# New labs-would like your thoughts



## mememe

Still waiting on my TSI result, so I will post that whenever I get it. I have listed all my lab work. The most recent is the last one, done on 7/27/10. I have never been on any thyroid medication as of yet. I have a multinodular goiter, and my previous doctor said I have Hashimoto's Thyroiditis-but I am no longer seeing him. I'm curious to know what you fine people think about the results. A random doctor told me that I should not be feeling tired based on my thyroid results. I just want to say that, something is wrong somewhere and I want to get to feeling normal again, whether it's my thyroid OR NOT!lol

ALSO, why do the TgAb and TRAb results have a "<" rather than an actual number? Does this mean if it is less than a certain number then it is not important?

*3/9/10*
*TSH * 1.730 (0.450-4.500)
*TPO Ab* 304 (0-34)
*TgAb * 28 (0-40)

*4/13/10*
*TSH * 1.090 (0.450-4.500)
*TPO Ab* 374 (0-34)
*TSI* 92 (0-139)
*FT4 * 1.38 (0.82-1.77)

*4/27/10*
*TSH * 1.760 (0.450-4.500)
*FT4* 1.26 (0.8201.77)
*FT3* 2.8 (2.0-4.4)

*7/27/10*
*TSH* 1.850 (0.450-4.500)
*TPO Ab* 355 (0-34)
*TgAb* <20 (0-40)
*FT4* 1.08 (0.82-1.77)
*FT3* 3.2 (2.0-4.4)
*TRAb* <0.51 (0.00-1.75)
*TSI* 56 (0-139)

**ultrasound revealed multinodular goiter


----------



## Andros

mememe said:


> Still waiting on my TSI result, so I will post that whenever I get it. I have listed all my lab work. The most recent is the last one, done on 7/27/10. I have never been on any thyroid medication as of yet. I have a multinodular goiter, and my previous doctor said I have Hashimoto's Thyroiditis-but I am no longer seeing him. I'm curious to know what you fine people think about the results. A random doctor told me that I should not be feeling tired based on my thyroid results. I just want to say that, something is wrong somewhere and I want to get to feeling normal again, whether it's my thyroid OR NOT!lol
> 
> ALSO, why do the TgAb and TRAb results have a "<" rather than an actual number? Does this mean if it is less than a certain number then it is not important?
> 
> *3/9/10*
> *TSH * 1.730 (0.450-4.500)
> *TPO Ab* 304 (0-34)
> *TgAb * 28 (0-40)
> 
> *4/13/10*
> *TSH * 1.090 (0.450-4.500)
> *TPO Ab* 374 (0-34)
> *TSI* 92 (0-139)
> *FT4 * 1.38 (0.82-1.77)
> 
> *4/27/10*
> *TSH * 1.760 (0.450-4.500)
> *FT4* 1.26 (0.8201.77)
> *FT3* 2.8 (2.0-4.4)
> 
> *7/27/10*
> *TSH* 1.850 (0.450-4.500)
> *TPO Ab* 355 (0-34)
> *TgAb* <20 (0-40)
> *FT4* 1.08 (0.82-1.77)
> *FT3* 3.2 (2.0-4.4)
> *TRAb* <0.51 (0.00-1.75)
> *TSI* (still waiting on results)


It appears that you have a smattering of Trab. If you have that, my money is on TSI as well.

http://www.ncbi.nlm.nih.gov/pubmed/1633635

http://www.liebertonline.com/doi/abs/10.1089/105072504323030951?journalCode=thy

Antibodies are alway important and there are some you should not have at all. TSI and Trab would be 2 of them.

You started a new thread and I can't remember; did you have a radioactive uptake scan?

Hugs,


----------



## mememe

No I have not had a radioactive uptake scan. Do you suspect my doctor will order one (or SHOULD). I just don't know what to expect. I hope he is a very good doctor for me. Thank you for the links. What is the main difference between a multinodular goiter and a TOXIC multinodular goiter, and how is it diagnosed?


----------



## Lovlkn

> FT4 1.08 (0.82-1.77)
> FT3 3.2 (2.0-4.4)


As far as your fatigue you are mildly under medicated.

FT4 mid range is 1.29
FT-3 mid range is 3.2

I bet adding a bit of levothyroxine would help with the fatigue by raising your FT4 into mid range.

What meds do you take now?


----------



## Andros

mememe said:


> No I have not had a radioactive uptake scan. Do you suspect my doctor will order one (or SHOULD). I just don't know what to expect. I hope he is a very good doctor for me. Thank you for the links. What is the main difference between a multinodular goiter and a TOXIC multinodular goiter, and how is it diagnosed?


Toxic produces too much hormone pushing the patient into hyper mode.

I think the RAIU would be a very excellent idea; I truly do! It will show everthing. Plus the rate of uptake.


