thyroid peroxidase >1000 please translate

[jherod]

Just got my peroxidase numbers back...reading over 1000 with a range of less than 35 being normal.

I have had a fluctuating THS number. GP accused me of not taking meds...grrrr....also was diagnosed with bipolar disorder.

Now internist says probably not, and that emotions should level out after thyroid is stable. In july TSH was 38. They upped my meds and I started taking them at night. Now the TSH is 7. They upped again...and are sending me to a specialist. I would post my other numbers, but they lost them....grrr.

They think it is hashimotos.

Also having a choking feeling in my throat and regular heart attack symptoms but the EKG and blood work show nothing. Sore hands and feet, swelling of the hands and feet. Major IBS symptoms.

What happens now?

[GD Women]

What do you mean what happens now? Its up to the specialist. Why are they sending you to a specialist? Do you have a specific question to ask here.
You will need another test 6 weeks after the last upped dose, to see how the dose did. Hopefully the test will be from the same Lab.
Your chocking might be from a large growing goiter/nodule, other test should be suggested to rule out thyroid cancer. If its not cancer, and if it is or gets too large, surgery will be recommended.
I can't tell you much without knowing all your levels (TSH FT-4 and FT-3) with Labs reference range. These can tell Hashi or other thyroid issues including non-thyroid illnesses. Hashi
is treat no different than treating hypothyroid and you are already being treated. You just need to get into Labs reference range at a level that is right for you. That might take many med. dose adjustments. What dose are you on anyway.

[kitty]

What will happen now is that you will see an endocrinologist.

He or she will most likely run more tests- TSH, free t4 and possibly free t3.

What were your fluctuating levels? And at what dose? How long have you been on this dose?

The high TPOab will likely remain high. There is no reason to test it again. It probably indicates that you have Hashimoto's hypothyroidism.

Have you had a thyroid ultrasound? If not, the endo may order this as well. It will tell them the texture of your thyroid (normal or indicative of Hashi's) and whether this are any nodules causing your symptoms.

Even if they find nodules (which is very possible), most nodules are benign. They will look at the size and characteristics of any nodules found and evaluate them. Nodules over 1 cm generally require a biopsy.

Hope this helps some. Relax and take care.

[jherod]

I was just wondering what I could expect. Thanks kitty!

I have been hypo for over ten years. I was on 175mcg of synthroid when my TSH came back a 38. The doc didn't give me my tests so I don't know my reference range. He accused me of not taking my meds. I never miss. Prior to that I had been on 175mcg for a couple of months with TSH in the normal range. All of a sudden it spiked. He upped me to 200mcg. The last TSH test came back a 7. Dont know the range, haven't seen the results. She upped me to 225mcg.

It has done this twice in the last six months and my gp was getting annoyed with me, thinking I am non-compliant. Even when he said I was in range, I was symptomatic. Over the last two years it has fluctuated multiple times, sending my hyperthyroid, requiring a reduction, then plunging and requiring him up the dosage again. The first ten years of my diagnosis, things have been relatively calm. I have had a slow and gradual need for a higher dose of synthroid. Since there was no problem keeping it even, I never concerned myself with it much. Took my 250mcg daily and went on with my life.

After all this time, it just freaks out. I went to an endochrinologist who ran several blood tests including freeT3 and freeT4, TSH, etc. I went yesterday to see what the results were and the doctor lost my lab work. All she could find was the anitbody test. She is supposed to fax the rest to me when she finds it, but the antibodies test was way out of range, so she is sending me to a specialist. Not being sure what to expect, and having symptoms out the wazoo I looked here for answers. I can't get in to the specialist for a month.

I didn't know if there were specific tests I should ask for? Heck, I didn't even know to post lab ranges...assumed they were all the same. Sorry for my ignorance. It has just never come up before.

The GP said it didn't matter, all that mattered was the TSH range. Said my T3 and t4 looked fine (not the free T3 or T4). He seemed a little insulted that I would consult anywhere else ending with "well, if it will make you feel better." I kept having this recurrent question, "if everything is okay, why is it swollen, why am I symptomatic?" I have done some reading, enough to be concerned and seek outside help.

As for GD Women's remark "do you have a specific question here?" I don't know enough to be more specific. Just getting started.

A major thanks to kitty for sharing a little of what I might expect. Thyroid scan huh? never had one of those...gives me a new avenue for searching for answers. THANKS.

[kitty]

You are very welcome. It sounds like you have done some good research.

The TSH levels in Hashi's can fluctuate in some people. Other people will always remain on a steady dose.

The TSH is the most important test, but the free t4 especially, in hypothyroidism, can also be of value. Particularly when the TSH goes way low or high. And yes, as you said, the frees are better than total t3/4.

The ATA (American Thyroid Association) recommends that the TSH be between 0.5 and 2.0 while on meds for hypo. There is a great brochure on hypothyroidism on their website with this reference on page 18. I am not sure if I am allowed to post the site here. You should be able to find it by doing a search for the ATA and hypo brochure.

Don't be worried that you didn't post reference ranges. How could you know?
The most important reference ranges are those for the free t3/4 as they vary a lot between each lab. The TSH range is also reported differently, but the method is the same for each lab. There is talk about bringing the upper limit down to 2.5 from the current 4.5-5.5. In the old days, it used to go as high as 7 and 10. A lot has been learned since then. (I work in the lab, so I am very familiar with all these changes over the years.)

I understood your question perfectly fine and I am glad to be of help to you. It is reassuring to hear it from someone else, isn't it? It took me 14 years to get diagnosed!

Hang in there and stand your ground! lol

[jherod]

OK! Got some lab results Most recent goodies while take 175mcg Synthroid:
T4: 9.3 range 4.87-11.72
T-Uptake: 1.06 range .69-1.41
Free thyroxine index : 8.8 calc.
TSH: 7.45 range .35-4.94
Thyroid peroxidase AB >1000 range <35

Cardiologist sending me to a diff endo...one that will see me sooner, thursday in fact.

so, tell me what hidden secret is revealed in my numbers...

[kitty]

Glad you can see another endo sooner!
First, I don't know why t uptake and Free thyroxine index were even ordered! They are outdated tests and both can be replaced with just one- the free t4.
Your total t4 looks good, but a better test is the free t4. It measures actual fee hormone, where the total t4 measures the bound as well.
As I am sure you know, the TSH is still too high, it needs to come down to around 0.5-2.0.

How long were you on 175 before these labs were drawn?

(the above is what my crystal ball told me! LOL)

[jherod]

I requested Free T3 Free T4, TSH, TPO...and this is what she gave me.

Been on the 175 3 months i think....

Was on 200 last summer
upped to 225 in september
cut to 125 in november
upped to 137 in january
Upped to 150 in march
Upped to 175 in may
back to 200 in july....the year before was a different doctor but the same basic pattern.

I have docs old records now...just a sec, let me see if there are any numbers to mention...

in march...upped to 150mcg because of the following lab results.
at the time TSH 28.644
t4, free (direct) 1.o2 range .88-1.93
T3 uptake 31 range 23-36
triiodothyronine (t3) 92 range 15-200

dont know what that means now? anywho...

[kitty]

Have you seen the new endo yet?