What is wrong with my thyroid?

[jannalynn]

I have a multinodular goiter which has been monitored for the last 3 years, ultrasound and blood work once a year. It has been stable and nontoxic every year. I went last week for the yearly checkup and my blood work came back somewhat abnormal, tsh is .006 and thyroglobulin antibodies are high 4.3 I think. My understanding from reading is that .006 tsh means hyper but my doctor's office called and asked me to come in for more lab work and she said that I probably have hashimoto's thyroiditis, it was not a nurse that I spoke to, it was someone from the lab.When I looked up hashimoto's it says tsh will be high and that is hypo not hyper so am I confused and don't know what to think while waiting for next results. Any ideas?

[gimel]

The T3 uptake and the Free Thyroxine Index tests are outdated and not very useful.  Your Total T4 and your Free T4 are way over the range, obviously.  That means you are very hyperthyroid and it correlates with the symptoms you mentioned.   Your tests showed Hashi's and related nodules which could totally account for the high levels of TT4 and FT4; however, if it were me I think I would ask for the TSI test at first opportunity, just to be sure that Graves' is not present as well.

[jannalynn]

Thank you so much and i will ask for t3 and free t3 and the tsi test

[jannalynn]

This is becoming a slow process of figuring things out. I have not had a chance to ask for t3 tests or tsi as I haven't actually talked to Dr. I did get a call from nurse saying he wanted to set up an uptake and scan which I had over a week ago. I haven't heard back from Dr's office but yesterday I went to hospital and picked up a copy of the report from that. It says uptake is 90.1 diffusely and no hyper or hypo functioning nodules. Says it is consistent with Grave's and would benefit from radioiodine treatment. I have read some about RAI and sounds very scary and I certainly don't want surgery, hopefully I can take medication.

[gimel]

I think I can interpret those test results as is, but just to be sure please post the reference ranges for the Free T4 and Total T4, shown on the lab report.

[jannalynn]

Tsh .006 ref is .40-4.50, T4 free 4.44 ref is .82-1.77, T4 is 21.1 ref is 4.5-12, Thyroglobulin antibodies is 4.3 ref is 0.0-.09, T3 uptake is 3% ref is 24-39, Free thyroxine index is 7.4 ref is 1.2-4.9

[jannalynn]

t3 uptake is 35% not 3, sorry

[gimel]

A high TG ab test pretty much confirms Hashi's.  The low TSH would most likely be due to nodules from the Hashi's.  Wouldn't hurt to make sure about the Graves' by doing the TSI test at first opportunity.

[jannalynn]

Thank-you so much for the info!

[jannalynn]

I received some more results this afternoon, they are T4 Free is 4.44,  T4 is 21.1,  Tsh is .006, Free thyroxine index is 7.4, and there is one that says T3 uptake 35% but no T3 free?

[gimel]

From your symptoms and the low TSH result I think it likely that the nodules are leaking thyroid hormone faster than would be normal.  The only other possibility is that in addition to the Hashi's, you could also have Graves' Disease, which causes hyperthyroidism.  The test to confirm or rule out that possibility is the Thyroid  Stimulating Immunoglobulin test, often shown as TSI.  

[jannalynn]

The endo doctor hasn't diagnosed either Hashi's or Graves', just the girl from the lab that asked me to come in for more blood work said it is Hashi's but I don't see how it could be  with the tsh .006 plus my symptoms. Maybe lab tech is just saying Hashi's because of high thyroglobulin antibodies, does that always mean Hashi's?

[gimel]

It could be that the Hashi's has caused a nodule on your thyroid gland that leaks thyroid hormone faster than normal and that can cause a low TSH.  This can be checked out by an ultrasound test of the thyroid gland.  

You really should be tested for the biologically active thyroid hormones Free T4 and Free T3 every time you go in for tests.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and Free T4 and Free T3.  What symptoms do you have?

[jannalynn]

I do have multiple nodules that have been stable for past three years. I did have an ultrasound last week and the Dr. said he saw nothing concerning. I think the blood work he is doing now is the free t4 and free t3. As for symptoms, hot all the time, excess sweating, insomnia, heart racing pulse is always between 100-130, shortness of breath, tired and I feel a bit shaky especially my hands. Thank-you.