# New, Need help with labs, symptoms



## A guy named Kelley (Jun 26, 2013)

Hi everyone,

I have been experiencing symptoms of hypothyroidism for a few years now, then suddenly around March of this year I seemed to begin having thyroiditis symptoms. 3 weeks to a month of pure hyper symptoms, then about a month of hypo symptoms. Now I feel like I am kind of caught in the middle and feel horrible. My labs going back to 2009 are as follows.

2/11/2009	TSH - .56	.49 - 4.67	
2/31/2009	TSH - .56	.49 - 4.67	
4/28/2009	TSH - .56	.49 - 4.67	
11/24/2009	TSH - 1.14	.46 - 4.69	
FT4 - .97	.78 - 2.19	13% of range
2/3/2010	TSH - 1.14	.46 - 4.69	
 FT4 - .97	.78 - 2.19	13% of range
10/1/2010	TSH - .608	.46 - 4.69	
FT4 - 1.03	.78 - 2.19	17% of range
10/3/2010	TSH - .863	.46 - 4.69	
FT4 - 1.07	.78 - 2.19	20% of range
2/16/2012	TSH - .697	.46 - 4.69	
1/24/2013	TSH - 1.61	.46 - 4.69	
3/7/2013	TSH - 1.06	.34 - 5.6	
4/7/2013	TSH - 1.04	.34 - 5.6	
FT4 -.90	.58 - 1.70	28% of range
FT3 - 3.25 2.50 - 3.90 53% of range
TGab - <20	<20	
TPOab - 11	<35	
5/18/2013	TSH - .682	.3-5	
FT4 - 1.43	.7 - 1.9	61% of range
6/5/2013	TSH - 
FT4 - 1.51	.8 - 1.80	71% of range
FT3 - 3.5	2.3 - 4.2	62.50% of range
TPOab - <10	<35	
6/27/2013	TSH - 1.39	.34 - 5.6	
FT4 - 1.39	.7 - 1.9	57% of range
FT3 - 3.4	2.6 - 4.8	34.50% of range

Any ideas or suggestions would be greatly appreciated.

kelley


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## joplin1975 (Jul 21, 2011)

Interesting that when you frees got a little better, your TSH crept up.

Are you on any kind of medication now?

Have you ever had your testosterone checked?


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## A guy named Kelley (Jun 26, 2013)

Hi Joplin, thanks for responding so soon!

Yes my Testosterone is low as is the testosterone free.
I am not on any medications either. I should have known to add the medication part but forgot.

Thanks again!


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## joplin1975 (Jul 21, 2011)

Gotcha. Honestly, I'm not sure...your numbers are fluctuating a bit and I can see why you'd feel bad...but I'll have to defer to the bloodwork gurus.

Is your doctor open to a trial of levothyroxine? Do you have any plans to treat the testosterone? Most people consider them connected.


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## Andros (Aug 26, 2009)

A guy named Kelley said:


> Hi everyone,
> 
> I have been experiencing symptoms of hypothyroidism for a few years now, then suddenly around March of this year I seemed to begin having thyroiditis symptoms. 3 weeks to a month of pure hyper symptoms, then about a month of hypo symptoms. Now I feel like I am kind of caught in the middle and feel horrible. My labs going back to 2009 are as follows.
> 
> ...












You do appear hyper; these tests would confirm.

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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

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

And I encourage you to get an ultra-sound of your thyroid.


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## A guy named Kelley (Jun 26, 2013)

Thanks for the quick reply's again.

I am currently waiting on the TSI result, I will be getting a CT of the chest to check for a sub sternal goiter as the left side of my thyroid is just slightly larger. Every once in a while it will feel like it swells up and makes my voice hoarse but then it will go away and I will get all warm feeling. Odd I know, also, I will have to check into the Trab as well. My sister has Hashimoto's but as usual only about half of our symptoms are/were the same.

Thanks again!
Kelley


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## bigfoot (May 13, 2011)

hugs6

It'll be interesting to see the results. I'll echo the other posters; look into "why" your testosterone is low. It could be from a myriad of factors. If you begin hormone replacement therapy with testosterone before your doc figures out why, it's hard to turn back the clock and do the detective work. I will say from personal experience that many signs & symptoms seem to blur between low testosterone and thyroid issues. I'd venture to guess your lipid panel is out of whack, too. Bet you have high triglycerides amongst other things, like low Vitamin D and B-12.

If you eventually do decide to go at the testosterone angle, you need to be sure to find a doc who knows what they are doing. Simply getting your total testosterone into the "normal range" isn't really enough; you want to optimize these levels -- similar to what we do for the thyroid. They need to be looking at your free testosterone, SHBG, estradiol, etc. And treatment basically consists of either topical gels, patches, or injections. The patches gave me a lot of skin irritation (common complaint), the gels are not bad (but messy, and can cause skin problems), and injections are ideally done on a weekly basis (not every 2-4 weeks as some docs think), otherwise you will get a roller-coaster of highs and lows.

