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antibody peroxidase AB...

is this the test for graves disease or hashis? Or would this test show both? I am so confused.
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Avatar universal
Well, since you have symptoms NOW and your U/S isn't for quite a while (did you say June?), I'd certainly ask.  After all, what's to lose with a low trial dose?  If it helps you feel better, great, if not you can always discontinue it.  

"I suppose my argument for asking for treatment for the low T4 could be that...I have symptoms of hypothyroid, I am low normal and it might be too low for me also stating that I am at the lowest tenth of my range and some people don't feel well there ???"  I think that's a very solid argument.  You might also mention that the ranges are flawed and have never been revised.  Furthermore, everyone does not feel well everywhere in the range...some of us need to be a little higher, some a little lower, most very close to the middle.  Just tell her to log onto the forum and read for a while!!!  LOL

Oh, yeah, and can she justify the TGab with the positive ANA???  After all, you have to find out what that's all about...
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Avatar universal
Okay, that does explain quite a bit:)  So then one last question, should I consider going to my dr and asking for a trial of meds for low t4 or wait until after the ultrasound? I am going to request that other test and see what that brings me...I am not sure how well that will go since she has guidelines to deal with and all these "normal" tests. I suppose my argument for asking for treatment for the low T4 could be that...I have symptoms of hypothyroid, I am low normal and it might be too low for me also stating that I am at the lowest tenth of my range and some people don't feel well there ??? is that a solid argument? Anything else to add to it that beefs up the argument for treatment?
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Avatar universal
So, you have never had TGab tested?  Some of us with Hashi's have positive TPOab, some TGab, and some both.  A positive TPOab is considered sufficient for diagnosis of Hashi's, but a negative TPOab does not rule it out because of the possibility of having just positive TGab.

Yes, your numbers do look hypo.  TSH is back in range (0.3-3.0 now), but it was definitely high in January.  FT4 is way too close to the bottom of the range.  I think your problem is hypo.  Swings from hypo to hyper are usually associated with Hashi's, but when the thyroid starts to malunction for whatever reason, it has a tendency not to do it along a nice, smooth downhill line, but rather to decline in fits and starts.  An ultrasound might reveal other issues that could be causing swings.  It's definitely worth doing.

With the positive ANA, I'd ask my doctor to run TGab, too.  It could be the answer to your dilemma.  It's a relatively inexpensive bloodtest and would confirm Hashi's.  There is also a very small percentage of people with Hashi's who do not test positive for either antibody.  Diagnosis is then based on ultrasound and/or nodule biopsy.

I'd keep pursuing this...I don't think you've ruled anything out yet.
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Avatar universal
No, sorry I did not make that very clear, I did not have autoimmune thyroid test come back positive.  I had a positive ANA 1:320  with speckled pattern, positive ENA and positive anti-dna.  Which can be indicative of Lupus.  I only have 2 out of the 4 markers for lupus, so it is only suspected.  However my rheumatologist wants me to take plaquenil for preventative measures.  I have a hard time taking this medicine due to some serious side effects until my thyroid has been completely ruled out. I had initial test in April 2009 TSH 1.36 Then I had the higher TSH of 4.12 in january 2010, which I felt was too high.I requested further testing and that came back with TSH 2.65 (0.3-5.5) and free T4 10 (9-22) and the tpo <10  (<35).  So it appears as if there is some other kind of autoimmune involvement.  I was hoping it was hashis as it would be a definitive diagnosis and one that I can start treatment for, with little side effects. However, it appears as though I am NOT dealing with automimmune thyroid and possibly just hypothyroid.(I think that is what my numbers indicate????) So now I will attempt to get treatment for that and keep looking for answers to the autoimmune mystery.  I still have an ultrasound in june to further diagnosis, but not holding out muhch hope that will show anything.  
I was wondering if I could have hypothyroid for a long time and have my TSH swing back and forth.  Seems like there would not be variations in your numbers because unlike hashis it is not a gradual sputtering and flaring of hormones into your system...or is it? I guess I just do not understand how hypothyroid progresses or if it does, or if I am hypothyroid or just a little off on my numbers.  I just want it to be the answer I guess.
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Avatar universal
I don't mind the questions at all...you SHOULD have questions, and you should get them answered.