----------



## mememe

Lovlkn said:


> As far as your fatigue you are mildly under medicated.
> 
> FT4 mid range is 1.29
> FT-3 mid range is 3.2
> 
> I bet adding a bit of levothyroxine would help with the fatigue by raising your FT4 into mid range.
> 
> What meds do you take now?


I'm not on any thyroid medications yet, but thank you for your insight!



Andros said:


> Toxic produces too much hormone pushing the patient into hyper mode.
> 
> I think the RAIU would be a very excellent idea; I truly do! It will show everthing. Plus the rate of uptake.


If my doctor doesn't say anything about it, I will ask him about it lol. 
******************
Just a hair over two weeks until my appointment! I feel like a kid waiting for Christmas morning!LOL...and today I actually feel pretty good....well I think I'm a little hyper. I noticed my heart rate felt fast so I checked my resting pulse-90 bpm. I checked my heart rate a couple weeks ago on a day I felt really sluggish and bad and it was in the low 70's. I also notice changes in my digestive system when I'm more energized like today, than when I'm really sluggish. Other than that issue, I feel better on days like this 
**edit: I also can tell a difference in my eyes on days like this. On my sluggish tired days my eyes feel really heavy and tired-like. On days like today they feel wide open and not heavy at all.


----------



## mememe

I got my TSI result back today. It is 56 , reference interval= 0-139.


----------



## Andros

mememe said:


> I got my TSI result back today. It is 56 , reference interval= 0-139.


There you go! I suspected that and now you know. These are the antibodies that cause hyperthyroid and/or Graves'.

And you also know that you should have none; zilch!

Has your doctor commented?


----------



## mememe

Well I don't see my doctor until the 16th, BUT the last doctor I saw didn't say anything about my TSI, until _I_ asked him. At that point, he said it is nothing to worry about. Now you see why I had to change doctors. He didn't explain ANYTHING to me, he acted like I was completely fine and wasting his time. He told me thyroid issues are no big deal-nobody dies from thyroid problems. He's a real winner, I tell ya!


----------



## mememe

I am wondering if there is a way (or what's the best way) to be able to test yourself (perhaps saliva?) on days when feeling super bad and super good. Levels change a lot and I can notice a difference in the way I feel. I always think it's too bad that I can't just test myself in those moments of feeling really bad or really good so I can get a more accurate picture of what levels are best for me? I hope I'm making sense here. I mean, I can't really remember exactly how I feel on those days I've been tested, and sometimes I feel way better or way worse days after. I know my levels must have changed enough to tell a difference. I mean, how do some of you know at what levels you feel best at? Do you just remember that you felt great on the day they drew labs?


----------



## GD Women

It's a trial and error situation. I keep a log or diary with thyroid levels, date tested, how I feel and any symptoms with date also, until next Labs.

With me symptoms are foolers. This time around all my hyper symptoms disappeared (for over a year now). I thought I had hypo symptoms and my levels would state such or at least state normal. However, last test proved me wrong with a TSH of 0.008 and FT-4 out of Labs hyper side at 1.83.

This crazy thyroid!


----------



## mememe

Okay, I really really need some serious advice right now...I just got home from my new doctor. He prescribed me synthroid 25 mcg once daily. What concerns me is he didn't mention my TSI, so when I asked him, he said it is normal. I said that I believed zero to be normal, and that I should have zero. He said normal is 0-132 (or w/e my range was). I asked him if I should get an uptake scan and he said no. He said I have hashimoto's thyroiditis. What bugs me is he is also like the last doc, in that he is only paying attention to what is "flagged" on my labs. SOOOO my dilemma is: should I start taking the synthroid as prescribed, or move on to another doc.

My mom is really trying to get me to go to the Mayo clinic, but my concern is, what if I go all the way there and they tell me the same thing? Then I just wasted all this time....or am I overreacting? I just don't feel like it's right in my gut...I really need some advice & support here, I'm obsessing about it really bad.


----------



## Andros

mememe said:


> Okay, I really really need some serious advice right now...I just got home from my new doctor. He prescribed me synthroid 25 mcg once daily. What concerns me is he didn't mention my TSI, so when I asked him, he said it is normal. I said that I believed zero to be normal, and that I should have zero. He said normal is 0-132 (or w/e my range was). I asked him if I should get an uptake scan and he said no. He said I have hashimoto's thyroiditis. What bugs me is he is also like the last doc, in that he is only paying attention to what is "flagged" on my labs. SOOOO my dilemma is: should I start taking the synthroid as prescribed, or move on to another doc.
> 
> My mom is really trying to get me to go to the Mayo clinic, but my concern is, what if I go all the way there and they tell me the same thing? Then I just wasted all this time....or am I overreacting? I just don't feel like it's right in my gut...I really need some advice & support here, I'm obsessing about it really bad.


I am w/you. Getting bad vibes here and of course you and I both know his answers were incorrect.

