# Please help me understand my first lab report



## butterfly (Jun 26, 2010)

Yesterday I received the lab report from my now-fired Endo. Here's what it says:

Ultra Sensitive TSH 0.11 (_Normal range 0.35-4.3 ul/U/L)

Free T4 1.6 (Normal range 0.6 - 2.2 ng/dL)

Thyrogobulin antibody (RIA) level is 3 (Normal Range 0-8 units)

The labs NOT tested are:

Free T3
Calcium
25-Hydroxy-Vitamin D
Intact PTH
Antithyroid microsomal antibody level
RAI Uptake

Other comments: Ms. W. follows up after a left lobe hemithyroidecotomy. She had gone for surgery although her predominate nodule in the left measuring 2.0cm was benign but based on ultrasound it was increasing in size. She tolerated surgery well, however, the pathology report indicates that she had two benign nodules measuring 1.7 and 1.5 cm, but there was a papillary thyroid microcarcinoma follicular variant of 0.5 cm. This was fully removed by the surgery and this was a tumor tht was fully encapsulated, although there was capsular invasion. Vascular invasion was not present. There was no extrathyroidal extension and 1 out of 1 lympth node was negative....

Under the assessment and plan, he wrote:

[1. ]Ms. ... had a left lobe hemithyroidectomy to remove what turned out to be a benign enlarging thyroid nodule. However, she did have a follicular variant microcarcinoma of 0.5 cm.
_

_2. I discussed with her that the risk to her health due to this microcarcinoma is very low. AT this point completion thyroidectomy or removeal of the other half of the thyroid is not indicated. What would be appropriate is for her to continue the Synthroid at the current dose as long as she is not having symptoms of high thyroid hormone levels, such as racing heart, anxiety, or jitteriness.

3. Additionally what would be appropriate is follow-up ultrasound. That can be performed in this office.

4. Ms. W. has not been on thyroid hormone for very long. I would like to see what her levels are in 2-3 months at which point she should return so hormone levels can be rechecked and ultrasound can be performed.

5. I discussed with her that the other thyroid half does not need to be removed. she has expressed desire to have it removed, but at least not at this point and perhaps next summer. I would ask her to reconsider that opinion, as I do not believe it necessary at this point.

6. Her autoimmune disease for which she sees her rheumatologist are not adverse predictors of worsened thyroid disease.

7. Follow up in 2-3 months.

I discussed the diagnosis, management, and plan with the patient and I have answered all questions._

My main questions (although feel free to comment on any of this!):

1. Isn't the TSH too low? 
2. Shouldn't the calcium and Vitamin D have been tested? 
3. What does capsular invasion mean in this situation, and is it something I should be concerned about?

Thanks a million for any feedback you can provide.


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## Andros (Aug 26, 2009)

butterfly said:


> Yesterday I received the lab report from my now-fired Endo. Here's what it says:
> 
> Ultra Sensitive TSH 0.11 (_Normal range 0.35-4.3 ul/U/L)
> 
> ...


This may help some.......
http://www.springerlink.com/content/e05784k4x7531r48/

TSH would not be too low if the Free T4 and Free T3 are in line. W/o the FT3, we just don't know. Alas.


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