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Old 04-29-2013, 06:00 PM   #1
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April Test Results

I finally asked the nurse to order a test to determine if T4 was converting to T3. She didn't think it was advisable because after all it is hard to get Armour or other meds optimized, and it is much easier with T4. She offered TSH and Free T4. The plan was to get thyroid results, Vitamin D (I run low), Magnesium (my request), A1C (I'm diabetic primarily because my morning readins run high and skew all other readings - I work long hours and eat late at night. All other two hour postprandial scores are between 85 and 105); TSH, and Free T4 as well as cholesterol screening.

I asked my doctor the same question, and she said we could. However, she was more concerned that I develop better sleep habits. True. I need to work on that. I have a high stress job, and often I work 14 hours a day.

She wanted to order an ultrasound of my carotid arteries because my tension/migraines have changed this year. This would be because of the demands of the job this year, but I have a lot of muscle tension which tends to last for about a week (affecting my neck, shoulder, scalp, face, and arm on the right side). My chiropractor has been able to help me manage the headaches so I very seldom need meds, but the ones the last few months have been bad.

I went in for labs early one morning and asked about the T3 conversion test. The technician added it to the list and said she would run it if the doctor approved.

Test results:
No A1C score.
Cholesterol 196
187 Triglyceride ( down about 25 points since August but should be <150 by labs)
44 HDL (labs indicate >39 is normal)
37 VLDL (range 2-45)
115 LDL (the lab score was whited out and changed to <70) This score had dropped since August as well.

1.3 Free T4 (range .85 - 1.76)
2.16 TSH (range .27 - 4.68)
2.1 Free T3 (range 1.6 - 2.6)

Vitamin D and Magnesium were OK. I need to continue taking the D3 supplement.

The ultrasound revealed absolutely no problem with plaque.

In August she started me on 1000 mg Metformin daily. She did recommend a statin, but I refused to take it.

This time she wrote on the lab results that I should continue taking the statin. No way. I know that my diabetes is behavioral, and that if I lose weight and eat better, I will be able to manage w/o meds. That is the plan for summer. I am disappointed that the A1C wasn't completed since it was listed, and it was 6 months since I started taking Metformin. The fasting glucose was a little high as I had predicted whether I take meds or not.

Any thoughts on the thyroid results? Do I request that she consider a med in addition to levothyroxine, or is it time for a 2nd opinion or new doctor? Those are the htoughts I am wrestling with this week.

Thanks!

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Old 04-30-2013, 05:32 PM   #2
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Do you have those results on the test results copies in front of you, or did you get those over the phone? I'm only asking because that range for FT3 looks like a range for a Total T3.

Otherwise, the TSH would be 'high for me but if my Free T3 were THAT high (again, doesn't look like any range I've ever seen for FREE T3...many doctors do 'apples and oranges' and do a FT4 to appease, and then the cheaper T3 test...Total T3) I'd not worry about thyroid conversion.

Do you lowcarb? Cuz if you do and you stick to the plan as written (most of them) those trigly's should be coming way down.
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Old 04-30-2013, 10:04 PM   #3
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Thanks! I appreciate your comments.

They always mail me a copy of the test results. It's late, but I looked the papers over again to see if I misread.

The nurse offered to do FT4, but when I asked her what that would really tell in regard to my question. She admitted that she didn't know, but they have ordered that test in the past for others. So she ordered TSH and FT4.

My lab tests were fasting, and I walked into the labs a few days later and requested the FT3 be added to the list. The technician wrote it on the order and said that the doctor could still choose not to approve the test. The only difference in the wording between it and T4 Free is a comma (T3, Free), but I attributed that to the fact that it was added to the list by the lab technician.

Yesterday I did not copy the range correctly from the lab report. I confused it with the range for the magnesium test which was next to it. The results I listed previously as FT3 were the magnesium results. sorry

The FT3 range is actually 2.3 - 4.2 and corresponds with the range listed on Mary Shomon's site. My reading was 2.6 which is at the low end of the reference range.



Re: TSH It's the lowest result mine has ever been. It took a lot of talking to convince my doctor that I wanted to work toward getting a result closer to 2. She finally upped my levothyroxine slightly in August and that brought the TSH level down from @ 3.05.

I have drastically reduced carbs (for me). I have done low carb in the past, and had no problems with it. So I could do that.

I won't do statins. I'm eating better and exercising more. I need to sleep more than 5 hours a night.
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Old 05-01-2013, 02:53 AM   #4
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I would find another doctor.

