Blood Work Results - Some Opinions Needed

Okay just got my lab results.

Blood counts look good nothing bad there.

Sedimentation rate
ESR 9mm/hr (<15)

Kidney
UREA 8.7mmol/L (2.3 - 7.6) elevated

TSH 4.40mIU/L (.5-4.0)
FT4 21.9pmol/L (10-19)
FT3 5.0pmol/L (3.5-6.5)

So since last blood test
TSH has started going back up by 1. FT4 has gone 3 points above the range. FT3 has gone down by 1.1

So doctor told me to take double my dosage so I am supposed to take 100mcg daily now. No doubt this will raise my FT4 even higher but he is not that concerned with that.

This is his treatment plan in order.

  1. Treat by TSH
  2. Treat by Symptoms
  3. Treat by T4 and T3

Once I start getting into the 24 to 25 range then some other action might be taken. But looks like I would be referred to an Endo ( waste of money and time)

Anyway I am back in Europe next week and have a doctor lined up from a family friend who is a doctor. So we will see…

I had a 24hr heart rate monitor on me also. I do have some extra beats per minute but nothing out of normal range. So he gave me the all clear with my heart and nothing to do with the T4 meds.

excess T4 converts to Reverse T3 (which you didn’t measure). RT3 blocks FT3 from working so it doesn’t matter what your FT3 levels are at if you have too much RT3, the FT3 can’t do anything.

simply taking more T4 when your FT4 is already over the range is not a good idea.

please check out this site. They have some good info that might be able to help you:

This:

[quote]VTBalla34 wrote:

For whatever reason your thyroid hormones are not activating receptors and/or the pituitary is not recognizing the activation and thus secreting more TSH to try and get the job done…

If rT3 is good, consider having a pituitary MRI to rule out a [benign] tumor on it (I consider this unlikely since your LH and FSH are low, but is still a possibility).

If all else fails, you may want to look into this and keep it in the back of your mind:

[/quote]

and this:

[quote]PureChance wrote:
you have major thyroid antibodies, an extremely high TSH, and high T4/T3 numbers… you really need to do research on what those antibodies mean and what steps you need to take - I do not believe that simply taking additional Thyroid medication will help (but that is just a gut feeling which is why I keep recommending additional research/reading on the subject).

yes, most doctors are idiots. It still amazes me how many bad doctors are out there. and how offended they get when you try and have a two way conversation with them as opposed to simply bowing down to their glorious all knowing commands.

check out these two thyroid sites as well, or print off information to take with you to the doctor.

nahypothyroidism.org[/quote]

…are now even more relevant given your latest bloodwork.

You have something wrong in your body which is prohibiting the thyroid receptors from utilizing your active T3. Either that, or your pituitary is not getting the feedback that this bonding is occuring and screaing for your thyroid to make more thyroid hormones…

You need to rule out the following:
-rt3
-pituitary tumor
-Thyroid disease

You have tested high for thyroid antibodies. This indciates that your thyroid may be under attack and being destroyed. This is something that I don’t know a lot about, but if you don’t look into it, you are doing yourself a great disservice.

I would also push to move to T3 meds or T4/T3 combo…this is the active hormone and you can adjust your dose more easily until you find what works for you, then move on to T4 meds to maintain that (if needed).

I keep pushing and pushing for rT3 test and they keep frigging me around. I think it is because they are going into the unknown territory and would rather avoid that. I can’t believe I am having so much issue getting a test for rT3 been to get blood drawn on 3 occasions and still keep getting a NO when I ask for it.

The Endo in Europe just wrote me an email since I asked some questions. This Endo is a friend of a family friend so I will see her when I get there next week.

The only positives from her email is that she said that my FT4 levels should not be over.
I asked about the combo meds and she said that they are really not prescribed that much since the % of T3 and T4 is not dosed properly so I would need to take extra T4 on its own. Which she said is another tablet and excessive. ( But who gives a crap if I have to take 2 tablets a day to feel better if so be it.) She also said that having said that she knows of people who feel better on the combined T3 and T4 then on T4 alone. So I will definitely have a chance getting that prescribed.

