Confused about results

[bopsytop]

I have symptoms of hypothyroidism but my TSH shows normal rage at last test was 1.49, but my gyno checked free t4 also and it shows to be .87.  I also have a goiter on my thyroid that doctors can't tell me why its there or why it is slowly growing.  Just want to feel normal and I don't.

[Barb135]

What's the reference range for the Free T4?  Ranges vary lab to lab and have to come from your own report.  If the range is near what we normally see, your level is very near the bottom and would easily explain why you feel bad.

A goiter is a swollen, inflamed thyroid.  You might want to ask your doctor to test thyroid antibodies to see if you have Hashimoto's Thyroiditis, which is an autoimmune disease, in which the body sees the thyroid as foreign and produces antibodies to destroy it.  With Hashimoto's, it's very common for symptoms to show up long before lab results indicate a problem.

The antibody tests to ask for are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both, since they are both markers for Hashimoto's and some of us have one or the other, some have both.  

[bopsytop]

Thank you for the reply, I saw an ENT about 2 weeks ago and he tested for Hashimotoes (because I demanded it) and all I got for the answer was it was in normal range, but have no idea where it was located at on the range scale for that lab.
The Free T4 result was listed on my Gyno patient portal but not the range for the test.  Will call office tomorrow and see what lab range is for test.
symptoms I am experiencing:
fatigue
weight gain
hair loss
dry skin
acne
legs aching
fullness in throat (which ENT is trying to tell me is acid reflux and put me on med for it)
goiter on thyroid
if I am not up moving around and sit for a few minuets I have to cover with a blanket from getting cold.  
my temperature when I go to the doc or take it at home runs 96.4-97.6 roughly.
Do you know of anything else I can ask them to test for?  I finally have an appointment with an Endocrinologist in about 2 weeks.
Thanks for any input.  

[Barb135]

Did you have a thyroid ultrasound on your thyroid?  Is that how they determined a goiter?  A goiter isn't something "on" your thyroid; a goiter IS your thyroid swollen and inflamed.  Did they happen to mention whether you had nodules on your thyroid?  Nodules are very common with hypothyroidism and Hashimoto's.

You should paper copies of all the lab tests that have been done in order to make sure they did all the lab tests that are needed.  Whenever I go to my doctor, I make sure I get a copy of the labs, before I leave; that includes any ultrasound reports, as well.  Those reports have become a running record of my illness.

Your symptoms all indicate hypothyroidism.  Hashimoto's is the # 1 cause of hypothyroidism in the developed world.  

The fullness in your throat "could" be acid reflux, but that's just once more symptom of hypothyroidism.  I'd been on very strong acid blockers for several years and that was one of the first symptoms that went away when I started taking thyroid med.  The problem is not that you have too much acid, but that you actually need more acid.  I learned that if I drank dill pickle juice or even just apple cider vinegar the reflux went away.

I would say that before you go to the endo, you need to get copies of all labs and/or other tests that have been done, so you can make sure everything I've mentioned above has been done, then you won't have to wait for the endo to do it all.  

You might also ask your doctor to test your vitamin B-12 and vitamin D levels, since vitamin B-12 deficiency causes horrible fatigue and vitamin D deficiency causes hypo-like symptoms.  

[bopsytop]

I called about ranges for ft4 this morning and nurse said it wasn't listed on lab.  Called about hashimotos test and they won't give me numbers over the phone.  
Have had vit d tested and it's normal range.
A month ago general doc tested my TSH and it was 1.10, last week gyn tested and TSH 1.49, is it normal for it to change like this?

[bopsytop]

Finally got a copy of the Antithyroglobulin Ab shows 1.0 range 0.0-0.9
then under this it says please note:
low positive thyroglobulin antibodies are seen in a portion of the asymptomatic populations

So what does this mean?  Please help.

[bopsytop]

I went by my general doc and picked up thyroid labs and my free t4 on May 20 was 2.8 range 1.0-3.9 then on June 11 it was down to .87 is it normal to have such a huge difference in less then a months time.  
Sorry to be asking so many questions just feel lost.

[Barb135]

Don't worry about asking so many questions...  TSH is a pituitary hormone, not a thyroid hormone and it's affected by a lot different variables.   It can fluctuate by as much as 75% over the course, of a day, so to answer your question: yes, it's perfectly normal for it to fluctuate like it is and the level is good.

When was the Free T4 of 0.87 that you listed above taken?

The antibody counts can be slightly elevated in people who don't have hypo symptoms - you have them.  Did they not run a TPOab test?  There are actually more people who have that antibody than the TgAb.

There's no need to be testing TSH on a monthly basis, but every time you test TSH, you also need to test Free T4 and Free T3.  Ask your doctor to do that.  Also ask for an ultra sound.

