New lab results.

Well, as stated in the description of this thread, I am not very happy about these latest results.   They are not terrible, but I just don't like that both the calcium and the PTH have increased.    My calcium was 9.8 (2.45 in UK numbers).  PTH was 43.0 (4.6 in UK numbers).   I did that rather quickly.  I hope I converted those numbers correctly.   Seven months ago, my calcium was 9.7 (2.43) with a PTH of 39.0 (4.1).  I think the latest levels are still acceptable, but I do not like that the calcium and PTH both increased!    I will not be waiting 7 months to get these levels tested again!     I will be insisting that they be checked every 2 months for a while just to be sure there is not another parathyroid tumor developing in there!!

Looks like my aldosterone is not improving at all.  I was really hoping in time it would.  It was 2 this time.   It was the same as it has been for a while now.   At its lowest, it was <1, so I guess it could be worse.  

My thyroid levels have changed since I increased from 105 mg of Armour to 120 mg.    My TSH has risen to 0.12 from <0.06 two months ago, which makes no sense.    My free T4 has dropped to 0.78 from 0.91 two months ago, which also makes no sense.    But my free T3 has risen to 3.3 from 2.7 two months ago.    That is the only thing that makes sense from the increased medication, but it is a good thing.      I would have thought my FT4 would have increased also after increasing the medication, and I thought the TSH would have dropped, which was not the case.     Edwin, I would love your opinion on all of this.

My hemoglobin and hematocrit have both increased slightly, which I am happy about.     Hemoglobin is now 13.9.   Hematocrit is 40.1.   I guess these improved from the iron supplements, but since I stopped taking the iron supplements due to severe hip, knee, thigh, and leg pain which started the day I started taking the iron, I'm thinking these levels may have dropped again now.     I restarted the iron today, now that all of that pain has subsided quite a bit.   I'm anxious to see if it will all return now.

Everything else has pretty much remained the same.    I haven't received the RDW or the MCV levels yet.  I'm very anxious to get those.   That will also help to determine if the iron deficiency is improving at all.

Audrey

Hi Audrey

An increase in TSH is consistent with a reduction in T4, but I do not believe that the TSH provides much, if any, meaningful value once anyone is on hormone replacement.
Also, from what I have read, the TSH can fluctuate over a wider range during the day than T3 and T4.

Regarding the drop in T4, the most obvious possibility is that something has impeded the absorption, such as not leaving enough time (at least 30 mins) between taking the Armour and other medication, food or drink (other than water). T3 does not appear to have such a restriction, so maybe you are benefitting from the extra T3 in the increase Armour dose.

Obviously, this is pure speculation, but also remember that NDT treatments have a higher ratio of T3 to T4 than with a healthy human thyroid.

Another thing is that ananaemia and low iron will have a negative impact on the absorption of both T3 and T4, so I doubt that you will find a satisfactory explanation.

Edwin

Thanks, Edwin!   Much appreciated!

I was aware that TSH pretty much means diddly when you are being treated with NDT, but I was still thinking that level would decrease when increasing the dosage.   I'm not really concerned what that level is, but I just thought it would decrease if I added more medication.   This is what surprised me.

And, I will admit that I do not always wait long enough before eating, after taking my thyroid meds.   I must be more careful with that.    

I like your theory about the higher ratio of T3 to T4 in the Armour causing my increased T3, but once again I am going to throw a wrench into the works here, as my previous labs showed a much higher T4 and a lower T3.   My body just doesn't make any sense.   Although, if there is a higher T3 to T4 ratio, I guess that WOULD cause in increased T3 when increasing the meds.   Still, would the T4 not increase also? Hmmm................

I know about the iron deficiency causing a problem with thyroid hormone absorption.   I am hoping that once we can get my iron up a bit, the thyroid symptoms will resolve.    I am really hoping now that I have started the iron supplements again, the joint and muscle pain will not increase as it did the first time I tried the iron.   That could have been purely coincidental.  I'm hoping that was the case.

