# New Here with Labs



## JessiMae (Sep 18, 2012)

Hi all! I've been experiencing symptoms consistant with thyroid issues for over a year now. I have some symptoms of both hypo and hyper but they seem to mostly fall into the hyper category. Anxiety has always been an issue for me but it's been much worse lately, I sometimes have shakiness, shortness of breath, elevated heart rate (generally slightly over 100 although BP is usually on the low end), increased fidgeting (I also have ADHD), sleep disturbances (excessive fatigue overall but also trouble falling asleep), sometimes a subjective feeling of muscle weakness, irritability, mood swings, I've had periods where I have persistant random painless muscle twitches, joint pain, sometimes muscle pain, constant flushing of my chest, neck, and sometimes face, sometimes increased sweating, sensitive to both hot and cold (seems like I swing back and forth), weight fluctuations (periods of loss followed by gains), memory issues (again worse than my usual ADHD symptoms), foggy headedness. These symptoms wax and wane in severity and when I'm feeling the worst I have them all.

My ADHD has been treated with Adderall for several years and these symptoms have persisted at varying dosages and even with the stimulant has been discontinued although the mental fogginess and fatigue are SO much worse when it's stopped. Neither the endo I'm seeing or my GP have suggested stopping the Adderall but next time I see my GP I'm going to inquire about switching to Provigil which isn't associated with as many cardiac side effects.

I do have a family history of graves disease with graves eye disease (maternal aunt). I sometimes have dry itchy eyes and it seems like this is the case when I'm having more symptoms overall but no other eye symptoms. After a year of discussing these issues with my GP, a few borderline low TSH levels, and one low TSH, I finally got an endo referral; my frees have been in range which caused my GP to look into other autoimmune issues first. The endo did sound concerned about Graves considering the family history and symptoms and explained that onset can be gradual. She said that my thyroid was "palpable", more so on the right, and it was my understanding that this isn't usually the case. After sending me for more labs (most recent first below) I'm being scheduled for a thyroid ultrasound as well as ultrasound of the ovaries. I probably have PCOS which is why they're doing the u/s of the ovaries; I rarely have periods but I've also had the Mirena IUD for 7 years and my understanding is that is common. My TSI was detectable but below there range although I know I should have no TSI. It's my understanding that the TSI with my symptoms indicative of hyperthyroidism? Spring of last year is when I was feeling at my worst so I think it's telling that was my lowest TSH was last March and in hindsight I really my GP had ordered FT3/FT4 that time.

I haven't had a chance to talk to the endo about these labs yet, just the NP, as I won't see her again until after the ultrasound. Would it be a good idea ask to have the blocking antibodies (sorry I can't recall the name right now) that are often present in Graves next time? I'm suspecting that this might be why my TSH has been borderline low or out of range low without a rise in T3/T4. What will the ultrasound be able to detect? Is that just to diagnose or rule out nodules? Is there anything that should be checked that's been overlooked? General input, advice?.. And finally, are they anything even available treatment-wise with my frees mid-range as they've been?

Labs (RR in parentheses):

9/07/12
Testosterone, Free 1.59% -- (0.50-2.80%)
Testosterone, Free 0.60 -- (0.10-0.85 ng/dL)
Testosterone, Serum 38 -- (8-48 ng/L)
DHEA Sulfate 423 -- (65-380 ug/dl) *H
Anti-TPO Ab 0.3 -- (0.0-5.5 IU/mL)
Free T4 1.31 -- (0.76-1.46 ng/dL)
Free T3 3.22 -- (2.18-3.98 pg/mL)
TSH 0.439 -- (0.358-3.74 uIU/mL)
Vit D3, 25-Hydroxy 16 -- (30-80 ng/mL) *L
TSI 84 -- (<122%)
Corisol, Salivary (midnight) 0.027 -- (0.022-0.254 ug/dL)

4/17/12
TSH 0.67 -- (0.40-4.50 mIU/L)
FT4 1.3 -- (0.8-1.8 ng/dL)
FT3 2.7 -- (2.3-4.2 pg/mL)

4/02/12
DHEA 1695 -- (102-1185 ng/dL) *H
Testosterone, Total 77 -- (2-45 ng/dL) *H
Testosterone, Free 6.6 -- (0.1-6.4 pg/mL) *H

3/22/12
ANA Screen NEGATIVE
Rheumatoid Factor 8 -- (<14 IU/mL)
TSH 0.27 -- (0.40-4.50 mIU/L) *L
Vitamin D, 25-OH 11 -- (30-100 ng/mL) *L

12/09/11
TSH 0.54 -- (.40-4.50 mIU/L)
FT4 1.3 -- (0.8-1.8 ng/dL_
FT3 3.1 -- (2.3-4.2 pg/mL)

11/9/10 (this was a routine lab before I started feeling awful)
TSH 0.92 -- (0.34-5.60 uIU/mL)

I've had a lot of other labs that came back normal along the way, if anyone thinks of something that would be relevant just ask - I've probably had it LOL. CBCs were in range, metabolic panels good, glucose/insulin (free & total)/HgA1C all in range, parathyroid intact, etc.


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## JessiMae (Sep 18, 2012)

Oh, I forgot the following symptoms: TONS of hair shedding, I'm amazed I have any left; flaky skin; occasionally frequent & loose stools; LOSS of appetite overall (nervous stomach, often too anxious to eat); Klonopin no longer does anything at all to relieve my anxiety; Adderall does little more than help me stay awake anymore; I am constantly tired. Fatigue and anxiety are by far my worst symptoms. I'm starting 50,000 IU Vitamin D weekly for the low D so hopefully that will help with the fatigue somewhat.


