discussed changing from Wellbutrin XL over to Citalopram (Celexa). Hopefully that helps some of the anxiety, too.
> 
> My recent TSH and FT4 test from 11/7/11 came back (on 88 mcg Levoxyl):
> TSH 2.31 (0.34-4.82)
> FT4 0.97 (0.47-1.23)
> 
> Also, my Vitamin D-25 and Vitamin B-12 test from 11/7/11 came back:
> Vitamin D-25 Total Level 25 (32-100)
> Vitamin B-12 430 (180-914)
> 
> Thoughts?


Being one of the few males on this site that also apparently has Hashi's, I'll try and chime in....

Ultrasound: Not sure why he's saying no. Have you had one before? If you have hashi's, its likely you have nodules. If you have nodules, you need to get an FNA, especially since your male. Thyroid cancer is not common at all, but is certainly something you want to cross off your list.

Retesting antibodies: I agree with him that theres no point to this, unless you suspect some sort of lab error. If you have them, you have them, a second test means nothing whether or not the numbers go up or down.

Vitamin D: Good. Where do you live? How much sun is there where you're at?

Testosterone treatment: roid rage? :confused0003: Not happening with ANY sort of TRT.

Labs: TSH can fluctuate greatly. I wouldnt put too much reliance on this. The Free T's are where the attention is needed. Your FT4 is perfectly fine.

Side notes: Have you had your estrogen levels tested? Low test can certainly be a result of a number of things... high estro being one of them. What is your current BodyFat %? Also, low vitamin D will definitely contribute to low test as well. All of this combined with the fact that you have thyroid issues will really shed light on your Test numbers (and ultimately, your symptoms)

Age?
Height?
Weight?
Test Levels?
Estrogen Levels?
Libido?
Other Hormone Panel #'s?

Great forum to check out for hormone related info on men: http://www.musclechatroom.com/forum/forumdisplay.php?2-All-Things-Male


----------



## bigfoot

My responses in bold below. Thanks for chiming in!



Negative101 said:


> Being one of the few males on this site that also apparently has Hashi's, I'll try and chime in....
> 
> Ultrasound: Not sure why he's saying no. *Me either.* Have you had one before? *Nope, never had an ultrasound.* If you have hashi's, its likely you have nodules. *Endo said he didn't feel any.* If you have nodules, you need to get an FNA, especially since your male. Thyroid cancer is not common at all, but is certainly something you want to cross off your list. *Totally agree, don't want a bigger problem creeping up.*
> 
> Retesting antibodies: I agree with him that theres no point to this, unless you suspect some sort of lab error. If you have them, you have them, a second test means nothing whether or not the numbers go up or down. *Ok. Your thoughts on the TSI test, then?*
> 
> Vitamin D: Good. Where do you live? How much sun is there where you're at? *Pacific NW. Not much sun up here unless you count the liquid kind.*
> 
> Testosterone treatment: roid rage? :confused0003: Not happening with ANY sort of TRT. *I feel quite a bit of anxiety / mild irritability, but no "rage". *
> 
> Labs: TSH can fluctuate greatly. I wouldnt put too much reliance on this. The Free T's are where the attention is needed. Your FT4 is perfectly fine. *Thanks.*
> 
> Side notes: Have you had your estrogen levels tested? *Yes (see below and added more labs to first post of thread.)* Low test can certainly be a result of a number of things... high estro being one of them. What is your current BodyFat %? *25* Also, low vitamin D will definitely contribute to low test as well. *Very interesting, had no idea. Thanks! * All of this combined with the fact that you have thyroid issues will really shed light on your Test numbers (and ultimately, your symptoms)
> 
> Age? *32*
> Height? *5'10"*
> Weight? *180*
> Test Levels? Most recent 9/2/11: *709 (see my first post in this thread for dates and levels for thyroid, testosterone, etc.)*
> Estrogen Levels? *Run once by Naturopath 6/2011: Free Estradiol 0.70 (<0.45), Estradiol 21 (adults <29). Neither endo or PCP thought it was bad levels, but naturopath did for Free Estradiol.*
> Libido? *Mostly very low. When adjusting thyroid meds and testosterone recently there was a "window" where it was better. Now low again.*
> Other Hormone Panel #'s? *Yes, will get those up on first page as well (SHBG, etc.).*
> 
> Great forum to check out for hormone related info on men: http://www.musclechatroom.com/forum/forumdisplay.php?2-All-Things-Male *Thanks! Been there briefly before, should go back.*


