# help with blood work, testing, treatment



## JenL (Sep 16, 2015)

I am a 49 yr. woman, postmenopausal, pre diabetic, obese (5'6" 221lbs.) Never have taken any thyroid meds, or any other medications, treatments or testing that would effect on my thyroid, haven't had any recent infections (that I'm aware of anyway) or illnesses-just increased in fatigue, anxiety and hair thinning within the past year or so. Which I attributed to a sh*t storm of massive negative life events in combination with going through menopause.

Back in 2013 CBC With Differential/Platelet, Comp. Metabolic Panel (14), & TSH 0.01 (range 0.450-4.500). No other thyroid testing was performed. I never saw an Endo, I didn't have insurance.

This July I had a Comp. Metabolic Panel (14) CBC With Differential/Platelet, Comp. Metabolic Panel (14),, Blood Glucose 108 (Range 65-99), Hemoglobin A1c 6.1 %, Cholesterol 198, LDL 127 (range 0-99), HDL 42 (range >39), Triglyceride 144 (range 0-149).

TSH with a level of <0.005. Referred to Endo.

Endo ordered Comp. Metabolic Panel (14) and thyroid tests: Below are the results that I just received from the Endo

TSH <0.005 (0.450-4.500)

Free T4 1.86 (0.82-1.77)

Free T3 4.7 (2.0-4.4)

T3 167 (71-180)

TPO >600

TSI -don't have the actual # all that was said was that the were there, and weren't significant, not really really high. (these results where left on my voice mail btw).

Endo said I need to get a Nuclear Medicine Thyroid Uptake and Scan to confirm the biochemical state of Hyperthyroidism and see how the thyroid is functioning, check for inflammation and nodules (I'm getting that done tomorrow). Will call me with the results when he gets them.

Vit. D level is 18, he Rx'd 2000 units once a day.

At my initial visit he did a physical exam which consisted of taking my BP (108/98), felt my neck (made no comment), listened to my lungs & heart, and pressed down on my abdomen in a few places asking me if it was painful, which it wasn't, tested my knee reflexes (said they were slightly hyper reactive) and made me hold hold my arms out in front of me like I was going to dive into a pool and said I had a very slight tremor), also had me follow a pencil with my eyes (said that looked ok).

Also talked to me about how my TSH level results mean that there is no TSH detectable in my blood and briefly explained that I need other blood work and to test for TPO and TSI something about antibodies and autoimmune system, graves disease. I asked him to test my Vit D levels, which he agreed to do, and asked him to test my B-12 levels, which he did not agree to and told me that I needed to get my primary doc. to do that as he would not be able to treat me for that if I need treatment. Told me depending on the results that I would more then likely need the thyroid scan and uptake test and he would let me know when the blood work came back if I needed to go forward with that. He went over some of reasons why I could be hyper such as graves disease, thyroiditis, nodule(s) (he didn't mention cancer, but I am aware that is an additonal possiblity) that could be causing my thyroid to over produce hormones and if that were the case, that would have to be stopped. Treatments included methimizole, RAI or surgery, which would make me Hypo thyroid and I would need medication for the rest of my life. He made it sound all so simple and like it was nothing, yes, I know it was my first visit and he couldn't get into all the ins and outs of those treatments, so I started reading up on them myself. I didn't like the sound of surgery at all, scary, of course, so I discounted it right away, and started reading about methimizole and it's side effects, that if you get sick while your on it your white blood count could drop to dangerous levels since it is an immuno supressive drug, even though they say the chance is low,-yikes - it will cause a nagging worry for me, to for every sniffle and not feeling good to begin with how will I tell if I'm sick or just tired?

And it's a long course of treatment, that needs monitoring, that it has a low chance of putting it into remission to begin with and most people end up having it return anyway. Then have to get RAI, (and sometimes have to get that twice) and intermediate and long term side effects ( permanent damage to the salivary glands and lacrimal glands), I already have Blepheritis which causes dry, red, burning eyes. Not to mention it's possible long term effects on the body, what about it causing secondary cancer in the future? I've read they've been using this treatment in the US for 40 years and it's GENERALLY safe, but I've also read that it could cause cancer. My personal choice is I do not want radiation in my body IF I can avoid it, and certainly don't want to drag out this whole process of eliminating my thyroid, that is, if that's what is required, over years and years by trying the methimizole and then having to do RAI and on and on and around and around. That will cost a fortune in time, energy, effort, and $$$ of which I do not have and I will be losing my health insurance in December and chances of me getting insurance again are ZERO (long story, won't go into all that here) so it's not like I can put off treating this- I have to do something before the end of the year- ASAP. And leaving it untreated they say is bad for your heart and can cause high heart rate, high blood pressure etc and causes bone loss. Then I just read a medical report about a study where they say that belief that stopping hyperthyroidism by getting rid of the thyroid doesn't eliminate the development cardio vascular disease, stroke, cancer and having bone loss. Sigh.

