Thyroid tests are normal?? Are you sure?

[ScrapDragon]

I just got some test results back for my thyroid and I'm very confused.

I'm within the normal range (but not what I've come to accept as normal -- just want my doctor says is normal)

She also tells me that I have the early stages of Graves Disease???

How can I be borderline HYPO and also have Graves disease??

Here are my results -- I'd sure appreciate some assistance. I've got quite a few symptoms of hypo thyroidism but except for fatigue and irritability, none of the ones associated with Graves disease

Auto-antibody: 476 (apparently normal is less than 35)
this is why the doctor is saying I have Graves disease

TSH: 4.4
FT4: 0.93
T3: 31.8

(I will get a copy of the results tomorrow when I go in, this is what I got over the phone this afternoon.)

The more I read, the more confused I get. I have an appointment tomorrow morning with my doctor and I want to go in "loaded for bear." She wanted to send me to an endo, but I don't know if I need/want one and would want to research one locally before choosing one.

If anyone would care to comment, I'd really appreciate some help in figuring out what I'm looking at here.

[ScrapDragon]

I was hoping someone would see my post and have some suggestions before my appointment this morning. I didn't expect an appointment so quickly, just got the test results back yesterday and my appointment is for 8:40 a.m.

I'll get a copy of my results and be back over here to see how it's going for everyone. I get the feeling that the doctor only did 1 free T test instead of both -- so I'm going to question her on that (why on earth would she only request one of them). I'm going to ask for the other free T test that she didn't request and if she won't authorize it I'll go to that HealthCheckUSA and get it there.

Thanks!

[nonstickpam107]

Doesn't tell ME anything without ranges there, and WHICH antibody test is that...the TPO or the TSI? You either have Graves or you don't, in which case she would have run BOTH antibody tests! Hashimoto's is called the 'rollercoaster' disease and you go back and forth between hyPO and hyPER symptoms...you CAN have BOTH diseases (I do, and waited 14 years for correct treatment, cuz my PCP kept saying I was ONLY hyPER..he would have RUINED me).

Re post with test, followed by it's range, please.

Pam

[nonstickpam107]

PS..that's NOT a T3 test, I can tell by it's numbers....it's a T3 Uptake test, which is really a T4 binding test in disguise, and I refuse to pay for those...if the doc doesn't know to run a FREE T3 on you...then they don't know much. I see you are in Eastern PA...I know someone with a doc in PA that's WONDERFUL. Here's link to site:

http://gawain.membrane.com/holistic_medicine/

Pam

[ScrapDragon]

Pam: Thanks so much!

I didn't know about the ranges until I got home, so didn't ask at the time. I'm getting a copy of the lab work when I go in this morning.

Thanks SO MUCH for the T3 info -- wonderful. For some reason she didn't order a FT3 and I didn't know why. Now I find out that the T3 that she ordered is really a T4 in disguise.

OK, so she doesn't know that much about thyroid. Sounds like I need another doctor. I'm going to talk with her and I'll make an appointment with the reference doctor you gave me and hopefully I can get on the road to feeling normal (which I don't now).

This doctor wants to put me on medication for depression instead of treating me for a thyroid problem.

[ScrapDragon]

Just to let you know, Pam -- after going to this doctor's website, I'm going to try and make an appointment with them regardless of what this doctor says. I like that the doctor is a DO instead of an MD and is an alternative medical practice.

Thanks SO MUCH for giving me his information!! Oh, crud -- I thought he was in Nazarath -- he's in Narberth. That's over an hour away. Well, I guess that's what sick leave is for.

Now I wonder if he will take my insurance (or if my insurance will take him).

[nonstickpam107]

Oh, you should know that most of us who have found a GREAT doctor are over two hours away (one way). You being in PA (I love the state, and will be retiring to Pennsylvania in a few years)....please DO make an appointment with that doc....one of the ONLY ones in PA to Rx. Armour and do the correct testing. Plus it's not an endo, so you may end up with a 'family' type doc as well as a really great thyroid doctor! Make that appointment NOW, this doctor's name is 'getting around' (I've tried to not over use it...but people need HELP). Don't be discouraged if the appointment is a month or more away either...go and get your tests, this doc is a 'beginner' and is working with several hypothyroid patients...if you need more info to 'get up to speed' then this website is GREAT: www.thyroid.about.com and read this whole thread through.

