# Help with lab changes



## Leroy (Jan 20, 2011)

Hi everyone.

Thank you in advance for taking the time to read my post, I will keep it as short as I can. By the way I am male and age 26.

About 3 months ago I went to my GP because my throat always felt slightly tight, right below my adam's apple area. Also I was just put on betablockers due to events of inappropriate tachycardia, which is likely due to some external cause since my heart tests went well. For the tightness, there are no bulges or anything like that and I don't feel strangled. It is just if I move my neck, the area feels tighter than normal. She sent me for an US and blood work, here were the results:

Left: 4.0cm x 1.1cm x 1.0cm (8mm Hypoechoic nodule, 3mm Cyst with calcification)
Right: 5.0cm x 1.6cm x 1.6cm (7mm Hypoechoic nodule)

TSH: 1.89 (ref range 0.4 - 5.0)
Free T3: 3.1 (ref range 2.4-4.2)
Free T4: 1.1 (ref range 0.7-1.7)

After this I saw a endocrinologist because of the nodules. He said I will be doing another US in a couple months (6 month wait). He also sent me for more blood work and the results were:

TSH: 1.40 (range 0.30 - 4.0)
Free T3: 5.2 (range 2.2 - 5.4)
Free T4: 18 (range 11 - 24)

TPO: Negative (No Range Given)
TSI: Negative (No Range Given)
TgAB: Negative (No Range Given)

Based on the fact that my symptoms were hyper and the fact that my Free T3 went from lower range to now top of range. Also not a large drop, but my TSH went down as well (I know it can go up and down quite quickly). Is any of this a cause for concern? I realize my labs are within range, so likely there is no issue at this time. I do know my heart rate has been faster and I just want to make sure I stay on top of it. My endo does not seem concerned and is in the wait and see yearly approach. Does this look like it is something to watch or are they normal labs?

Thanks a lot.


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## lainey (Aug 26, 2010)

They are normal labs, and it is good that you are apparently lacking antibodies. However you are correct that the free T3 is high in the range on the second test. The thyroid produces primarily T4, with the T3 being converted from that in your cells. With the mild hyper symptoms, a radioactive uptake scan of the thyroid would be the next step.

The idea behind this test would be to show how the thyroid is functioning and show the thyroid in greater detail as well as the nodules--specifically if either of them is producing thyroid hormone on their own ("hot" nodules). Nodules that produce hormone on their own are problematic.

Other wise, the endo has suggested a normal follow up based on the size of your nodules (it's not typical to try to biopsy these until they are greater than 1cm in size) and test results.


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## lavender (Jul 13, 2010)

thyroid issues can cause the tachycardia.


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## Andros (Aug 26, 2009)

Leroy said:


> Hi everyone.
> 
> Thank you in advance for taking the time to read my post, I will keep it as short as I can. By the way I am male and age 26.
> 
> ...


Hi, Leroy and welcome. It appears it is all cause for concern. it looks like you are going hyperthyroid. It is important to get these 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/unders...s/thyroid.html

And I would say waiting 6 months for another U/S is NOT a good idea because of the calcification. I do recommend FNA (fine needle aspriation) to see if it is cancer. Some cancers move rapidly so I am not in favor of waiting plus the fact that men are more "likely" to have cancer of the thyroid.

Here is info to support that.
http://www.umm.edu/endocrin/thytum.htm

Here is info on calcification.
http://www.ncbi.nlm.nih.gov/pubmed/12112538

Once again, welcome and please let us know what you decide to do here based upon some of our recommendations.

It would be good if you could get a copy of those labs as I find it hard to believe that you have "zero" antibodies. Some such as the TSI should be zilch and if they are present (even with in the range), there is something going on.

I don't know why they say that antibodies that are in range are negative but they do. It is wrong and incorrect to the maximum degree.

TSI is a good example of this.

TSI

Results and Values
What do the test results mean?
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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## midgetmaid (Jul 22, 2010)

I had symptoms when I was within range. Symptoms increased and I ended up in the hospital 3 1/2 months later. TSH was then below range.

Don't wait if you feel progressively worse. See a doctor.

Renee


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## Leroy (Jan 20, 2011)

Thank you everyone for your responses, I appreciate it.

I'll try to respond to all the recommendations you gave me.

As far a doing an uptake scan, my endocrinologist said he felt no other tests were neccessary at this time and would rather wait until our follow up due to the fact that my T3 was still in range. He didn't think my heart issue would be the cause since my numers weren't "abnormal". My family doctor agrees as she really just listens to whatever he says.

As far as the nodules go. I too wondered about the calcification, but my endo said due to it being so small, the calcification does not matter. Since the larger ones do not have calcification, he was not concerned and said an FNA was not needed.

