# Struggling to understand whats wrong. Please read.



## allthatis (Oct 14, 2014)

Hi, thank you so much for reading. This is going to be a bit of a long post. I will include lab results at the end.

In september 2014 I had a baby. I was induced for high blood pressure. After delivery, I was diagnosed with hyperthyroidism. I had an RAI uptake scan because an ultrasound revealed several nodules. The scan showed that my nodules were hot.

The first endo I saw wanted me to use radioactive iodine to nuke my thyroid that week. I was not comfortable with that. I saw another, who is currently my doctor who wanted me to wait and see what happens.

I was on tapazole for a few months. I have been off of it since April of 2015. My t3 and t4 fluctuate month to month but my t3 has never gone above 3.8, or below 3.2 . My tsh also fluctuates. Several times it has been 0.4 but mostly it is under range.

Everyone I speak to says I have a bit of a complicated case and just arent sure whats going on. I want to know why my tsh is so suppresed, but my free t3 and free t4 arent ever in the hyper ranges.

Ive seen three endos, and 2 pcps, and they all agree that I do not have to be tested for graves/hashis because of my history, the hot nodules, and symptoms that I do not have. My endo also does not think its a pituitary issue for the same reaons.

I obsess over this, I have terrible anxiety over it. I constantly fear that they are missing something. So my questions, which I will be asking my endo yet again tonight lol.

Could this be subclinical hyperthyroidism?

If my nodules were hot, wouldnt my t3 be elevated?

Should I have my pituitary tested?

Could this be cancer? ( I have never had a biopsy, again no doctor thought I should because my nodules were hot) I just have an irrational fear.

What would be going on?

My only symptom is anxiety, but Ive had this before. Its just way worse now that I obsess over my thyroid every month. I can never tell if im anxious and speedy because thats how I am, or if its from my thyroid.

What do you guys think? Thank you so much for reading, I hope this doesnt sound too crazy, I just deal with a lot of anxiety over this. Besides the questions above, should I ask my endo anything else?

Labs

Tsh range = 0.400-4.5
free t3 range= 2.6-4.4
free t4-0.7-2.0

*3/1/16*
tsh- 0.157

free t3- 3.6

free t4-1.1

*2/4/16*
tsh- 0.132

free t3- 3.8

free t4-1.2

*12/26/15*
tsh- 0.323

free t3- 3.3

free t4-1.1

*11/30/15*
tsh- 0.475

free t3- 3.6

free t4-1.1

*10/26/15*
tsh- 0.284

free t3- 3.7

free t4-1.1

*10/1/15*

tsh- 0.419

free t3- 3.7

free t4-1.1


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## Octavia (Aug 1, 2011)

Hi and welcome.

I suspect you have some antibodies at work. Have you had your thyroid antibodies tested?


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## allthatis (Oct 14, 2014)

No I havnt, all of the endos and pcps that I saw said that they didnt think it was necessary because of my history. Think I should push for it?

I just spoke with my endo and he said that he feels its subclinical hyperthyroidism , and that I should have another ultrascan done, which he ordered. ( havnt had one done since october 2014) He basically said because of the hot nodules, I could still be having these issues.

He said it doenst look like my labs are at a level that need to be treated unless I was suffering from a lot of symptoms. I am not, but I get crippling irrational anxiety worrying about this.

Are you thinking this could be a graves disease issue? I wonder why they just wont test it.


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## Octavia (Aug 1, 2011)

You say your labs are fluctuating...but I look at your labs and I think they look amazingly consistent. Yeah, they're up and down a little, but only a little. Very little. But what's odd is your low TSH, given your normal Free T3 and Free T4. Usually, that means antibodies are at work, making things not what they seem.

There's a lot I don't know about thyroid disease, I'll admit that, but I don't understand why hot nodules would be interpreted as "no further testing needed." That doesn't make sense to me.

Odds are extremely slim that it's cancer...so please try not to worry too much. That said, how large are your nodules? (They may not even be large enough to biopsy.)


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## joplin1975 (Jul 21, 2011)

I would get your antibodies tested. Antibodies don't exist in healthy people with normal thyroids. If you have them, then you will know you have an autoimmune thyroid disease. Generally, autoimmune thyroid disease is progressive. It might not change anything for you, but you will know (speaking very generally) what to expect in the near future and it will help clear up some treatment options for you.


