Confused about results

[bopsytop]

I have symptoms of hypothyroidism but my TSH shows normal rage at last test was 1.49, but my gyno checked free t4 also and it shows to be .87.  I also have a goiter on my thyroid that doctors can't tell me why its there or why it is slowly growing.  Just want to feel normal and I don't.

[bopsytop]

I have decided to get a second opinion,  hoping new doc gives better answers then TSH is in normal range so everything is fine.

[bopsytop]

woke up this morning with a swollen lymph node under my chin, can thyroid cause swollen lymph nodes?  

[bopsytop]

Doctor has me supplementing Vit D and Iron.  Trying to decide if I should get a second opinion on the thyroid function results. Plus worried about hoarseness I have had for the past 2-3 weeks non stop.  

[bopsytop]

Here is all the labs in one area.  Anyone give me any info if this is "normal" or if I should get a second opinion.

Labs 5/20/14
Ranges is parenthesis

TSH:            1.19          (.35-4.5)
T4:              10.10         (5.0-12.5)
T3 uptake:  28.10         (22.5-37.0)
FT4:             2.80          (1.0-3.9)

ESR Sed rate:  26     (0-22)
Vitamine D:      39     (30-89)

Test date 6/6/14
Antithyroglobulin Ab
Thyroglobulin, Antibody <1.0 IU/mL  (0.0 - 0.9)
Please Note:
    Low positive Thyroglobulin antibodies are seen in a portion of the
    asymptomatic populations.

Thyroid Stim Immunoglobulin:  36   range   (0-139)
Thyroid Peroxidase (TPO) Ab:   9 IU/mL      (0 - 34)

Date of test: 6/11/14

TSH:     1.49  (.4-4.5)
FT4:        .87  (.70-1.6)

Date of test 7/3/14

TSH: 1.38  (.35-5.5)
FT3:  2.46  (2.18-3.98)
FT4:  1.23  (.76-1.46)
T3:    .98    (.60-1.81)

Thyroid-Peroxidas Antibody:  <28.00   (.0-60.00)
TSI                                            39        (0-139)
antithyroglobulin antibody:      <20        (0.0-40.0)
Thyroglobulin:                           5.7       (.0-59.9)

Vitamin D:  19.9    (30-100)
Ferritin:       64.90  (8.0-252.0)
Iron:            40       (50-170)

Thyroid ultrasound 5/21/14
    
    1.The right thyroid lobe measures 4.78x1.80x1.73 cm.  There is a 2+ right thyroid lobe enlargement, unchanged in size from previous examination of 5/9/2012.  There is a homogeneous echo texture without evidence of a solid nodule development.

2. The isthmus is normal (AP measurement .37cm)

3. The left thyroid lobe measures 4.50x1.54x1.56cm.  The left thyroid lobe demonstrates 2+ enlargement on current examination.  The longitudinal measurement has increased from 4.1 to 4.5 since 5/9/2012 ultrasound examination.  there is a homogeneous echo texture.
   Opinion:   Generalized Thyroid lobe enlargements without evidence of a discrete hypeochoic solid nodule.

Thyroid uptake and Scan 7/15-16/14

     Findings: There is heterogeneous radionuclide uptake within both thyroid lobes. There is a focal area of increased radio tracer uptake in the left lobe.
At 6 hrs following ingestion, there is a 5.6% radionuclide uptake with normal limits being between 5 and 15%
At 24 hours  following radionuclide ingestion, there is 10.3% radionuclide uptake with normal being between 15 and 35%.

So from all this does it seem as if my thyroid is functioning normal or not?  Thanks for an information you can give me.

[bopsytop]

Thanks for the reply, no worries I hope you are enjoying your travels.  

Vitamine B12 was tested but not sure of the results because I had taken the B12 Shot the at the end of the week before.  
I am supplementing with Vitamine D 10,000 a day to try and get the level back up.  He also has me supplementing iron, don't remember the dose off the top of my head.

When I spoke to him yesterday he said as long as TSH is between 1-2 then none of the other results matter.  Because I asked why the FT4 goes up and down so much, and why the FT3 was so low much lower then the FT4 and he said those don't matter as long as TSH is good.  I asked about the RAIU being abnormal and he gave the same response about the TSH....  Is there anyone on the board who knows about RAIU scans and can shed some light on these results?  

I am wanting to go get a second opinion from someone who looks at things as a whole not just TSH.  I am still hoarse 24/7 and the ENT is still saying its not the goiter causing it, so wants to do a some other test.  

But thanks again for all your help and insight.

[Barb135]

You've probably already seen your doctor, but none of your results are "good", except the FT4.  The FT3 is really low in the range, indicating that you may not be converting FT4 to FT3 adequately.

Unfortunately, I'm not an expert at reading the RAIU results, but it doesn't look to me like your thyroid is really functioning "normally", or it's "normal", it's a long way from "optimal"...

Your vitamin D is also below range.  How anyone could think that's "okay" is beyond me.  Are you supplementing that.

Typically, ferritin should be at least 70-80, so yours isn't "horrible", but your iron level is abysmal, so obviously your ferritin level should be higher in order to get your iron store higher.

In view of the vitamin D and iron levels, I'd have to wonder what your vitamin B-12 levels are.  Were those tested?

