Could this be Hashimotos? Strange bloodwork result...

[mhomerjr]

I had thyroid nodules discovered incidentally in a CT about 1.5 years ago, and I have since been on Syntroid (5mcg) and Cytomel (10mcg) for a year to treat hypothyroid and to shrink the nodules down. My nodules are thought to be benign and are at the largest at ~1 cm in on dimension of the largest two that were found.
---------------------------------------------------------------------------------------------------------------
My recent bloodwork:

T4   7.3 ug/DL
Free T4    1.13ng/DL
TSH      1.3 UIU/mL
Vit B12  730 pg/ML
Vit D     36   ng/mL

Anti-Nuclear Antibody  negative

Free T3   3.6 pg/mL
Reverse T3  15.0 ng/dL

Thyroid Perox AB    1IU/mL
Thyroglob AB          <1 IU/mL

***Thyroid Stim IMM   209%  Positive***  OUT OF RANGE
---------------------------------------------------------------------------------------------------
All the bloodwork was within normal range except the THYRETAIN test testing for the thyroid stimulating immunoglobin - which this was high (normal range <140%). My doctor missed discussing this with me, and I called and am currently waiting on an answer. I was wondering if anyone has experienced this? Could this be a sign of Hashis? Or could it be that my medication is too high?

My doctor seems to think that I do not have Hashis, but just hypo thyroid... I was seeing that the Thyretain test is one used for Graves disease...

[mhomerjr]

Thank you very much to both you and Red_Star. I was unaware. I was diagnosed with non-toxic multinodular goiter a year ago and was put on the 50mcg of Synthroid a year ago today. I have solid nodules in both thyroid lobes. However, the imaging clinic has had two different doctors perform ultrasounds on my neck/thyroid and the reports from both conflict determining if the nodules are cystic and solid or just solid. Regardless, I do have small solid nodules in both. In the  the last few months that i have been on Cytomel, the inflammation that I have had in my thyroid has gone down, but I still get the choking feeling around my thyroid, and these cervical nodes have since become swollen. I am just concerned for lymphoma/cancer or a serious autoimmune disorder.I have seen numerous doctors and none seem to be concerned. My family doc has even referred me t a GI doctor to do an upper endoscopy to make sure I had nothing going on in my throat and stomach and that was clear.  I have also had other side effects:

-bad mood swings
-mild hair loss
-infrequent palpitations
-dry skin
-decreased libido
- depression and anxiety

Should I be concerned about the high TSI value and seek a second opinion? Again, my doctor is an ENT who specializes in treating thyroid disorders here in Texas.  I just started Armour Thyroid yesterday, and I thought about giving that some time.

Aside, I hope you both had a wonderful Christmas and thank you for taking time out of your holiday to talk to me. God Bless you!

[Red_Star]

The info about the sensitivity of ANA results is from The Rheumatologist article - Know Your Labs.

Excerpt from the Mayo Clinic - Thyroid-Stimulating Immunoglobulin (TSI), Serum...

"Positive results are strongly indicative of Graves disease, but do not always correlate with the presence and severity of hyperthyroidism.

Patients with Hashimoto's disease may have an elevated thyroid-stimulating immunoglobulins (TSI) index, which can be >1.8. A TSI index of >1.3 and < or =1.8 also is occasionally observed in various other thyroid disorders, including nodular goiter, and subacute thyroiditis."

[Barb135]

ANA is used, mostly, to diagnose Lupus and/or Rheumatoid Arthritis.  My ANA was also negative.  Elevated TPOab, goiter and inflammation were the basis for my Hashimoto's diagnosis.

"Although these tests are not harmful in themselves, their biggest danger is their huge room for error. An incorrect diagnosis can set you off on a treatment you don’t need, often requiring drugs with debilitating side-effects of their own."
http://www.healthy.net/Health/Article/Antinuclear_antibody_tests/3651

[mhomerjr]

My doctor seems to think that I have neither Hashimotos or Graves... My lymph nodes that are swollen are two level 5 cervical nodes and they have been just over 1cm for about 6 months. I was unaware of the really high inaccuracy of ANA testing with regard to Hashis and Graves... This is alarming. Can you tell me your source or a source to refer to?

[Red_Star]

Graves antibodies caused my two month hashitoxicosis flare up, thyroid eye disease, and pretibal myxedema. My lymph nodes were also swollen when I was in hashitoxicosis.  At the time my labs showed hypothyroidism while being very hyperthyroid but my thyroglobulin serum was high due to hyperthyroidism.  My ANA is listed as negative.  The sensitivity of ANA with thyroid disease 46% for Hashimoto's thyroiditis and 50% for Graves' disease.

[mhomerjr]

Barb,

I am really sorry... My Synthroid dosage is 50mcg and I am taking 5mcg of Cytomel 2x daily. I am a bit scatter-brained at the moment... With regard to my new prescription of Amour Thyroid, it is 30mg (1/2 grain). The doctor stated he may increase that after a month...

As far as the lymph nodes, the doctor is consulting with an oncologist to make sure that either a fine needle or excisional biospy aren't needed. I have been tested for Lyme with the Western blot, Brucellosis, Rickettsia, and Rocky Mountain Spotted Fever, and all were negative. I have also been tested for some autoimmune disorders but so far all negative. I am just praying that there is not something more serious going on and that I just have bigger nodes...

