Aa
Aa
A
A
A
Close
Avatar universal

Assistance with Lab Results

Hi Dr. Mark,

I had a few question on lab results.

Quest Diagnostics, 10/5/05: TSH 0.14 (0.40 - 5.50); T3 Total 244 (60-181); T3 Uptake 25; T4 Total 11.4 (4.5-12.5); Free T4 Index 2.9 (1.4-3.8).

Lab One, 10/13/05: TSH 0.312 (0.35-5.50); Free T3 3.1 (2.3-4.2); Free T4 1.0 (0.8-1.8).  Anti TgAB, TPOAb, TSI and TRAb all came back in "negative" range; however, TSI was elevated.

Quest Diagnostics, 11/2/05:  TSH 0.38 (0.40-5.50); T3 Total 225 (60-181); T3 Uptake 23 (22-35%); T4 Total 11.7 (4.5-12.5); Free T4 Index 2.7 (1.4-3.8).

Radioative iodine uptake scan: Uptake = 30%. Scan revealed an enlarged left lobe with homoegenous distribution of isotope.  Large photopenic area at the right lower pole and a possible small hot nodule at the right upper pole (Thyroid scan suggests either a multinodular goiter or possibly a solitary cold nodule at the right lower pole).  

Ultrasound:  My right lobe showed 5 nodules (the doctor indicated that the nodules appear to be actively producing thyroid hormone). My left lobe has a complex cyst and one small nodule. The doctor drained 2 cc's of fluid from the cyst, and then conducted the biopsy. I have not yet received the results.

My dr prefers not to pull the Free #"s (she feels she can derive the same info from the tests she requests).  Is this your opinion? My Free T3 (from 10/13) appears to be in range, but my Total T3 is typically high.  Can't this be caused by birth control pills? So, do I truly have T3 Toxicosis (as my dr suspects)?

I'm currently taking 20mg of Methimazole per day.  Is this dose too high?  

Thanks!
12 Responses
Sort by: Helpful Oldest Newest
Avatar universal
A related discussion, Should I be concerned was started.
Helpful - 0
Avatar universal
A related discussion, thyroid lab test was started.
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
Would repeat TSH with Free T4 to confirm what appears to be a moderately sever hypothyroidism.  Would also check an am cortisol to screen for adrenal insufficiency (relatively rare).  If the cortisol is completely normal (usually that means above 11 on an 8am draw) then a full replacement synthroid dose (0.7mcg/pound) is indicated.  If the cortisol is <11 then it may be wise to do an ACTH stimulation test (esp with the relatively low BP -- even though this is likely normal for you) before aggressively treating the thyroid...
Helpful - 0
Avatar universal
above question was meant for you- sorry I am a new user
Helpful - 0
Avatar universal
Hi.

I am feeling crazy.  I have been exhausted, stressed out, and in pain.  I work two jobs, I am going for my Masters, and I am in a rough marriage so I thought my symptoms were just that of stress- however I knew that I felt beyond bad and insisited that my Dr. test me instead of medicate the hell out of me with SSRI's anti-anxiety, etc.
It always seems when you are a female- the first thing that they want to do is give you an antidepressant and chalk it up to nerves!!
Even when I said that my throat felt funny- almost like a burning and scratching I was told it was acid reflux due to nerves???  I have severve muscle cramps and spasms and I was told it was because I exercise exessively.  My blood pressure is 85/50?  I usually run 90/60.
Anyway- I refused meds and insisted on tests- after the steroids and valium that he gave me didn't do "the trick"....since it appears that my doc thinks that I am a head case... I can't function- and I am trying sooooo hard!  
My lab came back with a TSH of 29.74-  Does this happen quickly?  What does this mean?  Should I have any other tests?
I started Sinthroid-(25mgs) what else can I do? Now I feel moody as hell!  I feel like I am dying.  I have no support system.  Please help.  What should my next steps be?  The saddest thing is that I counsel adults with brain injuries and I am suffering from the same memory loss- it is just horrible.  Any guidance would be greatly appreciated.

Thanks.
Charity
Helpful - 0
Avatar universal
Hi Dr. Mark,

Not sure how far back you check in the archives, so hopefully you will see this one.

I just received my latest blood test results:
11/18/05, Quest Diagnostics: T3 Total = 203 (60-181); T3 Uptake = 22(22-35%); T4 Total = 8.2 (4.5-12.5); Free T4 Index = 1.8 (1.4-3.8);TSH = 1.44 (0.40-5.50); Free T3 = 264 (230-220).  

My endo was a little upset that I requested the Free #'s (she is aware I'm on birth control).  She said that the #'s she uses are valid, and that Free T4 can be falsely decreased by binding protein.  Does this make sense to you?  She also said my lab (Quest) does not use the "gold standard" of equilibrium dialysis for the Free #'s, so she prefers the total #'s.

I just feel overmedicated right now.  I'm taking 20 mg of MMI (10 mg, twice per day).  I thought my endo would lower the dose, but she said to continue with current dose.  She did tell me to wean off my Toprol XL.

So, based on my bloodwork, am I taking too much MMI.  I'm also on Paxil CR(lowest dose available) and Xanax (2 times a day).

