# A question on blood tests for the veterans



## jumpinjiminy (Nov 27, 2010)

I finally have the numbers on my thyroid test results. The did a cortisol too, which looks kind of low but was judged to be in the normal range because it fell in the normal range for the 4:00 time but was drawn at noon.

FT4 0.89 (0.78 to 2.19)
FT3 3.2 (2.3 to 4.2)
Cortisol 6.3 (4.0 to 22 at 4:00 pm) (drawn at noon)
Tsh 1.370 (0.465 to 4.68)

Whatchya think? Do they look okay?

(have elevated TPOab and suspected HE)

I think I'd like to have my adrenal antibodies tested next.


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## GD Women (Mar 5, 2007)

I'll just comment on the thyroid levels.

All three levels are low but within Labs. According to my Labs which correlate to yours, am I correct that your Ts are FTs. My comments refers to FTs. Might suggest adrenals, allergies, hormonal imbalance (ED), yeast. Not enough spread between the Ts to suggest conversion issue, however, I'd keep an eye on your Ts for future just in case. Or perhaps it still early in the process (?)


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## jumpinjiminy (Nov 27, 2010)

GD Women said:


> I'll just comment on the thyroid levels.
> 
> All three levels are low but within Labs. According to my Labs which correlate to yours, am I correct that your Ts are FTs. My comments refers to FTs. Might suggest adrenals, allergies, hormonal imbalance (ED), yeast. Not enough spread between the Ts to suggest conversion issue, however, I'd keep an eye on your Ts for future just in case. Or perhaps it still early in the process (?)


Yes. Those are frees. Whatever it is is autoimmune because that is the only thing showing up abnormal in my blood work (TPOab 135 and C3 87). Except I had one spike of calcium to 11, but it came back down to normal on the next test.

I feel very hypo something. Not enough energy to get through most days, horrible brain fog, spiking fevers and a good day has only about five hours worth of energy, then the crash. I get maybe four good days a month anymore. Not nearly enough to accomplish anything.

Plus all the neuro symptoms, blurred vision, muscle spasticity, and more.

I had a big flare up of something in August that has died down currently. Nobody has ever tested these things on me in recent years. It took months to find the abnormalities. Because of the fevers, they were looking at infectious disease and tumors at first. These last couple of weeks, I think it might be flaring up again. Neuro wants to do a spinal tap, but I want to wait until it gets worse so something shows up in it. I'm currently on my second medrol pack and feel a ton better energy wise. It's also suppressing some of the neuro stuff. But for how long is anyone's guess. The lower the dose goes, the worse it gets.

I don't want to flare up or crash over the holidays. But it's looking like that's exactly what's going to happen.

Thanks for the reply. Do you think it would be worth a trial run of thyroid replacement for a month to see what happens? Doc said he's willing to try it.


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## GD Women (Mar 5, 2007)

jumpinjiminy said:


> Yes. Those are frees. Whatever it is is autoimmune because that is the only thing showing up abnormal in my blood work (TPOab 135 and C3 87). Except I had one spike of calcium to 11, but it came back down to normal on the next test.
> 
> I feel very hypo something. Not enough energy to get through most days, horrible brain fog, spiking fevers and a good day has only about five hours worth of energy, then the crash. I get maybe four good days a month anymore. Not nearly enough to accomplish anything.
> 
> ...


Did I read correctly, you are not on thyroid meds.

People are more at risks of developing hypothyroidism when TPOAb are present. HOWEVER, this antibody may also be elevated in other autoimmune conditions such as rheumatoid arthritis, lupus and Sjogren's syndrome. A certain percentage of patients who are healthy may be positive for one or more thyroid antibodies. The presence of these antibodies doesn't always indicate that a person has an autoimmune disorder. And, they may remain positive for years, and do not provide an indication of whether the person has normal or abnormal thyroid function.".

There is no cure or treatment for antibodies so thyroid levels prevail in diagnose and treatment. Your levels do not suggest the need for replacement meds. as yet.

