Antibody Questions

[S_9]

Good morning

I just wanted to get some input on my antibodies, I'm confused with what it means and if they point to a certain diagnosis of Graves or Hashi's or not/both. There are no endo's where I live and I'm not sure if traveling to see one would do any good or not. I've been diagnosed with Graves. Currently I am seeing a physician specialist and he thinks I'm in range and fine. I don't feel it. Ultrasound was fine, and RAIU percentage was only slightly lower than normal. Ranges are in brackets.

On 7/6/12 my hTRAb (instead of TSI) was <1.0 (1300 (<60) and my TgAb was 70 (<60).

I was hyper at the first test and hypo at the second. My levels have been slowly heading back to normal ranges since.
On 24/1/13 my TSH was 2.76 (0.50 - 4.00), my FT4 was 15.6 (10.0 - 19.0), and my FT3 was 5.0 (3.5 - 6.5).

I still feel bad, worse than I was a few months ago. Does this sound like I'm still slightly hypo? I am getting an MRI for pain at the base of my skull soon, but I have some strange cracking I didn't have before - in my neck and when I stretch my shoulders back, in the centre of my chest as well. I know muscle and joint pain can be caused by thyroid problems, but this has come on more in the last couple of months.

I'm also wondering about my RA factor. On 7/6/12 it was 10.3 (0.0 - 14.0). Is this normal or could it indicate undiagnosed RA or something else? Would the thyroid problems cause this to be high?

[S_9]

That sounds terrible! Hopefully all those blood tests I've had rule that out. My LFTs, FBC etc have been fine.

My GP said the pain is not the appendix, to leave it until it gets better or worse and let him know.

[Red_Star]

The right upper quadrant (RUQ) of the abdomen contains the right lobe of the liver, gallbladder with bilary tree, pylorus (region of the stomach that connects to the duodenum), duodenum (first part of the intestine), head of the pancreas, right suprarenal gland, right kidney, right colic (hepatic) flexure, ascending colon (superior), right half of the transverse colon, base of the right lung.

In other words, the list of RUQ pain is extensive. :)  And in some cases the pain is referred from outside the RUQ area.  I watched an episode of Mystery Diagnosis about unexplained RUQ pain. The gallbladder was removed but the pain continued. The specialist found the cause of the RUQ pain was Sphincter of Oddi Dysfunction. SOD is more common after gallbladder surgery but can occur without surgery. I have not come across one website that lists all the possible causes of RUQ pain. One website lists 141 causes but there are more reasons than that. :)  

[S_9]

I will go back to the GP that put me on Nexium and ask him to check that.
I asked my fiance's sister last night and she said the same thing, she's studying nursing. Said the pain usually starts in a different place, but hey - it could happen.

[Barb135]

Wow; once my gall bladder was removed all those sharp pains went away. What about appendix?

[S_9]

That makes sense. I will follow what the endo said.

Thanks so much for your help, you've definitely cleared a lot of things up for me!


Barb - Thanks for the pointer, but I had my gallbladder removed over a year ago, hence the off-beat gluten sensitivity suggestion.

[goolarra]

It's not "abnormal" for FT3 to be low compared to FT4, but many people find that FT3 has to be higher in its range than FT4 in its to feel well.  So, the "rules of thumb" for the two reflect that, with FT4 at 50% and FT3 at 67+%.  However, that spread is not for everyone, nor are the raw numbers.

I think if I were you, I might try your doctor's suggestion.  Your FT4 is still a little high, but if you discontinue the carbimazole, your FT3 might just come up a little and make that nap less necessary.  You can always start taking it again if it doesn't work out.

[Barb135]

I'm not going to comment on your thyroid status; I'll leave that for goolarra.  However, if you're  having sharp pains on your right side, you should ask to get your gall bladder checked.  I had those for years, and they turned out to gall bladder attacks....... unrelated to thyroid.

[S_9]

I could have linked back to it, but if I figured if it was me helping some person, I would rather not have to load more pages just to remember what I was up to.
Thank you for coming back to me :)

The endo I saw suggested I go back to the physician I've been seeing and ask him if I should try going off the meds to see if I relapse back into hyper territory or settle down. I'm still on the one 5mg carbimazole a day.

Is it not normal for FT3 to be that low compared to FT4?

I have been having some headaches, neck and back pain, stomach aches, jumpy feelings in my chest (not sure if this is heart or reflux), fatigue. Probably better than I have been, but still enough to make me want a nap around mid-afternoon to relieve it all a little.
I've seen a chiropractor a few times, x-rays I had show my cervical spine is straight, not concave (I think that's the right word for it) as it should be. And I have minor s-curves in the thoracic. She has given me exercises and a headache diary to start.
One last thing haha - my GP has put me on Nexium for some sharp pains I've been having on my right side, though it hasn't helped. Someone else on here mentioned non-coeliac gluten sensitivity and to try the gluten free diet, I may give that a go.

