# New here and need help with labs



## jenniepoo18 (Jun 9, 2010)

I had a baby 8 months ago, and returned to my pre-pregnancy weight by 3 weeks postpartum. My weight stayed the same until about 2 months ago when I started losing 1 to 2 pounds every week. I went to my PCP with concerns and he ran some labs that came back hyperthyroid as suspected since I was also tachycardic and my reflexes were hyperactive. He then ran an antibody screen to rule out postpartum thyroiditis. While his nurse called me with the results last Friday, she said he would call me this week, yet he has not yet, and I am just wondering what these labs point towards. I know it is an "auto-immune thyroid disorder" but can I give an actual name to it?

TSH: <0.005 (0.45-4.5)
T3: 282 (71-180)
Free T4: 4.75 (0.82-1.77)
Antithyroglobulin Ab: 739 (0-40)
Thyroid Perioxidase: 16 (0-34)


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## chopper (Mar 4, 2007)

Holy smokes! Those numbers are high. Yes, you can give it a name. Call it Graves disease with most certainty.

Unless there is some sort of "hot" nodule that is producing extra hormone or some oddball temporary post partum thyroid funk, its most likely Graves Disease.

Any endo worth his degree would probably put you on Beta blockers (Propranolol) right away to control the heart rate. He or she will also get you started on anti-thyroid meds.

Next you should probably get a thyroid ultra sound and radioactive iodine uptake scan (RAIU) to show exactly what's going on and to see if there are any nodules. I would also want a TSI (Thyroid Stimulating Immunoglobulins) blood test to confirm Graves.

Ultimately, you'll probably end up with a Graves disease diagnosis - Im most certain.

There is a ton of info on here and all over the net about Graves disease. Just google it and check the symptoms and treatment options.

Your numbers are very high, please get to an endo as soon as possible.


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## jenniepoo18 (Jun 9, 2010)

Thanks for your insight. I thought it might be Graves disease based on my labs, but my PCP has not gotten back with me yet, and my TPO antibodies weren't high, so I was kind of wondering. I've read some things online about treatments, but am currently breastfeeding, so it puts a little kink in things. I don't want to cause any long term problems by delaying treatment since my numbers are so high, so baby might have to switch to formula. Hopefully my doc will call me today!


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## chopper (Mar 4, 2007)

Depending on your priorities, you can get diagnosed pretty quickly and easily. Im not a doctor but I've seen tons of labs and as I said earlier, unless you have a hot nodule which can be ruled out by thyroid sonogram, you most likely have Graves. If that is the case and you want to continue to breastfeed, you can prepump a supply and opt for surgery to remove your thyroid. There is no cure for Graves. Some people go into remission for a bit but its usually short lived. Ultimately 90% of the people with Graves either swallow the radioactive iodine pill to kill the thyroid or get surgery. I don't believe its possible to do RAI and breastfeed due to the obvious radiation...a doc can tell you if that's the case or not but I wouldnt want my wife breastfeeding after getting nuked. With surgery you can be off meds within a day or two so that might be an option to explore if you want a permanent solution. Otherwise, baby goes on formula and you can take your time with treatment options while exploring whatever meds are available.

You know how many people come through here shortly after having a baby or quit smoking? Those two events seem to be a major trigger for Graves.


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## jenniepoo18 (Jun 9, 2010)

nasdaqphil said:


> If that is the case and you want to continue to breastfeed, you can prepump a supply and opt for surgery to remove your thyroid. There is no cure for Graves. Some people go into remission for a bit but its usually short lived. Ultimately 90% of the people with Graves either swallow the radioactive iodine pill to kill the thyroid or get surgery. I don't believe its possible to do RAI and breastfeed due to the obvious radiation...a doc can tell you if that's the case or not but I wouldnt want my wife breastfeeding after getting nuked. With surgery you can be off meds within a day or two so that might be an option to explore if you want a permanent solution. Otherwise, baby goes on formula and you can take your time with treatment options while exploring whatever meds are available.
> 
> You know how many people come through here shortly after having a baby or quit smoking? Those two events seem to be a major trigger for Graves.