I've never heard of a doctor diagnosing diabetes based on the fasting number alone. I'm not diabetic, but my endo uses the A1C to monitor my blood glucose. It is an average over 3 months and a far more reliable indicator of one's blood glucose issues than the fasting number. One endo I had was concerned about diabeties (all my siblings are Type 2), and she ordered a Glucose Tolerance Test. That's an additional way to check for diabetes.

If you're taking thyroid hormones, then your TSH should be in the range of 1.0. Any reading at 2.0 or above, usually means you need a dosage adjustment.

You don't need statins. As a matter of fact, if you get your thyroid hormones optimized, you may see that LDL go down. It is well known (apparently not by your medical group) that hypothyroidism will raise LDL if not properly treated.
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Old 05-01-2013, 04:00 AM   #5
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I'm sure there are still people and doctors who use the TSH to 'mean something'..well, it DOES..it's to be used in determining if there is a problem with the thyroid/pituitary as a first 'glimpse'. It's not, never was, supposed to be used to titrate incoming hormone. So..I'll just say that getting some T3 (Cytomel if your doctor isn't quite 'up to par' at realizing that Armour and other naturals aren't hard to use...only if they go by TSH to medicate...) would drop that TSH into the lowest of lows. Which might be a problem with your specific doctor..as some will rip that back out of your hands (the T3) because of the way it lowers TSH (any amount).

So, agree with Leo41...find a another doctor.

Now, a glucose tolerance test is ok IF YOU ARE NOT LOWCARB (and if you look up Dr. Eades, he discusses this)...an even BETTER indication would be for you to have a fasting insulin test.

But, if you lowcarb, and everything comes in line (I am a diabetic, I take no insulin, I don't have to, I stay lowcarb for life and my doctor...yes, the thyroid doctor...does fasting insulin test.

Insulin resistance goes with undertreated hypothyroidism.

It's the tri glys that will hurt heart vessels...and lowcarb is known to bring those down as well as LDL (but don't get it checked till you're six months in with no cheats..LDL rises slightly after beginning a lowcarb lifestyle.).
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Old 05-01-2013, 06:08 AM   #6
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That's the direction I'm leaning. This doctor has done so much for me since I walked away from a previous doctor who thought that the normal range for TSH extended to 6.0.

I have had an A1C three times in the last three years. I work long hours (12-14 hour days) in a high stress job. I was maintaining energy levels by drinking 3-4 Dr Peppers (20 oz) a day and eating junk food (high carbs). Busiest times of year are August through November and March through June. So the timing of A1C's were at the worst time of the year. 6.5, 6.7, and the last was 6.3. She knew the high A1C was driven by morning readings because many days I eat dinner later in the evening (often between 8 and 10). I was managing without meds and reducing carbs, but she wanted to add Metformin and statin in August. I went with Metformin but refused the statin. I'm even more frustrated that there was no A1C even though they said they were ordering it.

hmmm...

More later. Time for work.
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Old 05-01-2013, 06:54 AM   #7
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mmshadows, there are several very good recommendation list for thyroid doctors on the net...I have some for every state myself...if you would care to say what state you are in (some are very difficult to find a good thyroid doctor in...and most of us are travelling up to two hours one way...we know once we are stabile, we'll only return for testing a couple times a year) perhaps some of the people here can help you search.

Not long ago, I was sent to a specialist...I have bone disease and other autoimmunes...and the specialist actually WARNED me 'strongly' against lowcarb..as it wasn't 'natural' to have triglycerides at 36 and an HDL over 65!!! (LDL was 86)...he actually wanted me to 'raise these and if they go 'too high' we can add a statin!'

I won't say what I was thinking...it's not printable here.
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Old 05-01-2013, 02:27 PM   #8
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I'm from Iowa. I know of a few places in the Iowa City/Cedar Rapids area. I just haven't followed up yet. But I'm open to any suggestions at this point.

I have an autoimmune related issue myself, and I see a separate doctor in the Iowa City area for it. I understand that there may be someone in CR that practices integrative medicine. I believe that if I get the thyroid optimized that I won't need any meds except for the autoimmune issue. And I know it may be wishful thinking!! But...you never know unless you research and ask.

I can so relate to your last comments. Maybe not the same situation but similar experiences.
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Old 05-01-2013, 04:27 PM   #9
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I have a friend in CR that USED to be the head of the thyroid advocacy group there. She's still searching for someone to give her natural thyroid..but has found a doctor willing to 'let go of just TSH' and focus on her FT's...but has her taking synthetic T4/T3(Cytomel) combo...and if you get a savvy doctor...that can work just as well as natural.

Yes...I have two rare autoimmunes (that resulted in the death of both my parents under age 50) but having my thyroid optimized has made it possible for me to live life to the very fullest. But, I still take seven different meds daily to 'function' at this point.

