TSH & Free T4

I have been reading all over the Internet and on other blogs about how important it is to not only get your TSH tested, but also your T4, Free T3, and Free T4. I recently read an article about the under treatment of hypothyroidism on About.com. The author, Mary Shomon explained that a lot of people do not feel well on just a levothyroxine/T4 only drug (like Synthroid, which is what I am currently prescribed). Shomon explained that she feels better taking T3, such has Thyrolar, and others feel better by adding Cytomel, or time-released T3 to their levothyroxine. Shomon also mentions that some people have success taking a natural thyroid hormone replacement, Armour. In February 11, 1999, the New England Journal of Medicine published research that shows that many people feel better on a combination of T4 and T3, not T4 (such as Synthroid) alone. Many people, like me, have a normal TSH level but are still symptomatic. Apparently the addition of T3 helps relieve depression, brain fog, fatigue, and other symptoms. (Additional information can be found at http://thyroid.about.com/cs/hypothyroidism/a/undertreated_2.htm)

So, after doing a lot of research I sent an email to my physician:

"Could I come in for a lab appointment some time to get my T4, Free T3, and Free T4 testing done to get a better picture of the condition of my thyroid? My TSH level came back normal but a lot of the symptoms of hypothyroidism are still present, including weight gain and low energy."

My physician promptly replied a couple of hours later:

"If you are still symptomatic, then we could increase your synthroid to 88mcg to lower your TSH below 2. Then when you return in 6 weeks, will check both your TSH and free T4."

First thing...I am so thankful to have a physician who listens to me and responds to me so quickly. She is wonderful! Second...I wonder why she plans to only test my Free T4? Although I have been doing a lot of research about this subject lately, I am still confused about exactly what T4, Free T3, and Free T4 are...any one have any further information about this?

Just Lose It!

I have been saying to myself for the past month, "c'mon you need to workout...but I am too tired to go to the gym...I am going to work out at home...I am going to eat healthier...I am going to drink more water...I NEED TO LOSE WEIGHT!". I have failed miserably. So, I decided that I needed two things in order to lose weight and be healthier: to be held accountable and incentive. I realized that some kind of group fitness is what I need. So, yesterday after work I joined a free 12-week weight loss challenge sponsored by CoxHealth called Just Lose It. I am excited to see if this challenge will help me get motivated to lose weight. As part of the challenge I get:

• A free one-week pass to CoxHealth Fitness Centers
• A free pass to the Fitness Centers for every wellness walk and nutrition challenge I participate in
• Access to the Fitness Centers on weigh days
• A sling bag for completing all four weigh-ins
• A special Fitness Center membership rate if I complete all four weigh-ins
• The chance to win prizes, including fitness center memberships and gift cards

For more information about the Just Lose It challenge please visit http://www.coxhealth.com

I am going to post each of my four weigh-in results over the next 12 weeks. During my journey, I will also post any information that I find helpful for those of you who are also struggling to get fit and be healthy. I start the challenge today! I will be hitting the gym tonight...wish me luck!

Also, I would like to hear from you about your experience dealing with weight loss and chronic disease. What are you doing to lose weight and be healthier? What challenges are you facing trying to lose weight while battling your chronic disease?

I'm Normal! Maybe...

Yayyy! I just got my TSH test results back from my physician and my TSH result was 2.630 (Normal Range: 0.358-3.740). I was told to continue taking 75 mcg of Levothyroxine. Hopefully my TSH level remains "normal" for a while...one can hope, right?

I have been hearing a lot about getting not only my TSH level tested, but also getting T4, Free T3 & Free T4 tests done. TSH (Thyroid-Stimulating Hormone) evaluates your overall thyroid function. T4 (Total Thyroxine) evaluates the total amount of T4 produced by the thyroid gland. Free T4 (Free Thyroxine) evaluates the amount of T4 available to the cells and tissues. Free T3 (Free Tri-iodothyronine) measures the amount of T3 (the active form of the hormone) available to the cells and tissues.

So, what is "thyroxine"?

According to You & Your Hormones, thyroxine is the main hormone secreted into the bloodstream by the thyroid gland. It is inactive and most of it is converted to an active form called triiodothyronine by organs such as the liver and kidneys. Thyroid hormones play vital roles in regulating the body’s metabolic rate, heart and digestive functions, muscle control, brain development and maintenance of bones. Retrieved from http://www.yourhormones.info/Hormones/Thyroxine.aspx

So, why have my T4, Free T3, & Free T4 tested as well as my TSH?

