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Hyperthyroid or something else please help?
Hi I have been having these symptoms since June racing heart palps, tremors, nervousness, severe anxiety sweaty hands and feet , dirreah and weakness and lost weight 20lbs epigastric pain . I have had a thyroid ultrasound saying this BELOW on 8/7/08. My first endo doc and GP are saying I should not have these hyper symptoms so bad with my tsh at only .50 t3 and t4 are normal.
A few weeks ago I found out I have a 1cm adrenal adenoma . I found this when picking up medical records of a cat scan my GP ordered for kidney stones in Febuary of 2008. She never told me about it. I called the endo and she had me come in right away. The endo ran tests for pheochromocytoma and cushings and I had another cat scan to check for growth. The adenoma is the same size. The plasma free metenephrine test was normal and so was the vma urine and metanephrine urine. The 2mg demethasone cushings supression test was normal at 1.2 the next morning.
I asked to see someone with more experience since the endo was fairly new and she still had no idea why i am having symptoms. I went to the attending doctor last friday who is over my original endo doctor and she said she believes I maybe have early hyperthyroid or I am sensitive to the low tsh. She said if it was thyroiditis I should not still be having hyper symptoms. She put me on tapazole 5 mg once a day . She did not run another thyroid panel my last was 9/2.
Does anyone know if this is correct? I am so confused now. Should I be on tapazole. Do I need another thyroid test first My symptoms are still here.
All of my lab work so far
Thyroid ultrasound
there is enlargement of the gland right is 4.2x2.0x1.5 left is 4.5x1.6x1.6 cm
mild prominence of the isthmus 5mm in thickness. neg for discreet thyroid mass
impression- nonspecific enlargement of the thyroid gland with prominent blood flow suggestive of thyroiditis.
Thyroid scan and uptake
5 1/2 hour was 12.9% normal is 5-15%
24 hour was 21.9% normal is up to 24%
My labs
Last yr when pregnant which resulted in miscarriage on 9/07
TSH 1.12
THIS YEARS LABS
7/16/08
TSH 0.65 RANGE 0.36-3.72
FT4 0.81 RANGE 0.59-1.28
T3 - 3.52 RANGE 1.8-4.2
7/25/08
TSH 0.65
8/7/08
TSH 0.59 RANGE 0.60-3.30
T4 FREE 1.19 RANGE 0.71-1.40
T3 TOTAL 1.2 RANGE 1.0-1.7
8/12/08
TSH 0.50 RANGE .60-3.20
8/21/08
THYROID PEROX AB 0.5
9/2/08
TSI TEST NEGATIVE
9/2/08
TSH .50
free t3 2.6 range 2-3.5
free t4 1.12 range .7-1.4
addisons test acth cortsyn injection test
before test blood result
cortisol 15.2
aldosterone serum 10
1 hr later blood result
cortisol 42.5
aldosterone serum 13
Cushings demethasone supression test was 1.2 took 2 mg at 11pm and then blood draw at 8:30 am next morning.
sorry AR half of my post disappeared for some weird reeason so it does not make sense what I asked. The range for the test was less than or equal to 1.3 .
That is the TSI test you wanted.
Thyroid Stimulating Immunoglobulin. The IG is an abreviation of immunoglobulin.
<1.0 is good. Not sure what the range is, but 1.0 would be negative. Less than 1.0 is pretty close to zero.
So Grave's disease, autoimmune hyperthyroidism, is eliminated as a suspect. But that was already established in the tests you listed in your first post...
Still, it's nice to know what the actual TSI count was, rather than NEGATIVE on the report.
Thyroid Stimulating Immunoglobulin. The IG is an abreviation of immunoglobulin.
<1.0 is good. Not sure what the range is, but 1.0 would be negative. Less than 1.0 is pretty close to zero.
So Grave's disease, autoimmune hyperthyroidism, is eliminated as a suspect. But that was already established in the tests you listed in your first post...
Still, it's nice to know what the actual TSI count was, rather than NEGATIVE on the report.