With regard to the Vit D, I purchased a 2,000 NTU sublingual supplement today and i plan to take 10000 NTUs a day according to my doctor's recommendations. I am also going to boost the B12.

I appreciate your input on my labs and helping me understand them, and i am really sorry for the typos on my Synthroid dosage!

-Mike

[Barb135]

Here's what stands out, in your blood work.

Free T4    1.13    Range: 0.73 - 1.95
Free T3   3.6       Range: 2.3 - 4.2
Vit D     36   ng/mL  Range: 100 Toxicity Possible

I'm still confused about your Synthroid dosage... the lowest dose of Synthroid is 25 mcg; how are you getting 10?

Your thyroid labs really aren't really all that bad.  

Rule of thumb for FT4 is about mid range.  Yours is at 33% of the range, so could stand to come up a bit.  Rule of thumb for FT3 is upper half to upper third of its range and your FT3 is at 68%.  

When you say "30 units" of Armour, do you mean 30 mg?  That's 1/2 a grain.  Each grain of Armour has 38 mcg T4 and 9 mcg T3.  That means that 1/2 grain will have 19 mcg T4 and 4.5 mcg T3.

While it's true that thyroid nodules are "more" common in women, they aren't at all "uncommon" in men.  I can't think of any of the guys on this forum who don't/didn't have nodules.  Less than 5% of all thyroid nodules are cancer and thyroid cancer is one of the easiest to cure, by removing the thyroid.  Since  you have the swelling/inflammation indicative of Hashimoto's and the antibodies that diagnose Graves, I can't help wonder if you have both.  Early stages of Hashimoto's can be characterized by periods of hyper, switching to hypo and back to normal and Graves doesn't always lead to full blown hyperthyroidism.

It is, somewhat unusual for lymph nodes to be affected and though that could be caused by something else, I would suggest that possibly they might need further investigation.

Last, but not least, your vitamin D level is way too low.  Recommendation is for vitamin D to be at least 50-70.  Low vitamin D levels can cause many thyroid like symptoms.

Have you ever been tested for Lyme Disease?  It, too, can present a lot of thyroid-like symptoms.  You might want to check with your endo on that, but be aware that diagnosing Lyme Disease requires a specially trained doctor.

Merry Christmas

[mhomerjr]

Barb,

My Synthroid is 10mcg. Sorry for the typo. The reference ranges you ask are below:

Free T3   Range: 2.3 - 4.2
Free T4   Range: 0.73 - 1.95
T4   7.3 ug/DL  Range: 4.4 - 12.4
TSH      1.3 UIU/mL  Range: 0.5 - 4.7
Vit B12  730 pg/ML   Range: 250 - 1100
Vit D     36   ng/mL  Range: 100 Toxicity Possible
Anti-Nuclear Antibody  negative
Reverse T3  15.0 ng/dL    Range: 9.0 - 27
Thyroid Perox AB    1IU/mL  Range: <9
Thyroglob AB          <1 IU/mL  Range: <4
***Thyroid Stim IMM   209%  Positive***  Range:<140

My doctor's assistant called me this evening, and he appears to not be concerned of the Thyroid Stimulating Immunoglobin test. He expected the number to be elevated, and is not concerned for Hashis or Graves because the Anti-nuclear Antibodies test came back negative.

I have had some strange things happen over the last 1.5 years. I had some lymph nodes become swollen and I had recurring fevers, rashes, and weight fluctuations. I have also always struggled with depression. When i got really sick, I went to the ER and they did a CT of my neck to examine the lymph nodes and that is when the nodules were discovered in my thyroid. My thyroid was also really enlarged. The hospital ran a whole suite of different blood work to test for anti-immune and zoonotic diseases, but nothing came back conclusive except for some hypothyroid hormone levels. I started Synthroid last December, and in March i began experiencing a really tight throat, almost choking like feeling around my thyroid. I have it constantly, and it is really uncomfortable. Further, I have had 2 additional lymph nodes get swollen, but they are only around 1.3cm at the greatest dimension. I have asked my endocrinologist about whether or not the Synthroid can cause these symptoms, but he does not seem to think so.

I have seen 3 ENTs, 1 GI, and 1 Neurologist, and no one has seem concerned until today. My new endocrinologist switched me on Armour Thyroid 30 units effective tomorrow, and he is consulting with an oncologist about the lymph nodes to see if he needs to do further testing.

This has been pretty scary. I am 30 years old, I have a wife, and a 3 year old daughter. Especially, being a man, thyroid nodules are not as common.

Any advice you can give is appreciated.

Happy Holidays!

-Mike

[Barb135]

Thyroid Stimulating Immunoglobulin is the definitive test for Graves Disease, which is associated with hyperthyroidism.

Please verify your Synthroid dose.  Synthroid doesn't come in a 5 mcg tablet; are you splitting the pills?

What are the reference ranges for the Free T3 and Free T4?  Ranges vary lab to lab and have to come from your own report.

At this point, the only thing in your labs that stands out is that your vitamin D level is way too low.  

Do you have lab results from before you were diagnosed hypo and prescribed Synthroid?  If so, could you please post them.

Thyroid nodules are very common with both Hashimoto's and Graves Disease.

What, if any, symptoms do you have?