According to WebMD:

A thyroid-stimulating hormone (TSH) blood test is used to check for thyroid gland problems. TSH is produced when the hypothalamus releases a substance called thyrotropin-releasing hormone (TRH). TRH then triggers the pituitary gland to release TSH. TSH causes the thyroid gland to make two hormones: triiodothyronine (T3) and thyroxine (T4). T3 and T4 help control your body's metabolism.

• Total thyroxine (T4). Most of the thyroxine (T4) in the blood is attached to a protein called thyroxine-binding globulin. Less than 1% of the T4 is unattached. A total T4 blood test measures both bound and free thyroxine. Free thyroxine affects tissue function in the body, but bound thyroxine does not.
• Free thyroxine (FTI or FT4). Free thyroxine (T4) can be measured directly (FT4) or calculated as the free thyroxine index (FTI). The FTI tells how much free T4 is present compared to bound T4. The FTI can help tell if abnormal amounts of T4 are present because of abnormal amounts of thyroxine-binding globulin.
• Triiodothyronine (T3). Most of the T3 in the blood is attached to thyroxine-binding globulin. Less than 1% of the T3 is unattached. A T3 blood test measures both bound and free triiodothyronine. T3 has a greater effect on the way the body uses energy than T4, even though T3 is normally present in smaller amounts than T4.

Retrieved from: http://www.webmd.com/a-to-z-guides/thyroid-hormone-tests

Retrieved from: http://www.thenakedscientists.com/forum/index.php?topic=6576.1800

SO......

Looks like I wll be calling my doctor again soon. I would like to end this post with a little thyroid humor...enjoy!

For Visual Learners...

I am addicted to Pinterest and I got the bright idea the other day to look for pins related to hypothyroidism and I found a ton of pins! Some were humorous...some were passionate...and some were informational. I found an interesting visual representation of the symptoms of hypothyroidism that I just have to share with you all.

Retrieved from http://pathologypersonified.wordpress.com/2011/10/29/hypothyroidism/



The symptoms of hypothyroidism are drawn out above and are labeled as follows:

1. weight gain/water retention
2. fertility; reduced libido, heavy menstruation
3. constipation
4. depression, sluggishness
5. dry skin; itchy skin
6. Carpal Tunnel Syndrome (I wonder how this is related to hypothyroidism...hmmm...new idea for a future blog post!)
7. fatigue, slowness
8. myalgias
9. goitre
10. Hair - dry, brittle
11. Bruising

This visual representation of hypothyroidism is perfect! This is EXACTLY how I feel and how I feel that I look most of the time. After being so impressed by this picture, I decided to make my own...

My Visual Representation of Hypothyroidism:

Okay, so my visual representation does not include pretty labels, nor does it have a diagram-like quality, but I think it pretty much sums up how I feel about 90% of the time. JUST HYPO...

Letter To My Thyroid

Dear Thyroid,

Yesterday I was sad. I sunk into depression and saw darkness. Yesterday I gained weight. I had no energy to put effort into exercising and eating healthy. Yesterday I froze. My joints ached from the coldness and my mind was numb. Yesterday I created distance. I pushed my family and friends away. Yesterday I finally cried out for help and my doctor, friends, and family answered. Yesterday I went to sleep. Today I woke up. I dragged myself up and out of bed this morning. I took my medication, got dressed for work, and headed out the door. Today I went to work. I got to work on time, sat at my desk and did my job. Today I stayed warm. I wore my coat all day and turned on a space heater under my desk. Today I ate healthy. I had oats for breakfast and plenty of vegetables and fruit. Today I socialized. I went to dinner and a movie with my fiance. Today I stayed awake. I fought hard against my fatigue but I did not give in to it. Tonight I will rest. I will rest my tired eyes and my aching body. Tomorrow I will wake up again. Tomorrow I will work again. Tomorrow I will stay warm, eat healthy and socialize. Tomorrow I will stay awake and I might even exercise. I will do this again because tomorrow I will fight. I will continue fighting for my health. I will continue fighting for my family and friends. I will continue fighting for me.

And The Results Show...

