# Ultrasound and Bloodwork



## Tasha01 (Feb 20, 2014)

At a regular check up a week ago my doctor noticed my right thyroid was enlarged, he described it as being smooth to his student doctor. He ordered an ultrasound and took blood work. I called for my results and the secretary told me shed speak with the doctor and call me back. This was before my ultrasound results were in.
She called me back and said my thyroid was normal but the doctor needed to speak with me about my blood work and made me an appointment. Well im not very patient so i found something from the hospital he works through and sends his bloodwork to that allows you to view test Results and i have searched and searched.. And see no reason for further discussion. Im not complaining, id appreciate further discussion because theres a lot of stuff i didnt tell him. Im just not understanding why he feels the need to discuss my blood work in person. So im going to put my results here and hope maybe one of you can spot it. Im including my ultrasound results because theyve got me curious as well. I do find it rather particular that my thyroid that i cannot feel by touching is the one that has a cyst.
Right thyroid: 5.5x1.8x1.9cm
Left Thyroid: 4.9x1.6x1.3cm
Superior aspect of left thyroid Avascular cystic lesion 8x5x4mm the thyroid gland is otherwise homogenous and unremarkable in echotexture
Described under the impressions as : Mild Assymetry of thyroid gland
Small nonspecific simple cyst within superior portion of left thyroid Lobe. No other thyroid follicle abnormalties detected

On to the blood work Which all seems to be perfect according to standard ranges at the lab it was done with the exception of two blood counts all of one point off.

Vitamin b12 is 664, range is 250-900

Hemoglobin is 16, range is 12-15

Hematocrit is 47.3, range is 36-46

RDW is 13, range is less than 14.5
All other blood counts are smack dab in the middle of the range

FOLATE, Serum is greater than 24, range Is greater than 5.4

Free T4 1.2, range 0.8-1.8

Thyroglobulin is 22, range is less than 35

Thyroglobulin Antibody is less than 15, range is less than 60

Thy. Peroxidase Antibody is 35, range is less than 60

THS is 1.32, ranges 0.3-5

Uric Acid is 3.5, range is 2.6-6

Okay now some added medical history of mine and some more questions. I will not be offened if you stop reading at this point for i know this is extremely long!
Ive had my THS levels checked 5 times by 5 different doctors without me really knowing why. Ive had two ultrasounds on my right thyroid and one ct with contrast on my right thyroid. The ct was the begining of thyroid related testing for me. I was 16 (now 25) and my mom noticed by looking at me that the right side of my neck was huge. She insisted on taking me to the er where the doctors were for whatever baffled. Theyd come in one by one, feel my neck, and say "hm" then go get another doctor to do the same. After the ct i was diagnosed with a cyst and sent to a pcp. Where i was then told he was not the doc for me and sent to a ent.. Who told me the same thing and sent me to an endo whatever that word is.. Who sent me to someone else and someone else until i got sick of sitting in waiting rooms for hours only to be seen for a milisecond and sent away and gave up. 
It eventually went down but its always seemed a tad large to me but i figure thats because im self concious that it looks like a have a fat neck. 
Shortly before that whole thing i was diagnosed with PCOS. At 18 i was diagnosed with hypoglycemia. Ive lacked energy since 16. The past couple years Ive had my "spells" where im completely drained and cant get out of bed. I always put that off as me being a full time college student and having a household to manage being over run and my body telling me its time to take a break. However these "spells" are becoming more and morr common. 
I have almost all the symptoms for hypothyroid.. Though some can be explained by my ADD. My aunt has hashimotos and hypothyroid. Almost everyone in my family has an autoimmune disease. While taking all of this Into consideration along with my perfect thyroid numbers would it be more appropiate to ask for further testing on my thyroid such as free t3,reversed t3 ect or should we look elsewhere for a cause of my symptoms?
Also, should i mention these following symptoms to my doctor in relation to my enlarged thyroid or are they irrelevant. I have pain often located on the right side of the back of my neck. Sometimes just discomfort and hard to hold my head comfortably, other times if i move quickly a throbbing tightening. Sometimes it radiates through my back around my shoulder muscle. Lately its been radiating up my jaw and ear. Its uncomfortable to sit in any position or lay in any position. Ive always figured this was due to sleeping on it incorrectly, pulled muscle or something, but could it be related to my thyroid being enlarged? And i often lose my voice. Ill be completely fine and out of no where it starts cracking and then i cant talk for a while. I am a long time smoker though. And ive been getting out of breath quick and wheezing often. I use to park on the opposet side of my school building and Speed walk to class and up the stairs though i wouldnt have considered myself at the time to be in good shape walking and stairs didnt bother me any. Lately however i need to park much closer, walk somewhat slowly.. and by the time i get to the stairs my breathings already increased and i can barely make it up this small flight of stairs.. By the time im in my class i can hardly breathe and feel like im going to pass out. Can any of that be related to the size of my thyroid? Thank you so so much to anyone who has taken The time to read all of this and id appreciate any answers anyone may have for me.


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## Tasha01 (Feb 20, 2014)

Peculiar! Not particular haha


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## Tasha01 (Feb 20, 2014)

Been surfing the forumns here and noticed other peoples labs standard ranges are wayyy lower than mine for the antibodies. Why is this? At their lab my antibodies would be concidered high but at my lab theyre low? Makes no sense to me.


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## Andros (Aug 26, 2009)

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

For one thing; you should not have these antibodies at all except for a very small amount of Thryoglobulin.

Read the above link, please!


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## Tasha01 (Feb 20, 2014)

Thank you! So what I got from reading that.. Is they should be watched because it COULD develope into hashimotos since its not normal to have any... But Theres not enough to actually have it which is why im in range still?


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## Tasha01 (Feb 20, 2014)

More questions. Sorry i keep posting im just really confused and have a need to understand how things work.
1. On the differences of range. My levels and ranges of 35 and less than 60 compared to other ranges of 0-34.. Does that mean if i were go to a 0-34 lab id be considered out of range? Or does that mean my value would be 9 at a lab range pf 0-34 considering at my lab im 25 points under the max level
2. What exactly does this mean in terms of positive and negative? Would i be considered positive for the antibodies because i have detectable levels would i be considered negative for them because im within range?
3. The free t4. On some things i see that you may still need treatment if its on the lower range and my exact values and ranges being used as an example of a lower range. On others i seen the same example being used for a good amount of free t4. 
4. Is there a "formula" for free t4 in relation to ths? Like a this value should have the free t4 of this value. Wouldnt this be a much more accurate indicator of whats going on? Such as someone with a free t4 lower than it should be with x level with tsh indicates a problem with the pituitary gland.


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## joplin1975 (Jul 21, 2011)

1) You would likely have a different number if you went to a different lab, because the way they tested the blood and got the result would be different. You can't compare the two. Disregard the reference ranges for other labs and only focus on the ranges you have for your blood work for your lab.

2) I don't like the terms "positive" and "negative" in regard to antibodies. If you have antibodies but the result is in range, usually what they means is that you have a thyroid condition that is brewing but isn't "full blown" yet.

3) and 4) Simply, you should aim for mid point to 75% of the reference range for free t4 AND free t3 (which you haven't had tested and is critically important). The number itself isn't important, it's where you fall in the range that IS important. Midpoint of the reference range for your free t4 test is 1.3. You are just below that...and so you have some wiggle room. One approach might be to try to boost that with a some t4 meds. With thyroids, there is never a easy formula that X + Y = Z. Some people, for example, feel great with a TSH of 2...other would feel miserable unless it gets clsoer to 1. You have to try to optimize your lab results, analyze those in concert with your symptoms and then muddle through it from there.


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