[Barb135]

Also meant to ask about your vitamin D level.  Just because it was in normal range, doesn't mean it was okay.  Vitamin D needs to be, at least 50-80 in order to be sure you aren't deficient.  

Have you ever had vitamin B-12 tested?

[bopsytop]

My Free T4 was 2.8 on may 20
then on june 11 it was .87

They have done an ultrasound of my thyroid and have diagnosed me with a goiter, but ENT said they could not feel any nodules (doctor exam of neck).

test was done on June 6
Thyroid Stim Immunoglobulin : 30 range 0-139
TPO ab: 9 range 0-34

[bopsytop]

Vitamin d was 39 range 30-89
Nope never been tested for b-12

[bopsytop]

.87 was on June 11

[bopsytop]

Is free thyroxine index the same as FT4?  
I am not taking any type of thyroid med so is it normal for it to drop 2.0 points in the coarse of 3 weeks?
  So confused and lost. :-(

[bopsytop]

This was lab I had done on June 11, no ranges listed
Tsh, Serum Findings: 1.49
T4, Free, Serum Findings: 0.87

[Barb135]

Yes, Free Thyroxine is the same as FT4.  Why did you have it done only a couple weeks apart?

Let me make sure I understand.. On May 20, you had the following tests:
TSH   1.10
FT 4   2.8   (Range  1.0-3.9)

On June 11, you had
TSH   1.49
FT 4   0.87  (no range listed)   Was this done by the same lab?  If it wasn't done by the same lab, there's no way to compare the results, without a reference range, so you don't even really know if your FT 4 actually DID drop 2 whole points.  Different labs use different analysis methods, so you have to make sure you're comparing apples to apples and not apples to oranges.  You'd have to call the lab and find out the range they use.

The ultra sound would have indicated whether or not there was swelling/inflammation and there must have been in order for them to diagnose goiter, since a goiter is a swollen, inflamed thyroid.  Nodules would also have shown up on the ultrasound, so there must not have been any or the report would have indicated such.  They can't only go by touch... they couldn't feel my nodules either, but I had multiples.

Your vitamin D level is way too low, even though it's "in range".  Are you supplementing to bring the level up?  You should get it up to, at least, 50 to 80.

Again, regarding the drop in your FT4 - you don't really know that it did drop that much, as I explained above.

No need to feel lost and confused.  We can work through it, if you'll get the information we need to do that.

[bopsytop]

Yep the test was done that close together, my gyn does routine test when he does a pap so didn't know thyroid was part of his routine test.

I know the first test was done with solstas lab partners.  The second test I am not sure who it was done through but will get a copy of lab when I see doc next week.

My multivitamin has vitamin D in it but that is all I am taking.  

I was originally diagnosed with a goiter over 2 years ago. They did a thyroid ultrasound I think May 22 ish of this year and according to the ENT I saw the goiter is Goiter diffuse, nontoxic, so when I asked him what caused it to grow in the past 2 years he said he didn't know but he didn't feel any nodules.  

So my question to my GP Doc and the ENT about why do I have a goiter and feel like I have been through a ringer if my thyroid it "functioning normal".   All they tell me is they don't know but my thyroid is function fine.  

I originally went to the doc on the may 20 because I was tired and because my legs had started aching, since then I have progressively felt worse and now legs ache even worse.  

Thanks again for all your help.

[bopsytop]

Or that is what he has listed under his patient portal page for me, meaning the Goiter diffuse, nontoxic.  I might call my GP where the ultrasound was done and ask for the report from the radiologist that read it.

[bopsytop]

I have had thyroid test and a thyroid ultrasound is there anything else I should asked to have checked?  

[Barb135]

It's late in my world and I'm off to bed... I'll take a look at all this again in the morning and let you know if I think there is something else you should have done (or done again)... Don't worry... we'll sort it all out.

[bopsytop]

Thanks Barb for all the help and information, I think I am going to ask endo to run tsh, ft4 and ft3,  plus see if he will check vit b12.   Will post what I find out.  

[Barb135]

Try to get a written copy of the ultra sound report.  That will indicate whether or not there were nodules.  As I noted above, I don't trust the "touch", since no one could feel mine, either, but they were there, nonetheless.

You do need FT3 and FT4 to be run on the same blood draw and make sure you get a written copy of the report.  

As I noted above, you will have to know whether the previous FT4 samples were analyzed by the same lab.  If they were not, you can't compare them.

[Barb135]

I mean you can't compare them without reference ranges, from both labs in order to get the percentages. Sorry about that.

[bopsytop]

I finally figured out where I can get the ranges for the second ft4 hopefully, just have to wait till doc office opens Monday and speak with their lab tech.  I will hopefully pic up copy of ultrasound report Monday.  If I get the ranges for the free t4 Monday will post them.  
Just really want doc to tell me why I feel so bad thyroid or not, something has be the culprit.

[bopsytop]

Thanks Barb hope you have good weekend also.