As for the antibody testing, I did request the lab results. Literally all the paper had on it was this:

TPO: *** NEGATIVE ***
TSI: *** NEGATIVE ***
TGAB: *** NEGATIVE **

Sorry Andros, I would love to give more details but unfortunately the lab does not provide any.

Midgetmaid, I am sorry to hear it took so long to get better, but I am happy you did. I will ry my best to make sure that doesn't happen here. Unfortunately I'm kind of stuck right now with my doctors not wanting to test further. My only choice is to wait 6 months until my August appointment and see how my blood work is then. As an FYI, I live in Toronto, Canada, so it is impossible to get testing on your own without a family doctor referral.

Thanks a lot for your suggestions, I will mention the uptake again in August. I will be sure to stick around and keep you all updated, but it will be awhile unfortunately.


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## Andros (Aug 26, 2009)

Leroy said:


> Thank you everyone for your responses, I appreciate it.
> 
> I'll try to respond to all the recommendations you gave me.
> 
> ...


Can you call the lab? I never heard of not providing the ranges. I see now that you live in Toronto, Canada. Hmmmmmmmmmm; now I understand the problem with the ranges.

Well...............we must find out. This is very very important and I am sure you agree.

If all truly is negative, zero, zilch, nadda.........................I would be glad to hear it and that would send us in a different direction by the way.

I am very suspicious given the nodules, calcification and other symptoms that you indeed do have antibodies indigenous to the thyroid.

Please do keep us in the loop.


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## Leroy (Jan 20, 2011)

Hi Andros,

Thanks for your quick respond, I really appreciate the concern you and the others here show to everyone.

I tried calling the CML Lab (one of the biggest labs in Canada too) and they told me there was nothing else they could send. My only guess would be to try another lab and see, but of course both my doctors tell me as long as the antibodies are lower than the range, it wouldn't matter, so no retesting is to be done.

To be honest, the main reason I don't want to drop it is because I already have an autoimmune disease in Type 1 diabetes, so I know the relationship between the too. Of course it doesn't mean I will get it certainly, but it makes me cautious.

Just out of curiosity, what would be the two different approaches you mentioned...antibodies or no antibodies, just curious how you'd handle each situation. Thanks.


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## Andros (Aug 26, 2009)

Leroy said:


> Hi Andros,
> 
> Thanks for your quick respond, I really appreciate the concern you and the others here show to everyone.
> 
> ...


See?? OMG!! It certainly DOES matter. As I have stated, there are some antibodies and autoantibodies that you should not have at all; not even a smidgeon.

Since you have Type I diabetes, you know where I am coming from then. As long as we are on the same page.

"If" you had no antibodies (which I do not believe), then I would advise re-testing because they do wax and wane. The trick would be to "catch" them. However, based on the answer you received from the lab, more than ever, I do believe that you have some antibodies/autoantibodies indigenous to the thyroid.


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## Andros (Aug 26, 2009)

Leroy said:


> Hi everyone.
> 
> Thank you in advance for taking the time to read my post, I will keep it as short as I can. By the way I am male and age 26.
> 
> ...


I looked up TgAb as an example.

In general, their presence suggests that there is autoimmune thyroid involvement and the higher the level, the more likely that is. Rising levels may be more significant than stable levels as they indicate an increase in autoimmune activity.

If you read carefully and I know you will, it says, (In general, their presence suggests) which means you should have none and if you do "it suggests" etc..

So, how do we find out? Will your doctor find out for you, maybe? If they were below the range but there none the less?
http://www.labtestsonline.org/understanding/analytes/thyroid_antibodies/test.html


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## lainey (Aug 26, 2010)

Leroy said:


> Hi Andros,
> 
> Thanks for your quick respond, I really appreciate the concern you and the others here show to everyone.
> 
> ...


The reason your doctors say that the antibodies "don't matter" is because they don't treat the antibodies with the medication, they treat the thyroid disfunction when it happens. Regardless of whether you have them, the doctor isn't going to want to treat you until your thyroid levels move out of range. This is true even if your antibodies levels are very high.

The problem is the lab lists "negative" with no range, not zero. Yet consider that if you have any, the activity at the moment is so low as to be below the range....once again leaving you in the situation of, there really isn't anything to "treat" here.

Yet.

That is what monitoring is for.

And there is nothing stopping you from heading into the doctor if your symptoms increase. However, many times the first medication prescribed to sub-clinically hyper patients is beta blockers, because these do calm the symptoms somewhat. What I am implying here, is that you should be diligent about what symptoms to look for, as this drug may mask symptoms, so your levels may change before you will "notice".

