# Thyroglobulin Antibodies but normal TSH, T4 and T3: What does this mean?



## Seeking (Sep 19, 2013)

UPDATE: See Post # 21 for latest labwork and possibly-shocking result.

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I have had a lot of blood work done in the past year. The most recent include the following:

TSH: 3.36 uIU/mL
Reference: 0.45-4.5

Free T4: 1.49 ng/dL
Reference: 0.82-1.77

Free T3: 3.1
Reference: 2.0-4.4

*Reverse T3: 33.7 ng/dL*
Reference: 9.2-24.1

T4 (I'm guessing this is total): 10.7 ug/dL
Reference: 4.5-12.0

Thyroid Peroxidase TPO: 10 IU/mL
Reference: 0-34

*Thyroglobulin Antibody: 177 IU/mL*
Reference: 0.0-0.9

Vitamin B12: 325 pg/mL
Reference: 211-946

Vitamin D: 41 ng/mL
Reference: 30.0-100.0

*C-Reactive Protein: 3.72 mg/L*
Reference: 0.0-3.0

Folate: 12.8 ng/mL
Reference: >3

Cortisol, AM:
13.5 ug/dL
Reference for AM: 2.3 - 19.4

I also tested *positive* for Celiac Disease (just got the result back on this one today). I have tested *negative* for diabetes and pre-diabetes (6 months ago). My symptoms include:

• Depression
• Weight Gain
• In the past few years, gained more fat in my abdomen
• Brain Fog
• Memory loss
• Short-term and long-term memory dysfunction
• Reduced cognitive function
• Chronic fatigue
• Hypoglycemia symptoms
• Slow healing of bruises/wounds/cuts/nicks/scrapes/etc
• Irritability, poor mood and crashing after eating high amounts of sugary foods
• Bloating, water retention, and increased flatulence
• Acid reflux (comes and goes)
• Blurred vision/decreased vision in past 3-4 years
• Yellowish/darkened color on my skin in armpit area and inner thigh area (Acanthosis nigricans?)
• New hair growth in inappropriate areas such as chin and areas near but outside of pubic region (within a 5 inch radius of the pubic region).
• Lack of motivation since age 22. Used to be a very motivated, ambitious, and driven person.

So my question is: do I have Hashimoto's Thyroiditis, based on these lab results and my symptoms, or is it something else? If it is something else, what is it? I hope someone here knows more than I do...


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## joplin1975 (Jul 21, 2011)

Have you has an ultrasound?


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## Seeking (Sep 19, 2013)

No I have not had any ultrasound.


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## Andros (Aug 26, 2009)

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

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
(Copy and paste into your browser)

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
(Copy and paste into your browser)

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
(Copy and paste into your browser)

Only FNA is definitive for Hashimoto's. You should not have any Thyroglobulin Ab.

Information provided above!

Please get an ultra-sound.


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## Seeking (Sep 19, 2013)

Andros said:


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


I took a look at your links and they appear to be long, highly-technical and non-specific papers. And while I am an analytical thinker and enjoy a highly technical paper about once a week, I like it to be specific to the issue at hand or subject that I am currently interested in. I will eventually click on your links and take the time necessary to read them, but in the meantime I've been searching elsewhere for more specific and immediate information relating to rT3 and thyroid antibodies.

What I found so far seems to indicate that high Reverse T3 blocks T3, which causes hypothyroid symptoms. I also read that insulin resistance (which I have) and autoimmune diseases (of which I have at least one) can cause high levels of rT3.


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## bigfoot (May 13, 2011)

Many docs will test Thyroglobulin Ab's and TPO Ab's when looking for Hashimoto's. As Andros mentioned, this isn't 100% fool-proof, but gives a really good indication. Most docs aren't likely to biopsy if they suspect Hashi's; they will run a few blood tests and consider putting you on levothyroxine meds.

This is where most of us fall through the cracks. Lots of docs stop at this point. As patients, we languish, complain about continuing signs & symptoms, and are often written off as having a mood issue and given a fistful of drug samples.