AR & 898 i was looking at my labs and my TSI says
Thyroid Stim IG My result is < 1.0 and the range was type of test. Is this the right TSI test I need?
Thyroid Stim IG My result is < 1.0 and the range was type of test. Is this the right TSI test I need?
I was diagnosed with Graves' in August '06 but had suffered symptoms since early June that year. It started with the machine gun heart at night and the goiter, then more symptoms came. After being treated, even more symptoms. It took over two years for me to find a different endo. (I HAD to because my employer demanded it. I had already been suspended from work and put through therapy for anger and depression. The third time they just said for my sake I needed to find a doc who would help me get better.) I was on and off the Tapazole and every time I was taken off of it my hormones went out the roof again, so I was finally given the RAI. I am feeling better MOST of the time but still have anxiety. I am currently on 80 mg Inderal LA; 1200 mg Cardizen (a low dose because it doesn't go well with the beta blocker); 5 mg Zyprexa (seems to help the mood swings); 1 - 4 mg of Xanax (as needed); and I take a small dose of Trazodone, an old antidepressant that the newest endo said I could use for sleep aid. (If I take too much of that it seems to make the anxiety worse after a few days.)
I was hospitalized in August because Endo #1 (a young girl and a sweetheart but she has no clue about Graves') had me stop the thyroid blocker to see what would happen. Well, what happened was tachycardia and A-Fib. I thought I was dying and I called 911. It's a long story, but I was in the ICU for a day and a half. I've been in the ER once since then too. I just KNEW I was dying. It's a feeling I wouldn't wish on any one.
I've been riding the lightning and weathering the storm. It's really bad at times, but, gradually, five weeks since the RAI, I think it's getting better.
I was hospitalized in August because Endo #1 (a young girl and a sweetheart but she has no clue about Graves') had me stop the thyroid blocker to see what would happen. Well, what happened was tachycardia and A-Fib. I thought I was dying and I called 911. It's a long story, but I was in the ICU for a day and a half. I've been in the ER once since then too. I just KNEW I was dying. It's a feeling I wouldn't wish on any one.
I've been riding the lightning and weathering the storm. It's really bad at times, but, gradually, five weeks since the RAI, I think it's getting better.
TGab is another antibody that can be found in a patient with either autoimmune hypothyroidism or autoimmune hyperthyroidism.
Thyroglobulin antibodies, or antithyroglobulin antibodies, (has two names), attack the thyroglobulin in your thyroid. Thyroglobulin is a basic building block for making T4 and T3. TGab interferes with the production of hormones by destroying this basic building block.
If you have Hashimoto's, you can test positive for TPOab, TGab, or both. TRab is another, but it produces a set of symptoms that is unique.
TRab is Thyroid Receptor antibodies. They are antibodies that mimic TSH closely enough that they can dock at the TSH receptors and do nothing except occupy a receptor that is waiting for TSH to come along.
This causes your throid to receive less TSH, and in turn it produces less hormones, because your thyroid normally produces hormones based on TSH instructions. Your hormones go low, and your TSH goes high. When you are given replacement hormones to compensate, your T4/T3 return to normal, but your TSH remains high.
None of these antibodies are specific to Hashimoto's.
You could test positive for all of them, and if you have TSI antibodies, you will have Grave's, autoimminue hyperthyroidism.
Or a really big mess...
A high WBC indicates an infection. Thyroiditis is an infection. There are plenty of other chronic infections that may be hiding out, but it is fairly normal for someone with thyroiditis to have an elevated WBC.
Not sure if any of this helps.
Thyroglobulin antibodies, or antithyroglobulin antibodies, (has two names), attack the thyroglobulin in your thyroid. Thyroglobulin is a basic building block for making T4 and T3. TGab interferes with the production of hormones by destroying this basic building block.
If you have Hashimoto's, you can test positive for TPOab, TGab, or both. TRab is another, but it produces a set of symptoms that is unique.
TRab is Thyroid Receptor antibodies. They are antibodies that mimic TSH closely enough that they can dock at the TSH receptors and do nothing except occupy a receptor that is waiting for TSH to come along.
