# Help with Lab results?



## Koof

SO I finally got my lab results back today and they don't seem to tell me anything more about what is going on with me. Here's a summary:

TSH,BLD,QN	1.820	0.320-5.500	MIU/ML
T4 FREE 1.16 0.6-1.7 NG/DL
TPO AB NEGATIVE IU/ML
CALCIUM 9.9 8.5-10.5 MG/DL
PHOSPHATE,BLD,QN	3.2	2.1-4.5	MG/DL
CREATININE	0.5 0.5-1.3 MG/DL
PARATHYROID HORMONE INTACT	39.44	15-65	PG/ML
TESTOSTERONE, TOTAL	0.30 NG/ML
TESTOSTERONE FREE %	1.57	1.1-2.8	%
TESTOSTERONE FREE	4.7	0.1-6.4	PG/ML
DHEA-S 110.90	40-325	UG/DL

I'm still waiting on the cortisol (24 hr urine) test, but can anyone see anything that could be causing me to feel thyroid-y?


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## Andros

Koof said:


> SO I finally got my lab results back today and they don't seem to tell me anything more about what is going on with me. Here's a summary:
> 
> TSH,BLD,QN	1.820	0.320-5.500	MIU/ML
> T4 FREE 1.16 0.6-1.7 NG/DL
> TPO AB NEGATIVE IU/ML
> CALCIUM 9.9 8.5-10.5 MG/DL
> PHOSPHATE,BLD,QN	3.2	2.1-4.5	MG/DL
> CREATININE	0.5 0.5-1.3 MG/DL
> PARATHYROID HORMONE INTACT	39.44	15-65	PG/ML
> TESTOSTERONE, TOTAL	0.30 NG/ML
> TESTOSTERONE FREE %	1.57	1.1-2.8	%
> TESTOSTERONE FREE	4.7	0.1-6.4	PG/ML
> DHEA-S 110.90	40-325	UG/DL
> 
> I'm still waiting on the cortisol (24 hr urine) test, but can anyone see anything that could be causing me to feel thyroid-y?


It is too bad they did not run the FREE T3. When they say negative for the TPO, did they mean 0?

I do know and I am sure others feel the same; that TSH is somewhat high. Most of us feel best @ 1.0 or less.

There are many antibodies that should be tested for thyroid. Just because you don't have one does not mean you don't have the other.

TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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/

Some of the above are binding, blocking and stimulating which can make your thyroid panel "look" normal but you are not.


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## Koof

Andros said:


> It is too bad they did not run the FREE T3. When they say negative for the TPO, did they mean 0?
> 
> I do know and I am sure others feel the same; that TSH is somewhat high. Most of us feel best @ 1.0 or less.
> 
> There are many antibodies that should be tested for thyroid. Just because you don't have one does not mean you don't have the other.
> 
> TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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/
> 
> Some of the above are binding, blocking and stimulating which can make your thyroid panel "look" normal but you are not.


I think I had a TSI test as well, but I guess the results are not ready yet (seems odd, unless they take longer than the other tests - they were all taken at the same time).

My previous TSH tests were:
TSH,BLD,QN 2.240 0.320-5.500 MIU/ML earlier this month
and 2.090 in 2005

My online test result doesn't state whether the TPO meant 0 or what - I just cut-and-pasted the results from the web report.

I was really hoping something would show up, because the doctor was very clear with me that if the results don't show something abnormal, it means I do not have a hormonal issue (this is the endo). My GP has said she doesn't know what else to do. There is a light at the end of the tunnel - new insurance starts Jan with a new doctor who I've hear is very good. However, I am having a hard time dealing with just life right now. I got ~8 hours of sleep last night and woke up exhausted. I do think there is an adrenal issue too, but a lot of my symptoms feel thyroid-y+ adrenal.


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## Koof

Ok, I got back my TSI:
93
Reference range: <140
(NOTE)
Thyroid stimulating immunoglobulins (TSI) can engage
the TSH receptors resulting in hyperthyroidism in
Graves' disease patients. TSI levels can be useful in
monitoring the clinical outcome of Graves' disease as
well as assessing the potential for hyperthyroidism
from maternal-fetal transfer. TSI results greater than
or equal to (>=) 140% of the Reference Control are
considered positive.


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## Koof

So is TSI ok, or should there be none? I'm confused...


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## Andros

Koof said:


> Ok, I got back my TSI:
> 93
> Reference range: <140
> (NOTE)
> Thyroid stimulating immunoglobulins (TSI) can engage
> the TSH receptors resulting in hyperthyroidism in
> Graves' disease patients. TSI levels can be useful in
> monitoring the clinical outcome of Graves' disease as
> well as assessing the potential for hyperthyroidism
> from maternal-fetal transfer. TSI results greater than
> or equal to (>=) 140% of the Reference Control are
> considered positive.


I am not at all surprised; I did expect this, that is why I urged the test.

