# Oh, please somebody help me understand - Do I belong here?



## ifthespiritmovesme (Jan 8, 2014)

These are my labs:

TPO 17 <35

T S IMMUNOGLOBULINS ACTUAL/NORMAL 64 % <140

THYROGLOBULIN 93.7 2.0 - 35

THYROGLOBULIN AB <20 2.0 - 35

THYROXINE BINDING GLOBULIN 21.2 13.5 - 30.9

TSH, T4,T3 all low

Surprised I have TSI as I am definitely NOT hyper. My Pdoc said there were "very few" Hurthue cells, folicular, etc. found on FNA. No cancer, not Hashi's. My biggest supporter now thinks I'm a hypochrondiac. What the heck is going on?

Thanks for your help.


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## Andros (Aug 26, 2009)

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)

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
(Copy and paste into your browser)

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
(Copy and paste into your browser)

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
(Copy and paste into your browser)

http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660
(Copy and paste into your browser)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Okay; when you have TSI, there are the binding and blocking antibodies (Trab, TBII) and they make you feel not hyper. But, you are.

Also; that Thyroglobulin is very high. That means that the Thyroglobulin Ab is not doing it's work very well.

There are 2 kinds of Hurthle Cells; one indigenous to Hashimoto's and the other to thyroid cancer. If the doc said you don't have Hashi's; that leaves me, at least..........................wondering.

Low TSH, T3 and T4 also raise an eyebrow. I have seen this many times in posters who had thyroid cancer.

A second opinion never hurts.

If I were you, I would see an ENT.

Hopefully the above links will help explain some things!

Hugs,


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## ifthespiritmovesme (Jan 8, 2014)

Thanks,Andros- I did read those links- you had posted them in a reply to BigFoot. Still left me confused. Glad you replied here. Gads I wish things were simpler.

Crap - How do I know if I have Hashi's or not? I've read different things. One says if I have TPO and Thyroglublin, I have Hashi's. Another says something else. So if I am right, I have one or the other - Hashi's or cancer? right?

Now my staunchest supporter (Shrink, who is who I saw) thinks I'm a hypochrondriac! Says he thinks I am not as sick as I think I am.

I feel like crying.

BTW- What forum should I be in about this?


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## bigfoot (May 13, 2011)

Generally, they use the presence of TPO Ab's and Thyroglobulin Ab's to reach a diagnosis of Hashi's. But it sounds like you've had a FNA biopsy done, in which case it looks like they checked for Hurthle cells. I'm no expert on those, and I haven't had a FNA, so I defer to others like Andros. But the mere fact that you had *any* Hurthle cells present, and your doc now is backtracking and doesn't think you have Hashi's strikes me as very strange. I would think even the mere presence of Hurthle cells, regardless of quantity, would provide a firm diagnosis of Hashi's. But again, I am just speculating here...

As far as your TPO Ab's, Thyroglobulin Ab's, TSI, and Thyroid Binding Globulin results go -- I would keep in mind that one set of labs is just a snapshot in time. Antibodies will wax and wane. Tomorrow, next week, next month, next year; they could run those exact same tests and get different numbers every time. I think there are two schools of thought in the thyroid world, one says that the mere presence of the antibodies is enough data, while others want to see the antibodies over/under the "normal" range. And as we all know, "normal" can vary from person to person.

Who ran these lab tests? Was it your psychiatrist/psychologist, primary care doc, endo, ENT, or another doc? As far as the doctor who replied that you are a "hypochondriac" or "not as sick"; I would take that with a grain of salt. We are all good judges of how our body feels. Remember that thyroid problems can cause all sorts of random signs and symptoms. Things like brittle cracked nails, hair falling out, weight gain/loss, vision problems, intolerance to hot/cold temps, low body temp, tinnitus, libido issues, night sweats, poor reflexes, constipation or diarrhea, swelling neck/throat or goiter, poor cholesterol and high triglycerides, unexplained fatigue, hand tremors, fast/slow pulse, etc. Other things can include anxiety, depression, mood swings, and so on. And all of that is just a partial list.

