# Labs in



## KarinStanley (Aug 26, 2012)

Got my lab results. TSH 2.17
T4 total 1.8 range 8.9 range 4.5 to12.0
T4 free 1.8 range .8 to 1.8
T3 total 79 range 76-181

Thyroglobulin antibodies 53 range less than 20
Thyroid per oxidase antibodies 424 range less than 35

TSI 89

Ultrasound nodule.

Went to a new endocrinologist today. I still feel all the previously stated symptoms. Dr said none of the symptoms are due to thyroid. She switched levothyroxine to synthroid and ordered a CT scan of neck due to enlarged thyroid and swallowing issues. Otherwise no direction was given. The nodule will be rechecked in 6 months.
Still feel tightness in throat. The anxiety continues but probably making it worse since not sleeping and now have anxiety about not falling asleep.


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## Lovlkn (Dec 20, 2009)

Karin,

Did you ask about going onto Cytomel as your T-3 is low range?

When my FT-4 is above 3/4 range I have alot of anxiety and I bet that is what is happening to you.

Personally, I think you need to ask to reduce your Levothyroxine and add a small amount of Cytomel. Changing brands isn;t likely going to do much to raise your FT-3.

You also need to insist they start to run the FT-3 test instead of the T-3 test.


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## surge (Aug 15, 2012)

Karin-- do you see my endo? Because mine said the same exact thing to me-- my problems were probably just being on the generic and my other symptoms were not the thyroid. She suggested that "Women can sometimes have arrhythmias" and that I should follow up with my primary. I have similar symptoms to you (I've been following your posts): racing heart, sleeplessness. I also have massive hair loss, some days of diarrhea, weight loss intermittently. I gain and lose about 6-7 pounds in the course of a week and a half.

My primary said, I think it's thyroid, but let's rule some possibilities out. So she had me wear a holter, did all kinds of autoimmune tests, heavy metal tests, and suggested that if everything came back normal, I should consider having my thyroid removed. So now I have a follow-up with my endo and the questions I'm going to ask are:
-what do the antibodies mean and mean for treatment? (I know what they indicate, but she never actually even explained my results to me). 
-Does the presence of antibodies indicate that there also might be blocking and binding antibodies that effect hormone readings?
-If I have high antibodies and nodules, is it likely that a nodule is hot?
-if you think this is just anxiety, how would that correlate with sudden (as in overnight one night four months ago) onset that hasn't let up despite life style changes, despite the lack of non-health related stress? 
-Do you ever use symptoms as a guide for treatment or only numbers?
-Do you think there's something my primary and I have missed (as far as other possibilities)?
-Do you have advice on where I should get my second opinion?

I wish my case WAS easily remedied by switching to a name brand. I'm sure you do too. Your results say to me that with all those antibodies, you're thyroid is going wonky. Because you have these symptoms, that are new to you and occurred before you even knew you had high antibodies/autoimmune thyroiditis, the likelihood that it is not related seems very slim to me.


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## Octavia (Aug 1, 2011)

KarinStanley said:


> Went to a new endocrinologist today. I still feel all the previously stated symptoms. Dr said none of the symptoms are due to thyroid. She switched levothyroxine to synthroid and ordered a CT scan of neck due to enlarged thyroid and swallowing issues. Otherwise no direction was given. The nodule will be rechecked in 6 months.
> Still feel tightness in throat. The anxiety continues but probably making it worse since not sleeping and now have anxiety about not falling asleep.


I have very little faith (okay, none whatsoever) that changing from generic to name brand is going to make a difference. The active ingredients are the same. Yes, the name brand is a tiny bit more precise in amount, but really, if the generic isn't having an impact, I think the results will be the same for the name brand. Hopefully I'm wrong.

Because you have swallowing issues, a next step could be to see an ENT...have you seen an ENT for any of this?

EDIT: I am not minimizing your issues at all, and I hope I did not give that impression. My point is that I think you need to keep "fighting" to find the right treatment for you.