As you already know, you should not have any TSI. It is not okay to have any at all.

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

This means you probably have TBII as well.

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)

What has the doctor said. No wonder you don't feel good. You got it goin' on; that is for sure!


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## Koof

My doctor said everything is normal. The TSI came in under the threshold for the lab, so I'm not thinking she sees it as a problem. My Moms best friend is a pediatric endo and she has said that most likely stress. My brain is not able to handle it and it is shutting down. I need to reduce the stress to see a change. I do agree on this - I have had a lot of added stress from work in the last few months. The issue I have is that I've been feeling like something was wrong *before* the stress. In fact, I was feeling this way in the summer, when I don't work.


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## Andros

Koof said:


> My doctor said everything is normal. The TSI came in under the threshold for the lab, so I'm not thinking she sees it as a problem. My Moms best friend is a pediatric endo and she has said that most likely stress. My brain is not able to handle it and it is shutting down. I need to reduce the stress to see a change. I do agree on this - I have had a lot of added stress from work in the last few months. The issue I have is that I've been feeling like something was wrong *before* the stress. In fact, I was feeling this way in the summer, when I don't work.


Once again, I am going to stress that the healthy body should not have any TSI (thyroid stimulating immunoglobulin.)


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## Koof

If that's the case, then why don't doctor's see it that way? It is so frustrating because I know something is wrong and the doctors don't find anything. This is making me second-guess myself and kind of feel nuts. This, of course, is added stress and stress is definitely making everything worse as it is.


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## Koof

Ok, so possibly could the lower TSI numbers mean that I'm right now being affected by the TSI only mildly, which is why my symptoms are more hypo then hyper? Is there a good chance my body will produce more TSI in the future (into the above-"normal" category) and possibly cause me to go hyper?

If my ultrasound Monday doesn't show concerns, I think the endo is going to refuse to treat me. My new insurance in Jan will allow me to see ayn endo whenever I want, and therefore look around to find one who suits me. My current insurance isn't so flexible,


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## Andros

Koof said:


> Ok, so possibly could the lower TSI numbers mean that I'm right now being affected by the TSI only mildly, which is why my symptoms are more hypo then hyper? Is there a good chance my body will produce more TSI in the future (into the above-"normal" category) and possibly cause me to go hyper?
> 
> If my ultrasound Monday doesn't show concerns, I think the endo is going to refuse to treat me. My new insurance in Jan will allow me to see ayn endo whenever I want, and therefore look around to find one who suits me. My current insurance isn't so flexible,


TSI is stimulating and that is why I said you surely have TBII which is binding. Slowing things down and making it seem you are hypo.

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)

Here is a list of things that should not be found in the normal serum. This is a very credible source. You will note that TSI is one of those things.

http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

Show this to your doctor or better yet, consider finding another doctor who "gets it!"

And please know, I am not trying to argue anybody down here. It is my sincere desire to help you get to the bottom of this and for you to regain the health that you so deserve to have.


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## Koof

Andros said:


> TSI is stimulating and that is why I said you surely have TBII which is binding. Slowing things down and making it seem you are hypo.
> 
> TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
> http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)
> 
> Here is a list of things that should not be found in the normal serum. This is a very credible source. You will note that TSI is one of those things.
> 
> http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm
> 
> Show this to your doctor or better yet, consider finding another doctor who "gets it!"
> 
> And please know, I am not trying to argue anybody down here. It is my sincere desire to help you get to the bottom of this and for you to regain the health that you so deserve to have.


I read that link, the thyroid manager one, at least 3x last night and never noticed this:


> Normally, the test response is negative but results may be positive in up to 10% of the adult population. The frequency of positive test results is higher in women and with advancing age. The presence of thyroid autoantibodies in the apparently healthy population is thought to represent subclinical autoimmune thyroid disease rather than false-positive reactions


Amazing! This really helps. I will show it to my doctor (or email it to her). So basically, I am hyper, but because of the TBII it doesn't show in blood tests and I have the effect of feeling hypo?
After thinking about all of this, I am beginning to see a pattern. In the past; like before/ around puberty, I had panic attacks. In 6th grade I missed 30 days of school because I could not make myself go. Later on, I had many anxiety/panic attacks for about a two-year period in college. I was also dx with depression in my teens.

More recently, I had a period of about a month this summer where I had night-sweats and I sweated profusely. Of course, it was pretty hot and the daytime sweating I attributed to the heat. I've been ADHD-like in my thinking for a few years now. Only recently has it moved to foggy thinking - before it was like my brain was racing.

It seems to me that perhaps I have been oscillating between hypo and hyper on and off, but this recent time was the worst hypo as I've never felt quite like this.

One more question - the last few days my brain-fog has cleared and two days ago I started having a tight chest/anxiety feelings again. *Could that combined with my lower TSH this last time make me moving towards hyper, or does the TSH lag significantly?*

I will try to use the link you posted to help me get TBII tested. Should I ask for anything else that you think might put me into a position to be treated (by this doctor)? I figure she might go for one or two more tests before she shuts me down.

