Need help understanding thyroid labs please

[Mandy_K]

Hello all.  Thank you all for posting in this forum because I've already learned a lot from others posts!  I need guidance in understanding my current thyroid condition and welcome any information anyone has.  I have an appointment on the 29th of July to see an Endocrinologist for the first time, but before then I'd like to try to understand further what is happening here.  About 3 months ago I wasn't feeling well and went to the doctor.  Hair was falling out, very sore throat, very tired.  He checked my thyroid levels and we got the following:  

On the 22nd of April here were my test results (I included the Cholesterol because I know thyroid disorders can affect it as well):  
THYROTROPIN                        0.04 Low mcIU/mL Reference Range  0.34-5.60
THYROXINE.FREE                1.15 High ng/dL         Reference Range   0.61-1.1
TRIIODOTHYRONINE.FREE 4.00 High pg/mL         Reference Range    2.5-3.9
        CHOLESTEROL                              81 Low mg/dL         Reference Range   118-200
CHOLESTEROL.IN HDL               31 Low mg/dL         Reference Range    >40
CHOLESTEROL.IN LDL               38          mg/dL         Reference Range    <129

On the 27th of May at a "re-check" we had the following:
THYROTROPIN                           0.06 Low mcIU/mL Reference Range 0.34-5.60
THYROXINE.FREE                    0.83            ng/dL         Reference Range  0.61-1.12
TRIIODOTHYRONINE.FREE    3.40             pg/mL Reference Range   2.5-3.9
A complete blood count at this time showed all other normal levels. I also have a normal erythrocyte sedimentation rate as well as coagulation test results.  

I was still feeling poorly and throat was VERY sore by now, so my doctor did order a thyroid ultrasound for June.  Results showed two nodules, the largest being 1.3cm.  Both heterogeneous, hypo echoic, with potential calcification deposits.  However, after seeing the radiologist, they decided not to biopsy the nodules because of my lab work...they believed instead I most likely had "thyroiditis" and did not want to biopsy unless it was absolutely necessary. I was told they would repeat the thyroid ultrasound in 3 months (coming up this September) and if the nodules had changed or increased in size, a biopsy would be done at that time to rule out any malignancies.  Also at this time, the radiologist suggested additional blood work that may confirm/rule out potential thyroiditis.  The results of these tests were on June 17th:

THYROPEROXIDASE AB             1526 High  IU/mL        Reference Range:   <9.0
THYROTROPIN                             0.04 Low  mcIU/mL Reference Range:  0.34-5.60
THYROXINE.FREE                     0.97         ng/dL Reference Range:  0.61-1.12
TRIIODOTHYRONINE.FREE      3.40          pg/mL Reference Range:   2.5-3.9
THYROTROPIN RECEPTOR AB     2.46 High IU/L         Reference Range:   0.00-1.75
THYROXINE BINDING GLOBULIN 19         ug/mL Reference Range:   13-39
THYROGLOBULIN                       15 High ng/mL Reference Range:   <40  (why it says this is "high" seems an error? Am I not reading this correctly?)
THYROGLOBULIN AB            778.0 High IU/mL Reference Range:   0.0-0.9

A repeat test on July 9 yielded the following. I believe I have more results that are coming, but these are the only ones in yet.  The tests were done so I have multiple tests over the time period to take with me to the endocrinologist:

THYROGLOBULIN AB               700.6 High   IU/mL     Reference Range:    0.0-0.9
THYROTROPIN                                 0.15 Low  mcIU/mL   Reference Range:   0.34-5.60
THYROXINE.FREE                         0.77         ng/dL   Reference Range:  0.61-1.12
TRIIODOTHYRONINE.FREE         3.30        pg/mL   Reference Range:   2.5-3.9


I understand that the TSH levels have been slightly improving.  The sore throat is still there and the fatigue...some days it's all I can do to function!  If anyone has any thoughts just from looking at the numbers above I appreciate it. I've read thoroughly on Hashimoto's as well as Grave's, not to mention Thyroiditis.  I understand that if this is a true case of Thyroiditis, I will present hyperthyroid and slowly move into hypothyroid before returning to normal over a time period of what may be several months.  I also understand some patients stay hypothyroid after this event.  I also understand the presence of antibodies generally means the body is "attacking" the thyroid gland.  But, anyway, I welcome anyone's thoughts or experience here as well as advice on the radiologist's choice to hold off the biopsy until 3 months due to the lab work presenting in what she believed was thyroiditis.  Thanks!

