# Confused by Labs - Please Help



## Dory (Jul 23, 2012)

Hello Everyone!

I am new to this board & the world of thyroid issues. I am sorry in advance for the lengthy post. I am very confused & could use some help/guidance.

For as long as I can remember I have been colder than those around me. I always wore/wear sweaters inside and constantly have cold, almost painful fingers & toes. I have always been moody, and struggled with my weight. In 2006-07 I became very depressed mixed with bouts of extreme anxiety. I was diagnosed with PTSD and put on antidepressants (Lexapro & Buspar). They didn't help at all. That year, I gained from 126lbs to 178lbs in about 6 months. In late 2007, after trying numerous combinations of anxiety/depression meds (I can't remember all the names), I decided they were doing more harm than good & I requested to stop taking them. I was weaned off of them shortly there after and have not taken depression/anxiety meds since.

I struggled to lose the weight, and in early 2008 (27 years old) I went to my GP for a checkup. I told her about all my symptoms and she decided to test my THS level along with my regular blood work. It was 3.37 (normal : 0.47-5.01). She told me I was fine and to watch my calorie intake and exercise more. I continued to try to lose weight. Nothing I tried worked. I went on a strict 1200 calorie a day diet and gained weight. I was constantly fatigued. No matter how much sleep I got, I felt like I hadn't slept at all. Still constantly cold, fingers & toes freezing, moody, depressed. I resigned myself to feeling crappy. I didn't know what to do.

Back in January2012, after talking to one of my friends with hypothyroidism and doing some research, I made a list of my current symptoms (some I didn't even know were symptoms): Current weight 179lbs, extreme fatigue, always cold, low body temperature, hair falling out, brittle nails, cold hands & feet, ringing ears, depression, lack of energy, mood swings, body aches, total mind fog.

I went back to my GP & demanded a full thyroid panel. Here are the lab results from January 2012:

T-Uptake : 1.5% (Abn:H) (normal: 0.7-1.2) 
Free T4 : 0.7 NG/DL (normal: 0.7-1.9)
Triiodothyronine Free, Serum : 3.2 (2.0-4.4)
TSH : 2.83 uIU/mL (normal: .47-5.01)
T4 : 10.0 UG/DL (normal: 4.5-12.0)

Thyroid Stim Immunoglobulin : 119% (normal: 0-139)
Thyroid Peroxidase (TPO) Ab : 40 IU/ml (Abn:H) (normal: 0-34)
Antithyroglobulin Ab : <20 IU/mL (normal: 0-40)

At that time my GP said she thinks I have Hashimotos & did nothing. She wouldn't refer me to an Endo or give me meds.

I did some more research & decided to go off all medication. I had been on birth control pills for 13 years. I wanted to see what my numbers were with nothing in my system.

It's been 6 months & I just got my blood drawn again this past week. Here are the results:

TSH - 2.98 uIU/mL (.45 - 4.5)
T4 - 5.8 ug/dL (4.5 - 12)
Free Thyroxine - 1.7 (1.7 - 4.9)
TPO Antibodies - 29 IU/mL (0 - 34)
T3 Uptake - 29 % (24 - 39)

When I picked these results up from the lab place the nurse smiled at me & said, "you will be very happy, your labs are perfect." I'm not happy, I'm frustrated & confused.

I still have all the same symptoms plus a few new ones. I bruise badly. I feel like all you have to do is give me a nasty look & i'll have a big old bruise. My vision has gotten worse & I have bad floaters. Hair falling out worse than before & brittle. Haven't gained weight but haven't been able to lose any either. Periods are very painful & very heavy for the most part. I'm still cold all the time & my hands & feet get cold very fast. It's summer so I don't notice this as bad, but when I'm in air conditioning for a while my hands start to hurt. My thyroid seems like its aching from time to time. I feel stupid. I struggle to find words to form coherent sentences. I can't remember things. And, starting about a month ago I can't make it through the day without a nap, despite getting 8+ hours of sleep. I regularly sleep 13-14 hours at a time & still feel exhausted. Ears are still ringing & sometimes they "flutter" or "thump". That's the best way I can describe it. My skin is rough, extremely dry & my eczema flares up from time to time. And worst of all, flopping between depression & anxiety.

