# What does all of this mean?



## CandiceW (Jun 26, 2011)

I found out I was 9.5 weeks pregnant 1.5 weeks ago(so I'm 11wks now)
Dr did prenatal screening.. and I was called back to office to go over blood work.
Dr said TSH was hyperthyroid and that they needed to do more blood work. he called lab and had the same blood ran for T3/T4/and antibody test. The T3 and T4 came back but not the antibody yet.
T4 was fine dr said but T3 was LOW(I think they said low?) Looking at results now.. it says TSH should be 0.30-5.50mU/L and mine was 0.05.. and then T3 was 3.7 and says it should be between 4.0-7.8pmol/L. Dr I saw today said I have hyperthyroidism and is sending another referral to the endo to get me in quicker(I had referral out for months now because I have thought I had something going on with my thyroid but I felt I just could not get my dr to take it serious. My appt as is has been set for over a month now and is not until mid August) as as well as sending me for an u/s of the thyroid(she said she would try to get rush. We will see) BUT she did say she was a little confused as the T4 is fine but the T3 and TSH come back hyper or something. Why would that be confusing to a dr?
Antibody test has not come back yet, so I don't know any results on that. But she did say FOR SURE go back and re do all blood work tomorrow am.
I am confused a little myself as well as I have symptoms of both hypo and hyper(like hypo my temp dropping to like 35 and weight gain) But yet tests come back hyper. I guess that is why they are doing the antibody test?

I am a little worried for my unborn baby. Is 11wks TOO far a long to just be catching this? I ready about hyperthyroidism & pregnancy on the net and get scared.. it says lots of complication for me and the baby.. and even lots of deformities for baby 
I also had a question, does blood pressure have anything to do with this condition? I usually have low blood pressure(and even lower because I'm on a beta blocker for a heart arrhythmia) but I check it the other day and it was 145/99 or something. So pretty high! I forgot to ask the dr today. But I did talk to her about the vision problems I am having, like seen spots/stars as well as kinda like hologram like vision issues. She said to def talk to endo about that. Is that common with hyperthyroidism?


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## Andros (Aug 26, 2009)

CandiceW said:


> I found out I was 9.5 weeks pregnant 1.5 weeks ago(so I'm 11wks now)
> Dr did prenatal screening.. and I was called back to office to go over blood work.
> Dr said TSH was hyperthyroid and that they needed to do more blood work. he called lab and had the same blood ran for T3/T4/and antibody test. The T3 and T4 came back but not the antibody yet.
> T4 was fine dr said but T3 was LOW(I think they said low?) Looking at results now.. it says TSH should be 0.30-5.50mU/L and mine was 0.05.. and then T3 was 3.7 and says it should be between 4.0-7.8pmol/L. Dr I saw today said I have hyperthyroidism and is sending another referral to the endo to get me in quicker(I had referral out for months now because I have thought I had something going on with my thyroid but I felt I just could not get my dr to take it serious. My appt as is has been set for over a month now and is not until mid August) as as well as sending me for an u/s of the thyroid(she said she would try to get rush. We will see) BUT she did say she was a little confused as the T4 is fine but the T3 and TSH come back hyper or something. Why would that be confusing to a dr?
> ...


Good grief! For one thing, I don't see how they can tell anything with the T3 and T4 because the TOTALS are bound and unbound hormone.

The proper tests would be FREE T3 and FREE T4 and in hyper, we expect to see the TSH very very low and the "FREES" very very high.

Here is info on that.

understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid
http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

And this single test would be extremely important.

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

This might help you as well.
http://www.thyroidmanager.org/Chapter14/14-frame.htm

Bless your little heart; I know you are worried.


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## CandiceW (Jun 26, 2011)

Sorry I forgot the work FREE when I wrote it.., that is the tests they did.
Does that make a difference?


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## CandiceW (Jun 26, 2011)

maybe it will help for me to actually show instead of try to type out myself.. here is the actual lab results.


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## lainey (Aug 26, 2010)

I would say, retest it all completely. The doctor is confused because if you were truly hyper, the free T3 would be high out of range. Something isn't right with the lab results. Don't forget, lab errors are always a possibility.

Hopefully the antibodies test will lead to some clarification.

When are you seeing the endo?


