[One of the occasional series of posts about my typical day.]
Flipping the charts by photobunny
Or, Annual Physical update the 2nd (and hopefully final :)
What I didn’t mention before was that the day of my annual I was near the tail end of my period. It wasn’t bad enough that we couldn’t do my pap smear (yes, this 400lb 42-year-old woman has a sex life) but it did mean my urine sample had a bit of blood in it. Which necessitated going in to give another urine sample a week later. So my urine tests were all a week behind my bloodwork and pap. Which is probably why the THIRTEEN PAGES of full test results didn’t arrive for another week after the initial, “Here’s the summary of your results” letter I wrote about here (and that letter arrived a couple days after a phone call to discuss my vitamin B12 & D levels.)
Then WellRoundedMama made a few excellent suggestions about vitamin D & TSH. I started to write a reply, and dug in the file box for last year’s even longer test results for comparisons, and … well … my reply was getting onto all sorts of other stuff and, really, getting to post length. So, here ’tis.
| Vitamin D |
July 2007 | Nov 2008 | Desired Range |
| Results | 23 pg/mL | 28 ng/mL | 15-75 pg/mL 30-150 ng/mL |
No, that “desired range” isn’t a typo. Last year’s lab results were in pg/mL, this year’s are ng/mL. This year’s also includes a note that between 20 & 29 ng/mL is “a relative insufficiency”.
I’ve been taking 1000 ius of Vitamin D a day. Now I’m alternating between 1400 and 2400 in prep for going up to 2400iu / day.
| Thyroid | July 2007 | Nov 2008 | Desired Range |
| TSH Result |
3.22 uIU/mL | 2.67 uIU/mL | 0.40 – 5.00 uIU/mL |
| Free T4 Result | 0.8 ng/dL | — | 0.6 – 1.6 ng/dL |
I’ve read that some endocrinologists are pushing to lower the “normal” upper range for TSH to 4.5 or 3.0, but I seem to be moving in an okay direction here. I do have hypothyroidism in my family background, which is why she checked the Free T4 last year.
| Vitamin B12 | July 2007 | Nov 2008 | Desired Range |
| Results | 282 pg/mL | >1000 pg/mL | >247 pg/mL |
This is the biggie, for me. From what I’ve read, the 247 is indeed a very low value, and I’ve felt considerably better since I began treatment. Initially I was given a shot of B12, to get me to a “normal” level, and I’ve been taking OTC vitamins since then. I gradually increased to 3000mg a day, which is admittedly huge. Here’s the thing, though: If I forgot to take them, or if I just put them off til noon, I would feel very tired and a bit sick.
Until last Friday.
Last Friday I was fixing dinner in the kitchen and saw a familiar pile of vitamins. The exact pile, in fact, that I take each morning. I’d gotten them out, put them down, and hadn’t taken them. And I felt fine.
Part of why B12 deficiencies tend to develop gradually is that the body can use its “reserve supply” in the liver. I think I’ve finally got enough B12 built up in my liver that I can manage without the pills for a day without feeling dead. Don’t worry, I am still taking them daily! (And our “in case of earthquake” supply of canned food & bottled water includes B12.) But I am experimenting with dropping to 2000mg/day.
Otherwise…hm…my fasting blood glucose reading was 85 this year, 91 last year. And my BUN/creatine ratio was slightly high both years (21 and 22) despite both the BUN and creatine values being fine. Frankly I think it means I’m a bit dehydrated, or at least I am when I haven’t had breakfast….
Update: A primer on deciphering blood tests is here.
Living ~400lbs 
Good old D. I’m currently on 50,000 (yep, that’s prescription!) once a week, and 1400 the other days of the week. (Do not try this at home.) The 50,000s are supposed to help boost me up in a six-week course. If it works, I can go back to just OTC.
So I’d say that your thyroid results might merit a second look. Of course, I’m not a medical professional, yadda yadda, but you might want to research this a bit more.
The whole when-to-treat-the-thyroid thing is very controversial in endocrinology. Some use a norm of 0.5 – 5.0 (or thereabouts) for TSH, but a major endocrinological society has lowered their standards to something like 0.3 -3.0. A lot of docs who are very into thyroid stuff really believe that everyone should be between 1.0-2.0.
From what I’ve seen of the research (and I’m no expert on it, but I’ve seen some of it) it seems like asymptomatic people above these levels really don’t derive much benefit from treatment. But for those experiencing symptoms (and fatigue is a classic one!), treatment is often helpful.
Your T4 is borderline. It’s in the normal range but not by a lot. Your TSH is borderline by the newer standards…normal, but only just. If you have symptoms and wanted to try a trial of meds, you could probably find a thyroid-hip doctor who would work on this with you and see if it helped…and if not, they’d discontinue it. If you don’t have symptoms, I wouldn’t bother. But if you do, it might be worth considering.
Certainly, because you’re pretty borderline (by what *I* think should be the standards anyhow), this should probably get re-checked each year. I’d also suggest they check your T3 levels too.
Go over to Mary Sholomon’s site (spelling? It’s something like that) and check out her thyroid info. Take it all with a grain of (iodized!) salt, but it’s worth at least reading about more and watching carefully.
If they didn’t check you for anemia, you might want to do that too. Low B12 can be part of megoblastic anemia, and iron-deficiency anemia is not that unusual with fat folk either. Both of those can also be implicated in fatigue etc.
Just some more thoughts to consider! You do what is right for you, of course! Blessings on you.
Hi Wellroundedmama. The TSH is borderline by the newer standards, but:
* The symptoms I had – primarily fatigue – did not go away with taking synthroid a few years ago, and
* Did go away when I began taking vitamin B12. I will continue to watch the TSH, and will ask about T4 & T3 next year, but at the moment I’m not too worried.
Re: anemia – I was borderline anemic in 2007 with “weird” red blood cells. That was corrected on the b12 and anemia check they did 6 months ago, and confirmed with this round.
Your T4 is well below optimal. Synthroid also doesn’t work for many poeple, as most people need a combination of T3 and T4, or T3 only. Sadly, most doctors are unaware of this and so most people are left undiagnosed or undertreated.
Check out stopthethyroidmadness.com for some great information on this matter.