Have any of you seen lab results like mine? I had my blood drawn at almost 5pm. Does that matter? Why do I feel so flipping bad with normal (ish) numbers?

I have changed my insurance, so I dont need a referral to go to an Endo any more. With that being said, I don't want to go to another doctor unarmed just to be told I'm fine even though I feel craptastic.

Any help/advice/guidance would be greatly appreciated. Thank in advance for your time.


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## Octavia (Aug 1, 2011)

Dory, welcome. I'm sorry you feel "craptastic" but I have to admit that word made me laugh! (Not at you, of course...with you!)

Unfortunately, your labs are "okay" - they're not absolutely perfect, but there's nothing that's out of normal range and screaming "we have a problem." Yeah, some of them are at the bottom (or top) of the normal range, when ideally they'd be closer to the top (or bottom), but with the symptoms and severity you're describing, I would have expected to see at least SOMETHING that's way out of range.

But that doesn't necessarily mean the problem isn't thyroid-related.

I am wondering whether you've had a thyroid ultrasound? (I'm guessing no, since your doc doesn't see anything wrong.) I used to be cold ALL THE TIME...unless I was outdoors in 100-degree heat. I would take (or often wear) a sweater with me everywhere. People made fun of me for it. If I was comfortable, everyone else was hot. I was also tired a lot. And my thyroid labs over the years were always in normal range. Then one day, I noticed a golf ball (that's an exaggeration) popping out of my neck...long story short...thyroid is removed...no longer cold (hardly ever).

Also, have you and your doctor looked at a variety of possible causes, or just thyroid? I would hate for you to be chasing after a thyroid problem (which it may very well be), when the root cause is something else entirely. Something, somewhere is not working right, that is clear.

We have several members here who have been in your shoes...I'm sure they'll be along to provide insights and ideas. Hang in there!

Octavia

:hugs:


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## adenure (May 7, 2012)

T4 - 5.8 ug/dL (4.5 - 12)
Free Thyroxine - 1.7 (1.7 - 4.9)

Those numbers right up there say hypo to me! Especially your free T3! I have Graves Disease and had a TT 5 weeks ago and am on the hormone roller coaster right now. Sucks. I understand! My issue is insomnia- yuck and headaches and just not feeling like myself. I don't know everything nor am I a doctor, but just because you're technically in normal range, doesn't mean it's normal range for YOU! Besides, that Free T3 is just squeaking by into normal range! Free T3 is what your body actually uses (not T4), so if it's low, it is no wonder that you feel the way you do! Yes, it's possible some of your symptoms aren't thyroid related, but that free T3 says it all to me. I would get another opinion if you can. Maybe another GP could refer you to an endo? Are you able to shop around a bit with your insurance? I have Kaiser, so I understand it can be hard to get referrals and choose. I've been pretty fortunate so far, but I know it's hard.

It is your life though and you are more than a number on a range. Your normal probably isn't my normal or your doctor's idea of normal. I think labs are important, but so are your symptoms. If you can, I'd start with trying to find another GP to refer you to an endo. or if your GP is communicates well, discuss the low free T3 number and offer a plan to try and get your T3 higher- maybe Synthroid or Cytomel. Don't give up though; your life and the quality of your life matters!!! hugs3

Alexis


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## adenure (May 7, 2012)

Whoops! I didn't read carefully- free thyroxine is free T4/ not T3. Did you have your free T3 measured? That would tell a lot. Kaiser doesn't order free T3, so I'm going to a lab to get it done myself and then will give the results to my doctor. Free T3 is an important lab to have. I have to pay $85 for it, but it's worth it. Here's the link for it in case you can't get it through your doctor (a kind person here on the boards told me about it) :

http://www.healthcheckusa.com/Thyroid-Panel-II-T4-Free-T3-Free-with-TSH/46938/

Alexis


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## Andros (Aug 26, 2009)

Dory said:


> Hello Everyone!
> 
> I am new to this board & the world of thyroid issues. I am sorry in advance for the lengthy post. I am very confused & could use some help/guidance.
> 
> ...