Even so, I do know that being hyperthyroid will most likely result in me having more and more not really good health consequences and overt symptoms and disease if it's left untreated...and who knows how long it would take for those to crop up? I know there are immediate and long term risks with surgery, damage to the voice box or vocal cord nerves to name two, (I haven't read up totally on that topic at this time, I don't want to know more at the moment about it) but I've read you need to make sure you get a surgeon who does a lot of thyroidectomys per year to help lessen the associated risks of those side effects. But for me, it doesn't make sense to hack away at a tree little by little if the end desired effect is that the tree needs to come down-just cut it down all at once. Avoid Radation and immuo suppressive drugs and all the anxiety and nightmare of that whole experience of managing, monitoring, testing, and the endless hassle of dealing with doctors, hospitals, testing facilities, medications.

I took care of my grandmother during the last 20 years of her life, I was her caregiver, I was with her through 6 surgeries, several emergency room visits/hospitalizations, countless illnesses, chronic medical conditions, treatments, testing, stress and anxiety of dealing with it all the way till the end of her life and then beyond when she was gone. I know what can happen naturally as we age, what we can face. I have a history of heart disease in my immediate family, my father had a 3 way by pass surgery in his 60's. I know what I could already have in store for me later in life (if I make it that far) due to genetics and other factors. I just don't want to start down the path of endless health care management over this. I want this diagnosed and treated as quickly as possible.

Why couldn't I just get hypo thyroid like my Mom :-(.

Thanks for reading.

Any comments or opinion on my test results or anything else are welcomed.


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## JenL (Sep 16, 2015)

Thank for your response lovlkn. I've posted my most recent lab results with ranges above, I don't expect that the doctor will order anymore blood work, but if he does, I'll post it. I've always had a low "normal" TSH since I started getting it tested back in the 90's after my Mom was diagnosed HYPO and I have suffered from debilitating depressive episodes due to PTSD that made me exhausted. I have tried several anti depressants over the years each time I'd try a new one it would make me gain weight, pill after pill I'd try and I'd gain more and more, despite not increasing my caloric intake, and they did nothing to relive my depression. So I gave up on tyring anti depressants. I cut sugar out of my diet 10 years ago, follow a low glycemic diet, and low fat, low calorie, no red meat, which I never really ate anyway, only eat chicken or fish, fruit and veg diet, and drink only water and the occasional coffee, I don't drink or smoke and I still have gained weight. A friend of mine kids me about how healthy of a diet I have that I should be skinny. That if we put me on a desert island with no food for a month I still wouldn't lose weight.  She eats whatever she wants and drinks and hasn't gained hardly any weight at all over the years, she has that type of body that's just straight up and down, she has a problem gaining weight. Plus both of my parents are obese and their parents where also, so I'm fighitng genetics.

Thanks for the info about the Vit D. Could you tell me or point me in the direction of infomation that helped you form your opinion that I should take 50K instead of 2K so I can talk share that info with my Endo?

Is having Vit. D. at normal levels extra crucial for the thyroid or just in general?

Thanks again.


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## Andros (Aug 26, 2009)

Thyroid cancer in patients with hyperthyroidism.
http://www.ncbi.nlm.nih.gov/pubmed/12876418
(Copy and paste into your browser)

Thyroid storm symptoms
http://www.emedicinehealth.com/thyroid_storm/page3_em.htm
http://thyroid.about.com/od/hyperthyroidismgraves/a/thyroidstorm.htm
(Copy and paste into your browser)

You have a very good doctor. And you are indeed hyperthyroid and yes, cancer is one of many causes of hyperthyroid.

For that reason and given your insurance situation, you may be wise to get the surgery STAT.

It's not as bad as you may think on the come back trail. As I said, this doc seems to be w/the program and getting you on track after surgery should not be that difficult. Especially since we are here to help you with thyroxine replacement titration.

Of course we cannot tell you what to do but I will tell you that I almost died from a thyroid storm. This should be your biggest concern. And your eyes? Once ruined, they are ruined forever even after multiple surgeries.

Welcome to the board!


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## joplin1975 (Jul 21, 2011)

I just wanted to add that thyroid symptoms sneak up on you. I thought I had a good quality of life while I had my thyroid, but I didn't realize how badly I felt -- physically and mentally -- until I had my thyroid removed. I feel like I've gained back at least ten year. Taking a pill everyday is something I will gladly do if it means I can feel as well as possible.

Surgery is, in my opinion, your best option. Everything you mention is a risk, but if you have a experienced surgeon, those risks are minimal. For example, I asked my surgeon how often he has had complication with vocal chords. He said its never happened in 20 years of doing this. I asked him how often there is parathyroid damage and he said it happened once on a very elderly and frail woman.


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## JenL (Sep 16, 2015)

Thank you everyone for your comments and info. I'll post more when I get the scan results back next week.


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