# Went to the ER today...



## Enigma (Jun 13, 2011)

Was visiting my parents and had a horrible bout of emotionality, crying, jittery, everything I have been having for the past 2 months. They insisted on my going to the ER (reminder: had blood drawn last week and showed quite elevated TSI). I don't have all the ranges yet, but there were a couple that may warrant further looks:

Iron: 44 (down from 81 in May)
Iron Saturation was Low (9%?)
B12 401

But this here, this is what I've been experiencing and what my endo tried to write off as mood problems. Look at this:

Last week, 11/3/11
felt great, had a great day was feeling like it was a solid thyroid day, was calm and "with it" that day:

TSH .*92* (.34-4.82)
FT4 *.87 *(.59-1.61)
TT3 *1.4 *(.7-1.9) (doesn't really make a difference)
TSI 3.7 H (<=1.3)

Have been having some very disturbing ups and downs emotionally and physically, to the point that my brain is just not working and I litterally can't do anything, in incoherent. It's miserable. I want to die when I feel like this. It is ruining my life.

So I had on of those moments when I was at my parents house - balling, couldn't think, like the brain fog from hell, couldnt' even do anytning (almost unable to eat). Well, they took me to the hospital, fed up with all of this crap and doctors always saying that its in my head and it's my fault that I'm like this.

So they drew my labs, and remember, last week's TSH was .92 and last weeks FT4 was .87

Today's labs, one week later, at the SAME time of day, within an hour of the original blood draw, were:

TSH 4.92 (.3-3.9)
FT4 1.3 (working on the ranges)
FT3 was 2.7 (2.0-4.4)

What made it change SO MUCH in a week!!!??! TSH is up 4 points, and T4 is up a lot also. Give my TSI antibodies, how does this all play out? It's stimulating the thyroid to get going, But it is going and producing enough t4?? I'm confused.

But I do know that I felt really GOOD on the first labs last week, TSH @.93. Could have felt a lot better, but I had a lot of energy. Today, I was experiencing one of my hyper days, jittery, emotional, weak, tired, could not talk to anyone because it was just toooo much noise. Argh!!

Anyone have any idea why there would be such a change within one week (with corresponding DRAMATIC physical and mood swings)? The labs were both take at night, within one hour with each other. Meds were all the same.


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## Octavia (Aug 1, 2011)

I don't have any words of wisdom to share, but I'm sorry you're going through this, enigma.


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## Andros (Aug 26, 2009)

Enigma said:


> Was visiting my parents and had a horrible bout of emotionality, crying, jittery, everything I have been having for the past 2 months. They insisted on my going to the ER (reminder: had blood drawn last week and showed quite elevated TSI). I don't have all the ranges yet, but there were a couple that may warrant further looks:
> 
> Iron: 44 (down from 81 in May)
> Iron Saturation was Low (9%?)
> ...


Remember I mentioned that you probably have TBII as well?

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)

There are stimulating (immunoglobulins), blocking and binding immunoglobulins and antibodies. They are waging a mighty battle inside your body. It's an attempt to se the body to rights so that the bad guys don't win.

But, realistically speaking, the bad guys (TSI) will win.

And in your case w/TSI so high; your eyes are at risk.

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

TSI and the Eyes!
http://www.ncbi.nlm.nih.gov/pubmed/1677484
http://www.caleyes.com/webdocuments/Thryoid_Eye_Disease_paper.pdf

I am so sorry you ended up in the ER. What did they do for you? Were any comments made re what is going on with you and what course of action you should take?

If you want to get this over with, it might be best to see an ENT and talk about having your thyroid out. Humble opinion based on experience.


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## Enigma (Jun 13, 2011)

Andros said:


> Remember I mentioned that you probably have TBII as well?
> 
> ...
> 
> ...


