# My labs… what a mess. Can anyone decipher?



## starfire (Jun 10, 2014)

Hi all!

So&#8230; I wish I could say I knew when my thyroid issues began, but I can't figure that out either haha. Anyway, I started getting VERY sick in February. Then had ER gallbladder surgery in March. By April, I was a complete wreck. Couldn't get off the couch, heart rate was 40 bpm, blood pressure was nonexistent, I had lost 23 lbs, I had terrible constipation, my skin was so dry it was flaking off, my hair was splitting&#8230; everything was a mess.

Here is how the labs have gone&#8230; In March, they ran a basic thyroid panel were my TSH came back normal and my FT4 came back low. I can't recall exact results, and my doctor's office has my labs, but I do remember my TSH was somewhere around 0.9 (I believe normal range started around 0.8), and my FT4 was just under the recommended lab range.

They ran my labs again in April, where my TSH came back at 1.5, my FT4 has fallen even further and my FT3 was now tested and it was extremely low (again, sorry, don't have exact labs).

I was sent to an endocrinologist, and put on 100 mcg of Synthroid and 25 mcg of Cytomel. I ran labs 6 weeks after that, and my TSH came back REALLY low now, at 0.020 (range of 0.35-4.50), FT4 just made it over the lab range at 0.91 (range 0.89-1.76), and FT3 was at 3.1 (don't remember range, but it was normal now). Doctor lowered my Synthroid to 88mcg and Cytomel to 10mcg. I am now waiting for my next labs to be run.

We also did the whole work up for pituitary problems. She also ran all the thyroid antibodies tests, and this is where I get confused. My thyroid antibodies came back as this:

Anti-Thyroid Peroxidase: <28 (reference range <60)

Anti-Thyroglobulin: 20 (reference range <60)

TSI: <89 (baseline <140%)

Thyrotropin-binding INHIB Immunoglo: 20 (HIGH) (reference range <17)

Can anyone explain what's going on here? I'm so lost. Edit to add: I have been feeling better on medicine. Temperature and heart rate are normalized again, and I have put on some healthy weight again. So is it hyPER or hyPO? And it is auto-immune?


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## Andros (Aug 26, 2009)

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
(Copy and paste into your browser)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

TBG (thyroxine binding globulin) up, hypo............down, hyper
http://www.nlm.nih.gov/medlineplus/ency/article/003374.htm
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Hi there and welcome! For one thing; GB problems are so so common with thyroid problems. After reading your post; I am of the opinion that you may be flitting back and forth between hypo and hyper as evidenced by the TSI and TBII. And that thyroglobulin Ab should surely prompt an ultra-sound.

I am furnishing a lot of info for you. It will take some time to read through it but I hope you do so.


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## Lovlkn (Dec 20, 2009)

I want to add - you need to ignore TSH as you have both stimulating and blocking antibodies.

Your FT-4 and FT-3 are what you want to dose yourself off. Your doctor will likely continue to dose off TSH, push back and stress how you are feeling. I will try to locate some of my links to give you some backup as to why TSH is not reliable when you have the antibodies you have. Brooken is a doctor who has published many studies on this.


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## starfire (Jun 10, 2014)

Andros said:


> 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
> (Copy and paste into your browser)
> ...


Hi and thank you for all the wonderful advice! I have gone through most of it, and I have scheduled an ultrasound for next Thursday. I'm a bit anxious! Can you explain then&#8230; do I have Graves? Or Hashimotos? Or something else entirely?

Also&#8230; does it "count" that my antibodies are positive, but not out of lab range (except TBII)? I am currently on Synthroid & Cytomel, yet I still have very very sluggish and foggy days. But other days, my heart rate SKY rockets and I am a sweaty mess (but at least I can think straight). Is that indicative of Hashimotos or Graves? And am I on the right treatment? Can this treatment hurt me if I am hyPER?

And&#8230; is there anyway to tell how long I have had this problem? I tested positive for ANA 5 years ago, and doctors DX'd me lupus&#8230; but now they are saying they were wrong. Is it possible my thyroid was acting up 5 years ago and kept me borderline sick this whole time?


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## starfire (Jun 10, 2014)

Lovlkn said:


> I want to add - you need to ignore TSH as you have both stimulating and blocking antibodies.
> 
> Your FT-4 and FT-3 are what you want to dose yourself off. Your doctor will likely continue to dose off TSH, push back and stress how you are feeling. I will try to locate some of my links to give you some backup as to why TSH is not reliable when you have the antibodies you have. Brooken is a doctor who has published many studies on this.


Thank you for this advice! You answered one of my questions that I forgot to ask! I was wondering if my TSH number was "blocked", if it would be a useless test anyway. Does this mean a very, very suppressed TSH (like mine at 0.020) is safe for me? No chance of heart problems from a hyper TSH?

I would be very interested in the literature you have found in the past. Does this mean I am both hyper and hypo?? I am soooo confused. At present, my doctor seemed to just be saying I am hyPO per our last conversation on the phone, and that I would need to monitor my levels for life.


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## Andros (Aug 26, 2009)

Read this please...........

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

It counts as you should not have any of these antibodies. The ranges are to establish a baseline and to detect further changes either up or down.

Right now you are in a transitional stage headed towards hyper. We all will be anxious to know the results of your ultra-sound from next Thursday and please do your best to get a copy of the read-out!


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## starfire (Jun 10, 2014)

Andros said:


> Read this please...........
> 
> Substances not found in normal serum (scroll down to autoantibodies)
> http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
> ...


I cannot seem to get that link to open.  Is there another link with that information? I will certainly update you when I get my results  Thank you for being so sweet! I will definitely get a copy of the read-out. Actually I learned that lesson the hard way... my very first thyroid blood labs were totally ignored by my primary, because my TSH was normal&#8230; so she never told me I had low readings, because she thought my low FT4 and FT3 were "insignificant" in the presence of the normal TSH. I went several weeks just feeling worse and worse til I picked up a copy of my lab and saw the low values!! Needless to say, I'm looking for a new primary doc now.


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## Andros (Aug 26, 2009)

Lightweight Directory Access Protocol

You know what? I have tried several times to get into Thyroid Manager and I cannot. It's not just the link I have enclosed either. The site must be down. I sure hope not.

I will let you know. It is now an LAPD data base and may no longer be accessible to lay persons. At least it appears that way right now.

Durn.


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## joplin1975 (Jul 21, 2011)

I also think you've got a lot of antibodies going on making the picture confusing, but also wanted to note that you are on a really high starting dose for both levo and Cytomel. I'm no expert on Cytomel, but I know a lot of people start at 5mcgs and go up from there. 100mcgs of levo for someone without a thyroid is hefty too. Usually the titration process starts with levo alone and then small and steady changes over time are made from there.

Again, the antibodies make it tough, but starting so high also might be confusing the situation.


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