Another update including saliva and urine test results

[wendaeh]

Here's an update - any comments welcome - I got great feedback from my previous post healthunlocked.com/thyroidu...

Got blood test results back from 11/20/14 - this Dr insists on blood work 3-5 hrs after taking thyroid medication to see how it is working in the body; fasting otherwise. He is a holistic/MD doctor. The blood tests were from about 2 weeks ago and he also did saliva and urine testing. About 10 days before med increase my daughter began complaining of being cold again and her hair turned brittle. Positive benefits thus far are increased energy and concentration. Still low mood and lots of anxiety (typical for her but currently exacerbated by boyfriend breaking up with her and winter sport starting). She has lost about 6 lbs since starting thyroid tx (she works out a lot and also feels hungry a lot - was not able to lose weight even when eating less before now). She is losing a lot of hair - He increased compounded sustained release armour to 60mg starting Friday - hair is now shiny but falling out more! She has lost about 1/2 her volume in the past 4 months of treatment.

Results: CBC and metabolic panel all normal

Urinalysis and lipids normal

Vit B12 high 1003 (211-946) - said not to worry

Vit B6 - high 49.8 (2.0-32.8) - said not to worry

Sex hormones fine

Iron panel fine

Ferritin 49 (15-77) -- this was 18 before gluten free and supplementing

Vit C, copper, zinc, IGF-1 fine

DHEA high 1153 (40-491) said this is stress as DHEAs is normal

DHEA-sulfate 227.7 (110-433.2)

Thyroid - 45mg compounded suspended release Armour taken 4 hrs earlier so it is "in her system"

TSH 2.01 (.45-4.5)

T3 164 (71-180)

Free T3 3.9 (2.3-5)

Total T4 7.5 (4.5-12)

Free T4 1.17 (.93-1.6)

Reverse T3 14.5 (9.2-24.1)

Antibodies - negative

Saliva test

cortisol

8am 28.5 (5.1-11.6) high

2pm 2.6 (2.3-5.3)

6pm 1.4 (1.0-2.4)

11:30pm .9 (.4-2.1)

DHEAS 8am 4.5 (1.0-3.0) high

DHEAS 6pm 1.5 (1.0-3.0)

Neurotransmitters

serotonin low - 71.8 (optimal 200-415)

GABA low 181.5 (600-1100)

dopamine low 100.6 (250-400)

nor-epinephrine low 23.4 (30-50)

epinepherine low 6.0 (10-15)

Glutamate 10.2 (5-10) high

He increased thyroid meds from 45 to 60 mgs - with her weight loss, hair loss and anxiety I worry about overmedication, but I would assume that she even has room in free T3 since she took her medication before this test correct? Heart rate and blood pressure are fine. Does this plan below sound adequate? I am very nervous about so many supplements. Any suggestions on hair loss?

He said she could stop iron supplement except during her cycle; keep up with Vit D and C

To help with anxiety he gave her GABA (at a very large dose) and TravaCor (5-HTP, Taurine, L-theanine plus vitamins) to start for a few weeks as he wanted to calm her down, esp with the increase in thyroid meds before adding Adrenal support (ND), a dopamine supplement, and ExcitaPlus (for low epinephrine).

Thank you for your time

[Ruthi]

Her ferritin is still very low, so I wonder how effective her thyroid meds actually are. And that high cortisol at night and in the morning is quite enough to account for anxiety (and you haven't mentioned poor sleep, but I would guess she would be waking anxious in the middle of the night).

A lot of what the doc is offering is well outside my experience. So I can't comment! And I don't know whether what he is suggesting is the right thing to start with. I have to confess that I would be looking at general nutrition, Vitamin D, and magnesium, without which nothing else would work. Given her generation I think I would be asking for toxins to be tested, and hair minerals. Plus active B12, which is a much better measure of whether there is adequate magnesium where it is needed.

[wendaeh in reply to Ruthi]

Hi Ruthi - the ferritin is actually better (the range is 15-77). Vit D was 48.8 (30-100) and she is still supplementing 5,000 mgs D3. There is magnesium in her evening supplement - I didn't know there was a test for active B12 - I can ask him about it.

[humanbean]

Do you have the units for the ferritin result? The range is different to anything I've seen before.

[wendaeh in reply to humanbean]

Yes, it is ng/mL

[humanbean in reply to wendaeh]

Thanks. Your reference range for ferritin is much narrower than the UK reference ranges. For women in the UK a commonly quoted range is 13 - 150 mcg/L, and women are told on this forum (and others) that they should aim for a level of 70 - 90, which is mid-range.

