Hashimoto's, or what other problem might this be???

Well, in a recent test, conducted only a two weeks after the first one, it showed that my MICROSOMAL TPOab WAS 53. It was supposed to be below 35. Surprisingly, my TSH had dropped from 8.2 to 2.39, which is within the normal range, that too in just two weeks. NORMETANEPHRINE  was just a bit high... it was 206, when it was supposed to be below 148. METANEPHRINE was normal.

My HEART RATE is usually between 80 and a 100, but I have these spikes, when it goes up to 135, and I feel lightheaded, dizzy, and start sweating, and later get cold hands and feet. After an hour or two, my HEART RATE stabilizes again.  This happens about ONCE in 10 DAYS.

[Barb135]

In order to diagnose Hashimoto's, you also need to have the Thyroglobulin Antibodies (TGab) tested.  Both TPOab and TGab are indicative of Hashimoto's, however, some people only have TPOab, some only have TGab, others have both.

TPOab can be slightly elevated in several other autoimmune conditions, also.

With your heart rate issues, I'd also ask to be tested for Graves Disease.  The definitive test for that is Thyroid Stimulating Immunoglobulin (TSI).  

Do you have other symptoms of thyroid disease, such as weight gain/loss, fatigue, muscle aches/pains, constipation/diarrhea, etc?

What other thyroid tests have you had?  TSH, Free T3 and Free T4 are the basics.  If you've had those, please post the results and be sure to include the reference ranges, since these vary lab to lab and must come from your own report.

Not familiar with normetanephrine.  Quick google search says it's used a tumor marker for pheochromocytoma.

"A pheochromocytoma (fe-o-kro-mo-si-TOE-muh) is a rare, usually noncancerous (benign) tumor that develops in the core of an adrenal gland. You have two adrenal glands, one just above each of your kidneys. Your adrenal glands produce hormones that give instructions to virtually every organ and tissue in your body.

If you have a pheochromocytoma, your adrenal glands can produce too much of certain hormones, raising your blood pressure and heart rate. A pheochromocytoma may be life-threatening if unrecognized or untreated.

A pheochromocytoma can develop at any age, but most commonly occurs in middle age. Usually, treatment for pheochromocytoma can return blood pressure to normal."

http://www.mayoclinic.com/health/pheochromocytoma/DS00569

What has your doctor said?

[Barb135]

In order to diagnose Hashimoto's, you also need to have the Thyroglobulin Antibodies (TGab) tested.  Both TPOab and TGab are indicative of Hashimoto's, however, some people only have TPOab, some only have TGab, others have both.

TPOab can be slightly elevated in several other autoimmune conditions, also.

With your heart rate issues, I'd also ask to be tested for Graves Disease.  The definitive test for that is Thyroid Stimulating Immunoglobulin (TSI).  

Do you have other symptoms of thyroid disease, such as weight gain/loss, fatigue, muscle aches/pains, constipation/diarrhea, etc?

What other thyroid tests have you had?  TSH, Free T3 and Free T4 are the basics.  If you've had those, please post the results and be sure to include the reference ranges, since these vary lab to lab and must come from your own report.

Not familiar with normetanephrine.  Quick google search says it's used a tumor marker for pheochromocytoma.

"A pheochromocytoma (fe-o-kro-mo-si-TOE-muh) is a rare, usually noncancerous (benign) tumor that develops in the core of an adrenal gland. You have two adrenal glands, one just above each of your kidneys. Your adrenal glands produce hormones that give instructions to virtually every organ and tissue in your body.

If you have a pheochromocytoma, your adrenal glands can produce too much of certain hormones, raising your blood pressure and heart rate. A pheochromocytoma may be life-threatening if unrecognized or untreated.

A pheochromocytoma can develop at any age, but most commonly occurs in middle age. Usually, treatment for pheochromocytoma can return blood pressure to normal."

http://www.mayoclinic.com/health/pheochromocytoma/DS00569

What has your doctor said?

[amanbobby]

Yes, I've been having vague aches and pains, and stomach issues now and then. Well, a four fold increase in the normetanephrine and metanephrine is indicative of a pheochromocytoma. But, mine is not even double the maximum, so that's good.

THYROID TESTS

Nov. 2011
TSH 3.12,    REF. RANGE is 0.3-4.00
T4 0.9.        REF. RANGE is 0.9-1.5

March 2012
TSH 8.29,    REF. RANGE is 0.34-4.82
T4 1.05,        REF. RANGE is 0.78-2.19

March 2012- 2nd Test
TSH 2.39,     REF.RANGE is 0.3-4.00
TPOab 53,      REF. RANGE is <35

Other Tests
Ultrasound of Heart- Normal
CT Scan of the Head- Normal except for a negligible venous anomaly

Medical History-
Has iron-deficiency anemia because I was a poor eater. With better diet and iron supplements, which I don't take any more, my hemoglobin is normal for the past 2-3 months.

PLEASE READ THROUGH IT ALL AND GIVE ME YOUR OPINION.

[Barb135]

Your high TPOab indicates that you have Hashimoto's Thyroiditis, but low levels of TPOab can also be found in other autoimmune conditions, as well.

Your low T4 (is that "Free" or total?) indicates that you might be hypothyroid.  Do you have symptoms of hypothyroidism?  

TSH is a pituitary hormone, which fluctuates often, even intraday, so it's very unreliable as a diagnostic tool; you need both Free T3 and Free T4, which are the actual thyroid hormones.

Have you followed up on possibly adrenal issues?

