Subclinical Graves' ?

[1000catsyouknow]

Hi, my first post here. I was wondering if anyone knew if this is subclinical Graves' Disease.
TSI 103 (ref <+125%)
Thyroid Peroxidase <10 (ref <35 IU/mL)
TSH 1.97 (one year prior was 1.85 with a FT4 of 1.5 ref range .8-1.8)
Thyrodglobulin 16.9 (ref. 2-35 ng/mL)
small goiter

Of course, not asking for a diagnosis - only if someone knows if this is actually subclinical Graves'.
Vitamin D and blood calcium need to come up a little but they are within the ref. range.
Glucose Intolerant. Currently, normal FBS, normal BP, pulse 80
I don't understand... I have read that TSI's should not be there but the TSH has remained near perfect? for a year. Illness proceeded with a FBS of 180's before antibiotics.

Thank you in advance for any replies!!

[nonstickpam107]

I presented with almost the same..I have Hashimoto's...and they didn't do a TPO antibody...a thyroid peroxidase is just to 'see' if you have any antibodies (either Graves OR Hashi's) but a TPO antibodies will show Hashi's.

Hashimoto's is called the 'roller coaster' disease because it can swing wildly from one extreme to the other and usually one of the types of antibodies will be very slightly raised (your TSI) and the other (TPO antibody...you don't have that there) will be hugely high.

Your TSH is not 'hyper' and your FT4 is pretty high, BUT you don't show a FT3 to see if that is very high (a hallmark of Graves is for the FT4 to be pretty high in range and the FT3 to be hugely over range...but with Hashi's it would be either lower than the FT4, OR barely over 3/4 of range). And most with Hashimoto's have goiters (a 'goiter' is just the thyroid gland itself, swollen from lack of thyroid hormone or antibody 'attacks' on it, usually Hashimoto's).

I'd ask for FT3 and anti TPO antibodies. JMHO

Pam

[1000catsyouknow]

Pam -
I was so hoping you would answer me! I noticed a couple of your other replies and you know your stuff. (all my lab info that I'm stating has been over the course of a year and a half)
For some reason I have pg1 & 2 of the labs from the endo but missing pg 3. I know the endo was thinking Hashi at first but when she called me she said subclinical Graves' but I pulled out the lab of my TSH from a year prior and told her my TSH has basically remained the same. So she started talking premenopause. I can email you privately if your curious about my story and labs (I don't expect that and do very much appreciate your answer thus far) just don't want to list everything on a public site. But basically she didn't have my other labs and I don't see premenopause as being my issue. This all is such a long story.
All I can say is if they would have been clinical, professional and look at the information with an educated eye I wouldn't be in this mess. Oh and my favorite - the 'guessing game' they play. Let's not do the labs and tell the patient what is wrong.
Thank you, I will be making sure she did/does those tests. I was surprised she didn't do the FT3 or FT4 (after educating myself) maybe they were on that 3rd page. I do have an appointment with her in 3 weeks - she's not going to like me since I have other labs I want out of her too (oh well...my life, my money and my insurance's money!)
Thanks!!!
K

[nonstickpam107]

K you don't have enough posts to pm me yet. But at this stage, you are just not getting the 'correct' tests. But what you HAVE of the testing points to some autoimmune issue (thyroid-wise) and I'm just about feeling that ol' 'You got Hashi's cuz it's so common and your doctor won't understand just how crappy you can feel until she/he gets it her/himself'.

Tell me, do you have progesterone, estradiol, free testosterone testing too? (Cuz you deny the premeno...you'd have to have those tests to do that...FSH isn't reliable ... just like TSH isn't a reliable thyroid disease test and neither is just an 'estrogens' test bulking all the estrogens together). Also, have you done a 4x in one day salivary cortisol test?

You need to kind of 're wire' your circuitry too..you're talking like your TSH would determine something about your thyroid...it doesn't. Your FT's would do that. These docs who go by TSH..they make us believe that's necessary to discuss..but it's not a relevant test until you put it with all the others.

