Thyroid Disorders Community
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12226725 tn?1425350657

Lab results & other autoimmune diseases

Hello, I'll post my lab results below. My questions are...

1. I've read that elevated TPO could be Hashimoto's or another autoimmune disorder. Which other disorders? I don't have Grave's symptoms, but do have hypo symptoms.

2. I have had awful muscle and joint pain, muscle weakness and head and hand tremors. My doctor said that tremors aren't thyroid disease related. Do any of you have tremors? I'm scared that it's MS. I have an appt with a neurologist in early March.

Here are my lab results:

TSH 6.360 (.450-4.5)
Free T4 1.08 (.82-1.77)
Free T3 3.3 (2.0-4.4)
TPO Ab 556 (0-34)
TgAB 26.5 (0.0-0.9)

I'm on 50mcg of Synthroid (the generic Levo... can't remember the name of it at the moment). I feel like my body is betraying me and I'm getting overwhelmed by all of this, especially the symptoms. I just want to feel healthy.
17 Responses
649848 tn?1534637300
Oops, miscalculated the FT3... my bad!!
649848 tn?1534637300
TPOab can be present in smaller amounts in other autoimmune diseases (nobody ever says just how small those amounts have to be), but when the levels are in the hundreds, we, typically, consider that to be indicative of Hashimoto's.  You're also positive for TgAb, with is the other marker for Hashimoto's so I'd say that would be your dx...

To answer your question, though, TPOab can be present in Pernicious Anemia, Rheumatoid Arthritis, Lupus, MS, etc.  Typically, when one has any of those, with the exception of PA, you will also tested and positive for ANA.  

If you have MS type symptoms, make sure your Vitamin B-12 levels have been tested and are more than sufficient (upper part of the range), as B-12 deficiency can cause numbness/tingling and neuropathic pain in the hands and feet.  It can also cause stumbling and other MS like symptoms.

Muscle aches/pains/weakness are very common with hypothyroidism caused by Hashimoto's.

Tremors are often present with hyperthyroidism, but you don't have to have Graves to have hyperthyroidism; Graves has nothing to do with hypo.  Hashimoto's often presents with hyperthyroidism in early stages, which sometimes alternates with periods of hypo or normal before settling into permanent hypo.  Tremors can also be caused by things other than hyper or MS.

Looking at your labs, your FT4 is lower than the recommended 50% of the range (where most of us feel best), but your FT3 is at 65% of its range, which is pretty much in the ball park.

How long have you been on the Synthroid, if that's what you're taking? Synthroid is a brand of levothyroxine.  The generic is just that - levothyroxine - doesn't have a specific name, just a variety of manufacturers.
Avatar universal
TPOab can be somewhat (a term that's never defined) elevated with other autoimmune diseases as well, but yours is a strong positive, so I think it's safe to assume it's Hashi's.  However, once you have one autoimmune disease, you are more likely to get another than the general population is to get its first.  Hand tremors are usually a symptom of hyper.  

Your FT4 is still on the low side.  It's 27% of range, and the target for FT4 is 50%.

Your FT3 is at 54% of range, which is good.  It's in the top half of the range, but if you still have symptoms, there's plenty of room there for an increase.  If you increase your FT4 a little to get it to 50% of range, your FT3 would probably track it up.

Your TSH is high, which means your pituitary would like to see your FT3 and FT4 a bit higher.  

How long have you been on 50 mcg?  Are those labs on meds or before?    
12226725 tn?1425350657
Thanks so much for the feedback! That was really helpful. I've only been on levothyroxine for 12 days. The labs were taken when I was not on meds.  I know it takes awhile to see improvement, if I'm even on the right dose. My doctor also recommended a bunch of vitamins. The magnesium glycinate has helped tremendously with my migraines.

649848 tn?1534637300
You're right - 12 days isn't long enough for the levo to have done a whole lot.  And you're right, your dosage will have to increased, since with Hashimoto's, there's constant destruction being done to your thyroid and medication adjustment has to keep up with that destruction.

Magnesium is known to help with muscle/joint aches/pains and headaches, plus they're symptoms of being hypo, so hopefully, you'll see some improvement there... What other vitamins did your doctor recommend?  Quite often we don't realize what our diet and the nutrients we eat, actually do for us.
12226725 tn?1425350657
My doctor said ideally I'd get my nutrients from food, so she told me to take these because I was either deficient or had defiency symptoms:

5000 IUs vitamin D (my vitamin D was 14.8). I had melanoma and since then have had dysplastic nevi, so I always wear sunscreen (based on the EWG safe sunscreen guide).   :)

1-2 grams of Omega 3 fish oil - I'm not a big fish or egg eater. Working on adding eggs almost everyday. The only fish I eat is salmon - trying to have that 1-2 times per week.

400-600mg magnesium glycinate

5-20 billion (working up to 20 billion) of a multiple strain probiotic; changing it up every 3 months to different strains.

30mg of zinc

She also recommended glutamine, but I haven't bought that yet. I did so much research to find safe or clean, for lack of a better word, vitamins that I just haven't gotten around to researching glutamine.

I've had muscle/joint pain that will land somewhere in my body, cause excruciating pain, then move to another part of my body after a few days. I was seriously thinking it was all in my head. The head and hand tremors & muscle weakness are getting worse and now my hands aren't working right... it's hard to explain. It's almost like a breakdown of fine motor skills.

I'm so glad I found this community. There aren't a lot of people who understand this. I know I didn't before I got it.
649848 tn?1534637300
I think your doctor is on the right track as long as she doesn't plan to let the Synthroid dose sit at 50 mcg indefinitely...

