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"Atypical" test results... HELP?
Hello. I am in need of some assitance making sense of these results. If the doctor could let me know what he thinks, I'd be eternally grateful.
I am 39 years old and have a 13 month old daughter. I had severe hyperemesis gravidum during the ENTIRE pregnancy. I lost about 25 pounds during the pregnancy due to it and of course dealt with fatigue, etc. About 3 months post-partum I was still extremely fatigued and lost much more hair than was normal. My hair dresser told me she'd only seen chemo patients lose that much. It was coming out at the roots and breaking/dry. I still thought it was due to the hyperemesis and I just needed time to replenish my reserves. After just a couple weeks of exercise I had to stop because I was so easily winded, heart racing, etc. I have no tolerance for heat (but sometimes my hands and feet are ice to the touch), frequent stools (4-6 times a day), tingling in my hands which wakes me when I sleep sometimes, neck and back pain, problems sleeping, muscle fatigue and soreness, and the nausea never went away. It did subside drastically; but never totally went away until about 2-3 months ago.
I finally told my GP, who was farming me out to specialists for each symptom that a body just doesnt fall apart like this. I asked to have testing done and she ran a hormone panel.I was told that the results were all normal. I was referred to a cardiologist for the heart racing (88-135 beats a minute resting). He said my heart is in excellent shape after doing a stress test and EKG (thank God!).
Here are my test results:
3/12/08: (GP tested these)
free t4: .88 (reference range: .59-1.25), tsh: .32 (.34-4.82) cholesterol: 229 (<200), LDL: 162 (<100), All others were in the Normal range (DHEA, FSH, LH, Progesterone, Prolactin, Testosterone, Estradiol)
I was seeing an Endo for my diabetes (type 2) when he noticed the goiter, then saw March's test results in my file which the GP had sent over. He put me on simvastatin for the cholesterol, requested an ultrasound of the thyroid since he felt a large goiter. Then he requested more blood tests which resulted in the following results:
04/05/08
TSH: .15 (.34-4.82), thyroglobulin antibodies: <20 (reference <20 IU.mL), thyroid peroxidase antibodies <10 (<35 IU/mL), T3 total: 165 (60-181 ng/dL), LDL Cholesterol 177.
He then asked for an RAIU which showed 5% uptake at 4 hours and no nodules.
At my follow up visit with the Endo last week, he told me that the tests seem "atypical" for Graves (I have a family history of Graves); but that since my heart rate is still so high and I am having a hard time functioning with the symptoms getting worse (excessive energy, occasional fatigue, brain speeding, trouble getting to sleep, serious irritability, etc) he wanted to give me something to "calm down" my thyroid. He ran a final test to see if the results had changed:
05/19/08:
T4, Thyroxine: 8.5 (4.8-13.9) and TSH is now down to 0.11 (.34-4.82).
He put me on 5mg of Methimazole 2x per day. And I don't see him again for 2 months.
If I dont have the antibodies, can I still have Graves? If it is just transient thyroiditis, shouldn't he be treating the symptoms instead of giving me anti-thyroid medication?
I am 39 years old and have a 13 month old daughter. I had severe hyperemesis gravidum during the ENTIRE pregnancy. I lost about 25 pounds during the pregnancy due to it and of course dealt with fatigue, etc. About 3 months post-partum I was still extremely fatigued and lost much more hair than was normal. My hair dresser told me she'd only seen chemo patients lose that much. It was coming out at the roots and breaking/dry. I still thought it was due to the hyperemesis and I just needed time to replenish my reserves. After just a couple weeks of exercise I had to stop because I was so easily winded, heart racing, etc. I have no tolerance for heat (but sometimes my hands and feet are ice to the touch), frequent stools (4-6 times a day), tingling in my hands which wakes me when I sleep sometimes, neck and back pain, problems sleeping, muscle fatigue and soreness, and the nausea never went away. It did subside drastically; but never totally went away until about 2-3 months ago.
I finally told my GP, who was farming me out to specialists for each symptom that a body just doesnt fall apart like this. I asked to have testing done and she ran a hormone panel.I was told that the results were all normal. I was referred to a cardiologist for the heart racing (88-135 beats a minute resting). He said my heart is in excellent shape after doing a stress test and EKG (thank God!).