You're right, my doc did tell me that it is not possible to do RAI or antithyroid meds while breastfeeding or pregnant. Since it is something I will always have, and because of my antibody numbers, am I right in assuming that eventually I will become hypothyroid after my thyroid peters out from the antibodies attacking it? If I am going to end up hypothroid eventually, RAI or surgery seem better to me than trying an antithyroid med for a couple of years. My daughter is our first baby, and we had been hoping to have our children a couple years apart. Both antithyroid meds are Category D drugs, so pregnancy is not recommended. I think I would rather get this under control sooner and more permanently, and not trying for a year or two to get it under control.

I did go ahead and schedule an appointment with an endo to better explore my options. My PCP has yet to call me and discuss my antibody results, but when I got my initial labs back he was recommending the meds, so I thought a second opinion wouldn't hurt.

Thanks for all your help!


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## jenniepoo18 (Jun 9, 2010)

I should clarify, I do need to start on some sort of treatment, as my weight loss continues, and I am classified as "under-weight" according to my BMI.


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## chopper (Mar 4, 2007)

Yes, I would imagine you need to start on something soon. I cannot believe you are not a nervous wreck with those high numbers. If my T3 gets anywhere near above normal I get shaky and slight tremors and have panic attacks like crazy.

First, I give you the politically correct version: Take your time, research your options, do what's best for you.

Now, I give you the 'I had 8 years of hell option': Get a good endo this week. Get labs, asap. Set a surgery date and remove that sucker.

Yes, you will be hypothyroid forever after but millions of people are and do just fine. Yes, your thyroid will die eventually on its own due to the constant antibody attacks and inflamation (my sono tech said my thyroid was "ugly" - it looked like the surface of the moon) but that may take years - 8 or 9 for me so far but I am going for the thyroidectomy finally. If you were a family member, I would tell you the same thing, honestly. It will only spare you years lost with that new baby and feeling like crud each day. Get it over with now and get on with life AFTER you receive a real diagnosis first of course. It is very possible you have a hot nodule and not Graves. Graves is probably more common but a hot nodule isn't exactly rare either. You need a sono first before anything in my opinion. Here's the schedule I would go by:

1. Find good endo asap - control heart rate
2. Get a good sonogram and TSI blood test along with another full thyroid panel including antibodies to confirm results.
3. Get RAI uptake scan depending on results of sono.
4. Schedule surgery and get that sucker ripped out depending on diagnosis of course.


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## gravy (Jun 27, 2010)

Jennie im very curious about what course of action you took...?

I am 6 months post partum and in basically the same situation (and my names Jenn-ah). My endo put me on methamazole and told me it was safe for breastfeeding.. I rang the breastfeeding medication hotline and they said it did cross through breastmilk but was safe- but to keep an eye out for symptoms in her.. cant see how thats safe! I have cut down breastfeeding as quick as I can but I dont know if 1 feed a day is ok?
I am seeing a second endo on Friday as I just wasnt happy with the first one and just have so many questions..


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## Andros (Aug 26, 2009)

jenniepoo18 said:


> I had a baby 8 months ago, and returned to my pre-pregnancy weight by 3 weeks postpartum. My weight stayed the same until about 2 months ago when I started losing 1 to 2 pounds every week. I went to my PCP with concerns and he ran some labs that came back hyperthyroid as suspected since I was also tachycardic and my reflexes were hyperactive. He then ran an antibody screen to rule out postpartum thyroiditis. While his nurse called me with the results last Friday, she said he would call me this week, yet he has not yet, and I am just wondering what these labs point towards. I know it is an "auto-immune thyroid disorder" but can I give an actual name to it?
> 
> TSH: <0.005 (0.45-4.5)
> T3: 282 (71-180)
> ...