Pam

[1000catsyouknow]

First of all - THANK YOU again for your reply.
With my rambling..
9 years - melasma on face (just diagnosed a few months ago - I thought it was acne scars - jaw line)
psoriasis since 15 scalp, but 2 years ago moved to my elbows. Was mis-diagnosed until a few months ago
Cronic yeast infections, heavy pds with longer spans BUT this cleared up with antibiotics of all things.
Estradiol was done a few days before my pd (Aug 2006) came back right over 100 but oddly by FSH came back .5 (like is that possible? or an error?) I was very ill at the time and that is when I caught my FBS was elevated. I was having horrible night sweats and decided to cancel out diabetes with a home meter - but that is when I found my numbers were elevated.
HDL was 42, LDL 125 trig 80 in Aug 2006. Since then my HDL lowered to 28, LDL 95, trig have been 60 and 100. Very odd since I feel better now. The endo couldn't figure this one out.
One strange thing - about 3 months after my last course of antibiotics I could eat again without feeling as sick (I still feel sick from time to time but not as bad as before). My A1c dropped from 6.1 to 5.0 and I did NOTHING to cause this. I don't work out and I eat around 200 carbs a day. But not too much on the fast acting type or all at once - I graze. But I can't handle an oral glucose tolerance test. I start normal FBS, go up fast, stay there for 2 hours then crash.
I think that's it with testing you asked about and I included a little more. I'm not mental at all (you would be surprised.. or not... at how some of these doctors try to round peg, square hole - I even was told I had high BP because it was high when I was ill). I'm only concerned that I'm getting proper care and diagnosis - whatever that may mean. My interest has always been - do the testing and go from there. I once followed a GP's advice about a rash on my foot - well $1,000+ later (not covered by my insurance) and it moving to my nail and a few years down the road I'm almost cleared up from that. The foot doctor was shocked to hear I was told to put hydrocortizone on it - like gas to a flame. So I'm very hesitatant to listen to a doctor without testing to back it up.
Seriously, I think I need to make sure I'm not T1.5 (don't think so but better safe than sorry), and get the right testing for my thyroid. If you could tell me the correct list for that, that would be great.
Thanks!
K

[nonstickpam107]

Here goes: (the first list can be gotten through Online Lab Tests: blood work, blood testing and laboratory tests and several have gone through them for much less and then turned into insurance and been paid for part or all of it):

Free T3 (not a 'T3 Uptake')
Free T4
TSH
anti TPO antibodies

and if me, I would also want:
iron
ferritin
progesterone
estradiol
estriol
4x in one day salivary cortisol test

Pam

[1000catsyouknow]

Pam -
Thank you so much! As you can tell, I'm dealing with multiple issues (with thyroid and glucose)- not bad but they are there.
Thanks!
K

[1000catsyouknow]

Pam - they changed my call name to 1000 cats instead of 'just' 100 :-) I forgot my password

I don't know if you remember me but shortly after I talked to you I had new bloodwork done. My TSH rose in just a few months from the high 1's to 3.1 (March 2008) Had an oral glucose test and that came out positive for diabetes without signs of insulin resistance. Tested for slow onset T1 and fortunately that was neg. So new bloodwork 2 weeks ago and my TSH is still 3 My throat is getting/feeling sore too. As of right now small goiter (not much of anything thankfully)
I go in for some more bloodwork in a few days and have the list of what you stated I should ask for. Dr. thinks it's not autoimmune in nature that I am going hypothyroid. What do you think so far? More testing?? NOT that I want an immune system attack - I just don't understand I suppose.
Thank you so much if you read this and answer me. So far you have been right on. Now to get more testing to know everything for sure. Plus I'm getting an ultra sound to make sure my inners downstairs are ok since I've had problems there too.
K

[1000catsyouknow]

guess I was always 1000 cats - so that's what was up!! HUH...

[nonstickpam107]

Well, I wouldn't want a doctor 'guessing' if I had an autoimmune disease. How do you feel about that? Cuz all he has to do is a TPO antibodies (Thyroid peroxidase) to confirm/rule out Hashimoto's. Perhaps he doesn't know that TWO out of EVERY TEN women in the US have Hashimoto's (I once had a very noted endo tell me that Hashimoto's was 'rare' and when I presented the evidence, made him very angry for some reason, lol).

You need MUCH MORE than a TSH....and probably a doctor that 'gets it'. If you'll tell me where you live, I can maybe give a list of doctors who know the correct tests and interpretations so you don't have to see a doctor who 'guesses' at things.

If your insurance will pay for the testing, you'd want to have Free T4, Free T3, estradiol, progesterone (when progesterone drops during perimeno, that can trigger thyroid disease). Graves or Hashimoto's, or whether to give a hormone/block and replace treatment would depend on your Free T3/Free T4's NOT your TSH and TSI's. My TSI fell and crashed and burned, my TPO came up within six months of being given a block and replace treatment for thyroid disease.

