# Lab Results? When to treat Hashi's?



## kpowell (Sep 3, 2012)

Hi,

I am new to this forum. Last year I started having heart palpitations and was sent to the ER. It turned out my thyroid was not functioning well and I was diagnosed with Hyperthyroidism. They also found a small nodule and cyst on both sides of my thyroid. My Dr was cautious and wanted to do more bloodwork before I was treated and the next bloodwork my TSH shot up and was at 8.0! She then tested me for antibodies which were very high and diagnosed me with Hashimotos disease. Over the next few months after that I was watched closely and my TSH level went back down into the 1's. 
I had my TSH level checked in July and it was was 1.4. I started feeling bad so I went into the Dr last week and my results were:

TSH 3.1 (.4-3.7)
Free T4 1.0 (.6-1.9)
Free T3 3.3 (1.8-4.2)
Thyroid Perodidase Antibodies 35 (<35) (this is actually lower then last time they were checked I think they were in the 100's)

Is it normal for your TSH level to change that much in one month? I just started my period a week early which never happens (Im usually very regular) and its extremely heavy, I have no appetite, and I just overall don't feel well at all. 
Can Hashimotos disease go away? My antibody numbers have lowered originally they were very high and slowly they have come down to almost nomal.

Do you think I need to be treated for Hypothyroidism? How do you know when to start treating it? I made an appt with my Endo. for tomorrow but she doesnt seem interested in treating me yet. I would appreciate any help/advice ya'll can give me!


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## lainey (Aug 26, 2010)

Yes it is possible for the TSH to change that quickly. There could be several sets of antibodies at work, and depending on which are dominant, your levels can vary widely. It is very difficult to treat a person with replacement medication if their TSH varies widely in a short time as yours has done. Given that it takes 6 to 8 weeks to measure the effectiveness of thyroid medication, you can see why having your levels change that quickly on their own would be a problem. The bottom line is, it makes it difficult to settle on a dose, because your thyroid still seems to be working wildly at times, and at times not working at all.

Did you have an uptake scan? This would give a better idea of how the thyroid is working overall.

Have you had all of the thyroid antibodies tested--TSI, TPO and Thyroglobin? If you have the stimulating and blocking antibodies (TSI and TPO) chances are your levels may continue to change for quite a while---hence the endo's reticence to put you on replacement. Lacking any structural abnormalities, it is common for doctors to want to ride it out until your levels swing in one direction or another and stay there for a period.


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## kpowell (Sep 3, 2012)

I did have an uptake scan done when I started having problems back in October last year. That is when they diagnosed me with Hyperthyroidism because at that time not only did my bloodwork show hyper but so did the scan. I have not had another one since that time. Would you recommend me asking for that to be done tomorrow? Also, I have had all the antibody tests done but they have not All been done in a while. The only one they did with this last labwork was the Thyroid Perodidase Antibodies. Should I ask her to do more bloodwork tomorrow with all of the antibody tests?
So I geuss my question is when do you know its time to treat it? Im frustrated because I feel terrible but it seems like theres nothing that can be done about it  Do people with Hashimotos always end up with hypothyroidism? I appreciate your help!


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## lainey (Aug 26, 2010)

I see you posted again in lab results. Double posting confuses things. Stick to one thread for the same question.


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## lainey (Aug 26, 2010)

> I did have an uptake scan done when I started having problems back in October last year. That is when they diagnosed me with Hyperthyroidism because at that time not only did my bloodwork show hyper but so did the scan. I have not had another one since that time. Would you recommend me asking for that to be done tomorrow? Also, I have had all the antibody tests done but they have not All been done in a while. The only one they did with this last labwork was the Thyroid Perodidase Antibodies. Should I ask her to do more bloodwork tomorrow with all of the antibody tests?
> So I geuss my question is when do you know its time to treat it? Im frustrated because I feel terrible but it seems like theres nothing that can be done about it Do people with Hashimotos always end up with hypothyroidism? I appreciate your help!


If the uptake scan was high, than you really need to know if you have the thryoid stimulating antibodies (TSI). Generally these are discounted unless they are over a certain level, but if they are present they become a big player in this picture, and complicate replacement medication.

