# Tsh 0.01



## noblez

hi all,
I recently had blood work done and I had a tsh of 0.01. I just went back to my general practitioner and he took more blood to further check my thyroid. He called me today to say that my thyroid is over-active and we need to take the next step... as in a scan and uptake. I don't have the numbers from the thyroid test but I should have them by tomorrow. I assume they were bad if we have to take the next step.

I'm generally a healthy person with no family history of thyroid problems.

Could this all just be a "phase" (for lack of a better word)? I know these things can cycle

BTW, if anyone knows a great endo in manhattan I would love suggestions

Thanks to all

J


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## Andros

noblez said:


> hi all,
> I recently had blood work done and I had a tsh of 0.01. I just went back to my general practitioner and he took more blood to further check my thyroid. He called me today to say that my thyroid is over-active and we need to take the next step... as in a scan and uptake. I don't have the numbers from the thyroid test but I should have them by tomorrow. I assume they were bad if we have to take the next step.
> 
> I'm generally a healthy person with no family history of thyroid problems.
> 
> Could this all just be a "phase" (for lack of a better word)? I know these things can cycle
> 
> BTW, if anyone knows a great endo in manhattan I would love suggestions
> 
> Thanks to all
> 
> J


Hi there, J! I am glad you are going to do the uptake scan as with such a low TSH; it is suspicious of hyperthyroid.

Has your doctor done any antibodies' tests? Do you know if in addition to the TSH the doctor ran FT4 and FT3?

It is true that thyroid disease can "cycle" as you say but most usually each time it cycles back in, the patient feels worse. So, it is a good thing you are having the scan.

Please let us all know what the results of that are. When will you have it done?

Andros


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## noblez

Thank you for your response. My doctor ran the antibodies' tests and got the results back yesterday. They must have not been good as he has ordered the scan and uptake. I should have online access to the antibodies' tests results either today or tomorrow.

Tomorrow and Friday I go for the scan and uptake.


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## Andros

noblez said:


> Thank you for your response. My doctor ran the antibodies' tests and got the results back yesterday. They must have not been good as he has ordered the scan and uptake. I should have online access to the antibodies' tests results either today or tomorrow.
> 
> Tomorrow and Friday I go for the scan and uptake.


Oh, goody!!! Well, not good that you have thyroid disease of course but I must say your doctor sounds really on top of things. That is reassuring.

So..................I just joined today; ha ha, can you tell?

I will be very anxious to have you share those test results w/ me if you wish to do so and also the results of the uptake scan.

By the way, different labs do use different ranges so including ranges would be very very helpful.

Andros


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## noblez

Ok, so I got to see my test results today...

Name Value Reference Range
T3 UPTAKE 38.6 24.3-39.0%
THYROXINE(T4) 11.9 4.5-12.0
T3(THYRONINE),TOTAL 142 80-200
THYROXINE,FREE(FT4) 2.24 0.93-1.7
TSH 0.007 0.27-4.2
FREE T4 INDEX 4.6 1.1-4.5

I got back tomorrow for my thyroid scan and uptake.


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## chopper

noblez said:


> Ok, so I got to see my test results today...
> 
> Name Value Reference Range
> T3 UPTAKE 38.6 24.3-39.0%
> THYROXINE(T4) 11.9 4.5-12.0
> T3(THYRONINE),TOTAL 142 80-200
> THYROXINE,FREE(FT4) 2.24 0.93-1.7
> TSH 0.007 0.27-4.2
> FREE T4 INDEX 4.6 1.1-4.5
> 
> I got back tomorrow for my thyroid scan and uptake.


Sounds like you have Graves' Disease my friend. Ask your doctor for a TSI test - Thyroid Stimulating Immunoglobulins. Anything over 125 or 12.5% is indicative of Graves'. Mine is usually around 175 or so but I have Graves and Hashi's-like symptoms.

What's your resting heart rate like? How about body temp?


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## noblez

HI!

Thank you so much for your response, I really appreciate it as I am just learning about thyroid issues.

As for my body temp it seems to be normal... and my resting heart rate is normal, but I always thought it should be lower for someone who does as much cardio as I do.

And I don't know if I'm just being paranoid or what, but several months ago I began to have some discomfort swallowing.... and now I swear the front of my neck hurts


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## Andros

noblez said:


> Ok, so I got to see my test results today...
> 
> Name Value Reference Range
> T3 UPTAKE 38.6 24.3-39.0%
> THYROXINE(T4) 11.9 4.5-12.0
> T3(THYRONINE),TOTAL 142 80-200
> THYROXINE,FREE(FT4) 2.24 0.93-1.7
> TSH 0.007 0.27-4.2
> FREE T4 INDEX 4.6 1.1-4.5
> 
> I got back tomorrow for my thyroid scan and uptake.


Oh, wow..............I have seen worse but you sure are hyperthyroid. And hey, thank you so much for including the ranges. We sure don't like to guess when it comes to our health.

Bet the uptake scan will be rapid. Waiting with bated breath. Andros


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## Criterion

Well it is not that quite simple in my opinion.

Here are some suggestions. If your insurance covers these ask your doctor to perform the following tests:

Thyroid Peroxidase Autoantibody (TPO or TPOAb)
Thyroglobulin Antibody Test panel (TG or TgAb) 
Thyrotropin-Binding Inhibitory Immunoglobulin (TBII) 
Thyroid Stimulating Hormone (TSH) Receptor Antibody (TRAb) 
Thyroid stimulating immunoglobulin (TSI)

Some of these tests can take a week or so before they have the results back.

Next, ask for sonogram (ultrasound) of the thyroid. This will help determine the size of the tissue, and if there are any nodules (growths). If nodules are detected they can evaluate them.

