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hormonal testing and new thyroid results

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Cerebrus189
Cerebrus189 Posts: 315 Member
I had a slew of additional testing done including an additional TSH, T3, T4, RT3, and antibodies testing for my Hashi's. I wanted to get everything tested and although I've been told that my hormones were fine, they're not. I continue to struggle with PMS and cyclic cystic acne on my chin and along my jaw line. When I called back to get my results, the nurse said my hormones were all out of whack. These are the results:

Estradiol 117 (range of 21-251)
Progesterone .1 (range of .1-.3)
Testosterone (.47 (range of .4-1.80)

The nurse said that because my progesterone and testosterone were so low, my estradiol (estrogen) in comparison was very high, indicating estrogen dominance. My DHEA is at 118 and I'm getting ready to do my 24-hr Saliva Test tomorrow morning to check my cortisol. Once we get the results, my doctor wants to start me on Hormone Replacement Therapy. I'm relieved they actually found something this time. I think I've been so undertreated by my previous endocrinologist, that she simply didn't recognize all of the signs.

My labs results last time were slightly lower on T4, and slightly higher on T3, and lower TSH. I'm waiting for my RT3 results to come in still. My new lab results were not ideal but this is what they measured:

T3: 3.55 (1.71-3.71)
T4: .96 (.70 - 1.48)
TSH: 2.99
Antibodies: elevated, indicative of autoimmune Thyroiditis (confirmation of Hashi's diagnosis)

Should I ask my doctor to raise my dosage another grain (60mg) or half a grain? My hair is still falling out more than I'd like and my temperature is still lower than normal.

Replies

  • kats3boys
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    I am not a doctor and I don't play one on TV..

    Synthroid is synthetic T4 only

    Cytomel is a syntheric T3 only

    Armour ( desicated thyroid) is a natural source of thyroid hormone which is equal to 38 mcg of T4 and 9 mg of T3 per 60 mg ( 1 grain)

    The thyroid produces mainly T4 and a little T3..the rest of the T3 is converted by the body ( mainly the liver ) to T3.

    T4 has a 1/2 life ( the time it takes for 1/2 the meds to clear the body) of 24 hours.

    T3 has a half life of roughly 1 1/2 hours.

    When taking T4 it takes the body 4 hours to break down the pill move it to the blood stream and move it from the blood stream into the cells. ( the 4 hr window for calcium/iron binding)
    .
    TSH is not medication time specific which means it is an average of what your body thinking it needs for hormone levels.

    You have a high TSH for someone on medication..so your body thinking it needs more hormone..

    You have a low T4 which means your body has very little T4 to convert to T3 when the T3 replacement wears off.

    You have a high T3 which leads me to guess that either you are not converting or that you took your meds and then went off to do labs? ( labs can not tell what is going into the blood cells vs what is going out, for this reason I always delay meds on lab days or wait 4 hours)

    Assuming no T3 issues then you may want to find a way to increase your T4 instead of your T3..except with your TSH you have some issues but need to find out what first.. estrogen? reverse T3? Took meds at lab time?
  • islandmonkey
    islandmonkey Posts: 546 Member
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    My new lab results were not ideal but this is what they measured:

    T3: 3.55 (1.71-3.71)
    T4: .96 (.70 - 1.48)
    TSH: 2.99
    Antibodies: elevated, indicative of autoimmune Thyroiditis (confirmation of Hashi's diagnosis)

    Should I ask my doctor to raise my dosage another grain (60mg) or half a grain? My hair is still falling out more than I'd like and my temperature is still lower than normal.

    Did you take your meds before your labs? It can cause an artificially inflated free T3 result. Your free T3 looks really high compared to your free T4, and with the symptoms I'd say you need a higher dose.

    Make sure to take your meds AFTER your morning labs. The meds basically flood your body with T3 hormone, so if you get your labs done within a few hours after the binding proteins haven't picked it all up, so your free T3 shows as higher than it really is (simplistically speaking).

    Your TSH that high indicates that your body is still trying to get your thyroid to work hard. That, combined with your symptoms, tells me that you likely need a higher dose. I would talk to your doctor about increasing, and just make sure to take your pill after your get your next labs!
  • islandmonkey
    islandmonkey Posts: 546 Member
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    T4 has a 1/2 life ( the time it takes for 1/2 the meds to clear the body) of 24 hours.

    T3 has a half life of roughly 1 1/2 hours.

    Not quite: T4 has a half life of 5-7 days. T3 has a half life of 12-36.