I see these sorts of numbers all the time and they are far from perfect. Total 4 and Free Thyroxine (FT4) are in the basement! Your T3 uptake went down but prior it was through the roof indicating hyperthyroid.

This is info on the T3 uptake so you know how to understand your own labs.
T3 Resin Uptake (hyper if high)
http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm

T3 Uptake test
http://www.drstandley.com/labvalues_thyroid.shtml (high, hyper---low, hypo)

You should not have any TSI; 119% is very high.

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

And TBII and Trab.

blocking antibodies
http://www.suite101.com/lesson.cfm/19330/2899/4

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

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

The above stimulating, binding and blocking antibodies skew the numbers of the labs test for TSH, FREE T3 and FREE T4 (as well as the Total 3 and 4.)

It is my humble opinion that you indeed do have thyroid disease and that you need to find a doctor who knows what he/she is doing. Furthermore, if I were you, I woud demand an ultra-sound because "sometimes" cancer can cause this sort of flip flopping.


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## Dory (Jul 23, 2012)

You guys, THANK YOU!!!

Octavia - I have not had an ultrasound, but I have read that it is something I should have done. I haven't noticed any bulge or a goiter but certain ways I move my head I think I see swelling. I've gained so much weight that i feel like its hard to tell. My thyroid aches though. That's the only way I know to describe it. It's almost like that feeling you get when you start to cry. But different. I know that makes no sense.

I also read about doing a fine needle aspiration. Is that something I should look into?

Adenure - I think I had my Free T3 done back in January. Is that what this number is?
Triiodothyronine Free, Serum : 3.2 (2.0-4.4)

Andros - That information was very helpful! It helps a lot to know I'm not crazy.

I'm in the process of trying to switching insurance so I can go straight to an Endo without referral. I'm also self-employed so getting good insurance can be hard & expensive. I currently only get 4 office visits a year. Hopefully I can switch to a better plan & get to the doc ASAP!

Is there a place on this forum where people list good Endos? I'm in Atlanta, GA & will drive if I have to. So far I've had bad luck with doctors. :sad0049:

~Hilarye~


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## Octavia (Aug 1, 2011)

Hilarye, you asked about an FNA. That will come AFTER the ultrasound, but generally only if you have any nodules that are 1 cm or larger.

If your "thyroid aches" you may indeed have some abnormality or nodule there. Best get an ultrasound. My voice "ached" for several months, but I really didn't know what to do with that information (um...doc...my voice hurts???). Then one day I saw a large nodule...the rest is history.

You might consider skipping the endo for now, and go straight to an ENT (Ear, Nose, Throat doc) since you have a pain/ache in your neck. I think others here will agree that ENTs don't tend to waste much time getting down to business (as in getting an ultrasound), whereas many endos want to...oh..."experiment" with different things/treatments.

My guess is that if you went to an ENT and told him/her about this ache, as well as your symptoms, you'd get an ultrasound right away. But just be aware that ENTs are generally not the ones who would "manage" your thyroid hormones--they are surgeons, though, and they have a great understanding of what should and should not be going on in your neck.

You are not crazy!


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## Dory (Jul 23, 2012)

Hello again! I wanted to give an update because I just got new labs. I'm even more confused than before...

Free T4 - 0.9 NG/DL (0.7-1.9)
TSH - 0.63 uIU/mL (0.47-5.01)
Thyrotropin Receptor Ab, Serum - 0.85 IU/L (0.00-1.75)
Triiodothyronine (T3) - 118 ng/dL (71-180)
Thyroid Peroxidase (TPO) Ab - 27 IU/ml (0-34)
Antithyroglobulin Ab: <20 IU/mL (normal: 0-40)

Sedrate - 11 MM/HR (0-20)

These labs have my TSH DRASTICALLY different from the other two tests. I'm almost hyperthyroid. And my TPO antibodies have decreased. I'm not on any medication, so how is this possible!?!?!

My symptoms have not improved at all, so I'm not sure what is going on. I finally found an endocrinologist that I can go to, I just have to wait on an appointment.


