# Newbie, questions about odd and contradictory results



## MiaV (Sep 20, 2011)

Hi everyone, I'm new here but I had lurked a bit on the past. I have some questions, and I would very much like to get your input since there are very knowledgeable people here (I will still consult my endocrinologist, but I can't for a month or two). First, let me tell you my story so far:

I'm 23 years old and I'm not diagnosed with a thyroid dysfunction yet, but a lot of things say something is wrong. The first time it was considered was a year and a half ago, I consulted a gynecologist for the fist time after going almost 6 months without a period, I didn't do it earlier because I've always had irregular periods, up to 3 months was very normal for me, and 4 months had happened in the past, I only worried when it was about to reach 5 months. He ordered some tests, and the only thing out of range was TSH, which was only slightly elevated, 4.64uUI/ml (lab range 0.27-4.20). So he ordered a hormone injection to induce my period and put me on the pill so they'll be regular. I was busy and didn't get the injection but my period came on its own a couple of weeks later.

So, I was referred to an endocrinologist. She ordered more bloodwork, a thyroid ultrasound, and a TRH stimulation test. The TRH stimulus test is the one where they draw blood to check TSH, then wait 25 minutes and do it again, TRH is supposed to stimulate the production of TSH so a normal person will see a fivefold increase (below 25uUI/ml), its useful for detecting hypothyroidism, specially secondary.

This time, everything fell in the right range, TSH went down to 2.47 and TSH post TRH was 18.36uUI/ml. The ultrasound show no nodules, but the report did mention the image was very irregular. The ultrasound technician also said to me that I was very likely hypothyroid but that I should confirm with bloodwork.

My endocrinologist said I very likely was hypothyroid at some point, and that I should continue to do early checks because it was likely to come back sometime, but that I was fine for now. She suggested that the pill, which I started to take a couple of months before, had somehow fixed my thyroid problem.

A couple of months later, my GP asked for a lot of blood tests at my annual check-up, including thyroid hormones. TSH was perfect (1.39MUI/L), total T3 was low at 14,5ng% (lab range 79-149ng%), and total T4 was normal but close to the upper limit, 12.17ug% (lab range 4.5-12.5ug%).

Then, a couple of months ago, I went for my annual pap smear test, it was a new gynecologist because I changed insurances, when she asked for my history she disliked the way I had been put on the pill without further investigation into my amenorrhea, saying something was clearly wrong and we should find out what it is. So she did the pap smear, a colposcopy and more hormone tests.

T3 came back high, 195ng/100ml (lab range 58-159ng/100ml)
TSH slightly high too, 3.8uUI/ml (lab range 0.50-3.50uUI/ml)
and normal free T4, 1.3ng/100ml (lab range 0.7-1.48ng/100ml)

also Prolactin was 25.9ng/ml (lab range 1.9 to 25.0ng/ml)

My gynecologist said it was definitely my thyroid messing with my periods, prolactin just a bit high pointed to thyroid problems as well, and that even if my numbers were only slightly out of range, I should still get treated because I was having symptoms. She was very vocal about it, and referred me to a small medical center that specializes in endocrinology.

My newest endo was surprised by all of my contradictory results (If you see above, my T3 was low, then less than a year later it was high, and somehow managed to be high when TSH was high, makes no sense), so she ordered yet more blood test from a lab she trusted (same as the one my latest results had come from) and a new TRH stimulation test (she thought my number could be higher now that a year had passed).

In the meantime she did a physical, and asked for history. This actually pointed to hyperthyroidism instead of hypo! She said I have tachycardia and hand tremors. I also had sudden weight loss a couple of years ago, just after I started swimming my appetite went up a lot, and I lost over 20pounds in the following months without even meaning to. Even after I stopped swimming I never recovered much of that weight and my appetite remained high.

She said that unless my new results came very obviously high she can't really treat me with medications because of all my contradictory results, since they change every month it would be very easy to mess it up. She doesn't really know what's going on but she agrees something is wrong and hopes that my newest results would be more consistent.

I got my results but was unable to get an appointment with her yet.
My TSH went down to normal range again, 1.8uUI/ml (lab range 0.50-3.50uUI/ml)
Free T4 remained exactly the same 1.3ng/100ml (lab range 0.7-1.48ng/100ml)
Glucose 75mg/100ml (lab range 70-110mg/100ml)
Insulin 4.5uUI/ml (lab range up to 18uUI/ml)

The only really surprising thing was my TRH stimulation test.
TSH post TRH was 1.6uUI/ml

That's even lower than the 1.8 result before the injection, that number is supposed to increase fivefold! The drug information that came with the TRH says nothing about a decrease in TSH (why would it go down after its production being stimulated?), but it does mention that "no response" points to hyperthyroidism.