Regarding hashimotos disease she said there is not much I can really do.But will have to talk to her in more detail about this and really read up on if there is anything to combat hashimotos other than T4 medication or T3.

I might have more luck overseas with the Endo because I think she will be more open to experiment then what I have found here. But again I have doubt because when I asked her about Rt3 being a possible cause she did not think this could be a valid point…

Anyway my best bet is to just read up (thanks for the links) and self treat and just try and get the prescriptions from the doctors.

Still don’t understand what is so special about the rT3 test that they are so reluctant to give it. Would have given me the info I certainly require.

rt3 is not a very well understood aspect of thyroid disorders in America…it is even less well accepted outside of the US, so I’m not entirely surprised…

for the record, I think it is a low probability of causing your issues since your cortisol is good…usually we see the rt3 pooling in people with low cortisol who are not driving thyroid into their cells since cortisol is an important part of that…I don’t know if there are other hormones/minerals that are required in that process as well that we may be missing, but I am not aware of any…

Regardless, it would be nice to know for sure!

[quote]VTBalla34 wrote:
rt3 is not a very well understood aspect of thyroid disorders in America…it is even less well accepted outside of the US, so I’m not entirely surprised…

for the record, I think it is a low probability of causing your issues since your cortisol is good…usually we see the rt3 pooling in people with low cortisol who are not driving thyroid into their cells since cortisol is an important part of that…I don’t know if there are other hormones/minerals that are required in that process as well that we may be missing, but I am not aware of any…

Regardless, it would be nice to know for sure![/quote]

Interesting that we are able to find some valuable information on the forums regarding rT3 and its effects, yet the doctors have no idea. In this day an age you would think the doctors would have the best training and access to the best information out there. Just amazes me if you do your research and go to your doctor prepared, you can lose them real quick once you start talking about complex issues and specifics.

My doctor actually told me last visit that it is evident that I do a lot of research which is good. He goes I wish all my clients did that. In a way I don’t believe that, I can see how they would start to feel uncomfortable once you start talking about things that they are not too familiar with.

Even after all that he did not give me the rT3 test, so go figure.

Also on my last blood work sheet I have a note on the bottom of my Thyroid results.

History: Thyroxine therapy
High TSH indicates mild under-replacement over the last few weeks. Normal FT4 may be seen when thyroxine tablet is taken shortly before the blood sample or when compliance has only recently been improved.

The above makes no sense to me. I took my thyroxine tablet about 60mins before the blood draw.

Okay been a while since I last posted an update. It has taken me a while to get to a doctor to get my blood drawn. I am back in Europe ( Czech Republic) till the end of the year and going to continue trying to resolve my issue.

Anyway After taking 100mcg (t4) daily for the last 2 or so months my levels are as follows:
TSH: 1.83mU/l (.34-5.6)
fT4: 14.00pmol/l (7-15.96)
Anti TPO: 9.6kU/l (0-9)
Anti Tg: 138 (0-115)

So hashimoto still active that was given as that is never going to change.

TSH is now down below 2 which is good but still I think I could do with a little more t4 to get it lower. Would you recommend me trying 125mcg daily to bring it down closer to 1?

I was most interested in fT4 as now it is in range! Before I was taking 50mcg and it was over the top end limit I doubled the dose and now it has dropped below the limit. That is very interesting any thoughts? Unless they have a higher scale here in Czech and a value of 14 would correspond differently in Australia maybe? Who knows though…

I was frowned upon immediately by the female doctor when I walked to get my blood drawn. She said who thought of this?? I said what do you mean, she said Thyroid issues are problems females have ( I realy question if she is a legitimate doctor). She was so angry at me for some reason I really had no time to argue with this primitive doctor. She would not even look at me. She said something to the nurse take this and that… I had no time to even say anything and off I went to get blood drawn by the nurse. She never took fT3 and I wanted rT3. Then the doctor goes, go see an Endo and that was it. I picked my results up the next week and they are what I listed.