After January, I can "endo-shop" around, and there are quiet a few endos in the area.

Oh, this caught my attention too:


> Positive antibody titers are predicative of post partum thyroiditis


I have had concerns with health issues since my second daughter was born 4.5 years ago, but the first 4 years I really thought it was my copper IUD. Nothing has resolved since I got it removed in February, except the horrendous periods.


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## Andros

Koof said:


> I read that link, the thyroid manager one, at least 3x last night and never noticed this:
> 
> Amazing! This really helps. I will show it to my doctor (or email it to her). So basically, I am hyper, but because of the TBII it doesn't show in blood tests and I have the effect of feeling hypo?
> After thinking about all of this, I am beginning to see a pattern. In the past; like before/ around puberty, I had panic attacks. In 6th grade I missed 30 days of school because I could not make myself go. Later on, I had many anxiety/panic attacks for about a two-year period in college. I was also dx with depression in my teens.
> 
> More recently, I had a period of about a month this summer where I had night-sweats and I sweated profusely. Of course, it was pretty hot and the daytime sweating I attributed to the heat. I've been ADHD-like in my thinking for a few years now. Only recently has it moved to foggy thinking - before it was like my brain was racing.
> 
> It seems to me that perhaps I have been oscillating between hypo and hyper on and off, but this recent time was the worst hypo as I've never felt quite like this.
> 
> One more question - the last few days my brain-fog has cleared and two days ago I started having a tight chest/anxiety feelings again. *Could that combined with my lower TSH this last time make me moving towards hyper, or does the TSH lag significantly?*
> 
> I will try to use the link you posted to help me get TBII tested. Should I ask for anything else that you think might put me into a position to be treated (by this doctor)? I figure she might go for one or two more tests before she shuts me down.
> 
> After January, I can "endo-shop" around, and there are quiet a few endos in the area.
> 
> Oh, this caught my attention too:
> 
> I have had concerns with health issues since my second daughter was born 4.5 years ago, but the first 4 years I really thought it was my copper IUD. Nothing has resolved since I got it removed in February, except the horrendous periods.


Yes, yes, yes!!! What a great student you are. Now if you could only be your own doctor? We would have it made.

I just love it when the light bulb goes on, don't you???

Bear in mind that an endo is not necessarily essential. Most of them specialize in diabetes. What is essential as per our discussion that a doctor gets it. He/she could be GP, PCP, Internal Med, Naturopath etc.. As long as they get it, are willing to think outside the box and have a strong desire to get you, their patient, well.

And TSH does lag significantly as there are antibodies to the TSH receptor sites as well. How about that?


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## Andros

Koof said:


> Ok, so possibly could the lower TSI numbers mean that I'm right now being affected by the TSI only mildly, which is why my symptoms are more hypo then hyper? Is there a good chance my body will produce more TSI in the future (into the above-"normal" category) and possibly cause me to go hyper?
> 
> If my ultrasound Monday doesn't show concerns, I think the endo is going to refuse to treat me. My new insurance in Jan will allow me to see ayn endo whenever I want, and therefore look around to find one who suits me. My current insurance isn't so flexible,


Very anxious for you to get ultra-sound. They do have their limitations but it is better than nothing right now.

Can't wait for Monday; let us know.


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## Koof

:anim_26: Yea! I'm glad its starting to make sense.

So is my best chance of a test that comes back "abnormal" be the TBII? And being positive for TSI means I have Graves?


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## Koof

Ok, reading more and more!

Just to clarify, TBII is a test that includes TSI. The higher a TBII test, the more blocking antibodies I have. currently I am feeling hypo because I (most likely) have a lot of blocking antibodies that are overpowering the TSI and thus making me feel hypo and my TSH to be higher than optimal.

I've actually been feeling a little better (no more foggy brain and tired but not exhausted/unable to move). I'm actually feeling a bit peppy, but the tiredness makes it more into a jittery feeling.

Ok, so on Monday I have my ultrasound. I'm not sure what it will find - if I have antibodies but not the typical presentation of Graves, will I have any findings in my thyroid besides maybe some enlargement? As far as I know the doctors haven't felt anything unusual upon palpation, but sometimes I thin I might feel a lump in my throat inside, although it feels like it might be higher than my thyroid.

Should I wait for my ultrasound results to request the TBII test? Should I ask for a Thyroglobulin Ab test or ANA also or wait and see?