What has your doctor said about everything you are going through?


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## A guy named Kelley (Jun 26, 2013)

Hi Bigfoot,

Nice to meet you so to speak and thanks for responding!

As you mentioned, yes my cholesterol numbers have been high since the latter part of 2009, so essentially when I began to have the Hypo symptoms ie: cold hands and feet, poor memory, constipation, outer 4th to 3rd of eyebrows thinning. I had been on statins until Apr of this year when my regular doctor called and said to come off of them because suddenly I had very low cholesterol. Well, all except the HDL which was in the normal range. So 2 months now after stopping them, my cholesterol is now just above the high limit again. And that is with of course watching what I eat etc etc. Vitamin D is low or low normal on a regular basis, Vitamin B12, I honestly do not know this number since I am sure my doctor hasn't checked it. As far as the Testosterone goes, it was around Jan of 2010 when I was informed for the first time that it was indeed low. I began with the shots like you mentioned and you are very correct with the rollercoaster description. I would be given the injection, and roughly about 6 to 8 hours later I would go through uncontrollable anxiety that lasted for a week. The doctors then ( I was in the military from 2006 to 2011 ) checked my estrogen for dominance and it was fine. After that they switched me to Androgel. It didn't work at all, but then again I was putting it on in the morning and then would go to work in 100 degree weather causing it to not seep in so to speak. Anyhow, fast forward to where I am now, my current doctor who is a Hormone specialist and a DO, has stated that she has seen this numerous times where Thyroid patients, men mainly will use replacement testosterone and will not go much above the bottom cut off because they don't have the Thyroid helping out to produce the much needed testosterone.

As far as the thyroid goes, my current doctor is one of the ones that believe there is always a chance of having Hashimoto's Thyroiditis even with the low positive amounts of TPOab like I have. But she did say there is a good chance I might have both Graves and Hashi or even possibly the TSH blocking something or another. When I showed her my entire medical history, one thing she commented on immediately was a constant high CK/MB, slightly low WBC, high Calcium and a couple of others which she showed me are directly related to the Thyroid. This was especially true for me since I have had 2 echo stress tests , a thallium stress test and a heart cath at the end of 2010 so the heart was perfect then. My Parathyroid Hormone always reacts correctly although a bit slowly to lower the calcium and she brought up the slightly low WBC being a big thing in autoimmune Thyroid issues.

Needless to say i feel like utter $#!^, especially since the end of Feb. The anxiety is killing me and of course being a typical internet savy person we all are today I have looked up everything I could think of and have scared my self to death thinking it could be Dysautonomia or cancers etc etc....WebMD is NOT your friend when your not feeling good.

One thing I can say, is I have read the articles done by Philip and another woman on hashitoxicosis and the onset of the hyper symptoms are very close indeed. Palpitations, hot feeling, sudden interest in eating, bowels magically turn on, more energy, mind races.....feel good for a short period of time and then it's all down hill. And this happens repeatedly all day long with the exception of feeling hyper more times than not at night.

Sorry for the long drawn out post, i was feeling especially like crap when I did my first post and missed putting in valuable information.

and lastly, I have lost a LOT of weight from this. 30 lbs since March.

lemme know if you need any more info, If I have I will gladly post it.

Thanks again everyone!
kelley


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## Lovlkn (Dec 20, 2009)

> WebMD is NOT your friend when your not feeling good.


LOL

My 1st thought when reading your posts was Hashitoxicosis. Andros beat me to recommending a TSI test.

I had Hashitoxicosis - my symptoms presented mainly hyper and I never could regulate on Anti thyroid med's.

I found this definition a long time ago and felt it was accurate.