Let's back up a minute here...You tested positive for antibodies once, and then tested negative?  What were the actual numbers and ranges?  It's very unusual for antibodies to disappear (almost unheard of).  Can you get that info from your doctor?  Also, were TPOab and TGab tested both times?  This is starting to not add up...
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Avatar universal
So I do not have an autoimmune thyroid condition but possibly hypothyroid.  With hypothyroid does your body swing between normal and hypo and can that happen for years? I thought with hypo you would stay fairly consistent because there is constant disease as opposed to hashis where you have up and down swings of thyroid  destruction.  I seem to have ups and downs and so I was thinking with previous autoimmune tests coming back positive that it all pointed to Hashi's. Now that has been excluded I am left wondering what hypothyroid is all about.  Is it a disease that seems to come and go? why would a person have any thyroid antibodies present?
sorry about all the questions, I am very curious about how things work:)
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Avatar universal
Sorry about the antibodies...well, it's really GOOD news...thyroid disease does what vacuum cleaners do best!

Yes, there are doctors out there who will treat your FT4 level (don't remember your TSH).  Your FT4 is in lowest tenth of the range.  Many people don't feel well until FT4 is around midrange.  No, I think you've found the problem, and it's thyroid.  As I said, the original group that made up "normal" had a lot of us in it with Hashi's and a lot of people who were symptomatic, but hadn't been diagnosed.  So, a good part of the bottom of the range ought to be thrown out, and that's right where you are.

If your body isn't getting the thyroid hormones that it needs, it is going to affect your health, and it's going to make you feel miserable.  There are other reasons beside autoimmune disease for the thyroid to fail...some just go bad for indeterminate cause.  
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Avatar universal
Thanks again for answering, my antibody test came back fine and I was hoping that would clear up the diagnosis...which is does not.  I am not even sure how to go to my dr and request treatment at this point. My tsh has gone down and the free t4 is 10 (9-22)  and though it is low, it is still in range...all so "normal".. maybe I am looking at the wrong thing, maybe it just isn't thyroid. Could that low normal t4 and slightly high tsh make that much of a difference in my health?  Are there Dr's out there that would treat at those numbers? I am reading all I can find but everything seems to contradict everything else...like the normal not normal, etc etc...
thanks again, you seem to know your stuff!!!
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Avatar universal
Well, many DOCTORS can't figure it our!  So, don't feel bad.

You're absolutely right about "normal".  I can't even type that word anymore without putting quotes around it because it's so deceptive.  I prefer to use "in range" or "in reference range".  

There are a couple of problems with reference ranges.  One is that the original population that made up "normal" was tainted.  Some people with early stage autoimmune disease got into the group, skewing the "normal" results.  The other problem is that we all have our own "personal reference range", which is much narrower than the population range.  

So, if the range for FT4, for example, is 0.8-1.8, MY personal reference range might be 1.0-1.2, yours might be 1.5-1.7.  We're all different, and we're not going to feel well just because we're somewhere in that broad range.  But, if I get below 1.0, say to 0.9, I'm still "in range", but I'm out of MY range, so I'm going to feel hypo.  Higher FT4 levels, and I'll feel hyper, even though I'm still well within range.

Read, read, read...that's all I can say.  By and large, thyroid conditions are for life...it pays to be an educated consumer (patient).  Try to find arguments on both sides of issues that are controversial...there are some very biased people out there on the web.

Any other questions come to mind?  Or, maybe I shouldn't ask!!!
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Avatar universal
thank you for the info but even though you answered the question it isnt any clearer:)  lol...this medical stuff makes my brain swell...it seems like a negative doesnt always mean a negative and in the normal range isnt always normal...How does a person ever figure it out?
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Avatar universal
Actually, I should have said - "can be" elevated.  Some of us with Hashi's only test positive to TPOab, some to TGab, and some to both.  Likewise with Grave's.
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Avatar universal
TPOab is elevated in both Grave's and Hashi's.  If your other thyroid labs an symptoms look hypo, then it's most likely Hashi's, if hyper, then Grave's.  TSI is considered the definitive test for Grave's.
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Avatar universal
I meant to type antithyroid peroxidase Ab...silly me.
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