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## allthatis (Oct 14, 2014)

Ty! I just called in and left a message letting him know I'd like to have them tested. I hope he runs it. If not I'll go to my pcp.

Now if this is an antibodies issues what will that mean for me?

I really appreciate the replies


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## joplin1975 (Jul 21, 2011)

Antibodies would indicate an autoimmune disease. With hyperthyoid, it would more than likely be Grave's. If you have antibodies, then you'll want to keep in mind that it is a progressive disease. That is, sure, you might not have symptoms now, but you likely will eventually. So you'll want to consider your treatment options.


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## allthatis (Oct 14, 2014)

Thanks! I called and requested this from both pcp and endo, because I really want to have this done! Does graves normally equal thyroid removal?


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## joplin1975 (Jul 21, 2011)

That's certainly an option for some people. I didn't have Grave's so I don't want to give you the impression that I'm speaking from experience...but many people on these boards have had success with surgery.


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## allthatis (Oct 14, 2014)

I was hoping someone could help me interpret these labs. I always thought if anything Id have graves, but someone educated me on the labs, and thinks I may have hashimotos.

Also, the tumor marking one, could that be saying I may have cancer?

*Tpo antibodies*

Test Result Flag Unit RefValue
------------------------------------------------------------------
Thyroperoxidase Ab, S 366.1 h IU/mL <9.0

*TSI*

Test Result Flag Unit RefValue
------------------------------------------------------------------
Thyroid-Stimulating <1.0 TSI index < EQ 1.3
Immunoglob, S

Test Result Flag Unit RefValue

------------------------------------------------------------------
Thyroglobulin, Tumor Marker
Thyroglobulin Antibody, S 3.9 IU/mL <4.0 
Thyroglobulin, Tumor Marker, 8.7 h ng/mL
S

-------------------REFERENCE VALUE--------------------------

Athyrotic <0.1

Intact Thyroid < EQ 33

Thyroglobulin Interpretation

Thyroglobulin (Tg) levels must be interpreted in the context

of TSH levels, serial Tg measurements and radioiodine

ablation status. Tg levels of 2.1-9.9 ng/mL in athyrotic

individuals on suppressive therapy indicate an increased

risk of clinically detectable recurrent

papillary/follicular thyroid cancer.

-------------------ADDITIONAL INFORMATION-------------------

PLEASE NOTE: Thyroglobulin flagging is based on athyrotic

reference values.










Thank you so much for reading. I always thought hashimotos was diagnosed with those who have hypothyroid? I
was diagnosed with hot nodules which made me hyper. Is it common to have both? I havnt had hyper levels in a while now, just suppressed TSH.

What would you do in my case? I have a feeling my doctor is going to be much help. I had to beg for these tests in the first place, and hes the third endo I saw.


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## allthatis (Oct 14, 2014)

Wow I just talked to my endo. I feel like crying.

He told me " I dont know what youre talking about hashimotos, antibodies dont cause anything, you dont have hashimotos you have subclinical hyperthyroid . He said my hot nodules are working by themselves and that is why my TSH is suppressed.

He prescribed me 10 mg tapazol.....


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## Octavia (Aug 1, 2011)

Many of us here haven't had good luck with endocrinologists. What other options do you have as far as doctors you could see?


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## allthatis (Oct 14, 2014)

I am going to call a few naturopath /integrated medicine doctors.

I am so scared 

What does anyone think of my Labs? Does tjyroglogulin one look suspicious of cancer? I have an ultrasound Tuesday


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## WhatHappened (Nov 12, 2015)

There are things that might point towards more examinations for a closer look, the ultrasound is another tool towards that end (and when you get the report, don't forget to post). Thyroid cancer is relatively rare, and while it is still cancer is probably the most treatable going around. Don't borrow worry before it is necessary. I recently had a biopsy, but am not too concerned. Curious, occasionally nervous, but otherwise waiting for a result.

You are doing the right things, finding doctors and doing the tests. Make those phone calls, find a new doctor or two, and don't skip your ultrasound (in fact make sure you get a copy of all your results). If the doctor you don't like is the one interpreting the ultrasound result make sure to get a second opinion when you find your new doctor.


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