Apparently since my whole endocrine system is fine now, I need to look into other avenues to get my body back to normal operation!

[goolarra]

I should also clarify that it's very good that you brought up this thread.  It's YOUR thread, so we have all your history to read back on.  It gets confusing only when someone pulls up an old thread of someone else's and adds to it.  Sometimes, it's hard to keep track of who you're talking to!  

[goolarra]

Your FT4 is well up into range.  Midrange (50%) is the target for FT4, and yours is a little on the high side at 79%.  However, considering how high your FT4 is, your FT3 is actually a little on the low side.  67+% is the target for FT3, and you're at 60%.

How are you feeling, and what are your meds currently?

[S_9]

Sorry for bumping up an old thread, just thought it would be easier.

Labs done 24/4/13:
TSH 1.84 (0.5 - 4.0)
FT4 17.1 (10.0 - 19.0)
FT3 5.3 (3.5 - 6.5)

I did get my August ones that were missing, there were two. I forget what they were, can post tomorrow if needed, but as suspected they were in between and almost in range.
I have seen an endo, she said my issues are not related to my thyroid or any other hormones. Suggested I see a gastroenterologist, which I will also have to travel to see. No luck with the MRI, GP or specialist will not send me to get one.

[S_9]

I'm on the waiting list for cancellations at the specialist. I have a form for a panel now, and can get another if I ask, yes. If I still haven't gotten into the specialist towards the end of March, I'll get the panel done then and bump this back up with the results.

[Red_Star]

I was talking to my friend in Holland who told me his lab lists free T4 as 9 - 24 pmol/L.  Mine lab is 10 - 20 pmol/L. Your lab is 10 - 19 pmol/L. So there is a bit of difference but 15.6 pmol/L would not be considered high. When my TSH was 1.5mU/L my free T4 was 16.6 pmol/L.  Your 2.76 labs are the twin of mine so our negative feedback loop is working just fine. :)

Your lab:
TSH 2.76 mU/L
FT4 15.6 pmol/L

My lab:
TSH - 2.8 mU/L
FreeT4 - 15.5 pmol/L

[S_9]

Maybe they weren't heading back to normal fast enough for his liking?

I will have to get a copy of the August labs.
That would probably be around the time I felt...better. I haven't felt proper for a couple of years now!
Since I can't get back to the doc until late April, maybe I should try 5/2.5mg alternating until the next test. Or 5/0.

They have gotten worse, yes. My concentration is low, head/neck aches more frequent, and tired! I think I could have a nap everyday after lunch if I wasn't at work. Had problems with fatigue for a while now, but not this bad.

[goolarra]

Well, I find it interesting that on Jul 11, even though your labs were still quite high, your doctor reduced your meds.  However, it appears to have been a good move as he had to reduce them further in Aug, and by Sep 17, you were hypo.

On Oct 18, he reduced them agian (from alternating 10/15 per day to just 5...quite a reduction).  Since then, things have remained pretty much unchanged on 5 mg.  

Obviously, though those meds changes, your body was producing much different amounts of endogenous hormone.  Between Jul 11 and Sep 17 is when your labs probably looked best...in the transition from hyper to hypo.

Your symptoms now sound mostly hypo, but your levels could be fluctuating quite quickly, giving you a few hyper symptoms/days thrown in.  It almost sounds like you'd be more comfortable off the carbimazole.  Since the reduction to 5, your FT4 has been just a little bit high (barely), but your FT3 is right around midrange.  Many find that FT3 has to be in the upper half to upper third of range before symptoms go away.

Have your symptoms change or gotten much worse since your last labs in Jan?    

[S_9]

What makes them interesting?
I'm to have another panel done late April.

To be honest, I don't remember when I felt best. Probably somewhere in the middle of it all, when the muscle aches and palpitations eased off. I've always had good days and bad days though.

At the mo' I'm still very fatigued, my moods are a little off, brain fog/trouble concentrating. Aching neck, headaches, muscles tire easily. I have trouble getting to sleep/staying asleep. GI troubles. Sometimes I feel a little shaky, though that could be from not eating enough/properly. Sometimes I get palpitations/flutters for a second, but again I'm not sure if that's actually from heartburn/reflux or not.
I have no idea what's causing my problems or if something else is at play. I don't know what to do or who to see. I DO know that I don't need to see a shrink. My spec. won't order an MRI without seeing me late April, he's booked out until then.

[goolarra]

Interesting labs...your FT3 and FT4 look pretty good in the latest two, and TSH is back down.  I don't know though if you're at a point yet where you wouldn't be hyper without the carbimazole.  

What are your current symptoms?  Are you feeling hypo or hyper?  Do you remember at which of those labs you felt best?

[S_9]

The ranges change halfway through.

