? about Adrenal testing

[NURSELPN]

Hi Dr. Mark,
Welcome back, you were missed!!!
I have been treated for hypothyroidism since 1983 than diagnosed with hyper (not med induced)but(Graves) in 2004 & received RAI in 02/05. I've been working my way back to normal since the RAI & just can't seem to get there. I'm @ 3 grains of Armour & my thyroid lab has finally leveled out in 01/06. It's stayed pretty consistant w/ my last lab done 07/05/06. TSH 0.17 (0.40- 5.0)  Free T-3 261 (230-420)   Free T-4 1.1 (0.8-1.8)  Also thyroid antibodies TSI 152 (<125) & TPO 396 (<35). Is this antibody normally high in Graves? My TSI is going down 196 in 03/06 but this is the first TPO I've had checked. Why would it be high? tested because I'm having my second rt.eye decompression done 07/20/06.
I'm also taking 1 cc of B-12 wkly & my level is now 721 up from 89 in 06/05. Per your suggestion, Intrinsic factor Block AB-negative.  Gastric Parietal Cell AB 90.3 (>25 positive). My GP says I have malabsorption but not Pernicious Anemia because I'm not anemic.???? My lab sheet says antibodies to this protein are present in 80% of patients with pernicious anemia. I don't know what to think. Is my GP mistaken?
I'm also having some problems with my 07/05/06 CBC. WBC 16.1  HGB 16.3 HCT 48.3. They were also up back in 03/06 WBC 12.2  HGB 14.4  HCT 42.8. I'm being referred to a hematologist. Is the anything auto-immune that could cause this?
Also what is the best lab to test for Adrenal fatigue? GP wants to test that also.
I'm sorry, I'm a miss........

[Mark Lupo, M.D.]

cbc showed normal hemoglobin.  The high WBC is of unclear origin and with the elevatd LAP I agree with seeing the hematologist, but often this is just an infection or something transient.  There may be some autoimmune causes but not something I see that often in my thyroid practice to guess which at this time -- see what the hematologist thinks.

[NURSELPN]

I have one more question above. Sorry to be such a pain...Thanks

[NURSELPN]

Thank you very much for your answer. You didn't comment on the CBC though, is there anything auto-immune that might cause this elevation. I also forgot to say the GP. ordered more lab to exclude infection & also many others with the only positive reading to a Leukocyte Alkaline Phosphatase Stain 155 w/ normal of (13-140).   Thanks, TJ

[Mark Lupo, M.D.]

The TPO is high in Graves in most cases. Ab's including TSI & TPO will likely fall after I-131 but may never normalize.  TSI is linked to eye disease. Keeping TSH optimal will likely help keep eyes stable.  Good luck with the decompression.

I would say you have Pernicious Anemia (ie malabsorption of B-12) but at an early state without lab evidence of anemia (low Hbg) and the B-12 therapy should keep it that way!

Best test for adrenal insufficiency is an ACTH stimulation test and consider Adrenal Antibody testing.