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## Andros (Aug 26, 2009)

Dory said:


> Hello Everyone!
> 
> I am new to this board & the world of thyroid issues. I am sorry in advance for the lengthy post. I am very confused & could use some help/guidance.
> 
> ...


I really think that you are alternating between hypo and hyper w/ the ultimate result being hyperthyroid. These things wax and wane due to various antibodies such as the TSI which you have and that is stimulating but along comes Trab which is a blocking antibody to the TSI receptor site and lo and behold, your labs look in range.

You most definitely need an ultrasound if you have not had one.

Here is a lot of info and by the way, many of us have gained weight while hyperthyroid. Symptoms can and do cross over.

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

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

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/

T3 Uptake test
http://www.drstandley.com/labvalues_thyroid.shtml (high, hyper---low, hypo)

I do think you are low in ferritin from what you are saying..................
Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)

And if you need some good thyroid docs in the Atlanta Metro area; these folks can steer you right..................
Atlanta group
http://health.groups.yahoo.com/group/Georgia_Thyroid_Groups/


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## momof5bk (Nov 7, 2012)

Hi Dory. I don't have much to offer because I am going through ALL the symptoms that you have except the swollen thyroid. I have an achy throat sometimes but I attribute that to my allergies. Anyway I just wanted to say welcome to this board (I'm a newbie too) and just know that you are not alone in all this. My labs always come back "normal" by docs standards except that my antibodies were a little high.

I've also had a really hard time with docs. Hope you get some answers and better yet some treatment so that you feel better soon.

I've received some good responses on here especially from Andros so I'm sure you will like it here too. Take care. :hugs:


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## Dory (Jul 23, 2012)

Hey Guys! It's been a long time since I've been on the forum. I went & saw an endocrinologist & he looked at all my labs, diagnosed me with hashimotos and put me on a low dose of levothyroxine (25mg). We got my dose right (37.5mg)& I was ok for over 6 months. When I went in for my 6 month appointment my tsh was at 0.06. So my endocrinologist lowered my levothyroxine dose (25mg). This was in July of last year. By August, I wasn't taking levothyroxine anymore because I ran out & I didn't feel it was helping. I had an appointment to see my endocrinologist In December, so I was waiting to see him to discuss my numbers.

A few months later I was having heart palpitations when I laid down, but I chalked it up to stress. Around Thanksgiving last year (totally off the levothyroxine) I noticed that in the morning after I had showered & dried my hair I would sweat for hours & in general I was extremely hot. I would get winded going up stairs & my heart was still palpitating.

Around the first of December I had a sinus infection & when I went to the minute clinic for a z-PAC my heart rate was 141. My bloodpressure was 141/89. The PA suggested I see my doctor immediately. Well, that day I got a letter from my insurance company that they were dropping me. So I had to cancel my endocrinologist appointment, get new insurance & make a new appointment.

My endocrinologist had no appointments, but ordered labs. My TSH was undetectable, my FT3 & FT4 were high. He put me on beta blockers and I finally got in to see him on 2/11. He said he thought I was having thyroidisis, but there was a possibility I had graves. He drew more labs that day, including my TSI. Nothing lab wise changed & my THS receptor antibodies were high. Endocrinologist ordered a radioactive iodine uptake & thyroid scan.

Thyroxine Free: Result 2.5 ng/dL (High) / Normal: 0.7 ng/dL - 1.8 ng/dL
Triiodothyronine: Result 271 ng/dL (High) / Normal: 60 ng/dL - 181 ng/dL
TSH: Result < 0.01 mcIU/mL (Low) / Normal: 0.55 mcIU/mL - 4.78 mcIU/mL
TSH Receptor Antibody: Result 5.12 IU/L (High) / Normal: <= 1.75 IU/L

Scan results came back on Friday & it's official. I have Graves' disease.

I've been on Metoprolol 75mg (beta blockers) & he just started me on Methimazole 10mg.

I hope I have finally gotten the answer as to what has been wrong with me. Either I've had graves the whole time & it's been dormant, or not showing any major symptoms, or I have both hashimotos & graves. Is that possible???


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