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## Andros

Koof said:


> Ok, reading more and more!
> 
> Just to clarify, TBII is a test that includes TSI. The higher a TBII test, the more blocking antibodies I have. currently I am feeling hypo because I (most likely) have a lot of blocking antibodies that are overpowering the TSI and thus making me feel hypo and my TSH to be higher than optimal.
> 
> I've actually been feeling a little better (no more foggy brain and tired but not exhausted/unable to move). I'm actually feeling a bit peppy, but the tiredness makes it more into a jittery feeling.
> 
> Ok, so on Monday I have my ultrasound. I'm not sure what it will find - if I have antibodies but not the typical presentation of Graves, will I have any findings in my thyroid besides maybe some enlargement? As far as I know the doctors haven't felt anything unusual upon palpation, but sometimes I thin I might feel a lump in my throat inside, although it feels like it might be higher than my thyroid.
> 
> Should I wait for my ultrasound results to request the TBII test? Should I ask for a Thyroglobulin Ab test or ANA also or wait and see?


That is correct. TBII is binding/blocking immunoglobulin against the TSI which is the stimulating immunoglobulin. If you did not have Thyroglobulin Ab, that would also be a good idea.

It's like putting your foot on the gas pedal w/your other foot on the brake at the same time!

I would request the TBII test and wait and see on the rest of it. You may not have Graves'; you could just be hyper. Let's hope that is the case.

Ultra-sounds do have their limitations but I personally am hoping for the best. Sometimes the thyroid (goiter) will grow inward rather than outward. It takes the path of least resistance.


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## Koof

I had my ultrasound this am. Apparently the doctor will get the results in ~2 days. She seemed to do a through job - lots of stopping at a place and then typing. Does a thyroid ultrasound involve measurements in specific places like a fetus ultrasound or do they just move around looking for stuff? I'm not a patient person and I'm trying to guess if she say stuff or if that was standard procedure 

Thanks!


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## shellebean

Koof, they did a lot of that with my ultrasound. The gal was very thorough, it took a lot longer that I had anticipated (at the time, I had no idea there were really any issues except my gyno "felt something"). She would pause, type, wiggle around a bit, type some more...I ended up having a heterogeneous gland with increased vascularity (suspected then confirmed Hashimotos) and also 2 complex cysts and 2 small solid nodules. I don't want to concern you, this is only MY situation. Not sure if they stop and type if there is nothing going on though...please let us know the results. They told me that the ultrasound was abnormal immediately after the ultrasound. Then the following morning I got the specifics about the nodules.


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## Andros

Koof said:


> I had my ultrasound this am. Apparently the doctor will get the results in ~2 days. She seemed to do a through job - lots of stopping at a place and then typing. Does a thyroid ultrasound involve measurements in specific places like a fetus ultrasound or do they just move around looking for stuff? I'm not a patient person and I'm trying to guess if she say stuff or if that was standard procedure
> 
> Thanks!


Glad that is done; now we wait. Actually the person doing the ultra-sound is not to say anything either yay or nay. It all depends. If the doc is doing it, I guess they can say or not.

As far as I know, technicians are not to interpret for they are not trained for that. I may be wrong but that has been my understanding.


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## shellebean

You are correct, Andros. To clarify my situation, the technician didn't say one word during or after the ultrasound. She left and said the Doctor would come in and chat with me in a few minutes. After waiting for a while, the Doctor came in and mentioned very generally that my thyroid was abnormal. Then they send the results to my gyno who called me the following morning with specifics.


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## Koof

Yeah, I knew the tech wouldn't say anything, but boy is waiting tough!


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## joplin1975

Koof said:


> I had my ultrasound this am. Apparently the doctor will get the results in ~2 days. She seemed to do a through job - lots of stopping at a place and then typing. Does a thyroid ultrasound involve measurements in specific places like a fetus ultrasound or do they just move around looking for stuff? I'm not a patient person and I'm trying to guess if she say stuff or if that was standard procedure
> 
> Thanks!


Yes, it involved measurements. They will measure each lobe, the isthmus, and any nodules or other irregularities. Good luck!


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## Andros

Koof said:


> Yeah, I knew the tech wouldn't say anything, but boy is waiting tough!


And we will do what we do best and wait with you!


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## Koof

Thanks hugs4


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## Koof

Well that was quick!

FINDINGS: Vascularity of the lobes appears symmetric on transverse
images. The isthmus is about 2.5 mm. The left lobe measures 4.6 x 1.1
x 1.4 cm. Blood supply is normal. No nodules are seen. The right lobe
measures 4.5 x 1.3 x 1.5 cm, and contains a lower pole, solid,
slightly hypoechoic nodule measuring about 3.7 x 3 mm. There is a
second heterogeneous solid nodule also in the lower pole that
measures about 5.7 x 4 mm. The first nodule is vascular. The second
is not. The first nodule transversely is about 5 mm, the second about
4 mm.

IMPRESSION: Two small nodules right lower lobe.

Any thoughts? I haven't heard back about my request for a tbii test.