Here are my test results:
3/12/08: (GP tested these)
free t4: .88 (reference range: .59-1.25), tsh: .32 (.34-4.82) cholesterol: 229 (<200), LDL: 162 (<100), All others were in the Normal range (DHEA, FSH, LH, Progesterone, Prolactin, Testosterone, Estradiol)
I was seeing an Endo for my diabetes (type 2) when he noticed the goiter, then saw March's test results in my file which the GP had sent over. He put me on simvastatin for the cholesterol, requested an ultrasound of the thyroid since he felt a large goiter. Then he requested more blood tests which resulted in the following results:
04/05/08
TSH: .15 (.34-4.82), thyroglobulin antibodies: <20 (reference <20 IU.mL), thyroid peroxidase antibodies <10 (<35 IU/mL), T3 total: 165 (60-181 ng/dL), LDL Cholesterol 177.
He then asked for an RAIU which showed 5% uptake at 4 hours and no nodules.
At my follow up visit with the Endo last week, he told me that the tests seem "atypical" for Graves (I have a family history of Graves); but that since my heart rate is still so high and I am having a hard time functioning with the symptoms getting worse (excessive energy, occasional fatigue, brain speeding, trouble getting to sleep, serious irritability, etc) he wanted to give me something to "calm down" my thyroid. He ran a final test to see if the results had changed:
05/19/08:
T4, Thyroxine: 8.5 (4.8-13.9) and TSH is now down to 0.11 (.34-4.82).
He put me on 5mg of Methimazole 2x per day. And I don't see him again for 2 months.
If I dont have the antibodies, can I still have Graves? If it is just transient thyroiditis, shouldn't he be treating the symptoms instead of giving me anti-thyroid medication?
If you see a GP regularly he/she could order the TSI test and the TBII test.
What the radiologist mentioned is true. The symptoms you have today are from what your body experienced a month ago. Symptoms lag behind hormone levels and how they affect your body.
That is what makes dosage changes such a nuisence. It takes a while to feel better after your levels are correct, and it also takes a while to feel bad when they go out of whack.
What the radiologist mentioned is true. The symptoms you have today are from what your body experienced a month ago. Symptoms lag behind hormone levels and how they affect your body.
That is what makes dosage changes such a nuisence. It takes a while to feel better after your levels are correct, and it also takes a while to feel bad when they go out of whack.
1- I haven't ever taken thryoid meds (until last week after the latest TSH=.11 results).
2- He said the time course of the TSH pattern doesn't fit thyroiditis
3- Both the ultrasound and the one scan done with the RAIU showed no nodules
Does he mean that the TSH should be improving on its own (instead of dropping) by now if its thyroiditis? Because the radiologist mentioned something about the scan showing "what's happening now" and my current symptoms reflecting "the amount of thyroid hormone my body made weeks ago".
I guess this means the Endo just went with the only other choice (Graves) and just didn't confirm with the TSI or TBII? If Im not going to see him for another 2 months; does that mean I should just wait until then and ask for the tests to be run to confirm the diagnosis?
I am most worried that the scan showed my thyroid isnt overactive and maybe I am at the point of going euthyroid on my own; but the meds I'm taking now will put me hypothyroid in a few weeks if my thyroid isn't still overproducing/leaking.
2- He said the time course of the TSH pattern doesn't fit thyroiditis
3- Both the ultrasound and the one scan done with the RAIU showed no nodules
Does he mean that the TSH should be improving on its own (instead of dropping) by now if its thyroiditis? Because the radiologist mentioned something about the scan showing "what's happening now" and my current symptoms reflecting "the amount of thyroid hormone my body made weeks ago".
I guess this means the Endo just went with the only other choice (Graves) and just didn't confirm with the TSI or TBII? If Im not going to see him for another 2 months; does that mean I should just wait until then and ask for the tests to be run to confirm the diagnosis?
I am most worried that the scan showed my thyroid isnt overactive and maybe I am at the point of going euthyroid on my own; but the meds I'm taking now will put me hypothyroid in a few weeks if my thyroid isn't still overproducing/leaking.
by Mark Lupo, M.D.