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## Negative101

My apologies for not having read the thread -- 14 pages, I tend to skip to the end 

TSI -- I dont know enough about to have an opinion on this. However, from basic research, its link is mainly to Graves:

TSIs are somewhat unique in that they do not directly promote the destruction of any normal cells or structures in the thyroid gland. Instead they mimic the action of TSH itself, driving the TSH receptors to generate signals that stimulate the production and secretion of thyroid hormone. This process is not governed by the normal feedback mechanism that regulates the secretion of TSH from the pituitary gland. As such, TSIs that bind to TSH receptors may stimulate the production and secretion of excess amounts of thyroid hormone. http://www.hopkinsmedicine.org/endocrine/graves/Answer.asp?QuestionID=22

Ultrasound -- Try and get one, somehow, someway... You may have to go to another doctor and request this... it wouldnt hurt if on that particular day you were having some tightness 
His hands arent a substitute for an ultrasound.

Test levels: 700s is decent. Your initial under 300, definitely not. Did they ever find the source of this? Anyone ever mention a potential varicocele?

Estrogen: You need a sensitive E2 test done to determine your correct levels. The normal E2's are simply womens test with different ranges. Its not sensitive enough for a male. Few labs provide it, unfortunately. Check the link I provided for more info on that.

Couple other Q's for you...
- Do you have any children? If yes, was there any difficulty in getting your lady pregnant?
- Morning wood... yes/no?
- When you get a chance... SHBG, FSH, LH, etc


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## bigfoot

I can't fault ya' for skipping to the end -- I do that, too. 

Nope, never found the cause of the low testosterone. At the time I had just finished a year of chemo for liver disease. But unfortunately my PCP at the time didn't check into the "why" part of things. The current endo has mentioned doing this at some point, but that it would take a couple of months with no Androgel. With how bad I've been feeling, I took a raincheck on that for now.

Yeah, I don't know quite why the endo wasn't interested in doing an ultrasound. I imagine that he doesn't see any big red flags as far as swelling and what-not.

That sensitive estrogen test sounds like something else to look into. But... getting my endo or PCP to run that would be like pulling teeth at this point. I get the impression that male hormones are not very well understood or researched by the medical community, thus no real consensus on testing, values, etc. My endo said he likes to see total testosterone values between about 400-700.

No kids (although we'd like to at some point), AM lumber products have been hit or miss. For a brief while in the last few months there was some improvement, then it seems as though it's faded away. Mentioned this to both docs today, no real explanation.

The SHBG is what I have looking through my copies, I don't think I have FSH or LH labs at all.

Also got a message from the gastroenterologist today, need to call them tomorrow. Something about the results of the labs he ran (ANA and Celiac tests, on top of other liver labs).


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## bigfoot

Oh, and one silver lining. My triglycerides went down somewhat, from 403 to 328. Hopefully that fish oil and more exercise is working!

Lipids - Recent on 11/7/11:
Chol. 172 (0-200)
Trig. 328 (30-150)
CH/HDL 6.14 (1.0-5.0)
HDL 28 (35-50)
LDL 78 (0-130)
VLDL 66 (0-42)

Lipids - Older on 9/2/11:
Chol. 161 (0-200)
Trig. 403 (30-150)
CH/HDL 5.75 (1.0-5.0)
HDL 28 (35-50)
LDL 52 (0-130)
VLDL 66 (0-42)


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## Negative101

The fish oil doesnt seem to have raised your HDL -- a bit weird. It often isnt dramatic, but even minimal help is expected.

Has your doctor suggested Niacin at all for HDL? Im not sure what your liver issues were, so that may explain why no suggestion was made.

How is your carb intake daily?


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## bigfoot

Just heard back from the gastroenterologist; liver disease still negative 1.5 yrs. post-chemo (woohoo!). The other news -- my Celiac/gluten test came back negative, but my ANA test came back positive. Doc is worried I might have autoimmune hepatitis attacking my liver. He said that would explain fatigue and feeling sick, but not some of the other signs & symptoms. Due to come back for more labs in a month while we watch it for now. Treatment would potentially consist of pretty heavy-duty steroids.

