I have reviewed your recent lab work. Please see below for a summary of the results:
-The elevated alkaline phosphatase is confirmed that it is coming from the bone and this is related to being on too much thyroid hormone, at your visit next week we will discuss lowering your doses further as your TSH is much too low for your age and this may lead towards osteoporosis.
Alkaline Phosphatase159 U/L range 40 - 120 U/L
Alkaline Phosphatase Bone Calculated91 U/L range 0 - 55 U/L
Thyroid labs are as follows:
FT3: 3.58 pg/mL range 2.30 - 4.20 pg/mL
FT4: 1.12 ng/dL range 0.76 - 1.46 ng/dL
TSH: <0.01 uIU/mL range 0.36 - 3.74 uIU/mL
Thyroidectomy in 2004 due to thyroid cancer. I'm currently on 3 grains or 180 mg of Armour Thyroid.
I think my FT3 could go up in range.
I have an appointment next week to go over the lab results. I'm not sure what's causing the elevated Alkaline Phosphatase but I don't think I'm hyperthyroid.
Any input would be appreciated!
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susanmhall62
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There is a US version of the above link, and although it has some similar info to the UK link it is clearly trying to sell stuff to patients which, personally, I find annoying :
Since you have no thyroid and are taking NDT you have a few choices :
1) Raise your level of NDT in the hope that it will raise both FT3 and FT4
2) Raise your level of T4 by taking a separate Levo product (in addition to your current dose of NDT) and hope that it will convert to T3.
3) Check that your nutrients are optimal, supplement any which aren't optimal, and hope it has good effects on TSH, Free T4 and Free T3. The basic nutrients to check are vitamin B12, folate, vitamin D, ferritin, and if ferritin is high or low do an iron panel/studies test too.
But if i understand what is written there , it does mean the kind of ALP that is raised is definitely 'the one that comes from bones' (not the liver one) , ... so even though your fT3 isn't over range ...... doesn't the idea of increasing your fT3 level further concern you a bit ? ..... it's nearly 70% anyway, so it' not exactly low by anyone's standards, and i assume you timed the test to get the lowest level of T3/avoiding the peak after last dose , so for the rest of the time, it will be above 70%.
Which wouldn't normally concern anyone , but is it wise to increase it further when it seems there is already a bone problem going on ?
You can’t be hyperthyroid because you don’t have a thyroid. I guess your doctor is trying to imply that you’re overmedicated. But you aren’t. A suppressed TSH does not mean you’re overmedicated.
So I’d say it was a stretch to say that it’s definitely the thyroid medication causing the APB—before agreeing to reduce my dose I’d want to know that other causes had been ruled out, for example osteomalacia, Vit D deficiency etc.
Otherwise you could end up with two problems—being undermedicated with thyroid hormone (which will lead to a whole host of additional problems) and whatever is actually causing elevated Alkaline Phosphatase Bone.
I agree. The doctor went straight to reducing my thyroid dose without considering any other possible causes.
The Cleveland Clinic website states;
High bone alkaline phosphatase levels may indicate the following conditions:
Bone metastasis: This condition happens when cancer cells from elsewhere in your body spread to your bones.
Paget’s disease of the bone (osteitis derformans): This is a rare chronic bone disorder in which there is excessive breakdown and regrowth in the affected bone(s).
Osteogenic sarcoma: This is a type of cancer that starts in your bones.
Healing fractures.
Hyperparathyroidism: This condition happens when your parathyroid glands release too much parathyroid hormone, which causes calcium levels in your blood to rise.
Hyperthyroidism: This condition happens when your thyroid produces and releases too much thyroid hormone.
Osteomalacia: This is a disease that weakens your bones and can cause them to break more easily. It develops most commonly due to a vitamin D deficiency.
A high level of ALP may also be a sign of untreated celiac disease.
I feel well on my current Armour Thyroid dose. One of the ways I gauge my physical well-being is if I can exercise comfortably. I am currently running 1-3 miles a day seven days a week.
I think it’s worth asking. When pth is high, it draws calcium from the bones. It can also make you feel unwell, some of the symptoms are similar to thyroid.
What Is an Alkaline Phosphatase Test?Medically Reviewed by Jennifer Robinson, MD on May 20, 2021
Alkaline phosphatase is one kind enzyme found in your body. Enzymes are proteins that help chemical reactions happen. For instance, they can break big molecules down into smaller parts, or they can help smaller molecules join together to form bigger structures.
You have alkaline phosphatase throughout your body, including your liver, digestive system, kidneys, and bones.
If you show signs of liver disease or a bone disorder, your doctor may order an alkaline phosphatase (ALP) test to measure the amount of the enzyme in your blood and help in diagnosing the problem. Sometimes it’s part of a broader group of tests called a routine liver or hepatic panel, which checks how your liver is working.
I have this test done for my psoriatic arthritis to make sure my PSA medications are not killing me and Im also thyroid-less (cancer). I have never had my Endo or Rheumy comment about this test and I take combo of t3/t4.
Currently taking Armour Thyroid 180 mg every day. The doctor is proposing that I take the 180 mg five days a week and 135 mg two days a week. I was under the impression that with T3/T4 combinations like Armour Thyroid you can't dose like that due to the shorter half-life of the T3. Is this correct?
Yes, any T3 containing med must be dosed consistently. Thyroid levels look ok and if you feel well before agreeing to a dose adjustment I would ask for other investigations. Especially in the absence of raised bilirubin or liver enzymes such as ALT, AST.
Hyperparathyroidism is usually associated with low Vit D (your isn't) but I agree with the others to ask your GP to test PTH. Calcium results can not always be a definitive for hyperparathyroidism because as body struggles to keep a balance, stored bone calcium release may offset resorption of calcium by the kidneys for quite some time.
Therefore, you are looking for elevated PTH with ALP (alkaline phosphatase bone or total).
Thank you for the suggestions. I asked about the hyperparathyroidism and she was dismissive and insisted that no, I'm hyperthyroid. Clearly, she has no clue what she's talking about.
I do have a doctor in Chicago who has been writing my prescriptions for Armour Thyroid and he will continue to do so. I was trying to find a competent doctor closer to home which is how I came to deal with the other doctor.
I've started taking Thorne Iron Bisglycinate for the low Ferritin.
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Low Thyroid Symptoms/Lab Test Results June 2020
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