# Are these labs normal?



## JSprenkle (Feb 20, 2011)

I had been dealing with an "alternative" doctor by phone for help with my thyroid, but decided to give my family doc another try. The last time my labs were taken, she said they were normal, but I'm not sure. I also may have skewed the results by taking an extra 50 mcg of synthroid the morning I had the labs done, because I was feeling extremely tired. I went to the doctor for a non-thyroid visit and ended up having blood drawn for labs (if I had known this was going to happen in the afternoon I never would have taken more synthroid in the morning). Here are my results:

TSH 0.93 mcIU/mL (range 0.30 - 5.00)
Free T4	0.7 ng/dL (range 0.6 - 1.6)
Free T3	2.9 pg/mL (range 2.5 - 3.9)

I was diagnosed hypothyroid several years ago, but still am not feeling great. I go through periods where I don't feel too bad and even feel a little hyped up and anxious, but those alternate with periods of feeling very sluggish and fatigued, muscle aches in my thighs, brain fog and hair loss. My TPOab (<10 with range <35) and Thyroglobulin AB (<20 with range <20) were tested years ago, and came back normal. The last time my TSI was tested, it was 121 with a reference range of <=125. Since the TSI was so close to the range, I'm not sure if this means anything.

Thanks for any help!


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## Andros (Aug 26, 2009)

JSprenkle said:


> I had been dealing with an "alternative" doctor by phone for help with my thyroid, but decided to give my family doc another try. The last time my labs were taken, she said they were normal, but I'm not sure. I also may have skewed the results by taking an extra 50 mcg of synthroid the morning I had the labs done, because I was feeling extremely tired. I went to the doctor for a non-thyroid visit and ended up having blood drawn for labs (if I had known this was going to happen in the afternoon I never would have taken more synthroid in the morning). Here are my results:
> 
> TSH 0.93 mcIU/mL (range 0.30 - 5.00)
> Free T4	0.7 ng/dL (range 0.6 - 1.6)
> ...


TSI means a lot. You should not have any. This backs up your labs for in spite of the fact that you took "extra" Synthroid the morning of the labs, your FT4 is in the basement which means to me that the blocking and binding antibodies are at work and I did "think" that before I read your post. I could tell right away from your labs that they were being skewed by the blocking, binding and stimulating antibodies.

The other thought would be pituitary but I don't think so. I am rather familiar with this TSI stuff. But pituitary does need to be considered. The fact that you are taking Synthroid though kind of makes me think not. All your lab results are very low. (TSH, FT3 and FT4)

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://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

When you have any TSI at all, that means you are hyperthyroid. That also means that you may not appear to be if the binding and blocking antibodies to the receptor sites are in the scenario which I am thinking that they are.

As far as I am concerned, you are hyperthyroid and I would like to recommend that you get RAIU (radioactive uptake scan) for rate of uptake and to screen for cancer as hyper and cancer are often found as bedfellows.

Graves' and Hashi's cancer
http://www.thyroidmanager.org/Chapter18/18-cancothr.htm

I would like to also recommend that you get all these tests anew and not rely on old tests.

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/

You cannot be feeling well and for that I am sorry! And while I am not a doctor, I am not sure you should be on Synthroid at this time. Especially if you schedule RAIU; you need to be off of it for several weeks prior.

And I am "wondering" what your doctor has had to say about all of this? Can you share?

Let us know what "you" think also.


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## JSprenkle (Feb 20, 2011)

Hi Andros! Thanks for your reply. I have never considered being hyperT as I am overweight and tired more often than not. Don't know if this means anything, but I have been on an SSRI for years for anxiety. While under my alternative doctor's care, I had the TBII done 1-1/2 years ago, and it was <6 with a reference range <16. He also ran the ANA Titer which came back speckled and 1:320 (> 1:80 is considered high). We never did determine why that was high, but it went down a good bit after I eliminated gluten from my diet (not sure if related or coincidental). It's been years, but I had a blood test on the pituitary that came back normal.

