Re: Help needed interpreting test results.

[Guest guest]

Hi

i wonder about metabolic syndrome?

http://en.wikipedia.org/wiki/Metabolic_syndrome

is this dr an endo? i would try to get an appointment with a good endo to try

to sort this out or at least get a diagnosis/diagnoses? have you been

diagnosed as hypothyroid too?

>

> Hi everyone,

>

> I'm still at the beginning of the process of trying to find a solution to my

long term fatigue and abdominal weight gain, and note that I've had the

following issues, which may or may not be relevent to whatever causes the

fatigue: 20.5 cm3 goitre, 'brain fog'/ADD symptoms, carpal tunnel syndrome, slow

hair growth, GERD/gastritis, fatty liver, dry skin and hair, tinnitis &

deafness, tinea and candida issues, sensitivity to cold *and* heat, *fast*

heartrate (90-100 bpm), high bp 130/100.

>

[Guest guest]

Hi,

As your adrenals show low in range it is sensible to start support there

first. DHEA is a precursor to many hormones, though will not affect your lowish

cortisol levels. Low thyroid and low adrenals do tend to go hand in hand- the

adrenals try to help the thyroid keep up until they in turn become exhausted.

Treating adrenals efore starting on thyroid replacement is the best way to go.

your FT4 of 13 is certainly low in range- as always pity FT3 was not done-

though the showing of a high RT3 does tend to indicate that you may be having

conversion T4 to T3 problems- as does all the hypothyroid symptoms you list so

starting Armour should help with that.

The low iron and candida will also affect your utilisation of the thyroid

hormone availble to you and should be dealt with as a priority- ferritin in

particular should be around 90. Do treat the candida.

>

> Hi everyone,

>

> I'm still at the beginning of the process of trying to find a solution to my

long term fatigue and abdominal weight gain, and note that I've had the

following issues, which may or may not be relevent to whatever causes the

fatigue: 20.5 cm3 goitre, 'brain fog'/ADD symptoms, carpal tunnel syndrome, slow

hair growth, GERD/gastritis, fatty liver, dry skin and hair, tinnitis &

deafness, tinea and candida issues, sensitivity to cold *and* heat, *fast*

heartrate (90-100 bpm), high bp 130/100.

>

> Last I wrote, I'd just got an appointment with a doctor known for prescribing

Armour & DHEA. Here are the test results. The lab did not do the free T3 as

requested, as it unilaterally made the decision that I didn't need it. Nice, eh.

>

> Thyroid Function Tests:

> Free T4 13.8 pmol/L (Range 9.0-19.0)

> TSH 3/12/04 - 0.6, 7/8/08 - 0.5, 15/01/09 - 2.1, 9/9/10 - 0.7 units

mU/L(Range 0.4 - 3.5)

>

>

> Thyroid Antibodies

> Anti-Tg 14/10/08 - 12 9/9/10 - 9 (Range <34)

> Anti-TPO 14/10/08 - 1 9/9/10 - 2 (Range <12)

>

> Cortisol (am) 148 nmol/L (Range 100-535)

>

> Iron 9.0 9.0 umol/L (9.0-27)

> Ferritin 31 34 35 103 ug/L 15-200

>

> DHEAS 3.6 umol/L (Range 2.0-14.0 pre menopause)

>

>

>

> Reverse T3 478 pmol/L 140-540

>

> Urinary Free Cortisol

> Creatinine 21.1 H mmol/day 7.1-15.9

> Cortisol 125 nmol/L

> Free Cort. 240 nmol/day 55-320

>

> I'm concerned that the doctor in question is predisposed to seeing thyroid

issues, and so she might be biased towards treating with thyroid hormones. She

has prescribed me a small dose of DHEA for three weeks, vit D, a multi vitamin

which includes iron, and Armour. Do you think that this is indicated by these

results? My liver enzymes have recently just pushed up into the abnormal level,

and I have a fatty liver. Could Armour do it any harm?

>

[Guest guest]

Hi Kate,

OK, so right out of the blue, we have your cortisol level,

which, in a morning, should be at it's highest level in the refer. range and

yours is low. Your vitamin B12 should be at the top of the range, and them

giving a ref. range of >170 is crazy. We need to know what is considered the

bottom of the range and the top of the range so we can tell where about in the

range your levels lie. Often, from what I have seen, the B12 reference range is

somewhere in the region of 170 to 800. Your Iron is at the very bottom of the

reference range, which is worrying with your ferritin level being only 31.

