# New Hashi's Girl.



## xLeBeaux (Nov 10, 2012)

After years of feeling like I was dying, gaining a ton of weight for no reason over the last year, having 6 different doctors tell me I was fine and that my elevated TPO's didn't mean anything, I finally got to see an endo. He confirmed I have Hashi's and put me on 25mcg of Levothyroxine and just upped it half a grain yesterday.

So my question is&#8230; what is with my recent labs? Should my T4 be dropping if I'm on T4 replacement? Also, can someone explain my TSI? Are they like TPO's where they are only "suggestive" of something? (I tried to get him to do a Free T3 test but he tested Total T3)

Before the Endo:

9/5/2012 TSH: 0.83 (0.10-5.50 uIU/mL) 
9/5/2012 Total T3: 114 (50-170 ng/dL)
9/5/2012 TPO AB: 262 (< 35 IU/mL)
9/5/2012 Free T4: 1.1 (0.8-1.7 ng/dL)

Before starting Levothyroxine:

10/3/12 TSH: .68 (0.10-5.50 uIU/mL)
10/3/12 CORTISOL, 9H: 1.3 (0.0 - 1.7 ug/dL)

6 week check:

11/10/12 Free T4: 1.0 (0.8-1.7 ng/dL)
11/10/12 Total T3: 118	(50-170 ng/dL)
11/10/12 TSH: 0.71 (0.10-5.50 uIU/mL)
11/10/12 TSI: 298% (no reference range)


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## Andros (Aug 26, 2009)

xLeBeaux said:


> After years of feeling like I was dying, gaining a ton of weight for no reason over the last year, having 6 different doctors tell me I was fine and that my elevated TPO's didn't mean anything, I finally got to see an endo. He confirmed I have Hashi's and put me on 25mcg of Levothyroxine and just upped it half a grain yesterday.
> 
> So my question is&#8230; what is with my recent labs? Should my T4 be dropping if I'm on T4 replacement? Also, can someone explain my TSI? Are they like TPO's where they are only "suggestive" of something? (I tried to get him to do a Free T3 test but he tested Total T3)
> 
> ...


It is my humble opinion that you should not be on thyroxine replacement. W/TSI @ 298%; no way.

Also, if I were you, I would insist on an ultra-sound. And you need the FREE T3 run; not the T3. FT3 is your unbound hormone available for cellular uptake.

You are not fine; that is for sure. Many symptoms can and do cross over. Myself and many others have gained weight while hyperthyroid.

Here is some important information for you.

TPO
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

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


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## xLeBeaux (Nov 10, 2012)

Thank you Andros! I've been lurking the board for a long time and was hoping to get your input. You're like the Thyroid Guru!

So if I'm on T4 replacement and its lowering what does that mean? Shouldn't it be going up? And is it safe to believe I have Graves by looking at my TSI? I've been reading so much about what TSI is and what its linked to and it says Hashimotos, Graves, Hashitoxicosis... I'm confused. Can you have Graves and Hashi's?

My Endo did an ultrasound but apparently didn't save the results? I remember him saying I had two small nodules about 2 mm each.

I also emailed my dr about my TSI and his reply was:
" _TSI is the antibody ususally associated with Graves. Autoimmune thyroiditis is the overarching diagnosis and we have to monitor closely as your gland could produce too little (as it has been) or too much thyroxine_."

Seemed really ambiguous to me.


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## Andros (Aug 26, 2009)

xLeBeaux said:


> After years of feeling like I was dying, gaining a ton of weight for no reason over the last year, having 6 different doctors tell me I was fine and that my elevated TPO's didn't mean anything, I finally got to see an endo. He confirmed I have Hashi's and put me on 25mcg of Levothyroxine and just upped it half a grain yesterday.
> 
> So my question is&#8230; what is with my recent labs? Should my T4 be dropping if I'm on T4 replacement? Also, can someone explain my TSI? Are they like TPO's where they are only "suggestive" of something? (I tried to get him to do a Free T3 test but he tested Total T3)
> 
> ...


If you don't mind my saying so, I don't believe you should be on thyroxine replacement. You are hyper.

A FREE T3 test would be good and so would RAIU (radioactive uptake scan.)

Hopefully this info will interest you...........