You mentioned eliminating the synthroid. My alternative doc added that since my FT4 was always in the bottom of the range and I still was having no energy. I can say it really hasn't made a difference.

My family doctors have never wanted to consider more than the TSH, so that's why I sought help from another doctor. I am seeing my family doctor for sinus issues, so thought I'd try again with the family doctor on my thyroid. I think I'm going to have to go back to the alternative doc if I want to get anywhere. Only drawback, is he is about 1-1/2 hours away and we normally do a phone consult after I have labs done. Also, my family practice is "weird" and not receptive to having another unknown doc involved. I'm sure my alternative doc would order all of the labs you suggested as he is willing to look at all angles.

Thanks so much for your help and input!!


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## Andros (Aug 26, 2009)

JSprenkle said:


> Hi Andros! Thanks for your reply. I have never considered being hyperT as I am overweight and tired more often than not. Don't know if this means anything, but I have been on an SSRI for years for anxiety. While under my alternative doctor's care, I had the TBII done 1-1/2 years ago, and it was <6 with a reference range <16. He also ran the ANA Titer which came back speckled and 1:320 (> 1:80 is considered high). We never did determine why that was high, but it went down a good bit after I eliminated gluten from my diet (not sure if related or coincidental). It's been years, but I had a blood test on the pituitary that came back normal.
> 
> You mentioned eliminating the synthroid. My alternative doc added that since my FT4 was always in the bottom of the range and I still was having no energy. I can say it really hasn't made a difference.
> 
> ...


Many of us with Hyper/Graves' became overweight. Symptoms can and do cross over; believe that or not.

"If" you are hyper, the FT4 is converting to FT3 very very fast and your body could be burning it up really fast even while resting. This silent fast metabolism leaves the patient exhausted and they are challenged to know why because they know they did not run a marathon. This is all very insideous.

You probably know that TBII is a "blocking" Thyrotropin immunoglobulin and probably would not be present if TSI (thyroid stimulatining immunoglobulin) were not present.

Good luck with whatever doc you chose. I feel like more in-depth testing should be done.

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/

I meant to say that I think that SSRI inhibits the thyroid so....................?? If you have been hyper, it would mask it. Something to consider!

copy and paste

With antidepressant treatment, the most common change in thyroid hormones is a decrease in T4 and free T4 without a significant reduction in TSH.2,5 Of note, these changes are generally within the euthyroid range of values. Some studies have shown that responders to antidepressants show a greater decrease in T4 levels compared with nonresponders.8,9 Etc.

Full article here..
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC518867/


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## JSprenkle (Feb 20, 2011)

Thanks again, Andros. Your thoughts certainly make sense. Before taking SSRI's, I thought I was having panic attacks with heart palps, shortness of breath, dizziness, etc. Maybe it wasn't anxiety after all, but I've been on the Zoloft so long it's hard to know.

Is there any significance to the TBII being <6 with a reference range <16? Is this another one where there should be none at all? At the time, my doc didn't mention that this result was anything out of the ordinary. Also, I find it odd that none of the docs have ever felt my thyroid. Do they only do that if they can see a bulge on your neck?

Thanks so much for your help! I really appreciate it.


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## Lovlkn (Dec 20, 2009)

Personally, I would ask your doctor about increasing your Synthroid 100mcg and re-test in 6 weeks to see where you are. Your levels are extremely hypo and 50mcg is a low dose.


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## Andros (Aug 26, 2009)

JSprenkle said:


> Thanks again, Andros. Your thoughts certainly make sense. Before taking SSRI's, I thought I was having panic attacks with heart palps, shortness of breath, dizziness, etc. Maybe it wasn't anxiety after all, but I've been on the Zoloft so long it's hard to know.
> 
> Is there any significance to the TBII being <6 with a reference range <16? Is this another one where there should be none at all? At the time, my doc didn't mention that this result was anything out of the ordinary. Also, I find it odd that none of the docs have ever felt my thyroid. Do they only do that if they can see a bulge on your neck?
> 
> Thanks so much for your help! I really appreciate it.