Pam

[1000catsyouknow]

Pam - Thank you so much for your response!!! I might be getting to some light at the end of this tunnel. I am scheduled for labs on Monday and have the list you gave me. I am going to give it to her. She is an endo and with my insurance I have to cover a $$ deductible - so labs should all be ordered for anything before the year is up or I am back to paying to the nose again. Gets expensive for sure. I also want her to test for Addison's but that's another point. I would rather rule out things and know for sure what I am dealing with. Stuff isn't making sense. I don't have the typical T2 diabetes stuff but yet I have it. I want things based upon labs!! I've had bad things happen when doctors have guessed - expensive things too. Fortunately, nothing too bad but geesh why guess?? I agree with you 100000% percent. The hard part is getting them to do it and then even harder is for them to know what it means.
I'm going to try to get this done with her this week - if not I will ask for info from you. I really need this done this year. I'm not that bad off - I know that - but it's frustrating to be so tired - the waking up tired is the worst. I want my life back - that's all :-)
Thank you again!!!
K

[nonstickpam107]

Well, ask her what a TSH, FT4, FT3 (NOT T3 Uptake...) will cost...and if there is a charge, I can tell you if you get those from healthcheckusa.com that panel is under 90 dollars. And so on with other tests. (My doc's lab charges MY insurance well over 300 dollars for JUST that panel).

You really need to find someone (doctor) that is well versed in BHRT/thyroid (and most endo's only do diabetes...only one endo out of every 100 or so does thyroid/BHRT well). I have doctor's lists...perhaps someone on my lists is on YOUR insurance formulary. So, if you can give me your location (your State, maybe the neares major city, any state lines within one and a half to two hours driving time?), I may be able to help you get treated well.

Pam

[1000catsyouknow]

Pam -
I wrote down your list as it appears (except I excluded the TSH since that was done a few weeks ago). And the doctor is being handed the list. I've paid my deductible for the year so it's best to do this now. I do think I am going perimenopausal (sp?) at this point but I wasn't two years ago and I've had the marks on my face for nearly 10 years. One thing I told the endo that she did a huh on - I was on an antibiotic up until this week (ingrown toenail that got a little infected) it was just Keflex 3 times a day for 10 days. Well the marks on my face (melasma) started to get a little better. Why in the world would Keflex do that? I know it works on psoriasis a little (I have that too).

This is what I am asking for: Am I missing anything?

Free T3 (not a 'T3 Uptake')
Free T4
TSH
anti TPO antibodies
iron
ferritin
progesterone
estradiol
estriol
4x in one day salivary cortisol test

Thank you again - I am going to see what becomes of tomorrow. Am labs and then in the afternoon I get an ultrasound of my pelvic region. Oh so fun. I want none of this!! If I can't get the labs you suggested tomorrow or to be scheduled for another day I will be asking for another doctor from you. I just want to get the labs in hand before I do anything else. Thank you so much for being there and answering me :-)
K

[nonstickpam107]

Hope they do that list..if they will NOT do the female hormones, get the FT4, FT3, TPO for SURE..and yes, you still need another TSH...TSH can go up or down as much as 3 whole points in any given DAY. Best of luck to you! Make sure you get a copy of the lab results WITH lab ranges.

Pam

[1000catsyouknow]

Pam -
Got the list done except the TSH. She said it was just done so I couldn't get it. Oh and the 4x in one day wasn't done but the morning value was. It's a start I hope. Seeing that my TSH has been 3.1 or 3.0 the last 6 months I think I can estimate that it would have been this today (I hope so - I know that goes against what you are telling me but it's all I have to work with right now). She didn't want to do the female hormones but I told her my insurance deductible is covered for the year and if they were to be done it would be cheaper for me to get them now instead of Jan 1st. etc. So they got ordered also - if anything I think they will show I'm starting perimenopause (correct?). I don't think this was it two years ago but considering other factors I think it's true now. She also stated considering how tired I am that she would feel fine about putting me on replacement (I didn't state I wanted this but this was a comment made). Currently, I am waiting for all labs to come back and go from there - I'm not someone who likes drugs of any type and anytime I've jumped in and listened to a doctor on an estimation before and it's not been the best of calls (kind of gun/doctor shy at this point). It's been two years going to doctors between known glucose issues (now diagnosed) and an unknown something or other (which it's looking to be my thyroid). I can wait a few more days / weeks for the numbers.
Thanks for your help!!!!!!!!!! :-)
K

[nonstickpam107]

I can hardly wait to see them...and next time you should talk about replacement using natural Armour Thyroid (not synthetics!).