You want to take things past these few meager steps. It's great that you were tested for Celiac -- while it's unfortunate that you tested positive, do know that gluten has a nasty habit of continuing inflammation and possibly triggering the thyroid antibodies. So you want to approach treatment for Hashi's on two fronts: One is proper treatment with medication and continued monitoring; the second is trying to calm the inflammation via nutrition, exercise, sleep, consulting with someone like a naturopath, etc.

As mentioned above, an ultrasound at this point is a very good idea. This will give you a baseline to compare against in the future, plus it may catch anything that the doc can't spot via simple palpation (nodules, abnormal size, etc.). Your CRP being elevated, as well as your Reverse T3, certainly points to inflammation. This could be due to Hashi's progress, or even from the Celiac. Or both.

My humble suggestions to get started:

* Thyroid ultrasound for baseline.

* Run labs for Thyroid Stimulating Immunoglobulin (aka TSI, *not* the same as TSH), and Thyroid Receptor Antibodies (aka TRAb). This will check for Graves' Disease.

* Check adrenal function / cortisol levels via a 24-hr. urine or saliva collection, broken into different collection periods. A one-time blood test is not as telling.

* Go gluten-free ASAP. No cheating! Gluten can hang out in your body for days and weeks after ingestion.

You may have read this already, but steer clear of docs who diagnose and monitor treatment by way of TSH only. TSH is a pituitary hormone, *not* a thyroid hormone. It is only a rough guesstimate of thyroid function. If you already have a thyroid problem, the TSH becomes even less relevant. The Free T3 and Free T4 are far more crucial to keep an eye on, both before and during treatment, titration of medication, etc. They are the active forms of thyroid hormone floating around. It's good that you had a Reverse T3 test run, as that can be telling, too. You may be a poor converter of T4->T3.

As far as medications, if you haven't been started on one already, know that there are a few different approaches. What is best for you is what works for you as an individual. Your doc should be open to trying different medications, not just be stuck on Synthroid (T4 only), for example. There is generic levothyroxine (avoid this due to variations in manufacturers), brand-name levothyroxine (Synthroid, Levoxyl, Tirosint), generic T3, brand-name T3 (Cytomel), desiccated "natural" meds which combine T4 + T3 (Armour, Nature-Throid, West-Throid), and then there are custom-made T4 and/or T3 meds that can be offered by a compounding pharmacy.

--> Note: Many meds are *not* gluten-free. Synthroid brand-name is not guaranteed GF. I had a bad reaction to it, and have a nasty gluten sensitivity. Similarly, many generics are not GF. One that should be (double-check with pharmacy) is the generic made by Mylan. Also, brand-name Levoxyl (just came off recall) should be GF. Tirosint is a hypoallergenic gel capsule. Armour and Nature-Throid are GF, with lots of people having good luck with them. <--

The overall goal is to optimize your thyroid hormone levels, not just be "in range" or "normal" per the doc. Lots of folks here with Hashi's shoot for a suppressed TSH of 1.0 or less, and FT3 & FT4 in the upper 50-75% of the reference ranges. This is a good goal, but is easier said than done. Still, it's something to work towards. You will need to find the right balance that works for you.

Your signs & symptoms list reads like a biography for many of us here.  I probably checked off all but two or three items, and can definitely relate!


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## Seeking (Sep 19, 2013)

Since my last post I've been doing a lot of reading about thyroid conditions and diseases and symptoms and lab tests and I've come to a conclusion about it. Medical science currently does not have the answers. Medical science seems to have failed us all on this critical area. I have also concluded that classical lab tests such as TSH, T4, T3 and so on are not good enough. There are many problems with these tests. The first problem is that the reference ranges are too wide and don't (and cannot) catch everything. They are also not specific enough to detect a problem. I just read that someone can be hypothyroid at a TSH of 1 while another person will feel great at 1. Someone may be hypo at 2.1 but feel great at 2.

This tells me that TSH is nearly meaningless and that the specific biological problems caused by thyroid that people are having currently do not have a lab test to detect them.

However, I have come across some information that may change my life and I'd like to know more from other people who have the same problem I do. I have very high Reverse T3 accompanied by antibodies. But everything else is great. My T3 and T4 are in the upper half of the range, so I passed through the cracks.