That is correct; there should be none. You have a "smattering" so something is afoot! it is below the range but yes, it "is" there.

It is a blocking immunoglobulin and would not be there if there were not a stimulating immunoglobulin to block. Hope this makes sense. Sometimes it is hard to explain things the way I see it and would like others to see it the same. Yikes!

In all my life, I don't think a single doc ever felt my neck and I had a goiter. Doctors don't touch patients anymore if they can help it period. I am "lucky"; my doctor shakes my hand upon entering and hugs me upon leaving and I hug her back. It is awesome. LOL!!!


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## lavender (Jul 13, 2010)

Andros said:


> In all my life, I don't think a single doc ever felt my neck and I had a goiter. Doctors don't touch patients anymore if they can help it period. I am "lucky"; my doctor shakes my hand upon entering and hugs me upon leaving and I hug her back. It is awesome. LOL!!!


I want a doctor like that. My last PCP was very personable with me, and was willing to touch me (no hugs). Unfortunately, she was not willing/able to treat me. I like that my new doc is prescribing meds that are working, but I miss the sense of caring that I got from my last doc. (although she examined me for a goiter dozens of times after I was diagnosed and never found one!)


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## JSprenkle (Feb 20, 2011)

Thanks to everyone for the help.

Andros, sounds like you have a great doctor...hugs are definitely uncommon! Lavender, that is great that you have a doc that is successful in treating you. I really value the sense of caring in a doctor, too (maybe they should teach that in med school).

Thanks for the answer about the TBII, Andros. I thought your explanation was good...makes me think of football players (TSI) getting tackled by the other team (TBII). Probably a bad analogy, but all of this thyroid stuff gets confusing. Is this something most endocrinologists will understand? That sounds like a dumb question, but I know it's so hard to find a good, knowledgeable doctor.


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## Andros (Aug 26, 2009)

lavender said:


> I want a doctor like that. My last PCP was very personable with me, and was willing to touch me (no hugs). Unfortunately, she was not willing/able to treat me. I like that my new doc is prescribing meds that are working, but I miss the sense of caring that I got from my last doc. (although she examined me for a goiter dozens of times after I was diagnosed and never found one!)


Yeah; there are times when "hands on" are appropriate but everyone is sue crazy today. So, there are "problems" and I do acknowledge that. Sad but true.

If you touch, you get sued. What a life!! Too darn bad.


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## JSprenkle (Feb 20, 2011)

Andros - I have an appointment with an ENT (ear, nose and throat) doctor for some sinus problems and I saw in my "new patient paperwork" that my doctor specializes in thyroid and parathyroid disease. I'm assuming this would be mostly for people needing thyroid surgery, but do you think it's possible he could be familiar with all of the lab tests you suggested? I'm thinking it might be easier to ask questions of a new person, than trying to go back to my family doctor. Thanks!!


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## Andros (Aug 26, 2009)

JSprenkle said:


> Andros - I have an appointment with an ENT (ear, nose and throat) doctor for some sinus problems and I saw in my "new patient paperwork" that my doctor specializes in thyroid and parathyroid disease. I'm assuming this would be mostly for people needing thyroid surgery, but do you think it's possible he could be familiar with all of the lab tests you suggested? I'm thinking it might be easier to ask questions of a new person, than trying to go back to my family doctor. Thanks!!


You are on the right track. You "never" know who is the person who will step up to the plate to help you!!

I for instance owe my life to a rheumatologist! Go figure. LOL!!!

Please do let me know! When is the appt?


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## JSprenkle (Feb 20, 2011)

Thanks for the encouragement, Andros. I'll keep my fingers crossed about the ENT. My appointment is next Friday, so I don't have to wait too long. Have a great weekend!


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## Andros (Aug 26, 2009)

JSprenkle said:


> Thanks for the encouragement, Andros. I'll keep my fingers crossed about the ENT. My appointment is next Friday, so I don't have to wait too long. Have a great weekend!


I am keeping my fingers, toes and eyes crossed!! You have a great weekend too! Carpe' Diem and let your worries fly away for a few days.


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