# Results: Help Me Interpret Please!



## jfails (Mar 9, 2015)

I've just had a few of the Thyroid tests done at my own request (by my rheumatologist). I'm currently diagnosed with a few different autoimmune diseases, including Ankylosing Spondylitis, vitiligo, psoriasis. I take Humira (40 mg weekly) for my arthritis. This is a biologic and suppresses the immune system. I've been on cholesterol meds for a long time, but now my cholesterol is elevated despite the meds. I've been on anti-depressants for 7 years and within last year depression got worse and worse and I've had to increase the one med plus add another.

Symptoms: I've been extremely tired, depressed and gaining weight. I've gained 25 in the last 2 years, after maintaining my weight my whole life. It's increasing rapidly now, like 3 lbs per week.

Labs:

Free T3: 3.1 (range 2.3-4.2)

Free T4: .99 (range .73-1.95)

TSH: .9 (range 0.5-4.7)

Vitamin D: 24 (range for suboptimal category is 20-29, so I'm closer to insufficient range which is <20)

Cholesterol levels despite medicine:

cholesterol: 203 (range <200)

triglycerides: 168 (range <150)

Calcul. LDL: 127 (<100)

I'm really hoping this indicates some form of hypothyroidism so I can get help. I'm miserable.

THANK YOU!!

Jamie Fails

female, 38 years old


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## joplin1975 (Jul 21, 2011)

Your free t4 is low...and your free t3 is just a bit low. Did they do any thyroid antibody testing on you?


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## jfails (Mar 9, 2015)

I don't think so joplin - what is it called on the order?


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## joplin1975 (Jul 21, 2011)

There are a bunch of antibodies, but the most common are TPO and TSI.


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## jfails (Mar 9, 2015)

No she didn't do those. Thanks for your response. You mentioned the T4 and T3 are somewhat low. Should a doctor treat this for hypo when results are this combined with my symptoms? Do I need to see an endo instead of my rheum? Thanks!!


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## Andros (Aug 26, 2009)

SUGGESTED TESTS
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/
(Copy and paste into your browser)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

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
(Copy and paste into your browser)

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

Actually, you could be hyper. It appears that FT4 is converting quickly to FT3 and w/low TSH, that raises my suspicion.

Here are some tests that would sort it all out and please, please insist on an ultra-sound of your thyroid.

Welcome!


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## jfails (Mar 9, 2015)

Thanks Andros. Would hyper cause weight gain ever? I just had a bunch of tests run in the fall because I had an enlarged lymph node on my cervical neck, plus I was having headaches, neckaches and muscle aches. I had seen an ENT and he felt my thyroid, but didn't seem concerned- he was on the fence about biopsying the node. I had a brain MRI at the time and nothing of concern was noted. I'm just wondering if any of that could be related?

Also, I'm assuming I should see an endo for the more extensive testing?

THANKS!!


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## Andros (Aug 26, 2009)

Yes; I gained a lot of weight w/hyper and so have others. Symptoms are not carved in stone and often cross over!

Any doctor can run those tests.

Let us know how you do w/all of this. It is really hard to get the proper diagnosis but some of those lab tests will prove very useful in doing that.

Hugs,


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## jfails (Mar 9, 2015)

Andros, I have been doing a lot of research and from what I've read, a low TSH with a low FT4 points to hypo caused by a problem in the pituitary gland. I have a rheumatologist that I'm seeing Tuesday, and I've texted with her and she said she will treat me. I'm wondering if I will HAVE to have further testing done for some sort of confirmation? Or is the medical literature saying that those two things are pituitary related enough to treat as hypo? Thank you so much for your help!!


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## jfails (Mar 9, 2015)

From: http://www.endocrineweb.com/conditions/thyroid/thyroid-gland-function

*If the T4 level is low and TSH is not elevated*, the pituitary gland is more likely to be the cause for the hypothyroidism. Of course, this would drastically effect the treatment since the pituitary gland also regulates the body's other glands (adrenals, ovaries, and testicles) as well as controlling growth in children and normal kidney function. Pituitary gland failure means that the other glands may also be failing and other treatment than just thyroid may be necessary. The most common cause for the pituitary gland failure is a tumor of the pituitary and this might also require surgery to remove.


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## jfails (Mar 9, 2015)

I saw my rheumatologist today- she would not acknowledge that a pituitary gland could be causing me to be hypo. She feels my TSH indicates my thyroid is working perfectly. She basically told me I need to eat better and lose weight. She did order the blood work for the thyroid antibodies, but my appt is not until June, and I need to wait closer to June to do the blood work. I'm supposed to make a concerted effort to TRY and lose weight on my own between now and then and then maybe we will look into more testing. Not sure what to think.


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## Andros (Aug 26, 2009)

Yes, yes to the weight gain. Symptoms often cross over.


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