Ask for a Radioactive Iodine Uptake Test (RAIU scan). The results could indicate many things like:

RAIU scan with no significant uptake indicates: Thyroiditis (inflammation of the thyroid gland)
RAIU scan with homogenously increased uptake indicates: Graves' disease
RAIU scan with heterogeneously increased uptake indicates: Toxic multi-nodular goiter
RAIU scan with single hot nodule indicates: Toxic adenoma

Most important, keep a copy of your tests for your records.

Good luck


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## noblez

Criterion said:


> Well it is not that quite simple in my opinion.
> 
> Here are some suggestions. If your insurance covers these ask your doctor to perform the following tests:
> 
> Thyroid Peroxidase Autoantibody (TPO or TPOAb)
> Thyroglobulin Antibody Test panel (TG or TgAb)
> Thyrotropin-Binding Inhibitory Immunoglobulin (TBII)
> Thyroid Stimulating Hormone (TSH) Receptor Antibody (TRAb)
> Thyroid stimulating immunoglobulin (TSI)
> 
> Some of these tests can take a week or so before they have the results back.
> 
> Next, ask for sonogram (ultrasound) of the thyroid. This will help determine the size of the tissue, and if there are any nodules (growths). If nodules are detected they can evaluate them.
> 
> Ask for a Radioactive Iodine Uptake Test (RAIU scan). The results could indicate many things like:
> 
> RAIU scan with no significant uptake indicates: Thyroiditis (inflammation of the thyroid gland)
> RAIU scan with homogenously increased uptake indicates: Graves' disease
> RAIU scan with heterogeneously increased uptake indicates: Toxic multi-nodular goiter
> RAIU scan with single hot nodule indicates: Toxic adenoma
> 
> Most important, keep a copy of your tests for your records.
> 
> Good luck


Thank you! My GP has handed me off to a specialist, but of course I can't get into see him for over a month. I guess I should ask him to do the additional tests. Tomorrow I go for the scan and uptake so at least he will have those results to look at when I get into see him.

All of this is nothing to be afraid of right? (i'm a bit of a scaredy cat)


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## Andros

noblez said:


> Thank you! My GP has handed me off to a specialist, but of course I can't get into see him for over a month. I guess I should ask him to do the additional tests. Tomorrow I go for the scan and uptake so at least he will have those results to look at when I get into see him.
> 
> All of this is nothing to be afraid of right? (i'm a bit of a scaredy cat)


Aaaaaaaaaaaw; everything is going to be okay. It may be a bit of a rough road but we all are here to be supportive of you and helpful as well.

As matter of fact, that why I like to post on thyroid forums; just to let folks know that no matter how bleak it may seem, there is "much" hope for total recovery.

Andros


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## Criterion

It is ok to feel this way.

My stress comes not from testing but rather from the effects the thyroid has in my body especially my heart. When I have heart palpitations and arrhythmia it is not fun.

Regarding these tests there is nothing to be worry about. The radioactive material (RAI) used is relatively small quantity and only absorbed by the thyroid tissue.

Even if there are nodules in your thyroid the possibility of them being malignant is only about 5%, so really don't worry.


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## noblez

Thanks to all for your support.

I went for the scan today and was told I'll have the results next week, so all I can tell you at this point is that the pictures of my thyroid looked like a butterfly, very symmetrical, with "the wings" a red color in the middle and then outlined in blue. I have no idea what that means but I'll find out soon.

Also, I had wanted to mention that I have always had very low blood pressure (I often feel dizzy upon standing and I have fainted several times recently) and have purchased a blood pressure monitor to keep track of my blood pressure. Right now its on the low end of normal.....BUT isn't my blood pressure supposed to increase if I have hyperthyroidism???

Thanks!


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## Andros

noblez said:


> Thanks to all for your support.
> 
> I went for the scan today and was told I'll have the results next week, so all I can tell you at this point is that the pictures of my thyroid looked like a butterfly, very symmetrical, with "the wings" a red color in the middle and then outlined in blue. I have no idea what that means but I'll find out soon.
> 
> Also, I had wanted to mention that I have always had very low blood pressure (I often feel dizzy upon standing and I have fainted several times recently) and have purchased a blood pressure monitor to keep track of my blood pressure. Right now its on the low end of normal.....BUT isn't my blood pressure supposed to increase if I have hyperthyroidism???
> 
> Thanks!


So good to hear from you and I know you will be anxious for the results of your uptake scan as will I and others.

First and foremost, not all symptoms run true. Oftentimes, they do cross-over. No 2 persons react the same.

I wonder if you just have low blood pressure. Would you know what your BP was like "before" becoming hyperthyroid? Do any other family members have low blood pressure (genetic?)

Then....................you may have an underlying condition. I hope not but here is a good list of possible causes of low BP and all of this is assuming you are not on any medication that would cause this.............

http://www.medicinenet.com/low_blood_pressure/page4.htm

I would most certainly suggest you ask your doctor about this.

Andros


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## noblez

I would like to give some background and bring up another problem I've been having in the hopes that you all can shed some light.

I'm a 29 year old female with no health issues and no family history of thyroid issues. Earlier this year I was in an accident and had massive amounts of dental work done finally ending just this month. I mention this only b/c I read somewhere that people with hyperthyroidism should avoid novocaine and I've had lots of it this year. thoughts?

I'd also like to mention that earlier this year I had a fainting episode. I ended up in the ER and got some fluids and went home but still felt horrible. Not till I ate did I feel better. I assumed low blood sugar was the cause of my fainting. I brought this up in the ER and later to my doctor, but I was blown off both times by the docs who said that b/c I had eaten food earlier that day it could not be low blood sugar (I think the docs assumed a anxiety caused my fainting, but of course I didn't feel anxious). I however bought myself a glucose monitor and sure enough I have tested myself many times and found I've had low blood sugar on occasion....I would test when I felt sh!tty and most of those times it was low(I now carry glucose pills and take them whenever I feel like I may be low).