Ferritin should be around 70 to 90 for you to feel good. The lower your

ferritin (stored iron) falls, the greater your body will call on your Iron

level and this will eventually cause you to become anaemic. You need to start

on a course of some form of elemental iron such as Ferrous Sulphate 200mgs

daily, taken with food, and with high doses of vitamin C e.g. 5000mgs to help

with iron absorption.

It would help to know what the ref. range is for Progesterone

and Oestrogen. For many who are hypothyroid, their oestrogen level can be high

and they need natural Progesterone Cream to balance the two. High oestrogen can

cause many problems. Your DHEA is very low, but this is also usually an

indication your cortisol level is also low. You really need to get the 24 hour

salivary adrenal profile done through Genova Diagnostics to see where your

levels of cortisol and DHEA are at 4 specific times during the day. Also, DHEA

needs to be supplemented for quite a long time to build up its levels. It can

take up to 3 months for some people to even feel the effect - so 3 weeks trial

is a no go. Again, with the 24 hour salivary test, you would get a truer

picture of what is happening here.

How much Armour has she started you on: I am not sure what she

has based this recommendation on considering your TSH is already suppressed,

and your free T4 is 13.8 - perhaps she has based this on the results of a

physical examination, symptoms and signs. If you don't need thyroid hormone

replacement, your body will show this once you start taking the tablets.

However, I would strongly recommend you get the 24 hour saliva test because if

your cortisol and DHEA levels are low, these need to be treated first for at

least 7 full days, before starting any form of thyroid hormone replacement.

Are you also taking 200mcgs Selenium, essential for the

conversion of the mainly inactive thyroxine T4) to the active thyroid hormone

triiodothyronine (T3)? You should also be taking Siberian Ginseng daily to help

to boost your adrenals and at least 1000mgs vitamin C.

Hope this helps.

Luv - Sheila

PS - if you go to our FILES section (accessible from the Home

Page of this Forum), scroll down the list until you see a FOLDER marked 'Discounts'

and you will see that TPA members get a discount from Genova Diagnostics on all

adrenal, thyroid and candida tests.

For the last week or so, I've also taking B6 and sublingual B12, both of which

seem to be helping with the brain fog. I'm also planning on supplementing with

folate, and Vitamin E, which has been shown to be helpful for fatty liver.

Going gluten-free has helped in the past, and has been the only way I've lost

weight, so I'll have to make that a permanent dietary change, but the insulin

resistance means I'll have to try to be low GI and gluten-free, which can be

very difficult!

Thanks in advance for your help! This really is quite a quagmire, and very difficult

when you're wading through it all alone.

No virus

found in this incoming message.

Checked by AVG - www.avg.com

Version: 8.5.445 / Virus Database: 271.1.1/3146 - Release Date: 09/20/10

17:04:00

[Guest guest]

Hi

Thanks for your answer. Yes, certainly Metabolic Syndrome is included in my

issues these days, but that's only really within the last few years. Given the

weight (I'm 5'2 " and am now 92 kg), and lack of energy for exercise and I

suspect heart issues as well, I'm starting with a dietician next month but will

tend to go v low carb and no gluten, whatever she says. Failing that, I plan on

trying to push the doctors to allow me to have a gastric band.

For the last 3 months I've been on Pariet for the GERD, but I'm sure the

deficiencies predate these. Certainly the low iron has been an issue for me for

donkey's years - back int he 80s when I was vegetarian, I had a level of 4.

Kate

>

> Hi

>

> i wonder about metabolic syndrome?

http://en.wikipedia.org/wiki/Metabolic_syndrome

>

> is this dr an endo? i would try to get an appointment with a good endo to try

to sort this out or at least get a diagnosis/diagnoses? have you been

diagnosed as hypothyroid too?

>

[Guest guest]

Hi Sheila and

Thanks for your replies! I'm in Australia, and hope you don't mind my joining

your group for guidance, as otherwise there's pretty much nothing available at

all, and my issues are far too weird for the black-and-white blinkered system

here. The medical fraternity is so unbelievably conservative in Australia, which

makes it difficult to get any tests at all(hence the idiot pathologist himself

deciding free T3 was not worth testing).