Pam

[1000catsyouknow]

Thanks for everything. Still waiting on results. Ultrasound was fine - possible fibroid that's basically all and suppose that was expected. I'm trying to cover all bases before starting any meds so I have no surprises anywhere.
Thanks!
K

[1000catsyouknow]

I didn't get back some of the tests I asked for (guessing they were not done - the hormones - I didn't see they were done) But my B12 is low at 581 (normal but my doctor wants it above 800) and my iron was low - pd time and haven't been eating red meat so that explains that.
everything else was fine.

TSH from the other day was 3.04

from the new labs:
TPO's less than 10
FT3 269 ref 230-420
FT4 1.4 ref .8 -1.8
AM Cortisol 27.4 (lab person said this was excellent)
Then I had blood cell counts - all well within range

So...what do you think? looks good?

[nonstickpam107]

That sure looks like they did a T3 Uptake..cuz I've never seen ranges like that for a FT3 (unless you are in a foreign country?). Your FT3 is horrible, and your TSH is elevated over the NEWEST ranges (over a 3 is considered hypothyroid most of the time). I think the FT3 looks like garbage, personally, but I do believe it is because of low B12, iron and ferritin. So...just eating red meat isn't going to help that, and many have the thyroid 'go South' if they don't treat the low B12 and iron with supplements, not just eating a little red meat.

I'd be getting supplemented for the B12 (did he do a test for pernicious anemia?) and iron, and having the FT's run again in six to eight months. (And I caution you...anything that's 'just in normal range' isn't always 'good'...with iron, if the range goes from 10 to 210 a female should NOT be below 70 or so.

Pam

[1000catsyouknow]

Assessments: Goiter simple


Lab: Q-T-4, FREE

Name Value Reference Range


T-4, FREE 1.4 0.8-1.8





Name Value Reference Range


T3, FREE 269 230-420




Assessments: Fatigue


Lab: Q-IRON AND TOTAL IRON$BINDING CAPACITY

Name Value Reference Range


IRON, TOTAL 56 40-175


IRON BINDING CAPACITY 358 250-450


% SATURATION 16 15-50

[1000catsyouknow]

She gave me a script for diabetes meds and I think it had one for B12 on it also (but I don't know if it said over the counter stuff) for whatever reason I can't find that script - but it's here in the house and I will find it today. I'm in Arkansas. I'm passing yet again on the diabetes meds (but that's another subject) I want to figure out the thyroid stuff first - I think it is in control of why things are how they are. Just my thoughts...
I suppose I don't understand. I got the diabetes stuff under control. To the point I look almost normal. I don't have insulin resistance, don't have low C-peptide, normal FBS at 90 and and A1c in the 5's. I am of normal weight also without high BP - in fact it's great at 110/70 most days and sometimes even lower. Pulse rate is around 90 so working out may bring this down some. That's being taken care of except the B-12 should be higher.

I don't understand thyroid issues as of yet. When I showed the doctor my list she commented on why I wanted iron to be tested. I just told her that was part of the list to ask for. This is why I think testing is so important - I know she thought that one would come back fine and here it wasn't as great as it should be. TESTING tells me what I need to work on. I've done just about everything in the book for diabetes I'm a model patient! (ok, I wasn't at a very bad starting place and it was caught just about right after I crossed the line with it so not much with back-peddling there - BUT if I eat normal I WILL get sick again BUT I'm the one who caught it and I'm the one who pushed for answers!!)
So now on to the thyroid and figuring out what's what with it and do my best to get that in line. BUT what is best? And what is happening? Why do I not show TPO's and why do I show TSI's right around 100?
Thanks for being there!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
K :-)

[1000catsyouknow]

The rest of the labs:

Interesting you should question amenia - the person who helped me understand my diabetes was questioning this also. Have no idea if that is my issue. How do you know if it is?


ab: Q-CBC (INCLUDES DIFF/PLT)

Name Value Reference Range


WHITE BLOOD CELL COUNT 3.9 3.8-10.8


RED BLOOD CELL COUNT 4.21 3.80-5.10


HEMOGLOBIN 13.5 11.7-15.5


HEMATOCRIT 39.3 35.0-45.0


MCV 93.2 80.0-100.0


MCH 32.1 27.0-33.0


MCHC 34.5 32.0-36.0


RDW 13.8 11.0-15.0


PLATELET COUNT 188 140-400


ABSOLUTE NEUTROPHILS 2414 1500-7800


ABSOLUTE LYMPHOCYTES 1080 850-3900


ABSOLUTE MONOCYTES 308 200-950


ABSOLUTE EOSINOPHILS 78 15-500


ABSOLUTE BASOPHILS 20 0-200


NEUTROPHILS 61.9


LYMPHOCYTES 27.7


MONOCYTES 7.9


EOSINOPHILS 2.0


BASOPHILS 0.5

[nonstickpam107]

In the range it is given, your iron is in the toilet, and is impacting your thyroid. There are SEVERAL people here at LCF who had to bring their iron and B 12 up BEFORE they could find out IF they had a thyroid problem. Inatic comes to mind here on the boards (find her over at Muscle Matters board here)...she IS hypothyroid, but bringing up her iron helped her be able to tolerate thyroid hormone.