I am working on getting paper copies of the lab results so that I can be more specific with numbers and ranges. For those of you that understand this ANA stuff, is there anything else I should be chasing down with my PCP?


----------



## bigfoot

Negative101 said:


> The fish oil doesnt seem to have raised your HDL -- a bit weird. It often isnt dramatic, but even minimal help is expected.
> 
> Has your doctor suggested Niacin at all for HDL? Im not sure what your liver issues were, so that may explain why no suggestion was made.
> 
> How is your carb intake daily?


Hmm... that is strange, then. I've been taking quite a bit of fish oil daily. Have not heard anything about Niacin for HDL, but my liver issues were relatively bad (cirrhosis was starting) after 28 years of living with that disease.

Carb intake has been cut back a lot. Not perfect, but still way less than we used to eat. Been trying to substitute rice, tortillas, or potatoes instead of bread products. Still, room for improvement.


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## Negative101

bigfoot said:


> Hmm... that is strange, then. I've been taking quite a bit of fish oil daily. Have not heard anything about Niacin for HDL, but my liver issues were relatively bad (cirrhosis was starting) after 28 years of living with that disease.
> 
> Carb intake has been cut back a lot. Not perfect, but still way less than we used to eat. Been trying to substitute rice, tortillas, or potatoes instead of bread products. Still, room for improvement.


Try cutting back all carbs -- almost to ketosis levels. Im confident you'll see improvement. Rice, tortillas, etc... all sugar when it hits your gut.

For some reference, Ive been on low carb for some time now.... Definitely hard to start with, but it slowly becomes a lifestyle. Its helped my #'s, A LOT:

Age: 27
Triglycerides: 38.16
LDL Cholesterol: 74.08
HDL Cholesterol: 47.76


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## bigfoot

Stopping back by here for a quick update:

Well, I finally did it. Went and got a TSI test drawn and paid out-of-pocket. It is through one of the independent testing companies (Health Check USA) and the test itself goes through Lab Corp. They said it would take about a week to get the results back. If this comes back positive I really don't know what the next step is -- my endo wasn't interested in the TSI test. He is certain I am only hypo with Hashi's. Do I look for an ENT doc? A different endo's opinion? Try to raise the issue with my current endo? Look into ablation or thyroid removal? I guess I don't know how big a game-changer this TSI is; with regards to having Graves' or hyper or a really bad case of Hashi's. Advice, anyone?

In other news, recently talked to my gastroenterologist (who is awesome, BTW) about the recently discovered autoimmune hepatitis. He had me get some additional labs today to confirm and then if those look promising we will start on some prednisone for treatment. The idea is the least amount of prednisone needed for the least amount of time to put the AI hepatitis into remission. He'll be monitoring my liver labs every couple of weeks. He feels it may be contributing quite a bit to the fatigue, nausea, and sick feelings. He also suggested maybe seeing a rheumatologist doc for the joint pain and whatnot if things don't clear up.

Saw my PCP about a week and a half ago and discontinued the Celexa I briefly took. We went back to Wellbutrin XL. The Celexa made me feel completely awful; it was hard to even get out of bed or have any desire to eat, etc. Also prescribed me a low dose 0.25mg of Xanax as-needed for the anxiety. It does seem to help somewhat, but I know all of this is just a short-term Band-Aid solution for symptoms from an underlying condition(s).

And in better news, I just discovered that I will be starting a new job at the beginning of the year. Woohoo! So the rush is on to get all of this "stuff" figured out.


----------



## bigfoot

Well... the gastroenterologist just called back with more lab results. My liver levels are similar to a month ago and the serum protein electrophoresis (SPE) test came back positive, confirming his original autoimmune hepatitis DX. So he's got me starting on 20mg of Prednisone in the morning, after which we re-test liver labs in a couple of weeks and go from there, working on tapering down the dosage over time. He said he'll be interested to see if this helps with many of the symptoms I have been having. (Heck, that makes two of us!)

