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Old 08-05-2013, 06:41 PM   #1
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Do these lab results mean that I don't have Graves' Disease?

Several months ago, I was diagnosed with hyperthyroidism and given a prescription for Tapazole. I just had my first blood test since starting the meds about 7 weeks ago, and here are the results:

T3 Uptake: 32 (normal 24-39)
Thyroid Peroxidase (TPO) Ab: 10 (normal 0-34)
Antithyroglobulin Ab: <20 (normal 0-40)
Free T4: 1.19 (normal 0.82-1.77)
TSH: <0.006 (normal 0.450-4.5)
(the TSH was also that low for my first blood test I had back in May)


Since the TPO and Antithyroglobulin values are both within normal range, does this mean I don't have Graves' Disease or Hashimoto's?

Also, since my free T4 and T3 Uptake values are within normal range (previously, they were both 6.1 and 47), should I go ahead and stop taking my daily 20 mg dose of Tapazole?

The thing is, I can't see my doctor until Aug. 15th. For the last week, I have been feeling kind of sluggish when exercising (running), and I have gained a noticeable amount of fat around my mid-section. My face also seems to have looked a bit more bloated lately.

Do you guys think it's time to stop taking the Tapazole? Or should I continue taking it until I see my doctor? Back before I had thyroid issues, I used to be able to run the same distance I'm running now and was able to eat whatever I wanted without gaining any weight, so the fact that I'm starting to get fat seems to imply that my "old" thyroid hormone levels (back when I was healthy) were higher than what they are now.

 
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Old 08-05-2013, 11:04 PM   #2
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Re: Do these lab results mean that I don't have Graves' Disease?

hi there,

The tests performed say nothing about Graves (altough your TSH might indicate it, it sure does not give reliable information). The antibodies tested are relevant for Hashi's, for Graves and in order to know whether you have it, TSI or TSH receptor antibodies should be tested.

The fact that your levels are back within range (next time you want to have the Free T3 tested instead of the uptake) is due to the medication Tapazole.
Nevertheless your levels appear to be turning hypo.

It's common to start the meds retest after 6-8 weeks, once levels fall within normal range (be careful dosing should be done based on FT4 and not TSH!) the dosage should be adjusted accordingly. Your doctor should suggest a dosage decrease at your next visit.
Your want to be on the smallest dosage keeping FT4 in the upperhalf of the range.

TSh is not reliable since it's falsely suppressed due to graves antibodies.

The running is due to hypo, will get better once your levels are better.


 
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Old 08-05-2013, 11:24 PM   #3
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Re: Do these lab results mean that I don't have Graves' Disease?

Quote:
Originally Posted by lisa789 View Post
hi there,

The tests performed say nothing about Graves (altough your TSH might indicate it, it sure does not give reliable information). The antibodies tested are relevant for Hashi's, for Graves and in order to know whether you have it, TSI or TSH receptor antibodies should be tested.

The fact that your levels are back within range (next time you want to have the Free T3 tested instead of the uptake) is due to the medication Tapazole.
Nevertheless your levels appear to be turning hypo.

It's common to start the meds retest after 6-8 weeks, once levels fall within normal range (be careful dosing should be done based on FT4 and not TSH!) the dosage should be adjusted accordingly. Your doctor should suggest a dosage decrease at your next visit.
Your want to be on the smallest dosage keeping FT4 in the upperhalf of the range.

TSh is not reliable since it's falsely suppressed due to graves antibodies.

The running is due to hypo, will get better once your levels are better.


Thanks for your response. Since my next appointment with my doctor is not until Aug. 15th, should I just go ahead and stop taking the Tapazole now? I feel like if I take the Tapazole for 10 more days, I will definitely be in a full-blown hypothyroid state. Or should I take half the daily dose until my appointment?

I can definitely tell that I was "meant to be" in the upper half of the T4 range, because I am gaining fat at an alarming rate and seem to have gone into "slug mode." The only upside is that I seem to be having an easier time gaining muscle from my gym workouts! :-)

So do you think it would be a good idea to stop/reduce the Tapazole dose, at least until my appointment on the 15th?

 
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Old 08-05-2013, 11:26 PM   #4
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Re: Do these lab results mean that I don't have Graves' Disease?