You might want to check the site I mentioned for doc's list, and also join your Yahoo thyroid group for your State.

In the meantime, you might even post another post here saying 'who has a good thyroid doctor, who gives both T4/T3 in ________ Iowa? That might just bring you a name that could be more helpful to you.

Best of luck to you.
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Old 06-07-2013, 05:51 PM   #10
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I'm from Iowa. I know of a few places in the Iowa City/Cedar Rapids area. I just haven't followed up yet. But I'm open to any suggestions at this point.

I have an autoimmune related issue myself, and I see a separate doctor in the Iowa City area for it. I understand that there may be someone in CR that practices integrative medicine. I believe that if I get the thyroid optimized that I won't need any meds except for the autoimmune issue. And I know it may be wishful thinking!! But...you never know unless you research and ask.

I can so relate to your last comments. Maybe not the same situation but similar experiences.
mmshadows, I just saw this thread. I am in Iowa City, I go to UIHC docs based on my insurance. My DH sees Nisly at Internal Med and she is into complementary/alternative medicine and is working on getting in to a proper Amour dosage. My only quibble is that I think he needs more metformin (he has type 2) and she hasn't tested his insulin levels, but I guess that might go along with she would rather have him control it with diet. She also hasn't pushed statins on him yet for cholesterol, though based on her rec he is taking red rice yeast. He likes her a lot, switched over from a family practice doc that was terrible. I just saw another internal med doc last week, doesn't want to treat me even though I have low free T3 and high anti-TPO and fairly high TSH (I started another thread on that topic a few days ago). I am going to get a second opinion from Nisly as soon as I can get an appointment. If you have any recs for other docs in IC, I would be interested in hearing about them, if you are around.

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Old 06-12-2013, 08:18 PM   #11
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sorry, I'm a newbie, but why no statins? I'm taking Pravastatin- is that what you're talking about? My mom says no to taking it too because it gave her 'brain fog'.
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Old 06-22-2013, 09:30 AM   #12
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Hi Karenlee,

I don't know that my answers will make match what some of the others have to say about statins, but here goes.

I have been treated for high bp about 15 years. Off and on I have been on losartan by itself and sometimes combined with lasix. I had thought I had a thyroid problem since I was 30, and it took 20 years and a hospital stay to finally be diagnosed. Since diagnosis, I have been reading and asking lots of questions. I now know that when I was 30 I should not have been satisfied with a statement that I was normal, and I should have asked for copies of my test results. But that was then, and this is now.

Nearly 4 years ago, diabetes 2 was thrown into the mix. I knew my problem was behavioral, and I wanted to manage without meds. I was able to do very well, except I couldn't keep a good morning reading consistently (some mornings I had readings between 123 and 149). So my doctor prescribed metformin in August 2012.

During the time between the type 2 diagnosis and now, I began to read even more. I discovered that the lasix can elevate blood glucose readings. So that began my quest to get off lasix. My doctor refused until I blew a gasket and said I couldn't afford all these meds and didn't want to be a walking pharmacy. So 6 months after telling me that I couldn't go off lasix and potassium, she relented and told me I could drop those and take the statin.

I know the statin she prescribed was a lower dose, but some statins (including the one she prescribed) raise blood sugar readings. People who are not diabetic can become diabetic from taking it.

I'm not being a pollyanna. I do know that lasix was not what tipped the scales and made me diabetic, but it did contribute. I don't need that sort of help, so I've avoided statins too.

Janene

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Old 06-23-2013, 03:06 AM   #13
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sorry, I'm a newbie, but why no statins? I'm taking Pravastatin- is that what you're talking about? My mom says no to taking it too because it gave her 'brain fog'.

If you're taking a statin I hope you're also taking Coenzyme Q10 (CoQ10) as the statins deplete it, which is not a good thing.
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Old 06-24-2013, 10:41 AM   #14
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Would pravastatin be one of those statins we're talking about?
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Old 06-24-2013, 04:08 PM   #15
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Would pravastatin be one of those statins we're talking about?
Well yes, it Does have 'statin' in the name. Look up statins to get all the brands. Also, phenofibrate is used to lower cholesterol even though it's not a statin, but many people get the same side effects from it (muscle pain is one).
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Old 07-31-2013, 12:32 PM   #16
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mmshadows,