*crossing my fingers* arty0045:


----------



## Andros

bigfoot said:


> Well... the gastroenterologist just called back with more lab results. My liver levels are similar to a month ago and the serum protein electrophoresis (SPE) test came back positive, confirming his original autoimmune hepatitis DX. So he's got me starting on 20mg of Prednisone in the morning, after which we re-test liver labs in a couple of weeks and go from there, working on tapering down the dosage over time. He said he'll be interested to see if this helps with many of the symptoms I have been having. (Heck, that makes two of us!)
> 
> *crossing my fingers* arty0045:


Gosh; I hate all this for you! It just so happens that the liver is one of the major organs that converts T4 to T3 which I am sure you know but for our "readers' " benefit I thought I would slip that in there.

We are going to have a lot of crossed fingers around here on your behalf!


----------



## bigfoot

Yes, awesome point about the liver converting T4 to T3, thanks for reminding me! It's been a couple of days on the Prednisone now, but I haven't noticed much of anything.

I did start taking that 50,000 IU of Vitamin D a few weeks ago per the Endo's RX. Kinda seems like things flared up after that. Back to lots of fatigue, tingling in hands/legs, weak, memory problems, nausea, no appetite, etc. I know there is a *theory* that the Vitamin D going low in the body is its way of down-regulating the inflammatory process. (Wonder if that's what's happening, and by throwing in large amounts of external Vitamin D I am throwing things off.)

Still haven't gotten that TSI lab result back yet. Hopefully next week... Considering an ENT, rheumatologist, or neurologist as a consult maybe at some point.

Thanks for all of your support!


----------



## Andros

bigfoot said:


> Yes, awesome point about the liver converting T4 to T3, thanks for reminding me! It's been a couple of days on the Prednisone now, but I haven't noticed much of anything.
> 
> I did start taking that 50,000 IU of Vitamin D a few weeks ago per the Endo's RX. Kinda seems like things flared up after that. Back to lots of fatigue, tingling in hands/legs, weak, memory problems, nausea, no appetite, etc. I know there is a *theory* that the Vitamin D going low in the body is its way of down-regulating the inflammatory process. (Wonder if that's what's happening, and by throwing in large amounts of external Vitamin D I am throwing things off.)
> 
> Still haven't gotten that TSI lab result back yet. Hopefully next week... Considering an ENT, rheumatologist, or neurologist as a consult maybe at some point.
> 
> Thanks for all of your support!


You may be interested in giving this some thought.

Vitamin D
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

For that very reason, I get my D from the sun, egg yolks and other sources such as dairy and greens.

I am now wondering if in fact they ran the TSI; it sure is taking a long time!


----------



## bigfoot

Well, I sure hope they are processing that TSI test -- since I already paid for it! LOL

I'm onto Day 4 of the Prednisone 20mg for the autoimmune hepatitis. Haven't really noticed any huge energy changes, except now I have nearly-constant tingling in my hands, arms, feet, and legs. Gonna be calling my gastroenterologist today to let him know.


----------



## Andros

bigfoot said:


> Well, I sure hope they are processing that TSI test -- since I already paid for it! LOL
> 
> I'm onto Day 4 of the Prednisone 20mg for the autoimmune hepatitis. Haven't really noticed any huge energy changes, except now I have nearly-constant tingling in my hands, arms, feet, and legs. Gonna be calling my gastroenterologist today to let him know.


Sounds like peripheral neuropathy. Do let us know. The situation w/you is quite worrisome indeed!


----------



## bigfoot

Speaking of... just got my results from Health Check USA. I'm not sure how to interpret these, as there is no units in the range, but instead a number followed by a percentage:

*11/29/11 - TSI 31 (0-139%)*


----------



## Andros

bigfoot said:


> Well, I sure hope they are processing that TSI test -- since I already paid for it! LOL
> 
> I'm onto Day 4 of the Prednisone 20mg for the autoimmune hepatitis. Haven't really noticed any huge energy changes, except now I have nearly-constant tingling in my hands, arms, feet, and legs. Gonna be calling my gastroenterologist today to let him know.


Sounds like peripheral neuropathy. Gee; what next? Do let us know, you have a worrisome situation.