This causes your throid to receive less TSH, and in turn it produces less hormones, because your thyroid normally produces hormones based on TSH instructions. Your hormones go low, and your TSH goes high. When you are given replacement hormones to compensate, your T4/T3 return to normal, but your TSH remains high.
None of these antibodies are specific to Hashimoto's.
You could test positive for all of them, and if you have TSI antibodies, you will have Grave's, autoimminue hyperthyroidism.
Or a really big mess...
A high WBC indicates an infection. Thyroiditis is an infection. There are plenty of other chronic infections that may be hiding out, but it is fairly normal for someone with thyroiditis to have an elevated WBC.
Not sure if any of this helps.
AR -898 Thanks for your input! So what does the TGAB test for? I guess I mean when what thyroid disease would show an elevation in this? I have been reading about thyroiditis and I have read that upatake with the different forms of it is usually low about 1%. Mine was more hyper closer to the end of the range for normal. So I am wondering how can it be thyroiditis with this or does this 1% not always apply.
You are right my symptoms tests etc make no sense. They are not textbook for anything . I am so frustrated.
DC4u, You mentioned I should have my adrenals checked closely. Is there anything else I can do. I had a cortisol test in the am and it was 4.2. This prompted them to check for addisions the next week. results below. I was also checked for cushings with a 2mg supression test.
Is there any test I missed that would cause all of this?
addisons test acth cortsyn injection test
before test blood result
cortisol 15.2
aldosterone serum 10
1 hr later blood result
cortisol 42.5
aldosterone serum 13
Cushings demethasone supression test was 1.2 took 2 mg at 11pm and then blood draw at 8:30 am next morning.
I dont know if this is related but before all of this started I had miscarriage 11/7 then began to sleep a lot 14 hours a day for months. I also gained weight very easily. I was close to 160. I could eat one meal a day and gain. Now since June when all this stated I am the exact opposite. Insomnia, I am eating 2000 or more calories a day (eating when not hungry ). to maintain my weight and I am 137. My WBC is 15.6 and neutrophils high but oncologist said they dont know why. My sed rate is 3-5 usually and ANA is negative and rheumatoid factor is less than 6.3 .
You are right my symptoms tests etc make no sense. They are not textbook for anything . I am so frustrated.
DC4u, You mentioned I should have my adrenals checked closely. Is there anything else I can do. I had a cortisol test in the am and it was 4.2. This prompted them to check for addisions the next week. results below. I was also checked for cushings with a 2mg supression test.
Is there any test I missed that would cause all of this?
addisons test acth cortsyn injection test
before test blood result
cortisol 15.2
aldosterone serum 10
1 hr later blood result
cortisol 42.5
aldosterone serum 13
Cushings demethasone supression test was 1.2 took 2 mg at 11pm and then blood draw at 8:30 am next morning.
I dont know if this is related but before all of this started I had miscarriage 11/7 then began to sleep a lot 14 hours a day for months. I also gained weight very easily. I was close to 160. I could eat one meal a day and gain. Now since June when all this stated I am the exact opposite. Insomnia, I am eating 2000 or more calories a day (eating when not hungry ). to maintain my weight and I am 137. My WBC is 15.6 and neutrophils high but oncologist said they dont know why. My sed rate is 3-5 usually and ANA is negative and rheumatoid factor is less than 6.3 .
I would make sure your adrenal gland is closely checked. Adrenal hormone production can closely affect the thyroid. Also... since you're experiencing some hyperthyroid like symptoms but your labs are relatively normal... you may want to try ThyroSoothe. It is a tinacture of herbs that have research behind them for hyperthyroidism. See below...