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

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


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## Lovlkn (Dec 20, 2009)

xLeBeaux said:


> After years of feeling like I was dying, gaining a ton of weight for no reason over the last year, having 6 different doctors tell me I was fine and that my elevated TPO's didn't mean anything, I finally got to see an endo. He confirmed I have Hashi's and put me on 25mcg of Levothyroxine and just upped it half a grain yesterday.
> 
> So my question is&#8230; what is with my recent labs? Should my T4 be dropping if I'm on T4 replacement? Also, can someone explain my TSI? Are they like TPO's where they are only "suggestive" of something? (I tried to get him to do a Free T3 test but he tested Total T3)
> 
> ...


I had high Thyrotropin Receptor Antibody's which are in the same family as TSI. My endo did not run TSI until right before surgery at my insistence.

My TPO was in the 486 range at diagnosis of Graves disease and over 2000 at surgery 4.5 years later.

One time during the process I had an antibody "normal" lab while taking Tapazole. I never could stabilize on anti thyroid medications and eventually had surgery.

My diagnosis after surgery was hashitoxicosis from the Surgeon due to the destruction of my thyroid which was full of nodules I never knew I had.

I only presented hyper symptom's unless hypo induced due to anti thyroid med's which happened often.

You, in my opinion may have hashitoxicosis.

Your antibodies will be having war in your body, destroying your thyroid - your symptoms may be hyper or hypo.

Your FT-4 and T-3 labs indicate you are hypo, your TSH is about normal.

You will be better off dosing on FT-4 and FT-3 rather than TSH at this time.

Your body will go from hyper to hypo and it will be difficult for you to remain on the same drug and dosage for any amount of time.

Unfortunately, you likely will never be able to reach a remission due to the fact you have the entire spectrum of thyroid disease occurring in your body.

If this is your path - please consider surgery over RAI, especially if you have eye involvement. You want the attack to stop and the only to do that is to remove your entire thyroid.

I just re-read my reply and it does sound grim - I wish I had known what I know now and someone had told me. Please take what I say under consideration during your diagnosis and treatment phase. If I had known earlier I would have had surgery earlier - it was a long hard experience trying to stabilize on meds before my thyroid was removed.


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## Andros (Aug 26, 2009)

xLeBeaux said:


> Thank you Andros! I've been lurking the board for a long time and was hoping to get your input. You're like the Thyroid Guru!
> 
> So if I'm on T4 replacement and its lowering what does that mean? Shouldn't it be going up? And is it safe to believe I have Graves by looking at my TSI? I've been reading so much about what TSI is and what its linked to and it says Hashimotos, Graves, Hashitoxicosis... I'm confused. Can you have Graves and Hashi's?
> 
> ...


This is why a FREE T3 test is so important. If you are taking thyroxine (T4) and the lab results show your T4 going down, that does suggest a fast conversion to FREE T3 which is typical in hyperthyroid. If the patient is hyperthyroid, we would expect to see the FREE T4 going up as well as the FREE T3 going up w/TSH going down.

Since you are on a low dose of Thyroxine replacement that "could" mean you are really converting T4 to FREE T3 at a very very rapid rate.

2. Grave's Disease is an autoimmune disease in which an antibody is produced that mimics TSH. It signals the thyroid gland to make T4. As the T4 level rises, the pituitary tries to reduce the T4 level by reducing TSH levels and we get a low TSH. Typically we find elevation of Thyroid Stimulating Immuneglobulin or TSI. Most labs consider a level of 130 or higher as evidence of Grave's Disease. In reality, we often see the signs of hyperthyroidism begin to appear in a subtle way at a level of 90. At 110 the symptoms are easier to see. By the time we get to 130 the symptoms are usually severe. Unlike Hashimoto's Thyroiditis, in Grave's disease the T4 goes into high conversion to T3. This is like driving a car too fast and stepping on the accelerator. This is extremely stressful to the adrenals.
http://www.drrind.com/therapies/thyroid-scale-matrix

Re the Levothyroxine, you said, "he just upped it 1/2 grain." Are you taking dessicated thyroid? Levothyroxine is mcgs. Dessicated thyroid is grains.

Graves' has certain criteria.