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## CandiceW (Jun 26, 2011)

I actually asked another online acquaintance.. and she thinks this is what I have...

http://www.stopthethyroidmadness.com/hypopituitary-faq/
http://www.labtestsonline.org/understanding/analytes/t3/test.html (this one shows the table)

And suggested to ask my Dr for a reverse T3

I am going in to redo blood work this am.. as far as the endo.. NO clue. I had an appt set months ago for August..(it was like a 4 month wait  ) so we will see dr I saw that they were going to send referral again and say it was urgent I get in earlier.


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## lainey (Aug 26, 2010)

Re: STTM website--not authoritative necessarily.

We will start with, concerning hypopituitarism--you are pregnant and have high blood pressure--unlikely combined with this.

I'm not saying your doctor can't screen you for it by running the ACTH.

Reverse T3 is not really useful for the diagnosis and treatment of much of anything. It is an old test that was developed before we had accurate "free" T3 and T4 testing, to help analyze the available thyroid hormone when looking at the totals. It is not really used much in conventional medicine anymore, as we have more accurate testing.

You should see an endo or perinatologist who deals with endocrine in pregnancy (diabetes, thyroid disorders) really for a full workup.

Your diagnosis isn't going to happen on the internet.


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## Andros (Aug 26, 2009)

CandiceW said:


> maybe it will help for me to actually show instead of try to type out myself.. here is the actual lab results.


This is great! Thank you so much! And quite interesting in that you would also expect to see the FREE T3 high in the range like the FREE T4 is.

That makes me think that the body is trying to protect it's self with a blocking or binding antibody to the receptor site for the T3 or converting it to rT3 (reverse T3.)

It might be of interest to request rT3 test to see if that is what is happening.

This may be normal; I don't know............

Placental metabolism of thyroid hormones

The placenta contains high concentrations of the Type 3 or inner-ring (5) iodothyronine deiodinase 56-58. The inner-ring deiodination of T4 catalyzed by this enzyme is the source of high concentrations of reverse T3 present in the amniotic fluid. Reverse T3 levels parallel maternal serum T4 concentrations 59-62. This enzyme may function to reduce the concentration of T3 and T4 in the fetal circulation (the latter being still contributed by 20-30 % from thyroid hormones of maternal origin at the time of parturition), although fetal tissue T3 levels can reach adult levels due to the action of the Type 2 deiodinase (see Chapter 15) 50. The Type 3 deiodinase may also indirectly provide a source of iodide to the fetus via iodothyronine deiodination. However, despite the presence of placental Type 3 deiodinase in circumstances in which fetal T4 production is reduced or maternal free T4 markedly increased, transplacental passage occurs and fetal serum T4 levels (for the rest of it, go to the link.) 
http://www.thyroidmanager.org/Chapter14/14-text.htm


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## Andros (Aug 26, 2009)

CandiceW said:


> I actually asked another online acquaintance.. and she thinks this is what I have...
> 
> http://www.stopthethyroidmadness.com/hypopituitary-faq/
> http://www.labtestsonline.org/understanding/analytes/t3/test.html (this one shows the table)
> ...


I just read this post after I posted to you about the rT3; what a coincidence.


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## CandiceW (Jun 26, 2011)

That is what dr kept saying, "Interesting".
So I'm not really understanding the quoted site.. does it say in short that it might be normal in pregnancy?
And I know I am not looking for dx.. I'm looking for advise on what to ask dr ect. It took so long to get a dr to do these tests.. and even then it was not my GP. I kept going in to see my GP .. I would ask for tests(T3/T4) she kinda refused. I have no idea why.. she just had no interest in doing them. It was not until this TSH came back another dr ordered them. I even had my GP at one time tell me I needed to look up all my symptoms on the internet and try to find possibility as to why I was feeling the way I was as there is more up to date info on the net then what she has.


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## Andros (Aug 26, 2009)

CandiceW said:


> That is what dr kept saying, "Interesting".
> So I'm not really understanding the quoted site.. does it say in short that it might be normal in pregnancy?
> And I know I am not looking for dx.. I'm looking for advise on what to ask dr ect. It took so long to get a dr to do these tests.. and even then it was not my GP. I kept going in to see my GP .. I would ask for tests(T3/T4) she kinda refused. I have no idea why.. she just had no interest in doing them. It was not until this TSH came back another dr ordered them. I even had my GP at one time tell me I needed to look up all my symptoms on the internet and try to find possibility as to why I was feeling the way I was as there is more up to date info on the net then what she has.