Do you know what your vitamin B-12 level was?  Since she tested everything else, I can't imagine that she wouldn't have tested that.  Vitamin B-12 is one of those that has to be higher in the range than many realize - even many doctors.  Anything under 500 is suspect and can cause symptoms, so if your level is less than that, you should be supplementing that as well.

12226725 tn?1425350657
She didn't test that. It'd show up as B12 or Folate, right? Neither of those show up in my lab results. I'm surprised too because she's seemed pretty spot on with the rest of the stuff. Would it be listed as anything else in my labs? I have 2 pages of results.

I'm having my blood drawn again the last week in March, and then see her the first week in April. I'll talk with her about long term plans. I'm also seeing another doctor who specializes in thyroid issues (one of my friends goes to him). I'd like another opinion and to get his thoughts on a treatment plan, just for comparison's sake.
649848 tn?1534637300
Wow - that's unreal... Vitamin B-12 and Folate are 2 different things.  I've never seen Vitamin B-12 listed on a lab report as anything other than Vitamin B-12, but it could listed as cobalamin or or some variation of, though that's highly unlikely.  You might check with her prior to your blood draw and see if vitamin B-12 can be added.

What about Ferritin?  What was that level? That's another that has to be higher than just "in range"

It's always good to get a second opinion, though quite often, no 2 doctors will agree on how to treat the same patient.  For instance, if it were up to my pcp, I'd be hypo all the time, because he wants my TSH level in range, whereas my endo realizes that he can't do that with me.
12226725 tn?1425350657
Vitamin B definitely isn't on there then, neither is Ferritin. I went in for a regular check up, but I was fasting because I wanted routine blood work done due to my symptoms. Based on what I told her my symptoms were, she ran the original lab work (that doesn't include B or Ferritin). I wonder if she wasn't thinking I was hypo?? Based on my TSH, she ran the thyroid antibodies. My first panel included FT3 & FT4. My cholesterol is also high, but she thinks my thyroid is messing it up. My C-Reactive Protein is good & so were the 2 liver panels.
649848 tn?1534637300
Many people who are hypo are low in vitamin B-12 and the signature fatigue that goes with hypo also goes with vitamin B-12 deficiency, so that should always be ruled out.  

Ferritin is the iron storage hormone and iron is necessary for the metabolism of thyroid hormones, so we need adequate stores of iron.  

High cholesterol is a symptom of hypothyroidism, so it's very possible that once thyroid hormone levels are in control, cholesterol will be, as well.
12226725 tn?1425350657
Thanks so much for the additional info! There's so much to learn about all of this and I've been really overwhelmed. I appreciate your time and help!
12226725 tn?1425350657
Hello, I went to a neurologist this past week because of my tremors. He took a thorough health history and ordered additional blood work to rule out other autoimmune disorders.

Re the tremors... he thinks it may be benign essential tremor; however, I'm having an MRI next week just to be sure it's not something else. I think it's odd that the hypo/Hashi's symptoms would crop up at the exact same time as the essential tremors began. Why would that happen?

I'll post my test results below. The 3 that I can't figure out are high folate (is that a really high #?), kind of low B12 but I don't think it's too bad, and relatively low ESR and CPK.

CK creatinine kinase (CPK) 58 (38-234)
Ferritin 135 (11-307)
Glucose non-fasting 86 (65-99)
Creatinine .86 (.50-1.50)
BUN/crea ratio 15.1 (10-20)
Folic acid (folate RBC) 20.4 (greater than 5.9 is normal)
B12 335 (181-914)
See rate ESR 6 (0-20)

There were some other tests in the metabolic panel, but those were all well within normal ranges.
649848 tn?1534637300
Actually, of all of those, your B-12 is the one of most concern!!  Some countries consider 500 to be the lower limit and anything less than that to be deficient; my lab's lower limit is 200, but they put a note on the report saying that levels below 500 can cause symptoms.  My lab's upper limit is 1100 and I have to keep my level right near the top in order to keep symptoms at bay.

If Vitamin B-12 deficiency is untreated for long periods, it can cause neurological issues, such as neuropathy, etc.
12226725 tn?1425350657
Wow... I wonder if that's what's causing my tremors. Ok, I'll talk with my doc and get a supplement ASAP.
649848 tn?1534637300
I don't think B-12 deficiency will cause tremors; I had untreated Pernicious Anemia (autoimmune inability to absorb B-12) for years and never got tremors, but am left with peripheral neuropathy that gets worse as time goes on, in spite of med to control the pain.  Your level may not be low enough to cause neurological issues, "yet", but if left that low indefinitely, it can, including issues with the bladder, bowels, etc... trust me - don't leave your level that low.
12226725 tn?1425350657
Hello, I've now had 3 sets of lab tests, the most recent last week. My FT3 has gone down, but the other numbers appear to be going in the right direction. I'm on .75mcg of Levothyroxine. I'm going to talk with my doc in 2 weeks about switching to NatureThroid. That would help my FT3, right? I'm still having a bunch of neuro symptoms... as of now, it's not MS. My functional doc thinks maybe lyme. Getting tested for that too. Here are lost recent labs... what do you all think?

TSH = .924 (.450-4.50) originally 6.360
Free T4 = 1.5 (.82-1.77) originally 1.08
Free T3 = 2.6 (2.0-4.4) originally 3.3
TPOab = 396 (0-34) originally 1099
TgAB = 7.2 (0.0-0.9) originally 27.5
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649848 tn?1534637300
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