Trying to get somone to validate you medically and emotionally is very important. I am with your mom on this.


----------



## mememe

Thank you. It's good to hear from someone else that I'm not overreacting. I couldn't keep myself from crying today while telling someone about this--how I just want a doctor who I feel I can trust and feel confident in going to. It's not about finding a miracle cure...it's about going to someone who is knowledgeable!

I just can't see flying to the mayo clinic...I may opt to see someone a couple hours away that's part of the university hospital. I just don't see why it's so hard to find someone good and knowledgeable! I have no one around me to ask who to see. It's very frustrating!


----------



## Andros

mememe said:


> Thank you. It's good to hear from someone else that I'm not overreacting. I couldn't keep myself from crying today while telling someone about this--how I just want a doctor who I feel I can trust and feel confident in going to. It's not about finding a miracle cure...it's about going to someone who is knowledgeable!
> 
> I just can't see flying to the mayo clinic...I may opt to see someone a couple hours away that's part of the university hospital. I just don't see why it's so hard to find someone good and knowledgeable! I have no one around me to ask who to see. It's very frustrating!


What state do you live in? Yahoo has on-line groups state by state but not all states. They know the good docs; that I know. Our group here in Georgia kicks butt.


----------



## mememe

I am willing to try University of Kentucky area, or Cincinnati or Columbus OH areas


----------



## Andros

mememe said:


> I am willing to try University of Kentucky area, or Cincinnati or Columbus OH areas


Here is a Directory.

http://www.thyroidtalk.com/usa.html


----------



## mememe

THANKS!!:hugs:


----------



## Andros

mememe said:


> THANKS!!:hugs:


You are welcome. These gals and guys will know the best doctors. I can assure you of that.


----------



## mememe

I just feel like I'm more on the hyper side than the hypo side, although I could be wrong. I am tired all the time, but only physically. On the inside, my mind races, my heart flutters, I have desires to go out and be awesome...am I wrong to think synthroid is for hypo people?

You have TSI; that means hyper. You are not wrong. If you are hyper, you would be exhausted for the metabolism is constantly in high gear even when resting.

As you know, I am not the doctor here but I don't think you should be on thyroxine replacement. I think you need another opinion. Sadly.


----------



## mememe

I believe that I shouldn't have TSI and those other things, but is there a credible (to a doctor) site that I can actually print something off so I can have it in my possession that might say a normal, healthy individual should have zero TSI and w/e else? I can't seem to find, even on American Thyroid Association, anything to confirm this.


----------



## mememe

I just got these results back . I really don't know what a lot of it means, but maybe there's a bit of useful information here.

http://i203.photobucket.com/albums/aa37/keebert/documents/LABS.jpg


----------



## Andros

mememe said:


> I just got these results back . I really don't know what a lot of it means, but maybe there's a bit of useful information here.
> 
> http://i203.photobucket.com/albums/aa37/keebert/documents/LABS.jpg


High Neutrophils (granulocytes) can be from bacterial infection. Has your doctor commented?

You may wish to read this...

http://en.wikipedia.org/wiki/Neutrophil_granulocyte


----------



## mememe

No. Haven't heard anything from the doctor. I wonder if it could be from my constant allergy & sinus issues. They never get better. I'm almost use to it by now.


----------



## mememe

why do the TgAb and TRAb results have a "<" rather than an actual number? Does this mean if it is less than a certain number then it is not important?


----------



## mememe

Well, I have still been at a stand still. For a little bit I tried to put this on the back burner and not be so "obsessive" about it, but today I am back it and wondering where to turn. I did join two of those state thyroid yahoo groups, but so far I have really not had any help  I suppose I will have to just try out yet another doctor and hope for the best. I just wonder how many I will go through before getting a good one. I can't remember if I mentioned this, but that last doctor I went to, I asked him about getting an uptake scan and he said I didn't need one. I was surprised by that as well. I had a great day yesterday, didn't feel tired at all, now today I'm dragging behind


----------



## mememe

WOW I'm super jittery/shaky today...it's very strange. MAN I wish I had a doctor for my thyroid crap!!


----------



## Andros

mememe said:


> WOW I'm super jittery/shaky today...it's very strange. MAN I wish I had a doctor for my thyroid crap!!


I did not see your post about TSI.

http://graves.medshelf.org/Lab_Tests

The TSI Test 
TSI, which stands for thyroid stimulating immunoglobulin, is the antibody responsible for hyperthyroidism in Graves' disease. TSI are also known as stimulating TSH receptor antibodies or stimulating thyrotropin receptor antibodies because of their ability to stimulate the TSH receptor on thyroid cells. Acting in place of TSH, these antibodies stimulate thyroid cells to produce excess thyroid hormone. TSI also contribute to the related eye disease, Graves' ophthalmopathy. TSI is used to diagnose Graves' disease, to monitor response to anti-thyroid drugs and to helping predicting remission. While the normal range is <130% activity, individuals who are normal do not produce TSI and have levels <2% activity. Individuals with levels between 2 and 125 %, which indicates thyroid autoimmunity, do not generally develop symptoms of hyperthyroidism until levels rise. Therefore, levels much lower than 125% are necessary to predict complete remission. Levels, which are close to 100% activity generally rise when patients stop taking anti-thyroid drugs. Ideally, levels would fall to at least 20% before anti-thyroid drugs are safely withdrawn. The reference range is <130% activity or an index of <1.3 for tests that measure the increased activity caused by adding patient serum to a test solution of thyroid cells.

