# Lab results...what is wrong with me?



## ella_minnow_pea (May 12, 2013)

Good morning 

I've been poring over these boards since March 23rd when I went to the doctor for a weird twisty stretchy feeling in my supraclavicular region. Doctor found nothing in that area but noticed something in my thryoid after palpatation. Same day lab work showed all levels normal (I'm currently at work and left those labs at home), TSH was 1.05, Free T4 was 1.3, FT3 was not tested (same ranges as below). Oh and my calcium was 10.2, upper range limit was 10.2, so still *considered* normal but on the high end of normal.

3/28 ultrasound showed nothing in the supraclavicular region. Ultrasound screening showed a solid nodule on the right measuring 1.2cm, and a solid nodule on the left measuring 2.0cm. Second ultrasound on 4/4 said the EXACT SAME THING, only difference was that this ultrasound was focused on my thyroid and included measurements of the gland itself.

4/23 I had RAIU. Those results showed increased heterogenous uptake of 39% after 24 hours.

4/30 I visited my regular doctor and he prescribed metoprolol and hydrochlorothiazide to try and slow down my rapid heart beat and bring my BP down as well.

5/1 I had a biopsy on the right nodule at my 1st visit with the Endocrinologist. He uses Veracyte/Afirma. Those results came back as negative. The nurse only gave me a negative result, no further info, but I will get a copy of the results at the next visit. I go back this Wednesday for a biopsy on the left nodule. These results below are from the Endo visit on 5/1. I also had a 24hr urine test for Iodine but those results are not yet posted on their website.

Free T4 1.28 
RANGE 0.71-1.85 ng/dL

TOTAL T3 1.00 
RANGE 0.60-1.81 ng/ml

TSH 1.770 
RANGE 0.350-5.500 uIU/mL

THYROID PEROXIDASE ANTIBODY 48 <----- And this means?
RANGE 0-35 IU/mL

THYROGLOBULIN RESULT 283.1 <----Whaaa????
RANGE < 55 ng/mL

THYROGLOBULIN AB <1 
RANGE < 40 IU/mL

This is listed as one test by itself.
THYROID STIMULATING IgG: = NEGATIVE RANGE = NEGATIVE 
SAMPLE:REF RATIO = 37 RANGE < 140 %

As far as symptoms I go...I'm really unsure. I've had a series of high stress life events to happen between 2005 and 2010. Then in 2010 I changed my family's lifestyle and eating habits for the better, cut out just about all sugar, I also started taking supplements. In 2011 I started exercising and lost 20 lbs. Things were finally looking up. In 2012 I started having sleeping problems (sleep by 9p, up at 11p, sleep at 4a), thought nothing of it, just figured it came with the mid-30s. Hair sheds like crazy, but has been since 2006. Gained 20 lbs since July 2012, figured that was because I started working (after 3 yrs of unemployment) a new sedentary office job and I stopped exercising. I take fish oil, biotin, B complex, and a multivitamin. I also recently started taking Coq10 once daily, may try to increase it so I can get rid of Metoprolol. I crave salty foods/snacks all day.

So... any ideas as to what in THE world is going on? My regular doctor was thinking maybe Hashi's. Endo was thinking maybe iodine deficiency. I'm lost


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## ella_minnow_pea (May 12, 2013)

5/16: So had second biopsy done yesterday and discussed labs with Endo. He said my iodine levels ere somewhat low, will recheck that along with all other labs in a couple months. May need to start supplementing with iodine. Results from the biopsy are: The cytlogic preparations are moderately cellular and show sheets and clusters of follicular cells, some macrophages and colloid. The features are consistent with a benign hyperplastic/adenomatoid nodule.

Asked the doctor what he thought so far, and he feels like it is some Hashi's with inflammation. Will find out about the 5/15 biopsy early next week.

Hope this helps someone


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## joplin1975 (Jul 21, 2011)

Uh, interesting. I think the second biopsy will be telling.

The TPO, in laymen's terms essentially means your thyroid is under attack. Often seen in Hashi's, but it doesn't mean it IS Hashi's.

The thyroglobulin is often used as a tumor marker for people with thyroid cancer. Since your thyroglobulin antibodies are within range, the thyroglobulin (Tg) is considered accurate. You have a pretty high number so I think its really important to have that second biopsy.

But, just to confirm, the nodules were not visible on the RAIU?


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## ella_minnow_pea (May 12, 2013)

Nope, no nodules visible on the RAIU. Heterogenous increased uptake with no visible nodules. Confusing, right?


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## Andros (Aug 26, 2009)

ella_minnow_pea said:


> Good morning
> 
> I've been poring over these boards since March 23rd when I went to the doctor for a weird twisty stretchy feeling in my supraclavicular region. Doctor found nothing in that area but noticed something in my thryoid after palpatation. Same day lab work showed all levels normal (I'm currently at work and left those labs at home), TSH was 1.05, Free T4 was 1.3, FT3 was not tested (same ranges as below). Oh and my calcium was 10.2, upper range limit was 10.2, so still *considered* normal but on the high end of normal.
> 
> ...


Oh, wow!!! That Thyroglobulin is "really" high and Joplin laid it out for you. I concur. Move ahead w/biopsy and you may wish a second opinion from an ENT.

Solid unfortunately is a word that we are not comfortable with when it comes to nodules.