As someone with a tachycardia and a thyroid problem, I will tell you that most doctors see thyroid medication as a slippery slope where arrhythmia's are concerned. There is definitely a connection between the T3/T4 levels and heart rhythm--if you have a cardiologist that diagnosed the tachycardia and is prescribing the beta blockers, you might want to work on the thyroid through them.


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## Leroy (Jan 20, 2011)

Thank you Andros and Lainey! 

I see what you both are saying. Antibodies are important because they mean there is a potential for things to keep getting worse. I will make sure I keep on my doctors to try and convince them to do routine checks of my levels.

In regards to the tachycardia, I actually have a pacemaker as well. It is not in there because of structural heart issues (thank god, still in my 20's!! haha). It is in there because I was suffering from bouts of severe bradycardia a couple years ago due to my autonomic system not properly regulating my heart beat or blood pressure (on drugs to keep my blood pressure up.). So I'm hoping I don't end up with any thyroid issues if it is going to be even more hassle than a normal case, but not much I can do there.

My one question is, will my betablockers just relax the symptoms or will it actually mess up my blood tests?

Thanls.


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## lainey (Aug 26, 2010)

Okay, symptoms of hypothyroidism often include low heart rate and blood pressure. Did they ever test your thyroid when they were dealing with your bradychardia/low blood pressure? Thyroid levels can wax and wane, hmmm.

The beta blockers shouldn't alter your thyroid labs. They work by blocking the effects of adrenaline, and also lower your blood pressure. How is this going to work with the medications your are taking to raise your blood pressure?

Beta blockers can alter your blood sugars however, and also mask the symptoms of low blood sugar. If you have asthma, or a propensity to it, they can aggravate it. If you are taking them regularly, you should not stop suddenly because that can cause irregular heart rhythms, you need to taper off.

Did anyone consider a relationship between the tachycardia and the pacemaker ie--is the device functioning properly?


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## Leroy (Jan 20, 2011)

No, they didn't test my thyroid when I originally was having issues in 2008. The two lab results I posted were the only ones I had and they were over a year later.

The concern of taking a betablocker is something my doctors are monitoring. My average blood pressure was under 80/50 when they put me on the meds. Now it is more like an average of 95/60. Last time my doctor checked it, it was 120/80 when laying down and 80/40 when standing. If it keeps dropping I'll have to get off it.

Basically what happened is over the last year my heart rate tends to jump up too high during any from of exertion. When they reviewed my pacemaker last year they noticed I had a couple hundred cases of a HR over 200. Just to be safe they put a 2 week holter on me. It showed my HR would get up to 240 during even just weight training. If I go up the stairs it will go up quickly, stuff like that. My cardiologist told me my choice was to start taking a small dose of a betablocker or to live with the HR. He said it wasn't dangerous because the rhythm stayed sinus, but it never good to be that high. I chose the betablocker because I got sick of feeling like I would black out going so high. In the end, the pacemaker is still needed for the low bouts and the Bisoprolol is to stop it from going into the 200's.

I also suffer from random low blood sugar, so I hope the betablocker doesn't stop me from knowing when it does get low.

As far as I have been told, the pacemaker is working fine and not causing it.

Thanks again.


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## lainey (Aug 26, 2010)

Of course, because I don't know your history I have to ask the obvious. 

It will be interesting to see how this plays out with your thyroid levels. Post back when you have an update.


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## Andros (Aug 26, 2009)

Leroy said:


> Thank you Andros and Lainey!
> 
> I see what you both are saying. Antibodies are important because they mean there is a potential for things to keep getting worse. I will make sure I keep on my doctors to try and convince them to do routine checks of my levels.
> 
> ...


Holy cats! Now I am wondering which came first; the cart or the horse! Seems like you may have been struggling w/hyperthyroid off and on for many years! Ever give that some thought?

I just know you have TSI; I will admit it is based on pure instinct but I have been around a long long time working on forums and such so I do trust my instincts based on many observations over the years.

I do believe that because beta-blocker slows down the metabolism that it indeed does skew the T3 and Free T3 lab tests (making the result lower.)

http://www.eje-online.org/cgi/content/abstract/105/2/190

Also, did you know that beta-blockers increase the glucose level in diabetic patients?

Just found this........

Beta blockers and corticosteroids that only inhibit the peripheral conversion of T4 to T3 interfere minimally with thyroid function test results. Propranolol hydrochloride (>160 mg/d), atenolol, and metoprolol tartrate produce small reductions in total T3 levels. Large doses of corticosteroids (for example, >4 mg dexamethasone) produce reductions in total T3 levels, which are useful in the management of thyroid storm or severe hyperthyroidism.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070767/

I get so excited learning this stuff! LOL!!!