But I'm not going to just accept my symptoms and live the rest of my life hypo. I can't get the last 10 years of my life back but I want all the remainder that I have. I'm going to try it. I read that high Reverse T3 blocks free T3 from getting into the tissues and that the best way to get the Reverse T3 down is to go on T3-only medication and wait for 12 weeks or so. Anyone else done this? Where do you get these medications without a doctor's prescription? Is there an all-natural T3 med? I don't want synthetic.

And for the love of all things good, has anyone ever gotten their thyroid antibodies to go down?

Oh and for those of you who are going to recommend that I go and see Dr. Holtorf, I have already contacted his office asking for information and got blasted instead with how much office visits cost and schedules and such. I'd be looking at thousands of dollars. No thanks.


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## bigfoot (May 13, 2011)

As someone who had a Reverse T3 in the 500's (no kidding), I too, got missed. Heck, the docs who originally ran the Reverse T3 test didn't even comment on how astronomically high it was! Thankfully, I found a good ND who knew about it. I also did the T3-only protocol (a short-term treatment) you are describing, and it was a little rough. I'd like to say it totally fixed everything, but it didn't, though granted I have other issues going on. It did improve things, though. Eventually I transitioned over to Nature-Throid for the long-term.

You don't get thyroid medications without a doctor's prescription. Sorry. You'd be rolling the dice big time. (Who wants to get a bottle of fake who-knows-what drugs from China that is advertised as a bottle of genuine T3, anyway?)

Best you could do is look into Dr. Wilson's "Wilson's Temperature Syndrome" (hotly debated in medical circles, and not to be confused with Wilson's Disease). I believe there was a listing of physicans on the web page. Since the treatment protocol for Wilson's Temperature Syndrome involves T3-only, those docs may be familiar with thyroid issues, too, and by extension, Reverse T3. Many ND's are more in tune to this kind of stuff. You could also call a local compounding pharmacy and ask if they can suggest anyone, since the treatment for WTS generally requires compounded slow-release T3 meds.

You could then take those names in your area and cross-check them against names on the Armour or Nature-Throid websites. You might find somebody good that way. Worth a try at least.


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## Seeking (Sep 19, 2013)

bigfoot said:


> Many docs will test Thyroglobulin Ab's and TPO Ab's when looking for Hashimoto's. As Andros mentioned, this isn't 100% fool-proof, but gives a really good indication. Most docs aren't likely to biopsy if they suspect Hashi's; they will run a few blood tests and consider putting you on levothyroxine meds.
> 
> This is where most of us fall through the cracks. Lots of docs stop at this point. As patients, we languish, complain about continuing signs & symptoms, and are often written off as having a mood issue and given a fistful of drug samples.
> 
> ...


You mentioned treatment. What treatment? So far what I have done is order blood workup through DirectLabs. There was no doctor involved in this; I paid for these tests on my own after over a year of waiting to save up the money. I had a doctor friend look over the blood tests and he says yes I'm Celiac but no I'm not hypothyroid because my T4 and T3 numbers are in range. He says that as long as my T3 and T4 are in range that the antibodies aren't having any effect at this time. I do not believe him. I have many hypo symptoms. If I don't have Hashi's, then I have something else that is making me hypo.

You suggested that I do some things that are very expensive, but I'm uninsured and strapped for cash. I simply cannot afford ultrasound for baseline, even more labs, continued monitoring (except for once per year blood testing), and doctor's visits. And even if I could afford to purchase health insurance, I'd just be fighting against doctors who don't believe I have a problem. Naturopaths don't take insurance (most of them).

So really, what I've learned from this process is: 1) Thyroid problems are extremely complex and difficult to pin down, 2) You must be wealthy to fix it.

I would like to start on T3-only medication but I'd first need to see a doctor who would be willing to prescribe it ($$$$$ I don't have), then continued monitoring ($$$$$ I don't have). So I guess I'm totally stuck...


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## bigfoot (May 13, 2011)

My friendly suggestions were just that -- suggestions. As you pointed out, you're in a tough spot, no doubt about it. I don't know what the answer is for your situation, and each one of us has our own circumstances to deal with. Some folks here have been to low-cost or public clinics; I don't know if that is something in your area or an option.