The symptoms of both hyperthyroidism and hypothyroidism are non-specific and can be mimicked by other conditions. Adrenals for one.
It is suggest that if adrenals are suspected, to have them treated and cured first before thyroid treatment and medication, because, adrenals can effect thyroid levels, therefore give false readings and not true ones.

Have you had blocking TSH receptor antibodies done. This test is a better indicator. People who primarily have blocking TSH receptor antibodies will be hypothyroidism/Hashi when these antibodies predominate. Blocking TSH receptor antibodies can be measured with a test for thyrotropin blocking antibodies or TBA

I would definitely keep having thyroid test done on a regular bases for in the future your levels maybe become thyroid enough to warrant treatment/thyroid meds.

Sorry you are having issues. I would suggest to have each and every one of them check out separately and from thyroid.

http://www.endocrineweb.com/conditions/thyroid/graves-disease/graves-disease-diagnosis

http://www.mythyroid.com/bloodtests.html


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## jumpinjiminy (Nov 27, 2010)

Nope. Not on thyroid meds. This is all new. At first it was suspected I had MS. This is a waxing and waning 20 year+ problem. My cortisol level came up a low normal as well. Doc says endocrinologists in the area go by the book, so won't be willing to try this and that to see what helps. I see him Friday, so maybe he'll order an ACTH provocation test.

Everything I've read so far indicates a low TSH with low T4 points to a central hypothyroid disease. There might be adrenal or pituitary antibodies, but nobody has checked yet. This TPO thing has us going in a different direction than previously.

All the regular autoimmune antibody tests came up normal - lupus, rheumatoid, Sjgorens, etc. Nothing. CRPs are normal, RFs are normal, C4s are normal, uric acids are normal. Brain and c-spine MRIs normal. Electrolytes, RBCs, WBCs, liver, kidney, all normal.

I do know one thing, my ears have been filling up with fluid with this flare up, off and on since August and rupturing the tympanic membrane. They're filling up again but the steroids are keeping it under control.

Nobody knows what's going on. The neuro suspects Hashimoto's encephalopathy as a possibility, but doesn't have enough evidence to diagnose or treat it.

It's very frustrating. My family life and professional life is falling apart because I don't have the energy, memory or cognitive function to run it all anymore. But nobody can help me or stop this thing from ruining my life.

I don't have a big family to help out, and my husband is clueless an uninterested in doing things the right way. I'm getting really aggravated with him because I can't count on him to pick up the loose ends without things getting screwed up worse. Yesterday marks the fourth time in four months he's forgotten our son's therapy appointment. I've had to apologize and reschedule with the therapist every time.

It's like not even in his memory bank to call the guy to apologize and reschedule it. In other words . . . I have TWO friggin kids to look after and feed. He's not going to do it unless it comes out of a box and has breading. I can't eat that stuff because it makes me sicker. And most weeks I don't have the ability to concentrate long enough to get a menu plan and shopping list together. Then to muster together the energy to make the trip to the store and load all that up in the car twice and into the cabinets is even harder.

He's wearing down because he's had to take over getting our son ready for school since May. I just couldn't do it anymore. I was exhausted beyond belief. It's taken months to get to where I could get up early in the morning again, and that's only here and there. The only way it's happening lately is because the steroids make it so I can think in the morning. Otherwise, I'm barely awake until 10 am. Then sleepy until about 4 or 5, then I'm awake.

This can't be happening. It's been going on far too long. And I'm totally on my own as far as getting well and holding it all together around this house. My family needs me. My husband can't do it and is wearing out. And we have nobody to help. Our son has special needs and is a huge handful. The therapy and my insistence on doing things a certain way (and keeping the house and his room clean) are the only things keeping him on an even keel. When I go down, it all goes down.

Maybe I need to explain this to my doctors. They have to do something to help me.


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## stranazingarella (Dec 6, 2010)

Have you been checked for Sarcoidosis? It's hard to diagnose but you could get an ACE, CPK, CRP, and ESR test to check for more abnomalities.