I have a Endo lined up shortly so we shall see how I get along there. Probably my last hope it is through a family friend so I just might have some better luck.

I was feeling quite bad not that long ago and was pretty certain it was from the T4. I changed my routine and now I take the medication at night before bed instead of 1st thing in the morning. Been doing it like this for the last 2 weeks and feeling a lot better. Could just be coincidence who knows.

I’ll report back once I get endo results.

Getting off to a great start in Europe,

[quote]iroczinoz wrote:

TSH is now down below 2 which is good but still I think I could do with a little more t4 to get it lower. Would you recommend me trying 125mcg daily to bring it down closer to 1?
[/quote]

Does by symptoms, not lab ranges. If you feel awesome, keep it where it is. If you’re still feeling tired, change it. But I would talk to an actual KNOWLEDGEABLE doctor (unlike the ones you’ve had) before I would try to self treat (I am not a doctor myself).

[quote]iroczinoz wrote:
I was most interested in fT4 as now it is in range! Before I was taking 50mcg and it was over the top end limit I doubled the dose and now it has dropped below the limit. That is very interesting any thoughts? Unless they have a higher scale here in Czech and a value of 14 would correspond differently in Australia maybe? Who knows though…
[/quote]

I would wager it’s another effect of your hashi’s. Part of your thyroid was attacked and it released T4 into your bloodstream (causing a high value). Patients on hashi’s can flip between hypo- and hyperthyroid. Your thyroid is destroyed, releasing T4 into your bloodstream (hyperthyroid), but the destruction weakens your thyroid, which causes hypothyroid lab values once that T4 is used up. Additionally, low-dose thyroid meds exacerbate hashi’s as the antibodies will up their assault on the thyroid (causing more of the T4 spillage issue). Whether you found this dosing protocol by sheer luck or by reading STTM, good for you.

[quote]iroczinoz wrote:
I was frowned upon immediately by the female doctor when I walked to get my blood drawn. She said who thought of this?? I said what do you mean, she said Thyroid issues are problems females have ( I realy question if she is a legitimate doctor). She was so angry at me for some reason I really had no time to argue with this primitive doctor. She would not even look at me. She said something to the nurse take this and that… I had no time to even say anything and off I went to get blood drawn by the nurse. She never took fT3 and I wanted rT3. Then the doctor goes, go see an Endo and that was it. I picked my results up the next week and they are what I listed.
[/quote]

Don’t you love docs?

[quote]iroczinoz wrote:
I was feeling quite bad not that long ago and was pretty certain it was from the T4. I changed my routine and now I take the medication at night before bed instead of 1st thing in the morning. Been doing it like this for the last 2 weeks and feeling a lot better. Could just be coincidence who knows.
[/quote]

Again, could be caused by hashi’s. Remember, your thyroid is under assault and until you have the right medication/dosing, you will have symptoms of varying severity.

Most of what I know about Hashi’s is at Hashimoto's - Autoimmune Thyroid Attack - Stop The Thyroid Madness and http://drrind.com/therapies/thyroid-scale-matrix (in the footnotes), if you want to read more in-depth for yourself.

Cliff notes:
GET A DOC WHO IS KNOWLEDGEABLE ABOUT HASHI’S. I would bet $1000 (against 1000:1 odds) that you have Hashi’s.

Interesting stuff. I guess that explains why my FT4 levels leveled out with more T4 medication, I was expecting the opposite.

Yes I do have hashi’s as I have been told. On Monday I am seeing the ENDO got my notes with me and gonna lay it on the table. I’ll report back with how I go.