I would agree with you that thyroid problems can be complicated, and can require costly tests for initial diagnosis and ongoing monitoring. Sadly, there is just no way around that.


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## Tara1313 (Mar 11, 2014)

Just fyi., I am gf and all thyroid meds gave me horrible reaction I am on tirosint now it has no dyes or gluten works greay


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## Seeking (Sep 19, 2013)

It's time for an update, over a year later...

I've been following a strictly gluten-free diet for a year and have felt much better, but I'm nowhere near where I want to be with my health and quality of life and still pushing to achieve more. Money is no longer tight, as the gluten-free diet improved things enough for me to start up an online business and I'm doing well and now can afford doctor's visits and medication, but I'm not about to go bouncing around from Dr to Dr in the blind hope of finding something that will finally help. I'd rather wait and find the right Dr who will give me results, and just see that person only.

So here's my updated labs:


OLD VALUE = blood test in 2014 white eating gluten-rich diet
NEW VALUE = from blood test taken on June 11, 2015, which is after approximately one year of no-cheating gluten-free diet)
All tests taken at same lab and therefore the reference intervals for both blood tests are the same.

*Celiac Panel:*

OLD VALUE: Immunoglobulin A: 137 mg/dL
*NEW VALUE*: Immunoglobulin A: 165 mg/dL
Reference: 91-414

OLD VALUE: Deamidated Gliadin Antibodies, IgA: 21 units
*NEW VALUE*: Deamidated Gliadin Antibodies, IgA: 7 units
Reference:
0-19 = negative
20-30 = weak positive
>30 = Moderate to strong positive

OLD VALUE: t-Transglutaminase IgA: 28 U/mL
*NEW VALUE*: t-Transglutaminase IgA: 3 U/mL
Reference:
0-3 = negative
4-10 = weak positive
>10 = positive

*Thyroid Panel:*

OLD VALUE: TSH: 3.36 uIU/mL
*NEW VALUE: TSH: 2.82 uIU/mL *
Reference: 0.45-4.5

OLD VALUE: Free T4: 1.49 ng/dL
NEW VALUE: Free T4: 1.45 ng/dL
Reference: 0.82-1.77

OLD VALUE: Free T3: 3.1 pg/mL
NEW VALUE: Free T3: 3.1 pg/mL
Reference: 2.0-4.4

OLD VALUE: Reverse T3: 33.7 ng/dL
*NEW VALUE: Reverse T3: 18.0 ng/dL *
Reference: 9.2-24.1

OLD VALUE: T4, total: 10.7 ug/dL
NEW VALUE: T4, total: 8.6 ug/dL
Reference: 4.5-12.0

OLD VALUE: Thyroid Peroxidase TPO: 10 IU/mL
*NEW VALUE: Thyroid Peroxidase TPO: 12 IU/mL (increase)*
Reference: 0-34

OLD VALUE: Thyroglobulin Antibody: 177 IU/mL
*NEW VALUE: Thyroglobulin Antibody: 125.2 IU/mL *
Reference: 0.0-0.9

-----------------------------------

Now, this brings me to some questions for the experienced folks on the forums...

1. Can antibodies, in the presence of healthy-range T3 and T4, still cause hypo symptoms?

2. If so, should I consult a doctor about treatment for T3?

3. What might an ultrasound show? I don't believe I have nodules and I don't have goiter...

4. I am an uninsured, cash-paying patient. What might I be expected to pay for an ultrasound?

5. I recently saw a functional medicine doctor who suggested I do a cortisol saliva test that checks 4 times a day; should I do that? What might that tell me that I can act on to improve my health?

6. This particular doctor seemed to have a complete lack of interest in my health concerns; should I move on and find someone else? The next visit would be $100, and she is willing to Rx me bio-identicals, natural thyroid, etc.