Can't wait to hear how it all turns out!

As far as doc's taking insurance...many of the best thyroid docs don't take ANY insurance and are over 700 dollars per visit and over 1100 for blood work! So, these DO's and family type docs are much less cost.

Pam

[ew1]

Pam, the doc I just went to for the Cytomel is Mark Levy at Paoli Hospital, I found him by going to the Armour website. He's an internist and said he's be happy to be my PCP (primary care physician).
I go for my followup cytomel/blood test this weekend. If I am just doing thyroid and not lipids this time around, is it still better to do this as a fasting test?
Thanks!

[nonstickpam107]

Thyroid tests are never fasting tests. Make sure that FT4, FT3 are there though.

Pam

[ScrapDragon]

Pam (and others):

I went to the doctor's office "loaded for bear." Seems like this one is at least willing to listen.

After showing her documentation I got from About.com about the changes in the levels of TSH, we went back and forth about the validity of the documentation and the studies that created it.

I basically said to her -- I'm not totally convinced that I don't have hypothyroidism ... I believe that the documentation I have along with the test results & the autoimmune indicators shows that if I'm not already hypo, that I will be soon.

She agreed that my concern was valid -- even if I don't think she believed me. And was going to put me on a synthetic T4 and I asked her to put me on Armour since it's a T3/T4 drug. Again, she agreed.

She said that she didn't request a T3/free T3 test because the lab wouldn't do one if my results didn't show that I needed the test done. Sounded kinda hinky -- but I wasn't going to argue with her. I just stated that I wanted a T3/free T3 test done and asked her to order one for me. She did. She said that now that I'm showing such a high autoimmune that they will do the test without any problem (including that now my insurance won't refuse to pay for it).

Because one of the reasons she wanted me to come in today was to put me on anti-depressants, she wanted to know if I still wanted a a script. I said not at this time -- I'd rather see if the armour isn't able to correct that. I want to know if my symptoms are being addressed by the thyroid medication and not the anti-depressants.

She seems to think that she should be addressing the lab results and not my symptoms which concerns me greatly -- if I'm borderline all we may have to go by are symptoms. I also get the feeling that as soon as I'm within the normal range (new normal) of 0.3 to 3.0 for the TSH she will completely ignore my symptoms and go back to my test results.

She gave me a prescription for 60mg armour that she wants me to take once a day in the morning.

She stated that this was the "correct dose" for my weight range. When I mentioned starting low and working my way up -- taking a dose twice a day instead of once a day, she didn't think it was necessary.

Is it?

She also feels that this will fix me right up and then I'll live happily ever after in 4-6 weeks. (said with much sarcasm) I asked about this being a process that took time over months and she didn't seem to think this should be the case.

Here are my test results:

TSH: 4.40 (0.35-5.50) uIU/ml
TBI: 31.8 (22.4-36.7) %
FreeT4: 0.93 (0.89-1.76) mg/dL
TPO Ab H 476 (<35) U/mL

Pam: I'm thinking I should go ahead and schedule an appointment with the other doctor? She doesn't sound very knowledgeable, but at least she is willing to listen. I'm not sure if she is going to be right for on-going thyroid care. What are your thoughts?

Comments? Concerns? Suggestions?

Thanks so much!!

[ew1]

Pam, I always had the thyroid tests done on a fasting stomach because the doc coupled them with lipids and other 6 month tests. So if I take my Synthroid in the morning with some cytomel and then some cytomel in the afternoon, when's the best time to go for a test? I thought if I did it during the day that it might give a false reading ?