Then just this very evening I started to feel nauseous and jittery and like I did on the day I fainted earlier this year. I quick grabbed my glucose meter and found my blood sugar to be 58 (very low). I was going to faint unless I got some sugar fast. I couldn't find the glucose pills so I had a spoon full of sugar and then my husband found the pills and I took 2. About 10-15 min later I retested and had blood sugar of 122, and of course I felt much better. This is all very odd b/c I had a nice sized veggie burger for lunch with fries, came home and watched a movie and even ate some nerds....so my blood sugar had no reason to be low from my diet.

Which leads me to ask, is there a connection between hyperthyroidism and hypoglycemia? I read somewhere on the internet that some people believe there may be a connection, in that hyperthyroidism affects the body's ability to regulate glucose.

Anyone have similar issues or know anything about this? Of course this is something I will bring up to my endo, but my appointment isn't for a month.

Thanks again,
Jane


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## Andros

noblez said:


> I would like to give some background and bring up another problem I've been having in the hopes that you all can shed some light.
> 
> I'm a 29 year old female with no health issues and no family history of thyroid issues. Earlier this year I was in an accident and had massive amounts of dental work done finally ending just this month. I mention this only b/c I read somewhere that people with hyperthyroidism should avoid novocaine and I've had lots of it this year. thoughts?
> 
> I'd also like to mention that earlier this year I had a fainting episode. I ended up in the ER and got some fluids and went home but still felt horrible. Not till I ate did I feel better. I assumed low blood sugar was the cause of my fainting. I brought this up in the ER and later to my doctor, but I was blown off both times by the docs who said that b/c I had eaten food earlier that day it could not be low blood sugar (I think the docs assumed a anxiety caused my fainting, but of course I didn't feel anxious). I however bought myself a glucose monitor and sure enough I have tested myself many times and found I've had low blood sugar on occasion....I would test when I felt sh!tty and most of those times it was low(I now carry glucose pills and take them whenever I feel like I may be low).
> 
> Then just this very evening I started to feel nauseous and jittery and like I did on the day I fainted earlier this year. I quick grabbed my glucose meter and found my blood sugar to be 58 (very low). I was going to faint unless I got some sugar fast. I couldn't find the glucose pills so I had a spoon full of sugar and then my husband found the pills and I took 2. About 10-15 min later I retested and had blood sugar of 122, and of course I felt much better. This is all very odd b/c I had a nice sized veggie burger for lunch with fries, came home and watched a movie and even ate some nerds....so my blood sugar had no reason to be low from my diet.
> 
> Which leads me to ask, is there a connection between hyperthyroidism and hypoglycemia? I read somewhere on the internet that some people believe there may be a connection, in that hyperthyroidism affects the body's ability to regulate glucose.
> 
> Anyone have similar issues or know anything about this? Of course this is something I will bring up to my endo, but my appointment isn't for a month.
> 
> Thanks again,
> Jane


Hi, Jane! With autoimmune diseases, it is not at all unusual for the patient to have more than one autoimmune problem. And since thyroid disease "is" endocrine, yes..............there is an association. I refer to this as the cascade effect.

For instance, I have Graves' Disease, Lupus, Sjogrens and Insulin resistance (borderline diabetic) and I can assure you, I am extremely careful about my diet and my exercise. I never consume sugar or simple starches and I do have to watch my portions (gylcemic index) and otherwise pay careful attention to all I do.

If you are hyperthyroid, Novacain can be adrenergic causing arrhythemia of the heart and other unpleasant adverse effects so I do hope you advise your dentist/surgeon of this? There are other products that can be used.

By the way, not true what your doc said. Some with diabetes experience a "spike" when they eat and hours later "spiral" downwards into a dive.

You might consider changes doctors for better management of your health issues.

Please read this as it will explain the "spike and dive" syndrome.......

http://www.rd.com/content/printContent.do?contentId=36369

Andros


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## noblez

Its been a week since my scan and I still don't have the results. I'm going crazy!!!!!!!

(I hope everyone has a nice labor day weekend)


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## Andros

noblez said:


> Its been a week since my scan and I still don't have the results. I'm going crazy!!!!!!!
> 
> (I hope everyone has a nice labor day weekend)


The holiday weekend could be the reason for the stall. Many take the entire week off to get those 3 days added on.

The minute you know, I hope we know and have a "safe" weekend.

Andros


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## noblez

Got the scan results. They are consistent with graves disease. I will see the specialist to confirm.

blah


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## Andros

noblez said:


> Got the scan results. They are consistent with graves disease. I will see the specialist to confirm.
> 
> blah


Blah and bleck!! I am so sorry but at least you got a diagnosis. So many just suffer for years and years.

I guess after Labor Day you will make the appt.? Will you let us know?

Andros


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## noblez

Hi!
Yes, I see the specialist my doctor recommended on October 6th. I also got a great recommendation from a friend and I see that doc on sept 28.

Its nice to know what is going on.... and sometimes graves goes away all on its own right?

thanks!
Jane


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## Andros

noblez said:


> Hi!
> Yes, I see the specialist my doctor recommended on October 6th. I also got a great recommendation from a friend and I see that doc on sept 28.
> 
> Its nice to know what is going on.... and sometimes graves goes away all on its own right?
> 
> thanks!
> Jane


Hi, Jane!! Once in a Blue Moon, I do hear of a person going into remission but to my knowledge, as the years pass (and sometimes even months), that person has found that the antibodies have raised their ugly heads once again. And on the long haul, most patients do opt for a permanent resolution via RAI or ablation.

