# Lab Test Results



## Dave J (Jun 26, 2010)

My name is Dave

My lab Test Results came back:

TSH 0.08 L

Free T4 1.53

Total T3 109

Lab Ranges: TSH: 0.27-4.20 ml/U/L

Free T4: 0.80-190 ng/dl

Total T3: 80-200 ng/dl

I have seen an Endo Thursday 6-24-10 with blood work tests above and known goiters that have been checked for size and cancer. Ultra Sounds have been done now and in the past two years ago. My GP did not send me to the Endo I went on my own for a specialist to determine thyroid problems.

This was my first visit to an Endo and he looked at all my tests, took his own Ultra Sound noticed I did have multiple goiters and said there was nothing to really worry about. I did let him know my Mother had her Thyroid removed before us kids were born and both sisters have been diagnosed with Thyroid problems one Graves and the other Hashimoto.

My biggest concern over the past two years has been my depressive bouts and not knowing whether the thyroid was the cause. This Endo once this subject was discussed said it was definitely not caused by my Thyroid along with telling me there was nothing that really needed treating? Seems he thought I was a little crazy thinking my thyroid could cause my depression, this was the impression I got from his explanation.

He did relent and prescribed Tapazole 5mg since I was insistent about my TSH being low. Should the TSH low reading be a concern since his thoughts of the FreeT3 and Total T4 were within lab normal ranges and explained they would be the more important factors?

Maybe what I am looking for is a second opinion since I have been relying on doctors now 9 weeks and still feeling the way I do. I realize this is not long for many but work has suffered being out the entire 9 weeks and becoming cash poor.

Any help would be great appreciated,

Dave J.


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## Andros (Aug 26, 2009)

Dave J said:


> My name is Dave
> 
> My lab Test Results came back:
> 
> ...


If you have a goiter and nodules; something is afoot!! Welcome to the board, Dave!

It would interesting to know the ranges as no two labs use the same ranges. And your TSH is low but we keep mine @ 0.03 so I am not worried about that but I am worried about where exactly the FREES are within the range that your lab uses.

That said, if the doctor had all your signs and symptoms; he/she would be worried.

You may be hyperthyroid and there is one lab test that would let us know for sure. That is TSI (thyroid stimulating immunoglobulin.) You should have none; if you do, that is hyperthyroid.

Here is info on that........
http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22

Then, I think ruling out cancer if very important and for that reason, I suggest a radioactive uptake scan as sonograms/ultra-sounds have their good points and bad points. One bad being they do not pick up everything.

Here is info on that.......
http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid

It happens to be a fact that thyroid affect the brain in a very big way and yes; thyroid disease can lend it's self to depression.

Here is info on that............
http://www.mayoclinic.com/health/thyroid-disease/AN00986

http://thyroid-disorders.suite101.com/article.cfm/thyroid_disease_related_depression


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## CA-Lynn (Apr 29, 2010)

Dave, if you don't feel fully confident in the current endo, take the time to go to a university medical school and be checked by an endocrinologist there.

Good luck!


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## Lovlkn (Dec 20, 2009)

Hi Dave,

Do you have any other labs?

Low TSH says hyper but lower FT-3 says hypo.

Please explain... were these labs taken while you have been on Tapazole?

I would say further testing needs to be done before beginning any medications.

As far as your depression questions, any movement in thyroid levels can cause shifts in mental moods.

My personal opinion.


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## Dave J (Jun 26, 2010)

Lovlkn:

I have no other blood tests strictly for the thyroid other than what has been posted. I did have CBC Blood test and Lipid blood test when I was admitted to the hospital then a mental health facility. The meds I was put on had an adverse affect and was concerned so I was brought to the hospital upon my own request.

The blood tests were not taken while I was on Tapazole, I have just been put on Tapazole since Thursday June 24th only because the Endo was pressured by me about the Low TSH on the blood test. He prescribed only 5mg of Tapazole and said you may feel better after taking this a while but really thought it was unnecessary.

I have noticed loss of weight quickly overnight {2-3lbs} and during the day between meals even though my appetite is very healthy with no exercise and physical work being done.

I hope this reply helps.

Dave


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## Lovlkn (Dec 20, 2009)

Dave-

You need to get a second opinion and have some antibodies tests run.

Pressuring a doctor who then writes you a prescription for a thyroid medication is concerning to me.

You need to look at all thyroid results and consider them before treating. TSH is a screening test that the doctors use first to identify thyroid issues and dosing should not be based on it alone although many doctors do just that.

Check out this link from Labcorp -
A low TSH with a normal FT4 and an elevated FT3 would
be suggestive of T3 Thyrotoxicosis in the appropriate
clinical setting.

www.labcorp.com/pdf/Thyroid_Cascade_Flyer_1644_1.pdf

What you need to figure out is if it is being caused from a nodule or antibodies. If you have nodules further testing of them needs to take place.


