Interpreting blood test results

[EdWicks]

TSH       = .01 (Standard Range .27-4.20 mlU/L)
Free T4 = 2.24 (SR .93-1.70 ng/dL)
T3         = 212 (SR 80-200 ng/dL)
TSI        = 344 (SR <122%)
Will have RAIU soon
Awaiting Thyroid Peroxidase Ab results
No major Graves symptoms

What do these results suggest?
Thanks.
Ed

[Barb135]

Of course, symptoms are always the consideration, but one has to look at the labs, as well.  

My suggestion would be to get the TgAb tested, since that seems to have been missed, in the event that the person, whether it be you or someone else, has both Graves and Hashimoto's.  

As I noted, many symptoms apply to both hyper and hypo, and the only symptoms "opposite" of Graves are sensitivity to cold and constipation, which can both be caused by other things, as well.  I've know people with Graves who are sensitive to cold and diet could easily cause constipation.

While labs indicate hyperthyroidism, at this point, that can change, at any time, therefore, labs should be done on a regular basis.  

Do you know when the RAIU is to be done?  That will help confirm a diagnosis, but you (or the patient, if not you) still needs the TgAb test.

[EdWicks]

Scuse me if this is a duplicate. I thought I posted it but don't see it here.
******
I did not mean to focus on eyes and skin. Just that this person has few Graves symptoms and even more symptoms opposite of Graves. But from what I am reading here, the test numbers (especially TSI of 344) should be given more weight than the symptoms. Thanks.
Ed

[Barb135]

One thing missed was Thyroglobulin Antibodies (TgAb), which are also a marker for Hashimoto's, along with TPOab.  Those would also need to be analyzed in order to rule out Hashimoto's.  

I think you're focusing too much on the bulging eyes and thick skin, because many people with Graves Disease do not get those.  

[EdWicks]

Thyroid peroxidase AB Standard Range <0.3U/ml and so is TPOab of person I am talking about.

Has not had RAIU yet.

So, low TSH, high free T4, high T3, high TSI, low TPOab, seems to add up to
Graves even though no tremor, no bulging eyes or thick skin on tops of feet,
no weight loss, but experiences anxiety, fatigue/insomnia and, like hypo, is
sensitive to cold, constipated, and has small thyroid gland.

Thanks for all help.
Ed

[Barb135]

As I noted, the symptoms of Graves Disease are those of hyperthyroidism and if one doesn't have symptoms, what would one treat?  One doesn't treat a headache if one doesn't have symptoms a headache...

This patient has some irritability and insomnia right now, which can be symptoms of hyperthyroidism, so he could initiate treatment, but it's his choice.  He is, however, soon to have RAIU, which will show exactly what his thyroid gland is doing, so, at this point, it may be preferable to wait until after the RAIU to start treatment, since anti-thyroid meds reduce thyroid output.  I'm not suggesting that he "let it go", by any means; I'm merely suggesting that he delay treatment until after the RAIU.

Another thing to consider is that he's still awaiting TPOab tests which can confirm Hashimoto's... If he has both Hashimoto's and Graves Disease, he will need to be extra vigilant as symptoms of hypo and hyper can overlap - meaning that while he's producing too much hormones right now, his thyroid can stop producing at any time and he could still have those same symptoms of irritability and insomnia.

[Barb135]

Both Hashimoto's and Graves symptoms are those of, either, hypothyroidism or hyperthyroidism and the goal of treatment is to alleviate those symptoms.  If there are no symptoms of, either hypo or hyperthyroidism, what is one going to treat?   Simply putting one on replacement thyroid hormone medication for hypothyroidism or on anti-thyroid medication for hyperthyroidism is a waste...

It would be up to the patient, in this case, EdWicks, whether or not s/he wants to start on medication... He will be  having RAIU soon, which will give further information, so at this point, it's preferable that he not be on medication until after the RAIU in order to get the best results.

[doloMed]

I am assuming if one does hsve a positive test for Graves, it should be treated even if you aren't consciously aware of symptoms because it will only be more difficult to treat later, and damage might be done in the meantime.  But, also, hyperthyroidism increases osteoporosis, substantially, which you might not be feeling.  So, I would treat the hyperthyroidism even if it isn't Graves unless my doctor had reasons why I shouldn't. I can't see the advantage of letting it go unless you just want to wait a little while to see if it resolves on its own. Some of that lack of sleep and irritability might also diminish.  Sleep is so important; lack of it can only encourage other ailments.

[Barb135]

Some symptoms can apply to either/both hyper and hypo, including insomnia, and some of the other symptoms...

Is this the first time you've had antibody tests done?  Since you've been hypo and are now hyper, I'm guessing you probably have both, Hashimoto's and Graves, but, honestly, while the actual thyroid hormones (Free T4 and Free T4), as well as TSH, which is a pituitary hormone, can fluctuate, TSI is only present with a count like yours with Graves Disease.  