[Mandy_K]

If you're still following this thread, just logged into my testing info & the TSI levels were high. 280% with reference range up to only 130% so definitely high. Haven't spoken to the Endo about it yet but am on Monday. So am I understanding correctly that I'm showing both signs of Hashi & Graves? Help please!

[Mandy_K]

Hi! I had to tell you...remember when you and I spoke of the TSI test? I called my primary care doctor to ask for this test in preparation for my Endocrinologist appointment today but he never responded to me. And...as you can guess it was the test the Endocrinologist ordered today right away, so I'll have to follow up with her again in 2 weeks when those results are back but you were right that it would be ordered! She said if the results are abnormal she will order the RAIU scan. Second ultrasound still set for September.

[goolarra]

Well, you could have another autoimmune condition, but what were tested here were just thyroid antibodies.  TPOab and TGab were a strong positive, so Hashi's is pretty much confirmed.

TRab is also a strong positive.  However, TRab tests all the thyroid receptor antibodies.  Some of those are binding antibodies, some blocking antibodies and some stimulating antibodies.  It's only the stimulating antibodies that are significant when it comes to Graves'.  TSI will sort that out.

As far as other autoimmune diseases are concerned, they all have their very own antibodies.  Once we have one autoimmune we are more susceptible to developing another.  

[Mandy_K]

Are there other autoimmune conditions that mirror my labs? I've looked into the other conditions that may have Graves or Hashis as a symptom as well but I don't see anything that fits. I'm still concerned this could be thyroid cancer as well. In the end, all I can do is wait until the 29th to see what my endo says but just curious for now & want to learn all I can.

[Red_Star]

Aussie-ism huh. LOL. Nice one mate. :)  

[Mandy_K]

Hi.  Yes, I am in the States.  I emailed my doc requesting a TSI test.  Guess we'll see what they say on that.

[goolarra]

That's why I asked if Mandy_K were in the States...I know you've said TRab is all they do in Aus.  I haven't detected any Ausie-isms, but you never know!  LOL  

[Red_Star]

"It should be pointed out that, especially in the US literature, the term ‘hashitoxicosis’ is sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves’ and Hashimoto’s disease.2 In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease." - Hashitoxicosis – Three Cases and a Review of the Literature

The only test for Graves antibodies in Australia is TRAb as I found out the hard way requesting TSI twice only to have TSH and thyroglobulin serum (mine was high due to hyperthyroidism btw) tested instead. :)

[goolarra]

You can have Hashitoxicosis without having Graves'.  When you have Hashi's, the antibodies are killing off thyroid cells.  As the cells die, they "dump" thyroid hormone into the bloodstream, which can make you hyper.  Once they've done enough damage, your thyroid can no longer produce enough thyroid hormone, so you are hypo.

TRab is high, but TRab includes a number of subsets of antibodies.  TSI is the subset that indicates Graves'.  Are you in the States?

[Mandy_K]

Thank you for your thoughts.  Yes, that range is from the doctor's report, but 15 certainly looks normal so unsure why they're calling it "high"?  No test for TSI but I will request one before going to the endocrinologist in hopes that will help with a diagnosis as well.  I think it's Hashitoxicosis where you can have both Hashi & Graves happening at the same time?  

[goolarra]

So, there's a lot there, and I think it's best to take it one step at a time.  If I don't answer all your questions in the process, please feel free to give me a second nudge.

TPOab (thyroid peroxidase antibody) and TGab (thyroglobulin antibody) are both positive.  These are the two markers for Hashi's.  TRab (thyrotropin receptor antibody) is also positive, which is a marker for Graves'.  So, it looks like you might have both.  Did they test TSI (thyroid stimulating immunoglobulin)?

"THYROGLOBULIN                       15 High ng/mL Reference Range:   <40  (why it says this is "high" seems an error? Am I not reading this correctly?)"

I'm not sure what's going on here.  Is that range from your own lab report?  It really doesn't make sense.