Daughter's Lab Value Puzzle

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Two hundred heads are better than one here, so my daughter has been seeing Dr. Pucillo. Armour was upped to 2 grains from 60 several several wks ago, I think around 6 wks ago. Don't know what the Free T3 was initially, as she hasn't got a copy of her labs, but they told her just yesterday (6 wks later) that her Free T4 has not budged from the .6 it was at then. I don't have the ranges, but I'm supposing that this range probably starts at about .7 or .8. Anyway, they went over her test results, and they are puzzled as to why her Free T4 has not budged from where it was at initially. They are telling her that she is one of the people that is going to need a higher dose than some other people, and they upped it to 3 grains, this time telling her to split that between morning and afternoon. Initially, she was taking it all in the morning, but she just started this new regimen yesterday, then again today. If this was the Free T3, then I would think binding issues, since they also initially started her on biest and a tad of testosterone, then implemented the natural progesterone a short while later in this step fashion of things. But it is not the T3, it is the Free T4, so I'm thinking maybe gut issues here, possibility, who knows. Also, since even the 2 grains was first started, she feels somewhat better, but since she's having to get up at 6 a.m. again with her school children, she says she's not feeling very well then. Oh yes, forgot to add that they initially implemented 2.5 mgs of hydrocortisone right from the beginning with all of this, then upped it to 5 mgs, morning-only, and that was several wks ago now. They are having indepth discussions with her during her visits, these are long visits, plus they are calling her at home, plus they are telling her that if she has any pulse changes, palps, any changes at all, to call them immediately. She says that since they started all of this, and the Armour was originally upped from 60 to 90 then to 2 grains, she has had absolutely NO issues with anything else bad. In fact, just a few changes, none of which relate to overdose of Armour. What about the Estrogen binding, does that also bind the T4, before it can become Free? I thought this was mainly a conversion issue, but they are even puzzled as to why her Free T4 has not budged from a .6. Going to see if she will get them to fax all of her test results to her.

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T4 binds even more readily than does T3. Were they also to run a Total T4, they would know where all that T4 is going. Another factor to consider is that when she was undermedicated, her thyroid gland may have been putting out a little T4. As her dose of Armour is increased, that production is suppressed. Has there been any discussion of treatment goals in terms of lab results? wrote: Two hundred heads are better than one here, so my daughter has been seeing Dr. Pucillo. Armour was upped to 2 grains from 60 several several wks ago, I think around 6 wks ago. Don't know what the Free T3 was initially, as she hasn't got a copy of her labs, but they told her just yesterday (6 wks later) that her Free T4 has not budged from the .6 it was at then. I don't have the ranges, but I'm supposing that this range probably starts at about .7 or .8. Anyway, they went over her test results, and they are puzzled as to why her Free T4 has not budged from where it was at initially. They are telling her that she is one of the people that is going to need a higher dose than some other people, and they upped it to 3 grains, this time telling her to split that between morning and afternoon. Initially, she was taking it all in the

morning, but she just started this new regimen yesterday, then again today. If this was the Free T3, then I would think binding issues, since they also initially started her on biest and a tad of testosterone, then implemented the natural progesterone a short while later in this step fashion of things. But it is not the T3, it is the Free T4, so I'm thinking maybe gut issues here, possibility, who knows. Also, since even the 2 grains was first started, she feels somewhat better, but since she's having to get up at 6 a.m. again with her school children, she says she's not feeling very well then. Oh yes, forgot to add that they initially implemented 2.5 mgs of hydrocortisone right from the beginning with all of this, then upped it to 5 mgs, morning-only, and that was several wks ago now. They are having indepth discussions with her during her visits, these are long visits, plus they are calling her at home, plus they are telling her that if she

has any pulse changes, palps, any changes at all, to call them immediately. She says that since they started all of this, and the Armour was originally upped from 60 to 90 then to 2 grains, she has had absolutely NO issues with anything else bad. In fact, just a few changes, none of which relate to overdose of Armour. What about the Estrogen binding, does that also bind the T4, before it can become Free? I thought this was mainly a conversion issue, but they are even puzzled as to why her Free T4 has not budged from a .6. Going to see if she will get them to fax all of her test results to her.

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They probably did run a Total T4 also, but she keeps not getting a copy of all the results. This is one of the problems, I'm only getting the results of what she tells me. Yes, there is a full program, with a whole lot of discussion, but I'm not there, and she doesn't understand a whole lot of it. Actually, I wish that I could go with her, and also see the full range of test results. I know that I'm not getting the full picture here either. They are just telling her that she needs this larger dose of Armour, but I don't know all the reasons for that. May be partly the estrogen, for all I know. They just put her up to 3 grains. They are monitoring her at home also, in between visits, and made it very clear that if she has any signs or symptoms of hyper or anything else to call immediately. The visits are very close together right now. You know, she has also had a tubiligation, like her mother, so this could very well acct for some of the other hormonal losses, as well as from the hypo. From everything I can get, her body is not utilizing the thyroid hormones properly. I think I really don't have a full picture here because I don't have those test results.

Re: Daughter's Lab Value Puzzle

T4 binds even more readily than does T3. Were they also to run a Total T4, they would know where all that T4 is going.

Another factor to consider is that when she was undermedicated, her thyroid gland may have been putting out a little T4. As her dose of Armour is increased, that production is suppressed.

Has there been any discussion of treatment goals in terms of lab results?