Labs

[yankeeRN]

I have Grave's diagnosed about 10 months ago.  I am on PTU and it has been decreased gradually --I am on 50 mg daily since about March.  My last two total t4 levels were 9.3 and 9.8   (normal range 5.3-12.3)  they were done about 5 weeks apart.  My doctor has not ordered any further labs--How long should I wait before I should have my labs rechecked?   I feel good:)  Should these labs be done at certain intervals?  Also with the PTU should I be having my liver enzymes checked?  I don't think my md has ever checked them.  Another question--my Grave's was diagnosed by Nuclear scan--is this a sure way to diagnose Grave's?  I had asked for my MD if he was ever going to do an antibody test and he finally did and I was told by his nurse that it came back negative.  Does this mean that I don't have Grave's or what?  I have so many questions and I hate to make an appointment to see him. I am hoping someone can shed some light on this.  Thanks :)

[goolarra]

Nodules can leak hormones (as opposed to secreting them).  It's also possible that your antibodies just fluctuate.  The TRab antibodies attach to the TSH receptors in the thyroid and act like TSH, stimulating hormone production.  Antibodues go up, and more hormone is produced.  Unfortunately, antibodies can fluctuate pretty wildly.  

Best of luck...keep speaking up!  

[yankeeRN]

Yes I agree that I will need the FT3 checked.  I have good insurance too thank God.
That was my thought also about the possiblility of the labs not being parallel at some point---I kinda felt like someone was saving money at my expense.  I also have thyroid nodules--is it possible that a nodule might kick out a little burst of thyroxine and that is what causes my rare but occasional palpitations or hand tremors?
It IS scarey to think what other people who don't advocate for themselves do...  One of my sisters ,her doctor gives her a pill for this or that and she blindly takes them all----one pill and 5 other pills to treat the side effects from the one pill.   I an a nurse so I do see it all--I don't have all the answers but I do speak up when I don't agree with something.  
Thanks for your help goolarra.

[goolarra]

FT3 is the test that correlates best with symptoms.  It's cheap...mine costs me $10 after my insurance "discount".  Why NOT test it directly?  Saying it's been parallel and assuming it will stay that way is a little like saying "I haven't died so far, so I guess I can quit worrying about that."  LOL  

I think we're all pretty familiar with the "pulling teeth" syndrome.  I don't know what people who are incapable of being their own advocates do...

I don't know the long term effects of PTU (I'm hypo).  Our members' who have Graves' always seem to consider meds a temporary solution, and almost all eventually seek a "permanent" solution.  LFTs would certainly set your mind at ease to some extent.  It's hard to evaluate symptoms, and it's easy to become a hypochondriac (or assume everything is thyroid related).   You seem to be taking a good approach...don't ignore what your body tells you, but make sure a symptom is really a symptom before you pick up the phone.  

Good luck.  

[yankeeRN]

Thanks  for your response.  My Endo said that my t3 and t4 had been parallel so that he only needed to monitor the total t4--Does this sound like it makes sense or is this balonie?  My thoughts were that I would like to know what my FT3 and FT4 because I am wondering if these are what cause me to have occ palpitations, infrequent but occasional
hand shakiness, and occasional anxiety.  
Well I felt the same about the possible trend and I think I will ask my doctor about checking things out again and the other labs.    I am not sure which antibody he checked --I only spoke with the nurse and I guess I assumed he did the one for Grave's since that is what I was told by him that I have.  I will check if they did the TSI.  
I am not sure why they didn't check my liver enzymes out--as far as the signs and symptoms of liver failure I do know what to watch for but these could be late signs---I feel like my endo and my doctor were not as on top of things as they should have been--it has been like pulling teeth.
If I have to stay on the PTU 50 mg long term what are my risks of liver issues or agranulocytosis?  This is the only pill I take except for an occasional multivitamin. I know with the agranulocytosis one sign is sore throat--I had had a rare mild sore throat but did not want to  push the panic button and fortunately the sore throat went away both times after 2 days--I don't want to ignore anything but I also don't want to become a hypochondriac.  
Once again thanks for the info--I will check with my md on this stuff once he is back from vacation.

[goolarra]

Thyroid levels should be monitored regularly and should include FT3, FT4 and TSH.  Stable levels over several labs usually indicate that labs can be spread out a little,  Yours look good (although they are total and not free T4), but, in my opinion, I'd want to know if that change from 9.3 to 9.8 was a trend or just a fluctuation.  Of course, your symptoms can be your guide to some extent.  Whenever meds are changed, follow-up blood work should be done to evaluate the meds change.

"Closely monitor PTU therapy for signs and symptoms of liver injury, especially during the first 6 months after initiation of therapy."

There's more if you want to read it:

http://emedicine.medscape.com/article/767130-treatment

Do you know which antibody test the doctor ran?  TPOab, TGab and/or TSI?

TSI is considered the definitive test for Graves'.  In addition to diagnosis, changes in TSI levels can predict remission.