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## Texaschick (May 26, 2012)

Karin, I agree with Surge - my ENT told me with the high antibodies numbers and after seeing the inflammation in my thyroid "no wonder you didn't feel good, it was eaten up with hashi "....I had symptoms like y'all: insomnia forever, then the racing heart and pulse hit out of the blue, hair loss (even half the eyebrows bailed on me! - oh yeah theres a hot look!) and so on and so on...every thing under the sun was ruled out a long the way...hang in there! You will get there sweetie - listen to your body, it never lies to you! Prayers and hugs!


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## Andros (Aug 26, 2009)

KarinStanley said:


> Got my lab results. TSH 2.17
> T4 total 1.8 range 8.9 range 4.5 to12.0
> T4 free 1.8 range .8 to 1.8
> T3 total 79 range 76-181
> ...


OMG!!! I can't believe this. TSI is Thyroid Stimulating Immunoglobulin, the Thyroglobulin Ab, the Thyroid peroxidase Ab. Are you kidding me? Nothing to do with the thyroid?

You should not have any of these antibodies and your symptoms are from them attacking your thyroid and the thyroid receptor sites. Bet you have Trab too!

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 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)

Also, I don't know how you can function. Your T3 which is Total 3 (bound, unbound and rT3 {reverse}) are in the basement. You have nothing from which to derive any energy. FREE T3 (unbound) is your life-giving energy source.

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
FREE T3 explained by Woliner
http://thyroid.about.com/cs/testsforthyroid/a/freet3.htm


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## KarinStanley (Aug 26, 2012)

Thank you for all your replies. It makes me feel better knowing it is not all in my head. I am not sure what to do next. There are very few endocrinologists in my health plan. I have been to two. The other was not recommended by my internist. I guess I go back to general doctor and see if can get referral to ENT. I am still not sleeping so feel extra lousy. Just got a call for CT scan. Will schedule for tomorrow.


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## Octavia (Aug 1, 2011)

Most endocrinologists "specialize" in diabetes, or that's at least what they see the most of, so they're not as accustomed to working with thyroid patients. Can you find one who successfully works with a large(ish) number of thyroid patients, by any chance?


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## CA-Lynn (Apr 29, 2010)

Actually, the stats show that thyroid disease and diabetes run pretty much at the same rate in the US population, which infers that endocrinologists who don't specialize in one disease  or the other, have a patient base split between diabetic patients and thyroid patients. As a matter of information:

DIABETES:

Data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011)

Total: 25.8 million children and adults in the United States-8.3% of the population-have diabetes.
Diagnosed: *18.8 million *people
Undiagnosed: 7.0 million people
Prediabetes: 79 million people* [typically not seen by the endocrinologist yet]

THYROID:

approx 1 in 13 or 7.35% or *20 million people* in USA


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## surge (Aug 15, 2012)

Hi, Karin-- I just wanted to check back in. I went back to the same endo I went to 6 weeks ago, who said the problem was the generic. When I went back to the endo this week, she said, obviously I had an atypical case of hashis, that with my antibody count, symptoms and nodules, she'd advise thyroid removal. What happened in the interval?

It def. helped that we'd ruled everything but anxiety out (which is a part of every hashis story to a degree, but with the antibody counts on paper looking high, it points more towards thyroid).

My primary care physician was key in this for me b/c she brainstormed with me all the possibilities other than thyroid and then systematically eliminated them. She also called my endo personally to report the findings and took the reins on thyroid removal. She's a DO, and totally went the extra mile for me. To have her advocate for me, I think, made my endo see the scene more clearly. Or it could've just been that endo honestly needed to rule out the generic/name brand thing for her own piece of mind. I don't know.

Here's what I did: I agreed to be on a low dose of the name brand (25 mcg Levoxyl), but also went back to my primary. Your primary can/and even might refer you right to an ENT or general surgeon to at least consult...]

I did wear a holter which did reveal no arrhythmias, but streaks of elevated heart rate. This was confirmation for me, but it was useful for my doctors.

I also prioritized sleep. When my heart is racing, there's no sleep w/o ambien. And if I don't get sleep, my anxiety kicks in, and everything feels worse. Consider asking your primary for an ambien Rx. Don't take it if you don't need it-- I keep mine by the bed. Some nights, the when my hr is up there, I just start the night off with one or a half. Another nights, I try to go to sleep on my own first. I'm down from needing it every night to need it 3/7 nights.

Good luck!


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