Lycopus europea (bungleweed) has juice that can be used as a fabric dye and was reportedly used by gypsies to darken their skin, which may be the origin of the common names applied to the European species of Lycopus – gypsyweed. Studies suggest that bugleweed may reduce thyroid hormone by decreasing levels of TSH (the hormone that stimulates the thyroid gland) and by impairing thyroid hormone synthesis. (Kohrle J, Auf'mkolk M, Winterhoff H. Iodothyronine deiodinases: inhibition by plant extracts. Acta Endocrinol. 1981;96:15–16)
Melissa officinalis (also known as Lemon balm) preparations are made from the leaves of the plant and when rubbed between fingers a tart and sweet smell, like lemons, is released. This herb has been studied for its ability to block the action of thyroid-stimulating antibodies found in Grave's disease. (Auf'mkolk M, Ingbar JC, Kubota K, et al. Extracts and auto-oxidized constituents of certain plants inhibit the receptor-binding and the biological activity of graves' immunoglobulins. Endocrinology. 1985;116:1687–1693)
Leonurus cardica (also known as Motherwort) was employed by the ancient Greeks and Romans to treat heart palpitations as well as depression - which they considered a problem of the heart. Recently, Germany's Commission E (the herbal regulating body in Germany) has authorized the use of motherwort as part of an overall treatment plan for an overactive thyroid - hyperthyroidism. (Blumenthal M, ed. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Austin TX: American Botanical Council; Boston, Ma: Integrative Medicine Communications; 1998: 172)
Lycopus europea (bungleweed) has juice that can be used as a fabric dye and was reportedly used by gypsies to darken their skin, which may be the origin of the common names applied to the European species of Lycopus – gypsyweed. Studies suggest that bugleweed may reduce thyroid hormone by decreasing levels of TSH (the hormone that stimulates the thyroid gland) and by impairing thyroid hormone synthesis. (Kohrle J, Auf'mkolk M, Winterhoff H. Iodothyronine deiodinases: inhibition by plant extracts. Acta Endocrinol. 1981;96:15–16)
Melissa officinalis (also known as Lemon balm) preparations are made from the leaves of the plant and when rubbed between fingers a tart and sweet smell, like lemons, is released. This herb has been studied for its ability to block the action of thyroid-stimulating antibodies found in Grave's disease. (Auf'mkolk M, Ingbar JC, Kubota K, et al. Extracts and auto-oxidized constituents of certain plants inhibit the receptor-binding and the biological activity of graves' immunoglobulins. Endocrinology. 1985;116:1687–1693)
Leonurus cardica (also known as Motherwort) was employed by the ancient Greeks and Romans to treat heart palpitations as well as depression - which they considered a problem of the heart. Recently, Germany's Commission E (the herbal regulating body in Germany) has authorized the use of motherwort as part of an overall treatment plan for an overactive thyroid - hyperthyroidism. (Blumenthal M, ed. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Austin TX: American Botanical Council; Boston, Ma: Integrative Medicine Communications; 1998: 172)
I think 898 is correct. His last post describes thyroiditis perfectly, and your tests...well, your tests don't make much sense.
Normally with thyroiditis you see more variation in lab results.
Your question at the moment is should you take the tapazole.
Honestly, I think it is not warranted. Your Free T4 and Free T3 do not suggest that you are hyper now.
I would take the current test results and show them to your doctor, or take copies of all the tests you posted here and get another opinion.
You had a TPOab test and a TSI test that both showed negative. Did you have an antithyroglobulin antibody (TGab) test as well?
Normally with thyroiditis you see more variation in lab results.
Your question at the moment is should you take the tapazole.
Honestly, I think it is not warranted. Your Free T4 and Free T3 do not suggest that you are hyper now.
I would take the current test results and show them to your doctor, or take copies of all the tests you posted here and get another opinion.
You had a TPOab test and a TSI test that both showed negative. Did you have an antithyroglobulin antibody (TGab) test as well?
In the first stage of thyroiditis the inflammation ruins the walls of follicles [hormone storage walls] so hormones are released into the blood stream causing elevated T4 level. As response to this the pituitary lowers the TSH level in attempt to slow down hormone production [because it does not know why thyroid overproduced the hormones].the blood test indicates hyperthyroidism at this time. In about 4 to 12 weeks depending of the severity, the destruction of follicles stops, no more hormone is released and levels return to normal.
Although 5% of Hashimoto's patients do not have antibodies, your case can favor subacute or silent thyroiditis.
