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Help Interpreting Numbers

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I am really confused about what my numbers are doing and if I'm getting good medical care. My numbers were (on 60mg Armour/day):

TSH .07 (.40 -4.50)

T4, Free .8 (.8-1.8)

T3, Free 3.2 (2.3 - 4.2)

T3, Total 106 (76-181)

Antibodies 155 (<20)

So I went down to 30m Armour/day and now my numbers are:

TSH 4.18 (.40 -4.50)

T4, Free .9 (.8-1.8)

T3, Free 2.9 (2.3 - 4.2)

Antibodies 193 (<20)

Can the TSH change that dramatically? I don't understand why the TSH fluctuates so greatly, yet the T4 and T3 stay virtually the same.

Any help here? Thanks.

I've been gluten free since January when my Antiboties were about 400. Thanks.

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I am really confused about what my numbers are doing and if I'm getting good medical care. My numbers were (on 60mg Armour/day):

TSH .07 (.40 -4.50)

T4, Free .8 (.8-1.8)

T3, Free 3.2 (2.3 - 4.2)

T3, Total 106 (76-181)

Antibodies 155 (<20)

So I went down to 30m Armour/day and now my numbers are:

TSH 4.18 (.40 -4.50)

T4, Free .9 (.8-1.8)

T3, Free 2.9 (2.3 - 4.2)

Antibodies 193 (<20)

Can the TSH change that dramatically? I don't understand why the TSH fluctuates so greatly, yet the T4 and T3 stay virtually the same.

Any help here? Thanks.

I've been gluten free since January when my Antiboties were about 400. Thanks.

Hi cmost, and welcome to the forum!

Yes. TSH can fluctuate even in one day, however your result is simply a response to the drop in Armour dose. The key to getting a good thyroid test is to have it done consistently at the same time of day, and also to make sure (especially with Armour) that you do NOT take your pill before testing. It causes a T3 spike that will scare your doctor.

I don't see anything in your first test that would call for reducing your Armour (though, keep in mind I am not a doctor). What was your doc thinking?

Armour Thyroid will suppress your TSH even in the presence of NORMAL free hormone levels, and a doc who prescribes it should know that. Just because your TSH was low didn't mean you are hyper. Your metabolism is managed by THYROID hormone, not by the PITUITARY hormone known as TSH.

Your thyroid hormone was fine, though the FT4 was at the bottom of normal. That is expected on Armour. Free T3 is what your cells pick up, and that was FINE. Your FT3 is almost exactly in the 50th percentile of range, almost perfect. There is some thought out there that people with Hashimoto's should be treated to a suppressed TSH, supposedly causes great reduction in antibodies. Armour does a great job of that, though in some people it causes increased antibodies. Judging from your test, yours increased with the drop in med strength.

I've read (though I can't remember where) that organ specific antibodies can be affected by a gluten free diet, glad to see it seems to have helped you!

I also present with a low FT4, my doc has overcome that by adding a little synthetic T4. The problem with Armour is that it does not offer the same ratio of T4 to T3 that your body makes, so you will have screwy lab tests. The pig produces roughly 80% T4 and 20% T3, the human makes closer to 90% T4 and 10% T3.

The big question is, how were you feeling? And how are you feeling now?

I repeat, I am not a medical professional and I am just offering things to think about derived from my own research on thyroid conditions. I am a thyroid patient who suffered greatly from the blithe mishandling of my thyroid by docs who don't have a clue.

Best,

beachbirdie

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Hi cmost, and welcome to the forum!

Yes. TSH can fluctuate even in one day, however your result is simply a response to the drop in Armour dose. The key to getting a good thyroid test is to have it done consistently at the same time of day, and also to make sure (especially with Armour) that you do NOT take your pill before testing. It causes a T3 spike that will scare your doctor.

I don't see anything in your first test that would call for reducing your Armour (though, keep in mind I am not a doctor). What was your doc thinking?

Armour Thyroid will suppress your TSH even in the presence of NORMAL free hormone levels, and a doc who prescribes it should know that. Just because your TSH was low didn't mean you are hyper. Your metabolism is managed by THYROID hormone, not by the PITUITARY hormone known as TSH.

Your thyroid hormone was fine, though the FT4 was at the bottom of normal. That is expected on Armour. Free T3 is what your cells pick up, and that was FINE. Your FT3 is almost exactly in the 50th percentile of range, almost perfect. There is some thought out there that people with Hashimoto's should be treated to a suppressed TSH, supposedly causes great reduction in antibodies. Armour does a great job of that, though in some people it causes increased antibodies. Judging from your test, yours increased with the drop in med strength.

I've read (though I can't remember where) that organ specific antibodies can be affected by a gluten free diet, glad to see it seems to have helped you!