6 hours ago
This could be Graves, though not a typical case -- without nodules the only other possibility (besides you taking thyroid meds...) is thyroiditis but the time course of TSH pattern does not fit. Would test TSI and TBII to confirm Graves.
6 hours ago
This could be Graves, though not a typical case -- without nodules the only other possibility (besides you taking thyroid meds...) is thyroiditis but the time course of TSH pattern does not fit. Would test TSI and TBII to confirm Graves.
Great .. let us know what he says .. I'm sure we will go over and look too! Dr.Lupo really is very good!
Cheryl
Cheryl
Thank you for the suggestion. Due to the limit in # of questions per day, I've tried a few days and not been able to post. I guess your suggestion gave me the luck I needed. I was just able to post a question to the doc. Thanks!
I agree with barleypop.
If he was looking for Grave's, he should have run a TSI test, and a Total T3 test is not worth much.
Your Free T4 is not high. Your Free T3 is not known, yet he is treating you as if it is high. He is treating based on your rapid heart rate, from the sound of it.
That may be a correct educated guess, or it may not.
If he was looking for Grave's, he should have run a TSI test, and a Total T3 test is not worth much.
Your Free T4 is not high. Your Free T3 is not known, yet he is treating you as if it is high. He is treating based on your rapid heart rate, from the sound of it.
That may be a correct educated guess, or it may not.
The GP apparently ran a Free T4 (the results posted for 3/12/08). Honestly, the Endo is one of two available. He's completely disinterested in humans (just their glands). The other Endo in our area tried putting me on an insulin pump while I was throwing up 20 times a day with hyperemesis during my pregnancy because it "always settles down by the 4th or 5th month"... another good listener! I am always super sick all the way through pregnancy and *I* know my body better than your textbook does. Sure enough, I got sick until they rolled me out of surgery and I had low blood sugars all of the way through. Bah...
I'm mainly concerned because he's never actually asked me about my symtoms (noticed the heart rate and the goiter during an exam). Secondly, my cousin tells me that her TSH was on the low side of normal once a few years ago. 4 months later she asked to have it retested during a routine exam and her new doctor asked her what took her so long to get to the docs since she had Graves and her thyroid was ready to burn out. I didnt know things could change that quickly?! She did antithyroid stuff for 12 months (pre-op protocol), then had it removed (she's currently living in Europe, where surgery is done instead of radiation, which she'd have refused anyway)
I'm mainly concerned because he's never actually asked me about my symtoms (noticed the heart rate and the goiter during an exam). Secondly, my cousin tells me that her TSH was on the low side of normal once a few years ago. 4 months later she asked to have it retested during a routine exam and her new doctor asked her what took her so long to get to the docs since she had Graves and her thyroid was ready to burn out. I didnt know things could change that quickly?! She did antithyroid stuff for 12 months (pre-op protocol), then had it removed (she's currently living in Europe, where surgery is done instead of radiation, which she'd have refused anyway)
I don't know much about Graves either but you might ask you doctor about other thyroid anitbody tests.
Thyroid stimulating hormone receptor antibody (TRAb) and Thyroid stimulating immunoglobulins (TSI) which can occur in Graves disease. It looks like you only had TgAB and TPO tests.
I would also ask that you doctor run Free T4, Free T3 with a TSH because the total T4 and total T3 are outdated tests. It is concerning that your TSH is 0.11 (hyper) but can't tell much because the doctor ran totals and not frees. It just doesn't make sense that your doctor didn't run freeT4 and freeT3 with you last TSH.
hope somebody with knowledge on GD will come along!
Thyroid stimulating hormone receptor antibody (TRAb) and Thyroid stimulating immunoglobulins (TSI) which can occur in Graves disease. It looks like you only had TgAB and TPO tests.
I would also ask that you doctor run Free T4, Free T3 with a TSH because the total T4 and total T3 are outdated tests. It is concerning that your TSH is 0.11 (hyper) but can't tell much because the doctor ran totals and not frees. It just doesn't make sense that your doctor didn't run freeT4 and freeT3 with you last TSH.
hope somebody with knowledge on GD will come along!
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