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## Andros (Aug 26, 2009)

Dave J said:


> Lovlkn:
> 
> I have no other blood tests strictly for the thyroid other than what has been posted. I did have CBC Blood test and Lipid blood test when I was admitted to the hospital then a mental health facility. The meds I was put on had an adverse affect and was concerned so I was brought to the hospital upon my own request.
> 
> ...


I agree w/ Lovlkn. Here are some antibodies' test indigenous to the thyroid.

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/understanding/conditions/thyroid.html


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## Dave J (Jun 26, 2010)

Hello:

Mentioned in the replies are more testing? My first visit to an endo was Thursday June 24th 2010 prior to this I was strickly seeing my GP the past two years with some time gaps in between testing.

Below I have listed the testing done from 8-2008 till 6-2010:

1.} Thyroid ultra sound {exam name} 8-25-08

Impression: Multi nodular goiter with large nodules bilaterally. Findings consistant with multi nodular goiter.

2.} Thyroid Uptake and Scan. {exam name} 9-5-08

Impression: Multi nodular goiter hypofunctioning {cold}
Redioiodine uptake normal.

3.} Ultrasound guided biopsy of three thyroid nodules. 6-11-09

Impression:Benign no cancer.

4.} Thyroid Ultra sound. 6-11-09

Impression: Multi nodular goiter. Some growth of dominant nodule upper pole left lobe thyroid.

5.} Thyroid ultra sound follow-up. 4-28-10

Follow-up multi nodular goiter.

Impression: Mild interval increase in overall size of thyroid gland. Given the heterogeneity of the thyroid parenchyma some of the nodules are not discretely identified on current examination. Apparent change in the nodule sizes is partly related to difference in technique and measurements.

The above reports I requested from the GP before my visit with the Endo June 24th 2010 which he looked at and really saw nothing wrong except the multi nodules which didn't seemed to worry him.

As mentioned earlier I pressed the issue of the TSH being sensitively low on the blood tests in May 2010 and the Endo reluctantly agreed to prescribe Tapazole. He knew I was worried about the low TSH level and said Maybe this will make you feel better try it. My impression was he was appeasing me with the low dosage of Tapazole 5mg daily. I have been taking the dosage as of 6-24-10 with no benefits appearing yet.

I have mention in a previous post I am eating regular with a good appetite, snacks before bed with loss of weight overnight on average 2 lbs. Hunger seems to reappear soon after I eat within an hour or so and eat 3-meals a day with late night snack is this normal?

The GP wants me to realize my depression is totally not related to my thyroid but am still not convinced it couldn't be something with the endocrine system or other problems? He wants me just to continue on his prescribed anti depressants to recover.

Thanks,

Dave


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## CA-Lynn (Apr 29, 2010)

Doctors other than psychiatrists, neurologists, and some neuroendocrinologists are, in my opinion, ill-equipped to diagnose depression and too often hand out antidepressants like M&M's. Too, taking antidepressants without dealing with the psychological issues themselves rarely works. Doctors would do better to refer the patient to a psychiatrist.

Nonetheless, *NEVER *stop taking antidepressants without a doctor's supervision.

Which antidepressants did the doctor prescribe? Were they prescribed PRIOR to any thyroid issues?


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## Andros (Aug 26, 2009)

Dave J said:


> Hello:
> 
> Mentioned in the replies are more testing? My first visit to an endo was Thursday June 24th 2010 prior to this I was strickly seeing my GP the past two years with some time gaps in between testing.
> 
> ...


Just a thought. Any further testing you might require at this point for the thyroid could possibly be skewed by the Tapazole.

And................of course you know that hypofunctioning cold nodules need to be watched regularly. Out of 40% of patient with the above, 15% end up having cancer.

So, talk to your doc about it.


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## Dave J (Jun 26, 2010)

CA Lynn:

I was on both Wellbutrin and later on Depakote between end of April 2010 and June 12th 2010 which I did stop and began Sam-E around the 6-14-2010. The anti meds were making me feel worse rather than better and wanted to try the natural aid including sleep aid and fish oil.

The anti depressant I was not on long enough to really have affects of withdrawal. The problems that still exist now are depression not lifting and minimal sleep 3-4 hours along with a healthy appetite and weight I lose between meals. The natural aids have only been taken for about 7-8 days though with hopes they will begin helping my condition soon.

I realize this seems drastic but the anti depressants are not good, my thoughts are this could be caused by other medical conditions that come on and then disappear. The thyroid nodules {multi} and the TSH at: 0.08 or possibly hormones like cortisol or testostrone levels?

Thank you for your help,

Dave


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## Dave J (Jun 26, 2010)

Andros:

Why won't one of the doctors I have been to request an anti-body test not just The T4,T3, and TSH ?

