What tests would you request?
I'll be seeing my endocrinologist later this week for my bi-annual exam. I started seeing her a couple of years ago for hypothyroid symptoms. Thyroid issues don't seem to be the beginning and end of what is going on, so I'd like to test some other things to see if I can get a more complete picture of my health.
I just got tested for general cholesterol (fairly worthless), TSH (definitely worthless) and fasting blood sugar. I'll be getting those results at my appointment.
My issues are: I'm not overweight (5'4" and 140), but after losing 12 lbs. last year, my weight suddenly jumped up by over a pound a week until I gained 10 of it back. Now, no matter what I do I can't lose it. I've been primal for 3 months and have lost a total of 4 lbs. I eat no dairy, no fruit, and very few nuts. Fat is generally 70% of my daily intake. I also have extreme sensitivity to cold and, despite my vast increase in fat and water intake, my skin has become even more dry, to the point where it's flaky in several areas. My general energy level is better than it was prior to going on thyroid meds (very low dose - 12.5 g levothyroxin and 2.5 mcg of generic cytomel daily), but certainly not up to where I used to be before all this started several years ago. My fasting blood sugar is normal, but a glucose tolerance test was not. Also, I'm 35 years old.
I know I'd like to get a cortisol test and Vitamin D (I've tested low before). I'm also going off the pill so will want to test my hormone levels as I've been on the pill for 20 years. I'll also be asking for a VAP test to get a better grip on my actual cholesterol numbers.
Any other suggestions?
You're on meds, and your endo tests only TSH? If so, I'd find another endo because this one won't even know how to deal with your thyroid issues.
I'm hypo, and your symptoms definitely sound like you need to increase your meds. What you're taking is almost laughable--the lowest Cytomel dose is usually 5 mcg--in fact, the non-generic doesn't come any smaller.
In any case, you should get a FREE T4 and FREE T3. Keep in mind that if your T3 is lower than half of the range, that's the reason for the weight gain and difficulty losing. Ideally, your T3 should be in the upper half of the range and your T4 about mid-way in the range. Just being "in range" as it standard for many other blood tests is not useful for thyroid--it's where you are that's important.
Definitely get the Vit D tested and be sure to supplement if you're low. I felt much better when I raised my D level and am still supplementing to get it higher.
Thanks Emmie, right now she has me taking 1/2 pill each of T3 and T4, so it really is that low. I'm getting a copy of all my past lab tests when I go in, so I can get some comparative numbers. Thanks for the info for the range I should be shooting for.
When being treated for hypothyroid freeT4 and freeT3 are important. They are even more important, when taking a T3 medication such as cytomel. Having frees tested is also important when on the pill as estrogen can bind thyroid hormones making then unavailable for use.
You say your blood sugar is normal when fasting but not after OGTT. Do you have your results? Because of this discrepancy I would ask for a Hb1ac and fasting insulin test. For some people fasting blood sugar is the last thing to go awry when one has blood sugar problems.
Another issue that mimics thyroid symptoms is low ferritin. You might want to have that checked as well.
Ditto all of the above. If you're not getting Free T3/Free T4 testing, you're not getting appropriate treatment. And 2.5mcg is minimal, I take 10mcg/day and it ROCKS! LOL... and if your doc won't do the extended thyroid testing, change docs. There's really no excuse for that.
Ferritin is important, but you should get your "stored' ferritin as well. Sometimes the ferritin level in your blood can be okay, but your "stored" level super low which will cause other issues that can be masked by the blood ferritin test. It can be really hard to raise your stored ferritin, too. (I may have to look that one up to get you more technical language, but that is the gist of it.)
"Boy I got vision and the rest of the world is wearing bifocals" - Butch Cassidy and the Sundance Kid
Ferritin is the test for "stored" iron in the body. It can be low long before other blood tests for iron-hemocrit, hemogloblin- indicate anemia
Make sure you get reverse T3 test and all the antibody tests (TPO, TAb and TBG). I'll post a list of the "functional ranges" when I get home from work in a bit.
As far as cortisol goes, blood tests won't tell you much. You need a 24 hour adrenal saliva test (ASI)- the kind with 4 samples taken in order to see your cortisol pattern throughout the day. Also, a saliva hormone profile is important to make sure something like estrogen dominance isn't a factor.
This is the problem I had, weight gain! I didn't get my period either. So it was time for my annual pap and asked them to please check all hormone levels. (I'm 44 and thought maybe I was premeno) well aside from high cholesterol, the only test that came back abnormal was my prolactin levels. The hormone we produce as if we were lactating mother's. I did research and found that these levels are high because #1 because you're pregnant, (and no I wasn't!) and sometimes due to high protien meals, exercise and stress. Well, I had two out of three. I was into my second month of Crossfitting and Primal Blueprint...
You might want to ask them to run that test. Hopefully when I see him next month they will be normal. I suspect they will be. I lowered my intake of protien at supper and I feel much better and got my period! I have also lost the 2 lbs. that I gained.
Thank you everyone for all of your suggestions. Saw my endo this morning and I haven't decided if it was a good appointment or not. My cholesterol is great (yay!) as is my fasting blood glucose (84). My TSH was 2.26, which she said left room to increase the dose, but she doesn't want to yet. We have another appointment in 3 months and most likely I'll be asking for an increase then.
In the meantime I got my Vit D tested today as well as my cortisol. I could have sworn when she sent me to the lab she said it was the saliva test, but when I got there they said blood. Bummer. I called back to the Dr. and her assistant said it was to be a blood test as well.
I also got copies of all my past labs, including my free T3 and T4 that were tested in November, so I may post those numbers up and see what folks think.
Thanks again everyone