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Old 10-15-2008, 09:21 PM   #1
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TraumaJunkieVA HB User
New labs... new doctor

Hi Everyone!

I had posted a little while back when I first got an appt to see my family doc about my enlarged thyroid. He ordered a couple of labs and a thyroid ultrasound.

My labs at that time were: (labs done 9/12)
TSH 2.01 (0.35-6.20)
T4, total 8.92 (4.5-12.0)
Free T4 0.93 (0.73-1.85)

Labs I had done the other day so that I would have new ones for the endo they are sending me to: (labs done 10/14... at almost the exact same time of day as first readings.. same ranges)

TSH 2.55
T4, total 8.30
Free T4 - 0.76

In addition I had a couple other tests run (I had one of the dr's I work with order some outpatient labs for me)
T3, free 309 (230-420)
T3, uptake 29 (22-35)
Thyroid Peroxidase Antibodies <10 (range <35)
Thyroid peroxidase antibodies
Anti-TPO antibodies

Ultrasound:
Conclusion - Enlarged Thyroid

the right lobe of the thyroid measures 9.2x5.0x5.5cm. the left lobe of the thyroid measures 9.0x6.7x6.2cm. The istmus measures 2.4cm thick. The thyroid is diffusely inhomogeneous without descrete masses or cysts identified. The finding are compatible with goiter.

The thyroid results were reassuring to me since my mother had a thyroidectomy following a diagnosis of thyroid cancer in multiple nodules on both lobes. She never developed irregularities in her lab values nor a goiter.

If anyone could help me shed some light on my labs and all the information I have in front of me I would greatly appreciate it. I have an appt with the endo soon... I have heard horror stories about them from other people. I would have much rather just been able to deal with my PCP but he does not feel anything is wrong. I had to insist on a referral to someone else.

Thanks!

 
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Old 10-16-2008, 06:52 AM   #2
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Re: New labs... new doctor

TraumaJunkieVA,

Welcome to our dysfunctional thyroid family! Let's see what your thyroid is telling us.

My labs at that time were: (labs done 9/12)
TSH 2.01 (0.35-6.20) This is climbing toward hypothyroidism. My Hashimoto's had me in the tank level wise with a TSH of 2.077

T4, total 8.92 (4.5-12.0) This is often inflated in females and has a 20% source of error. you have to take this test with a grain of salt.. heck a shaker of salt. This value has you 58% of the normal range. You are actually MUCH lower.

Free T4 0.93 (0.73-1.85) This is the latest version and a direct measure of your actual thyroid hormone. There is a 2.5-5% source of error inherent in this test. Your Free T tests are the ones you want.. the other are 20-40 years out of date. Here your level shows you to be 17.85% of normal. There is a 40% DIFFERENCE! Are you on birth control pills? Hormonal replacement therapy? Estrogen mimic diet can cause inflated T4 results as well. You definitely need to only consider your FT4 and FT3 results. WOW!

Labs I had done the other day so that I would have new ones for the endo they are sending me to: (labs done 10/14... at almost the exact same time of day as first readings.. same ranges)

TSH 2.55
Free T4 - 0.76 You are now at 2% of the normal range. You are definitely way too low not to be considered subclinical hypothyroid. I was barely able to stay awake and move when I hit 5% in my Ft4 range. Ugh! Wow! I am sorry.

T3, uptake 29 (22-35)
T3, free 309 (230-420) You are at 41% of normal range here. Okay. This shows that you are suffering from suboptimal thyroid hormone levels and your levels are out of balance. Because your conversion/uptake of T4 is normal (T3 Uptake) and your Ft3 level is almost 40% higher than your Ft4 level you need to have your adrenal function evaluated. Most often this type of imbalance is the result of hypoadrenalism.. in particular your body not producing enough hydrocortisol. If you get supplementation and do not address any adrenal dysfunction thyroid medication regulation is going to drive you hyperT in T3 while you languish hypoT in T4.

The basic adrenal profile you need:
8 am fasting ACTH, Cortisol, DHEA test
Saliva/urine 24 hour cortisol test
ACTH stim Test

If there is an adrenal issue these tests will show it.

Thyroid Peroxidase Antibodies <10 (range <35)
Thyroid peroxidase antibodies
Anti-TPO antibodies

You need TGAb antibodies run as well. Maybe even TSI.