There's so much to think about, and it's all so complicated!

Okay 1. Reference ranges. For B12, the way they're wording it is that the bottom

of the range is considered to be 170 pmol/L, with anything above that considered

to be 'within normal range'. I'll ring the labs to see whether they can provide

a top level, but I suspect this is standard Australian practice not to.

2. Ferritin has been an issue for a long time for me. Given that I eat a lot of

red meat - I crave the stuff, even sometimes eating it at breakfast - I'm

assuming that the low ferritin, D3 and B12 levels relate to some sort of

absorbtion issue?

3. Okay, here are the full hormone assays again. They've given several ranges.

Projesterone 4.9 nmol/L Ranges are: (less than 1.0 = follicular)

(3.8-5.0 = luteal phase)

Oestradiol 623 pmol/L Ranges are: 80-920 Early Follicular

140-2400 Preovulatory Peak

80-1150 Lueal phase

I've no idea when in my cycle this was - my periods have always been pretty

random, anything from 25 - 60 days between, so I long ago stopped tracking them.

4. DHEA levels. Is there any possibility of accessing the Genova testing from

Australia? If not, then I might have to go from the way I feel. Certainly I wake

sort of weak, have a huge crash at about 11.30-12.30 every day (sometimes

needing to sneak a nap), struggle through the afternoon, and after dinner

generally feel awake. In the absence of the 24 hr saliva testing, would that

help pin things down?

5. Armour. She's started me on one capsule of 30mg strength for one week, then

increasing by one capsule on a weekly basis until 90 mg, then stop there for

three weeks, and increase by 30mg every three weeks until symptoms improve or

the symptoms of a racing heart or tremor are seen. (So basically, it's a slow

titration to hyperthyroid symptom relief, or hyperthyroid symptoms start).

I'm pretty sure she is basing this on symptoms and physical exam. I have a lot

of hypothyroid symptoms - puffy face, hands and angles, eyes, abdominal fat,

extreme fatigue, cold intolerance, excess urinary creatine, male pattern

baldness, thinning hair, food intolerances. But, I also have some quite

different symptoms: relatively high testosterone, lactation, high bp (although

possibly because I wasn't sure about this doctor...), tachicardia.

She also applied a machine which measures the speed of tendon reflexes. My

reflexes were significantly slower than normal, which she claimed was an

indication of thyroid disease. The device fits over the wrist, and then a tendon

is struck in the arm, and the test is repeated three times. It seemed like a

valid measure of reflex speed - but I do wonder whether there might be other

conditions which lead to the delayed tendon reflex? Googling suggests it's

possible.

My TSH results jump around a lot. They've been tested many times, thanks to my

goitre, with the following results:

(units are pmol/L)

5/2003 0.9

12/2004 0.6

1/2007 1.0

8/2008 0.5

1/2009 2.1

12/2009 1.8

09/2010 0.7

(Reference range is 0.4 - 0.35)

What I note is that they jump around a lot from very low (almost hyperthyroid)

to very high (2.1, hyperthyroid by some US labs). Is that normal?

This new doctor has ordered an MRI of my pituitary gland, because of the issue

of lactation.

6. Candida - How does one go about treating Candida? Because of the insulin

resistance, I'd already taken myself off all fructose, and have also been trying

to head towards lower GI foods. Ought I switch to lower carb foods?

Thanks very much for all your help and guidance. It's very difficult trying to

muddle through all this pretty much on my own.

Kate

>

> Hi Kate,

>

> OK, so right out of the blue, we have your cortisol level, which, in a

> morning, should be at it's highest level in the refer. range and yours is

> low. Your vitamin B12 should be at the top of the range, and them giving a

> ref. range of >170 is crazy.

[Guest guest]

Just rereading this, I've typed 'hyper' for 'hypo' twice... Oops. Just ask if it

didn't make sense.

>

>

> Hi Sheila and

>

[Guest guest]

have you considered whether you might have sleep apnea too? i got diagnosed

with this last yr after putting on weight, think i'd had it a long time. it can

be linked to thyroid issues

chris