Here's more............
http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22

http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

http://www.gluetext.com/content/t/Thyroid/Thyroid_stimulating_immunoglobulin.html

I am so sorry I missed that post.

Now, if you are feeling that bad and you sound like you are, I recommend you go to the ER.

You could be having a thyroid storm.

http://www.medicinenet.com/script/main/art.asp?articlekey=77774

Let me know and again, I feel bad I missed that post.


----------



## mememe

Hi Andros, no problem about missing that post. I actually missed where you posted info. on my post through an edit lol, I read it like 3 times wondering "what in the WORLD did I write?"lol...Yes I tested positive for TSI once at 92, and again at 56 (0-132 reference) anyway, this has never happened. The only other time I felt like this was when I took adipex, and I haven't taken that in a long time b/c I don't like how it makes me feel. I felt this way for roughly about an hour today, but that was all. I even had a hard time typing correctly. Thanks for all the great info. and links. I will check them out later. I just wanted to do a quick check on here.

...And to think that doctor prescribed synthroid... 

I'll write back later! Thanks for your reply!

**edit
I read over that information. About the thyroid storm, not saying I didn't have it, but I really only had the rapid heart rate out of those possible symptoms. I didn't feel dizzy or anything, but there was one point where I did wonder "what if I pass out?"....Anyway, I'm just glad whatever it was, I came through it ok.

BTW, I did get one reply back on one of those state yahoo groups. Someone is going to see one of the doctors I asked about soon, and she said she will write back afterward and let me know how her appointment was. I suppose at this point, something is better than nothing when I'm completely lost in the dark about these darn doctors!


----------



## Andros

mememe said:


> Hi Andros, no problem about missing that post. I actually missed where you posted info. on my post through an edit lol, I read it like 3 times wondering "what in the WORLD did I write?"lol...Yes I tested positive for TSI once at 92, and again at 56 (0-132 reference) anyway, this has never happened. The only other time I felt like this was when I took adipex, and I haven't taken that in a long time b/c I don't like how it makes me feel. I felt this way for roughly about an hour today, but that was all. I even had a hard time typing correctly. Thanks for all the great info. and links. I will check them out later. I just wanted to do a quick check on here.
> 
> ...And to think that doctor prescribed synthroid...
> 
> I'll write back later! Thanks for your reply!
> 
> **edit
> I read over that information. About the thyroid storm, not saying I didn't have it, but I really only had the rapid heart rate out of those possible symptoms. I didn't feel dizzy or anything, but there was one point where I did wonder "what if I pass out?"....Anyway, I'm just glad whatever it was, I came through it ok.
> 
> BTW, I did get one reply back on one of those state yahoo groups. Someone is going to see one of the doctors I asked about soon, and she said she will write back afterward and let me know how her appointment was. I suppose at this point, something is better than nothing when I'm completely lost in the dark about these darn doctors!


Good; you are becoming a very good advocate for yourself. Also glad you found the Yahoo group in your state. If anybody knows............they do!

< means less than and it does not necessarily bode well for a lot of these antibodies and autoantibodes should not be present at all. Just like the TSI. But it is always good that they are low. And do bear in mind, these antibodies do wax and wane and you can tell that by how you feel sometimes.

Huggles,


----------



## mememe

In the meantime about finding a doctor, do I need to take it easy on the exercising? Just not let my heart rate get too crazy?

A lot of things make sense to me now that I'm thinking hyper instead of hypo. I just can't believe those doctors so totally overlooked my info. That's just ridiculous!

Andros, you say you see a rheumatologist for your thyroid? Do you think most rheumatologists do this kind of stuff? Since I think a lot of us (including me) have discovered most endos we go to see put diabetes first, and thyroid on the backburner, I wonder if, on average, rheumatologists are more into the thyroid than endos? *I'm just wondering if it is common for them to see patients for the thyroid, or you just got lucky?*


----------



## Andros

mememe said:


> In the meantime about finding a doctor, do I need to take it easy on the exercising? Just not let my heart rate get too crazy?
> 
> A lot of things make sense to me now that I'm thinking hyper instead of hypo. I just can't believe those doctors so totally overlooked my info. That's just ridiculous!
> 
> Andros, you say you see a rheumatologist for your thyroid? Do you think most rheumatologists do this kind of stuff? Since I think a lot of us (including me) have discovered most endos we go to see put diabetes first, and thyroid on the backburner, I wonder if, on average, rheumatologists are more into the thyroid than endos? *I'm just wondering if it is common for them to see patients for the thyroid, or you just got lucky?*


I just got lucky you might say as I got a referral from my ophthalmologist who was fed up with the endos in our area. She is no longer taking any patients with just thyroid. In the interim, thanks to her, we discovered that I have Lupus and Sjogren's so that justifies her treating me also. She is into immunology as well.

