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my labs and diagnosis

I haven't done a lot but today I went to a doctor and he told me I have Hashimoto's.

Just a few labs:

TSH: 6,85 (0,27-4,2)

blood glucose: 6,3 ( 4,4-6,4)

liver enzymes:
AST: 26 ( 8-30)
ALT: 38 (10-36)

cholesterol: 6,39 ( <5)
triglycerides: 1,57 ( <1,70)

Urin: a lot of bacteria found, leukocytes, erythrocytes(They prescribed me antibiotic).

I knew I was severely hypothyroid( I've been feeling totally awful for moths, almost suicidal ) but Hashimoto's came as a surprise and I don't know to deal with that. The procedure is probably the same as for hypothyroidism?

I have just started taking Thyroid-s, and I have tianeptine here ready to go( haven't' used it yet).
should I take both?
should I take the antibiotic?
What else can I do?

Every advice is appreciated.

asked Sep 19, 2013 by Nemesis

4 Answers

answered Sep 19, 2013 by jb4566

I think starting with tianeptine is a good idea.

Judging from your labs+symptoms you are definitely hypothyroid and should start supplementing either NDT or a T4,T3-combo as soon as possible.

Why do you want to take tianeptine? I would hold off on that and first wait for the effect of the thyroid to kick in.

answered Sep 19, 2013 by Bukowski

because I cannot digest anything, I am bloated and have inflammation in the stomach all the time, and cramps. Also, I am depressed and anxious, haven't left the house for a long time. My stress hormones are high, and I cannot sleep. I have a racing mind and cannot shut it off. Etc...I thought that lowering serotonin is what I need at the moment also together with NDT.

All these symptoms are also a sign of hypothyroidism. So the thyroid supplement may fix most of those alone already. If you start with both now at the same time its harder for you to tell what helped and also it's harder to know what makes things worse, in case some symptoms deteriorate. I'd go for the thyroid first, changing only one thing at once.

Well yeah, you're hypothyroid. The high cholesterol is probably just a consequence of hypothyroid.

I wouldn't take the antibiotic, as the risk of acute endotoxemia in hypothyroid people is quite high. Whatever bacterial problem you may have, should resolve itself after your thyroid is fixed.

You can safely take the tianeptine. Bukowski may have a point in saying that you won't be able to tell what medication produced what difference, but that's not important in the beginning since the thyroid medication takes quite a long time to produce noticable differences in the severe state of hypothyroidism you're in right now. Apart from that, tianeptine has a pretty short half-life, so if you wan't to see if any effects are caused by the tianeptine and not by the thyroid, just stop taking the tianeptine for a few hours.

Seeing how your hypothyroidism will probably result in a state of estrogen dominance, it would also be a good idea to take some progest-E. If you tolerate it, take aspirin as well.

If you really have Hashimoto's, thyroid and progesterone should supress most of the symptoms. However, I'm wondering how your doctor came to that diagnosis?

answered Sep 19, 2013 by Dewitt

by observing the blood flow in the thyroid gland at the ultrasound which is typical for only Graves or Hashimotos,the blood is somehow not evenly distributed or.... I don't know, I forgot:/

should I take tianeptine with meals? or it doesn't matter

I would take it before meals, based on this study.

Hey people! Here are some newer labs I've done in December 2013 and I would appreciate your opinion:

TSH: >0,01 ( 0,35-4,94)*
FT3: 10,7 (2,63-5,70)*
FT4: 19,49 (9,01-19,05)*

blood glucose: 6,4 (4,4 -6,4)*
creatinine: 55 (63,107)*
cholesterol: 4,7 (< 5)
HDL cholest: 1,5 (>1,2)
triglycerides: 2,1 (<1,7)*

AST: 17 (8-30)
ALT: 22 (10-36)

urine protein negative
urine glucose negative
urine ketones negative

prolactin: 378 (102-496)

answered Jan 15, 2014 by Nemesis

Diagnosed Hashimoto's
No antibody tests done

What were they thinking? But of course... in this country, probably nothing...

Did you take any thyroid medication the day of the test?

On what kind of dose is that?

I take Cynoplus, 1 pill a day, so that is 120 mcg T4 and 30 mcg T3.

If somebody could elaborate on my TSH, FT3 and FT4 values I would be grateful.
If TSH is so suppressed why is cholesterol relatively high?
Also, my blood glucose is always a bit high, could that be a sigh of poor blood glucose use?