[nonstickpam107]

Sande, you have Hashimoto's, this doc doesn't know enough to really help you...in my opinion...RUN, don't walk. It doesn't GO by weight, and if she doesn't have a LOT (like, 15 years) experience with Armour...I wouldn't want her giving it! I'll say it again (4000th time here, lol) I would rather just take synthetic T4 and wait for an experienced doctor before I would LET a doctor GIVE me Armour Thyroid who isn't experienced. My goodness...reading what she is telling you is like tossing out my last 22 years of thyroid and endocrine research. It does NOT go by weight (especially Armour Thyroid). OH< and it was just absolutely presumptive (and STOOPID) of her to tell you you had GRAVES...you have Hashimoto's...she doesnt' even KNOW which test is for which autoimmune disease! ACKKKK!!! You don't go by TSH, and all labs will do a FT4, FT3 IF the doctor writes it in. You have to go by those, not TSH to titrate Armour Thyroid. And the T3 in the Armour only has a four HOUR half life so why would you take it ALL in the am???? I think I know who this doctor is too...if you want the list where you can 'warn others' let me know. I think this doc may already be there.

ew1, call the doc and ASK when he/she wants them done. My doctor wants them done exactly 5 hours after my first dose of Armour Thyroid (because T3 only has a four hour half life).

Pam

[nonstickpam107]

OH, Sande...if we would all be ok in 4 to 6 weeks...then NONE of us would be going through all this crap@! Call that doc and ask her what she is proposing to get your TSH at?? (Cuz most of us are at about .50 or LESS as 'normal'...the docs who will only medicate till your TSH is down to a 1 or 2...those are the patients that suffer the MOST). See?? You're going to pay HER to tell YOU how you feel. Should be the other way around.

Pam

[streaker1971]

Here are my test results:

TSH: 4.40 (0.35-5.50) uIU/ml
TBI: 31.8 (22.4-36.7) %
FreeT4: 0.93 (0.89-1.76) mg/dL
TPO Ab H 476 (<35) U/mL

OK, stupid question?(I think?!) I had my annual check up Monday. My dr. ran tests because I have been having major hot flashes for about 2 months now along with other "problems". My friend who works in the lab at the hospital I went to gave me my lab results. She told me the thyroid TSH was 4.72. She didn't have any other numbers. Are these other t4 and t3 things tested separately? I hope I am asking that right. I have been reading about hypothyroidism and have ALOT of the signs and symptoms. But I guess we all can say that about most of the diseases out there. If when I go back he says everything is normal should I seek the opinion of a specialist on this? Would that be considered high or do you need the other numbers to say whether or not that's "normal"?

[nonstickpam107]

A TSH over a 3 is VERY suspect for hypothyroidism. My TSH is kept at .003 (not a typo) on hormones. The newest suggested range for TSH is .03 to 3.0. Yes, you need to ASK for a Free T4 and Free T3. I have lists of doctors who treat thyroid (but they aren't in the millions like the list of doctors who don't know CRAP about treating thyroid). The TSH test is a test of your pituitary's action UPON your thyroid. Congrats. Your pituitary works, but we have NO idea if you have hypothyroidism. Any doctor willing to let a patient have a TSH that high without testing the actual thyroid hormones OR doing autoimmune testing for Hashimoto's needs to have his/her thyroid removed and see how THEY feel without enough hormone.

A TSH that high would make most doc's sit up, take notice (unless your doc ONLY goes by TSH, which means his patients aren't doing well at all).

AND..if you read this WHOLE thread, you'll have the answers to all your questions you asked.

Pam

[streaker1971]

Thank you!

[ScrapDragon]

Pam:

OK, I'm guessing that I need to NOT take this Armour?

I get the strong feeling that this is the completely wrong dose level and I have no idea what the correct dose level is.

sigh

[nonstickpam107]

It's a starting dosage...most cut it in HALF and take HALF in the am and the other half about 2, 3 pm. You will feel really GREAT for a couple of weeks (or days...depending on just how long you've been without treatment and if the antibodies go into 'attack the thyroid more' mode) and then you will 'crash'. Meaning, as the thyroid 'senses' incoming hormone...it will work on it's own less and less. The trouble comes into play with Armour because it DROPS the TSH IMMEDIATELY...that's WHY you use FT4 and FT3 to dose. (and you don't even KNOW if you NEED T3...they didn't test that...if you DO NOT need it, if your body converts part of the incoming T4 into T3...than you won't need much T3). Then in six to eight weeks, you need to be tested AGAIN...FT4, FT3, and then your dose would come up.

