# 3 blood tests and still no clue...help!



## GatorAdrian (Sep 25, 2011)

Hey guys, I'm new here and I was hoping someone may be able to shed some light on my mysterious medical issues...sorry if this is a little long: 
I'm a 24y/o female and was diagnosed with ADHD ~4 years ago (currently taking 30mg of Adderall twice/day), though I've had symptoms of it my whole life. But now I'm wondering if this was (at least partly) due to undiagnosed hypo/hashi's (there definitely seems to be a connection between ADD and thyroid issues)...but I moved from the US to England a year ago and since then I've been having a lot of medical problems that seem to be getting worse, including:

- worsening attention, memory, 'brain fog' 
- horrible fatigue and periods of depression that are getting more and more frequent..if I didn't have my daily dose of adderall I would be totally useless
- oily skin, hair and acne (skin used to be super clear), and my hair is starting to feel more and more straw-like at the same time
- steady weight gain when it used to be really easy for me to lose weight and now I've been eating really healthy and exercising but I'm only getting fatter
- fluctuating between constipation and diarrhea...seems like my bowels haven't been normal for months
- itchy skin, especially when I'm tired
- occasional breathing problems...feels like I can't get enough air in (this is even worse when I'm tired as well)
- ongoing back issues that won't go away despite physical therapy and weekly trips to the chiropractor
- Horrible insomnia..have always had trouble falling asleep but lately I'll be up literally all night trying to fall asleep. Like I'm tired all day but I still just can't sleep!
- heavy periods and absolutely no sex drive
- big, fluctuating appetite (food intake probalby doubles right before my period)
- identical twin (not a symptom per se, but I've read that hypo is much more likely in multiples http://jcem.endojournals.org/content/early/2007/05/08/jc.2007-0238.full.pdf)
- probably a bunch of other symtoms I'm forgetting..I just generally feel awful, fat and ugly these days!!

Anyway, it seems like the tipping point for me health-wise was when I got the Mirena IUD put in in April 2011 (i've never been pregnant). 3 months later I had a sudden attack of what they think was pelvic inflammatory disease that sent me to the emergency room with horrible pain, bloating, nausea, etc. I had it removed a few days later, and was put on 2 weeks of antibiotics, but no infection or anything ever showed up in my labs and my dr. had no explanation for why this might've happened. But after that episode, it felt like all of the symptoms I described above started getting worse quickly, which is why I started thinking my thyroid was to blame. (My theory is that I was already on the road to becoming hypo and the mirena threw my whole hormonal balance out of whack. Of course the doctor says mirena can't effect my thyroid, but I think she's an idiot.)

I've had 3 blood tests so far and after my last one the GP FINALLY gave me a referral to an endo. because my TSH was finally high. Here's how the tests came out: 
Blood test 1 (Aug 17):
TSH=2.8 mu/L (.3-5.5)...that's all they tested thyro-wise, but I demanded more tests since I was certain something was wrong and they begrudgingly obliged (though the dr said she thought it was just depression..psh!).

Blood test 2 (Sep. 2): 
FT4: 16.8 pmol/L (10.0-19.8)
FT3: 5.3 pmol/L (3.5-6.7)
TSH: 3.2 mu/L (.3-5.5)..(I know that this normal range is up for debate though!)
Thyroid peroxidase antibodies: 66.2 IU/mL (0-60)
Was given a 3rd blood test because my antibodies were high, but the dr. said not high enough to be hashi's (???)

Blood test 3 (Sep 19): 
FT4: 17.9 pmol/L (10.0-19.8)
TSH: 7.8 mu/L (.3-5.5)
Thyroid peroxidase antibodies: 52.7 IU/mL (0-60)
(don't know why they didn't do FT3 again or why they never did regular T3/T4..all I can say is the doctors in the UK are absolutely horrible)

My doctor was totally baffled after my last test (though I could tell she felt bad for telling me it was all in my head last time). She said it didn't make sense for my TSH to fluctuate so much in such a short period, but since my antibodies and FT4 were 'normal' there was no way it could be hashi's. She referred me to an endo, but my appointment isn't for 3 more weeks. In the meantime, I am trying to do as much research as possible so I can be prepared with all of the right questions and get more blood tests if need be.

So would the blood tests above be consistent with a Hashi's diagnosis? Are there any more tests I should ask for before i see the endo on Oct 13? I've read that the UK is not great for thyroid treatment, and this whole thing has made me seriously consider going back to the US for proper medical care. I'll wait to see what the endo says first, but if anyone has any advice I'd love to hear it!