Also, I'm hearing positive feedback on ethanol injections, for toxic multinodular goiter.  Will this ever "catch on" in the U.S.?

Thanks!
Dani
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
your thyroid is slightly large - normal is about 1-1.5x1-1.5x 3.5-4.5cm

I usually do FNA on nodules >1cm particularly with suspicious features (such as increased vascularity)  Cysts are mostly benign -- I would consider FNA of the remaining nodules above 1 cm.
Helpful - 0
Avatar universal
Hi Dr. Mark,

I received my ultrasound results.
Right thyroid lobe:
- Very hetergenous in echotexture.  
- Lobe measures 1.59 x 1.83 x 5.59 cm.  
- There is a hypoechoic nodule in the right mid to lower thyroid measuring 0.75 x 0.83 x 1.08 cm which has increased vascularity on Doppler flow studies.
- There is an isoechoic nodule in the right upper pole close to the isthumus measuring 0.63 x 0.70 cm.  Lateral to this is a isoechoic 3 mm nodule.  Both of these nodules have increased vascularity on Doppler flow studies.
- There is another isoechoic nodule in the right upper pole measuring 0.77 x 1.58 x 1.77 cm.  This has mild vascularity peripherally and centrally on Doppler flow stuides.

Isthmus is enlarged measuring .42 cm.

Left thyroid lobe:
- Heterogeneous in echotexture.
- Lobe measures 1.33 x 1.88 x 6.40 cm.
- There is a small hypoechoic nodule in the left upper pole close to the isthmus measuring 0.35 x 0.50 x 1.21 cm, with predominantly increased peripheral vascularity and a small amount of central vascularity on Doppler.  
- There is a large dominant complex, solid cystic nodule occupying the left mid and lower thyroid measuring 1.71 x 1.71 x 2.70 cm, with peripheral vascularity on Doppler.

A biopsy was performed on the cyst on the left lobe, and the results came back as normal (benign).

My questions are:
(1) What are the normal dimensions for a thyroid?  Is my thyroid majorly enlarged, or just slightly enlarged?
(2) What are the general rules around when to conduct a biopsy?  Should I have biopsies done on the remainder of my nodules?

Thanks
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
just b/c there's a hot nodule there does not need to be treatment unless there is clear hyperthyroidism -- this means to most of us a TSH < 0.1 and some clinical sign/symptom of hyperthyroidism that would warrant treatment.  Methimazole is a temporary treatment of hot nodules - doesn't make them cold and when stopped there is a trend towards progressive overactivity.  I-131 treatment is usually best long-term option.
But I sometimes use methimazole for 3-6 months to see how a patient feels with normalizing TSH.

I prefer the free t3 & t4 - esp if on BCP's or other situations that alter thyroid binding globulin.

Ask you doc to review the ultrasound and the scan films (not reports) side by with you to understand the situation better.
Helpful - 0
Avatar universal
Thanks Dr. Mark,

My TSI anitbodies were 94 (lab report shows this as "negative", with >130% being indicative of Graves).

My endo believes I have toxic multinodular goiter.  My uptake scan showed "hot" nodules, which I beleive is why she increased my Methimazole dose to 20mg.

I need to ask my endo to elaborate on the scan results. I interpreted "right lower pole" and "right upper pole" as referring to regions on my left lobe.  The doctor performing the scan did not see any nodules on the right lobe that she felt needed to be aspirated or biopsied.  I should have full, written results available in 7 to 10 days.

Also, do you agree that TSH, T3 Total, T3 Uptake, Total T4, and Free T4 Index are sufficient tests?  Or, should I ask my doctor again about TSH, FT3 & FT4?

Thanks
Helpful - 0
Avatar universal
The question above is for Dr. Mark (sorry, did not specify that in teh "Comment To" section).
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
Complex situation - regarding the labs - you have a mildly suppressed TSH in response to some autonomy within a nodular gland (ie, overactive nodules) -- the FT3 is normal while total is high - this suggests against T3 toxicosis and is more consistent with an elevated thyroid binding globulin (most commonly from estrogen containing meds or pregnancy).  The TSH is improving -- perhaps in repsonse to methimazole.  The dose is not too high for treatment of hyperthyroidism - but you  have lab evidence of only mild hyper --- if there are not significant symptoms (primary concern would be cardiac palpitations or racing heart beat) -- then observation may be preferred over treatment unless you are above age 65 or so (doesn't sound that way however..)

The TSI cannot be elevated and normal at the same time - if the TSI (expressed as a %) is above the reference range that is suggestive of possible Graves Disease -- having multiple nodules can happen with Graves.

The scan showed a cold right nodule, yet you mention a left cyst that was drained -- almost invariably, cysts are cold and the scan showed homogenous uptake on the left. What was seen on ultrasound on the right in the region of photopenia?  If there is a nodule - that should be aspirated.  If there is no nodule then it simply may be "suppression" of the normal thyroid tissue in the setting of overactivity among one or more nodules in the gland.

Good Luck
Helpful - 0

You are reading content posted in the Thyroid Cancer / Nodules & Hyperthyroidism Forum

Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.