Here is some info for you!

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf


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## joplin1975 (Jul 21, 2011)

ella_minnow_pea said:


> Nope, no nodules visible on the RAIU. Heterogenous increased uptake with no visible nodules. Confusing, right?


Very confusing! I'm not sure what to say except I have heard people talking about rare cases of iodine insufficiency and high Tg. I have no idea if there's any truth there, but...

Hopefully someone with much more knowledge will be along shortly!


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## ella_minnow_pea (May 12, 2013)

Thank you both! Endo wasn't worried, he said Thyroglobulin would need to be in the thousands before worrying...made no sense to me, but what do I know. I'm going back to my GP in a couple weeks to discuss it all and see if I needed a second opinion/referral. Will update on the next biopsy result.


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## joplin1975 (Jul 21, 2011)

ella_minnow_pea said:


> Endo wasn't worried, he said Thyroglobulin would need to be in the thousands before worrying...made no sense to me, but what do I know.


I still can't help much but just wanted to say this statement is...suspect. REALLY suspect. If I recall correctly, in a normal patient, Tg levels rarely go above 40. You might want to poke around online because there's a good amount of reliable sources that dispute his claim.

http://emedicine.medscape.com/article/2089532-overview


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## ella_minnow_pea (May 12, 2013)

joplin1975 said:


> I still can't help much but just wanted to say this statement is...suspect. REALLY suspect. If I recall correctly, in a normal patient, Tg levels rarely go above 40. You might want to poke around online because there's a good amount of reliable sources that dispute his claim.
> 
> http://emedicine.medscape.com/article/2089532-overview


Would it matter that these labs were taken about 15 minutes after the FNA?


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## ella_minnow_pea (May 12, 2013)

Results of my 05/15 biopsy on the left side are pretty much the same as the right side: Cellular changes of Adenomatoid nodule. Benign. I have a doctor appointment with PCP next Tuesday. Endo's next appointment isn't until July.

*HOWEVER*, I did finally get the actual results of my iodine tests:

Iodine, 24 hour urine 
207 mcg/spec ....RANGE = 93-1125mcg/spec
---Iodine Concentration
94 mcg/L ....RANGE = 26-705MCG/L

Iodine, Total Serum
56 mcg/L ....RANGE = 52-109mcg/L

So it looks like all of this may be caused by low iodine levels. I was just reading about what Joplin posted... high thyroglobulin in iodine deficiency. Could be why I crave salty foods, etc?


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## Andros (Aug 26, 2009)

ella_minnow_pea said:


> Results of my 05/15 biopsy on the left side are pretty much the same as the right side: Cellular changes of Adenomatoid nodule. Benign. I have a doctor appointment with PCP next Tuesday. Endo's next appointment isn't until July.
> 
> *HOWEVER*, I did finally get the actual results of my iodine tests:
> 
> ...


For the sake of clarity, we need to use the proper terminology. We have small amounts of Thyroglobulin and should not have any Thyroglobulin Ab. This is of course for the well person.

Read this please...............

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/e...cle/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/

Therefore, if you have high titers of Thyroglobulin Ab, I say something is up.


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## joplin1975 (Jul 21, 2011)

ella_minnow_pea said:


> Would it matter that these labs were taken about 15 minutes after the FNA?


I have no idea, but I did just stumble upon this:



> Simply examining the thyroid or carrying out a thyroid biopsy can produce significant elevations in the circulating blood level of thyroglobulin.


http://www.mythyroid.com/thyroglobulin.html


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## Andros (Aug 26, 2009)

joplin1975 said:


> I have no idea, but I did just stumble upon this:
> 
> http://www.mythyroid.com/thyroglobulin.html


Interesting find!! I could see that happening. Of course.


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## ella_minnow_pea (May 12, 2013)

Andros said:


> For the sake of clarity, we need to use the proper terminology. We have small amounts of Thyroglobulin and should not have any Thyroglobulin Ab. This is of course for the well person.


Thanks Andros. Just to clarify, I do not have ANY Thyroglobulin Ab, I do have slightly higher than normal levels of TPO Ab. My Thyroglobulin is much higher than normal.



joplin1975 said:


> I have no idea, but I did just stumble upon this:
> 
> Quote:
> Simply examining the thyroid or carrying out a thyroid biopsy can produce significant elevations in the circulating blood level of thyroglobulin.
> ...


Thanks Joplin, I came across that article too. That's why I was sort of wondering about that number. I'll ask (beg, plead, same thing, lol!) PCP to recheck Thyroglobulin/Iodine and add in a check for Selenium.

Thanks you guys for all of your assistance


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## Andros (Aug 26, 2009)

ella_minnow_pea said:


> Thanks Andros. Just to clarify, I do not have ANY Thyroglobulin Ab, I do have slightly higher than normal levels of TPO Ab. My Thyroglobulin is much higher than normal.
> 
> Thanks Joplin, I came across that article too. That's why I was sort of wondering about that number. I'll ask (beg, plead, same thing, lol!) PCP to recheck Thyroglobulin/Iodine and add in a check for Selenium.
> 
> Thanks you guys for all of your assistance


Thank you for that and as we all now know, it should not be that high. Did doc run Thyroglobulin Ab? If not, that would be of interest.

Bless your heart; hang tough!


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