Can anyone make sense of this?

[4leesclover]

I recently had blood work and an ultrasound of my thyroid.  The results are baffling to me when I search for information on the internet.  Maybe someone can help as I am going crazy waiting for my appointment with an Endocrinologist.  Here goes:
TSH was low .30
The only other out of range - Thryroglobulin Antibody was High, 1.0

I have several solid, hypoechoic nodules with the biggest 1.3x.7x.9 cm.  I should also note that I have Rheumatoid Arthritis and am 52 years old.  My concern was leaning towards Grave's but the TSI is not elevated, only the low TSH and high Thyroglobulin.

Any thoughts? Thanks in advance.

[Barb135]

There are a couple of things I see, but the most important is that there's nothing in the rest of your labs to indicate hyperthyroidism...

Your Free T4 and Free T3, actually, indicate hypothyroidism.  Your Free T4 is only at 22% of range and most of us feel best when Free T4 is about mid range.  Your Free T3 is at 46% of range and most of us feel best with Free T3 in the upper half to upper third of its range.  

Even though you may have Hashimoto's, it also appears that you may have Secondary or Central hypothyroidism, as your main problem.  Secondary hypothyroidism is when the pituitary gland doesn't produce enough TSH to stimulate the thyroid to produce enough thyroid hormones.  This would be a pituitary problem, at this point, not a thyroid problem; though with Hashimoto's, it would eventually become a thyroid problem.

What, if any, symptoms do you have?

[4leesclover]

Hot flashes, sweating, waking up like every hour so I am tired all the time, and weirdest is frequent leg cramps. Having rheumatoid arthritis I usually chalk every twinge of anything to RA and being 52 and on hormones I had believed maybe I needed to up the dosage.  I guess we will see what the Endo has to say but am worried about all the solid hypoevjoicd                        

[Barb135]

I had a lot of those symptoms when I was hypo, too, even after I was started on replacement medication... There are other things that could be causing them for you, as I now believe there were  other things causing them for me...

One of the big possibilities is cortisol or adrenaline.  I'm relatively sure that's what caused my hot flashes, night sweats and waking up/not being able to go back to sleep.  You can do a 24 hr saliva cortisol test to find this out... Cortisol should be highest in the morning, when we're preparing for the day, then it should decline as the day goes on, preparing us to sleep at night.   For some of us, it stays high all the time.  

I've recently learned that fluctuating blood glucose levels can also cause sweating/waking up during the night.

Vitamin B-12 deficiency can cause horrible fatigue and believe it or not, the fatigue, itself, can cause us to not be able to sleep.  

Low potassium or magnesium levels are primary causes for frequent leg/foot cramps.  Dehydration is also a major cause. Make sure you drink plenty of water throughout the day and talk to your doctor about testing your potassium and magnesium levels.  I take magnesium supplement all the time to make sure my levels are high enough.  It really helps keep the cramps under control.  Potassium should be taken under a doctor's supervision, because if levels get too high, it can cause other problems.

Nodules are common with Hashimoto's and < 5% of all nodules are cancer.

[Barb135]

Thyroglobulin Antibodies (TgAb) is a marker for Hashimoto's, as is Thyroid Peroxidase Antibodies (TPOab).  

Since your TSI wasn't elevated, it sounds like you could be having a hyper phase of Hashimoto's - if you're hyper, that is.  Is TSH the only thing that was tested to determine thyroid function?  What about Free T4 and Free T3?  If they were tested, please post the results, with corresponding reference ranges.  Just because they were "in range" doesn't mean they were adequate.

Nodules are very common with Hashimoto's and are usually nothing to be concerned about, but your endo may suggest an FNA just to sure, since your largest is greater than 1 cm and solid.

[4leesclover]

Thanks for ya'll's input.  The rest of my labs are as follows:

T4-Free 1.03 (range .082-1.77)
Reverse T3 Serum .574 (range .45-4.5)
TSI 55 (Range 0-139%)
Thyroglobulin Antibody 1.0 (.0-.9)
Thryroxine Binding Globulin 31 (13.39
TPO ab 9 (0-34)
T3 Free 3.1 (2.0-4.4

TSH w/Reflex to Ft4 .32 (.40-4.50)

[Red_Star]

Excerpt from the book "Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?" by Dr Kharrazian...

"Hashimoto's Disease and "Normal" Lab Results

Jan - TSH 4.5
Feb - TSH 0.08
Mar - TSH 2.3
April - TSH 3.8
May - TSH 8.7
June - TSH 7.4
July - TSH 1.6

One reason hypothyroidism goes misdiagnosed is because a person with Hashimoto's can present with normal TSH. This graph illustrates the monthy TSH levels of a person with Hashimoto's who is receiving no treatment. As the autoimmune condition fluctuates, TSH levels vary wildly. Using standard lab range of 0.45 - 4.5 this person would fail to be diagnosed. During the month of March the patient's TSH even falls within functional range 1.8 - 3.0. That's why also testing for immune antibodies and evaluating symptoms and history are so vital."