Also, if you have any eye involvement, I cannot urge you strongly enough to see a Board Certified Ophthalmologist because treating the thyroid while very helpful does not directly treat the eyes.

How are your eyes? Do you know the eye signs?

http://www.uic.edu/com/eye/LearningAboutVision/EyeFacts/ThyroidEyeDisease.shtml

I am glad you have those 2 appts. lined up. I and others will be anxious for you in regards to your treatment options and what course you chose to follow.

Sending hugs,

Andros


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## chopper

Hi Jane,

I wish Graves went away by itself but in all honesty, it does not.

About 2 years ago I felt nearly perfectly well. Got tested. My TSI went from 175 years prior to just 25. I felt like a million bucks.

That lasted about 5 glorious months and then it started rising again and so did my problems.

I'm not saying to make any hasty decisions but sometimes its just better to get this junk over with and get on with your life. I wasted too many of my prime years feeling crappy to these thyroid troubles.


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## noblez

So, just to throw another wrench in the mix.... today I went to my psychiatrist. I am being treated for BDD (body dysmorphic disorder) and take 60mg of Prozac and 2mg of Abilify daily. My hyperthyroid symptoms started around the same time I began to take the abilify (in fact I blamed my trouble sleeping and anxious feelings on the drug) and apparently hyperthyroidism can be a RARE side effect of abilify.

who knew?

So today during my appointment my psychiatrist didn't know that hyperthyroidism could be a rare side effect of abilify, but wanted me to ask the specialist if there could be a connection. Of course I got home and googled it and there it was. Now I'm wondering if I should even be taking the abilify anymore....not that its too much longer till I see the specialist (sept 28)

thoughts?

Thanks!
Jane


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## Andros

noblez said:


> So, just to throw another wrench in the mix.... today I went to my psychiatrist. I am being treated for BDD (body dysmorphic disorder) and take 60mg of Prozac and 2mg of Abilify daily. My hyperthyroid symptoms started around the same time I began to take the abilify (in fact I blamed my trouble sleeping and anxious feelings on the drug) and apparently hyperthyroidism can be a RARE side effect of abilify.
> 
> who knew?
> 
> So today during my appointment my psychiatrist didn't know that hyperthyroidism could be a rare side effect of abilify, but wanted me to ask the specialist if there could be a connection. Of course I got home and googled it and there it was. Now I'm wondering if I should even be taking the abilify anymore....not that its too much longer till I see the specialist (sept 28)
> 
> thoughts?
> 
> Thanks!
> Jane


Gosh, Jane ............that is quite the conundrum. The only thing I know to say is to get all these doctors on the same page if you can Re this Abilfy. I wonder if it really caused the hyper or if it merely exacerbates it? I did look up side effects and that is sort of a scary med.


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## Goingtogetbetter

Hi All, Hi Noblez...

Just wanted to say hello and tell you I'll be saying a prayer for you.. We are in a very similar situation and I still don't have any answers yet, and can't seem to find a good doc or one person to champion all the issues! i share your frustration. I posted something earlier today in the forum if you want to read it our TSH are very similar some of my other numbers are a bit different though.

Please post if you've learned anything since your last post, I'm very curious to know how things are going.

Hope everything reading this has a good night~
Antoinette


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## noblez

hi Antoinette, Thanks for the thoughtful message.
I went to the specialist today and she believes I have graves disease and is doing additional blood work including the antibody test. I'll have the results by thursday. I told her I had been feeling better recently, less tremors, gained some weight back, easier to sleep etc... and she mentioned that graves can wax and wane and all that I may need is to take some meds when I'm not feeling well. I hope that is the case as the radioactive therapy scares me (although I know its really nothing to fear).

Anyway, I go to another specialist on oct 6th and I will be sure to update.

Take care,
Jane


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## Andros

noblez said:


> hi Antoinette, Thanks for the thoughtful message.
> I went to the specialist today and she believes I have graves disease and is doing additional blood work including the antibody test. I'll have the results by thursday. I told her I had been feeling better recently, less tremors, gained some weight back, easier to sleep etc... and she mentioned that graves can wax and wane and all that I may need is to take some meds when I'm not feeling well. I hope that is the case as the radioactive therapy scares me (although I know its really nothing to fear).
> 
> Anyway, I go to another specialist on oct 6th and I will be sure to update.
> 
> Take care,
> Jane


Good to hear from you, Jane. And that doctor is so right. Graves' indeed waxes and wanes.

Will be looking forward to any updates and learning of what you and the doctor plan to do by way of medical intervention.


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## noblez

hey all, So I went to see the second specialist yesterday and I loved him. He took a full history, listened to everything I had to say and even explained my low blood sugar and fainting issues.

As for treatment we are waiting for more labs, and on oct 13 I go back for a ultrasound.

As usual I'll let you know how it goes.

I hope everyone is doing well.

JANE


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## Andros

noblez said:


> hey all, So I went to see the second specialist yesterday and I loved him. He took a full history, listened to everything I had to say and even explained my low blood sugar and fainting issues.
> 
> As for treatment we are waiting for more labs, and on oct 13 I go back for a ultrasound.
> 
> As usual I'll let you know how it goes.
> 
> I hope everyone is doing well.
> 
> JANE


So good to hear from you, Jane! I and others will be "very" interested to hear from you after the ultrasound!!

How have you been feeling?


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## noblez

First, I will suggest the obvious, get 2 opinions. While the first doc I went to was just fine the second was amazing. Took full history, listened to every little detail I had to give him, helped to explain my low blood sugar problems (which the other doc just ignored). Diagnosis was still the same of course....Graves. Second doc took more blood, haven't gotten the results back. Hopefully since my heart rate has been so normal I won't even need meds.