I now have something new I am researching.   I checked the patient portal this morning to see if my renin level was available yet.   It wasn't, but while I was on the portal, I was reminded that my lithium level was rather low when tested on March 4th.   My level was 0.02.  Normal is 0.50-1.50.    So mine is really low.   This is funny, because I had previously thought my lithium level might be elevated, because of the way I was itching so terribly when using my laptop.   I thought maybe it was the lithium in the battery causing a problem.   However, I removed the battery, and still itched terribly.   I and my cats are still itching!!  It's been 3 months now for that problem.    That was when I asked my PA if she would check my lithium level.    I was VERY shocked to see my level was abnormally low!     So anyway, this morning I started checking out the symptoms of low lithium.   It seems many of them are similar to low thyroid function!     I'm wondering now if some, if not all, of my lingering symptoms are being caused from the low lithium.    I will be discussing this with my nephrologist at my next appointment on the 14th.    If anybody can help me with this, he can.    One more thing to think about.

By the way, Edwin, how are YOU feeling?   I hope things are improving for you!!

Audrey

hi Audrey

It will be interesting to see if your T4 increases if you ensure that you leave at least 30 minutes before/after taking Armour.
Some forums suggested 2 hours, but 30 minutes seems to be good for me and Nelly's sister who is a pharmacist.

Sorry, but I do not know anything about Lithium

Edwin

Thanks again, Edwin. Yes, I started making a point of waiting at least 30 minutes this morning after taking the meds before eating. I am anxious also to see what a difference that will make.

Audrey

Not just eating, but also coffee, tea and other meds.

It may be a couple of weeks before you notice any difference and probably longer before there is an impact on your blood results, but you should also see an increase in your FT3 resulting from improved conversion (due to having more T4 available).

Fingers crossed ;-)

Edwin

Thanks, Edwin. Yes, when I said eating, I meant drinking as well, except for water. I did take the Armour by itself this morning with no other meds, but I wasn't aware I actually needed to do that, so thank you for the tip. I do hope you are right about the increased FT3. Today my hips, knees, thighs, leg tendons, and elbows are all aching very hard. I sure wish I knew what was causing this! The fact remains, I restarted the iron yesterday, and now today this pain is back full force. I think I need to contact my hematologist and ask him about a different iron supplement. I'll give it several more days, unless the pain gets so bad I can't stand it! I know these symptoms could be from thyroid. It appears they also could be from the iron deficiency and the lithium deficiency. I hope eventually I can figure this out! I'll keep working at it.

Audrey

Audrey, I see no much difference in the last 2 labs. Seem ca, PTH change in a very narrow range. In my opinion it is the behavior of a normal gland.

Thanks, Shery. I do hope you're right. I guess if I had to have another surgery it wouldn't be the end of the world, but I'd rather not have to deal with that. I'll just keep getting those levels checked and hope for the best.

Audrey

Came across something I think many of us can relate to.

Have you considered having an iron infusion.
Faster and much more effective than iron tablets.

I am waiting for my next one in two weeks, after which my Hb will start to recover, finally.

Edwin

Actually, Edwin, that is what I thought my hematologist would suggest.  He didn't, and I didn't say anything.   I guess he figured since my iron was in the normal range at 88, this was not an emergency.    I figured with a ferritin level of 11, he might feel differently.   I have decided if my hips, knees, thighs, and upper arms continue to hurt as badly as they have been, I am going to call him anyway to ask about a different type of iron supplement.   If that happens, I will ask him them.    Actually, I might call and ask him anyway before then.   I think that would make mores sense then to piddle around with these supplements.   I've been talking to some other people with iron deficiency on Facebook, and they are all taking a LOT more iron than 65 mg daily, which is what I'm taking.   One woman is taking 600 mg daily!     The hematologist told me it takes 6 months to replete iron once it is where mine is right now.    I sure hope I start to feel some improvement before then!!

Thanks for the suggestion.    

Is your hemoglobin still extremely low?    I had hoped it was improving by now.   Wouldn't it be nice to be 10 years old again and not have to be thinking about all of this crap?!!  

Audrey

The renal docs told me that iron tablets are a waste of time for renal patients, which is why they go for infusions.
I think that bypassing the digestive system is part of the reason why the infusion is more effective.

