# All labs in



## turnkey (May 8, 2013)

So this is my first post, and its a complex question, at least to me. So any and all help is greatly appreciated. Please note the ultrasound was done prior to the blood tests.

I am a 28y/o male 6'0" 213lbs with lean/athletic build. At my last physical the Dr said my thyroid was enlarged. And ran 4 separate blood tests + an ultrasound. Now the blood tests came back fine with no antibodies (eliminating hasimotos, or graves.)

My question is why would my thyroid by enlarged, and why do I have multiple nodules?

And why do I have NUMEROUS hyperthyroid symptoms such as:
occasional heart palpitations, anxiety, irritibility, eyes feel sensitive to light, I often feel very warm/hot when others are cold.

Also I have to eat 4000+ calories a day not to lose weight. I work out a lot 5/days a week, but if my calories don't stay up I can drop pounds without even trying. I am literally eating from sun up to sun down to maintain my current weight, and I know that has to be taking a toll on my body's other systems.

Test results:

THYROGLOBULN AB (GHC)	
THYROGLOBULIN ANTIBODY=	3.7, Range	0.0 - 4.0	IU/mL	
INTERPRETIVE INFORMATION: Thyroglobulin Antibody
A value of 4.0 IU/mL or less indicates a negative result
for thyroglobulin antibodies.

FREE THYROXINE (FT4)	
FREE THYROXINE= 1.39, Range 0.9-1.8	NG/DL

T3 TOTAL
T3,TOTAL=	107, Range	70-170ng/dL

TSH (REFLEXIVE)
TSH=	1.56, Range 0.3-5.5	uIU/mL

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U/S neck and/or thyroid (not a carotid doppler)

Narrative
[HST]: 28 yo male with enlarged thyroid on exam. no discrete nodules.

Thyroid ultrasound and neck ultrasound

Comparison: None available.

The right lobe measures 53 x 25 x 21 mm in length, AP diameter, and transverse diameter respectively.

The left lobe measures 53 x 20 x 22 mm in length, AP diameter, and transverse diameter respectively.

The thyroid gland is diffusely abnormal. It is diffusely 
heterogeneous with innumerable tiny hypoechoic nodules as well as hypervascularity. The pattern is most consistent with that expected with Hashimoto's thyroiditis. A circumscribed hypoechoic mass adjacent to the lower pole of the left lobe, inferior to it, is most consistent with a prominent lymph node that can be associated with Hashimoto's. It measures 13 x 8 x 11 mm in diameter. Please correlate clinically, including laboratory tests such as thyroid peroxidase antibodies.

Std/normal size by US = 4 cm long x 2 cm wide x 2.5 cm thick. 
Isthmus < 3 mm.

Impression
IMPRESSION:
Probable Hashimoto's thyroiditis
2. Prominent lymph node inferior to the lower pole of the left lobe is probably related to the suspected Hashimoto's thyroiditis


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## joplin1975 (Jul 21, 2011)

Hi there and welcome.

Am I reading this correctly that the only antibodies run were thyroglobulin? The most common antibodies to run to look at an autoimmune process are TPO and TSI, which I'm not seeing. The thyroglobulin is used to look for thyroid cancer, usually.

I think you'll also want to ask them to run a free t3 test (not total), as you sound a bit on the hyperthyroid side of things.

Did your doctor comment in the results?


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## turnkey (May 8, 2013)

Yes the only Antibody test that has been ran is THYROGLOBULN AB (GHC). My primary has not said much but has stuck with my referral to the Otolaryngologist, which is next week.

I did ask the question to an online Endocrinologist and this was his response:

Hashimotos can go through a period of thyroid inflammation, and then stabilize and become hypothyroid.

That is shy you might go from more hyperthyroid symptoms to hypothyroid symptoms.
Many symptoms overlap.

You don't always have to have positive antibodies even though this goes against hashimotos.

It can stay just as it is, or can become hypo over months 2 years.

Just because you have a high metabolism right now does not mean you are hyperthyroid...simply that your metabolism is high.

But the TSH needs to be watched as it is already heading to the higher end of normal. The higher the TSH, the more hypo.

3 and up is hypo.

So do I push my primary for the other antibody tests, and can it really still be hashis? This has been quite the roller coaster so far,.


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## joplin1975 (Jul 21, 2011)

It sure sounds like Hashi's. And, yes, you can easily swing back and forth.

I might wait for your appointment next week and see where that takes you, then reassess.


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## turnkey (May 8, 2013)

Thank you for the quick reply! I guess I will have to see where next week takes me.


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## turnkey (May 8, 2013)

Last result in :
Thyroid Peroxidase AB (GHC)= 456.3, Range 0.0 - 6.0

Confirming Hasi's according to my Dr.

Dumb question but is 456 abnormally high, I know I needed 0, but 456 seems ridiculously high.


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## Andros (Aug 26, 2009)

turnkey said:


> Thank you for the quick reply! I guess I will have to see where next week takes me.


Just in case while you are waiting to see your doc about all this, you may find the info below useful.

And as pointed out, the FREE T3 test is essential.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

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.healthcheckusa.com/

TSI
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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and 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/


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## joplin1975 (Jul 21, 2011)

turnkey said:


> Last result in :
> Thyroid Peroxidase AB (GHC)= 456.3, Range 0.0 - 6.0
> 
> Confirming Hasi's according to my Dr.
> ...


It's pretty high, but not out of the ballpark. Mine was in the 700s and I just recently saw another poster had hers in the 1,000s. But, yes, the 400s is high. You officially have a grumpy thyroid.


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## Andros (Aug 26, 2009)

turnkey said:


> Last result in :
> Thyroid Peroxidase AB (GHC)= 456.3, Range 0.0 - 6.0
> 
> Confirming Hasi's according to my Dr.
> ...


It is high; here is info on that because TPO is only suggestive of Hashi's. It is also suggestive of a myriad of other things.

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test


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## turnkey (May 8, 2013)

Just got back from the Otolaryngololgist.

Diagnosis: Hasimoto's Thyroiditis. You have completely normal thyroid function. Sometimes the thyroid can begin to put out too little thyroid hormone and supplements may be needed. Currently yours is normal.

So he wants to do nothing and thinks that a "free t3" test wont tell us anything. He did say I can go to the endocrinologist for another opinion on it if I would like, which I will probably do.

So is that it, just sit back an wait to go hypo?


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