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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
? about Adrenal testing
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.
? about Adrenal testing
by NURSELPN, Jul 16, 2006 12:00AM
Hi Dr. Mark,
Welcome back, you were missed!!!
I have been treated for hypothyroidism since 1983 than diagnosed with hyper (not med induced)but(Graves) in 2004 & received RAI in 02/05. I've been working my way back to normal since the RAI & just can't seem to get there. I'm @ 3 grains of Armour & my thyroid lab has finally leveled out in 01/06. It's stayed pretty consistant w/ my last lab done 07/05/06. TSH 0.17 (0.40- 5.0) Free T-3 261 (230-420) Free T-4 1.1 (0.8-1.8) Also thyroid antibodies TSI 152 (<125) & TPO 396 (<35). Is this antibody normally high in Graves? My TSI is going down 196 in 03/06 but this is the first TPO I've had checked. Why would it be high? tested because I'm having my second rt.eye decompression done 07/20/06.
I'm also taking 1 cc of B-12 wkly & my level is now 721 up from 89 in 06/05. Per your suggestion, Intrinsic factor Block AB-negative. Gastric Parietal Cell AB 90.3 (>25 positive). My GP says I have malabsorption but not Pernicious Anemia because I'm not anemic.???? My lab sheet says antibodies to this protein are present in 80% of patients with pernicious anemia. I don't know what to think. Is my GP mistaken?
I'm also having some problems with my 07/05/06 CBC. WBC 16.1 HGB 16.3 HCT 48.3. They were also up back in 03/06 WBC 12.2 HGB 14.4 HCT 42.8. I'm being referred to a hematologist. Is the anything auto-immune that could cause this?
Also what is the best lab to test for Adrenal fatigue? GP wants to test that also.
I'm sorry, I'm a miss........
Welcome back, you were missed!!!
I have been treated for hypothyroidism since 1983 than diagnosed with hyper (not med induced)but(Graves) in 2004 & received RAI in 02/05. I've been working my way back to normal since the RAI & just can't seem to get there. I'm @ 3 grains of Armour & my thyroid lab has finally leveled out in 01/06. It's stayed pretty consistant w/ my last lab done 07/05/06. TSH 0.17 (0.40- 5.0) Free T-3 261 (230-420) Free T-4 1.1 (0.8-1.8) Also thyroid antibodies TSI 152 (<125) & TPO 396 (<35). Is this antibody normally high in Graves? My TSI is going down 196 in 03/06 but this is the first TPO I've had checked. Why would it be high? tested because I'm having my second rt.eye decompression done 07/20/06.
I'm also taking 1 cc of B-12 wkly & my level is now 721 up from 89 in 06/05. Per your suggestion, Intrinsic factor Block AB-negative. Gastric Parietal Cell AB 90.3 (>25 positive). My GP says I have malabsorption but not Pernicious Anemia because I'm not anemic.???? My lab sheet says antibodies to this protein are present in 80% of patients with pernicious anemia. I don't know what to think. Is my GP mistaken?
I'm also having some problems with my 07/05/06 CBC. WBC 16.1 HGB 16.3 HCT 48.3. They were also up back in 03/06 WBC 12.2 HGB 14.4 HCT 42.8. I'm being referred to a hematologist. Is the anything auto-immune that could cause this?
Also what is the best lab to test for Adrenal fatigue? GP wants to test that also.
I'm sorry, I'm a miss........
Doctor's Answer
by Mark Lupo, M.D., Jul 16, 2006 12:00AM
, Jul 16, 2006 12:00AM
The TPO is high in Graves in most cases. Ab's including TSI & TPO will likely fall after I-131 but may never normalize. TSI is linked to eye disease. Keeping TSH optimal will likely help keep eyes stable. Good luck with the decompression.
I would say you have Pernicious Anemia (ie malabsorption of B-12) but at an early state without lab evidence of anemia (low Hbg) and the B-12 therapy should keep it that way!
Best test for adrenal insufficiency is an ACTH stimulation test and consider Adrenal Antibody testing.
I would say you have Pernicious Anemia (ie malabsorption of B-12) but at an early state without lab evidence of anemia (low Hbg) and the B-12 therapy should keep it that way!
Best test for adrenal insufficiency is an ACTH stimulation test and consider Adrenal Antibody testing.
Member Comments (4)
by NURSELPN, Jul 16, 2006 12:00AM
To: Dr Mark
Thank you very much for your answer. You didn't comment on the CBC though, is there anything auto-immune that might cause this elevation. I also forgot to say the GP. ordered more lab to exclude infection & also many others with the only positive reading to a Leukocyte Alkaline Phosphatase Stain 155 w/ normal of (13-140). Thanks, TJ
by NURSELPN, Jul 19, 2006 12:00AM
To: DR MARK ????
I have one more question above. Sorry to be such a pain...Thanks
by Mark Lupo, M.D., Jul 22, 2006 12:00AM
, Jul 22, 2006 12:00AM
cbc showed normal hemoglobin. The high WBC is of unclear origin and with the elevatd LAP I agree with seeing the hematologist, but often this is just an infection or something transient. There may be some autoimmune causes but not something I see that often in my thyroid practice to guess which at this time -- see what the hematologist thinks.