My Hb has crept up from 73 to 77 in the last two weeks, so I am still struggling.

My iron infusion is booked for 21st April, so I have a few weeks to go before I start to see a real difference.

I would not want to be 10 again. For me, tomorrow is more important than yesterday.

Edwin

Yes, I have heard that about the iron tablets, Edwin. That was why I was hoping my hematologist would have opted for the infusion instead. As poorly as I am feeling, I think an infusion would make a lot more sense. I need to feel better NOW, not in 6 months! I am going to ask my nephro about the infusion next Tuesday. He is a very intelligent man. I have not talked to him since my ferritin was found to be at 11. I bet he will be all for an infusion. I'm hoping so.

I was wondering something. Since my iron is at 88 (normal being 40-150), would an infusion raise this too high? I'm guessing not? And this might sound stupid, but are there different strengths of infusions, or do they just inject less, according to what a person needs?

That is great that your Hb has risen, even if it is just a tad. Mine just rose VERY slightly this time, and I was thrilled! Although, mine is not as low as yours, so I can understand why you are anxious to get your level up in a hurry. I'm sure you are counting the days until your infusion! As crappy as I feel with my levels as low as they are, I can't even imagine how awful you must feel with yours so much lower!

I received my latest renin level today. I was really hoping it would have gone up a bit. It didn't, but it didn't go down either. It stayed exactly the same at 0.17. Normal is 0.25-5.82. I had read that iron aids in the production of enzymes throughout the body. Since renin is an enzyme, I'm hoping that once I get my iron level up, the kidneys will start producing more renin, which in turn would trigger more aldosterone production, and maybe I will be able to stop taking the Florinef. I don't know, what do you think? Does that make any sense to you?

Something has bothered me since I saw the hematologist. I took a list of my symptoms with me to that appointment. I always do take a list of symptoms with me to my appointments, just in case I might forget to mention some of them. Some of my symptoms included, extreme fatigue, dizziness, weakness, shortness of breath, frequent infections (UTIs), muscle cramps, muscle twitches, muscle pain, etc. The hematologist looked at my list and told me that none of my symptoms could be caused by low iron, and that I should keep searching for the cause. ???? That really surprised me. All of those symptoms are listed all over the internet as being symptoms of iron deficiency. Since he was a new doctor, I didn't want to argue with him, but I think he is wrong! I am HOPING he is wrong!

Audrey

I am not sure that it is as simple at looking at just the iron and Ferritin levels, because saturation is also important.
My Ferritin is actually quite good, but the iron saturation is not.

http://www.rixg.org/results/iron.html

Edwin

Yes, it is quite complicated, Edwin, but my hematologist told me that my ferritin should be much higher, and because it's not, I am iron deficient. My transferrin saturation is 25%. Normal is 20-55. So it is in the normal range, but low/normal. I'm guessing, as the hematologist stated, if this deficiency was not treated now, it would soon be full-blown anemia, and then that saturation level would be below the normal range.

The link you posted here states that transferrin and TIBC are the same thing. Here in the US those are 2 separate tests. The tests I had done are iron, transferrin, TIBC, ferritin, and transferrin saturation. Now it's even MORE confusing!!

My results were iron 88 (normal 40-150), transferrin 249 (normal 187-346), TIBC 349 (normal 235-406), transferrin saturation 25% (normal 20-55), and ferritin 11 (normal 11-307).

The hematologist also viewed my RDW and MCV levels. My RDW has been elevated for several months now. My MCV has been as low as possible without below normal range. I'm sure you are aware that this combination reveals an iron deficiency.

He also viewed my hemoglobin and hematocrit levels. Both of these levels, like the MCV, have been as low as possible without being below the normal range. My last lab results of 1-1/2 weeks ago, revealed that both of these levels have very slightly improved.

This is all very interesting, especially how the tests are so different. I am going to discuss this with my nephro on Tuesday. I wonder if he might know why the UK considers transferrin and TIBC the same thing, and the US does not. Might you know?