The criteria for Graves' is clinical. You must exhibit..........goiter, exophthalmos, pretibial myxedema and thyrotoxicosis as per Dr. Robert Graves' of the 1800 era. 3 out of the 4 qualify.
(3 chapters) http://www.thyroidmanager.org/chapter/graves-disease-and-the-manifestations-of-thyrotoxicosis/

http://www.thyroidmanager.org/chapter/diagnosis-and-treatment-of-graves-disease/


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## Lovlkn (Dec 20, 2009)

> The criteria for Graves' is clinical. You must exhibit..........goiter, exophthalmos, pretibial myxedema and thyrotoxicosis as per Dr. Robert Graves' of the 1800 era. 3 out of the 4 qualify.
> (3 chapters) http://www.thyroidmanager.org/chapte...hyrotoxicosis/


I only had 2, goiter and thyrotoxicosis. Thank God my Endo did not wait for the other 2 to develop.

xLeBeaux,

Whatever thyroid disease you may have it is very important to lab at least every 6 weeks to monitor what's happening in your body.

Ask alot of questions to your endo - be proactive in your care.


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## xLeBeaux (Nov 10, 2012)

angel1976 said:


> Not sure why you were put on L-thyroixine first time (your TSH was less than 1.0)
> First time you were tested for TPO and now for TSI (the testing parameters should be consistent with each other!)
> The TPO antibodies are not reduced by thyroid hormone; according to one controversial study, about 33% of participants got them lower after taking 120 to 200 micro(?)grams of selenium (equal to 2-3 Brazilian nuts per day)
> If thyroid itself is unremarkable (normal size and echotexture) the blood flow pattern should be tested: patchy means thyroiditis; overall increased means beginning of the Graves.


He said he put me on L-thyroxine because of my TPOab, low T-4 and I had hypo symptoms. The TPO was done by my Primary and my Endo wouldn't test my TSI until I begged him because he said it was pointless because I don't have Graves. Thus the tests being months apart. I'm definitely taking Selenium to try to lower these antibodies.



Lovlkn said:


> Your body will go from hyper to hypo and it will be difficult for you to remain on the same drug and dosage for any amount of time.
> 
> Unfortunately, you likely will never be able to reach a remission due to the fact you have the entire spectrum of thyroid disease occurring in your body.
> 
> ...


I'm so sorry you had to go through that. I'm definitely giving removal much thought. I put in a request to see an ENT so I can figure out what my options are with my thyroid, or at least to try to get a better idea of whats going on.



Andros said:


> This is why a FREE T3 test is so important. If you are taking thyroxine (T4) and the lab results show your T4 going down, that does suggest a fast conversion to FREE T3 which is typical in hyperthyroid. If the patient is hyperthyroid, we would expect to see the FREE T4 going up as well as the FREE T3 going up w/TSH going down.
> 
> Since you are on a low dose of Thyroxine replacement that "could" mean you are really converting T4 to FREE T3 at a very very rapid rate.
> 
> ...


Oops! I meant 25mcg and he upped it half of that. They look like grains so thats what I thought they were. Sorry!

I asked my Endo a ton of questions and I feel like he was just blowin' smoke. He said that since I have Hashi's then I'll more than likely have TSI present. Since my TSI is really high as of right now he's calling me "Hashitoxicosis" but is worried that I am going to go Grave's. So he just wants to monitor me and see how I react to increasing my meds. I feel like a guinea pig. I also asked about my T4 dropping and he said it just does that and doesn't mean anything. He did increase my labs though so I can go sooner than 6 weeks. I'm gonna make him add my Free T3 cause it's stupid that I can't get anyone to test it.

Thank you for all the responses! It really does help knowing I'm not alone in this.


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## Andros (Aug 26, 2009)

xLeBeaux said:


> He said he put me on L-thyroxine because of my TPOab, low T-4 and I had hypo symptoms. The TPO was done by my Primary and my Endo wouldn't test my TSI until I begged him because he said it was pointless because I don't have Graves. Thus the tests being months apart. I'm definitely taking Selenium to try to lower these antibodies.
> 
> I'm so sorry you had to go through that. I'm definitely giving removal much thought. I put in a request to see an ENT so I can figure out what my options are with my thyroid, or at least to try to get a better idea of whats going on.
> 
> ...


Maybe you would like to read our Admininstrator/Owner's story.....................

Read Nasdaqphil's Special Report on Hashitoxicosis here........ http://www.thyroidboards.com/hashitoxicos


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