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## Andros

Koof said:


> Well that was quick!
> 
> FINDINGS: Vascularity of the lobes appears symmetric on transverse
> images. The isthmus is about 2.5 mm. The left lobe measures 4.6 x 1.1
> x 1.4 cm. Blood supply is normal. No nodules are seen. The right lobe
> measures 4.5 x 1.3 x 1.5 cm, and contains a lower pole, solid,
> slightly hypoechoic nodule measuring about 3.7 x 3 mm. There is a
> second heterogeneous solid nodule also in the lower pole that
> measures about 5.7 x 4 mm. The first nodule is vascular. The second
> is not. The first nodule transversely is about 5 mm, the second about
> 4 mm.
> 
> IMPRESSION: Two small nodules right lower lobe.
> 
> Any thoughts? I haven't heard back about my request for a tbii test.


Solid is not usually a good thing. It raises suspicion for cancer so this has to be followed through.

This could be another reason your labs look the way the do and sadly, cancer and hyper seem to be bedmates. They are not sure which comes first.

http://www.ncbi.nlm.nih.gov/pubmed/12876418

Hope you will be seeing an ENT about this!


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## Koof

Andros said:


> Solid is not usually a good thing. It raises suspicion for cancer so this has to be followed through.
> 
> This could be another reason your labs look the way the do and sadly, cancer and hyper seem to be bedmates. They are not sure which comes first.
> 
> http://www.ncbi.nlm.nih.gov/pubmed/12876418
> 
> Hope you will be seeing an ENT about this!


What are the next steps possible by the doctor? FNA or more imaging? So far I have just seen my GP and an endo.

Can cancer cause the TSI result or is that definitely Graves?

Oh, and I heard back from my endo about the tbii - she said it is not routinely done unless other results show an indication of a need... wouldn't my TSI test being positive and not particularly low be a need? Anyway, she said she can write up a slip fr it to be done, but kaiser labs don't do it and I'd have to go to another lab. weird.


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## shellebean

Hi koof! I too have two small solid nodules. My are 4 and 6 mm but on my isthmus, not on a lobe. I was told to watch and wait since neither of mine were 1cm. Both of mine are hypoechoic. I don't know if they will say the same or not, I'm curious. Do you have Graves? I have Hashi's.
Had they told you they saw calcification, I didn't see that on the report?


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## Andros

Koof said:


> What are the next steps possible by the doctor? FNA or more imaging? So far I have just seen my GP and an endo.
> 
> Can cancer cause the TSI result or is that definitely Graves?
> 
> Oh, and I heard back from my endo about the tbii - she said it is not routinely done unless other results show an indication of a need... wouldn't my TSI test being positive and not particularly low be a need? Anyway, she said she can write up a slip fr it to be done, but kaiser labs don't do it and I'd have to go to another lab. weird.


Not surprisingly, cancer and hyper are bedmates.

FNA would be the next sensible step in my opinion or just go straight on to an ENT and see what he/she might have to say about all of this. Sometimes they like to bypass FNA and just go for the kill as they say.

You are getting the run around by Kaiser. They are trained very well to do this.

Thyroid cancer in patients with hyperthyroidism.
http://www.ncbi.nlm.nih.gov/pubmed/12876418

Keeping you in my prayers here.


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## joplin1975

Koof said:


> What are the next steps possible by the doctor? FNA or more imaging? So far I have just seen my GP and an endo.


They wanted to do a RAIU after my u/s...I wanted to go straight to a FNA, but *shrug* I went ahead, played the game, and had a RAIU.  Actually, in retrospect, it was somewhat interesting because while my uptake measures were totally normal and while the two primary nodules (on the left lobe) where 2.5 and 2.1 cms, the entire left lobe was essentially non-functioning. Anyway, it wasn't until I had the FNA that I felt like I was getting concrete answers vs. teeny pieces to the puzzle.


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## Koof

I found this about FNA:


> According to our results, the best compromise is probably to use FNAC on nodules with at least one of: microcalcifications, blurred margins or hypoechoic pattern. Compared to the strategy of using FNAC only on nodules ⩾10 mm, this strategy requires a similar number of procedures but reduces the percentage of missed carcinomas from 20% to 2%.


http://qjmed.oxfordjournals.org/content/100/1/29.full

The study looks really good. However, FNA is pretty difficult in small nodules and they often come back inconclusive. I'm not sure which way to go. I'm really getting tired of the run-around. My endo wants to wait and re-ultrasound in 6 mo IF I notice issues with my neck (swelling, difficulty swallowing, etc). She says small nodules have a low risk of cancer and are difficult to biopsy. I agree with the latter, but not the former.
_
I don't know much about RAIU; what does that tell you? Can it give more information about the nodule to point towards or against thyroid cancer? Can if give more info about how the Graves antibodies are affecting my thyroid?_

I have presented more hypo (TSH 2+) and hypo symptoms, but I have a feeling I am swinging back and forth. My brain fog has lifted, but I am still tired. While I am freezing most of the time, I am now beginning to get hot at times, especially at night (night sweats). Today during class I was warm, but my fingers were freezing - I freaked out one of my students when I touched his arm!

I have Graves antibodies (TSI) and my doctor has just mailed me a lab slip for a TBII test as well.