You are really hyperthyroid. For now, that is the name. What I don't like is that our antithyroglobulin is so very very high. I believe that you should have a radioactive uptake scan to rule out cancer.

What Abnormal Results Mean
A positive test means antithyroglobulin antibodies are found in your blood. This may be due to:

Graves disease 
Hashimoto's thyroiditis 
Hypothyroidism 
Myxedema 
Systemic lupus erythematosus (SLE) 
Thyroid cancer 
Thyrotoxicosis 
Type 1 diabetes

Out of the list above, the reason I suggest you rule out cancer is because cancer of the thyroid often will cause hyper symptoms.

Here is the link for the info above.

http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm

As you already know by my siggie; I am not a doctor. But, I have been around the boards and forums for thyroid for many many years and have seen it all.

So, please talk to your doctor about this and let us know.

Welcome to the board. You are in a wonderful place here.


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## jenniepoo18 (Jun 9, 2010)

gravy said:


> Jennie im very curious about what course of action you took...?
> 
> I am 6 months post partum and in basically the same situation (and my names Jenn-ah). My endo put me on methamazole and told me it was safe for breastfeeding.. I rang the breastfeeding medication hotline and they said it did cross through breastmilk but was safe- but to keep an eye out for symptoms in her.. cant see how thats safe! I have cut down breastfeeding as quick as I can but I dont know if 1 feed a day is ok?
> I am seeing a second endo on Friday as I just wasnt happy with the first one and just have so many questions..


I have scheduled an appointment with a recommended endocrinologist, but the soonest available appointment is not until the end of July. So, in the mean time, I have started on Methimazole to try and halt my weight loss. I can't imagine what I would weigh if I waited until the end of July. I used my remaining stash of frozen breastmilk and mixed it with formula in slowly decreasing amounts until it was used up. It was hard for my daughter the first couple of days, but now she is doing fine and eating like a champ. My doctor told me no breastfeeding, as did the pharmacy. Methimazole is excreted in breastmilk, although at low levels. I have read conflicting studies about it, with some showing that it can effect the baby's thyroid. The last thing I wanted was for my baby to be hypothyroid from my meds. Another opinion would be a good idea!


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## jenniepoo18 (Jun 9, 2010)

Andros said:


> You are really hyperthyroid. For now, that is the name. What I don't like is that our antithyroglobulin is so very very high. I believe that you should have a radioactive uptake scan to rule out cancer.


I am hoping to get more answers when I go to see an endocrinologist July 26th. I called the 3 endo recommendations that I had, and none could see me before then. I started on Methimazole until then to try and stop the weight loss and tachycardia.

In regards to the RAIU, do you know if there are contact restrictions afterwords? Having an 8 month old baby kind of complicates things, because I am a stay-at-home mom, and would have to make some serious arrangements if I could not be around her. Not fun, especially since she has entered the "I only want Mommy" stage. Would the scan be able to tell with all certainty if there is cancer, or would further testing afterwords be necessary to diagnose?


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## Andros (Aug 26, 2009)

jenniepoo18 said:


> I am hoping to get more answers when I go to see an endocrinologist July 26th. I called the 3 endo recommendations that I had, and none could see me before then. I started on Methimazole until then to try and stop the weight loss and tachycardia.
> 
> In regards to the RAIU, do you know if there are contact restrictions afterwords? Having an 8 month old baby kind of complicates things, because I am a stay-at-home mom, and would have to make some serious arrangements if I could not be around her. Not fun, especially since she has entered the "I only want Mommy" stage. Would the scan be able to tell with all certainty if there is cancer, or would further testing afterwords be necessary to diagnose?


Uptake would be pretty thorough. You could have a sonogram but they are not as good and they "do" miss stuff.

Talk to your doctor about this. There has to be a way and a way to keep baby safe too! RAIU is of course a low dose but still I would not take a chance to be with baby so I sure would not expect you to either.

Or, if you have palpable nodules, they might be able to do an FNA (fine needle aspiration.)


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