I finally heard back from my pulmonology doctor's nurse today about the results of my sleep study and the results show...that indeed I do have obstructive sleep apnea. According to the results I stopped breathing 9.9 times per hour, which is relatively mild compared to others' results. However, although mild I was instructed to come in for a second sleep study on March 5 to be fitted for a CPAP machine. Honestly, I am looking forward to wearing a CPAP to see if it helps me get better and more restful sleep. At this point I will do just about anything to get more rest. I will post about my sleep apnea again after the second sleep study. I'll keep you posted! Thanks for visiting!

I Need Sexy Back

With all of the unappealing symptoms of hypothyroidism it is no surprise or shock that this disease affects my sex drive. Here's why...

Symptom # 1: Fatigue. Who wants to get sexy when all your body wants to do is sleep.

Symptom # 2: Unexplained weight gain. Having confidence in how you look is important when it comes to sex. If you feel like a swollen whale chances are you do not feel sexy.

Symptom # 3: Muscle weakness, aches, and stiffness. Makes you feel "bleh". 'Nuff said.

Symptom # 4: Depression. Depression is strongly linked to low libido-the sex hormone.

What can we sufferers of hypothyroidism do to alleviate these symptoms so that we can bring sexy back?

-Exercise! I know that as soon as I walk in my door after a long day at work I will not want to exercise. I will want to lie down on my comfy couch and pass out. So, in order to get my exercise in before I feel like passing the out I go to the gym before going home after work.

-Lose weight! Eat healthy...find a way to make yourself exercise.

-Make sure your thyroid treatment is optimal. Whatever treatment you are receiving make sure to follow the treatment plan as prescribed by your physician. I have to take my medicine every morning at least 1 hour before eating to achieve optimal results.

-Make sure your TSH levels are within normal range. Keep open communication with your physician and go in for TSH testing when prescribed. If you start feeling crappy again let your physician know because that might mean your medication needs to be adjusted.

-If supplements work for you and are approved by your physician...go for it! I do not and have not ever taken any supplements so my knowledge on this subject is subpar.

-Therapy. If you need someone to talk to...find a therapist...or start a blog. :-)

The above information and more can be found at http://thyroid.about.com/cs/symptomsproblems/sexdrive.htm

Obstructive Sleep Apnea and Hypothyroidism

Because my depression and anxiety ended up being linked to hypothyroidism, I wondered if sleep apnea is also linked to hypothyroidism. And of course, there is a link. According to explain-health.com, the link lies within one of the many symptoms of hypothyroidism - swelling of the mouth, tongue, and throat. Because obstructive sleep apnea occurs when one's airway becomes blocked, narrowed, or floppy then swelling of the mouth, tongue, or throat would cause blockage of the airway. I have not found out yet what is causing me to stop breathing during my sleep, but I had no idea before now that hypothyroidism and sleep apnea are linked. What else is linked to this disease?!