BTW He did tell me there were 3 options to treat Graves
1) Meds
2)Radioactive therapy
3)Removal

I almost fell off my chair at removal. He said it is the most popular option in Europe. Minus the scar, after I actually thought about it, the removal sounded like a decent option b/c then its much easier to get medication levels correct.

All thoughts appreciated.
Thank you
Jane


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## Andros

noblez said:


> First, I will suggest the obvious, get 2 opinions. While the first doc I went to was just fine the second was amazing. Took full history, listened to every little detail I had to give him, helped to explain my low blood sugar problems (which the other doc just ignored). Diagnosis was still the same of course....Graves. Second doc took more blood, haven't gotten the results back. Hopefully since my heart rate has been so normal I won't even need meds.
> 
> BTW He did tell me there were 3 options to treat Graves
> 1) Meds
> 2)Radioactive therapy
> 3)Removal
> 
> I almost fell off my chair at removal. He said it is the most popular option in Europe. Minus the scar, after I actually thought about it, the removal sounded like a decent option b/c then its much easier to get medication levels correct.
> 
> All thoughts appreciated.
> Thank you
> Jane


So good to hear from you, Jane! Yes; I think now you really have a very very good doctor.

If I knew then what I know now, I would not have delayed. I would have had that nasty thyroid out. Then you can just get on w/ your life.

Give this a lot of thought though. It is truly your decision so you have to try and decide what is the best route for you.

Hugs,


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## themainemom

Jane, please let us know how it goes and what you decide. I'm pretty sure I'm in your same boat although I have not been to my endo yet. All tests and ultrasound point to Hyper. I can't wait to find out if he suggests meds or rai. Sounds like rai may be something to consider as I WANT THIS GONE, AND DO NOT A RELAPSE!!! I want my life back. Let us know what you decide!


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## noblez

Thanks to all for all of your support and I will keep you posted as to my treatment.

*HUGS*


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## Andros

noblez said:


> Thanks to all for all of your support and I will keep you posted as to my treatment.
> 
> *HUGS*


Hugs back at ya'!


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## Andros

noblez said:


> Thanks to all for all of your support and I will keep you posted as to my treatment.
> 
> *HUGS*


Checking on you, Jane. Hope everything is going well for you?


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## LonelyVoyager

Hi Everyone. Hope all is well with everyone. I am new to this forum. This is my story: I remember from many years ago that I was always an anxious kid, fretting about every minor thing. On several occasions the anxiety got to a point where it actually interfered with my life and school and all. The sad part is that every time I went to a doctor or student health office they just blamed it on school and I was given a prescription of Xanax, which I tried not to take much of as it made me really sleepy. Long story short, while at school couple weeks ago, I had an episode all of a sudden of severe headache, sweating, and tremblings. I had to go to student health. Now, that I was more grown up (24 y.o. male), and being a physiology major at college, I tried to persuade them to look at my thyroid levels. I really mean persuasion cause they DID NOT want to do anything, maybe go up on the xanax dose. Couple days passed and I got a letter in my mail:

*TSH: 0.014 (L) (normal range: 0.350-5.50)
T4Free: 2.87 (H) (normal range: 0.89-1.76)
T3Free: 9.0 (HH) (normal range: 2.3-4.2)*
TSI: 31 (normal range: 0-139)

I was so happy to have found a cause to my relentless anxiety episodes. I just feel so sorry for many of us out there who are having similar problems and are not taken seriously.

My results however are not consistent with an inflammatory/autoimmune etiology to the hyperthyroidism as the TSI and TSH Receptor Antibody levels were all normal.

So, finally, after I would say 8 years of misery, I am being seen by an endocrinologist who has scheduled me to have a thyroid scan and uptake.

Now, my question is that if inflammation is not the likely cause, does that mean that I have a tumor (benign or otherwise) in my thyroid that's causing the hyperthyroidism?

Any suggestions would be appreciated. I am so glad that this forum and hope everyone feels better soon.

Thanks.


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## Andros

LonelyVoyager said:


> Hi Everyone. Hope all is well with everyone. I am new to this forum. This is my story: I remember from many years ago that I was always an anxious kid, fretting about every minor thing. On several occasions the anxiety got to a point where it actually interfered with my life and school and all. The sad part is that every time I went to a doctor or student health office they just blamed it on school and I was given a prescription of Xanax, which I tried not to take much of as it made me really sleepy. Long story short, while at school couple weeks ago, I had an episode all of a sudden of severe headache, sweating, and tremblings. I had to go to student health. Now, that I was more grown up (24 y.o. male), and being a physiology major at college, I tried to persuade them to look at my thyroid levels. I really mean persuasion cause they DID NOT want to do anything, maybe go up on the xanax dose. Couple days passed and I got a letter in my mail:
> 
> *TSH: 0.014 (L) (normal range: 0.350-5.50)
> T4Free: 2.87 (H) (normal range: 0.89-1.76)
> T3Free: 9.0 (HH) (normal range: 2.3-4.2)*
> TSI: 31 (normal range: 0-139)
> 
> I was so happy to have found a cause to my relentless anxiety episodes. I just feel so sorry for many of us out there who are having similar problems and are not taken seriously.
> 
> My results however are not consistent with an inflammatory/autoimmune etiology to the hyperthyroidism as the TSI and TSH Receptor Antibody levels were all normal.
> 
> So, finally, after I would say 8 years of misery, I am being seen by an endocrinologist who has scheduled me to have a thyroid scan and uptake.
> 
> Now, my question is that if inflammation is not the likely cause, does that mean that I have a tumor (benign or otherwise) in my thyroid that's causing the hyperthyroidism?
> 
> Any suggestions would be appreciated. I am so glad that this forum and hope everyone feels better soon.
> 
> Thanks.


