First Blood tests

[hschmidt]

Hi.  I am 40 years old and have been feeling terrible for the past several months.  Some of my symptoms include night sweats even though I am HRT (diagnosed POF at age 17), sore muscles and very stiff hips, shaking hands and body, hair loss, anxiety, angry, trouble sleeping but tired all of the time, hives and itching all over my body, increased appitite and some weight gain, headaches, frequent sinus infections and high blood pressure.  I could go on and on. My father has Graves and my aunt has Hashimoto's  An allergist sent me for labs having to do with my thyroid and here are some of the numbers I got back.
Anti thyroglobulin 187.0
TPO ab 111.0
TSH 0.01
I am going for an ultrasound on my thyroid tomorrow.
First question is ......is it possible to be both hypo and hyper thyroid at the same time?  How will an endo likely treat this?  What are they looking for with the ultrasound?  Cancer?  I am very worried as I am a wife and a mom to twin 4 year old boys by IVF+donor egg.  Any feedback would be appreciated.

[hschmidt]

Normal for T4 the range was 0.9-1.8. Mine was 1.4. Also the tech doing the ultrasound today said that she did not see any nodules but my thyroid appeared irregular, vascular, and heterogeneous. Not sure what that would indicate. Thanks for all of your help.

[Barb135]

Doubt seriously that you have hypopituitarism.  Based on the results you've already provided, you have Hashimoto's Thyoiditis, but if the TSI comes back positive, I'll say you have both Hashi and Graves.  These are autoimmune diseases that destroy your thyroid, so it can no longer produce hormones.  Many of us are totally dependent on thyroid medication to get the hormones we need.

Will also be interested in the FT3 level.  Be sure to post reference ranges with results, because ranges vary from lab to lab, so must come from your own report.

What is the range for your FT4?

[hschmidt]

FT4 is 1.4. Other labs taken today including T3 FT3 TRAb/TSI. I also have low estrogen and LH. Could this be hypopituitarism?

[Barb135]

The antibody tests (TPOab and TGab) indicate that you have Hashimoto's, but these antibodies can also be present in Graves Disease.  You need to have a Thyroid Stimulating Immunoglobulin (TSI) test done to confirm/rule out Graves Disease.  

Some symptoms can cross over - i.e. be the same for both hyper and hypo.

Your low TSH indicates that you are hyper, but symptoms indicate hypo.  TSH is a pituitary hormone and is not necessarily indicative of thyroid function. You need to have Free T3 and Free T4 tested.  These are the actual thyroid hormones, and are needed to give a really clear picture.  

Thyroid cancer is not all that common.  It is pretty much standard to do an ultra sound to check for nodules on the thyroid.  Most of us with Hashimoto's have nodules on our thyroid and they are usually nothing to be concerned about; they are just watched in case something changes.
The ultrasound will also determine if your thyroid is inflamed/swollen (goiter).  

I would hope that an endo would not initiate treatment without testing the FT3 and FT4.