Hi Andros,

Thank you for the response. I do remember you mentioning that test, and I'd like to have it done, I just don't know how likely it is to get a doctor do it!! I am hoping I can convince the new endo (who I see on Nov. 23rd unless there is a cancellation) will look into this, especially given my up and down TSH and T4, along with crazy symptoms. I will be asking for this test, so hopefully he will do it. Especially if I mention the part about eye complications, regardless of whether my labs show that I am technically "hyper".

The ER ran a whole bunch of tests (because my dad made them!) such as an iron panel, B12, complete blood work up, TSH, FT4, FT3, lyme. It was two pages of results. Nothing seemed odd except the thyroid things when compared the previous week, and iron binding was high but iron saturation was low. They did not give me the ranges, but I will be getting them in the mail this week. There was nothing that the ER could do emergency-wise (no numbers that were pressing) but it will be interesting to see what the endo says next week with all the numbers and symptoms.

The ER doc did write down recommendation to do an MRI since I am having some neurological symptoms, as well as a catacholamine (spelling?) urine test? And he was very nice and didn't just say "ANXIETY!!!" which is a huge change.

Is it weird to have a TSH and FT4 fluctuate that much? I mean, I have seen people's on here fluctuate maybe a point within a certain period, but 4 points in a week, with no changes in meds or anything? Is that just uncommon?


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## Andros (Aug 26, 2009)

Enigma said:


> Hi Andros,
> 
> Thank you for the response. I do remember you mentioning that test, and I'd like to have it done, I just don't know how likely it is to get a doctor do it!! I am hoping I can convince the new endo (who I see on Nov. 23rd unless there is a cancellation) will look into this, especially given my up and down TSH and T4, along with crazy symptoms. I will be asking for this test, so hopefully he will do it. Especially if I mention the part about eye complications, regardless of whether my labs show that I am technically "hyper".
> 
> ...


Usually patients that are going hyper experience a wild topsy turvey ride for months and sometimes even for years. So, that TSI would be important. As would a few other antibody and immunoglobulin tests indigenous to the thyroid.

TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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/

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

TSI and the Eyes!
http://www.ncbi.nlm.nih.gov/pubmed/1677484
http://www.caleyes.com/webdocuments/Thryoid_Eye_Disease_paper.pdf

See if any of this fits your emotions..........

Psychiatric Manifestations of Hashimoto's Thyroiditis
http://www.drrichardhall.com/Articles/hashimoto.pdf

Graves', neuropsychiatric
http://www.ngdf.org/cms/modules/files/uploads/7699.PDF

hypo, psychiatric
http://www.biopsychiatry.com/hypothyroidism.htm


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## Lovlkn (Dec 20, 2009)

Andros said:


> Remember I mentioned that you probably have TBII as well?
> 
> TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
> http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)
> ...


Enigma,

Ditto - Andros is absolutely right.

Your emotions are because your body is having an all out war going from hyper to hypo. Your tests so far have shown hypo but you present both hyper and hypo antibodies.

You should have your thyroid removed -RAI will only make it worse. Surgery is the best solution to your problems.

I ha to go to a therapist when initially treated for hyper thyroid because of the extreme thyroid hormone movements down. Your issues are because of thyroid hormone fluxuations -most likely extreme fluxuations happening continually.

If you need a referral to a thyroid surgeon get one, otherwise make an appointment with one and tell them you want your thyroid removed. They will take it out, especially if you have both high stimulating and hypo antibodies.

Life will get better.


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## Enigma (Jun 13, 2011)

Which is a better test - TBII or Tg Ab, or are they the same? I wnat to make sure i use the correct wording with the doc. Thanks!


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## Andros (Aug 26, 2009)

Enigma said:


> Which is a better test - TBII or Tg Ab, or are they the same? I wnat to make sure i use the correct wording with the doc. Thanks!


TBII is immunoglobulin and is "binding" to TSI (thyroid stimulating immunoglobulin.)

Tg Ab is Thyroglobulin Ab. If high, it could suggest cancer.

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

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)

In my humble opinion, they are both important tests.


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