New test results...but nothing is adding up!

[Jules77733]

4/15/08--onset of symptoms begins; developed a lump in throat within 2 wks

5/8/08
TSH: 4.05 (range: 0.4 - 4.0 mIU/L)
mono: negative
CBC: all normal

5/16/08
TSH: 5.45 (range: 0.4 - 4.0 mIU/L)
Free T4: 1.3 (range: 0.8 - 1.9)

6/19/08
TSH: 1.58 (0.4 - 4.5 mIU/L)
T-4, total: 7.2 (range: 4.5 - 12.5 mcg/dL)
LDL cholesterol: 126 (range: < 130 mg/dL)
Total cholesterol: 195 (range: 125 - 200 mg/dL)
Ultrasound: Right lobe measures 4.8 x 1.3 x 1.6cm; left lobe measures 4.6 x 1.1 x 1.4 cm. The thyroid parenchyma is slightly heterogeneous, however no discrete nodules are identified. The isthmus is unremarkable.

6/30/08
No thyroid tests done
LDL: 133 (range: < 130 mg/dL)
Total cholesterol: 197 (range: < 200 mg/dL)
everything else fairly normal--lipid panel, CBC, etc.--but some values were high or low borderline (should I be looking at anything specifically?)

7/2/08
TSH: 2.77 (range: 0.4 - 4.5 mIU/L)
TgAb: < 20 (range: < 20 IU/ml)
TPOAb: < 10 (range:  5.45 --> 1.58 --> 2.77, and while everyone keeps telling me I'm developing hypothyroidism, my RAIU & some symptoms are indicative of hyperthyroidism. My antibodies are normal, although TgAb is at the high-normal, but I don't know if this could be significant. I can't get to an endo for two months & the GPs I'm seeing now are baffled, so I'd greatly appreciate your input. Thank you for your help!

[Mark Lupo, M.D.]

The thyroid blood tests are the ones that determine hypo vs hyper and the most recent ones are normal.  The I-123 scan did not add anything (perhaps the slight high uptake was due to a relative low iodine dietary intake or a recovery from a mild transient thyroiditis - keep reading).  The ultrasound report sounds normal and the antibodies are negative.  At this point one consideration would have been a transient mild thyroiditis (lump sensation) causing a fluctutation with a slight but not significant TSH elevation of around 5 and some mild heterogeneity on ultrasound.....but there is not enough evidence of thyroid dysfunction based on this data to recommend treatment as things seem to be normalized.

[Jules77733]

Whoops, forgot to mention the 6-hr uptake results:

7/7/08--RAIU started
6-hour uptake measured: 18.5% (range: 10 - 15%)

Now, I'm really finished with my question.

[Jules77733]

And here is the final part of my question. Sorry it is so disjointed; the information just didn't want to post all at once, for some reason!

What are your thoughts on this now that I have the US, RAIU & additional blooodwork? My TSH used to always be ~2.00, but in the course of 6 weeks it's gone from 4.05 --> 5.45 --> 1.58 --> 2.77, & while everyone keeps telling me I'm developing hypothyroidism, my RAIU and some of my symptoms are indicative of hyperthyroidism. My antibodies are normal, although TgAb is at the high-normal, but I don't know if this could be significant. I can't get to an endocrinologist for two months & the GPs I'm seeing now are baffled, so I'd greatly appreciate your input. Thank you for your continued help!

[Jules77733]

7/8/08
24-hour uptake measured: 39% (range: 10 - 35%)
Radiologist's impression of RAIU: Thyroid is in hyperthyroid range. Correlate with T3 and T4 values. Normal scintographic imaging without any nodules. (even though the right lobe looks brighter to me; pics are in my profile)

[Jules77733]

I don't know why my comments aren't posting correctly...so I'm going to try posting the information separately to ensure that all of it actually gets posted.

7/2/08
TSH: 2.77 (range: 0.4 - 4.5 mIU/L)
TgAb: < 20 (range: < 20 IU/ml)
TPOAb: < 10 (range: < 35 IU/ml)
AM Cortisol (non-fasting, taken at 9:40am): 15.4 (range: 4.0 - 22.0 mcg/dL, 8am)

[Jules77733]

Sorry Dr. Lupo, for some reason my question was messed up and everything after "TPOAb: < 10" is incorrect because some information was deleted. Here is the correct version:

7/2/08
TSH: 2.77 (range: 0.4 - 4.5 mIU/L)
TgAb: < 20 (range: < 20 IU/ml)
TPOAb: < 10 (range:  5.45 --> 1.58 --> 2.77, & while everyone keeps telling me I'm developing hypothyroidism, my RAIU & some symptoms are indicative of hyperthyroidism. Antibodies are normal, although TgAb is high-normal, but I don't know if this could be significant. I can't get to an endocrinologist for two months & the GPs I'm seeing now are baffled, so I'd greatly appreciate your input. Thank you for your help!