LonelyVoyager, welcome to the board. Wow!! I think that in your lifetime, you will be in a position to help many in your travels.

I am really sorry about the Xanax; this is a sin. I can just imagine how you feel about all of this. Many here have similar stories, myself included.

And, you "really" are hyperthyroid, aren't you? Firstly, can you wean off the Xanax? Secondly, did doc Rx a beta blocker and explain your treatment options to you?

Do you have a goiter? Has doc made arrangements for you to have a radioactive uptake scan which you should have to rule out cancer or any other irregularities.

For everyone's edification: they have to use ranges so they have a "baseline"; the well person should have NO TSI (thyroid stimulating immunoglobulin.) Here is a credible reference for that............

What do the test results mean?
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that this abnormal antibody is responsible for causing the person's hyperthyroidism.

http://uimc.discoveryhospital.com/main.php?t=enc&id=1516


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## noblez

Just checking back in...

Of the two specialists I saw I really liked one of them and just had the results of my thyroid uptake scan sent to him this week and should have his comments back next week.

He wanted to see the scan b/c I was negative for the graves antibodies and my numbers were greatly improved (although still hyper) from my initial blood work done back in Aug.

Boy are thyroid issues tough to diagnose, I feel sorry for all the rest of you out there who have gone through a long diagnosis process like myself. I just want an answer 

How is everyone else doing?


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## Andros

noblez said:


> Just checking back in...
> 
> Of the two specialists I saw I really liked one of them and just had the results of my thyroid uptake scan sent to him this week and should have his comments back next week.
> 
> He wanted to see the scan b/c I was negative for the graves antibodies and my numbers were greatly improved (although still hyper) from my initial blood work done back in Aug.
> 
> Boy are thyroid issues tough to diagnose, I feel sorry for all the rest of you out there who have gone through a long diagnosis process like myself. I just want an answer
> 
> How is everyone else doing?


Good to hear from you and glad you are pleased with your doctor. What antibodies did the doctor run that were negative?

Do you know if the doctor did TSI (thyroid stimulating immunoglobulin?)


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## LonelyVoyager

Thanks Andros for the message. Yes, it's kind of hard to wean off the xanax considering how long I've been getting these medications with couple dose increases. Unfortunately, I am depended on them for now (i.e. symptom exacerbation when not taking them), but now that I know what the root reason is I will try my best to gradually wean myself off of these medications. The doctor told me about the b-blocker thing but I refused it at that visit, worrying that I may become addicted to just another medication, but now I think I should have considered it.

That was actually a question for me too. If TSI is an abnormal antibody why is there a normal range for it when the lab reports the numbers? That is something I should remember to ask someone about it.

I have been scheduled to have an uptake and scan done in a couple weeks time. Interestingly, with my very high levels of thyroid hormone, I do not have a goiter. Maybe that played a part in the fact that I suffered for so long before realizing what was going on.

Will keep you guys posted as this is a new development off the bat. Hope everyone ends up with a nice doctor. Thanks


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## Andros

LonelyVoyager said:


> Thanks Andros for the message. Yes, it's kind of hard to wean off the xanax considering how long I've been getting these medications with couple dose increases. Unfortunately, I am depended on them for now (i.e. symptom exacerbation when not taking them), but now that I know what the root reason is I will try my best to gradually wean myself off of these medications. The doctor told me about the b-blocker thing but I refused it at that visit, worrying that I may become addicted to just another medication, but now I think I should have considered it.
> 
> That was actually a question for me too. If TSI is an abnormal antibody why is there a normal range for it when the lab reports the numbers? That is something I should remember to ask someone about it.
> 
> I have been scheduled to have an uptake and scan done in a couple weeks time. Interestingly, with my very high levels of thyroid hormone, I do not have a goiter. Maybe that played a part in the fact that I suffered for so long before realizing what was going on.
> 
> Will keep you guys posted as this is a new development off the bat. Hope everyone ends up with a nice doctor. Thanks


I don't think a beta-blocker can be addictive so you may wish to reconsider that one and yes; slowly but surely wean your self off the Xanax. But, please do discuss all you do w/your doctor. Sadly, the Xanax has been masking your real and true symptoms and this is a case where that has not been good because the symptoms are thyroid related. Pooey. I feel bad for you. But, you are not the first and you won't be the last. The docs love to dole out the antidepressants. That is a sin.

They have to have ranges for all lab work so they can have a "baseline."

That is interesting that you have no goiter. But I am glad.

Please do keep in touch.


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## noblez

Andros said:


> Good to hear from you and glad you are pleased with your doctor. What antibodies did the doctor run that were negative?
> 
> Do you know if the doctor did TSI (thyroid stimulating immunoglobulin?)


According to the paperwork he sent me he did not test TSI the paperwork also said that "I do not have grave's antibodies (but 10-20% of all cases are AB-neg)"

So he asked to see my thyroid scan, which I sent to him two weeks ago and I still have not heard from him


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## Andros

noblez said:


> According to the paperwork he sent me he did not test TSI the paperwork also said that "I do not have grave's antibodies (but 10-20% of all cases are AB-neg)"
> 
> So he asked to see my thyroid scan, which I sent to him two weeks ago and I still have not heard from him


LHM (Lord have mercy.) To my knowledge, there are no antibodies specific to Graves'. TSI (thyroid stimulating immunoglobulin) is specific to hyperthyroidism. Graves' is based on "clinical evaluation" only. As per Dr. Robert Graves.

If you have 3 out of these 4, you probably have Graves'..........