Once you have "any" autoimmune disease, you have it for life, but it's not the end of the world - most of us, here on the forum have Hashimoto's... If you aren't having symptoms, you really don't have to do anything, at this point; however, at the first sign of "any" issues, you'll need to start on anti-thyroid meds or consider RAI or TT.

[doloMed]

Are you sure a person with Graves shouldn't start on anti-thyroid medicine just because they don't have symptoms? I've read Graves has a better chance of going into remission if it is treated early, and might one be asking for more problems later if you don't treat it now?  Is the goal of the treatment for Graves only to treat the symptoms, or is it to hopefully reduce the antibodies so the Graves has a chance to go into remission?

I was recently diagnosed for Graves and only got tested because thyroid problems run in the family. My symptoms were similar to Ed Wicks, almost non-existant and I was very surprised by the diagnosis.  But my doctor said I should go on medication, and would be on it for a year or two when I asked her if she thought I even needed to go on medication. I've also read that people who stay on anti-thyroid medicine longer have a better chance of the Graves going into remission.

Is the goal of treatment for Graves different than the treatment for Hashimotos--that is, not only to get the hormone levels in line, but to also give one a better chance for remission.  This might be an important distinction as the only other option to remission in Graves is to kill off the thyroid which would be great to avoid if possible.

I also suspect that the minor symptoms of trouble sleeping should not be taken lightly, as poor sleep stresses the body, and leaves one vulnerable for more medical issues.  Those of us with autoimmune diseases have a greater chance of getting other autoimmune diseases.  I too have a history of difficulty sleeping for decades, but I suspect my Graves has been making it worse, though I, too, discounted that symptom.  I have been on 15 mg per day of Methimzole for 6 weeks, and I am getting some more solid sleep, even though not perfect.

[EdWicks]

Re what prompted lab tests, was hypo several years ago and put on 88 mcg synthroid, later Armour,  gradually reducing dosage, and have been tested regularly ever since. Results "normal" in May 2014 (on 30mg Armour, then 15mg, then 7.5mg throughout 2014-15). Since Feb 2015, TSH low and T3 & T4 high  but not told to stop medication til August 2015. Article on Thyroid Disease Manager by Dr. leslie DeGroot says "The diagnosis of Graves’ disease is usually easily made. The combination of eye signs, goiter, and any of the characteristic symptoms and signs of hyperthyroidism forms a picture that can hardly escape recognition." I did not recognize such a picture. Since I have no eye signs or goiter, anxiety/irritability could have many causes, insomnia has been chronic problem for decades, and PVCs are rare, and I have hardly any of the hyper symptoms you mention, I was looking for cause other than Graves. But if the numbers tell the story, even in the absence of major symptoms, I guess that's it. Thanks for your help.

[Barb135]

What prompted the lab tests?

Just because you don't have the symptoms, doesn't mean you don't have the condition... Both Graves and Hashimoto's can be present for years without us knowing we have it.  

I'm really not trying to "convince" you of anything... it's all right there in the numbers.  With both your Free T4 and T3 being over range, that means your thyroid is producing more than it should be (unless you're taking replacement thyroid medication, in which case you're over medicated).  Add to that, anyone who does not have Graves Disease does not have TSI antibodies, particularly over range like yours... it's that simple.

Not everyone gets all of the symptoms, or even most of them, but the few symptoms you have are, typically, those of hyperthyroidism.

You still don't have your TPOab results back and if that's positive, you'd most likely have a diagnosis of, both, Hashimoto's and Graves, though TPOab can be present in small amounts with Graves Disease.  As I said, Hashimoto's is often characterized by periods of hyperthyroidism...

[EdWicks]

I looked up Graves symptoms. Only ones present are:
Some anxiety/irritability
Insomnia (but had it for years)
Occasional palpitations (PVCs)

No tremor of hands/fingers.
No heat sensitivity. Very sensitive to cold. Fingers cold.
No weight loss.
Thyroid not large; in fact is small.
No diarrhea; in fact constipation.
No bulging eyes.
No thick red skin on shins, top of feet.

[Barb135]

All of your labs are over the reference ranges (except TSH) and indicate that you have hyperthyroidism, of which Graves Disease is the main cause and since your TSI is definitely positive, that would be your diagnosis.

Some people do have, both, Hashimoto's and Graves Disease at the same time, with one or the other dominant... Also, Hashimoto's is often characterized by periods of hyperthyroidism, in beginning stages; however, with the positive TSI, you would still have a diagnosis of Graves Disease.

The symptoms of Graves Disease would be those of hyperthyroidism, such as sudden weight loss, sweating when others are comfortable to cool, diarrhea, hand tremors, heart palpitations (these can be present with hypothyroidism as well), rapid heart rate, irritability, mood swings, fatigue and many others.