# Post from a new member



## Octavia (Aug 1, 2011)

Members...the post below is from a new member who is having some trouble posting on his own this evening. The issue should be fixed tomorrow, but in the meantime, he'd love to hear our thoughts on these issues if anyone is still up and running tonight...thanks!


_From wonderboy27:_

For the last 10 years, I have had thyroid lab results that simply do not make sense, at least to me.

I am male in my early 30's.

My TSH is always suppressed, usually around 0.04.
It can invariably increase, but is always flagged "low"

My T3 is ALWAYS high-normal: never flagged "high" but on the high-end of normal.

My T4 is ALWAYS low-normal: but normal - never flagged.

Other lab work: Thyroid Peroxidase Antibody (TPOAb); Thyroglobulin Antibody (TgAb)

-These are always normal.

Now....here is the kicker.

My doc had me complete an Iodine Uptake Scan.
The result shocked me. It indicated --low-- uptake
(at 5.7%) no nodules or other pathology noted,
and the report even stated "this is commensurate
with a patient with hypothyroidism.

My question is: given my low (flagged) TSH, but
normal T3 and T4, how is this possible?

We also continued after this study to investigate pituitary function (including labs...and an MRI)
all normal.

I wasn't taking any supplements at the time of the Iodine Uptake Scan, and have read the report contained ... on here... concerning other substances which might confound the results: and I do not meet any of these.

Would anyone have any suggestions..or feedback.

Thanks!
wonderboy27


----------



## CA-Lynn (Apr 29, 2010)

Just wondering if the comment about "consistent with hypothyroid" was written because you have a history of it.

In the past ten years have you ever had abnormal labs? Specifically antibodies?


----------



## lainey (Aug 26, 2010)

There is a spectrum of "normal" regarding thyroid results--there are people who do fall out side of the ranges. Plenty of people in forums such as these actually advocate medicating themselves until their numbers similar are to yours if they are hypothyroid.

So, my questions are:

What were the symptoms that generated the testing over this period of time?

Where the thyroid stimulating antibodies run?

A TRH test to see how the thyroid/pituitary axis is actually working?


----------



## wonderboy27 (Sep 16, 2012)

No. I have never had a history of hypothyroidism. I think she was interpreting a specific, acute, result.

*TSH* - always flagged low

*t3* - always normal, but normal high, w/o flag
example 0.5-4.5 mine will always be 4.3

not exact numbers..just examples

*t4* - always normal, but on the lower side -- but
again, not flagged example: 0.9-4.2 - mine have always remained around 0.10 or 1.0)

*Other blood studies*: TRH TSI All the Antithyroid tests,
and even several ANA Tests, including a pituitary gland MRI, and associated blood tests, as well as a basic ultrasound...were all normal, and have remained normal. The most perplexing test result, as stated, was the --low-
uptake result from the Iodine Uptake Scan.

*Ultrasound of Gland*: I do not have the report in front of me, but I remember it was very benign in nature, I do, however, remember that he stated that the gland was slightly asymetrical, but did not seem to indicate any worry or pathology.

He concluded in the report stating, "_this condition is self-relenting, 
and at this time, I only suggest monitoring function every 6mo_."

During his observations he did note: 1. _a very slight minor tremor _ 
and 2. _hyper-relexia_

His first diagnosis was: *subclinical hyperthyroidism*

After the Iodine Scan .... it changed to:

*self-relenting idiopathic lymphocytic thyroiditis*

The Iodine Uptake Scan: My uptake was very low 5.7%
The report indicated there were no hot or cold nodules, and based on these findings, would be consistent with hypothyroidism"

(this obviously does not jive at all with my TSH, T3 and T4)

I read the journal article (provided on this site) specifically concerning certain substances (ie supplements....) that might create confounding results. 
I did not meet any of these.... in any approximation.

Three years later, with lab work not moving in any direction
(all my values the same as mentioned above)
my doctor diagnosed me with: *Chronic Lymphocytic Thyroiditis*

I am not a doctor, but I simply feel this cannot be the case.

I am making this statement based on the following:

______________________________________________________

1. For a diagnosis of Chronic Lympocytic Thyroiditis
*an autoimmune condition is present, characterized by high titers 
of circulating antibodies to thyroid peroxidase and thyroglobulin*

Again, these labs present (for the last 10 years) as normal.

2. *Chronic Lympocytic Thyroiditis* is represented by fluctuating lab levels My primary labs have all remained the same over a ten year period, except for the iodine uptake scan.[/I]

source: http://www.aafp.org/afp/2000/0215/p1047.html

As mentioned, given this information, I am perplexed concerning
the Iodine Uptake Scan showing very low uptake.....given all my other labs.

Again, there are no nodules, pain, or a goiter * and never has been *

My primary presenting symptom is *profound fatigue*.

Example: there are some days I will sleep 11 hours, and find it necessary
to take a 45min-1hour nap...just about every day. Again, I am male 
in my early 30's


----------



## Andros (Aug 26, 2009)

Octavia said:


> Members...the post below is from a new member who is having some trouble posting on his own this evening. The issue should be fixed tomorrow, but in the meantime, he'd love to hear our thoughts on these issues if anyone is still up and running tonight...thanks!
> 
> 
> _From wonderboy27:_
> ...


There are several reasons for a low uptake and one of them is this.

Low RAIU uptake and cancer
http://journals.lww.com/nuclearmed/...cosis_Caused_by_Functioning_Metastatic.1.aspx

It would be a very good idea for you to get some antibodies' tests. You may be hyperthyroid. Unfortunately, sometimes cancer and hyper go together.