You could do well w/ an Internist, a GP, a D.O.........................just any doctor who has an interest in seeing you get better.

Take it easy on the exercise; you could permantly damage your heart or cause a stroke. Nothing is working right right now. Watch your diet like a hawk and walk, walk, walk. Do some yoga too.


----------



## mememe

I just wanted to update. I have not yet gone to another doctor. I am going to try to get a doctor to order an RAIU test before choosing another doc. for my thyroid, that way I'll have something else to bring to the table.

I go back and forth on feeling hyper/hypo, like to the extreme. Is this what hashitoxicosis is? (Not saying I have it for sure, but...) So far these doctors don't seem to understand (no body seems to understand) how I feel, esp. on going back and forth. I get pretty down when I think about finding a doctor. How many will I have to go through before I am satisfied?

Is it possible that ENTs could be good thyroid docs? I had sinus surgery several years ago, and I absolutely LOVED my doc. Today I talked with a woman at the gym who said her daughter had a thyroid nodule removed form this same doctor. I'm thinking about calling and seeing to what extent they see thyroid issues. It would be great if I could get my allergies under control AND my thyroid all in one place!lol

Other than that, I have NO LEADS. Yahoo group hasn't helped me. All I hear about certain good doctors is that they prescribe Armour, and honestly, I don't know if I'd take Armour anyway. Others say that the good doctors don't take insurance.


----------



## Andros

mememe said:


> I just wanted to update. I have not yet gone to another doctor. I am going to try to get a doctor to order an RAIU test before choosing another doc. for my thyroid, that way I'll have something else to bring to the table.
> 
> I go back and forth on feeling hyper/hypo, like to the extreme. Is this what hashitoxicosis is? (Not saying I have it for sure, but...) So far these doctors don't seem to understand (no body seems to understand) how I feel, esp. on going back and forth. I get pretty down when I think about finding a doctor. How many will I have to go through before I am satisfied?
> 
> Is it possible that ENTs could be good thyroid docs? I had sinus surgery several years ago, and I absolutely LOVED my doc. Today I talked with a woman at the gym who said her daughter had a thyroid nodule removed form this same doctor. I'm thinking about calling and seeing to what extent they see thyroid issues. It would be great if I could get my allergies under control AND my thyroid all in one place!lol
> 
> Other than that, I have NO LEADS. Yahoo group hasn't helped me. All I hear about certain good doctors is that they prescribe Armour, and honestly, I don't know if I'd take Armour anyway. Others say that the good doctors don't take insurance.


Have you read our illustrious administrator's special report?
Read Nasdaqphil's Special Report on Hashitoxicosis here........ http://www.thyroidboards.com/hashitoxicosis/

I think it would be worth checking in with your ENT. They may not handle your everyday care but certainly would be in a good position to recommend a good doc to you.

I would say I went to at least 20 doctors myself. I think it should be against the law to have to pay them when they don't diagnose the medical condition. That is what I think. Harumph.


----------



## chopper

Illustrious?? 

I've been called a lot of things in my time but never illustrious. Thanks!  I think Im changing my handle from NASDAQPhil to IllustriousPhil. Owwiee...think my head is swelling.

il·lus·tri·ous
[ih-luhs-tree-uhs]

-adjective 
1. highly distinguished; renowned; famous: an illustrious leader. 
2. glorious, as deeds or works: many illustrious achievements. 
3. Obsolete . luminous; bright.


----------



## McKenna

I second reading the article on hashitoxicosis. That fits me to a T and I'm scheduled for a TT this month.

I've seen two ENT's in regards to my nodules and a TT, and neither of them would touch the actual hormone issue. One of them, the second I saw that was originally supposed to do my TT (I have since gone to a general surgeon who is taking my thyroid out) told me that he would not do any replacement and my Endo was in charge of that department. I agree with Andros that an ENT would be able to give you the names of a few Endos to check in with.

My family doc was the one who scheduled my uptake scan, not my endo. Can you ask your primary doc? My family doc is the one who has been more supportive for me with tests and information than my endo is.


----------



## mememe

omg omg omg I'm completely and overly too excited right now! I just got an appointment with that doctor for TUESDAY! He DOES see thyroid patients! He does do TT also, he does it all! I just really hope I'm not getting my hopes too high once again, but at least, in the past I have had great experiences with this doctor!