Thyrotoxicosis, goiter, pretibial myxedema, exophthalmos.

http://www.thyroidmanager.org/Chapter11/11-frame.htm

Maybe your doc ran these (would you know?)......

ANTIBODIES TO TSH-RECEPTOR
Thyroid stimulating antibody assays (TSAb) have become readily available, and a positive result strongly supports the diagnosis [10.1]. The assay is valuable as another supporting fact in establishing the cause of exophthalmos, in the absence of thyrotoxicosis, and high levels may predict neonatal thyrotoxicosis. Measurement of TRAb (TSH-R binding antibodies), any antibody that binds to the TSH-R, is generally available, and while not as specific as TSAb, also supports the diagnosis of Graves. Using current tests, both are positive in about 90% of patients with Graves disease who are thyrotoxic. "Second generation" assays becoming available use monoclonal anti-TSH-R antibodies and biosynthetic TSH-R in coated tube assays, reach 99% specificity and sensitivity(10.11). Although rarely required, serial assays are of interest in following a patient's course during antithyroid drug therapy, and a decrease predicts probable remission [ 11.1, 11.2].

Are you going to call this guy? I am on pins and needles here. How are you feeling?


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## LonelyVoyager

LonelyVoyager said:


> Hi Everyone. Hope all is well with everyone. I am new to this forum. This is my story: I remember from many years ago that I was always an anxious kid, fretting about every minor thing. On several occasions the anxiety got to a point where it actually interfered with my life and school and all. The sad part is that every time I went to a doctor or student health office they just blamed it on school and I was given a prescription of Xanax, which I tried not to take much of as it made me really sleepy. Long story short, while at school couple weeks ago, I had an episode all of a sudden of severe headache, sweating, and tremblings. I had to go to student health. Now, that I was more grown up (24 y.o. male), and being a physiology major at college, I tried to persuade them to look at my thyroid levels. I really mean persuasion cause they DID NOT want to do anything, maybe go up on the xanax dose. Couple days passed and I got a letter in my mail:
> 
> *TSH: 0.014 (L) (normal range: 0.350-5.50)
> T4Free: 2.87 (H) (normal range: 0.89-1.76)
> T3Free: 9.0 (HH) (normal range: 2.3-4.2)*
> TSI: 31 (normal range: 0-139)
> 
> I was so happy to have found a cause to my relentless anxiety episodes. I just feel so sorry for many of us out there who are having similar problems and are not taken seriously.
> 
> My results however are not consistent with an inflammatory/autoimmune etiology to the hyperthyroidism as the TSI and TSH Receptor Antibody levels were all normal.
> 
> So, finally, after I would say 8 years of misery, I am being seen by an endocrinologist who has scheduled me to have a thyroid scan and uptake.
> 
> Now, my question is that if inflammation is not the likely cause, does that mean that I have a tumor (benign or otherwise) in my thyroid that's causing the hyperthyroidism?
> 
> Any suggestions would be appreciated. I am so glad that this forum and hope everyone feels better soon.
> 
> Thanks.


Hello Everyone! As promised, I am writing back with an update to my story. As you may know, I was diagnosed with hyperthyroidism (depressed TSH level, elevated T3 and T4 levels, with negative auto-antibodies) and was scheduled to have a radioiodine uptake and scan. Today concluded the second day of the test. Basically, the technician told me that both my 4-hr and 24-hr uptake results were abnormally low at 1% and 1.4% respectively. In the literature, the normal range of values is usually given as between 10 and 35% for 24-hr uptake, and between 6 and 18% for 4-hr uptake, according to the Society of Nuclear Medicine.
I do not know what the results mean exactly and am scheduled to see my endocrinologist in a couple weeks. Based on my blood tests, I was guessing that my test would show abnormally increased uptake, suggesting something like Hashimoto's Thyroiditis. But now I am a bit confused. How could you be both hyperthyroid and at the same time have a profound decreased uptake of iodine, one of the building blocks of thyroid hormone, into your gland? I guess my gland for one reason or another is just releasing whatever thyroid hormone it has in store without "feeling" like producing more. I don't know, but will keep you posted. 
Thanks for listening to my story.


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## Andros

LonelyVoyager said:


> Hello Everyone! As promised, I am writing back with an update to my story. As you may know, I was diagnosed with hyperthyroidism (depressed TSH level, elevated T3 and T4 levels, with negative auto-antibodies) and was scheduled to have a radioiodine uptake and scan. Today concluded the second day of the test. Basically, the technician told me that both my 4-hr and 24-hr uptake results were abnormally low at 1% and 1.4% respectively. In the literature, the normal range of values is usually given as between 10 and 35% for 24-hr uptake, and between 6 and 18% for 4-hr uptake, according to the Society of Nuclear Medicine.
> I do not know what the results mean exactly and am scheduled to see my endocrinologist in a couple weeks. Based on my blood tests, I was guessing that my test would show abnormally increased uptake, suggesting something like Hashimoto's Thyroiditis. But now I am a bit confused. How could you be both hyperthyroid and at the same time have a profound decreased uptake of iodine, one of the building blocks of thyroid hormone, into your gland? I guess my gland for one reason or another is just releasing whatever thyroid hormone it has in store without "feeling" like producing more. I don't know, but will keep you posted.
> Thanks for listening to my story.


First I must thank you for including your original posting with all previous info intact. That is a huge help to me.

Okay............

If the iodine uptake is very low in the presence of hyperthyroidism, this often implies the presence of inflammation or suppression of iodine uptake by excess iodine or exogenous drugs or ingestion of thyroid hormone. (so, this has to be ruled in or ruled out)

Radioactive iodine uptake can be measured. A trace amount of radioiodine is administered orally or IV; a scanner then detects the amount of radioiodine taken up by the thyroid. The preferred radioiodine isotope is 123I, which exposes the patient to minimal radiation (much less than 131I). Thyroid 123I uptake varies widely with iodine ingestion and is low in patients exposed to excess iodine.

