Out of reference range lab values... Hyperthyroid? Secondary Hypothyroid? Adrenal Disease?
My primary told me I was hyperthyroid and is setting up an appointment with an endocrinologist. I do not exhibit standard hyperthyroid values (Low TSH, High T4). I have Low TSH and borderline low T4, very high Thyroglobulin and low DHEA and Ferritin. Thyroid autoantibodies Negative. I do not take any type of thyroid or steroid medication. I have many hyperthyroid symptoms but also overwhelming fatigue and recently have occasional face swelling in the morning and occasional hoarse voice. My hair is dry and falling out, my skin seems thinner, I am horribly exhausted but have extreme insomnia, I have constant fidgeting and can not sit still, I am having painful onset of extreme abdominal pain and diarrhea, appetite loss and nausea. I do not have chrons, ulcerative colitis or other digestive health issues (all work ups negative). I am becoming overwhelmed with all of these physical symptoms and do not know what is wrong with me.
Are there any suggestions on an area I might research based on the below values? Please help if you have similar values, know someone with similar values or have suggestions based on your experiences or research.
DHEA LOW 16 Range 35-430
Ferritin LOW 5 Range 6-200
Thyroglobulin HIGH 171 Range 1.6-59.9
TSH LOW .23 Range .6 - 4.5
Free T4 BORDERLINE LOW .9 Range .8-1.8
T3 NORMAL 106 Range 84-172
Thyroglobulin Antibody NORMAL
Thyroid Peroxidase Ab NORMAL
Sed Rate NORMAL
CBC with Differential ALL NORMAL
Additional comment... I have lost 13 pounds in the past 3 weeks with no intentional dieting and actually stopped exercising. My primary has drawn lab work to look for disease processes that cause fatigue (contagious, viral ect) and even obscure things like whooping cough and lyme disease... all negative.
By the way, Lyme Disease is not obscure. A high percentage of the population may have it and not know. For that matter, one is lucky if they show any indication of Lyme on the mainstream tests since the bacteria prefers to hide out in cell walls instead of the blood stream.
I hope someone with far more knowledge here will be able to give you some answers.
It sounds like the doctor is just covering some basics sending you to the endo for a second opinion. It doesn't sound dire at all.
In the symptoms catagory it sounds look like you are having some mild episode of Hyperthyroidism but why? and your labs do not show immediate levels for treatment ASAP.
In the thyroid labs I have a few questions. The Free T4 is your conversion hormone so it can be in that range and be fine. Some feel best a little higher but since it is conversion you want to see that lab show lower levels than on the Free T3.
Note - I see a T3 test - not Free T3 - that is a definate needed test to have w/ your symptoms and I would inquire on if this was a Total T3 or a Free T3. If total - waste of time to look it based off your symptoms.
On the TPOaB test - you say normal - but with the symptoms you are describing you should have had the TSI - Graves test - over - the test TPOaB test that was ran. The globulin tests high indicate autoimmune cells are present but normally in conjuction with TPOaB ( Hashimoto). It looks like your doctor understands autoimmune thyroid labs only when Hashimoto hypOthyroid and is not savy with Graves - ESPECIALLy with your symptoms you stated.
Thank you for some additional information and comment. My symptoms are more than stated and have impacted my quality of life severely, the fatigue is overwhelming. The abdominal pain (when it happens) and resulting bathroom trips keep me from doing anything but staying in the bathroom. They do not think it is irritable bowel or food allergy, celiac disease, etc. I have heard heart arrhythmia (tachycardia) where my pulse shoots up to 140+ beats a minute, hand tremor, orthostatic hypertension, bloodshot 'gritty feeling' eyes and blurred vision.
I would like to better understand why the ferritin (iron deficiency?) or dheas (adrenal/pituitary?) values are low and if that might be causing some symptoms? The lab sheet did not specify a Free or Total designation for T3. Thank you for the additional information on the additional antibody testing unique to Graves, it looks like in my lab draw there was not a thorough assessment of all of them. The Thyroglobulin test I found a lot of information related to occasional high with Graves, thyroiditis but often used for a cancer marker after thyroid cancer is treated.
I will consult with the endo and be sure to inquire on more complete auto antibody testing and see what direction they take the testing in.
good luck at the endocrinologist. sounds very thyroid-related.
um, is anything getting done about your (very) low iron? the low DHEA and low Ferritin would be contributing to your fatigue...
maybe you're not absorbing iron in your digestive system as well as it seems to be going straight through. you can't be living well if your food doesn't get to the rest of your body...
I am going to talk to the endocrinologist regarding the DHEA (since it is adrenal) and also the ferritin. My appointment is in two weeks. My primary did not know what to do with those low values. I will just hang tight... but oh so tired.
Today I got the radioactive iodine uptake test results and ultrasound results. Next week they are doing needle biopsy and I will get the results four days after. There is goiter and cold hypoechoic nodule on both sides. The nodules are solid and > 2.5 cm. Doctor suspects thyroid cancer and is starting me on beta blockers. Maybe that explains why I have had so many symptoms and been feeling so awful. Who knows. Hoping to get some decent news soon.
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