I also present with a low FT4, my doc has overcome that by adding a little synthetic T4. The problem with Armour is that it does not offer the same ratio of T4 to T3 that your body makes, so you will have screwy lab tests. The pig produces roughly 80% T4 and 20% T3, the human makes closer to 90% T4 and 10% T3.

The big question is, how were you feeling? And how are you feeling now?

I repeat, I am not a medical professional and I am just offering things to think about derived from my own research on thyroid conditions. I am a thyroid patient who suffered greatly from the blithe mishandling of my thyroid by docs who don't have a clue.

Best,

beachbirdie

Thanks so much - I saw the PA that day and she lowered the Armour because the TSH was "too low". She seemed very unsure of herself... I have a consult with the doc on Monday, though, and I'm feeling pretty lethargic, so I'll bet he raises me back up. Adding Levothyroxine was also one of the things that had been discussed at one time, so now that would make sense also. So having that low of TSH doesn't cause any side effects? I still have so much to learn!

Your comment "people with Hashimoto's should be treated to a suppressed TSH" - I did not follow what that means. Sorry -

Thanks for all the info -

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Thanks so much - I saw the PA that day and she lowered the Armour because the TSH was "too low". She seemed very unsure of herself... I have a consult with the doc on Monday, though, and I'm feeling pretty lethargic, so I'll bet he raises me back up. Adding Levothyroxine was also one of the things that had been discussed at one time, so now that would make sense also. So having that low of TSH doesn't cause any side effects? I still have so much to learn!

Your comment "people with Hashimoto's should be treated to a suppressed TSH" - I did not follow what that means. Sorry -

Thanks for all the info -

About the suppressed TSH, I don't have a citation at hand but it's out "there" somewhere in the vast reaches of the Internet. What I meant to say is, if a person has Hashimoto's, there are knowledgeable endocrine people who have written that the TSH should effectively be as close to zero as one can get. That is accomplished by gradually increasing the dose of thyroid meds till the TSH is as low as possible without making the person have symptoms of overmedication.

A low TSH, by itself, if artificially suppressed with meds, does not on its own necessarily cause symptoms if thyroid is the only problem in the pipeline. Low TSH is simply an indicator to the body, via a complex feedback loop, that there is sufficient thyroid hormone circulating, and that the thyroid gland doesn't need to make more. That statement does NOT fit everyone, because some people have pituitary problems and that can cause a low TSH too.

I'm addressing ONLY a TSH that looks like it was suppressed by Armour. It is too high of Free thyroid hormone (again, generalizing for "normal" thyroid treatment) that will cause symptoms.

My TSH is .03 (yes, point zero three...no typo), just to give you an idea. And I feel fine. My free hormone is about like yours, T4 is a little lowish, and T3 is about mid-range.

You might have to play around with your doses a bit to get where you feel well, it sounds like your doctor is on the ball with it if he is offering to add a little synthetic to your Armour.

You can find some dose calculators to play around with that were created by a regular (and one of the smart people!) at the about.com thyroid forum. You can play with different ratios of T3/T4, and can find where you are in your lab range as a percentage of range, some other stuff too. I use the Excel versions because the HTML don't work for me.

Actually, for thyroid, the thyroid forum at about.com is a pretty good place to learn. That's where I started many years ago.

Best,

beachbirdie

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About the suppressed TSH, I don't have a citation at hand but it's out "there" somewhere in the vast reaches of the Internet. What I meant to say is, if a person has Hashimoto's, there are knowledgeable endocrine people who have written that the TSH should effectively be as close to zero as one can get. That is accomplished by gradually increasing the dose of thyroid meds till the TSH is as low as possible without making the person have symptoms of overmedication.

A low TSH, by itself, if artificially suppressed with meds, does not on its own necessarily cause symptoms if thyroid is the only problem in the pipeline. Low TSH is simply an indicator to the body, via a complex feedback loop, that there is sufficient thyroid hormone circulating, and that the thyroid gland doesn't need to make more. That statement does NOT fit everyone, because some people have pituitary problems and that can cause a low TSH too.

I'm addressing ONLY a TSH that looks like it was suppressed by Armour. It is too high of Free thyroid hormone (again, generalizing for "normal" thyroid treatment) that will cause symptoms.

My TSH is .03 (yes, point zero three...no typo), just to give you an idea. And I feel fine. My free hormone is about like yours, T4 is a little lowish, and T3 is about mid-range.

You might have to play around with your doses a bit to get where you feel well, it sounds like your doctor is on the ball with it if he is offering to add a little synthetic to your Armour.