[bopsytop]

Here is what the RAIU uptake scan results stated:

Findings: There is heterogeneous radionuclide uptake within both thyroid lobes. There is a focal area of increased radio tracer uptake in the left lobe.
At 6 hrs following ingestion, there is a 5.6% radionuclide uptake with normal limits being between 5 and 15%
At 24 hours  following radionuclide ingestion, there is 10.3% radionuclide uptake with normal being between 15 and 35%.

What does this mean?  Doctor didn't not seem concerned.   If thyroid is functioning normally shouldn't all of these reading been within range.

[bopsytop]

Hey Barb,
   I was able to get a copy of test when I went to start the RAIU test today.  Results are below.

3rd Generation TSH 1.380  Range .35-5.5
FT3 2.46 Range 2.18-3.98
FT4 1.23 Range .76-1.46
Total T3 .98 Range .60-1.81
Ferritin 64.90 range 8.0-252.00
Vitamine D  19.9 Range 30.0-100.0
Iron 40 Range 50-170
percent of Iron Saturation 10.6 Range 15-55.0

Have any insights on any of these results?  I see the doctor tomorrow after the last scan of thyroid.  Any questions I should ask.  Thanks

[bopsytop]

Should be able to pick up labs on Tuesday, so will post as soon as I can after I get home from appointment.  

[bopsytop]

yeah Barb I really want to see the result form test and see where things fall in range.  Hopefully I can get a copy on day one of the RAIU test so I can ask Doc question the next day at appointment with him.

I have a question is there anyway to shrink a goiter?  

[Barb135]

It'll be okay.  When will you actually get the copy of the labs?  I never believe "okay" until I see the results, because "in range" and "okay" are not equal.  I hope you get a copy, so we can go over them before you see the doctor.

Hoarseness is common with hypothyroidism, but other things can cause it, too, including anxiety, which I know you've had plenty of.  We'll get it figured out, once we see the labs.

[bopsytop]

Hi Barb,
  I don't have the exact lab numbers, but according to the call from my doctors office today from the labs last week my thyroid is functioning fine.  But I am low iron and vitamin D, so doc wants me to start supplementing that.  I still have the RAIU scan next week so hopefully that tell me something, but I have a lot of questions for the doctor next week.  The big one being is why am I suddenly hoarse 24/7.  Once I get labs will post what my numbers are, but needless to say even more lost and confused.  

[Barb135]

Look forward to see the labs...

[bopsytop]

Yeah plan to get copies from all lab work.   I was confused about the graves thing because the symptoms don't seem to apply.  
What makes me think he is only going to look at TSH was when I asked him why did the ft4 drop between two labs he said its wasn't important that the main thing was the TSH, but he still testing for the ft4 and ft3 when I looked at the lab paper.  Once I know more will post for help interpreting it.   Thanks

[Barb135]

I'm not sure where the endo is getting Graves Disease from either the test results you had or your symptoms... Many doctors go only by TSH and if that's what this one is going to do, you aren't going to get very far, because TSH is a pituitary hormone and is rarely indicative of actual thyroid status.

Make sure you get copies of all the blood work, so you can post it here for us to see.

[bopsytop]

Feeling frustrated.....I feel so bad and don't feel like myself,  hoping for answers from this doc soon.

[bopsytop]

Well went to endo today and he is doing a RAIU test he thinks I might have graves disease and wants to rule that out.  
Plus he is doing a whole tone of blood work from TSH, ft4, ft3, ferrin(or something like that) vitamin D, iron, and more I don't remember from the paper.  
When I told him some of the stuff going on and felt my thyroid he said it felt firm and was worried about the hoarseness I have going on.  
I told him I have keep being told my thyroid is fine but I feel horrible, his response was who keeps tell you it is fine, because from what I am seeing its not.  
So could graves disease be causing the symptoms I have going on?  
I got the impression he thinks TSH is the main thing from something he said.  
But right now going to see what he tells me and go from there.  

[bopsytop]

One more question is the antibodies test the only way to test for hashimotos?  

Thanks for all the info, I feel more prepared going into this appointment.

[Barb135]

Might be too soon to redo antibody tests, but that's up to you.  Once positive, they don't have to be done again.

Sounds like you've about got it covered.

[bopsytop]

I am asking him to test TSH, FT4 and FT3 all in one lab test.  I am thinking of having him run the antibody test again.   Thought about having him recheck thyroid with ultrasound because it getting where when I eat food is getting stuck at times and take 2-3 times swallowing to get it down.  

I printed out hypo checklist and have gone through and check all that apply to me.

Anything else you could suggest having him check or do that I haven't thought of?  

[Barb135]

Thyroglobulin antibodies are markers for Hashimoto's, but low levels of them can be seen on some people who don't have Hashimoto's or symptoms of hypothyroidism.  That may not mean they don't have it; it could just mean that maybe the antibodies haven't ramped up or hypo symptoms haven't showed up yet.

Have you made a list of the tests you need?

[bopsytop]

Low positive Thyroglobulin antibodies are seen in a portion of the
    asymptomatic populations
What does this mean?  I am trying to have all my ducks in a row before I go to the doctor on the 3rd.    So hoping for answers.  
All I know is that as the weeks are going by lately I am feeling worse and worse.  I honestly feel so bad and out of sorts lately I just want to sit down and cry.
Thanks for all the information and help you have given me its been greatly appreciated.

[bopsytop]

Hi Barb,

Can thyroid problem cause elevated white blood cell count.   I was checking recent lab report and it showed high wbc and high gr#.  

[bopsytop]

No just started them at gyns recommendation, so other day was first one.  I do take a multivitamins with b 12 though.