----------



## Andros

nasdaqphil said:


> Illustrious??
> 
> I've been called a lot of things in my time but never illustrious. Thanks!  I think Im changing my handle from NASDAQPhil to IllustriousPhil. Owwiee...think my head is swelling.
> 
> il·lus·tri·ous
> [ih-luhs-tree-uhs]
> 
> -adjective
> 1. highly distinguished; renowned; famous: an illustrious leader.
> 2. glorious, as deeds or works: many illustrious achievements.
> 3. Obsolete . luminous; bright.


I choose my words carefully; illustrious describes you to a T!!!


----------



## mememe

I came across some old labs, although they're not relevant now, I thought I would post them. Not really sure what this reflex test means either. Is the value for this test simply TSH?

2004: TSH W/REFLEX TO FT4 1.56 (0.40-5.50)
2005: TSH W/REFLEX TO FT4 1.70 (0.40-5.50)
B12 244 (200-1100)

EDIT**
PS Tomorrow is my appointment with the ENT. I took my records over there today and also included about a paragraph explaining my concerns and how I want one of those uptake scans.

Can you think of anything else that might be helpful for my appointment tomorrow?


----------



## Andros

mememe said:


> I came across some old labs, although they're not relevant now, I thought I would post them. Not really sure what this reflex test means either. Is the value for this test simply TSH?
> 
> 2004: TSH W/REFLEX TO FT4 1.56 (0.40-5.50)
> 2005: TSH W/REFLEX TO FT4 1.70 (0.40-5.50)
> B12 244 (200-1100)
> 
> EDIT**
> PS Tomorrow is my appointment with the ENT. I took my records over there today and also included about a paragraph explaining my concerns and how I want one of those uptake scans.
> 
> Can you think of anything else that might be helpful for my appointment tomorrow?


Good luck tomorrow. I will be thinking of you and will be anxious to hear. "If" you can get ENT to order RAIU (radioactive uptake scan), that will be a huge coup. One step at a time here. That's my motto!! LOL!!


----------



## mememe

Just wanted to report on how my doc. appointment went.

About the thyroid, much wasn't said or done, but he did comment on the goiter saying that since there is no dominant nodule, that is a good sign and scheduled me for an ultrasound in 6 months.

He tested my TSH today, along with vitamin D, ferritin, TIBC (I think), I think B12, and some others to see about this fatigue. I am to start vitaminD3 4,000IU a day for now at least.

I was also there for other reasons which I am happy with the outcome. I was diagnosed with having laryngopharyngeal reflux disease (sp?), and was also given some meds for my allergies.

BUT anyway, I TOTALLY forgot to ask about the uptake scan, but in 6 weeks when I go back, I will TRY TRY TRY to remember! I also meant to say something like "what is your opinion on the antibodies" but I, too forgot.

I brought in all kinds of lab papers, health history, etc, and there was a lot to go through, and on top of that I feel like he was kind of in a rush, so I just forgot to ask. Overall I was happy with my appointment except for me forgetting to ask this stuff!

Will post lab results when I get them. I will call Thursday or Friday if I haven't heard from them!


----------



## mememe

Got my lab results today.

TSH 1.3506 (0.3000-3.4000) [this is a different reference range than I have previously been using]

Iron 81 (50-175)
Vitamin B12 257 (114-875)
*Vitamin D, 25-HYDROXY 27.6 (30-100)*
Ferritin 63.5 (4.6-204.0)
*Total Iron Binding Capacity 531 (250-450)*

Then there is a CBC with automated differential, there are a lot of them, so for the sake of typing them all out, I will only post the two that were flagged.

RBC 5.16 (3.83-5.07)
Absolute Neutrophils 7.3 (2.5-6.9)

I have been prescribed 50,000 IU VitaminD2 once weekly for 12 weeks, and have been instructed to take a multivitamin with iron.

I go back in 6 weeks.

I spoke with my doc's PA on the phone yesterday. I mentioned the RAIU test and she said that the doctor usually doesn't order those unless there is a dominant nodule, and he usually does an FNA on those anyway. She also said something about those tests seeing for cold and hot nodules. Is this the same test? I thought it just measured the intake of the iodine to see if it's fast or slow, or w/e. Does it do both or were her and I thinking of two different tests? I also mentioned my concern for the TSI and TRAB. She asked when the last time I had it checked. I told her July, and those numbers were not as high as previously, but that I could tell a difference in how I feel. Worse when they're high, better when they're low. She said she would look into it.

Anyway, so in the meantime I'll be taking my VitaminD and multivitamin, and I assume in 6 weeks for my appointment they will probably check my levels again. I believe I will be seeing the PA for my next appointment, so I may have some more leeway with her in getting more in depth with my thyroid.


----------



## mememe

I wonder what the significance is, if any, in the new TSH test having a difference reference range compared to all the others I had?