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## Leroy (Jan 20, 2011)

Lainey: No worries, questions are the only way to get proper answers 

Andros: I know, I've always wondered which came first. You say bouts of hyper all the way along, but I was only having tachycardia recently, bradycardia is where is started. Hyper wouldn't go along with brady would it?

About the TSI, that just rang a bell for me. My TPO, TgAB both came back as negative but TSI said (lab still working, to send results later). My Endo never called me back so I assume it was fine or like I have had before, the lab never finished the test or they never sent it. Hmmm...I'll ask my endo's office, but I know their response will be "If you had the test done, he would of checked it and if you weren't called, it was ok" lol always the same.

Great, so it affects blood glucose lol. I actually am on both beta blockers and corticosteroids to raise my BP, hmmm...my thyroid tests are likely not going to be very truthful. I have a lot to think about now, thank you!


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## lainey (Aug 26, 2010)

The effects of beta-blockers on lab work tend to be very dose dependent. Most of my research shows that their influence kicks in much more at higher doses--for most beta blockers this is in excess of 100mg per day. Lower doses tend to be less problematic.

In this sense, if you are hyper, higher doses will mask the symptoms because they do mildly impact the free T's, as I said, this is why they are prescribed commonly to hyperthyroid patients.

However, don't be fooled that heart rhythm problems are limited to hyperthyroid issues. The bradycardia/low blood pressure is definitely common with hypothyroidism. Increased blood pressure and tachycardia are possible also. Thyroid hormone is needed by the heart and arteries for normal function. When there is too little thyroid hormone and the metabolism slows, the heart rate does also, as does the blood pressure. The adrenal glands compensate by producing more adrenaline. However, over time, deficient amounts of thyroid hormone causes the arterial walls to stiffen. As a result, blood pressure rises. The excess adrenaline causes the heart rate to increase to compensate for the extra work moving blood in the stiffer arteries.

Steroids, even in low doses can cause hyperthyroid symptoms in sensitive patients. They can alter thyroid lab results also. If you are hypothyroid, steroids are metabolized at a much slower rate, and retained by the body for longer, and cause a suppressed TSH see:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC297463/ Now I know that you are not diagnosed as either hyper or hypo, but once again, I wonder about the relationship between your thyroid status, heart rhythm problems, and current medications.

Obviously your situation is much more complicated than any of us here is in any way qualified to address. I am almost thinking, in a lay person sort of way, if your medications are counter productive to each other. Given that your latest blood pressure was normal, if the steroids were tapered back a little, could that have a positive effect on the tachycardia? Your TSH may come up a bit and the Frees then come down in response? Maybe then less or no beta blocker?

I am just giving questions now, playing the devil's advocate a little, because only you know which things you have discussed with the doctors, and perhaps there are some questions you haven't had a chance to ask yet.


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## Leroy (Jan 20, 2011)

Thanks for the response lainey, I appreciate the questions. That is why I love this site, it lets me talk to people who have an understanding of these issues and can help me think of what to discuss with my doctors. By no means do I expect any of you to tell me what is wrong or what to do, it is just nice to learn new things and to talk about it.

As for your question about lowering my steroid, well it is unfortunately not too likely at this point. Originally 2 years ago I was on the maximum dosage of florinef a day. For the last 6 months I am only on the recommended starting dosage, so a low dose. Even though my BP was normal last time, it was abnormal when I stood up. It spikes so much that if my average blood pressure were to go back down, the spikes would send me low enough to pass out. 80/40 is already cutting it close enough for me haha. It is a good thought though, maybe someday.

As it stands right now, my thyroid has no effect on my health. So maybe they are right, but I am going to keep on it, especially since the nodules are almost 1cm and my free t3 is a bit high.

Thanks again.


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## Andros (Aug 26, 2009)

Leroy said:


> Lainey: No worries, questions are the only way to get proper answers
> 
> Andros: I know, I've always wondered which came first. You say bouts of hyper all the way along, but I was only having tachycardia recently, bradycardia is where is started. Hyper wouldn't go along with brady would it?
> 
> ...


You are going to freak out when you read this. Hypo for sure causes bradycardia BUT..........

http://www.ncbi.nlm.nih.gov/pubmed/11515279

http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442008000200018&lng=pt&nrm=iso

On this one, scroll down to extracardiac causes........
http://www.aafp.org/afp/2005/0215/p743.html

There is a lot more. I just Googled "bradycardia and hyperthyroid"


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## Andros (Aug 26, 2009)

Andros said:


> You are going to freak out when you read this. Hypo for sure causes bradycardia BUT..........
> 
> http://www.ncbi.nlm.nih.gov/pubmed/11515279
> 
> ...


Nothing is carved in stone, it would appear!


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