http://www.thyroidboards.com/showthread.php?t=853

Hashitoxicosis is an autoimmune thyroid disorder, in which individuals with autoimmune hypothyrodism, usually Hashimoto's thyroiditis (HT), experience intermittent or sporadic periods where they also have symptoms of hyperthyrodism. In some ways, these patients can be described as having both HT and Graves' disease since the antibodies associated with both diseases are present. 
The disease process in Hashitoxicosis focuses around the thyroid cell destruction seen in autoimmune hypothyroidism. Here, thyroid peroxidase and thyroglobulin antibodies cause thyroid cell inflammation and destruction. As thyroid cells die, their stored supplies of thyroid hormone are suddenly released into the blood circulation. These sudden bursts of thyroid hormone are responsible for the symptoms of hyperthyroidism. Often patients think that they need to have their medications adjusted and they suspect that their thyroid medication is too high. On other days, when they're dragging, depressed and experiencing weight gain, they suspect that their thyroid hormone replacement dose is too low. 
Blocking TSH receptor antibodies in Hashitoxicosis can prevent the thyroid cell from absorbing thyroid hormone, worsening hypothyroidism. And stimulating TSH receptor antibodies can cause periods where excess thyroid hormone is produced. Depending on which antibodies predominate on a given day, symptoms can vary. 
Furthermore, these sudden bursts of thyroid hormone affect laboratory results. If a patient experiences many recurring bursts of thyroid hormone, their blood thyroid hormone levels will be elevated. If this happens over a period of weeks, their TSH levels will drop. Depending on when they have their laboratory tests run, it can appear as if they're now hyperthyroid. If their medication is cut, they may soon be complaining of symptoms of hypothyroidism. 
Patients with GD who have achieved remission after being on antithyroid drugs may also experience Hashitoxicosis. So can ablated patients who still have some remaining functional thyroid tissue. These patients worry that active Graves' disease has returned and ask to be put back on ATD's. Others who have had RAI end up having a second or third dose of RAI. A wait and see approach can prevent this from happening. 
For patients who have symptoms of both hypothyroidism and hyperthyroidism but have never been diagnosed, diagnosis can be elusive. Often the periods of hypothyroidism and hyperthyroidism will balance each other out, causing normal thyroid hormone levels. Without a careful evaluation of symptoms, it will appear as if these patients are euthyroid. One clue is in the patient who shows signs of Graves' ophthalmopathy or thyroid eye disease. 
If they have the proper antibody tests run, and are diagnosed with Hashitoxicosis, then they can be properly monitored and learn how to adjust their own thyroid meds depending on symptoms. A definitive diagnosis can be made by biopsy, that is, fine needle aspiration. A lymphocytic (white blood cell) infiltration of the thyroid will be seen, and there will be certain cellular changes, particularly the presence of Hurthle cells. A probably diagnosis can also be made by thyroid antibody tests. In Hashitoxicosis, thyroid peroxidase, thyroglobulin, thyroid binding inhibiting immunoglobulins (TBII) and thyroid stimulating immunoglobulins (TSI or stimulating TSH receptor antibodies) will all be present. 
Anyone who is genetically predisposed to autoimmune thyroid disease can develop Hashitoxicosis. It's not uncommon in one's lifetime to have HT, GD, primary myxedema and Hashitoxicosis at different times. According to some researchers, Hashitoxicosis is most likely to be encountered in the early stages of autoimmune hypothyroidism. Patients with GD who have achieved remission may actually be experiencing the early stages of spontaneous hypothyroidism when symptoms of Hashitoxicosis emerge.


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## A guy named Kelley (Jun 26, 2013)

Hi Lovlkn!

I can definitely understand the hyper part, it seems mine cycles towards hyper usually after noon and then again before bedtime. Its getting frustrating since my Endo won't do anything medication wise and the pain is unreal at times. It feels like my heart is way past tired and the lower back pain and flank pain suck.
I have been seeing a new doctor but she wants more tests done in the meantime which leaves me dealing with the headaches and other pains. I am hoping she will at least give me a chance to try the block and replace method since I cycle every day it seems. And of course if I eat anything with Iodine it's game over.

Anyhow, thanks for responding and I will post my results of the TSI once I get them. I will also have to ask about the TRab as well.

kelley


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## sleepylady (Mar 18, 2012)

@Lov-

Do you have to have TPO to have H T? Mine always says <6 but the other antibodies register, albeit in "normal ranges". I feel just like that description.


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## Andros (Aug 26, 2009)

A guy named Kelley said:


> Thanks for the quick reply's again.
> 
> I am currently waiting on the TSI result, I will be getting a CT of the chest to check for a sub sternal goiter as the left side of my thyroid is just slightly larger. Every once in a while it will feel like it swells up and makes my voice hoarse but then it will go away and I will get all warm feeling. Odd I know, also, I will have to check into the Trab as well. My sister has Hashimoto's but as usual only about half of our symptoms are/were the same.
> 
> ...


If you have TSI; you probably have Trab! Let us know when the CT is set up and you know we all wish you the best. I am glad your doc is doing a CT!


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## A guy named Kelley (Jun 26, 2013)

Andros, thank you very much for the reply and help. I truly appreciate it.

I do have an odd question that I have only been able to find very limited information on and would like to know if you have any insight on it.

Basically after the first HYPO period that followed the HYPER beginning of all of this I began to notice that during the cycling HYPER periods, my blood vessels seem to dilate or become extremely noticeable. Sometimes they hurt as well. I have found information regarding Thyroid hormone over abundance leading to dilation of bloods vessels as it is also one of the mechanisms for keeping tabs on vaso-dilation and vaso-constriction. And I have done a search on this board as well and have noticed only a couple of people mentioning this happening.