Have you tried taking less T4 and/or only T3? If you do have an excess of estrogen/pufa/etc., the T4 might be an unnecessary burden for your liver.

What's your daily diet/supplementation at the moment? I'm pretty sure RP views Hashimoto's as the body's immune response to endotoxin leaking into the blood through damaged gut - which is all symptomatic of low thyroid. Do you consistently eat the raw carrot salad?

Carrots once a day,sometimes twice. I don't take any supplements except Cynoplus. Sometimes Progest E.

I'm curious about the whole less T4 more T3 thing. When winter hit, I started feeling really down. I wanted to reduce my cynoplus and use T3, but it didn't seem to help. However, I'm a bit messed up on the 2 grains (1 pill) of cynoplus per day. Granted, it's all better than taking no thyroid, but I feel my digestion and sleep/energy should be better.

Well T4 needs to be converted to T3 with certain cofactors (selenium, zinc) and a large portion of the conversion takes place in the liver. So either mineral deficiencies or an overburdened liver (excess circulating pufa, carotene, estrogen, food junk, etc.) would hamper this process. So some hypo patients need less T4, at least initially.

I think it takes a lot of experimentation to figure out the right ratio of T4 and T3. Cynoplus is 4:1 and some may do much better on 3:1, 2:1 or 1:1 or all T3 for a time. I definitely do better on a 2:1 ratio, so I add some cynomel with cynoplus when I supplement.

The winter time is just an added stress in general, so you have to take more anti-stress countermeasures to combat it. I've been doing ok so far with extra liver, fruit, red light and niacinamide.

I agree Cbar. But I would like to live to a day where I don't have to experiment any more, I am a bit tired to be honest. Especially if I don't understand biochemical stuff enough to make extra smart conclusions. I don't know what to do next, I guess i will probably lower Cynoplus to half a pill a day. and that is just wild guess

You're right. Experimenting with thyroid is very tedious. I quit consuming cynoplus altogether because it wasn't making me feel great and it takes about 4 weeks to get something from the mexican drug stores. I think I built up too much T4, which I just read in a RP article has a half life of 2 weeks.

So I'd try stopping cynoplus for a while - your cholesterol labs definitely show that the thyroid has normalized it anyway, I don't think anything catastrophic will happen if you stop for a couple weeks. If you don't have any cynomel, I would order a bottle as well - only $16.50 USD.

I've found niacinamide to be even more powerful than thyroid, and I think it's something which has very few side effects. Even at a dose of 2,000mg, it simply acts as a mild sedative to me. Coconut oil can also work in the same vein. Small frequent meals can keep the stress hormones down, but if you aren't able to store much glycogen, simply sleeping through the night can be very stressful and that is where I find niacinamide to be useful since it inhibits the release of FFA (

Edit: This is a good synopsis of rT3 issues and how to help them (i.e. the excess T4 may cause a rise in rT3):

I hate it when the lab monkeys use mmol/L for cholesterol measurements.

Alright, let's start with FT4. It's a bit on the higher side, but not higher than you would expect if you take cynoplus.
FT3 is definitely quite high. This could mean that your thyroid dosage is too high, but I doubt it, seeing how both total cholesterol and prolactin are still elevated.

I disagree with cbar. Your lab tests don't show a normalization of thyroid function or cholesterol levels. Your cholesterol level is 180 mg/dL, which is a bit too high. 160mg/dL would be optimal.
The same thing goes for your prolactin levels. They are much too high. But seeing how the thyroid hormones have a very direct downregulatory effect on prolactin secretion, it would seem that you are still hypothyroid. On what day of your menstrual cycle were those tests done?

It would also be important to know if your symptoms have improved.

I had FT3 over top range, 6.20 (5.99) in late 2012, which would have made me really hyperthyroid yet all my symptoms told the opposite (at the same time I also had a TSH of 6). I have no idea what it is now, but it didn't seem to be a very telling test in my case.

There is some talk that the FT3 test measures both FT3 and RT3 at once, with no way of telling them apart. This would explain why results can sometimes be quite high but not be representative of symptoms. Do you have an idea if this is true, Dewitt?

I have never heard about that, but I'm pretty sure it's not true. Free T3 and reverse T3 usually have an inverse relationship. The discrepancies between results and symptoms is more likely caused by differences in the sensitivity toward thyroid hormone, as well as differing uptake rates.

