Thyroid Disorders Community
26.1k Members
Avatar universal

Help understanding these levels..

I am new to this site, just found it. Though I am not new to graves disease. I was diagnosed in Feb. 08 whle in the midst of a thyroid storm. I do not have copies from my labs when I was in the hospital, but I know they were off the charts. Been on ptu, atenolol, and xanax since that time. My latest labs from thursday just came in today. The phys. asst. had called and told me the thyroid is good and to continue doing what I am doing. But, I feel lousy! I actually feel more like hypo than hyper but here are my new levels and I am having a difficult time understanding them...

Free T4... 0.97 (range 0.48-1.23)
TSH .... 0.02 (range 0.44-4.21)
T3.... 35.7 (range 32.0-48.4)
Anti-thyrglb ab .... <0.9 Then it says reference range < 4.0 (I have no idea what this level is or how to read it)

Sodium is low at 133.... (135-146)
CO2 is low at 21 (23-33)
Anion Gap high at 12.0 (3.0-11.0)

Glucose is high at 130 (65-1000 though this is range for fasting glucose and I was not fasting, that is what the asst. said not to worry about it cause it wasn't a fasting test)

WBC is high at 15.0 (4.5-11.0)

All the other ranges are good and in range. Liver, kidneys etc. I can list them all if you would like..

Below is test results from 6 mths ago. ( I can't fine the ones from 3 mths ago but they were about the same as these from 6 mths ago)

T3... 44.1 (32.0-48.4)
T4free .. 2.13 (0.48-1.23)
TSH ... 0.04 (0.44-4.21)

Sodium was low then too.. 134 (135-146)

I can't understand why my tsh went down more. t3 and t4 came into range and that is the first time in 2 years! I do have more results from other dates, but figured I would give you the most recent I have. If you need further info please let me know..
Just wondering if these sound right, where am I??? Am I going hypo or still very hyper?? Why do I feel lousy??
Anyone know about the sodium or thise anion gap level?

I am now on ptu 50 mg day, atenolol 25 mg. up to 3 times a day, and xanax .5 as needed. I only take the xanax during stressful times or to help me sleep. Don't need any other problem on top of this graves disease battle.

I sure am glad I found this group. Wish I had found it 2 years ago. I really hope someone out there can help.. Thanks for your replies.

7 Responses
Avatar universal
Going by your FT3 and FT4 you are hyper.
Its a well known fact that Graves sufferers TSH doesnt come up much while you STILL have a thyroid.
I dont think mine ever came up past 0.05 until I had RAI and TT nearly 2 years ago.

With the levels you have at present, the PTU should be decreased a fraction but as I am sure you are aware that Graves is very hard to manage and basically a catch 22 situation with the anti thyroid meds.
If you decrease too much, you go HYPER.
If you increase too much, you go HYPO
And most Docs like their patients with Graves to err on the side of caution and would rather have you HYPO than HYPER...basically to avoid thyroid storm and atrial fibbrillation.

Your WBC (white blood cell count) is high which usually means some form of infection...maybe sinus or glands??

The Anion Gap is a blood test for acid imbalances and sometimes can pick up if you have diabetes.

CO2 is carbon dioxide in the blood (bicarbonate) which is your electrolyte level and which measures whether you have too much or too little fluid in the body.Yours is borderline so you could do with more fluids.
Sodium is tested as low levels are found in thyroid disorders and it is also an electrolyte needed by the body.With the CO2 low and the sodium low, it seems you may be dehydrated and could do with more fluids.

Anti-thyrglb ab is antithyroglobulin antibodies found in the following disorders:

    * Graves disease
    * Hashimoto's thyroiditis
    * Hypothyroidism
    * Myxedema
    * Systemic lupus erythematosus (SLE)
    * Thyroid cancer
    * Thyrotoxicosis
    * Type 1 diabetes
Yours shows that you have antibodies but they look good (maybe in remission).

In regards to everything......I would say that you ARE HYPO and need a slight decrease in the PTU.
The good thing is the PTU is not affecting your Liver which is usually the first organ it upsets (enzymes) and that your antibodies are very low at present.

I hope that clears things up a bit for you.
Obviously I am no Doctor but hope this helps.

Sodium is vital
Avatar universal
Thank you! Wow, even 2 years in and I still have so much to learn. Well, doctor isn't about to change the dose she said continue on the same dose. I may decrease a bit on my own. Is it something that we have to decrease very slowly?

I do have a sinus infection currently, allergies aren't draining properly and can't take allergy meds.

Okay, so I have antibodies, but may be in remission?? Graves could be in remission?? If that were true wouldn't the meds send me hypo?  I feel somewhat hypo and that is what sent me for these labs, wasn't due for another couple weeks. Like you said, doctor is happy with the levels because I am sure she would like me on the hypo side. Yet, I still sometimes feel a bit hyper too.

You're right, thank God my liver has not been affected! Have been on this low dose (50mg) ptu for quite a while. Didn't need a high dose for very long.
Found out this visit, the nodules disappeared and the thyroid is now still enlarged but now smooth. I am sure these allergies are causing some of the way I have been feeling.