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## Koof

If I request an FNA, do I go to an ENT?

Oh, and when they say you can be at risk for thyroid cancer if you have had lots of x-rays, radiation???, what exactly do them mean. How much is too much?

ETA: it was hard to find any information. I'm guessing I have a low/moderate risk. I had frequent headaches as a child and I know I had a CT scan of my head as well as at least one x-ray.


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## shellebean

From what I've recently found out, some Endo's do FNA (some in their own facility), my Endo set me up to go to radiology at the hospital and an actual radiologist did the procedure with a lab tech right there in the room. I would think that an ENT can do too, but not positive.


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## Octavia

shellebean said:


> my Endo set me up to go to radiology at the hospital and an actual radiologist did the procedure with a lab tech right there in the room.


Ditto for me, but mine was set up by an ENT, not an Endo.


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## webster2

I declined having one because Graves can skew the results. It would have been done by an ENT.


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## Koof

webster2 said:


> I declined having one because Graves can skew the results. It would have been done by an ENT.


Can you tell me more about how Graves can skew the results? Seeing as I have Graves antibodies, it seems I do have Graves. What did you do instead?


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## Koof

Has anyone had a successful FNA with a nodule around .5 cm? I'm not sure how hard to push for a FNA if it is doubtful it will produce results... If so, should I try to get both done? One is .4 and one is .5 cm.


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## webster2

Koof said:


> Can you tell me more about how Graves can skew the results? Seeing as I have Graves antibodies, it seems I do have Graves. What did you do instead?


The cells can appear distorted or revved up, anyway not an accurate picture for a procedure that the results are not always conclusive to begin with. The endo agreed with me on this, even though she was pushing for me to have one, and felt that my decision was soundly based. At that point, the risk for cancer was only between 5-20%. The cancer has proven to be really no big deal, it was the Graves that was driving me over the edge.

I had half of the thyroid removed 20 years before and was not afraid of the surgery at all. In fact, the FNA scared me more!

I am not sure what symptoms you are having from Graves. The imaging tests confirmed that I had been untreated for a long time, and the mood swings were wrecking my life. I wanted the target of the antibodies, the thyroid, gone.

It has been about 4 months since the eviction of the thyroid. The Graves symptoms are gone. I feel pretty good. I am tired but once the medication is at the proper level, I expect I will feel fabulous!

I have not regretted my decision once. My scar doesn't look horrible but it is not as inconspicuous as some because they used my old scar. This doesn't bother me at all. I like to think it is my badge of honor, I am a tough old broad!

I hope my rambling response has answered some of your questions. And, I do hope you will get the treatment to make you feel better too!


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## Koof

Thank you, that does help! My TSI was last tested at 93 (I am unmedicated) and I'm waiting on paperwork to get a TBII test because my symptoms are more hypo. Currently, my doctors think there is nothing wrong, but I've had a "feeling" for at least a year there was a problem. Symptoms have gradually come on since my younger daughter's birth 4.5 years ago.

Right now, the brain fog that was causing me the biggest problems has left, but I'm beginning to feel some anxiety/tight chest that I've had in the past. I don't want to drop my search and wait and see because I have a feeling I will start to feel worse again. I'm able to tolerate my symptoms right now, but I don't want to just survive; my family is suffering with me because I can't do work and give them time too these days, and sadly I need to work 

I'm not at a point where anyone will take out my thyroid yet, not am I sure I want to go that route without knowing more about what is causing me to feel crummy. I just want some more answers so I feel like I can make some informed decisions, and nothing is straightforward with me!


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## webster2

I think you are wise to keep looking for answers. Thyroid imbalances are really hard to get doctors to take their patients seriously. Menopause was the answer they gave me for over 2 years. Thyroid symptoms are so vague that they fit a lot of things. Sadly, most doctors don't let symptoms come into play, they go just by lab results. Meanwhile, the patient continues to feel like crapola, and so many things in their life suffer. My hope is that you won't have to fall into that category.

Make sure you get copies of all of your lab work, imaging reports, and office visits. It can be very helpful in the future. Also, it makes for interesting reading!


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## Koof

Grumble, I just noticed my endo must've removed my lab results from my online profile. It's a good thing I cut-and-pasted everything (I think). It's just wrong though. I think I'll contact my PCP to see what's wrong, or maybe member services.


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## Koof

I finally heard back from member services... I have to go into the labs to get my paperwork. I don't get it. I think my endo is scared I have something wrong she doesn't know how to treat so she is hiding my results to make it harder for me to cause a stink. The funny thing is, I didn't tell her my insurance is over with them in Jan and I will be going to a new doctor!