7. For those of you familiar with using basal body temperatures to confirm ovulation as a method of birth control or timing for achieving pregnancy (i.e. the Sympto-Thermal method), is it true that temps below 97.2 and especially in the 96 range confirm a hypo condition? I very consistently have temps in the 96 range (I can hear a Dr friend of mine going, "But your T3 and T4 are normal, therefore nothing's wrong!)

Any help is much appreciated.


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## Seeking (Sep 19, 2013)

bigfoot said:


> My humble suggestions to get started:
> 
> * Thyroid ultrasound for baseline.
> 
> ...


bigfoot,

I'm wondering at this point, having been gluten-free for over a year now, if your intial suggestions would still be useful to me. Due to lack of money back then, I didn't get an ultrasound done, so I guess the baseline idea is gone. Should I still do the TSI, TRAb, saliva AM/PM cortisol?


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## josie1 (Oct 11, 2015)

I would definitely do the cortisol saliva test. If your body temp is consistently low and you have hypo symptoms with in range thyroid labs, you may likley have adrenal fatigue causing all your symtoms. What also strikes me about your situtaion is the recent fat gain around the middle and the hypoglycemia symptoms. Those are all related to adrenal issues. A good resource to see the interplay between the thyroid and adrenal is this article:

https://www.drlam.com/articles/adrenalfatiguevshypothyroidism.asp

Dr. Rind also discusses this a lot. He has a website drrind.com

High RT3 can sometimes be the body downregulating the thyroid because the adrenals cannot handle too much energy production.

Also, I would google supplementation with Selenium to lower thyroid antibodies or talk to the ND or functional medicine doc about it.

I have a similar situation where my adrenals impact my thyroid, but labs are pretty normal. In fact I recently attempted a very low dose thyroid glandular and got insomnia, anxiety etc. Its very tricky and very confusing. The endrocrine system is very interconnected. Estogen dominance is another issue that can cause lots of these symptoms.

Good luck to you!


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## joplin1975 (Jul 21, 2011)

Still no ultrasound?

From my personal experience? You will be spinning your wheels if you have thyroid cancer, as it causes a tsunami of antibodies and illogical symptoms that will never respond "normally" to traditional treatments. You really need that ultrasound to rule out the bad stuff first, before fiddling with everything else.


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## Seeking (Sep 19, 2013)

joplin1975 said:


> Still no ultrasound?
> 
> From my personal experience? You will be spinning your wheels if you have thyroid cancer, as it causes a tsunami of antibodies and illogical symptoms that will never respond "normally" to traditional treatments. You really need that ultrasound to rule out the bad stuff first, before fiddling with everything else.


I sure hope I don't have cancer. My antibodies came down some (post #12) after over a year of GF diet; to me that would seem to qualify as responding to treatment. (unless antibodies vary wildly by the day or week or month for no reason...)


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## bily (Mar 18, 2013)

Seeking said:


> (unless antibodies vary wildly by the day or week or month for no reason...)


I'm not sure what drives antibodies up or down or what their relevance is in relation to thyroid disease. Unfortunately I'm not sure the medical community knows either.


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## Seeking (Sep 19, 2013)

jenny v said:


> If it comes down to it, tell your doctor you're having physical issues like trouble swallowing or pressure in your neck (even if you aren't). Most doctors will order an ultrasound if the patient is complaining of physical symptoms.


I haven't taken that step yet and I'm not sure if that's the route I'm going to take. Because I'm already a chiropractic patient, I had a free consultation with the chiropractor (I know he is not an MD, but so far he has been more helpful than any MD I've ever seen in my entire life), and he said (this is his opinion) that tissue accumulation of bromine in the thyroid can trigger autoimmunity and thyroid problems (which I believe) but he said that taking high doses of iodine can detox the bromine out of my thyroid. He suggested 15mg/day of iodine. He believes that the RDA of iodine is only the minimum dose to prevent goiter, and that the upper limits proposed before health risks will occur are unfounded. I believe the proposed upper limit in the medical world is 500mcg? I haven't heard these claims before and am in the process of researching them to find out if they are valid.

He suggested that if thyroid storm occurs due to high intake of iodine, then an alternative detox would be necessary to purge the bromine out of the thyroid.