So more contradictory results once again, I can't be hyperthyroid with a high-ish TSH (I also have no goitre) and it's not high enough for hypothyroidism either. In the mean time, I have symptoms for both things and blood test results that make no sense to anyone. There is a history of hypothyroidism in my family, all of my aunts (all 6 of them!) on both sides of the family have it, but not my mother. Besides the amenorrhea I also had alopecia areata (partial hair lost, a circle, that grew back on it's own after a couple of months) and I get consistent high cholesterol results, just out of range around 210 with the upper limit being 200, this no matter whether I'm eating healthy or not, makes no impact.

Although I don't get to see my Dr until a couple of months from now at the earliest, I'm pretty sure she won't be able to do anything about this, she says my symptoms are much to exaggerated for my numbers and that they correspond to more severe thyroid dysfunction. I think she may tell me to wait until it gets worse so it can be treated and check it every year. She also asked me to check with my allergist that my allergy shots do not affect thyroid testing, since it's immunotherapy, I haven't had the chance yet but everything points to it being irrelevant.
Is there any other test I may suggest to her that would be able to shed some light into this? Anyone with a similar experience?

I can't believe I made my first post so ridiculously long, I'm sorry! I just wanted to try and include everything since I thought anything might turn out to be important with such strange results. If you have any ideas please let me know! Thanks in advance.


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## Andros (Aug 26, 2009)

MiaV said:


> Hi everyone, I'm new here but I had lurked a bit on the past. I have some questions, and I would very much like to get your input since there are very knowledgeable people here (I will still consult my endocrinologist, but I can't for a month or two). First, let me tell you my story so far:
> 
> I'm 23 years old and I'm not diagnosed with a thyroid dysfunction yet, but a lot of things say something is wrong. The first time it was considered was a year and a half ago, I consulted a gynecologist for the fist time after going almost 6 months without a period, I didn't do it earlier because I've always had irregular periods, up to 3 months was very normal for me, and 4 months had happened in the past, I only worried when it was about to reach 5 months. He ordered some tests, and the only thing out of range was TSH, which was only slightly elevated, 4.64uUI/ml (lab range 0.27-4.20). So he ordered a hormone injection to induce my period and put me on the pill so they'll be regular. I was busy and didn't get the injection but my period came on its own a couple of weeks later.
> 
> ...


Mid-way my brain started saying, "hyper, hyper!" Yes you can be hyper with a high TSH.

Because there are blocking, binding and stimulating antibodies to the receptor sites. How about that?

Here is my world famous list for finding that out. LOL!

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/

About TSI, Thyroid Stimulating Immunoglobulin

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

Because the antibodies wax and wane, so do your numbers and there is also a lag time between the TSH and the T3 and T4 which by the way are not the best tests.

It would be "better" to get FREE T3 and FREE T4.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

Also, since you had an "irregular" image on the ultra-sound, it would be a good thing to get RAIU (radioactive uptake scan) as cancer needs to be ruled in or ruled out.

Sonograms have their purpose but they have their downside.

Also, radioactive uptake scan (RAIU); sonograms have limitations.

Ultra-sound limitations http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid


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## MiaV (Sep 20, 2011)

Thank you for a such a helpful answer! I was hoping to get an appointment this week and discuss this with my endocrinologist, but as I suspected, it wasn't possible. I'm having scoliosis surgery this monday, so I guess I'll just have to come back to this at least a month from now, once I'm able to go to appointments without help.
I'm definitely going to be mentioning this to my doctor, and see what she thinks, and I'll update this post again after that happens and I may even bug you with more questions!
In fact, one question now, if it were to be hyperthyroidism after all, is this something I should me mentioning to my spine surgeon? I guess it could be a problem if this were a heart surgery, but it's not related, it is, a major surgery however so I thought I should ask.


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## Andros (Aug 26, 2009)

MiaV said:


> Thank you for a such a helpful answer! I was hoping to get an appointment this week and discuss this with my endocrinologist, but as I suspected, it wasn't possible. I'm having scoliosis surgery this monday, so I guess I'll just have to come back to this at least a month from now, once I'm able to go to appointments without help.
> I'm definitely going to be mentioning this to my doctor, and see what she thinks, and I'll update this post again after that happens and I may even bug you with more questions!
> In fact, one question now, if it were to be hyperthyroidism after all, is this something I should me mentioning to my spine surgeon? I guess it could be a problem if this were a heart surgery, but it's not related, it is, a major surgery however so I thought I should ask.


Absolutely because most with hyper are violently allergic to Iodine in contrast material and anything that is adrenergic.

Please give the doctors, the surgeon and the anethesist a heads up on this.

I am keeping you in my prayers for your scolisosis surgery; God bless!


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