I also emailed my endo to ask where the paperwork was she was sending so I could take a TBII test. She didn't say what happened, but she is writing out new paper work and will drop it in the mail immediately. I better get it soon, and I will be VERY upset if she doesn't post it right away. I guess I'm spending my winter break running around getting my medical records together for the big insurance switch. So much for time off:confused0081:


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## Andros

Koof said:


> I finally heard back from member services... I have to go into the labs to get my paperwork. I don't get it. I think my endo is scared I have something wrong she doesn't know how to treat so she is hiding my results to make it harder for me to cause a stink. The funny thing is, I didn't tell her my insurance is over with them in Jan and I will be going to a new doctor!
> 
> I also emailed my endo to ask where the paperwork was she was sending so I could take a TBII test. She didn't say what happened, but she is writing out new paper work and will drop it in the mail immediately. I better get it soon, and I will be VERY upset if she doesn't post it right away. I guess I'm spending my winter break running around getting my medical records together for the big insurance switch. So much for time off:confused0081:


Look at it this way; it's an investment in yourself. You have garned much information about the thyroid in the past month or so; therefore...........you are making much progress.


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## Koof

I finally got the TSII slip... I'm going to try to go in tomorrow. I know levels wax and wane. I'm feeling hyper right now (as in at this moment, HR ~90 resting; I was freezing this morning). Should I wait to take the test until I feel hypo again? I know probably not, but i figured I'd check


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## Koof

My TBII test was finally done... And the doctor reports it was "normal". She didn't say what it was exactly, so I will run to another Kaiser tomorrow to pick up the results. I know "normal" doesn't mean "negative" so I need to et the numbers!

She also wanted to know if there was an error because my record says I am no longer a Kaiser member... LOL! I finally have more medical freedom with a new insurance plan. Yeaaaaaahhhhhhh!


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## Koof

I just received this message from the endo re: the TBII test:



> Your level was less than 6% and the normal reference range is below 16%.


Now, I'm feeling crappy and my TSI was 93% and my TBII is 6. I know I have antibodies but if the levels are low, why am I feeling the effects? I get it, but I don't get it.


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## Andros

Koof said:


> My TBII test was finally done... And the doctor reports it was "normal". She didn't say what it was exactly, so I will run to another Kaiser tomorrow to pick up the results. I know "normal" doesn't mean "negative" so I need to et the numbers!
> 
> She also wanted to know if there was an error because my record says I am no longer a Kaiser member... LOL! I finally have more medical freedom with a new insurance plan. Yeaaaaaahhhhhhh!


Yes; the number will be important so you can have established baseline and detect movement up or down.

Will be waiting w/bated breath!


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## Koof

Numbers are posted above!


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## Andros

Koof said:


> I just received this message from the endo re: the TBII test:
> 
> Now, I'm feeling crappy and my TSI was 93% and my TBII is 6. I know I have antibodies but if the levels are low, why am I feeling the effects? I get it, but I don't get it.


The TSI is winning over the TBII; that's why. There is a huge battle going on.

And as you know, you would only have TBII if you have TSI and if the TSI were lower, the TBII most likely would be higher.


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## Koof

Andros said:


> The TSI is winning over the TBII; that's why. There is a huge battle going on.
> 
> And as you know, you would only have TBII if you have TSI and if the TSI were lower, the TBII most likely would be higher.


I figured that since most of my symptoms are hypo, the blocking antibodies were winning. But is looks the TSI is... and it doesn't make sense to me. I have had more hyper symptoms lately though. Night sweats and some times with a hot face, but still the constant cold usually wins...


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## Koof

I'm back! I visited an endo who basically said she couldn't find a problem. Symptoms were not quite as bad and I got super busy so I dropped it. Fast forward to earlier this month and I finally made an appt at a new PCP's office. I saw the PA who ordered blood tests and suggested L-Theanine for stress/anxiety. He mentioned a possible thyroid problem and I gave him my history.

Reminder - I've had issues with symptoms but haven't found anyone that has an idea on how to help me feel better - I was feeling better this summer when I don't work, but a lot of the symptoms were there still - especially brain fog/memory/easily distracted.

I finally got the results of my tests back today - most things were normal but here are they thyroid #s and the other things that stood out or might be asked about:
BUN/Creatine ratio 23 ref 8-20 H
DHEA-Sulfate 63.8 ug/dL ref 98.8-340 L
Cholesterol total 223 mg/dL ref 100-199 H (usual for me)
Triglycerides 176 mg/dL ref 0-149 H
HDL Cholesterol 51 mg/dL ref >39 (usual for me)
LDL Cholesterol 137 mg/dL ref 0-99 H (usual for me)
Vit D 25.1 ng/dL ref 30-100 L (will take D3 1x/week again)

Thyroid stuff:
TSH 2.470 uIU/mL ref .450-4.500
T3, Free 3.2 pg/mL ref 2-4.4
T4, free (direct) 1.21 ng/dL ref .82-1.77
T3, reverse 43.6 ng/dL ref 13.5-34.2

I calculated the ratio of fT3 to rT3 and it is 7.3

What are my next steps do you think? I need to make an appt and I'll try tomorrow, but it is the first week back to school and I'm swamped so it might not happen :/

How are reverse T3 issues treated? How successful is this treatment on average? What forum do I visit on this board for help in this area (am I missing it)?
TIA!