Tests were done on the second day of the cycle. I am confused about my labs, because the TSH, T4 and T3 seems in collision with cholesterol and prolactin, as you said Dewitt. I can understand what Cbar means, but that just doesn't work with me-if I stop with the Cynoplus for few months my TSH rises to 7. And my symptoms get 10 times worse than usual. And when I take it I get TSH too suppressed and still feel hypothyroid and my health issues are still there. My current health issues are: IBS, insomnia and irregular cycle, I don't ovulate every month, maybe every other( hence the lack of progesterone).

Thanks guys for helping, I am really tired and confused about everything. I cried a lot today.

Poor Lilly :( I empathize with you. My doctors only test TSH, but mine was low and I still have some hypo symptoms - IBS, no cycle whatsoever, tired a lot, weird sleep patterns and very sensitive to adrenaline. But if I lower my dose even a little, things get worse. So if you come up with any solutions, I would love to hear!

Are you taking any medications/supplements besides thyroid?
Vitamin E and Zinc can bring prolactin (and often times estrogen) down to normal levels, especially in a stressed state. IBS, insomnia and irregular cycle all point toward a basic malfunction of metabolism, usually accompanied by a rise in pituitary stress hormones and serotonin (and sometimes estrogen). The symptoms are relatively easy to manage, but finding the cause is a bitch. I've come to the conclusion that any stressful events in the past might cause this kind of reaction. This may include anything from excessive dieting, a stressful job or marriage, to being abused or neglected as a child. So trying to generally de-stress is probably just as important as managing symptoms, altough not always easy to do.

Thyroid, progesterone and vitamin E seem like the most important things to consider in your case. Don't get confused about your thyroid panel. As I said many times, the uptake rate and sensitivity towards thyroid hormone differ widely and especially in a very stressed state, even high concentrations of thyroid hormone might not have the expected effect. In these cases, it is important to bring down stress hormones first and supply all necessary nutrients, in order to increase the sensitivity to thyroid hormone. Caffeine and butyric acid can help with that as well.

nicely put. True, true and true. Unfortunately I have some stresses in life that I cannot get rid off.
Also, shall I keep the 1 pill a day?
what about bromergon to take down prolactin?
what about tianeptine?

Lecomer I'll let you know for sure:) I am not that poor but I do feel helpless often, this stuff is pretty hard to handle. But we can do it!:) Have you tried eating more? Like, give yourself a couple of months of eating constantly, everything that you crave, gain a bit weight, who cares, I think your body might still be in a starving mode and needs more calories and more nutrients.

Lilly - yeah, trying to figure it all out stinks :( I gained a lot of weight when I first came out of starvation mode last March. I can't really eat anything I want, because I don't have a gallbladder, so lots of stuff makes me sick. But, I have been eating more. I don't count all my calories, but I think I eat between 2,000 and 2,500 calories per day (I usually wake up in the middle of the night needing to drink juice so I can fall back asleep), depending on the day. I've lost a little bit of weight since I began taking thyroid, but I still have a lot of symptoms of either hyper or hypothyroidism. I eat massive amounts of sugar too - I drink soda all the time (organic ginger ale) and lots of orange and other juice. I've even given up and started eating bread again (usually sourdough or ciabatta). So I think I am eating enough, but like you said, I have sources of stress that I can't do anything about other than deal with them.
On a side note, have you tried taking a magnesium supplement Lilly? In addition to thyroid and progest-e, adding in a magnesium supplement seems to have helped me battle estrogen dominance a little.

I soak my feet in Mg sulfate and it's great, I feel better afterwards

Looking at the blood tests, I'd say that 1 pill per day should be enough. But ultimately, you have to judge by symptoms.

Tianeptine can definitely be helpful in the long-run and is mostly free of side-effects.

Bromocriptine should be considered a last resort, since it also acts as a (weak) serotonin- and adrenaline-agonist. Your prolactin levels are still in the "safe" range, so you should stick with milder substances for now.

"I've come to the conclusion that any stressful events in the past might cause this kind of reaction. This may include anything from excessive dieting, a stressful job or marriage, to being abused or neglected as a child. So trying to generally de-stress is probably just as important as managing symptoms, altough not always easy to do. "

So true.