Although 5% of Hashimoto's patients do not have antibodies, your case can favor subacute or silent thyroiditis.
I have had tons of thyroid panels the last few months and they all have been around .50- .60 with bad hyper symptoms and my t4 has been 1.12.
Now tsh has changed to .90 the level I have been comfortable with my whole life. Both endos agreed my thyroid was inflamed and the impression of the radiologist was thyroiditis. My symptoms have been better the last 5 weeks so maybe because my tsh went up to the normal level. While I was at .50 I was so sick and barely able to function.
Thats why I am wondering if it could be thyroiditis like at first suggested not early hyper and my levels are coming back up or if it could hasimotos without antibodies? It is definitely something thyroid related.
Now tsh has changed to .90 the level I have been comfortable with my whole life. Both endos agreed my thyroid was inflamed and the impression of the radiologist was thyroiditis. My symptoms have been better the last 5 weeks so maybe because my tsh went up to the normal level. While I was at .50 I was so sick and barely able to function.
Thats why I am wondering if it could be thyroiditis like at first suggested not early hyper and my levels are coming back up or if it could hasimotos without antibodies? It is definitely something thyroid related.
The hormones are normally fluctuating like that; these levels are effected by time of the day or time after last meal [similar5 to blood glucose test]. the 0.9 TSH is normal.[unless you made typo:)]. On your ultrasound the lobes are of normal sizes [upper end], except isthmus is thicker then normal which is not really important.
Ok need more help.
I got my basline labs back today and my labs have changed. Now I am totally confused. Should I take the tapazole?
Can the labs change be from hashimotos? I dont have tpo antibodies when I was tested in early august. Can hashimotos cause your labs to go back and forth? Can you have this without antibodies or am I more than likely having thyroiditis and my numbers are now going hypo instead of hyper.
Labs done Yesterday
Tsh - .90 RANGE IS .34 - 5.66
THYTOXINE FREE (T4 FREE) .75 RANGE IS .52- 1.21
T3 TOTAL 149 RANGE IS 80-178
LABS DONE 9/2/08
TSH .50
free t3 2.6 range 2-3.5
free t4 1.12 range .7-1.4
I got my basline labs back today and my labs have changed. Now I am totally confused. Should I take the tapazole?
Can the labs change be from hashimotos? I dont have tpo antibodies when I was tested in early august. Can hashimotos cause your labs to go back and forth? Can you have this without antibodies or am I more than likely having thyroiditis and my numbers are now going hypo instead of hyper.
Labs done Yesterday
Tsh - .90 RANGE IS .34 - 5.66
THYTOXINE FREE (T4 FREE) .75 RANGE IS .52- 1.21
T3 TOTAL 149 RANGE IS 80-178
LABS DONE 9/2/08
TSH .50
free t3 2.6 range 2-3.5
free t4 1.12 range .7-1.4
little Ed,
Yes it feels like my body is wacko. In june when it started I was so bad off I was nauseous all the time and a nervous wreck. I got put on Klonopin .5 mg and that has taken the edge off some. I do not know how I would have lived without it. I was so bad my hubby was helping me take shower and he had do everything for me. I really thought my days were numbered. I went to er with palps and racing heart many times. Its like you have symptoms affecting every organ in your body. My aunt and cousin with this were the same way . Family members told me they did nothing the first 6 months and could barely function and thought they were dying.
I am now so forgetful I cannot remember peoples names half the time or to turn off oven and other crazy things. Its like I am in a brain fog all the time with this.
Did you get your thyroid destroyed eventually? What happened to put you in the hospital? Are you ok now and on any meds?
Yes it feels like my body is wacko. In june when it started I was so bad off I was nauseous all the time and a nervous wreck. I got put on Klonopin .5 mg and that has taken the edge off some. I do not know how I would have lived without it. I was so bad my hubby was helping me take shower and he had do everything for me. I really thought my days were numbered. I went to er with palps and racing heart many times. Its like you have symptoms affecting every organ in your body. My aunt and cousin with this were the same way . Family members told me they did nothing the first 6 months and could barely function and thought they were dying.