I am thinking I might try and get my Pituitary gland maybe looked at Lowish LH levels, lowish testosterone (400) and TSH issues.

My grand mother has an over active thyroid and grandfather has underactive. Dad’s is fine but they say it skips a generation…

I wanted to ask what people think about supplementing COD liver oil for Vitamin D? Are there better alternatives? In Europe I can get cod liver oil a liter for about $10. I would usually dose with a tablespoon a day but honestly I have no idea how effective cod liver oil is for vitamin D.

I know that my Vitamin D was on the low end probably deficient but I can’t seem to find my test results, although I remember the doctor said I should fix that.

Even though I was working in the summer in Australia outdoors in the sun 10hrs a day (for 3 months) it looks like it was not enough to boost the values.

From the sounds of it taking cod liver oil is probably not the best option anyway since it contains heaps more Vitamin A then it does D. Having more vitamin A also renders absorption for Vitamin D useless so really probably no gain would be seen.

Maybe supplement with D3? Gotta see what is available here as I am not very familiar with the European Market.

Got some blood taken today and will get most of the tests I have missed so far excluding rT3 ( apparently they don’t do it here in Czech) that was the only downer…

I’ll get E2 done which I am happy about as well as a lot of other tests that I have missed so far. Results I will get the 18th.

Also I was prescribed some T4+T3 combo for a test run 2 month supply which is awesome. However the doc said to take them in the morning and not at night like I have been doing for the last couple of months. This might be causing my troubles falling asleep she said.

Currently I am on 100mcg of T4

This new medication is as follows:
1 tablet of Thyreotom (10mcg T3 & 40mcg T4)
1 tablet of Letrox (50mcg T4)

So I will be taking 90mcg of T4 and 10mcg of T3. Which she said should equal roughly my 100mcg of T4. Is there any formula I can use to calculate exactly what the equivalents would be?

Would say maybe 30mcg of T3 and 50mcg of T4 work better?

There is no formula as far as I am aware…its more an art than science and you have to dose iteratively to find out what works for you…it looks like your doc is willing to work with you though, which is great…so I would just follow her advice and see how you feel

[quote]VTBalla34 wrote:
There is no formula as far as I am aware…its more an art than science and you have to dose iteratively to find out what works for you…it looks like your doc is willing to work with you though, which is great…so I would just follow her advice and see how you feel[/quote]

Yeah I felt pretty good walking out that finally I might have someone who listens. I think that because our family friend is a doctor and knows this Endo is the only reason she is working to work with me but maybe not, but it sure does help.

She did say gee you have done your research (laughing) a few times during my 60min consultation with her.

Just got an email from my family friend who just looked at my results before I go see the endo on monday.

Cholesterol elevated
Liver values elevated

On Monday I’ll post my full results.

This is just such bad news as I thought fixing the TSH my cholesterol would follow. According to the doctors my cholesterol was metabolic but this is the 1st time it was checked in 5 months while on T4 meds.

I am lost at the moment and have no idea what else could be causing my elevated cholesterol values.

I can’t go on a diet since what I eat day in day out would be considered a diet. I was on a diet last year for 3 months which made absolutely no change at all. I was actually worse off after the 3 months in cholesterol values. The diet I was on then is not much different to what I eat now.

I am going to search the internet about this and see if I can find anything. I thought I would post if some people have had any experience or maybe give me advice in which direction to look at?

Post your standard diet and see if anything sticks out…if you’ve already done this, I haven’t seen it but you can just copy/paste…

First off, ideal TSH does not mean your thyroid hormones are optimal, it simply means your body isn’t requesting more. It’s usually a good indicator, but in some cases doesn’t tell the whole thyroid picture.

I’m not sure taking so much T4 is a good idea for you. Since you haven’t been able to test for RT3, I’m going to use my “best guess” that your body is converting way too much FT4 into RT3… making T4 supplementation sub-optimal. My reasoning is that your labs routinely show your FT4 to be slightly or significantly higher in their lab range than FT3 - so your body is probably converting a lot of your FT4 to RT3. If I’m right – and I would NOT stake a substantial amount of money on this - t3-only meds would be a better option, or at least a more equal mix.