----------



## Koof

bigfoot said:


> Speaking of... just got my results from Health Check USA. I'm not sure how to interpret these, as there is no units in the range, but instead a number followed by a percentage:
> 
> *11/29/11 - TSI 31 (0-139%)*


It means you are positive for TSI, which is an indicator of Graves disease. The range helps you track the number. Generally (from what little I know) most people aren't symptomatic - hyper - at that end of the range, but it IS positive.


----------



## bigfoot

Thanks Koof!


----------



## bigfoot

Well, I just returned from the PCP. He doesn't think the Prednisone is causing the tingling in my arms/legs, and doesn't think the thyroid or any other autoimmune disease is intertwined with it (which is different than what the gastro. doc thought). He is sending a referral over to another office for nerve testing for me, though. I wonder what on earth is causing this; I find it odd that it started happening a couple days after I starting taking the Prednisone (20mg).

Oh, and he's upped the Wellbutrin XL from 150mg to 300mg. That's great if it helps my mood, but what the heck is that going to do for the rest of my problems? I will feel good, but I still won't be able to remember things, my skin will keep cracking, no libido, sick feeling, nausea, peeing all the time, hot flashes, cold & hot sensitivity, high BP, weakness, fatigue, etc.

So now I have more questions than answers. What else is new? LOL


----------



## Andros

bigfoot said:


> Well, I just returned from the PCP. He doesn't think the Prednisone is causing the tingling in my arms/legs, and doesn't think the thyroid or any other autoimmune disease is intertwined with it (which is different than what the gastro. doc thought). He is sending a referral over to another office for nerve testing for me, though. I wonder what on earth is causing this; I find it odd that it started happening a couple days after I starting taking the Prednisone (20mg).
> 
> Oh, and he's upped the Wellbutrin XL from 150mg to 300mg. That's great if it helps my mood, but what the heck is that going to do for the rest of my problems? I will feel good, but I still won't be able to remember things, my skin will keep cracking, no libido, sick feeling, nausea, peeing all the time, hot flashes, cold & hot sensitivity, high BP, weakness, fatigue, etc.
> 
> So now I have more questions than answers. What else is new? LOL


Wellbutrin has listed as adverse effect parathesia.

http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm

You will find parathesia under nervous system.

Nervous system side effects have frequently included headache (27%), insomnia (16% to 33%), dizziness (12%), tremor, somnolence, thinking abnormality, abnormal dreams (6%), sleep abnormalities, disturbed concentration, dysphoria, decreased memory, paresthesia, central nervous system (CNS) stimulation, akathisia, migraine, impaired sleep quality, pseudoparkinsonism, sedation, sensory disturbance, seizure, myoclonus, and dysarthria. Abnormal coordination, confusion, decreased libido, hyperkinesia, hypertonia, hypesthesia, vertigo, amnesia, ataxia, abnormal electroencephalogram (EEG), akinesia, aphasia, coma, dyskinesia, dystonia, extrapyramidal syndrome, hypokinesia, increased libido, neuralgia, neuropathy, unmasking tardive dyskinesia, abnormal neurological exam, impaired attention, sciatica, and aphasia have been reported rarely.

http://www.drugs.com/sfx/wellbutrin-xl-side-effects.html

What made me think of it was you said you are being raised from 150 mg. to 300 mg. and I was startled! And I do mean startled. Something is not right here if you don't mind my saying so.

Pretty soon you will be so numb, you won't care about anything. I "am" very concerned.

What has your doctor said about the TSI?


----------



## peacesells560

bigfoot said:


> Well, I just returned from the PCP. He doesn't think the Prednisone is causing the tingling in my arms/legs, and doesn't think the thyroid or any other autoimmune disease is intertwined with it (which is different than what the gastro. doc thought). He is sending a referral over to another office for nerve testing for me, though. I wonder what on earth is causing this; I find it odd that it started happening a couple days after I starting taking the Prednisone (20mg).
> 
> Oh, and he's upped the Wellbutrin XL from 150mg to 300mg. That's great if it helps my mood, but what the heck is that going to do for the rest of my problems? I will feel good, but I still won't be able to remember things, my skin will keep cracking, no libido, sick feeling, nausea, peeing all the time, hot flashes, cold & hot sensitivity, high BP, weakness, fatigue, etc.
> 
> So now I have more questions than answers. What else is new? LOL


Do you have excessive thirst along with the excessive urination? If you do, I would be concerned about diabetes. Type 1 diabetes is actually an autoimmune disease, if you didn't know about that already.