However, with your reference range, the middle of it is 46 ng/mL, so your daughter's result is already mid-range.

I wonder if the range you've been given is an optimal range? But if it is, it seems terribly low.

If you think her iron panel is fine, then I don't think she needs more iron.

Incidentally, mcg/L and ng/mL should come back with the same reference ranges. The difference is that litres are 1000 times bigger than a millilitre, and micrograms (mcg) are 1000 times bigger than nanograms (ng). So it all comes out in the wash and the ranges should be the same. Sorry if I'm labouring the obvious though.

Sorry - I really don't think I've helped at all!

[wendaeh in reply to humanbean]

Hmmmm...that makes me wonder if the range can be converted like that. Iron saturation was 38%; other iron ranges were:

Iron Bind. Cap 312 (250-450)

UIBC 195 (150-375)

Iron, serum 117 (35-155)

Any thoughts, humanbean?

[humanbean in reply to wendaeh]

The serum iron result : Mid range would be 95, and your daughter's result is quite a bit above that without being in any danger of going over the range, so that is absolutely fine.

Iron Binding Capacity (which is often referred to as TIBC I think) : This is 31% of the way through the reference range. There is no way it could be described as being low (or high!) in range, so this is a healthy level too.

UIBC : Your daughter's result is 20% of the way through the reference range. In conjunction with the other (very healthy) results this doesn't seem low to me.

Iron Saturation : The reference ranges I've found for this suggest a range of 20% - 50%. A result of 38% is neither high nor low, so is a good result as far as I can tell.

labtestsonline.org/understa...

nlm.nih.gov/medlineplus/enc...

I don't think your daughter should take iron supplements. Her results are very good indeed.

[wendaeh in reply to humanbean]

Thank you for such a detailed explanation! It helps so much to understand the results.

[Clutter]

Wenda, by insisting on meds taken before the blood test the peak level of medication is measured. It's more useful to measure the circulating level of hormone by allowing 24 hours between last dose and blood draw.

Weightloss shows that she is metabolising the hormone, her thyroid labs indicate your daughter is undermedicated not overmedicated. TSH is usually comfortable for hypothyroid px just above or below 1.0 but the T3 in NDT usually suppresses TSH and can also lower FT4. FT3 is just over halfway in range and should improve on the increased dose.

Low thyroid and low zinc are particularly associated with hairloss. Hairloss should decrease 2/3 months after thyroid meds are optimal and vitamin deficiencies are corrected. Biotin and evening primrose are often recommended for hairloss and splitting nails but can take up to a year to see results.

[wendaeh in reply to Clutter]

Thank you for the quick reply - it was my feeling as well that she is undermedicated...but she is 17 and feels like crap AND losing her hair at such a young impressionable age that it is breaking my heart. Today there was less in her brush. She takes Black Currant Oil instead of evening Primrose as I was concerned it might affect her hormonally. I left a message for the Dr about possible Inositol and Choline for her hair. Biotin gave her cystic acne even at a low dose

[wendaeh in reply to Clutter]

Also, Zinc was 91 (range 56-134)

[wendaeh]

Another question - Clutter - her blood test results were only after being on Armour for 10 days (since she needed to get blood work during her menstrual cycle for sex hormone testing). I assume the T4 was not totally in her blood in that short of a time, but T3 should have been accurate, correct? So even if not just looking at TSH or T4, a med increase can be seen just on the T3 which should be much higher based upon her taking the medication that morning?

[Clutter in reply to wendaeh]

Wenda, 10 days is too soon to test thyroid hormone and it's pretty useless to go on the peak levels anyway IMO. Her elevated TSH means both her FT4 and FT3 are low. TSH responds to replacement a lot quicker than FT4 and FT3 and FT3 takes the longest to improve.

Her recent blood test shows that her FT3 isn't high so the dose increase won't push her over range, it probably won't even push it into the 75% of range sites like STTM consider ideal.

It takes 7/10 days for thyroid replacement to get into the cells to start working and 6/8 weeks for the dose to fully metabolise which is why thyroid testing is recommended 6/8 after starting replacement or a dose change.

thyrophoenix.com/adjusting_...

Use the orange Reply button underneath the post you are responding to and the member will b sent an email notification.

[wendaeh in reply to Clutter]

Ok, thank you! Her next labs are in 6 weeks - he is very adamant that she take the meds...UGH - first endocrinologist was horrible and I like this guy. Says he knows what he is looking for....I have no other options for treatment I feel. I will just have to be assertive if I think she needs another increase and labs look ok.