new labs

[McKenna]

I guess I should have posted this info on this board instead of my intro thread?

I had hypo symptoms for several months, then in April I had a breakdown of sorts with a lot of hyper feeling symptoms. I went to the doc and he ran a ton of tests which came back as a thyroid issue. I went to an endo and he diagnosed me with Hashi's and put me on 25 mcg of synthroid. This was one month ago. I thought I felt a bit better at two weeks but then last week I started to feel hyper symptoms again. I got lab work and went to the endo today.

This is what happened. I copied and pasted the following from my intro thread:

I'm even more confused! Help!

I wrote that a few days ago I was feeling hyper-ish symptoms. They got worse over the weekend and I had a lot of leg and arm pains, shoulder pain, major heart palps and major anxiety. I also did not sleep more than 1/2 hour at a time from Monday to Tuesday.
I called the endo Tuesday and went for bloodwork and saw the nurse practitioner this morning (doc is on vacation).

These are my new lab results from 6/29

TSH 3.150 uIU/mL .450-4.5
Free T4 1.17 ng/dL .82-1.77
Free T3 2.6 pg/mL 2.0 - 4.4
TPO 269 IU/mL 0 - 34
Antithyroglobulin AB (results will follow) They didn't have them in yet.

So..... My TSH went down a bit but my Free T's also went down. That's not the way it's supposed to work, right?

And my TPO went up again.

These were my results from May:
T4 Free 1.27 ng/dL 0.82 - 1.77
T3 Free 3.5 pg/mL 2.0 - 4.4
TSH 5.330 uIU/mL 0.450 - 4.5
TPO antibody 198.30 IU/ML range: 0.00 - 9.00

The nurse practitioner called the endo (he is on vacation) and endo's suggestion was to go off the synthroid for a week to see if it helps and then we'll know if the synthroid is the problem. If it is, then we can see about a different med, maybe Armor. And to see a cardiologist for the heart, just to make sure something else is not going on. I have MVP and a chronic arrythmia anyway.

I asked her about my free T's dropping and she said they are still in range and they really only look at the TSH anyway. This is frustrating!

I feel better today, not as hyper. But she said I wasn't hyper anyway, based on my labs.

I also had my FNA yesterday. It wasn't too bad and the results should be in next week.

[Lovlkn]

Thyroid movement can cause your symptoms - I am not sure I would quit the Synthroid with your current labs but I think you should listen to your doctors nurse. Based on your current labs you ill only fall further into hypo zone.

What other lab tests have they run on you?

[McKenna]

Hi,
I'm not thrilled about going off they synthroid either.
What do you mean thyroid movement? When the numbers change? I'm just wondering about why my free T's went down instead of going up.

My other labs and tests are:
5/8/2010:
B12 515 pg/mL 211 - 946
VitD 25 Hydroxy 32.7 ng/mL 32.0 - 100
AM cortisol 16.5 ug/dL 6.2 - 19.4
Potassium, serum 4.2 mmol/L 3.5 - 5.2
Folate (Folic Acid), Serum 19.8 ng/mL > 30
Indeterminate: 2.2 - 3.0
Deficient: <2.2
AM Cortisol 16.5 ug/dL 6.2 - 19.4


Then these from 5/13:
TPO antibody 198.30 IU/ML range: 0.00 - 9.00
Anti-Thyrgbl <0.9 * f
Anti-Thyrglb AB reference Range: < 4.0 IU/ML
Legend: * = Abnormal.

This is what is written on the uptake report from 5/21:
The patient presents for evaluation with elevated TSH.
Following the oral injestion of 244 microcuries of I123, 24 hour uptake of 29.1% was calculated which is within the extreme upper ranger of normal in our laboratory.
Static images reveal asymmetric enlargement of the right thyroid lobe compared with the left with homogeneous type uptake identified.
Impression: Asymmetric promininence in size of the right thyroid lobe compared with the left with homogeneous uptake with 24 hour radioiodine uptake within the extreme upper limits of normal. Suggest consideration of thyroid ultrasonography for further evaluation of the thyroid asymmetry.

And finally my ultrasound report from 6/9:
The transverse and longitudinal scans revealed that the right thyroid lobe measures 4.3 x 1.2 x 1.5 cm. The isthmus measures 2 mm in thickness. The left lobe measures 3.8 x 1.2 x 1 cm. The thryoid scan asymmetry is due to a hypodense poorly marginated 15.3 millimeter solid nodule in the upper pole on the left which was cold on recent thryoid uptake and scan. The occupies the extreme upper pole of the left lobe.

Mild inhomogeneity of the thyroid lobes otherwise is identified. No adenopathy was demonstrated.

Impression: The apparent asymmetry of the thryoid lobes was due to presence of a 1.5 cm hypoechoic solid nodule in the upper pole on the left which was cold on thyroid nuclear imaging. Recommend biopsy.


I just had the FNA yesterday.

[Lovlkn]

Hi,
I'm not thrilled about going off they synthroid either.
What do you mean thyroid movement? When the numbers change? I'm just wondering about why my free T's went down instead of going up.

Stuff is happening most likely because of the antibodies. I did not notice a TSI test - have they run that test? You say they did a FNA - obviously you have nodules as well?

Having been put on Synthroid and being classic hypo your numbers should have gone up. Something else in happening and I want to point out one HUGE mistake your current doctor is doing - dosing on TSH.

Run and find another doctor to treat you - runrunrun - TSH is a diagnostic test - not a test to gauge replacement meds on.