[amanbobby]

I have symptoms of hypothyroidism frequently, but not on all days. I feel that some days I'm hyperthyroid and other I'm hypothyroid. My symptoms change a lot. Sometimes I have cold hands and feet, and other times they are sweaty. Sometimes I'm restless, and other I'm really sleepy. And also, I occasionally have balance problems while walking. The T4 I mentioned is free T4. My endo has not been suggesting any follow up on the adrenal issues. He says that normetanephrine and metanephrine should be 4 times higher than normal for it to be of any concern... I'm not sure what to do further with the adrenal issues.

Next week, I'm going to see the endo to get him to test me for:
TSH, T4, T3, TSI, TGab, and TPOab.

[Barb135]

It's not uncommon, in those with Hashimoto's, to have symptoms of both hyper and hypo, or to swing back and forth.

Some doctors don't really recognize a lot of adrenal issues. Sounds like your endo is stuck on the "4 times larger than normal for it to be a concern".... some doctors think there is a "one size fits all" and everyone should fall into neat little compartments... unfortunately, that doesn't always happen.  Every one of us is individual, so what's "normal" for me, might not be "normal" for you.  You're very young, so maybe age plays a role, too; I don't know about that, just presenting possibilities.

What do your parents say about this?  Is there any way you can get them to take you to another doctor for a second opinion?

[gimel]

Please make sure that the T4 and T3 tests are for Free T4 and T3, not Total T4 and T3.  With the symptoms you describe, it would be good to test for TSI, as Barb suggested, just to check that possibility.  Also, with Hashimoto's as a possibility, and in consideration of your symptoms, it would be good to have an ultrasound test of your thyroid to determine if there are any nodules.  I also suggest that you talk to the doctor about testing for the possibility of adrenal issues.  The best test for that seems to be a 24 hour saliva cortisol test, but many doctors won't do that one.  A good alternative would be a 24 hour urine cortisol test.

[amanbobby]

Yes, I'll ask my doctor about the cortisol, ultrasound, and TSI. My dad's side has these thyroid problems and that's probably where I got it from. I plan to go to my doc on 4/24/2012... This isn't an emergency, is it?

[Barb135]

It doesn't sound like an emergency, but whenever you don't feel well, you should talk to your parents and have them take you to a doctor/ER.

[amanbobby]

My endo gave me Propanolol to eat whenever I have those episodes, which happens once in about a week. I haven't eaten any yet, even though I've had these episodes twice since then.

[Barb135]

If your doctor gave you propanolol to take when you feel hyper, why don't you take it?  It can't help alleviate your symptoms, if you don't take it>.

[amanbobby]

Today, in the morning, my neck area near the thyroid was red. It became less red after some time, but then in the evening, it became red again, and I had one of the episodes... My pulse was 115 and my BP was 140/100. Also, since two-three days, I can feel a sense of constriction near the thyroid and neck area. I'm going to the doctor tomorrow...

I'm going to request him to order these tests:
Free T4 and T3, TSI, TGab, TPOab, TSH, 24 hour cortisol urine/saliva test, and an ultrasound of the thyroid!

[amanbobby]

Today, in the morning, my neck area near the thyroid was red. It became less red after some time, but then in the evening, it became red again, and I had one of the episodes... My pulse was 115 and my BP was 140/100. Also, since two-three days, I can feel a sense of constriction near the thyroid and neck area. I'm going to the doctor tomorrow...

I'm going to request him to order these tests:
Free T4 and T3, TSI, TGab, TPOab, TSH, 24 hour cortisol urine/saliva test, and an ultrasound of the thyroid!

I POSTED THE SAME THING AGAIN SO GIMEL GETS A NOTIFICATION AS WELL... SORRY IF IT CAUSES ANY INCONVENIENCE.

[Barb135]

Most/many doctors do not recognize the 24 hr saliva/urine tests, so won't order them.  You can mention it to your doctor, but don't be surprised if s/he says "no" on those.

The rest of the tests are the ones you need, but you've already had a TPOab, so that may not need to be repeated.

I don't know what the redness on your neck would be; thyroid issues are usually not seen on the skin.  It's best not rub or palpate your thyroid, as that can irritate the skin.

The early stages of Hashimoto's can be marked by periods of hypo, then hyper.  This may be what you're experiencing with the higher pulse rate and BP; however,  anxiety over your condition could also cause those symptoms.

[amanbobby]

My doc didn't order any of the tests I previously mentioned. He's looking into intestinal carcinoids by getting the 5-hydroxyindoleacetic acid (5-HIAA) when I  have one of my episodes....

[amanbobby]

So my neck and lymph nodes in the neck were paining... I was wondering why. Here's my hypothesis; tell me if I'm right...

Since my lymph nodes are part of my immune system and my immune system is creating antibodies against my thyroid, it is like I have an infection all the time. And lymph nodes swell during infections... That is why they, along with my thyroid are sore.

[amanbobby]

Since yesterday, my heart rate/bp is slightly elevated upon waking up from sleep... Any idea what this might be?

My mom is doubting I might have intestinal parasites because many of my symptoms represent their infestation. I eat a lot of vegetables and fruits and a few years ago my immunogolbulin E(IGE) levels were raised exponentially. This is apparently cause by the parasites irritating the intestinal tract... I'm going to take albendazole for a few days...

[amanbobby]

Hey Barb, please reply...

[amanbobby]

:) Hey there. My thyroid ultrasound and 5HIAA urine test came normal :)
However, I can feel and see a slight lump on my lower right abdomen, right of of my navel. What might this be???

[Barb135]

Sorry, life's been hectic lately.  
I can't begin to tell you what the lump in your abdomen might be.  There could be dozens of causes. To my knowledge, lumps in the stomach are not thyroid related and should be checked out by your primary care physician or an ER.  

If your doctor won't order the thyroid tests recommended, I really have no other suggestions, because those are the tests that would help us determine if your symptoms are thyroid related.