I have really tried to keep this thyroid, yet I am starting to get to the place where I wonder if it will ever balance properly..

At this point, she is talking about only testing every 3-4 months, is that enough? I know I can push her a little bit to test a little sooner. Just don't want to push too much because so far this is the best doctor I have found in the area. First one who actually will listen to me and cares about my symptoms.
Avatar universal
Your antibodies are low and that is a sign that you may be heading for remission but you know as well as I do that with Graves...you can feel hypo one minute and hyper the next.....
Graves is very hard to control and I must say congratulations at working so hard and getting this far without thowing the towel in...so to speak!
Every 3-4 months is not enough.
You should be tested every 3-4 weeks when on PTU but she may feel the same...that you are balamncing the levels well and not feel the need for labs.
Personally myself, I would be going for labs every 6 weeks and even sooner if symptoms change.
I still say you are HYPO by the FT3 and FT4,
The hyper symptoms would be from the TSH still being low.

I cant tell you the dosage of PTU to cut down too as I am no Doctor and dont know your body well enough to know how slow or how fast you reatc to decreases,,,,,only you and your Endo would know this.

But maybe you could say to her.....".I know you have said to stay on the same dose but I do feel hypo so do you think I could reduce a fraction with the PTU and if my symptoms change, I will go back to the level I was on before decreasing? :
Just a suggestion............

Rather than charging in like a bull, you are asking for her advice but also letting her know that you feel hypo and will go back to the normal dosing should you feel hyper at any stage.

Its great that you have confidence in this Endo and she seems to be doing ok by keeping you away from RAI or TT.

Some people do go into remission but also come out of remission too so maybe that is what she is afraid of.
Its worth trying....nothing to lose.
Avatar universal
My apologies.....it was late at night when I did my first posting and it shouldve read

.....Going by your FT3 and FT4 you are hyper.

It is your TSH causing the hyper symptoms.
Avatar universal
So, you still feel I am hyper, or hypo? I thought the FT4 was showing more on the hypo side and thought about cutting back a bit on the ptu.. The t3 isn't free, it just says t3.

With the labs, the reason she suggested not testing as often is because the labs weren't looking much different from one to another. I guess my insurance was giving a hard time having them every month. Talked to her office today and decided to go in 6-8 weeks, this way I can go at 6 weeks on my own.
She is going to call back later today and let me know if she feels I can cut the dose at all.

I know, I have heard that many people go into remission and come out of remission even faster. My sister had TT and RAI for thyroid cancer, now my other sister was just diagnosed with mild Graves. Believe me, many times I have felt like throwing in the towel and doing RAI. It still may come to that, but since I seem to be responding right now to the drugs, will play it day by day.

Are you ever sorry you did the TT and RAI?
Avatar universal
Gees I will get it RIGHT this time...HYPO.
Levels show HYPO.
Avatar universal
I have never looked back or regretted the day I had RAI.
The only regret I had was...not doing it SOONER.

Graves is he// to live with if it is uncontrollable and can be so debilitating to your life in the form of day to day living.
IMy hyperthyroidism was uncontrollable......If I increased MMI , I would still go hyper and would be on a see saw of hyper to hypo every 2 weeks.
It was mentally draining and to be honest, I wasnt living...I just existed.

My Graves was traced back to 1985 but I went underdiagnosed until 2007.
Two days before RAI...thyroid cancer was detected so I had the RAI (surgery was too risky at the time) and then 3 months later I had TT keyhole surgery done (from under the armpit).

In getting my levels balanced, I have gone med induced hyper a few times but the symptoms were no way as bad as hyper with a thyroid.
Neither were the hypo symptoms.

Give me Graves ANYDAY without a thyroid.

I still have times when my levels go slightly 'off' but it doesnt take long to get back on track.

It is true what you say about remission.
I honestly believe that the enevitable happems eventually and that the thyroid has to be ablated or removed with Graves.....it basically depends on the severity of the hyperthyroidism.
Look at a pic of me in a pink top in my pictures and then a pic in January 2010 and you will see a BIG difference.
In the meantime...learn all you can about Graves, Hyperthyroidism and the "other side of the fence " Hypo.
This is all so that when the time does/may come that you need ablation or TT...you will know just what to do and the more knowledge you have and the more you are able to recognise your symptoms...the easier it will be.

I was petrified of RAI......I even wrote a death note to my kids in case I didnt "make it".
Sounds stupid but its true.
RAI was like being a leper to most and its amazing how in the last 2 years, people are more acceptable of RAI now.

I dont ever regret it at all.

Am I the same as before RAI?
The answer to that is ...No.
I have back 99% of the old me but I also am a lot stronger now in being able to deal with it all.
Thyroid issues dont scare me anymore...I just deal with them as the needs arise.

It made me a stronger person when I felt all hope was lost.
Have an Answer?
Top Thyroid Answerers
649848 tn?1534633700
Avatar universal
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.