You can find some dose calculators to play around with that were created by a regular (and one of the smart people!) at the about.com thyroid forum. You can play with different ratios of T3/T4, and can find where you are in your lab range as a percentage of range, some other stuff too. I use the Excel versions because the HTML don't work for me.

Actually, for thyroid, the thyroid forum at about.com is a pretty good place to learn. That's where I started many years ago.

Best,

beachbirdie

looking at all the stuff you posted above- in the whole thread- about suppressing the TSH, etc...

1st off- u do know that our doctors are fixated on the TSH- this is how they base our dosage.. at least most of them do- :(

2nd- what's your opinion on your advice above about suppressing the tsh to someone in my situation (Hashi & Graves)??? if i only had Hashi- i would be printing out this thread and demanding to be suppressed... but im concerned cause i do have hyper as well :/ ??? i wanted to ask her last visit- what the harm would be in keeping my tsh suppressed- as long as my symptoms & ft4 & ft3 are ok, but we ran out of time. :/

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looking at all the stuff you posted above- in the whole thread- about suppressing the TSH, etc...

1st off- u do know that our doctors are fixated on the TSH- this is how they base our dosage.. at least most of them do- :(

2nd- what's your opinion on your advice above about suppressing the tsh to someone in my situation (Hashi & Graves)??? if i only had Hashi- i would be printing out this thread and demanding to be suppressed... but im concerned cause i do have hyper as well :/ ??? i wanted to ask her last visit- what the harm would be in keeping my tsh suppressed- as long as my symptoms & ft4 & ft3 are ok, but we ran out of time. :/

To answer your first question, they use TSH because that's what they are taught in medical school and it's in their literature. Wish it were deeper than that. Because TSH is a good tool for diagnosing thyroid in the untreated individual, they think it works in a treated person the same way.

As for the dual Hashi/Graves thing, I don't know anything about that. You might head over to thyroidmanager.org and look at the chapters on Graves.

How have they been managing that so far, and how long ago were you diagnosed? Did they do any radioactive iodine (RAI) or thyroid suppression drugs? In my case, I have no natural thyroid function left, and am completely dependent on thyroid meds. TSH doesn't tell my doc anything, because my feedback system is broken.

How you feel should be a very important consideration. They should be willing to work with you to get you to the point where you feel good...able to function close to normal, as few symptoms as possible. The ups and downs of Graves and Hashimoto's make it very difficult for even the best of docs to work with I think, based on what I've heard from people with both conditions.

Sorry I can't offer more to think on with this...

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To answer your first question, they use TSH because that's what they are taught in medical school and it's in their literature. Wish it were deeper than that. Because TSH is a good tool for diagnosing thyroid in the untreated individual, they think it works in a treated person the same way.

As for the dual Hashi/Graves thing, I don't know anything about that. You might head over to thyroidmanager.org and look at the chapters on Graves.

How have they been managing that so far, and how long ago were you diagnosed? Did they do any radioactive iodine (RAI) or thyroid suppression drugs? In my case, I have no natural thyroid function left, and am completely dependent on thyroid meds. TSH doesn't tell my doc anything, because my feedback system is broken.

How you feel should be a very important consideration. They should be willing to work with you to get you to the point where you feel good...able to function close to normal, as few symptoms as possible. The ups and downs of Graves and Hashimoto's make it very difficult for even the best of docs to work with I think, based on what I've heard from people with both conditions.

Sorry I can't offer more to think on with this...

i was diagnosed with Hashi last October, and with Graves in January. i THINK i have had thyroid antibodies since i was 8 possibly. i believe i went years & maybe decades undiagnosed. i think having both masks the bigger symptoms so you dont suspect a thyroid problem. i ASSUME im Hashi dominant- as my TPO were 512, and my TSI were 233. plus at the time of dx my TSH was 11.39. if only i knew all the symptoms, then i could have asked for thyroid tests years ago.

i have not been treated for graves at all... apart from heat sensitivity & anxiety, my labs are all hypo-ish. from everything ive read online- i hope that after some time, the TSI abs will have died off, leaving me with just Hypo. as crappy as i feel- i would prefer this scenario as opposed to being left with only Hyper, and Radiation or Surgery.

ya, i was wondering what u thought on suppressing the TSH when i also have Graves- cause i still have so much Hypo crap- and i would prefer to feel much better even if my TSH is below range. my doc is following my TSH closely- and i really feel like i need more medicine :(

honestly-> the TSH doesnt totally correlate with my symptoms. i had WAY MORE HYPER symptoms when my TSH was at 4, but my Free T4 was at 1.44. it was HORRIFIC. when my TSH was .1 and my free t4 was down to 1.11-> i felt only a TINY BIT Hyper. i had Palpitations when my free T3 was above range, but since i started taking Iron (im critically low)- the palps went away.

ok, tired, gotta go

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