So my question for you is basically, have you come across anyone noting this happening or know if this is indeed Thyroid Hormone related?

This has without a doubt caused me major anxiety and fear. I have tried to stay away from searching the internet regarding it because I always come up with things like Systemic Candidasis, or Lyme Disease or Vasculitis, but then again they state that the blood vessel dilation is a constant where as mine seems to only occur during the hyper cycles.

Oh and the Chest CT is this coming Monday along with an Echo of the Heart and Ultrasound of the Kidneys

Any input would be enormously appreciated.
Kelley


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## Andros (Aug 26, 2009)

A guy named Kelley said:


> Andros, thank you very much for the reply and help. I truly appreciate it.
> 
> I do have an odd question that I have only been able to find very limited information on and would like to know if you have any insight on it.
> 
> ...


Hyper thyroid can and does lend it's self to dilation of the blood vessels. One of the many reasons why it has to be treated before permanent damage is done. I do really recall having that situation and I could see the vessels in my neck, top of hands and top of feet, temples. BP was high when I was hyper.

However, as you already know there are many other causes of this. But since you do have hyper periods and you do only notice this when you are hyper, one could think that that is the cause. It would be wise to discuss this with your doc if you have not previously brought it up because assumptions are not the way to go when it comes to one's health and well-being.

Monday can't come too soon and it sounds like you have a wonderful doctor who is very very thorough.

Will be sending good thoughts for you Monday!


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## A guy named Kelley (Jun 26, 2013)

Thanks again Andros,

As I said it definitely worries me since I can feel the vessels in my face. And yes Monday can't come soon enough. It is frustrating since my last doctor just wrote me off as a psychiatric case and wasted 4 1/2 months running a CBC over and over and saying nothing is wrong with me. And like you said I truly hope it's not too late for permanent damage.

Anyhow I will update you once I get some information. I should be able to give you some new TSH and FT4 and FT3 later today once I get them back.

Kelley


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## A guy named Kelley (Jun 26, 2013)

Ok so right after I put in my last post I was called about the TSI and TSH and FT4, here goes...

TSI less than 89 percent range being less than 140 percent.
TSH .862 range .3 - 5.6
FT4 1.49 range .7 - 1.90 so 65.5% of range

So this means detectible TSI correct?

Kelley


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## Andros (Aug 26, 2009)

A guy named Kelley said:


> Thanks again Andros,
> 
> As I said it definitely worries me since I can feel the vessels in my face. And yes Monday can't come soon enough. It is frustrating since my last doctor just wrote me off as a psychiatric case and wasted 4 1/2 months running a CBC over and over and saying nothing is wrong with me. And like you said I truly hope it's not too late for permanent damage.
> 
> ...


Good deal! Meanwhile; don't push yourself too hard. Try to have a relaxing weekend. Monday is just around the corner!


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## A guy named Kelley (Jun 26, 2013)

Okay so I got all the tests done today. My heart was perfect according to the cardio tech. The other tests I will have to wait for the results on.

As of Friday I have been having issues with postural hypotension and pupils that fluctuate when light is shined in them. I have been feeling much colder for the last few days as well. Can anyone shed light on this? I am very concerned about this possibly being Dysautonomia. And is it normal for the Free t3 to drop like it did? It dropped to 25% of the range now when the free t4 went from 57% to 65%. Are odd fluctuations like this normal?!? And is the TSI what is keeping my TSH from going into the HYPO range?

Sorry, just very concerned and scared at this point. I don't even want to think about a non thyroidal illness or dysautonomia.

Thanks
Kelley


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## HotGrandma (Sep 21, 2012)

Kelley. When T4 converts to T3. When the T3 drops below the 50-75% of range it does make you get cold easily. TSH takes 6 weeks or longer to catch up with the Frees. 
TSI and TRab (aka TSH receptor antibody) are virtually the same. TRab is cheaper and quicker. Do you have any of those results? You have noticed a "trigger" of iodine. After keeping a log I discovered other triggers that would make me go hyper and hypo all day long. Triggers can be environmental or what you eat. For me any over the counter medication made me hyper. Aspertame was probably the worst. Its different for everyone. Let us know your antibody results.


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## A guy named Kelley (Jun 26, 2013)

Thanks HotGrandma,

As far as antibodies go I tested with 11 for TPOab range being less than 35. The second time I was tested it was less than 10 same range. My TSI says less than 89 percent with 140 being the baseline. TGB is less than 20


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## A guy named Kelley (Jun 26, 2013)

Also it seems like iodine no longer has the same effect either. Not sure if maybe I just don't feel it at this low of level or what.


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