[McKenna]

I want to point out one HUGE mistake your current doctor is doing - dosing on TSH.
I completely agree. The nurse practitioner told me that the TSH is what they look for and that sent up major red flags for me. I was researching other endos to see who my insurance will cover. But she did say she thought the TSH was not low enough. I specifically told her that my free T's went down and she said they were still within normal limits. She blew it off like it was nothing. She didn't have a reason or answer for it.

I have the script for my next bloodwork to take in three weeks and she listed the TSI on it. That might be too long for me. She did not list the other antibodies this time, to have them checked. Should they continue to check the TPO since it's going up? This was the nurse practitioner, since the doc is on vacation.

She also ordered the following to do in three weeks:
Comp Metabolic Panel
TSH, Free T 3 and 4
Insulin (fasting)
TSI
Plasma Free Catecholamines
Plasma Free Metanepherine/Normetanephrine

I have no clue what the metabolic panel and the bottom two are for. I'll have to look them up.

You say they did a FNA - obviously you have nodules as well?
Yes, in my last post I put the ultrasound results. A 1.5 nodule on the left lobe. When they biopsied it yesterday, the ultrasound tech and the surgeon think it's smaller, more like 1 cm.

[hillaryedrn]

Well, I don't like the ultrasound results for your nodule. I'm very interested to see what the biopsy shows. Yeah, I'm thinking I'd have to find a new doctor. I don't like they way they are brushing you off!!

[McKenna]

I called two other endos today that are in my insurance network and one can't see me until the end of September and the other can't see me until November or December. They're both an hour away, but I don't care. I didn't make the appointments yet, I'm waiting to hear back from my family doc to get his take since he'll have to refer me.

Day 1 off the synthroid and I woke up feeling like I normally have....cruddy. I called the cardiologist like the endo suggested and they don't take my new insurance so I had to call around to find one in my network. I'm waiting to hear back from my family doc about that one too. I had a lot of palps earlier, but really not any other symptoms. Some arm pains that come and go, some edgy feelings, and I feel tired.

I called the endo's office to tell them that I can't get in to a cardiologist for a while since I have to find a new one and asked if they will prescribe inderal for the palps. They told me to call my family doc. No help again from them.

I had been on Inderal years ago for MVP and arrythmia issues, so it's not like I'm new to it. The thyroid mess seems to have stirred it all up again. On the rare occasion that it would act up over the years, it wasn't bad and it died down quickly. But now it's every day and very erratic at times. Especially when I stand too quickly.

Well, I don't like the ultrasound results for your nodule. I have zero experience with this and the surgeon said he didn't see anything that would alert him as cancerous when he did the FNA. He said the borders looked clean and if it comes back ok, he would be comfortable watching it. But if I absolutely couldn't sleep at night worrying about it, he would consider taking it out. I don't know how I would feel about it staying in there, even if it came back ok. Are the results usually accurate? I can't see letting something in there, waiting for it to grow.

He did say that he had a patient a few years ago that had a tiny module, something like 5 mm, too small to biopsy but she couldn't stand it in there so he took it out and it wound up being cancer.

[Andros]

Hi,
I'm not thrilled about going off they synthroid either.
What do you mean thyroid movement? When the numbers change? I'm just wondering about why my free T's went down instead of going up.

My other labs and tests are:
5/8/2010:
B12 515 pg/mL 211 - 946
VitD 25 Hydroxy 32.7 ng/mL 32.0 - 100
AM cortisol 16.5 ug/dL 6.2 - 19.4
Potassium, serum 4.2 mmol/L 3.5 - 5.2
Folate (Folic Acid), Serum 19.8 ng/mL > 30
Indeterminate: 2.2 - 3.0
Deficient: <2.2
AM Cortisol 16.5 ug/dL 6.2 - 19.4


Then these from 5/13:
TPO antibody 198.30 IU/ML range: 0.00 - 9.00
Anti-Thyrgbl <0.9 * f
Anti-Thyrglb AB reference Range: < 4.0 IU/ML
Legend: * = Abnormal.

This is what is written on the uptake report from 5/21:
The patient presents for evaluation with elevated TSH.
Following the oral injestion of 244 microcuries of I123, 24 hour uptake of 29.1% was calculated which is within the extreme upper ranger of normal in our laboratory.
Static images reveal asymmetric enlargement of the right thyroid lobe compared with the left with homogeneous type uptake identified.
Impression: Asymmetric promininence in size of the right thyroid lobe compared with the left with homogeneous uptake with 24 hour radioiodine uptake within the extreme upper limits of normal. Suggest consideration of thyroid ultrasonography for further evaluation of the thyroid asymmetry.

And finally my ultrasound report from 6/9:
The transverse and longitudinal scans revealed that the right thyroid lobe measures 4.3 x 1.2 x 1.5 cm. The isthmus measures 2 mm in thickness. The left lobe measures 3.8 x 1.2 x 1 cm. The thryoid scan asymmetry is due to a hypodense poorly marginated 15.3 millimeter solid nodule in the upper pole on the left which was cold on recent thryoid uptake and scan. The occupies the extreme upper pole of the left lobe.

Mild inhomogeneity of the thyroid lobes otherwise is identified. No adenopathy was demonstrated.

Impression: The apparent asymmetry of the thryoid lobes was due to presence of a 1.5 cm hypoechoic solid nodule in the upper pole on the left which was cold on thyroid nuclear imaging. Recommend biopsy.


I just had the FNA yesterday.

Oh,my goodness..........................you will have to let us know when the FNA report comes in. Just know I am thinking of you and have whispered a prayer for you re all of this.

[McKenna]

Thanks! I appreciate the prayer.

[Lovlkn]

Since you just had the TPO antibody you probably can skip it on the next round of testing.

If you have a lab slip maybe you could go in early and at least get the TSI -