Having both sets of antibodies and changing TSH levels is called hashitoxicosis. We have a thread here about it. I suggest going in there and reading about other people's experiences.


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## Andros (Aug 26, 2009)

lainey said:


> Yes it is possible for the TSH to change that quickly. There could be several sets of antibodies at work, and depending on which are dominant, your levels can vary widely. It is very difficult to treat a person with replacement medication if their TSH varies widely in a short time as yours has done. Given that it takes 6 to 8 weeks to measure the effectiveness of thyroid medication, you can see why having your levels change that quickly on their own would be a problem. The bottom line is, it makes it difficult to settle on a dose, because your thyroid still seems to be working wildly at times, and at times not working at all.
> 
> Did you have an uptake scan? This would give a better idea of how the thyroid is working overall.
> 
> Have you had all of the thyroid antibodies tested--TSI, TPO and Thyroglobin? If you have the stimulating and blocking antibodies (TSI and TPO) chances are your levels may continue to change for quite a while---hence the endo's reticence to put you on replacement. Lacking any structural abnormalities, it is common for doctors to want to ride it out until your levels swing in one direction or another and stay there for a period.












Just wanted to welcome you. I cannot add to what Lainey has told you.

TSI is important as is Trab. Also Thryoglobulin and Thyroglobulin Ab.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

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/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)


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## kpowell (Sep 3, 2012)

Thanks for the reply!

I went to my Endo. yesterday and she basically said that most people dont show any symptoms of hypo until there TSH is over 10...well mines 3.1 and I feel like crap. She said that she doesnt feel its necessary to treat me yet in her words "it would be like me giving you a placebo drug" just to say Im treating you which really upset me! She said that she wants me to have bloodwork done in 6 weeks and see what my TSH, FT3 and FT4 look like. The only antibodies shes testing me for are thyroid peroxidase antibody... is that what I should be tested for? Or are there other tests that are better?

I appreciate your help!


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## sleepylady (Mar 18, 2012)

You know why this is a stupid comment for a physician to make? A placebo is a sugar pill that has no known effect on the body, but thyroid medication regulates a hormone. If it changes something, then it works! Doctors are really getting on my nerves lately.


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## CA-Lynn (Apr 29, 2010)

If the antibodies are bouncing around all over the place, perhaps they'll be sliding down a bit.......in which case you wouldn't necessarily need meds just yet.

I think since the TSH is in the "normal" range that it would be prudent to wait 6 weeks and see what it looks like then.

Your insurance might dictate a certain minimal level of treatment when there is no "documentation" [i.e., blood tests that are abnormal, which yours is not] to support treatment.


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## midgetmaid (Jul 22, 2010)

The fact that she's willing to test FT3 and 4 again that soon is a good sign.

Renee


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## Andros (Aug 26, 2009)

sleepylady said:


> You know why this is a stupid comment for a physician to make? A placebo is a sugar pill that has no known effect on the body, but thyroid medication regulates a hormone. If it changes something, then it works! Doctors are really getting on my nerves lately.


Ditto that!


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## Andros (Aug 26, 2009)

kpowell said:


> Thanks for the reply!
> 
> I went to my Endo. yesterday and she basically said that most people dont show any symptoms of hypo until there TSH is over 10...well mines 3.1 and I feel like crap. She said that she doesnt feel its necessary to treat me yet in her words "it would be like me giving you a placebo drug" just to say Im treating you which really upset me! She said that she wants me to have bloodwork done in 6 weeks and see what my TSH, FT3 and FT4 look like. The only antibodies shes testing me for are thyroid peroxidase antibody... is that what I should be tested for? Or are there other tests that are better?
> 
> I appreciate your help!


I furnished a list of tests for you in a previous post. Plus an ultra-sound of the thyroid. We are seeing a lot of cancer lately!

TPO is good but only "Suggestive" of a myriad of things.

Please go to the link and read............

Negative test is normal; you should not have any of these antibodies. And the healthy person does have a low titer of TPO.
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

And do let us know what the TPO Ab results are.


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