Decoding labs, Is it really Graves? feeling hypo and hyper

[JT84]

I'm 27 and have been having problems with anxiety for for about six years. Every doctor tried to blow me off with a prescription for anti anxiety meds and referall for counseling. FINALLY, my new primary care dr did a complete blood count and thyroid testing. Here are the results:

White blood count 3.50 L (4.5-10.8)
TSH 8.45 high (.465-4.68)
T3 Free 3.37 normal (2.77-5.27)
FT4 .97 normal (.78-2.19)
Thyroid PERO AB >1000 Very High (0-34)
THY STIM IMMUNO TSI 139 (0-139)
AST 38 high (14-36)

I need help decoding some of these labs and figuring out what they mean for me. My Dr. said that I have a high TSH which indicates Hypothyroidism and he wants to treat with .25 mg of Synthroid. He said I also have high antiboides which indicate Graves disease. However, in my own research, Graves is hyperthyroidsm, not hypothyroidism right? He said because my FT4 was almost low, he suspects that it probably dips down during the day causing some of my symptoms. I feel like I have most of the symptoms of Hyperthyroidism...anxiety, hot flashes & heat intolerance, nausea but he's treating me as a hypo. I'm also concerned that taking synthroid would aggravate my hyper symptoms. I'm just a bit confused and asked for a referal to an Endocrinologist but he refused!! He said that I have a very clear case that can be managed at the clinic.  Help!

[flyingfool]

I'd recommend too that you see a good THYROID endo.  That may be like finding hens teeth unfortunately.

As stated your FT4 and FT3 levels show you need more Thyroid.  And your Hashi (TPO ab) levels are high which indicates that you almost certainly have Hashi's. Both of these are Hypo related.  At least hashi's is in the later stages.  In the initial stages a person can experience fluctuations between Hypo and Hyper.

Your TSI test is high which would be indicative of Graves.

So you definitely are in a very difficult situation.  As stated some people have BOTH Hasi's and Graves.  And you might be one of those people.  As both are autoimmune conditions I suppose a person susceptible for one autoimmune condition are also susceptible for others.

Hyper is nothing to fool with so you are right I think to be concerned about taking more Thyroid meds.  However the lack of thyroid in your blood is also real.

You may also wish to ask about testing you adrenals.  I understand the 24 hour urine or 24 hour saliva test is better for the cortisol test as those levels fluctuate so much during the day.  However most Dr will want to do a simple one time blood test. If at all possible demand to get the longer 24 hour test.

[Cammie5269]

Insist on that referral!!! GP DO NOT no the Endro system. My Endro saved my life. My GP did the same thing to me. Anti-depression meds and anxiey meds every other month. There is so much to these glands it vital you get the right info. Your doctor can't refuse a referal. Remember your doctor works for you just like your plumber or mechanic. If he does I would get a new doctor. I ended up call and making my own appt with the Endro and they took care of getting the referal.
I have had thyroid issues (cancer) and had my levels all over the place. It is a work in progress.
The internet is a great resource for finding information. Thyroid values are very confusing. High TSH mean your thyroid is underactive. Low means it's overactive. BUT, Graves is an overactive issue.
I wish you the best of luck. I know what you are going through.

[Red_Star]

Hyperthyroidism lowers white blood cells. Both hypothyroidism and hyperthyroidism can raise liver enzymes. I personally would see another doctor and ask for a referral to an endocrinologist.

"The A-Ha Moment:  The Trifecta of Antibodies Confirms Hashitoxicosis

TPO Ab.  TG Ab.  TSI.

Thyroid Peroxidase Antibodies (TPO Ab) will be high.  Mine are off the charts.  A "normal" person will have no antibodies.  Mine are over 1400.  This is the main antibody responsible for Hashimoto's.  The attacks from these antibodies will eventually make you hypothyroid as it kills off your thyroid gland but this can take years.

Thyroglobulin Antibodies (TG Ab) may or may not be high.  TG Ab's are fairly common in Hashimoto's patients as well as Graves patients as well as thyroid cancer patients.  This test is not as important to a diagnosis as the other two but this test is commonly used as a marker to track thyroid cancer.  NO it does not mean you have cancer if you have these.

Thyroid Stimulating Immunoglobulins (TSI) will be high.  This test usually confirms a Graves Disease diagnosis.  If you have high TSI as well as high TPO Ab's, you either have a scorching case of Hashimoto's or Hashitoxicosis.  It is my opinion that TSI runs the show.  When TSI is high, I feel like crap.  When TSI is low, I feel perfectly normal."

- excerpt from Hashitoxicosis by Philip Bernie

[goolarra]

Your doctor is right that your TSH indicates hypo.  What's more important is that your FT3 and FT4 are both low in the ranges, also indicating hypo.

TSI (the definitive test for Graves') is at the very top of the "normal" range.  The top of normal is where most people start having hyper symptoms.  One school of thought is that if you don't have Graves', TSI ought to be zero...period.  Graves' is exclusively hyper.  I'd be worried about aggravating my hyper symptoms with Synthroid, too.

Your TPOab is quite elevated.  Elevated TPOab is a marker for Hashi's (hypo).  It's relatively rare, but it is possible to have both Graves' and Hashi's, even though that seems to be a contradiction in terms.

With both antibodies elevated, I'd get a second opinion...if you do have both, then it's not "a clear case that can be managed" easily.