The Rest of My Story

I was first diagnosed with hypothyroidism on March 2, 2011. The main symptoms that I was experiencing were weight gain, fatigue, depression, sensitivity to cold, dry skin, and constipation. My TSH result was 3.980. The normal range is 0.358-3.740. My test results were slightly above normal and at that time I did not need treatment. I was told to return for more testing 8-10 weeks later. So I went back 8-10 weeks later and on May 17, 2011 I found out that my TSH was at 5.080, which was a lot higher. I was then put on a low dose of levothyroxine-25mcg to be exact. Levothyroxine is a synthetic form of the thyroid hormone thyroxine. I took my medication every morning as instructed and my hormones seemed to level out after a few months. My TSH dropped down to 3.220, which was within normal range. I started to feel a little better and was slowly getting back to my normal self. Less than a year later I started experiencing symptoms of depression. I worried constantly about insignificant matters and I would cry at the drop of a hat. I was confused because I started to feel better a few months after I began treatment for hypothyroidism but the symptoms started to come back. I saw my doctor again in May 2012 and found out that my thyroid had jumped back up to 4.780. My dosage of levothyroxine was increased to 50 mcg and I was put on 20 mg of citalopram to relieve my symptoms of depression. Citalopram is the generic brand of Celexa, which is an antidepressant. After my dosage of levothyroxine was increased to 50 mcg in May 2012 and I started taking antidepressants I started to feel relief of my symptoms. My TSH levels were tested again in July 2012 and my TSH level was at 3.170-normal again! I started working out again at a boxing gym and losing weight and I did not worry about the little things in life anymore. I thought to myself during that time that I might just get back to the way I was before all of this thyroid madness began. BUT...that normalcy was short lived. In October 2012 my sluggishness and fatigue set in. I started gaining the weight I had lost back and I started to lose interest in boxing. I quit going to the boxing gym and all I wanted to do was sleep...all the time. It was a chore for me to stay awake during the day and have enough energy to simply get out and walk my dog, which was something I used to love doing every day only 3 years ago. Around the same time that this started...again...I had just had the depo shot, so I dismissed my symptoms to be side affects of the birth control. However, in January 2013 (last month) I was due to get my TSH levels checked. I found out on January 2, 2013 that my TSH level had jumped up to 5.510, the highest it has ever been. My doctor increased my dosage of levothyroxine to 75mcg. During this time I also discovered that I was experiencing pauses in my breathing during my sleep. My doctor ordered a sleep study and during my sleep study a few weeks ago I found out that I might have mild sleep apnea. So, currently I am waiting for a follow-up appointment to be scheduled to get the results of my sleep study and I have to get my TSH levels checked again next week to see if 75 mcg of levothyroxine is effective. I am still struggling with fatigue and weight gain. I am currently about 20lbs overweight and I am dieting and trying to exercise as much as I can. My fatigue is having a very negative effect on my attempts to lose weight, though. I was so tired this past Friday that I fell asleep at 8pm and slept until 9am the following morning and I STILL felt as if I did not sleep at all. Hopefully I will get more answers soon. I will keep you posted!

So, what is hypothyroidism?

Before I explain what hypothyroidism is and what causes the disorder I would like to introduce myself and my story. I am a 25 year old female who was diagnosed with hypothyroidism about two years ago. Before my diagnosis I was full of energy and in the best shape of my life. I was working two jobs, going to school, taking spinning classes 3-5 times a week, walking my dog every day, and simply enjoying life to the fullest. I graduated from college in December 2010 and shortly after my quality of life began to diminish. I began noticing that my energy levels were slowly decreasing and activities that I enjoyed, such as spinning began to seem like a chore. I lost interest in a lot of things and I started to slowly gain weight. I was so tired and sluggish and depressed. I thought that I was going crazy. Then one day while I was working in a client's home I had to excuse myself several times so that I could go to their bathroom and sit on the side of their bath tub and sob uncontrollably. Whatever was wrong with me was beginning to interfere with my job and important relationships. That is when I decided to call my doctor. During this time I had confided in my mother and my aunt about my symptoms and they both told me that I should ask my doctor to test me for hypothyroidism, which can be detected by simply having your blood drawn. My mother and aunt, as well as my grandmother have been diagnosed with hypothyroidism as well. So, I saw my doctor, talked to her about my family history of hypothyroidism, had my blood drawn, and found out the very next day that I too suffer from hypothyroidism. So, what is hypothyroidism?

What is Hypothyroidism?

According to MayoClinic.com, hypothyroidism is defined as a condition in which your thyroid gland doesn't produce enough of certain important hormones. Hypothyroidism can cause obesity, joint pain, infertility and heart disease.

Symptoms

• Fatigue
• Sensitivity to cold
• Constipation
• Dry skin
• Unexplained weight gain
• Hoarseness
• Muscle weakness
• Elevated blood dholesterol level
• Muscle aches, tenderness, and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory

What Causes Hypothyroidism?

• Autoimmune diseases or disorders, such as Hashimoto's thyroiditis cause your immune system to produce antibodies that attack your own tissues-sometimes this involves your thyroid gland. The antibodies affect the thyroid's ability to produce hormones, which in my own words blows everything out of wack.
• Treatment of hyperthyroidism. Hyperthyroidism occurs when your thyroid gland produces too much thyroid hormone. When a person is treated for hyperthyroidism sometimes the hormone production is slowed too much and hypothyroidism occurs.
• Having your thyroid removed through surgery results in permanently having hypothyroidism and having to take medication the rest of your life.
• Some medications, such as lithium can affect your thyroid gland.
• Other less common causes of hypothyroidism are congenital disease (babies are born with a defective thyroid gland or none at all), pituitary disorder, pregnancy, or an iodine deficiency.

This information and more can be found at www.mayoclinic.com.