Lab Results

[tlheyman]

Hi!  I've been dealing with thyroid nodules since 2007.  I've had them biopsied and checked every six months to ensure they're not changing, and they haven't.

I have also been dealing with anxiety since around that time as well and today decided to look back at some of my lab results to see if any of them could point to an issue with my thyroid (and possibly the anxiety).  Well, unfortunately, I only have one complete set of labs from a few years ago (was told they were normal results).  They are as follows:

T4 .99 (4.5 - 12.0)
TSH 1.5 (.47 - 4.00)
T3 Free 4.0 (2.3 - 4.2)

My T4 is ridiculously low.  While maybe this doesn't mean anything, I'm surprised it was considered a "normal" result.  Thoughts?  Could any of this relate to my anxiety?

Thanks!
Tracy

[goolarra]

You can have antibodies even if your thyroid labs are "in range".  In fact, we often have antibodies for years, or even decades, before they damage the thyroid enough to knock results out of range and/or cause symptoms.  If you have TPOab, TGab and TSI tested, as Barb suggested, you'll have a much better idea of what you're dealing with and what to expect or watch out for in the future.

[tlheyman]

Thank you both so much!  I will call my endo's office and request that they send me copies of my results.   I've also, as I mentioned above, asked my gp's office to check on my results from the summer but I'm guessing they probably didn't test FT4.

I've never been tested for antibodies.  When my nodules were found (I actually discovered my enlarged thyroid one night while sitting at my computer).  I just felt a large lump and didn't even know it was my thyroid.  I went to my gp where they did an ultrasound to discover two nodules (one rather large).  From there I went to my endo who had them biopsied (both benign) and then monitored for three years with ultrasounds and bloodwork every six months.  Blood work was always "normal" and ultrasound results never changed.  But, no one ever mentioned antibody testing to me.  Maybe because my labs were normal?  

Prior to my nodules being discovered, I was having a TON of palpitations constantly throughout the day.    That is the only thyroid symptom that I would say I was having at that time.  But, I started having the palpitations when I was pregnant with my twins and it got worse over the next year after they were born.  I chalked it up to hormones.  My nodules were discovered when my twins were just shy of two.  

[Barb135]

If you are in the U.S. your doctor is obligated to give you a copy of your lab report, upon request. You might want to try to get the one from this summer, so you can compare labs with symptoms.

I agree with goolarra that you should try to get FT3, FT4 and TSH repeated to see where your levels are now.  

Have you been tested for thyroid antibodies?  That would be Thyroid Peroxidase Antibodies (TPOab), Thyroglobulin Antibodies (TGab) and Thyroid Stimulating Immunoglobulin (TSI).  The TPOab and TGab will confirm/rule out Hashimoto's Thyroiditis (most often associated with hypoythyroidism) and the TSI is the definitive test for Graves Disease (most often associated with hyperthyroidism).  Both of these are autoimmune diseases in which the body sees the thyroid as foreign, and produces antibodies to attack it.  This is usually a gradual process, during which the production of thyroid hormones declines over time.  It's not uncommon for symptoms to show up before the labs get out whack.

Nodules often go hand in hand with autoimmune disease.

[goolarra]

Total T4 is fairly useless, but it is a bit odd that T4 is low and FT3 is so low.  TT4 measures the total T4 in your blood, but a lot of that is bound by protein and unusable by your cells.  FT4 tells what's "free" and available.

You might consider calling your endo and asking for the last couple of results while you were still under his care.  Be sure to ask for reference ranges as well since those vary lab to lab.

It sounds like you're accumulating quite the array of thyroid symptoms.  Even if you do get the results from last summer, it might be worth it to request FT3, FT4 and TSH again now.  Most of us don't go longer than 6 months between labs.

Has either doctor ever tested you for thyroid antibodies?  Nodules usually come with autoimmune thyroid disease.  How was it that your nodules were discovered in the first place (most of ours are discovered because we start having thyroid sympoms is why I ask).

[tlheyman]

Thank you so much, goolarra!  I'll try to answer all of your questions....

The T4 test doesn't say free or FT4 so it must total.  And yes, it seems me FT3 is high.  Kind of weird results, right?

And yes, these test results are ancient history, unfortunately.  They were taken by my GP back when I was diagnosed with the nodules.  Once he found the nodules, I was referred to an endo who I saw from 2007 until this summer.  He monitored my nodules with 6 month ultrasounds and also checked my thyroid levels.  I never saw those lab results, though, unfortunately but was always told they were "normal" by my endo.  My endo actually released me from his care this summer because my nodules hadn't changed in 3+ years and my labs were fine.

I did have my thyroid levels checked again by my gp this summer as part of my annual exam.  Was told all was normal.  I did leave a message at my gp's office this afternoon asking about my very off t4 level from 2007 and asked if they could look at my results from the summer to see if it was still low.  

I have been having a lot of symptoms lately (past few months).  Low temp (usually in the 97 range), seem to be cold regularly (but with occasional hot flashes), hair loss, muscle twitching/cramping and then, of course, the anxiety.   I guess the twitching could be a result of the anxiety.  Mentioned all of this when I left the message with my dr.  

And no, I'm not on any meds.  Hope I covered everything for you and thank you again so much!   Oh, and I'm also 38.  don't know if that makes a difference.  :)

Tracy

[goolarra]

Is that a FREE T4 test or a total T4?  If it doesn't specifically say "free" or "FT4", it's total.  And, yes, you're right, it is ridiculously low.  It's way out of range and in no way "normal".  At the same time, your FT3 is really quite high...in range, but in the very top of the range.

It looks to me like the doctor who said these tests were "normal" is one who really only looks at TSH.  FT3 and FT4 are much more important since they're the actual thyroid hormones (TSH is a pituitary hormone and can be affected by numerous factors).  

Anyway, these tests are ancient history at this point, and you really should consider having FT3, FT4 and TSH repeated.  Anxiety can be a symptom of both hypO and hypER, so it's very possible thyroid is causing this.  Any other hypo symptoms, either hypO or hypER?  Intolerance to heat.cold?  Weight gain/loss?  Fatigue?  Insomnia?  Constipation or diarrhea?  Incresed or lowered HR or BP?

In addition to monitoring your nodules, has your doctor been ordering regular blood work?  Have you been diagnosed with a thyroid disease?  Have you had antibody tests to see if you have an autoimmune thyroid disease?  How does your doctor explain the nodules.

One last question...I promise!  Are you on any meds?