# Lab results with goiter



## histojen (Mar 5, 2011)

Hello everyone. I am new to the boards. I recently was diagnosed by ultrasound with a goiter of equal swelling on both sides. No signs of cancer. All my lab results seem normal though. My tsh the first time was 1.4 [.27-4.20]. The second time, two weeks later it was .81 [.27-4.20]. I also had other tests
FT3 3.7 [1.5-4.1]
FT4 1.4 [.9-1.9]
Anti TPO <10 [0-35.0]
Thyroglobulin 27.10 [0-40]
Anti-Thyroglobulin <20 [0-40]
My T4 was alo tested which was 10.0 but I do not have ranges. I know the upper level was 12. I am having more frequent menstrual cycles, muscle aches, weight gain, and a mental fatigue. I am 34 and female. Do my levels seem ok? I mentioned to doctor I had a miscarriage 6 months earlier and she just ignored it. I don't understand why I have a goiter.


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## Chromatic (Mar 31, 2011)

I know what the pcp/gp's know, and utilize in their diagnosis or 'lack of' -- from my study of medicine in college. However, it is very evident that , I dare say, a majority of the medical community doesn't have a clue at the diversity in what ranges of thyroid hormones, pituitary output/axis ranges, that exist in hypo and hyper thyroid individuals.

In other words, your levels are very much in NORMAL range, and even would be seemingly quite healthy.

Your TSH (Thyroid Stimulating Hormone) Decreased , and while still in range is heading towards a hyper state. The lower the TSH , generally the more thyroid hormone is present. IE: Your T3 and T4 -- which are the chemicals that your body uses for metabolism. These are hormones.

If you look at your test results you will notice that your T3 and T4 are in the upper range of the the reference. Or on the higher end of 'normal'. This points to a lower TSH.

The name is just as it implies.. Thyroid STIMULATING hormone. When the pituitary gland releases this , it signals our thyroid to produce more T3/T4. So the higher the TSH , the more our pituitary is sending out or 'screaming' at our thyroid gland to produce T3 and T4 hormone. When there are thyroid problems such as hypo-thyroidism (hypo just means 'less'.. which is underactive thyroid). -- when this is occurring the pituitary , in our brain, is sending out this signaling hormone to speak to the thyroid gland because there isn't enough T3 and T4 in the blood. However, if there is a problem, the thyroid won't produce enough T3 and T4 that the pituitary gland is signaling for. So what does the pituitary gland do? It sends MORE TSH (Thyroid Stimulating Hormone) out into the blood ,..and this continues. So generally when you have ALOT , or high TSH levels and relatively low T3/T4 levels you have hypothyroidism.

The reverse can happen as well. The thyroid can be overactive,.. producing too much hormone which is "Hyper thyroidism" -- or over active, "Hyper essentially means more" -- So using the same logic,.. if the T3 and T4 are too high in the blood, the pituitary gland will lower or even STOP signaling the thyroid to produce. So the TSH level will be low, or in some severe cases be undetectable because the thyroid is , for lack of better description, out of control.

Not to confuse -- but this can also , much more rarely, be a problem with the pituitary gland itself.. but generally it is the thyroid.

Both of these are very treatable.

The problem with thyroid problems is diagnosis and getting the PROPER treatment.

While your numbers really look good, even to me (others may disagree) -- they can potentially still be not optimal for YOU and your body/metabolism.

Basically the best way for a doctor to treat thyroid issues, imho, is to take into account the patients overall symptoms -- rule out other diagnosis or possibilities and then start with thyroid treatment if the numbers (after some repeated and varied) testing of the labs have been done.

In some cases, as you can imagine .. you would have a TSH of say.. 0.1 -- which is very low, and then you would have FT3 of 8, and Ft4 of 3.0 .. and so on. Basically low TSH and high levels of the hormones despite the low TSH. Which would be very evident and 'textbook' of hyperthyroidism.

On the other hand, you can have a TSH level of say 8.4, with a FT3 of 0.5, and FT4 of 0.3 -- which would be textbook of HYPOthyroidism. Where the pituitary gland is yelling for more hormones t3/t4 but the thyroid is malfunctioning and unable to produce it. Which is very obvious with those results.

But it is so common to have people all between these variations. Where they are on the border of normal range, or even in normal range but they still have thyroid problems. This is, again, where the doctors have to start treating based on their repeated labs (trends) are things going up, or down.. how are they in relation to each other? How severe is the patient experiencing symptoms, (symptoms common with thyroid issues) and so on.

Unfortunately, this often times takes going through a great many doctors to find one who has a clue.

This is just a laymans explanation of the more obvious cases..(example) --

I am only really commenting because I noticed you don't have a reply after so long.. hopefully others can remark on your levels.

Lastly, the doctor should not have ignored your mention of miscarriage,.. doctors should not ignore ANY worry or complaint of any patient even if it is trivial and to the doctor has no relevance to their problems. Your menstrual cycles, aches, weight gain, and mental fatigue could be natural progression of your miscarriage and regulating hormones -- but these are also very common signs of thyroid issues.

Thyroid issues are hormone issues,.. alot of people don't realize this so much. But t3 and t4 and big time hormones, just as important as testosterone and estrogen.

Your goiter, further, is not normal. In the civilized world we don't often get them because we don't have any iodine deficiency -- You had the appropriate tests, the ultrasound, thyroid panels.. etc -- But the problem is with your doctor.

If you have symptoms/problems and the tests come back seemingly 'normal' -- it isn't ok for the doctor to just say, "oh well.. it all looks good to me.. sorry." -- They have to dig deeper, OR, be the bigger person and refer you to someone else who has a better chance of figuring out why. Be that another specialist, or just another doctor who has different experience and a different BRAIN. 

Hope you get things worked out.


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## Andros (Aug 26, 2009)

histojen said:


> Hello everyone. I am new to the boards. I recently was diagnosed by ultrasound with a goiter of equal swelling on both sides. No signs of cancer. All my lab results seem normal though. My tsh the first time was 1.4 [.27-4.20]. The second time, two weeks later it was .81 [.27-4.20]. I also had other tests
> FT3 3.7 [1.5-4.1]
> FT4 1.4 [.9-1.9]
> Anti TPO <10 [0-35.0]
> ...


Hi there!









Something is wrong if you have a goiter. My experience has been that antibodies' tests are essential as labs can come in in normal range yet the patient can be very very symptomatic.

I am so so sorry about your loss and dollars to donuts, thyroid disease may have been the cause.

Please insist on antibodies' tests.

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

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

Also, RAIU which is radioactive uptake scan. With a goiter, one has to be sure there are no suspicious nodules (cancer.)

You have had some of the above tests. Omit them. Not necessary to repeat. There is something afoot. The other antibodies are antibodies to the antibodies and stimulating. They are important too.

I have a funny feeling you are trying to be hyperthyroid.

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


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