Ultrasound:
Conclusion - Enlarged Thyroid

This is the result of your underactive thyroid having to grow in an attempt to compensate for low thyroid output. Even growing it is not keeping up with your needs.

You might want to look over two research threads I have posted on thyroid care and concerns. The information may help you prepare for your appointment. I think you do have an issue, maybe more than one. I also think that you will need thyroid supplementation. I think it is highly probably you have an adrenal issue as well. Your lab levels are almost identical to mine before I was treated for hypoadrenalism.

[url]http://www.healthboards.com/boards/showthread.php?t=597479[/url]
[url]http://www.healthboards.com/boards/showthread.php?t=599141[/url]

Good luck finding that rare thyroid savvy MD that will work to fix you!
MG
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If we learn by our mistakes, I am working on one hell of an education.

 
Old 10-17-2008, 03:04 AM   #3
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TraumaJunkieVA HB User
Re: New labs... new doctor

I got in to see the endo yesterday... he didnt have the best of news for me...

basically said he has not seen a tyroid like mine in at least 10 years if ever... it is rock hard, does not move, and HUGE... and that it has to come out. He said that not only that put he would question the person reading the ultrasound because he whole thyroid is encapsulated and he can see at least one large nodule within one of the lobes. Basically my thyroid stetches the whole length of the front of my neck. If you come straight down from my earlobe on the one side it starts there and comes to about a 1- 11/2 fingers in front of the other ear. and height wise it comes all the way up to my lower jaw. He personally called the surgeon to get me in next week and wants it out asap... and has sent my case to a "tumor board" at the med school because he said that this is anything but a normal thyroid. He is also very concerned with the fact that it has grown to this size in such a short period of time.

I went from thinking I had a goiter... was just going to get a script... fill it and within a couple of months start feeling better to having cancer in about 5 minutes. He was great with showing me exactly what he sees on the ultrasound and reviewing a lot of information with me... answering questions, etc. He said that he would let the surgeon decide if a biopsy was even going to be worth it because with the just general size determining where you biopsy and where you dont would be difficult.... but his biggest concern is the fact that it is rock hard... like has in the firmness of a tendon and not like any other soft tissue type mass.

I will see the surgeon next week and go from there. Hopefully all of this will go smoothly. The tumor board has an onco on it as well so if it is cancer I will be treated as soon as I am medically cleared... and that the course of treatment will be determined by him but judging by size he can not see how there would not be at least one lymph node involved.

It is disheartening and concerning when the doctor gets enough of an urgency that he takes out his cell and calls the surgeon himself telling him that he has a pt that HAS to be seen ASAP.... and is completely amazed that I can breathe, swallow, and move my neck. He even asked if I would take some digital pictures to send to him so he can have them for reference.

 
Old 10-17-2008, 05:48 AM   #4
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Re: New labs... new doctor

TJVA,

If you have thyroid cancer. Thyroid cancer is one of the easiest treatable cancers. It has a 98&#37; survival rate. If you have thyroid cancer it just means they cut out that pain in your neck and chase it down with an RAI.

My mom had half of hers go bad. They just removed half of her thyroid and sent her on her way. My Aunt had papillary which they didn't suspect. They gave her 2 RAIs for Graves then she requested its removal because it was still fighting back. After the TT they found she had cancerous nodules in her thyroid. She had a token RAI after that and has been clear ever since. Both my mom and her sister have been living over 10 years with no additional thyroid cancer scares.

I dug into the RAI versus TT issue a while back. Many people with Graves and Hashimoto's debate this fact. I want mine out because it is a pain with or with out cancer. Having Graves and Hashimoto's will do that to you. I think your Endo is making a good call given the size of your thyroid alone. It does seem that the US tech should have been more observent about the anomolies in your thyroid. Sounds to me like they were just taking the picture and letting another worry about analysis.

Also note that Hashimoto's has been known to cause a nodule riddled groiter that atrophes in its death throws. Hashimoto's can be present even if you do not test positive for antibodies. This may be your case. Here is the url to my thyroid care and concerns post on TT versus RAI. It has statistics and figures and pros and cons of the various procedures. I hope that the surgeon your Endo called was a specialized ENT that has a HIGH confidence level with thyroid issues. I will also be thinking of you and hoping for the best.

[url]http://www.healthboards.com/boards/showthread.php?t=610550[/url]

MG
__________________
If we learn by our mistakes, I am working on one hell of an education.

 
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