I have tried looking up articles on PubMed to validate his claims and see if detoxing the thryoid has been studied and substantiated, but so far have come up with nothing that looks scientifically sound. Perhaps someone here has more information.


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## joplin1975 (Jul 21, 2011)

Oh.

Um...be careful, ok? Iodine is contraindicated for thyroid patients, but especially for thyroid cancer patients.


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## Octavia (Aug 1, 2011)

Seeking, I'm quite late to the party here, but your first post in this thread makes me wonder whether you and your doctor have looked into Polycystic Ovary Syndrome (PCOS)?


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## Seeking (Sep 19, 2013)

A possible breakthrough? Thyroglobulin Auto-Antibodies plummeted. Recent 2016 results are in:

*Celiac Panel:*

Immunoglobulin A:
2014: 137 mg/dL
2015*: *165 mg/dL
2016*: *145 mg/dL
Reference: 91-414

Deamidated Gliadin Antibodies, IgA:
2014: 21 units
2015*:* 7 units
2016*:* 6 units
Reference:
0-19 = negative
20-30 = weak positive
>30 = Moderate to strong positive

t-Transglutaminase IgA:
2014: 28 U/mL
2015: 3 U/mL
2016: 3 U/mL
Reference:
0-3 = negative
4-10 = weak positive
>10 = positive

*Thyroid Panel:*

TSH
2014: 3.36 uIU/mL
2015: 2.82 uIU/mL
2016, April: 2.81 uIU/mL

Reference: 0.45-4.5

Free T4:
2014: 1.49 ng/dL
2015: 1.45 ng/dL
2016, April: 1.54 ng/dL
Reference: 0.82-1.77

Free T3:

2014: 3.1 pg/mL
2015: 3.1 pg/mL
2016, April: 3.0 pg/mL
Reference: 2.0-4.4

Reverse T3:

2014: 33.7 ng/dL

2015: 18.0 ng/dL

2016, April: 17.5 ng/dL
Reference: 9.2-24.1

T4, total:

2014: 10.7 ug/dL

2015: 8.6 ug/dL

2016, April: 9.4 ug/dL
Reference: 4.5-12.0

Thyroid Peroxidase TPO:

2014: 10 IU/mL

2015: 12 IU/mL

2016, Jan: 2 IU/mL (different lab: reference: <9 IU/mL)

2016, April: 9 IU/mL
Reference: 0-34

Thyroglobulin Antibody:

2014: 177 IU/mL

2015: 125.2 IU/mL

2016, Jan: 202 IU/mL (different lab: reference < or = 1 IU/mL)

*2016, April: 19 IU/mL !*
Reference: 0.0-0.9

I also received a lab result back for saliva cortisol and two other items. The results are as follows:

Cortisol (saliva):

1st Sample: 0.094. Reference: 0.435 - 0.797 ug/dL

2nd Sample: 0.078. Reference: 0.181 - 0.326 ug/dL

3rd Sample: 0.023. Reference: 0.109 - 0.254 ug/dL

4th Sample: 0.026. Reference: 0.036 - 0.109 ug/dL

DHEA-S (saliva):

8261. Reference: 2000 - 10000 pg/mL

sIgA (saliva):

149.1. Reference: 93.2 - 974.0 ug/mL

I have not yet had time to research and figure out what all this means, in the big picture. Is it normal for auto-antibodies to suddenly plummet, as did my April 2016 result? I did change one thing shortly after the Jan 2016 scary result: I started supplementing iodine daily. Could the resulting plummeting test result be pure coincidence, or did it result from the iodine supplementation?

Thyroid ultrasound scheduled for next month.


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## jenny v (May 6, 2012)

Did you doctor address the cortisol results? Those are very low across the board.


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## Seeking (Sep 19, 2013)

jenny v said:


> Did you doctor address the cortisol results? Those are very low across the board.


These are tests I ordered on my own; I don't have a doctor as of yet. But maybe I will next month; I'll have to see if I like this new Dr.


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## joplin1975 (Jul 21, 2011)

It could be due to the iodine. But I wouldn't jump to conclusions. Some times, antibodies just drop off...only to come back again with avengence. It just happens with autoimmune disease...


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