----------



## Andros

mememe said:


> Got my lab results today.
> 
> TSH 1.3506 (0.3000-3.4000) [this is a different reference range than I have previously been using]
> 
> Iron 81 (50-175)
> Vitamin B12 257 (114-875)
> *Vitamin D, 25-HYDROXY 27.6 (30-100)*
> Ferritin 63.5 (4.6-204.0)
> *Total Iron Binding Capacity 531 (250-450)*
> 
> Then there is a CBC with automated differential, there are a lot of them, so for the sake of typing them all out, I will only post the two that were flagged.
> 
> RBC 5.16 (3.83-5.07)
> Absolute Neutrophils 7.3 (2.5-6.9)
> 
> I have been prescribed 50,000 IU VitaminD2 once weekly for 12 weeks, and have been instructed to take a multivitamin with iron.
> 
> I go back in 6 weeks.
> 
> I spoke with my doc's PA on the phone yesterday. I mentioned the RAIU test and she said that the doctor usually doesn't order those unless there is a dominant nodule, and he usually does an FNA on those anyway. She also said something about those tests seeing for cold and hot nodules. Is this the same test? I thought it just measured the intake of the iodine to see if it's fast or slow, or w/e. Does it do both or were her and I thinking of two different tests? I also mentioned my concern for the TSI and TRAB. She asked when the last time I had it checked. I told her July, and those numbers were not as high as previously, but that I could tell a difference in how I feel. Worse when they're high, better when they're low. She said she would look into it.
> 
> Anyway, so in the meantime I'll be taking my VitaminD and multivitamin, and I assume in 6 weeks for my appointment they will probably check my levels again. I believe I will be seeing the PA for my next appointment, so I may have some more leeway with her in getting more in depth with my thyroid.


This doctor did not run Free T4 and Free T3 knowing that you have TSI (thyroid stimulating immunoglobulin?)

And that is correct, the RAIU not only gives the rate of uptake which is important information but also whether there are hot and/or cold nodules and other irregularities. It is important to rule out cancer.


----------



## mememe

No, did not order FT3 or FT4, but I will request this when I go for my next appointment with the PA, she seemed more "moldable", if that makes sense. I really do like my doctor, and hope that he was just rushed or overwhelmed with all of my information I provided. (I know that sounds bad, but it's better than thinking he just didn't care or wasn't knowledgeable enough)

SOOO, for my next appointment, I will request TSH, FT3 & FT4, as well as discuss the RAIU, and hope to get that. If they simply won't order the RAIU, I do have another option up my sleeve to get the test ordered.lol:evilgrin0036:

Is there anything else you can think of for me to bring to the table on my appointment? No rush, because I'm sure I will post again asking the same thing a day or two before my appointment lol (I get so obsessive about things sometimes lol)

As far as the other things going on, I started taking my weekly D2. So far, I can't tell a difference. I can tell a difference though in the treatment of the LPRD, and am happy so far with _this_ treatment.


----------



## mememe

I go to get blood drawn monday for my appointment on the 30th. I haven't seen the order yet, which they will fax to where I'm going monday, but I assume they will be checking vitamin D and Iron. I can add anything I want to the test. Of course if TSH isn't on there, I will add that, as well as FT3 and FT4.

Is there anything else I should get tested for?


----------



## Andros

mememe said:


> I go to get blood drawn monday for my appointment on the 30th. I haven't seen the order yet, which they will fax to where I'm going monday, but I assume they will be checking vitamin D and Iron. I can add anything I want to the test. Of course if TSH isn't on there, I will add that, as well as FT3 and FT4.
> 
> Is there anything else I should get tested for?


What is LPRD? And the tests look good; just make sure they "mark" the FT3, FT4 correctly. They are tricky. They will mark the totals and say, oh!

We know you have TSI so I hope that comes up for discussion. You now know you should have none. Also, YES on the Radioactive uptake scan (RAIU.)

Good luck Monday! You will be in my thoughts and prayers for all of this.


----------



## mememe

LPRD= laryngopharyngeal reflux disease. I'm taking 40mg prilosec every day before dinner, as well as 150mg zantac before bed every night. Def. has helped!

I can tell somewhat of an improvement in not feeling as tired with the weekly dose of vitamin D and daily multivitamin.

I will be absolutely sure about marking the FT3 and FT4 correctly. I will take a print out from lab corp website with the codes on them, and it's my friend who is doing it, so she knows what I want.

When I go to my appointment, I am going to discuss further the TSI and the RAIU. I will be seeing the PA and I will convey my concern about this, and will tell her that I really want it done for my own peace of mind. Maybe then, even if she doesn't think I need it, she will order it. If I can't get that place to order one, then I will try to get ir ordered by someone else.

About the TSI, yes, I DO believe I should have zero! BUT, do you have a link to a site that may be reputable in a doctor's mind that says this? If I can get something in writing from a reputable source, maybe they will understand. I've looked around, but not really much luck.