Thyroid panels:
7/6/12
TSH 0.01 (0.27-4.20 mIU/L)
FT4 35.0 (12.0-22.0 pmol/L)
FT3 10.9 (3.1-6.8 pmol/L)
hTRAb done.

[10mg/day carbimazole. Ultrasound done.]

26/6/12
TSH 0.01
FT4 33.8
FT3 9.7

[20mg/day carbimazole.]

11/7/12
TSH 0.01
FT4 22.3
FT3 6.4

[15mg/day carbimazole.]
[August- changed to 10mg-15mg/day alternating. Missing labs.]
[13/9/12 RAIU done.]

17/9/12
TSH 7.55
FT4 12.2
FT3 4.1

[Diagnosed Graves on RAIU scan.]

18/10/12
TSH 8.64 (0.50-4.00 mIU/L)
FT4 12.6 (10.0-19.0 pmol/L)
FT3 4.3 (3.5-6.5 pmol/L)
TPOAb and TgAb done.

[5mg/day carbimazole.]

22/11/12
TSH 3.31
FT4 15.3
FT3 4.7

24/1/13
TSH 2.76
FT4 15.6
FT3 5.0

That's everything I have.
Every other blood test I've had has been fine. Calcium, cortisol, FBC etc. My symptoms were all over the place from day dot - I had some hyper and some hypo ones pretty much all the time.
The ultrasound said normal size lobes, isthmus slightly thickened. No hot or cold nodules. Intense homogeneous uptake throughout the gland consistent with diagnosis of hyperthyroidism.

Thank you for helping me out.

[goolarra]

Post 'em if you got 'em...any other thyroid tests, that is!  

[S_9]

Holy heck I need a new GP.
This is so confusing. I'm glad I asked.

So my thyroid panel at the moment is good. OK.
And my antibody results and RAIU show that I have Hashi's, not Graves.

I am still on 1 tablet of 5mg carbimazole per day. Next panel is to be done late April before I see the specialist again.

When my RAIU was done, I had an injection instead of a tablet, then the scan was done half an hour after that. That would be why those percentages are so different. I didn't do a 24 hour test.

Thank you both.
Is there anything else/results I can post that will make things clearer?

[Red_Star]

Hey S_9.  Medhelp is a bit touchy with the under or over symbols.  I found that out myself. :)

I've had a pressure/pain at the back of my head and pressure/pain around my hips since 2000. It was only when i started thyroxine last year that i realised both symptoms were due to hypothyroidism.

I gained 9 kg in 6 months when my TSH was 3.7mU/L and my free T4 was 15 pmol/L.  Pretty impressive since i was eating once a day due to a very poor appetite.  2% RAIU uptake is low uptake. Low uptake means either thyroid inflammation, iodine contamination, or excess thyroid hormone. I see no labs or tests to show you have Graves though. I had a two month hyperthyroid flare up (Hashitoxicosis) due to Hashimoto's thyroiditis.

A couple of excerpts...

"Graves disease usually yields RAIU values of 40 to 80% (normal 10 to 30%) at 24 hours. However, high-turn over varieties may manifest only as elevated 4-6 hour RAIU values (normal 4 to 15%), as 24 hour RAIU results may be normal or only mildly elevated." - Neuroradiology On The Net - Graves disease

"People with Hashitoxicosis will have a low RAI uptake result because the thyroid isn't working well and can't absorb much of the RAI. But in people with Graves' disease, the RAI uptake test will be high because the thyroid is absorbing a lot of iodine to produce thyroid hormone." - Hashimoto's Thyroiditis - Diagnosis and Treatment

[goolarra]

This site used to have a problem formatting when we used the less-than and greater-than signs.  I thought the problem had been "cured", but maybe I just got used to writing out the words!  LOL

Okay, so let me re-iterate, just so we're sure I'm understanding correctly:

TRab  less-than 1.0 (0- 2.0)
TPOab 1,300+ (0-60)
TGab 70 (0-60)

As far as these antibodies are concerned (and bear in mind that I don't have any other clinical findings to go on) your elevated TPOab and TGab indicate Hashi's.  At the same time, your TRab is negative, indicating you don't have Graves'.  

Your FT3 and FT4 look good, as I mentioned above, but your TSH (the least reliable indicator of thyroid status) is a little on the high side (indicating you pituitary thinks your levels might be a little low).  

Are you still on carbimazole?

Hashi's, Graves' and RA are all autoimmune diseases.  Once we have one autoimmune, our chances of getting a second increase.  All I can say about yout RA factor test is that it's "in range".  I don't know much about the finer points of interpreting the RA test.  

Hashi's can have an initial hyper phase or swings from hypo to hyper.  
  

[S_9]

Unbelievable. I only used one less than tag in that one.
This would be easier if we could edit posts.

The range on the hTRAb is less than 2.0.
Yes, it is TPOAb, at more than 1300, range less than 60. The TPOAb and TgAb were done on 18/10/12.