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## Andros (Aug 26, 2009)

JessiMae said:


> Hi all! I've been experiencing symptoms consistant with thyroid issues for over a year now. I have some symptoms of both hypo and hyper but they seem to mostly fall into the hyper category. Anxiety has always been an issue for me but it's been much worse lately, I sometimes have shakiness, shortness of breath, elevated heart rate (generally slightly over 100 although BP is usually on the low end), increased fidgeting (I also have ADHD), sleep disturbances (excessive fatigue overall but also trouble falling asleep), sometimes a subjective feeling of muscle weakness, irritability, mood swings, I've had periods where I have persistant random painless muscle twitches, joint pain, sometimes muscle pain, constant flushing of my chest, neck, and sometimes face, sometimes increased sweating, sensitive to both hot and cold (seems like I swing back and forth), weight fluctuations (periods of loss followed by gains), memory issues (again worse than my usual ADHD symptoms), foggy headedness. These symptoms wax and wane in severity and when I'm feeling the worst I have them all.
> 
> My ADHD has been treated with Adderall for several years and these symptoms have persisted at varying dosages and even with the stimulant has been discontinued although the mental fogginess and fatigue are SO much worse when it's stopped. Neither the endo I'm seeing or my GP have suggested stopping the Adderall but next time I see my GP I'm going to inquire about switching to Provigil which isn't associated with as many cardiac side effects.
> 
> ...












Looks like you may be hyper. Glad you are getting an ultra-sound.

This is what you may be thinking of.

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

Your labs may look normal because that is what the binding, blocking and stimulating antibodies do. They make the numbers look normal but meanwhile the patient is very ill because of course, things are not right within the body.

Please let us know when your ultra-sounds are scheduled.


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## LeahLana (Aug 26, 2012)

My god, all of this could be me!


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## Andros (Aug 26, 2009)

LeahLana said:


> My god, all of this could be me!


Yep and me too many years ago. I recognize the symptoms; big time!


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## JessiMae (Sep 18, 2012)

Thank you for the feedback! Your replies echoed my aunts (the one who had ablation for Graves years ago) when I started feeling bad & my weight was plummeting (luckily that's evened out for now). Every time I'd tell her how I was feeling she'd tell me she knew exactly what I was talking about and to make them keep checking my thyroid.

Both ultrasounds will be next Monday. I'll update & will no doubt have a bunch of questions once I know those results lol. And yes, TRAb is exactly what I was thinking of Andros, thank you for jogging my memory. I'll ask them to make sure to order it next time I have labs drawn. At least the picture seems to be getting clearer - slowly but surely. It's something of a relief to at least know what it is that's making me feel so awful.


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## Andros (Aug 26, 2009)

JessiMae said:


> Thank you for the feedback! Your replies echoed my aunts (the one who had ablation for Graves years ago) when I started feeling bad & my weight was plummeting (luckily that's evened out for now). Every time I'd tell her how I was feeling she'd tell me she knew exactly what I was talking about and to make them keep checking my thyroid.
> 
> Both ultrasounds will be next Monday. I'll update & will no doubt have a bunch of questions once I know those results lol. And yes, TRAb is exactly what I was thinking of Andros, thank you for jogging my memory. I'll ask them to make sure to order it next time I have labs drawn. At least the picture seems to be getting clearer - slowly but surely. It's something of a relief to at least know what it is that's making me feel so awful.


I could not agree more. Getting a definitive diagnosis gives one hope and validation. Now something can be done to make you feel better!


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## JessiMae (Sep 18, 2012)

So here is the report from the ultrasound of my thyroid:

ULTRASOUND THYROID-
Indication- Large thyroid.
Examination- Ultrasonographic evaluation of the thyroid
Comparison- None

FINDINGS-

RIGHT LOBE- 4.9 x 1.3 x 2.0 cm. Two small nodular foci noted.

Nodule Location- Anterior midportion of the right lobe
Size- 0.5 x 0.3 x 0.5 cm
Echogenicity- Hypoechoic
Margins- Well circumscribed
Vascularity- Peripheral color flow noted
Microcalcifications- None identified. There is, however, an echogenic focus in the midportion measuring greater than 0.2 cm.
Acoustic enhancement- None identified

Nodule Location- Posterior midportion of the right lobe
Size- 0.4 x 0.3 x 0.5 cm
Echogenicity- Hypoechoic
Margins- Well circumscribed
Vascularity- Peripheral color flow
Microcalcifications- None identified. There is, however, an echogenic focus in the midportion measuring greater than 0.2 cm.
Acoustic enhancement- None identified

LEFT LOBE- 5.1 x 1.1 x 1.9 cm. Solitary tiny nodular focus without additional abnormality.

Nodule Location- Midportion left lobe
Size- 0.2 x 0.2 x 0.3 cm
Echogenicity- Hypoechoic with some vague central increased echogenicity
Margins- Circumscribed
Vascularity- Peripheral color flow
Microcalcifications- None identified
Acoustic enhancement- None identified

Isthmus- Unremarkable.

Cervical lymph nodes- None identified.

IMPRESSION- Three small nodular foci noted as detailed above all measuring up to 0.5 cm in maximum dimension. Echogenic foci centrally suggests colloid cysts.​
References I could find for they typical size of a 'normal' thyroid were 4-4.8 x 1.0-1.8 x 0.8-1.6 cm. I'm pretty close to the upper numbers so does that mean my thyroid is 'normal' sized or slightly enlarged? I was actually surprised it's so close to the average size considering I have shortness of breath & discomfort/pressure swallowing food. Recently I've also had this feeling like I have to strain to when I need to raise my voice, similar to how it feels when I'm getting over a bad sore throat but without the soreness. I had been thinking these were thyroid related but could my thyroid be causing those issues since it's barely enlarged? Any input on these u/s findings in general? Should I be concerned about the cysts?


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