Candace; I can't say if this is normal routine or not. Best discuss this w/ a qualified and learned individual. And I am always anxious to learn something so if you find out yay or nay, could you please let us know?


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## Andros (Aug 26, 2009)

CandiceW said:


> That is what dr kept saying, "Interesting".
> So I'm not really understanding the quoted site.. does it say in short that it might be normal in pregnancy?
> And I know I am not looking for dx.. I'm looking for advise on what to ask dr ect. It took so long to get a dr to do these tests.. and even then it was not my GP. I kept going in to see my GP .. I would ask for tests(T3/T4) she kinda refused. I have no idea why.. she just had no interest in doing them. It was not until this TSH came back another dr ordered them. I even had my GP at one time tell me I needed to look up all my symptoms on the internet and try to find possibility as to why I was feeling the way I was as there is more up to date info on the net then what she has.


http://www.obfocus.com/high-risk/Thyroidtests.htm

The above is informational; it would appear that you are hyperthyroid but I am still curious about what is happening to the FREE T3. You do need someone that knows their stuff about the thyroid as related to maintaining a safe pregnancy and a healthy baby.


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## lainey (Aug 26, 2010)

The link provided speaks about rT3 found in the amniotic fluid and that it's purpose is thought to be to modulate the fetal T3. Because the amniotic fluid is separate from the maternal blood, there really isn't a connection between the two.

Don't you have an ob/gun monitoring this pregnancy? Get a referral to a perinatologist. August is too long to wait for an endo.

From the same link, you can also read that TSH is often low in the first trimester. You need repeat testing from a specialist that can read the results.


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## CandiceW (Jun 26, 2011)

humm interesting. I did go redo blood work this am already. They told me results will be back by end of day. So guess we will see. All of it is confusing to be honest and I'm just hoping the results are just fine and no issues(being pregnant and it may be normal)
Thanks!


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## Andros (Aug 26, 2009)

CandiceW said:


> humm interesting. I did go redo blood work this am already. They told me results will be back by end of day. So guess we will see. All of it is confusing to be honest and I'm just hoping the results are just fine and no issues(being pregnant and it may be normal)
> Thanks!


And I wish the same for you and your precious little baby.

Please keep us updated.


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## CandiceW (Jun 26, 2011)

Thanks, I will


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## CandiceW (Jun 26, 2011)

Here are today's results..










Do you know what the # of the Anti-TPO means? 
I did not get call back from the dr's office yet so..


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## lainey (Aug 26, 2010)

Hmm, no TSH. This was the oddball before--and it's not here.

If the doctor was thinking you were hyper because of the low TSH, however, they should have run the TSI--thyroid stimulating antibodies. Because of the first low TSH, it would have been nice to see this.

Both numbers are slightly lower than before. There is a lag in the feed back system--ie, the T4 and T3 have to drop first before the TSH rises. My gut reaction is that you are actually trending toward hypo if you are going anywhere--the T4 and T3 would be high near the top or over the range if you were truly hyper. Or, you could just be in a normal swing due to the early stage of your pregnancy.

The presence of TPO antibodies indicates the possibility of autoimmune thyroid disease. However, these are below their ranges--and as it says right in the labs, that a percentage of the general population can have them.

Keep in mind also, that estrogen binds thyroid hormone, and the early hormones of pregnancy do tend to lower TSH--so I think these are also a factor in your results. You're in the first trimester, so it is not the same as a person who is not pregnant, simply because the female hormones play a role.

Umm, likely the dr's office is going to say "there's no problem". I still think you need a specialist--an endo with an emergency opening, perinatologist that does endocrine disorders.


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## CandiceW (Jun 26, 2011)

thanks  never got call back from dr's office.. nor from the endo.. so I assume they all think I'm fine.


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## lainey (Aug 26, 2010)

Ummm yah, as stated. Don't let it slide too far--get repeat labs in a few weeks to follow up on what is happening. Things may normalize, but then again they may not.

I would still try to see a specialist for my own peace of mind.


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## CandiceW (Jun 26, 2011)

well I left a message at the endo's office. we will see if they call back. I already had appt there for August. But the dr I saw the other send in another referal for me to see sooner.. but again I never got a call. I do have u/s scheduled for 2 weeks away.


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