I am now so forgetful I cannot remember peoples names half the time or to turn off oven and other crazy things. Its like I am in a brain fog all the time with this.
Did you get your thyroid destroyed eventually? What happened to put you in the hospital? Are you ok now and on any meds?
Jolle Fille,
I had a TPO antibodies for my first test since the new resident endo thought i had hashis thyroiditis. It was only .5 Then she ran TSI antibodies for graves and it was negative. So she changed it to silent thyroiditis. I have read online that not all people have antibodies though most people do.
The endo I just saw Friday which is her attending doc said she thinks it may be early hyper . My aunt had hyper and my cousin had graves so its in the family. Thank goodness I was sweating and hand tremoring so she believed me.
My Blood pressure has always been 80 or 90 over 60. Since this has started it is usually 110 or so over 70 and I have gotten spikes of 135 and 145 over 90. I have even been to some docs and the machine kept erroring out when my heart was racing and I felt bed. My bpm are now around 85-90 and go up to like 140 or more sometimes.
I wanted to get a tsh baseline and other labs before starting the 5mg tapazole so I had that done today along with white blood count and liver function my last was 9/2 . This way I could see if any changes occur when I start meds.
My eyes have been getting weird pains in them and sometimes go blurry. They are a little puffy in the morning. Is this what happens to you?
What are your labs and symptoms? Hopefully this med will help us!
I had a TPO antibodies for my first test since the new resident endo thought i had hashis thyroiditis. It was only .5 Then she ran TSI antibodies for graves and it was negative. So she changed it to silent thyroiditis. I have read online that not all people have antibodies though most people do.
The endo I just saw Friday which is her attending doc said she thinks it may be early hyper . My aunt had hyper and my cousin had graves so its in the family. Thank goodness I was sweating and hand tremoring so she believed me.
My Blood pressure has always been 80 or 90 over 60. Since this has started it is usually 110 or so over 70 and I have gotten spikes of 135 and 145 over 90. I have even been to some docs and the machine kept erroring out when my heart was racing and I felt bed. My bpm are now around 85-90 and go up to like 140 or more sometimes.
I wanted to get a tsh baseline and other labs before starting the 5mg tapazole so I had that done today along with white blood count and liver function my last was 9/2 . This way I could see if any changes occur when I start meds.
My eyes have been getting weird pains in them and sometimes go blurry. They are a little puffy in the morning. Is this what happens to you?
What are your labs and symptoms? Hopefully this med will help us!
Your symptoms sound a lot like mine in the early days before and immediately after I was diagnosed with Graves'. Ahhhh, the good ol' days. Hehe. Only my TSH was something like .006 after the first blood work.
If you have what I have, it will gradually start destroying your mind and body even if the TSH is normal. I did drugs for a couple years on and off, and in that time the first endo kept telling me my thyroid was fine but I was a real mess and almost lost my job and became totally unfunctional, ended up in the hospital and almost died.
If you have what I have, it will gradually start destroying your mind and body even if the TSH is normal. I did drugs for a couple years on and off, and in that time the first endo kept telling me my thyroid was fine but I was a real mess and almost lost my job and became totally unfunctional, ended up in the hospital and almost died.
wow-we have some similar symptoms of hyperthyroidism. I think yours is the beginning as well. How is your BP?
our labs look similar except I have TSI antibodies. Do you have other thyroid antibodies?
I see my endo in 2 days and i expect her to to start me on thyroid block for symptom relief.
When do you see your endo again? Are you feeling anybetter since starting tapazole?
Usually repeat TSH/thyroid panel are done 6-8 weeks after med changes.
I am also having eye problems.
Ill keep you updated
jolie
our labs look similar except I have TSI antibodies. Do you have other thyroid antibodies?
I see my endo in 2 days and i expect her to to start me on thyroid block for symptom relief.
When do you see your endo again? Are you feeling anybetter since starting tapazole?
Usually repeat TSH/thyroid panel are done 6-8 weeks after med changes.
I am also having eye problems.
Ill keep you updated
jolie
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