BUT..if the doc goes by TSH, and the doc sees how LOW it is on Armour, doc will keep you in limbo on that one tiny 60mg. See...after the thyroid senses enough incoming hormone, it shuts down. The problem happens when the doc won't give you enough to REPLACE your metabolism, but just shuts you off when the TSH goes down, so you are left with JUST ENOUGH hormone to shut your own thyroid down, but not enough to replace you to normal.

Pam

[nonstickpam107]

Whoops...also...there are things (foods, meds) that will bind the incoming thyroid hormone. You must put calcium at least four hours away from taking that med. You must put iron at least six HOURS away from that med. You take it, and then wait an hour to eat in the am. UNCOOKED cabbage, broccoli, cauliflower, strawberries, peanuts...all these things bind the incoming hormone.

Also, if you are on any type of HRT (and birth control IS HRT) than that binds the hormone in the blood stream...FT's are the BEST way of isolating that out and knowing your TRUE amount/level of hormones.

Pam

[ew1]

Strawberries? I LOVE strawberries. I usually have them in the evening as dessert, long time away from my meds. Waagh.

[nonstickpam107]

I eat them too. Because we are all individuals, certain things won't affect certain people. OH...gosh, before I forget the WORSE thing you can eat (in ANY form) for a hypothyroid person is SOY...it acts just like super birth control HRT and binds up the thyroid hormones almost completely!

I eat raw cauliflower and broccoli with spinach dip a LOT as my 'chips and dip'...if I do it for several days in a row...I then start with the feeling tired, muscles achy, etc. and then I have to knock it off for awhile. Usually when your doctor keeps you well medicated and your FT levels at the high end, it won't affect you much. It's the people who aren't optimized on their meds that it affects more.

Pam

[voj]

Hi Pam, Good to see you feel good enough to be posting. How are your treatments going?
Wanted to let you know that my hometown doctor looked at my last test results and upped me to 3 grains and agreed to treat me. I am going to use you as my guide if you don't mind. I point blank told him I thought I was dying cell by cell!! Actually wanted to tell him I thought my other doctor was trying to kill me off but held my tongue.

He wants to see me in a month which I suppose is too soon for another thyroid test - I would have been on the 2 grains for 3 months previously. He did test the B12, ferritin,rheumatoid arthritis etc and got a call that all were normal but I have to go pick up my copy to see where in the normal range I am. I asked them to send it but haven't received it.

I do not feel much or any change as yet.....I still have the achy body so bad; wrists, ankles hips but have had that for so many years I would not know how to act if I didn't. I'm hoping for the metabolism to perk up - I need to lose weight before the surgeon will operate on my back. I'm contemplating a second opinion from the doctor my son recommended in the first place but couldn't get into see him at the time.

I am so cold all the time, shivver inside all the time - 75° and I'm still wearing the sweatshirt over t-shirt trying to keep warm. Using the electric blanket every night and my temp is 96.6 every morning and don't take it during the daytime.

So hopefully I am going to get some positive help. I have sure appreciated all your knowledge and willingness to listen to my complaining!!
Jean

[nonstickpam107]

Jean, next week is my last week of chemo (I hope and pray...think it will be though...pray for NO radiation needed!).

I would go and see that doc in a month...either for blood tests or to get another Rx. for another grain (you can always do creative pill cutting 101 as you go along). Absolutely, I'd take any chance I could to get more of what I needed, lol.

You know how I am though, hee hee.

Pam

[ScrapDragon]

Pam:

I'm happy to hear that you are almost at the end of your treatment! Fingers crossed that you won't have to undergo radiation.

I wanted to come and thank you again for replying to my information from yesterday.

I'm going to continue on the 60mg Armour because it's all I have -- make an appointment with the doctor you told me about and hope that I can get in to see him before my prescription runs out (3 months).

I'll cut the pills in half and talk 1/2 in the morning 1 hour before any food. Second 1/2 around 3 p.m. and avoid soy & raw cauliflower & broccoli & cabbage & strawberries totally.

Thanks for helping when my own doctor couldn't.

