Monday, November 29, 2010

October Thyroid Labs

By Diana Hsieh

On October 19th, I had another round of thyroid labs. At the time, I was on 1.25 grains of dessicated thyroid. And I was enjoying (!) various hypothyroid symptoms, most notably terribly dry skin and severe carpal tunnel pain. Due to the latter almost any time spent on the computer was very painful for many weeks. (That wasn't all bad, however, as that gave me the excuse I needed to buy my new horse Lila.)

The results of these new labs were as follows:

  • TSH = 1.75 (normal range .3 to 3.0)
  • Free T3 = 2.7 (normal range 2.0 to 4.4)
  • Free T4 = .97 (normal range .82 to 1.77)
Although within the normal range, those Free T3 and Free T4 numbers are still lower than they ought to be. So, realizing that 1.5 grains was not too much, as we'd previously thought, my doctor was willing to increase my desiccated thyroid dose to 1.75 grains for six weeks, then to 2.0 grains if my symptoms persisted. (I just increased to 2.0 last week, since my carpal tunnel pain returned, albeit not quite so strongly.)

The difficulty for me -- as you can see from my prior lab values -- is that my TSH will read as normal, even though my Free T3 and Free T4 are low and even though I'm experiencing unmistakable hypothyroid symptoms.

Most doctors use the TSH as the gold standard in diagnosing and treating hypothyroidism. Some ignore the patient's symptoms. Some refuse to test anything other than TSH. Happily, my doctor is willing to work with me, provided that we manage the risks of too great a dose of thyroid medication, particularly increased heart rate and palpitations and osteoporosis. To monitor the latter, she ordered a bone density scan to use as a baseline. Mine was normal, with a z-score of -0.9 for lumbar spine, 1.3 for femoral neck, 1.1 for total hip. Also, we re-scanned my thyroid on ultrasound at the same time, and the single-nodule goiter had shrunk quite a bit.

The most interesting -- but distressing -- news was my thyroid antibodies. Due to a simple oversight, I'd never had those tested before. Here are the results:
  • TPO Ab = 11 (normal range 0 to 34)
  • Antuthyroglobulin Ab = 68 (normal range 0 to 40)
Here's how Janie Bowthorpe of Stop the Thyroid Madness explains these tests:
Hashi's is confirmed by two antibodies labs: anti-TPO and TgAb. The first antibody, anti-TPO, attacks an enzyme normally found in your thyroid gland, called the Thyroid Peroxidase, which is important in the production of thyroid hormones. The second antibody, TgAb, attacks the key protein in the thyroid gland, the thyroglobulin, which is essential in the production of the T4 and T3 thyroid hormones.
In essence, my hypothyroidism has some auto-immune component, although it's not clear to me just how bad those number are.

For some people, gluten seems to be a major contributor to auto-immune thyroid disease, such that thyroid antibodies disappear on a gluten-free diet. I've not eaten gluten (except unknowingly and/or accidentally) over the past year, but I do wonder whether dairy consumption might be an issue. So at some point, I'll want to do another dairy-free experiment, then test my thyroid antibodies again. I'm not sure what else I can do to preserve my thyroid over the long term. Mostly, I need to do a whole lot of reading on Hashimoto's.

Finally... I was first diagnosed as hypothyroid on November 6th, 2009. It's rather depressing that I'm still struggling to understand the nature of my problem and to find the right dose of my desiccated thyroid. It's depressing that I'm 20 pounds heavier than I was a year and a half ago. Every ounce of that weight gain was due to thyroid insufficiency, in that it happened before I began taking desiccated thyroid and then when I've been on less than 1.5 grains. I hope that I can lose some of that, now that I'm on a decent -- even if likely still not adequate -- dose of dessicated thyroid.

Mostly though, I'm hugely grateful that I'm no longer in the very sorry state that I was last winter. I've got a working brain and tolerable energy again, and that's huge. All the rest is gravy.

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