Also, I believe I read on another thread somewhere that you also said we should have no trab, or maybe it was tgab? I can't remember.

I go in and say these things, but no doctor ever takes my word for it from me doing my own research. If I could just go in there armed with proof (from reputable source), then I think they will listen.

**EDIT**
I just found this while searching google, but once again, it is only a post, but it is from someone who works with the graves' disease foundation.

http://ngdf.org/phpBB3/ngdf/viewtopic.php?f=3&t=41153
Just a comment about antibody tests and Graves' disease. There are two antibody tests (TBII and TSI) specifically for Graves'. Only if you have Graves' disease will they be positive. However, not everyone who has Graves' disease will test positive for these antibodies. Only 85 to 90% of Graves' patients will test positive for TBII and TSI antibodies-that means that as much as 15% could have Graves' and none of these antibodies. Negative test results are more likely to occur if the hyperthyroidism is mild.

What is TBII? I know I've heard of that, but can't place it. Is that the the same thing as trab?


----------



## Andros

mememe said:


> I wonder what the significance is, if any, in the new TSH test having a difference reference range compared to all the others I had?


Probably a different lab or a different "method!" That is why ranges are so important for us to see w/ the results. They vary from lab to lab and from method to method used.


----------



## mememe

Okay, got lab results back today. Doctor appointment tomorrow.

My vitamin D has gotten back up into range, as I've been taking a weekly dose of 50,000IU. My total iron binding capacity though is still high after taking multivitamin daily. I can tell you that I felt better this day that I got my blood drawn. This is probably at least partly due to the vitamin D, plus, I believe I feel better when my TSH is around this number, rather than, say when it was 1.090. However, I did not get antibodies tested, as I believe when they are higher I feel worse, and feel better when they are lower. BUT, it's hard to pinpoint exactly the things that make me feel better and what makes me feel worse....

*TSH* 2.220 uIU/mL (0.450-4.500)
*T4, Free (Direct)* 1.20 (0.82-1.77)
*Triiodothyronine, Free, Serum* 3.1 (2.0-4.4)
*Ferritin* 73 (13-150)
*Vitamin D, 25-hydroxy* 39.4 (32.0-100)
*TIBC * 515 (250-450)
*UIBC* 390 (150-375)

There was also a CBC with a lot of different labs in there, I will only list the two that were flagged. I don't know what they are, but I will look them up after posting this lol Oh, and also the UIBC, I don't know what that is either, but I am going to look now.

*Hematocrit* 45.8 (34.0-44.0)
*MCHC* 31.2 (32.0-36.0)

**edit
Can someone explain to me, or refer me to a site, the difference in units: uIU/mL & mIU/mL? All of my TSH levels have been in the uIU/mL, EXCEPT the one from october, which was mIU/ml, and I'd like to see if I can convert it to see it in relation to the rest of my TSH results?


----------



## lainey

Here is an answer to your math question regarding uIU/mL and mIu/mL:
http://www.ahdionline.org/forum/index.php?action=printpage;topic=3069.0

I'm going to go on a limb and say that your TSH is probably directly comparable--labs have standards re: units they use to report and while ranges do vary the units in US labs tend to be typical to each other, if different from the units they use, say, in the United Kingdom.

It would have to be, or it there simply would be too much variation for the doctors themselves to make comparison--they're not going to sit and read 50 lab reports per day with a calculator in hand to make comparisons.

Your vitamin D could be higher, and ferritin is best close to 100.


----------



## mememe

Thanks for your insight, and the answer to the conversion question!

My appointment is tomorrow, so I will find out what they think about that vitamin D, and about the ferritin, I'm sure that since it is not flagged, they won't comment on it. Sad, but true I'm sure. However, since the TIBC is high AGAIN, I believe they will proabably put me on some kind of iron supplement. I will update tomorrow!!


----------



## mememe

I just realized I forgot about updating!

I saw the PA and we went over my allergy/sinus stuff and got all that out of the way and then moved onto the lab work. I am to finish my 12 week vitamin D, and then once that's finished, move to 4,000IU a day. Keep taking the multivitamin for the iron. Said everything else looked ok.

She reminded me of my ultrasound in April, but I fought to get it sooner, since I my last one was last April, it had been about 8 months. She said ok and they got me scheduled to come in on the 16th, BUT I was able to get in sooner (the 9th) closer to home, so I go thursday bright and early (well, before the sun comes out!lol 7:30am) to get my ultrasound done! I have a follow up appointment on the 22nd.

I already have my lab orders for my April appointment. She circled TSH, FT3, FT4, thyroid antibodies, 25-Hydroxy vit D. But she did not circle thyroglobulin serum nor thyroglobulin antibodies. *WHAT IS THYROGLOBULIN?* I have plenty of time before getting these labs drawn, but I will be able to add whatever I want to.


----------