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## jumpinjiminy (Nov 27, 2010)

stranazingarella said:


> Have you been checked for Sarcoidosis? It's hard to diagnose but you could get an ACE, CPK, CRP, and ESR test to check for more abnomalities.


I've had CPK, CRP, ESR and chest xray - as well as a cspine MRI that showed the upper part of the lungs. Brain MRI was perfectly clear as well. All things are normal - except the TPOab and C3. Except for these lab numbers for the thyroid and cortisol which are low normals. And still - they're normal. Technically. But my doc said he wasn't going to go by the book based on how I was feeling. Maybe a little T4 would help. Maybe a little cortisol would help.

Probably better request that ACTH stim test first then. I'll probably go ahead with the spinal tap as well. I'm sure this is another nervous inflammation flare up coming on. This second round of steroids is not doing as good of a job controlling the symptoms as the first. I fear for the taper this time. It could be brutal.

And my cycles have been almost a week late these last two months despite having been a normal 28 days cycle for the four or five previous months. Another clue? Plus I'm experiencing these sensations of having let down reflexes, but no secretions. Odd?

My body and brain are freaking out.


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## stranazingarella (Dec 6, 2010)

The reason I asked is because some of the symptoms really sounded like Sarcoidosis, of course, I'd rather you didn't have it. Have you had D levels checked and iron? B-12?

Have you been checked for Chronic fatigue or Lyme? Have you seen a cardiologist for an echo?

I hope you feel better soon. I know what trying to keep up with life while feeling like utter crap feels. And I don't even have kids. (Just a bi-polar husband)!


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## jumpinjiminy (Nov 27, 2010)

stranazingarella said:


> The reason I asked is because some of the symptoms really sounded like Sarcoidosis, of course, I'd rather you didn't have it. Have you had D levels checked and iron? B-12?
> 
> Have you been checked for Chronic fatigue or Lyme? Have you seen a cardiologist for an echo?
> 
> I hope you feel better soon. I know what trying to keep up with life while feeling like utter crap feels. And I don't even have kids. (Just a bi-polar husband)!


Bipolar is tough! Not an easy road there either.

Chronic fatigue and fibro have been suggested, but it's agreed neither of those would explain the neuro problems.

I was tested for lyme's but one tenth off from a positive result. They ruled it out because either you are or aren't, according to the group that's doing the testing.

And the MS specialist I saw said they don't believe in CNS lyme's there at all.

Cardiologist did a TEE, echo, and event monitor. There was minimal valve damage - so he went in to look for autoimmune or infection related issues and found nothing. The event monitor showed heart rate variability both high and low, but all within normal ranges. Told me to up my salt and water intake. It helped. But the event monitor and near fainting spells (along with the low C3 the rheumatologist found) prompted the neuro to search for the TPO ab and they were elevated.

Oh. Yes. The vitamin D was low at 25, but not super low. Parathyroid hormone was a high normal, and Ca was 11 at that time, but came back down to 9.6 two weeks later when tested after being on Vitamin D. I've been on 50,000 IU of Vitamin D for almost two months now. Iron was not tested. Hemoglobin is fine. B12 is fine. Folic acid is fine.


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## GD Women (Mar 5, 2007)

jumpinjiminy,

Central hypothyroid conditions are characterized by paradoxically normal or slightly elevated serum TSH and FT4 is low and the cause is a dysfunction of the pituitary gland or hypothalamus. Actually, TSH cannot be used to diagnose central hypothyroidism because current TSH assays measure biologically inactive TSH isoforms.

Have you had a TRH stimulation test. This test can tell whether a person has in reality an overactive, normal or underactive thyroid, that would enclude Central hypothyroid.

Sorry about your family and professional life. It must be really rough, especially when one is not feeling their best.

There is a reason out there some place that you are not feeling well and with your patiences, doctors help and by elimination of health issue you will find the reason and thereby the treatment.