    Generally the issue with taking meds before labs is that it floods your body with T3 hormone, that is not yet bound to protein carriers (and hence included in the "free" count). Over 99% of T3 hormone is usually bound to protein carriers and is biologically inactive, so it can make quite a difference in the labs.
  • islandmonkey
    islandmonkey Posts: 546 Member
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    The nurse said that because my progesterone and testosterone were so low, my estradiol (estrogen) in comparison was very high, indicating estrogen dominance. My DHEA is at 118 and I'm getting ready to do my 24-hr Saliva Test tomorrow morning to check my cortisol. Once we get the results, my doctor wants to start me on Hormone Replacement Therapy. I'm relieved they actually found something this time. I think I've been so undertreated by my previous endocrinologist, that she simply didn't recognize all of the signs.

    Should I ask my doctor to raise my dosage another grain (60mg) or half a grain? My hair is still falling out more than I'd like and my temperature is still lower than normal.

    Honestly, I would get your thyroid in check before considering any (other) hormone replacement. Hypothyroid generally causes low progesterone, and you are still REALLY hypo (assuming you took your meds before your labs) with that TSH and free T4. I would get that in check, and THEN see how far out your other hormones are....if they're still out of whack. I suspect they won't be.

    I would say you need at LEAST one more grain, but I'd probably do it in 1/2 grain increments.
  • Cerebrus189
    Cerebrus189 Posts: 315 Member
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    Thanks for the replies. After the first response from kats3boys, I was really thinking hard about asking my doctor for another 1/2 grain, up to another whole grain since my T3 and T4 levels can clearly go up. I had taken my medication that morning unfortunately, because I did my labs on a whim when I could've waited another day.

    My doctor wants me to finish the cortisol test first before any additional hormone treatment, so I still have some time to raise my dosage and get tested again before any hormonal treatments. I'll definitely put that off.

    The main symptom that sticks around is cystic acne on my chin and along my jawline indicating hormonal imbalance. I've had acne since I was 19 years old but didn't have it as a teenager. I only got it once I got diagnosed with thyroid issues. Could it be that my thyroid has never been successfully treated and that's why I continue to have acne?

    I was on a T4-only medication at that point and have been until about 6 months ago when I asked to be switched to Armour. I felt better initially and after reading what I have, I now realize my doctor should have increased my dosage within the first month to keep up with it. But she doesn't know a lot about it. If she's not willing to dose me another 1/2 grain to whole grain, I've got another doctor lined up behind her who is a functional medicine doctor and would be willing to at least listen. But I really hope I don't have to change docs. I like this one.

    Thanks for your help, Kats3boys and IslandMonkey.
  • islandmonkey
    islandmonkey Posts: 546 Member
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    I know what you mean - starting with a new doctor is exhausting, and feels like it puts you back months. Hopefully this one will agree to upping your dose.

    And I absolutely think your thyroid has never been properly treated. It's tough to know if there are any additional hormonal issues, because the thyroid impacts everything in your body - so you need to get that to optimal in order to see what (if anything) else is left to treat.

    I would be wanting to go up 1/2 a grain right away.
  • Cerebrus189
    Cerebrus189 Posts: 315 Member
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    IslandMonkey, what do you know about DHEA? My DHEA is at 118 and the range is somewhere between 50 and over 800. Do you know what causes low levels of DHEA? I've heard it called the mother of all other hormones so I'm wondering what the connection is between less-than-optimal thyroid hormone levels and sex hormones being out of whack. As I understand it, DHEA could also be the driving force behind my low libido, joint pain, and bad memory (low testosterone doesn't help either).

    http://www.testcountry.org/signs-and-symptoms-of-dhea-hormonal-imbalance.htm
  • fiberartist219
    fiberartist219 Posts: 1,865 Member
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    I don't know too much about the hormones, but I have acne too. My acne sounds a lot like yours.

    When I was on birth control pills, most of it was under control. I might have a pimple here or there, but it wasn't an all out mess. When I got off the pills, it felt like puberty all over again, and my face broke out. It has settled down some, but it is definitely worse off the birth control. However, I do have more energy now, so being off the pills is worth it to me. I would rather have acne than be tired all the time.

    I wish you the best of luck in getting things figured out with your doctor.
  • islandmonkey
    islandmonkey Posts: 546 Member
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    IslandMonkey, what do you know about DHEA? My DHEA is at 118 and the range is somewhere between 50 and over 800. Do you know what causes low levels of DHEA? I've heard it called the mother of all other hormones so I'm wondering what the connection is between less-than-optimal thyroid hormone levels and sex hormones being out of whack. As I understand it, DHEA could also be the driving force behind my low libido, joint pain, and bad memory (low testosterone doesn't help either).

    http://www.testcountry.org/signs-and-symptoms-of-dhea-hormonal-imbalance.htm

    It sounds like you might have adrenal fatigue from so many years of being "off". That's sort of a non-descript "illness" that isn't well received by the medical community, but to me just means your adrenal system is beat down and needs some support.

    This article had some good info:
    http://drhedberg.com/2011/02/24/the-thyroid-adrenal-pancreas-axis/

    I don't know enough about it specifically to comment, but it could definitely be worth exploring!