Audrey

I forgot to mention that your normal range for ferritin is a bit narrower than ours here in the US. Your normal range is 17-300. Ours, as stated earlier, is 11-307. My level at 11 is still considered in the normal range; although, VERY low/normal. In the UK, my level would be considered abnormally low. I know different labs use different reference ranges, but it they're using the same unit of measure, shouldn't they be the same?

Audrey

I would not read too much into the ranges, as they vary between different labs, so they are more of a guide than being absolute or national levels.

Edwin

Edwin, do you think my doctors would consider an infusion since my levels are not extremely low at this point? I don't want to feel like an idiot asking my nephro about this, but I'd really like to discuss it with him.

Audrey

You have nothing to lose by asking and it gives your doc an alternative to you continuing to suffer with the iron tablets.

Edwin

Thanks, Edwin.    I think I will ask him about the infusions.   If they would hurry things along for me, that would sure be nice!

I am also going to ask him about switching me to Nature-throid instead of Armour.   I keep hearing about how bad the fillers in Armour are for some people.   I'm wondering if possibly I am allergies to something in the Armour, and maybe that's why I'm having so much muscle pain and stiffness.   I figure I also have nothing to lose by trying this.

Thanks again for your help!

Audrey

As far as I know, all of the FDA approved NDTs have the same T4/T3 levels, so you have nothing to lose by trying an alternative.

I know that some people have allergic reactions to specific manufacturer's T4 tables, which is assumed to be caused by fillers/binders in the tablets.

Thanks again, Edwin.

I saw my little nutty nephro on Tuesday, and I talked him into prescribing Nature-throid for me.   I didn't think he was going to go for this at first.    He looked at my latest lab results and said, "But your levels look GREAT now!"   I didn't feel like arguing with him that my FT4 was still rather low at 0.78, so I didn't say anything.   I told him I am still feeling like crap with a LOT of muscle and tendon pain, edema, fatigue, etc., so I am not finished looking for answers or trying different treatments to feel good again.   I told him I know Armour has more fillers and binders than Natur-throid, and I have a VERY sensitive body.  I told him I am wondering if possibly I am allergic to something in the Armour, which might be causing me problems.    I feel bad asking this doctor for thyroid help, since he is a nephrologist, but he was the one who was not happy with my FT4 being at 0.55 and 0.60 back in July, and told me I needed to increase my Armour.    So I am now letting him treat my thyroid.     This is a weird situation, because I am still seeing my endocrinoloigst, and she is now not treating ANYTHING for me!     It will be very awkward seeing her next week, but she couldn't diagnose the HPT, she wasn't properly treating my thyroid, she wouldn't diagnose the adenal issuue, and then when that was proven through labwork, she didn't know how to treat that.     I really don't know why I still see her.    I guess I figure if I have several different doctors, I have a better chance of getting all of the tests run which I request

My Nature-throid has not yet arrived in the mail.   I am VERY anxious to get started on it!!

I am going to start a new thread to post my entire appointment experience of Tuesday.    Other than getting the script for the Nature-throid, it was not a very good appointment.    

Audrey

It sounds like you have made some progress, in that you have something new to try.

Just from my reading of patient experiences, Endocrinologists are the worst people to see about Thyroid issues beause what they are taught is inadequate and they are bound by official guidlines.

I am not surprised that good Cardiologists and Nephrologists are sometimes better for Thyroid treatment.  Firstly, becasue they see the effects of under medication (unlike Endos) and, secondly, because they have not been brainwashed by official Thyroid guidelines and influenced by the manufacturers of T4 tablets (who have considerable influence on Endos).

Edwin

Yes, I am very excited about the new thyroid medication, Edwin.   It might not make a difference, or it might make things worse, but I'm very anxious to give it a try.

I agree that endos are not very good at treating thyroid issues.   In my endo's case, she is not very good at treating ANYTHING.   I think she mainly deals with diabetes.  She might good at that, but I am not diabetic, so I don't know.   

I also agree that endos and most other doctors are trained to look only at the TSH, and we all know that just doesn't work.    With a normal body, it might work to simply look at the TSH, but if there's a thyroid issues, the TSH means diddly.  And there is no way of knowing if a body is functioning correctly, so ALL levels need to be tested, not just TSH!

Audrey