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## jumpinjiminy (Nov 27, 2010)

Thank you. Sorry for that TMI. I was a little frustrated last night. Lack of sleep. My SO has some habits that interfere with my ability to sleep (tv at bedtime when you're finally half asleep anyone?).

Between that and our/his difficulties handling our special needs son, all of the yelling and lack of sleep - sometimes I think the stress will kill me. It's certainly not helping me get my strength and energy back. It's constantly sapping whatever reserves I've managed to build up.

Adrenal fatigue could very well be a big part of this whole thing. I will bring it up with my doc tomorrow. All the symptoms fit.


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## Andros (Aug 26, 2009)

jumpinjiminy said:


> Yes. Those are frees. Whatever it is is autoimmune because that is the only thing showing up abnormal in my blood work (TPOab 135 and C3 87). Except I had one spike of calcium to 11, but it came back down to normal on the next test.
> 
> I feel very hypo something. Not enough energy to get through most days, horrible brain fog, spiking fevers and a good day has only about five hours worth of energy, then the crash. I get maybe four good days a month anymore. Not nearly enough to accomplish anything.
> 
> ...


If those are the Frees, my opinion is that you are low in hormone (thyroxine, triiodothyronine .) It is desirable to at least have the FT3 1/2 way above the mid-range of the range given as long as it is not over the range. FT3 is your active hormone.

T3 is essential for healing, energy, good mental status and a whole bunch of things.

You might like to edit your post to FT3 and FT4 so others can offer proper input.


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## jumpinjiminy (Nov 27, 2010)

Thank you for the input, Andros.

For the FT4, is it the same? Half-way through the high end of normal?


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## GD Women (Mar 5, 2007)

jumpinjiminy said:


> Thank you. Sorry for that TMI. I was a little frustrated last night. Lack of sleep. My SO has some habits that interfere with my ability to sleep (tv at bedtime when you're finally half asleep anyone?).
> 
> Between that and our/his difficulties handling our special needs son, all of the yelling and lack of sleep - sometimes I think the stress will kill me. It's certainly not helping me get my strength and energy back. It's constantly sapping whatever reserves I've managed to build up.
> 
> Adrenal fatigue could very well be a big part of this whole thing. I will bring it up with my doc tomorrow. All the symptoms fit.


Your FT4 is every low although still in Labs.

Well stress can certainly keep us from good physical and mental health. That is why I am on anxiety medication. You sound like you are under quite a bit.

A lot of things can effects your thyroid levels and health. Environment, Chemicals and Drugs, etc.

Your TSH is below Labs mid range so its considered on the low side. FT3 is mid Lab range which is not a bad thing and considered an optimal level. *But *your FT4 is very low although in Labs. The FT4 is the issue or problems. So I repeat again your levels might suggest allergies, hormonal imbalance (ED), yeast. Cushing syndrome and some prescription drugs or central (secondary) hypothyroidism and possibly adrenals, although normally levels are way out of Labs. 
One cause of low cortisol levels is adrenal insufficiency.

In some cases if the initial health issue isn't corrected first, the thyroid/levels will never be corrected and still cause havoc with health.

I hope you are feeling better. Let us know how the "adrenal antibodies test" goes or your next doctor appointment.

Wishing you better health soon.


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## Andros (Aug 26, 2009)

jumpinjiminy said:


> Thank you for the input, Andros.
> 
> For the FT4, is it the same? Half-way through the high end of normal?


Yes it is "unless" you are taking T3. Then the FT4 drops down which is natural and normal as T3 is your active hormone.


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## jumpinjiminy (Nov 27, 2010)

Next step is seeing an endocrinologist to rule out adrenal issues. Steroid packs worked to suppress a flare up for a couple of weeks - although not completely.

I felt wonderful on them. Too bad they're so bad for you. Now taking an SNRI for the fatigue. It's helping with the mental fog/fatigue, but the physical is still dragging.

Looks like I might be going to Mayo for a dx. No thyroid meds yet. Waiting to see how it all pans out . . .


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