If you have other recommendations, please let me know.

[peony8702]

After reading this thread , I believe its clear I am not on the right meds. Five years on synthroid( 100-75mcg.) and my biggest symptom is i cannot lose a pound!! not to mention feeling crappy most of the time....I thought the symptoms i have are menopause...don't think so now. I just moved to NYC, and don't know where to start to find a Dr. that knows what they are doing with this condition. I will pay ANYTHING...I don't even have health insurance, I am 60 lbs. overweight, and I am so depressed because I cannot lose it...i try everything, exercise, low carb, supplements, counting calories, low-fat,,,,blablabla..................thanks for ANY SUGGESTION.

[streaker1971]

Originally Posted by streaker1971

OK, stupid question?(I think?!) I had my annual check up Monday. My dr. ran tests because I have been having major hot flashes for about 2 months now along with other "problems". My friend who works in the lab at the hospital I went to gave me my lab results. She told me the thyroid TSH was 4.72. She didn't have any other numbers. Are these other t4 and t3 things tested separately? I hope I am asking that right. I have been reading about hypothyroidism and have ALOT of the signs and symptoms. But I guess we all can say that about most of the diseases out there. If when I go back he says everything is normal should I seek the opinion of a specialist on this? Would that be considered high or do you need the other numbers to say whether or not that's "normal"?

Well, my doctor said everything is fine. I am considering trying to find an endo dr. But after reading alot (haven't finished yet) of this forum I am worried about how to go about finding a dr. What should I do??

[nonstickpam107]

Streaker, here is the www.thyroid.about.com Top Thyroid Docs list (for EVERYWHERE, cuz in the South, it's difficult to find a doctor who treats thyroid disease unless your TSH is like...um....100000000000000000000000000):

http://thyroid.about.com/cs/doctors/a/topdocs.htm

Please, PLEASE keep in mind that most of us with GREAT thyroid docs travel about two hours ONE WAY, and many FLY to another state (I'm serious...my doc is NOT taking ANY new patients now, and has several from Fla, and other states...I'm in IN). Also, look for recommendations that say 'Doctor does T3 and T4 treatment', or "Doc gives Armour or Cytomel and tests FT's", please DO NOT think a rec. of "The doctor listened to me" (cuz my dog will listen to ME for free but doesn't write Rx's).

Also, FIRST go to www.armourthyroid.com and use the 'docfinder' feature...many of us have found GREAT docs (who are NOT endo's) who charge basic family doctor fees but do a wonderful job.

Same for you Peony...read this WHOLE thread, but also know that having optimized thyroid doesn't mean the weight goes away...it just 'evens the playing field' so you have the energy to EXERCISE and eat right. Menopause AND thyroid disease together need special treatment (and specifically meaning your T3 needs tested, and if you aren't converting any of that T4 into T3, you need to find a doctor who tests, and treats that...and if you are in meno...you need ALL your hormones balanced, not JUST your thyroid...I know...I went post meno at 41 yrs. old because of very POOR thyroid treatment, it's been a LONG road, and I have to be careful of every mouthfull of food and I lift weights...six days a week when I'm not sick/having chemo).

Pam

[loveshinesthru]

how can you tell if someyhing is wrong with your pituitary?

[nonstickpam107]

You would usually 'know' it because your FT4, FT3 labs would look a certain way to a doctor used to reading them. And there are a few other symptoms. But you'd eventually have MRI or CT if it was thought to be a pit adenoma, it's not common but operable easily (through the nose and nasal cavities).

Here's a really nice site for thyroid learning: www.thyroidmanager.org Here's one that's a little more 'layman's' type knowledge that is wonderful too: www.thyroid.about.com

Pam

[loveshinesthru]

i havent been able to get anylabs done yet and healthcheckusa doesnt have a lab near me. i was just wondering cus the back of my throat feels full up by my sinuses. other than that i have so many symptoms of being hypo. my temp was 97.5 this morning. when i had thyroiditis in 99 even tho i was hyper i still had hypo symptoms. isnt that weird? im wondering if i have hashis as i have heart palps too. i tried to call my dr on fri but no answer, i guess she was off for the day.