# Bummed by lab results



## applepie (Apr 6, 2011)

Background about me: I was Dx'ed with Graves Disease in April 2011. I had RAIU in Sept. 2010 b/c of suspicious blood work, PCP said result were fine. I progessively got sicker and sicker. HORRIBLE weakness, racing heart, short of breath, numerous bowel movements daily, awful tremors. Went back to PCP in March, was now dx'ed hyperthyroid. Saw Endo in April 2011, more test ran, dx'ed Graves.

I was put on Methimimazole 10mg intially, gradually increased to 40mg & propanolol ER. My symptoms have responded well, currently I have an occasional bout of tummy issues, but nothing like it was. All other symptoms are gone IMO.

I see my endo this Wednesday, I went and did the blood work he requested prior to the appointment. This time I opted to go to my PCP since they email me the results, the endo doesn't share them with me (I know I could ask, but was feeling better so I didn't really need to see them).

For comparisons sake here are thyroid related results from March 2011 that the PCP took-- this is what signaled the problem that sent me to the endo:

TSH <0.006 uIU/mL scale 0.450-4.500
Thyroxine (T4) 17.9 ug/dL scale 4.5-12.0

I've had 4 blood draws via the Endo since March I don;t have records of. Endo ovverview was its getting better, but not as much as I hoped.

Septemebr 2011 reults are:

Thyoxine (T4) Free, Direct 1.08ng/dL scale 0.82-1.77
TSH <0.006 uIU/mL scale .450-4.500
Triiodothyronine, Free Serum 4.9 pg/mL scale 2.0-4.4

I know the Doc porder other types of thyroid test on previous draws, but again..I don't have those #'s. Only # I understand is TSH...which hasn't changed?!?!

I'm bummed b/c Endo said if things aren't better by this blood draw we need to condider RAI-- which I prefer not to do. I *feel* better, if I didn't maybe I'd be all for RAI, but the medicine seems to be working to some degree, right? I'd rather ride out the medicine as long as I can? Are there any itfalls in doing that?

Any words of wisdom for me?


----------



## Andros (Aug 26, 2009)

applepie said:


> Background about me: I was Dx'ed with Graves Disease in April 2011. I had RAIU in Sept. 2010 b/c of suspicious blood work, PCP said result were fine. I progessively got sicker and sicker. HORRIBLE weakness, racing heart, short of breath, numerous bowel movements daily, awful tremors. Went back to PCP in March, was now dx'ed hyperthyroid. Saw Endo in April 2011, more test ran, dx'ed Graves.
> 
> I was put on Methimimazole 10mg intially, gradually increased to 40mg & propanolol ER. My symptoms have responded well, currently I have an occasional bout of tummy issues, but nothing like it was. All other symptoms are gone IMO.
> 
> ...


You are still hyper because your Triiodothyronine is over the range. In advanced cases of hyper, antithyroid rarely works well. That has been my personal observation; please don't carve that in stone.

Also, the anti-thyroid med is very very hard on your liver. Hopefully your doc is running liver enzymes periodically?

Now to the RAI. If I were in your shoes, I would opt for surgery so that the pathologist can have a good look at your gland. I had to have RAI 3 times (that goes to show how resistant advanced cases can be) and I regret not having the surgery. I was not given that option many years ago. I will always wonder about cancer. They do scans, they do FNA but bottom line; many many have been told they don't have cancer only to find that they in fact do when the gland is sent out to pathology. You see?

Do know that the above is only an opinion and whatever you choose to do, we will support you in that endeavor.


----------



## applepie (Apr 6, 2011)

Thank you Andros! You have been such a resource of knowledge for me!! I still plan to ask my Doc the same questions I threw out here, but at least I'm not going in totally ignorant of the spectrum of answers he can offer.

Is he doing liver enzymes tests... I can't recall him talking about it specifically, but he always gives me a slew of lab orders saying if X happens get Y lab drawn, or get X lab frawn this date...etc. I had lab done 4 weeks ago that was a more expansive list of what I just did.

I'd honestly prefer surgery, but from our conversations he seems like that is the road almost never travelled in his practice. He knows I'm not thrilled with RAI and casually discussed why, but I'm ready to have a more serious coversation of why's. None the less, surgery & RAI pose almost the same non-physical problems for me. (Young kids, time off from work, scheduling conflicts with DH) not to mention the phyiscal conerns. sigh...nothing is ever easy..



Andros said:


> You are still hyper because your Triiodothyronine is over the range. In advances cases of hyper, antithyroid rarely works well. That has been my personal observation; please don't carve that in stone.
> 
> Also, the anti-thyroid med is very very hard on your liver. Hopefully your doc is running liver enzymes periodically?
> 
> ...


----------



## Andros (Aug 26, 2009)

applepie said:


> Thank you Andros! You have been such a resource of knowledge for me!! I still plan to ask my Doc the same questions I threw out here, but at least I'm not going in totally ignorant of the spectrum of answers he can offer.
> 
> Is he doing liver enzymes tests... I can't recall him talking about it specifically, but he always gives me a slew of lab orders saying if X happens get Y lab drawn, or get X lab frawn this date...etc. I had lab done 4 weeks ago that was a more expansive list of what I just did.
> 
> I'd honestly prefer surgery, but from our conversations he seems like that is the road almost never travelled in his practice. He knows I'm not thrilled with RAI and casually discussed why, but I'm ready to have a more serious coversation of why's. None the less, surgery & RAI pose almost the same non-physical problems for me. (Young kids, time off from work, scheduling conflicts with DH) not to mention the phyiscal conerns. sigh...nothing is ever easy..


You can always elect to see an ENT surgeon on your own.

And if you so desire, please share comments made by your doc when you throw those questions in his/her direction!

And you are very welcome; it is always nice to know I am good for something! ROLF!


----------



## AZgirl (Nov 11, 2010)

Apple, first off, did they test your Ft3 and your Ft4? those numbers are very important here. As far as your TSH, which is also very important however, those numbers take longer to adjust with ATD. Doc do, but should NOT adjust according to your TSH.... FT3 and FT4 should change within the first 5-6 weeks, and TSH sometimes takes months to change! So eventually if you are finally going into somewhat normal range, becasue your ft2 and ft4 show it, but your TSH hasnt changed , that is normal for many people! please research this...There are also TSH-Receptors on the Pituitary gland ---- which is why people who have circulating TRab antibodies *OFTEN* will not be secreting TSH (which is a hormone that comes from the pituitary in response to hormone level).

THIS IS WHY IT IS DANGEROUS TO USE TSH AS A GUIDE DURING ATD THERAPY. USE FREE T4 and FREE T3 ***ONLY*** until TSH recovers.

.I agree i would prefer sugery over RAI most def!!! but i think you havent had the proper medicine evaluation which is quite common. I was very hypo, VERY and wash pushed into RAI and i refused, they argued with me that the meds will not work and its not perminate. So onto the next endo i went. At least she agreed to let me continue with meds, but she was not the greatest for reading labs!!! I finally have hooked up with a 3rd endo, who is 100% in agreeance with me regarding meds and h ow to regulate. I am doing quite well now, almost a year has gone by, My levels are almost perfect now, and my antibodies are FINALLY dropping quite a bit! as per my new endo, and myself, i will continue even when all is well for an additional year to be certain to clearify me as in REMISSION!


----------