That being said, why would poor thyroid function raise your cholesterol?

Also, if you lifted recently before your blood test, that can raise liver markers - I took 3 days off lifting before I had my liver tested, for safety’s sake.

[quote]scj119 wrote:
First off, ideal TSH does not mean your thyroid hormones are optimal, it simply means your body isn’t requesting more. It’s usually a good indicator, but in some cases doesn’t tell the whole thyroid picture.

I’m not sure taking so much T4 is a good idea for you. Since you haven’t been able to test for RT3, I’m going to use my “best guess” that your body is converting way too much FT4 into RT3… making T4 supplementation sub-optimal.

My reasoning is that your labs routinely show your FT4 to be slightly or significantly higher in their lab range than FT3 - so your body is probably converting a lot of your FT4 to RT3. If I’m right – and I would NOT stake a substantial amount of money on this - t3-only meds would be a better option, or at least a more equal mix.

That being said, why would poor thyroid function raise your cholesterol?

Also, if you lifted recently before your blood test, that can raise liver markers - I took 3 days off lifting before I had my liver tested, for safety’s sake.[/quote]

Yeah I think the FT4 to Rt3 conversion is probably happening but I will have to get tested for that next year when I am back in OZ. I expected to have it done here in Czech but apparently no tests for it here so yeah.

Agree that the T3 would be a better option might ask for more of that and lower T4.

Cholesterol values do get elevated if you are HYPO. Basically they say not diet related but metabolic related.

I trained the day before most likely it was back. But looking back at previous blood results back to 1999 it was elevated there too. So nothing new and liver markers also elevated most of the time in the last 10 years. Had liver ultrasound nothing detected.

VT - my diet is like this

Meal 1
50grams of protein with about 200ml of milk.
100grams of oats with 300ml of milk

train at 9 or 10 usually

shake
after workout I’ll have 25grams of protein mixed with milk
meal 2
250grams of beef or chicken breast with rice or baked potatoes bit of sweet chilli and mayo.

meal 3
I’ll either have another 100grams of oats with milk 300ml or I’ll make myself a shake which consists of a banana and 125grams of cottage cheese and 300ml of milk.

meal 4
same as meal 2. or occasionally I’ll have baked beans with 4-5 eggs.

Then throughout the day I might eat some bananas etc…

Milk is Low Fat 1.5%, baked potates can be substituted with backed chips (4.5% fat) however I was on basmati rice for 4 months from January to May pretty much everyday. So with my meals I either have potatoes,rice,or baked chips. Meat wise I eat chicken,beef,pork all lean stuff.

don’t drink,don’t smoke don’t eat fried stuff at all, don’t use oil to cook. The only unhealthy thing I have is mayonnaise with sweet chilli with my meat. That is pretty much the only fatty stuff I eat and according to the labels a tablespoon has 1% of cholesterol intake per day. So I might have 2 of those a day. Usually the mayo stuff is cholesterol free so to speak.

If you think the mayo could be a problem I have my doubts. I went on a diet for 3 months no mayo and it made no change at all.

Eating 200grams of oats a day and that is not lowering my cholesterol either.

I really doubt it is food related.

Eating 4-5 eggs daily is really a new addition to my diet have not really been doing it long.

Have you ever considered eliminating the half gallon of milk you are drinking per day?

[quote]VTBalla34 wrote:
Have you ever considered eliminating the half gallon of milk you are drinking per day?[/quote]

haha not that much mate but around 1 litre. You think that is too much? The milk is UHT stuff at 1.5% fat so I am getting around 15grams of fat from that per day.

Or am I missing something more crucial?

You may be allergic/intolerant to milk…it is one of the most common intolerances on the planet…