Have you found a dr in Iowa you like yet? That treats with ndt? I am still looking.
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Old 07-31-2013, 01:17 PM   #17
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Also, mmshadows, have you heard of Integrative Health and Hormone Clinic in Cedar Rapids? Or has anybody heard of them and what do you think?
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Old 07-31-2013, 05:02 PM   #18
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I checked out the website catkan...and nowhere do I see that they use anything except supplements (that they sell) and alternatives. You might want to call and make sure that they WILL RX. NDT and/cytomel before you start an expensive process. Just a thought.
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Old 07-31-2013, 07:38 PM   #19
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you can get the same effect of a statin from taking niacin/baby aspirin.. managed under a drs care.
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Old 08-01-2013, 06:43 AM   #20
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I checked out the website catkan...and nowhere do I see that they use anything except supplements (that they sell) and alternatives. You might want to call and make sure that they WILL RX. NDT and/cytomel before you start an expensive process. Just a thought.
Thank you for taking the time to look. I did e-mail them yesterday with a bunch of questions. I got an e-mail back this morning, she uses medicines/supplements to treat thyroid, so yes you are right. Thank you for pointing that out. They didn't really answer the questions I asked either.



Cindy,



Thank you for your email.



Dr. Gray deals with several issues. Thyroid is just one area she is proficient in.



Dr. Gray uses all types of medicines/supplements to treat thyroid issues.



Dr. Gray will test the TSH, T4 free, Free T3 and Thyroid peroxidase and Thyroglobulin antibodies and reverse T3.



We also use saliva tests and yes Dr. Gray knows how to interpret the tests.



Yes we can order iron tests.



Dr. Gray is very proficient in how iron, thyroid and adrenals are related.



Dr. Gray treats issues that fall on the low and high end of the normal range.



I have also attached the new patient packet. If you are interested in becoming a patient of Dr. Gray please complete the packet and return to the office. Once we receive the new patient packet Dr. Gray will review and we will contact you to schedule an appointment. We are currently scheduling new patients for the beginning of September. All additional questions may be asked during your initial consultation with Dr. Gray.
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Old 08-01-2013, 05:47 PM   #21
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It's a pity Dr. Gray wasn't proficient in the area of answering your questions spot on. Sigh.

Perhaps if you re email and just put 'I'm looking specifically for a doctor who uses natural dessicated thyroid OR a combination of synthetic T4 and MORE IMPORTANTLY, Cytomel, and I cannot waste time nor money on any medical care that does not include the above, thank you.

???
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Old 08-02-2013, 06:15 AM   #22
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You know, I did re e-mail back. It was her assistant that replied to each e-mail along with a new patient packet. I won't be seeing her. I am done with travelling miles if they can't answer the questions.


Thank you for replying.

Would you answer the question of which she uses, synthetics or NDT's to treat the thyroid? Or neither, just supplements.

Answer:
What is suggested and/or recommend will vary per patient.

Me:

I am trying to understand if she can write scripts or does she just use supplements?

Answer:

She can write prescriptions if need be.
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Old 08-03-2013, 12:46 AM   #23
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Wow, talk about V A G U E.
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Old 08-03-2013, 07:57 PM   #24
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Wow, talk about V A G U E.

That is a good word for the whole convo.
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Old 08-25-2013, 09:15 PM   #25
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I haven't moved forward yet, Catkan. I have to set an appointment with my gyn who treats my autoimmune condition. I am going to ask her about Nisly because that one has been mentioned here and by a friend who works at UIHC.

I don't know if the other one you contacted is the same one I was leaning toward. The one I had in mind was a nurse practitioner who practices integrative medicine. I've been hesitant to take that step just because I have seen other places that push expensive tests and supplements.

I have not talked to my local doctor, and I might give her one more follow-up. I hesitated because I felt her nurse's response would probably also be my doctor's response. I want to try natural thyroid or Cytomel. I want to know that there might be a difference.

I can't help believe that a bunch of other things I'm dealing with will change if this option is explored. Emphasis on change as in improve not necessarily go away.
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Old 08-30-2013, 06:41 PM   #26
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Mmshadows, I have an appointment with Nisly on Wednesday. I can post about how it goes. She was booked about 2 months out. DH sees her every 3 months.
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Old 09-02-2013, 07:47 AM   #27
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Mmshadows, I have an appointment with Nisly on Wednesday. I can post about how it goes. She was booked about 2 months out. DH sees her every 3 months.
Not Mmshadows, but looking forward to your review of her.
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Old 09-06-2013, 10:52 AM   #28
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Mmshadows, I have an appointment with Nisly on Wednesday. I can post about how it goes. She was booked about 2 months out. DH sees her every 3 months.
how did you appt go?
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Old 09-11-2013, 09:41 AM   #29
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Mmshadows, I have an appointment with Nisly on Wednesday. I can post about how it goes. She was booked about 2 months out. DH sees her every 3 months.
Can you give us an update?
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Old 09-16-2013, 06:26 PM   #30
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how did you appt go?
Quote:
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Can you give us an update?
Sorry for the delay! Posted my update in this thread:

TSH test results
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