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## Andros (Aug 26, 2009)

GatorAdrian said:


> Hey guys, I'm new here and I was hoping someone may be able to shed some light on my mysterious medical issues...sorry if this is a little long:
> I'm a 24y/o female and was diagnosed with ADHD ~4 years ago (currently taking 30mg of Adderall twice/day), though I've had symptoms of it my whole life. But now I'm wondering if this was (at least partly) due to undiagnosed hypo/hashi's (there definitely seems to be a connection between ADD and thyroid issues)...but I moved from the US to England a year ago and since then I've been having a lot of medical problems that seem to be getting worse, including:
> 
> - worsening attention, memory, 'brain fog'
> ...


Welcome to the board!

Thyroid peroxidase antibodies (TPO) are only "suggestive" of Hashimoto's and a myriad of other things as well. High titers of TPO are common in those with Hashimoto's but I do not consider that a carved in stone diagnosis as you will discover when you read this.

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

I would like to suggest you get these other tests excluding the TPO as your numbers are very strange indeed. With high TSH, we expect to see very low FREE T3 and FREE T4. Conversely, Low TSH with high FREE T3 and FREE T4.

This tells me that because your TSH is high and your FREES are high that you have binding and blocking antibodies and immunoglobulins and even some stimulating immunoglobulin (TSI) at work. This off sets the numbers in an attempt to set the body to rights. Meanwhile the numbers don't really indicate what is truly going on with the patient.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

It is entirely possible that you are trying to go hyperthyroid. Your symptoms point to that and yes; many of us hypers have gained weight, believe that or not. The symptoms can and do cross over.

For that reason, this test is really really important.

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

Please also bear in mind that you are not supposed to have any TPO Ab. So, your test was NOT normal. The healthy person should have a low titer of TPO but NO antibodies to TPO. So, something is afoot!


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## GatorAdrian (Sep 25, 2011)

Wow, thanks..that's really helpful. I will see about getting those tests while I wait for my endo appointment and post the results when I get them. From the research I've been doing I'm also starting to worry that this might stem from an issue with my pituitary gland/adrenals. I'm thinking the worsening insomnia might indicate too much cortisol, so maybe I should have them test that too?

The other thing I am worried about now is that our UK apartment has had an ongoing issue with mold and from what I've read that can lead to thyroid problems and pituitary tumors. It might make sense that the mold is a factor given that my symptoms seem to have worsened since moving here (though the weight gain, bouts of depression, trouble focusing, etc. were going on before the move, they were just less debilitating.)

Not sure if it's the right type of immunoglobulins you're referring to, but in my first blood test I tested high for IgM - 2.8 g/L (.5-1.9). They said this could be because I was getting over a cold and they didn't retest. Also, in the 2nd blood test I also tested high for ALT/SGPT serum - 40 u/L (0-35), which has something to do with liver function, and high estimated glomerular filtration rate - 85 mL/min on blood test 2 and 80 mL/min on blood test 3 (no normal rage for this one, they just say to refer to the UK CKD eGuide: http://www.renal.org/whatwedo/InformationResources/CKDeGUIDE.aspx)..still don't really understand though. And I don't know why they didn't retest my liver function in the 3rd test.

But the dr. didn't seem concerned with any of these numbers, and just said not to worry about it. (seriously?!)

I've also had high blood pressure the past few times I've been to the doctor, even though my blood pressure is usually on the low end. (I once had a nurse tell me my blood pressure was so good I'd probably never have blood pressure problems)

But do these numbers shed any more light on what could be going on? Does this maybe sound more like a pituitary problem? I'm just so freaked out about how crappy I feel lately--I mean I'm only 24! :-(


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## Phoenix (Mar 20, 2010)

Hi, and welcome.

In early stage Hashimoto's, the numbers can fluctuate a lot, and it can be difficult to diagnose. It took me about 6 years, after I started feeling really bad, to get a diagnoses... and that was with me pushing them all the way.

I had a TPO antibodies come back in the 400's, and the doctor told me one of my thyroid test was off "a little bit". :scared0015: So I totally understand.

You may want to look around and see if you can find a good endocrinologist (they are not all created equil) that likes to treat thyroid patients. Most are more into treating diabetes issues.

IgM can also be an indicator of an autoimmune disease, which is what Hashimoto's is.

Hang in there. It can be hard getting a diagnosis sometimes, but don't give up, you have to keep going, and keep pushing for answers.

:hugs:

Phoenix


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