FYI, there is a good article by Dr. Richard Hall titled, "Anxiety and Endocrine Disease". The Cliff Notes take away version is that hormones can affect MANY things. Here's a link: http://www.drrichardhall.com/anxiety.htm

My point is that this stuff doesn't generally happen in a vacuum. There is a reason or underlying problem(s) likely driving your illness or issue(s). If you are having mood problems, as docs like to call them, they are quite possibly and likely secondary to a larger issue. Running some thyroid tests, getting mediocre results, and then telling someone they are "fine" doesn't exactly instill a lot of confidence. Especially if you have many physical signs that are hard to ignore. They should be doing their due diligence in looking under all the rocks. It could be anything from sleep apnea to liver disease to sex hormones to food allergies.


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## ifthespiritmovesme (Jan 8, 2014)

Thanks, Bigfoot. I have many, many troubles - all connected to my thyroid I believe. Been chasing symptoms for years without addressing the primary cause. So frustrating!!

The first tests, other than TSH was done by my shrink in August. It was FT3 and FT4. I am at the bottom of "normal" in all 3. They don't see a problem there. (DUH). The antibodies were tested in January and March by my PCP. I am asking for more antibody tests when I see him on May 20th.

Thanks for the article. I'll read it right now. I'm currently looking for a new doctor.


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## bigfoot (May 13, 2011)

ifthespiritmovesme said:


> I'm currently looking for a new doctor.


Boo-yah!  Good luck with the search! You might even try doing a "meet and greet" to see if a particular doc(s) will match up to you. The usual questions about how they monitor thyroid (magic answer is TSH, FT3, and FT4), if they will order yearly ultrasounds, how they feel about suppressing a TSH and getting FT3/FT4 into upper range. The real test is if you ask about desiccated thyroid (Armour, Nature-Throid, etc.) and they roll their eyes or go ballistic! Hehe. Keeps your from falling into their tentacles and can save you headaches down the road.


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## ifthespiritmovesme (Jan 8, 2014)

Yes, I am making sure the doc I pick is one that would "pass muster" here...smiles. My biggest hurdle is finding one who will accept VA payment. What a huge hurdle that is turning out to be. Now I'm starting the fight to get them to just reimburse me instead of having to find a doc who accepts them for payment. Wish me luck - I've been fighting an uphill battle with them for a long,long time.

Thanks for your support and help!!


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## bigfoot (May 13, 2011)

Lots of positive thoughts headed your way! It sucks to have to do so much research and coordinating for something so simple, but that seems like the name of the game nowadays.

Funny story -- when I did one of those "meet 'n' greets" with one prospective doctor, I made an appointment to speak with him, stopped by his office and we talked for ten minutes or so. He was very nice, but clearly and in no uncertain terms said, "thanks, but no thanks, I am trying to slow down and retire."  One person told me, gee whiz, how could a doctor turn a patient down? But I really appreciated his honesty and no bull approach. Saved us both a lot of time.


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## ifthespiritmovesme (Jan 8, 2014)

Thanks for the positive thoughts, Bigfoot! I learned that the VA will reimburse me, but I may only get 20-30% of what my costs are, because of their cap on what they'll pay. I may end up doing that anyway, as I really want to see this doc in Annapolis. Gads, they make everything so complicated. So, I gotta think about it a bit more before i decide what I'm gonna do. Maybe I'll just bi_ch at them until they give up and do what they should for me. I should make them pick a doctor for me from a list I provide - let them ask the questions, wait for replies, negotiate with the docs, etc. I am tired, my brain doesn't work right, and I'm very frustrated. I could raise a lot of heck because their top endo. now refuses to treat me. He can't refuse. I don't want to see him, anyway., but a threat about that may make them do more for me seeing a civilian doc. I don't know...I am giving this issue a few days rest. My poor brain needs a break! I need to be coherant when I write my congressman.

Till then, I am waiting on my T3 prescription to come in the mail (IF it actually got through the pharmacy watchdogs). That should make a significant difference in the way I feel. I have an appointment with my PCP on May 20, and will be asking for further antibodies tests. Everything is such a big fight. If those are authoried, we'll know a lot more about what's wrong with me, and maybe be on the way to fixing things. I've been sick so long I don't even know what it's like to feel normal.

Gotta keep a positive attitude, and be grateful for the blessings I have. Right now, though, I'm ready for a few pain pills and a nap! Thanks again for your concern and good thoughts!


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## buttonwood (May 4, 2014)

Did you ever find a good thyroid doctor in Annapolis? My daughter is looking for one in that area.


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