----------



## Andros

peacesells560 said:


> Do you have excessive thirst along with the excessive urination? If you do, I would be concerned about diabetes. Type 1 diabetes is actually an autoimmune disease, if you didn't know about that already.


Good one; that too can cause peripheral neuropathy. Thank you!


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## bigfoot

Thank you for the concern over the Wellbutrin. My wife is pretty mad that my PCP is boosting the dose and wants me to change docs. So I am holding off on the increase for the moment and will try to find a new PCP if I can. Had no idea the Wellbutrin could be causing the tingling.

Thanks for the suggestion about the diabetes. I've been monitoring my blood sugar here and there, and a couple of times since starting the Prednisone (which can spike glucose). I am considered "pre-diabetic" with an A1C of 5.5. I don't have a lot of thirst, but some days seem to be peeing a *lot*. Who knows, I wonder if that could also be tied into the autoimmune hepatitis.

The tingling seems to have calmed down somewhat, but is still present. My hunch is it's tied to the Prednisone as a side-effect, but none of the docs feel strongly that it's the case.

Saw the ENT this morning; no ultrasound and she didn't have any big answers for me, but was friendly & helpful. I have another appt. this afternoon with the PA who helped get the ball rolling on treatment for Hashi's this year. We shall see what I discover...

hugs3


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## Gwen1

Hi Bigfoot, if you don't mind me asking, how are you doing on your thyroid medication? 
And is your dosage being increased at all?


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## bigfoot

Okay, well, good news: I saw the PA this afternoon and explained everything that's been going on. When I said nobody had given me an ultrasound she couldn't believe it. Ordered me one right there on the spot for tomorrow. She also palpated my thyroid and said it felt enlarged. She is super-nice and very smart; knows all about the Free T numbers and whatnot. I asked about the TSI and she looked it up -- she still feels that I am hypo right now. She was also kinda surprised about all the various medications I've been put on lately. Sounds like she has worked with a lot of thyroid patients in the past, including those that slipped under the radar of normal docs.

Gwen1: I am presently on 88mcg of Levoxyl. When I was recently bumped up to 100mcg it was a little too much, causing my TSH to nose-dive and my Free T4 to skyrocket. Honestly, the 88mcg seems like it's not enough some days. Other days I have more hyper symptoms.


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## Gwen1

Thanks bigfoot, I have been following along, and reading other threads for everything "thyroid". Just wondering how you were doing on it. It could be that it takes the body awhile to "learn" how to utilize/metabolize the thyroid medicine.


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## bigfoot

Ok-dokey; had my thyroid ultrasound this afternoon, and got a voicemail with the results. Need to try to get a copy of the report for more details, but apparently there were two "small" nodules found. Sounds like the radiologist wants me to get another ultrasound, too. And the urgent care PA wanted me to follow-up with an endo as far as the results. More as I learn it...


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## bigfoot

Well, nuts. I am trying to copy & paste from a PDF file, but I give up. So I'll type out the meat and potatoes from the 12/10/11 thyroid ultrasound report:

Findings:
The right thyroid gland measures 3.7 x 1.6 x 1.4 cm. The left thyroid lobe measures 3.8 x 1.2 x 1.2 cm. The isthmus measures 2 mm in thickness. The thyroid lobes bilaterally demonstrate mild diffuse heterogenous echogenicity and echotexture. There are two small hypoechoic nodules within the left thyroid lobe measuring 3 and 6 mm in dimension each. The larger nodule mastery is a fairly well-defined peripheral margin. No internal vascularity is noted. The smaller nodule demonstrates a less well-defined peripheral margin without internal vascularity.

Impression:
Two small hypoechoic nodules in the left thyroid lobe, indeterminate. Neither of these nodules has the appearance of hyperplastic nodule or colloid cyst. Follow-up ultrasound is recommended to document stability.


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## Negative101

I'm not sure if theyll bother with an FNA of that... Might be too small, depends I guess. Either way, seems like the follow up u.s is only to check and see if they grow or new ones come. Remember, nodules are pretty common (more than 30% of healthy ppl have them). For now, just wait and see. Enjoy life


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