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## lainey

Most conventional doctors don't look at ratios or do math to thyroid numbers. For that matter, they generally ignore reverse T3. This test was developed before there was a reliable way to detect the free T3, and is an indirect measure of it. Reverse T3 is the natural by product of T4 synthesis, and a lot of it usually is a sign that someone is doing a quick conversion of T4 to T3--that extra T3 is turned into an inert form.

The things you read about "treating" reverse T3 are largely bogus. They generally involve a short course of T3 only medication to "short circuit" the conversion process.

I doubt the endo will have much to say about your numbers. The frees are mid range and the TSH is not really elevated.

Low vitamin D can be the source of a host of thyroid-like symptoms. Interesting also that your DHEA is low--that is a hormone precursor--has anyone looked carefully at the balance of your sex hormones? A problem there can also cause fatigue, anxiety, hair loss, etc.


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## Andros

Koof said:


> I'm back! I visited an endo who basically said she couldn't find a problem. Symptoms were not quite as bad and I got super busy so I dropped it. Fast forward to earlier this month and I finally made an appt at a new PCP's office. I saw the PA who ordered blood tests and suggested L-Theanine for stress/anxiety. He mentioned a possible thyroid problem and I gave him my history.
> 
> Reminder - I've had issues with symptoms but haven't found anyone that has an idea on how to help me feel better - I was feeling better this summer when I don't work, but a lot of the symptoms were there still - especially brain fog/memory/easily distracted.
> 
> I finally got the results of my tests back today - most things were normal but here are they thyroid #s and the other things that stood out or might be asked about:
> BUN/Creatine ratio 23 ref 8-20 H
> DHEA-Sulfate 63.8 ug/dL ref 98.8-340 L
> Cholesterol total 223 mg/dL ref 100-199 H (usual for me)
> Triglycerides 176 mg/dL ref 0-149 H
> HDL Cholesterol 51 mg/dL ref >39 (usual for me)
> LDL Cholesterol 137 mg/dL ref 0-99 H (usual for me)
> Vit D 25.1 ng/dL ref 30-100 L (will take D3 1x/week again)
> 
> Thyroid stuff:
> TSH 2.470 uIU/mL ref .450-4.500
> T3, Free 3.2 pg/mL ref 2-4.4
> T4, free (direct) 1.21 ng/dL ref .82-1.77
> T3, reverse 43.6 ng/dL ref 13.5-34.2
> 
> I calculated the ratio of fT3 to rT3 and it is 7.3
> 
> What are my next steps do you think? I need to make an appt and I'll try tomorrow, but it is the first week back to school and I'm swamped so it might not happen :/
> 
> How are reverse T3 issues treated? How successful is this treatment on average? What forum do I visit on this board for help in this area (am I missing it)?
> TIA!


It is normal to have some rT3.

Have you had any antibodies' tests?

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

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/

And have you had an ultra-sound of your thyroid?

How is your Ferritin level?

Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)


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## Koof

Other tests (older):

TPO AB NEGATIVE
TSI 93 (Reference range: <140)
TBII less than 6 (not sure of reference range).
Ultrasound found two small nodules and will be re-checked each year.

Ferritin was 18 in a range of 13-150.

My doctor (not the endo) suggested the rT3 and said in the letter to me that when it is high it "can cause symptoms of hypothyroidism even when TSH, T4 and T3 are normal" but didn't suggest a course of action.

Most of what I read suggests what to do when you are already on thyroid meds... but I'm not. So, I don't know what to ask when I do get to the doctor.

Lainey, what tests would you be looking at to test sex hormones? I may have had some in the last year but I've only posted unusual results.


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## lainey

Estradiol, FSH, LH testosterone. They should be balanced for your sex and age.


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## midgetmaid

When my ferritin was that low in the range I had a lot of symptoms that improved when I brought it up.

Renee


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## Koof

Lainey, I have added those to my list of tests I want. I did have these tests last year, when I was actually feeling worse than I am today:
Testo .30 ng/mL
Testo free/testo 1.57 (rr 1.1-2.8%)
testo free 4.7 (rr .1-6.4 PG/mL)

Other things I was tested for by an endo at the same time were:

CA 9.9 (rr 8.5-10.5 mg/dL)
PO4, BLD QN 3.2 (rr 2.1-4.5 mg/dL)
PTH INTACT 39.44 (rr 15-65 pg/mL)

I'm actually not quite sure what those are...

Oh, and Andros - my rT3 was labeled high, so it isn't just the ratio I am concerned about. The test came back 43.6ng/dL with a rr of 13.5 - 34.2.


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## Kaykay2

I have been reading on this thread and my curiosity has the best of me. Has anyone heard from Koof and how she is doing?


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