Again, your FT4 is high, you do not show Hashimoto's, your iron is awful, your B12 is terrible, and MOST of the women who had to bring up their iron/ferritin certainly didn't do it with OTC multi-vit plus iron...they usually took (you can get this OTC) Floradix or something like that. I think you really need to bring your iron up into aruond the 100 range, and a goiter is THE thyroid itself, swelling up alerting you. T3 is known to shrink 'some' goiters.

You really need to find a doctor well versed in this.

Pam

[1000catsyouknow]

Pam -
Could the low iron be due to my pd which I was in the midst of when labs were taken. ?Now my pd has been more to almost completely normal so I'm not doing the heavy bleeding like I used to but it was on a mild to heavier day labs were done. I looked over what I eat and my vit. Now I don't eat red meat but my mult is 100% iron and with the stuff I eat it's another 100% (I don't eat junk because of the glucose issues). Also the diet drink I consume about twice a day is 100% C. Now the B12 is up from a year ago - it was 512 then. That does need to be addressed. So what I am understanding with my labs is there is a very good chance if I can get things into balance that my TSH will go back to normal? It was normal when all this started and stayed that way for a little over a year. I had a systemic infection two years ago and things seem to have snowballed. Are there any good doctors in Arkansas? (northwest to be exact). I know if I do have iron issues that needs to be tended to by a doctor since overload is not a good thing.
Thanks!
K

[nonstickpam107]

Well, actually, not to burst your bubble, but TSH isn't anything to do with your thyroid hormones. Ok? YOur TSH could be all over the place, up and down as much as 5 points in any given day, and means..um..nuttin' to me or anyone else. It's the actual thyroid hormones that 'mean anything' that would be your T4/T3 or FT4, FT3..so let's not put any importance at all on TSH. After all, I almost died from myxedema coma with a nice, normal TSH of .30 or so.

If you have pernicious anemia, you could eat 20 steaks aday, and take forty multi vits with iron and nothing would happen. People with hypo have low iron, and people with low iron have hypo. ??

I agree that a doctor should monitor your iron intake as well as B12. Let's see who's in Arkansas....

Bear with me here..I'm good at thyroid research...bad at geography...don't know one side of Arkansas from another, lol. Here's a list for you:

Betsy Hendricks, MD, 444 Hwy 64E, Office 1, Conway, Arkansas 72032. 501 327-2967http://www.betsyhendricksmd.com
She is said to treat with Armour

Dr. Hugh Jackson Family Practice W/Obstetrics Primary Care Associates 4200 Jenny Line Fort Smith, AR 72903 (479) 709-7245 http://www.sparks.org/sphp.htm
Treats with Armour, does adrenals (yay)

Dr. Carol Chaney M.D., Natural and Alternative Medicine P.O. Box 1254, 701 N. Walnut St. Suite B, Harrison, AR 72601 741-7211.
Her choice is Armour for thyroid patients

John Baldridge, M.D., Endocrinologist, St. Vincent Circle, Little Rock, AR 72205, 501-552-4763
Said to treat with Armour or will do a Cytomel/T4 combo if you want.

Mary Sain, MD, Internal Medicine, 2601 Kavanaugh, #6, Little Rock, AR 72205, 501-614-8072
(I got the impression you need to ASK for Armour)

William Ford MD, Surgeon, Mountain Home, Arkansas, Ph/Fax: 870-425-9120
Uses Armour

Dan Martin DOM, OMD, Alternative OM Medicine, 619 East 6th Street, Texarkana, Arkansas 71854, 870-772-8622, nfc@txk.net Northfieldclinic.info

Hope this helps you,

Pam

[1000catsyouknow]

Pam -
thanks! I've started to look into them and the one closest is no longer with Sparks Medical. But from what I can tell he is still in Ft. Smith.
Thank you again!!!
K

[nonstickpam107]

You are welcome...let me know how it all goes will you please? Keep in touch, and