Dave


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## Andros (Aug 26, 2009)

Dave J said:


> Andros:
> 
> Why won't one of the doctors I have been to request an anti-body test not just The T4,T3, and TSH ?
> 
> Dave


I have no earthly idea unless your insurance is controlling all this. Demand those antibodies' tests; this is the only way to get to the bottom of all this.

Let us know what happens.


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## Dave J (Jun 26, 2010)

Andros:

I have begged my GP to order these anti body tests once he hadn't that's when I decided to see an Endo hoping he would. He has delayed any blood tests until my next appointment in August two months from when I had seen him. I want to know now especially the TSI, what should I do? Is the TSI the most important of the anti-body tests??? Please advise me what should be done immediately. Lots of questions and requests have thrown into my GP's lap prior to seeing the Endo, am very anxious the get results hopefully he agrees.

Thanks,

Dave


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## CA-Lynn (Apr 29, 2010)

Curious why your doctor prescribed Depakote. Were you having seizures? Are you bipolar? *Prescribed by the general practitioner?* What kind of doctor diagnosed the depression?

The PDR indicates there could be problems with the outcome of thyroid function tests if the patient is taking Depakote. In any case, if you are no longer on Depakote, could be the endocrinologist is waiting for it to clear the system before retesting for thyroid.


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## Dave J (Jun 26, 2010)

Ca-Lynn:

Depakote was prescribed to replace Wellbutrin while in a hospital setting which acts like a mood stabilizer I was told.

I have had other depressive episodes over the years but just recently learned {2 yrs ago} my older sister was diagnosed with Graves along with younger sister having Hashimoto. My Mom had her thyroid out before all us kids were born and never really took that into account with my medical problems especially depression. I began having tests two years ago and it was discovered I had Low TSH 0.08 {suppressed} and over sized goiters Multi nodular. My GP did testing: Ultra Sounds, Thyroid Uptake Scan, Biopsies, blood tests and concluded there was nothing out of normal. I didn't pursue anything then because I began to feel better but my symptoms returned this Spring and did want to totally rule out thyroid as a problem. Please read my earlier posts to get a handle on my medical history and why I am leaning toward this. I do feel doctors immediately prescribe anti depressants too freely and in my case when possible thyroid and endocrine could cause this?

Thanks,

Dave


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## CA-Lynn (Apr 29, 2010)

Actually, I had reread the thread before I posted the last message.

Depakote is not generally the first line of drugs to prescribe for depression, which is why I asked if there was another diagnosis that perhaps you had not posted here.

Seems to me that the best course of action is to stay on track and get all those tests run in August.


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## Dave J (Jun 26, 2010)

Ca-Lynn:

I have suffered from late April till now and am still suffering not feeling well, being out of work and with debilitating symptoms {Depression Like} begging for anti body blood tests when the doctors have written off the thyroid as not being troublesome. I still believe without thoroughly eliminating thyroid I won't have peace of mind. Unless the thyroid tests are so conclusive seems the doctors disregard any chance of problems and look no further maybe it stems with insurance companies........??

Dave


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## CA-Lynn (Apr 29, 2010)

Dave,

Being out of work can play havoc on your mental well-being especially when you're already dealing with a physical condition. I'm really sorry you're going through all that.

What is the reason for waiting until August to see the endo? Is it just that he wants to allow some time to go by and see if anything shifts?


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## Dave J (Jun 26, 2010)

Ca-Lynn:

The endo prescribed a small dosage of Tapazole {5mg} to suppress the thyroid now in June and I am guessing we wants to see what affects it has on the blood work in August. What I really want is the anti body test now though.

Dave


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## Lovlkn (Dec 20, 2009)

Hi Dave,

My experiences were before my eventual diagnosis of Graves was the doctors continually pushing anti depressants on me. I always refused and after 2 years of telling them I had a thyroid issue my gyno finally sent me to an endo after running some tests.

Go to a different endo or go to a different GP. I tried 3 doctors before I got one to recognize it was a thyroid issue. With such a family history I would think they would be monitoring your thyroid function.

How is the tapazole working for you and how much are you taking?

Has one of your symptoms been heart palpitations? (due most likely to the high T-3)


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## Dave J (Jun 26, 2010)

Hello Lovlkn:

The tapazole {5mg} was just begun last Thursday 6-24-10 and haven't felt any different.

No heart palpitations are noticed.

All I want is a doctor that will be completely thorough and look for possible problems even if most of testing seems normal to them with exceptions like my TSH {0.08} and Multi Nodular Goiters.

I mope at home all day long getting through the day with no improvements which leads the the next day. I do get online to this very helpful Thyroid Boards that has helped me at least discuss problems.

Please advise me if you have seen others on this site with similar symptoms that could be contacted.

Thank you,

Dave


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