The test is valuable in the differential diagnosis of hyperthyroidism (high uptake in Graves' disease, :confused0068:low uptake in thyroiditis-see Thyroid Disorders: Diagnosis). It may also help in the calculation of the dose of 131I needed for treatment of hyperthyroidism.

This all means that you "may" have Hashimoto's and that you are in the hyperthyroid state of that. The words Thyroiditis and Hashmoto's are used interchangeably.

Reference.......
http://www.merck.com/mmpe/sec12/ch152/ch152a.html#CIHJCBJI

Your doctor may also do a radioactive iodine uptake test to measure your thyroid's ability to take up iodine. A high uptake of iodine means your thyroid gland may be producing too much hormone, which indicates Graves' disease or a hyperfunctioning thyroid nodule. A low uptake of iodine indicates thyroiditis as the cause of your hyperthyroidism.
http://familydoctor.org/online/famdocen/home/common/hormone/869.html

I hope the above info has helped to erase the confusion. Do talk to your doctor about this.


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## LonelyVoyager

Andros said:


> First I must thank you for including your original posting with all previous info intact. That is a huge help to me.
> 
> Okay............
> 
> If the iodine uptake is very low in the presence of hyperthyroidism, this often implies the presence of inflammation or suppression of iodine uptake by excess iodine or exogenous drugs or ingestion of thyroid hormone. (so, this has to be ruled in or ruled out)
> 
> Radioactive iodine uptake can be measured. A trace amount of radioiodine is administered orally or IV; a scanner then detects the amount of radioiodine taken up by the thyroid. The preferred radioiodine isotope is 123I, which exposes the patient to minimal radiation (much less than 131I). Thyroid 123I uptake varies widely with iodine ingestion and is low in patients exposed to excess iodine.
> 
> The test is valuable in the differential diagnosis of hyperthyroidism (high uptake in Graves' disease, :confused0068:low uptake in thyroiditis-see Thyroid Disorders: Diagnosis). It may also help in the calculation of the dose of 131I needed for treatment of hyperthyroidism.
> 
> This all means that you "may" have Hashimoto's and that you are in the hyperthyroid state of that. The words Thyroiditis and Hashmoto's are used interchangeably.
> 
> Reference.......
> http://www.merck.com/mmpe/sec12/ch152/ch152a.html#CIHJCBJI
> 
> Your doctor may also do a radioactive iodine uptake test to measure your thyroid's ability to take up iodine. A high uptake of iodine means your thyroid gland may be producing too much hormone, which indicates Graves' disease or a hyperfunctioning thyroid nodule. A low uptake of iodine indicates thyroiditis as the cause of your hyperthyroidism.
> http://familydoctor.org/online/famdocen/home/common/hormone/869.html
> 
> I hope the above info has helped to erase the confusion. Do talk to your doctor about this.


Thanks Andros for your insightful comments. They are always much appreciated. I waited to see my doctor for my next visit before I posted a reply. He was also hinting at a possible case of thyroiditis. However, he said that my thyroid levels are increasing as measured on multiple visits spanning the last 2.5 months. The endocrinologist was saying that usually with thyroiditis the levels should be coming down in six weeks or so or at least show a sign of decline, but mine are trending up. At my last visit, he repeated the blood tests once again to see whether the thyroid hormone levels are showing signs of decline or further exacerbation. In addition to the usual TSH and free T3 and T4 hormones, he ordered an anti-thyroperoxidase and anti-thyroglobulin tests. He said that if the hormones are still elevated, I need to undergo a whole body scan to look for possible ectopic sources of thyroid secretion. He did mention that my case is rather unusual and perplexing. I didn't quite get some parts of the discussion, but the doc was saying that some germ-cell tumors can also cause hyperthyroidism. Let's just hope that that's not the case. I am so hopeless and confused and tired of all this. I just want my symptoms to go away or at least decrease in intensity or frequency. It seems that the investigation continues.:anim_03:


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## Andros

LonelyVoyager said:


> Thanks Andros for your insightful comments. They are always much appreciated. I waited to see my doctor for my next visit before I posted a reply. He was also hinting at a possible case of thyroiditis. However, he said that my thyroid levels are increasing as measured on multiple visits spanning the last 2.5 months. The endocrinologist was saying that usually with thyroiditis the levels should be coming down in six weeks or so or at least show a sign of decline, but mine are trending up. At my last visit, he repeated the blood tests once again to see whether the thyroid hormone levels are showing signs of decline or further exacerbation. In addition to the usual TSH and free T3 and T4 hormones, he ordered an anti-thyroperoxidase and anti-thyroglobulin tests. He said that if the hormones are still elevated, I need to undergo a whole body scan to look for possible ectopic sources of thyroid secretion. He did mention that my case is rather unusual and perplexing. I didn't quite get some parts of the discussion, but the doc was saying that some germ-cell tumors can also cause hyperthyroidism. Let's just hope that that's not the case. I am so hopeless and confused and tired of all this. I just want my symptoms to go away or at least decrease in intensity or frequency. It seems that the investigation continues.:anim_03:


Oh, ho!! I am impressed w/ this guy. Do you realize how many doctors do NOT know what ectopic thyroid tissue is??? Good for you.

Yes; thyroid tissue can and does attach it's self to other bodily organs such as the ovaries, heart, lungs, liver.......you name it.

Who is this guy? He knows his stuff boy!

Thank you so much for the update and I am keeping you in my thoughts and prayers.


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