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

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), 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/

T3 Resin Uptake (hyper if high)
http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm
High RBC, hyper
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(76)91920-6/abstract

Hyper/Graves' and cancer
http://www.thyroidmanager.org/Chapter18/18-cancothr.htm


----------



## wonderboy27 (Sep 16, 2012)

I think we posted at the exact same time.  As I covered these variables

and one edit: correct term - hyperreflexia I spelled/stated this wrong.


----------



## Andros (Aug 26, 2009)

wonderboy27 said:


> No. I have never had a history of hypothyroidism. I think she was interpreting a specific, acute, result.
> 
> *TSH* - always flagged low
> 
> ...


It's hard to decipher what is meant by normal. Ranges in my humble opinion are only to establish a baseline and to detect movement.

Antibodies should not be present.

Please read. This means zero, zilch. Wonder if you can get ahold of some copies of these tests you had?

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

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

TPO Ab should be negative, 0
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm
(The normal thyroid has TPO but should not have antibodies to TPO)

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)


----------



## lainey (Aug 26, 2010)

> My primary presenting symptom is profound fatigue.
> 
> Example: there are some days I will sleep 11 hours, and find it necessary
> to take a 45min-1hour nap...just about every day. Again, I am male
> in my early 30's


If your free T3 runs high in the range, it is not surprising that the TSH and free T4 are a little low--the feedback mechanism relies on the T3 levels for its cues.

As for the confounding uptake scan--mistakes are known to happen. Repeating this test, after an appropriate amount of time could be done perhaps to answer that.

TRH testing is rarely done, but could be revealing: http://thyroid.about.com/od/gettestedanddiagnosed/a/trhtest.htm

I would suggest, diagnosis or no, that given that your levels have remained stable for the last 10 years, you do not have a thyroid problem requiring medication at this time--and keep in mind, with high free t3 and low TSH the most likely scenario is the first--subclinical hyperthyroidism, which would require antithyroid medications for treatment. Thyroid replacement medication would be contradictory for you.

That said, as a male with debilitating fatigue, your sex hormones should be tested. In addition, Vitamin D and ferritin should be looked at. All of this can contribute to excessive fatigue.

Any results for any of those?


----------



## CA-Lynn (Apr 29, 2010)

Last night Wonderboy replied to my earlier post by sending me a private message. For the record, he wrote:

"The answer is no. I have never been diagnosed with any labs which might suggest hypothyroidism....and all antibody studies have been normal."


----------



## CA-Lynn (Apr 29, 2010)

Let's go back to the symptom: profound fatigue

Any one of a number of physical and psychological disorders can cause this. I don't think it's appropriate to be focused on thyroid.


----------



## Andros (Aug 26, 2009)

CA-Lynn said:


> Let's go back to the symptom: profound fatigue
> 
> Any one of a number of physical and psychological disorders can cause this. I don't think it's appropriate to be focused on thyroid.


I agree w/you on that. Perhaps a silent cardiac situation, respiratory, low ferritin..............the list could be a long one.


----------



## sleepylady (Mar 18, 2012)

What about secondary hypothyroidism? That causes a low TSH and low FT4 with a higher than average FT3 (I think)

So could the problem be pituitary?

http://pituitarydisorder.net/central_hypothyroidism.html


----------



## wonderboy27 (Sep 16, 2012)

[quote name='lainey']If your free T3 runs high in the range, it is not surprising that the TSH and free T4 are a little low--the feedback mechanism relies on the T3 levels for its cues.

Thanks for your note. My t3 has never been "flagged" on any lab report as high; it is simply (_and slightly_) in the higher-range of normal.'

I think you are correct about re-testing the Iodine Uptake Scan.

Also.,,when I had an ultrasound completed (I am assuming this is what it was)....it was in the doctor's office with images of the gland in real-time....

if cancer was a variable, wouldn't it be likely that he would see something during that test that would catch his eye?


----------



## wonderboy27 (Sep 16, 2012)

Andros mentioned above about ferritin. My number for ferritin was in the lower-end of normal:

*35 (30-400) ng/Ml
*
What might this mean, if anything??

Concerning the statement about secondary hypothyroidism, my FT4 was normal.

When I stated labs, for dx possible hypothyroidism, I meant serology work.

The only labs that came back abnormal, which I do not understand, were
*
DHEA-S* 
mine was 81 (160-600) L

IGF-1
*Insulin-Like Growth Factor-1* 328 (115-307) H

Anyone have any ideas on these?


----------



## lainey (Aug 26, 2010)

Ferritin reflects the body's stores of iron--so when it is low, your overall iron levels are also low. Fatigue is a primary symptom of many forms of anemia. For a man, your levels are quite low in the range.

DHEA-S is the precursor hormone to the sex hormones made by the adrenal glands. The primary symptom of low DHEA is overwhelming fatigue. Further adrenal testing could reveal if there are other issues in this area. Also, if you have not had testosterone tested directly, you should. When DHEA is low, it is quite possible that your sex hormones are off.

The IGF-1 was likely ordered as part of the profile to look at your pituitary function.


----------



## wonderboy27 (Sep 16, 2012)

I read that a high IGF-1 Insulin-Like Growth Factor-1 could be a predictor of future
prostate disease. Does anyone know more about IGF-1? I know it is elevated in puberty, but mine is high and I am a male in my mid 30's.


----------



## Octavia (Aug 1, 2011)

IGF-1 is not something I am familiar with.


----------