I think the Dr will want to reduce your Tapazole, not just stop it. If you are anxious to do that, I would call office and see if they can move your appt sooner so you can discuss the next step. It appears you do not have Hashimoto's, according to the negative antibodies. When your Tapazole is reduced, your exercise tolerance should improve. It will take some time and patience to get your thyroid levels at optimum.

 
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Old 08-06-2013, 12:03 AM   #5
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Re: Do these lab results mean that I don't have Graves' Disease?

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I think the Dr will want to reduce your Tapazole, not just stop it. If you are anxious to do that, I would call office and see if they can move your appt sooner so you can discuss the next step. It appears you do not have Hashimoto's, according to the negative antibodies. When your Tapazole is reduced, your exercise tolerance should improve. It will take some time and patience to get your thyroid levels at optimum.
Thanks for your input. I'm surprised my doctor only wanted to test the TPO and Antithyroglobulin values -- wouldn't he be interested in finding out if I have Graves disease?

Also, if it's just thyroiditis (crossing my fingers), will I just be able to stop taking Tapazole and that will be the end of my problems?

 
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Old 08-06-2013, 12:29 AM   #6
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Re: Do these lab results mean that I don't have Graves' Disease?

I don't think stopping Tapazole is a good idea. I agree with Ladybud, try to see whether there is a possibility to reschedule the appointment a little sooner, if not I'd sit it out. i know it's tough, but I cannot recommend lowering your dosage without doctors advice, if nothing else if you'd do that, your labs will be useless when you do go to the doctor and the advice you'll receive consequently will be useless too. Labs are the key in getting things balanced out and that week might end up being 'short' if one messes things up and prolongs the process due to that.

I agree that it does not make sense that your doctor did not test for the Graves antibodies. Be aware that your dosage is not adjusted (or remains unchanged) based on TSH alone. Most doctors falsely focuss on that, while dosing should be done on FT4!

hang in there!

 
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Old 08-06-2013, 10:41 AM   #7
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Re: Do these lab results mean that I don't have Graves' Disease?

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Originally Posted by lisa789 View Post
I don't think stopping Tapazole is a good idea. I agree with Ladybud, try to see whether there is a possibility to reschedule the appointment a little sooner, if not I'd sit it out. i know it's tough, but I cannot recommend lowering your dosage without doctors advice, if nothing else if you'd do that, your labs will be useless when you do go to the doctor and the advice you'll receive consequently will be useless too. Labs are the key in getting things balanced out and that week might end up being 'short' if one messes things up and prolongs the process due to that.

I agree that it does not make sense that your doctor did not test for the Graves antibodies. Be aware that your dosage is not adjusted (or remains unchanged) based on TSH alone. Most doctors falsely focuss on that, while dosing should be done on FT4!

hang in there!
On the paper he wrote for me to take to the lab facility, he wrote everything but the order to test for Graves antibodies... maybe he just forgot? LOL.

Honestly, today I just took half my first dose and am planning on taking half the second dose later on. I know this may not be advised to do since a doctor didn't order it, but I know that in 10 more days, I will definitely be hyperthyroid if I keep taking the full dose. I do plan to tell him that I started taking half the dose on Aug. 6th, so if that's going to be his plan anyways (and what else could he recommend?), it just means that, instead of taking half the dose for 6 weeks and getting another blood test done, it means I will take half the dose for 4.5 weeks and get the blood test done.

This may not have been ordered by him, but then again, what else is he going to recommend when I actually do go in to see him? It really can't be anything other than a dosage reduction or stopping the meds, right?

And it looks like I'll be getting another blood test to see if I actually have Graves or not, anyways!

 
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Old 08-06-2013, 01:28 PM   #8
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Re: Do these lab results mean that I don't have Graves' Disease?

yes he should order you to lower the dosage, so in that regard yes its the same.
the bloodresults are done from now right? then make sure to tell him they were done without adjustment, that should give him the information needed.

 
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Old 08-06-2013, 08:29 PM   #9
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Re: Do these lab results mean that I don't have Graves' Disease?

Quote:
Originally Posted by lisa789 View Post
yes he should order you to lower the dosage, so in that regard yes its the same.
the bloodresults are done from now right? then make sure to tell him they were done without adjustment, that should give him the information needed.
That's exactly what I plan to do.

Just a curious question.... since there is a possibility that I may just have a case of thyroiditis and not Graves (since I wasn't tested for Graves antibodies), why wouldn't the doctor consider taking me off Tapazole completely? If I don't have Graves, would my thyroid hormone levels just stabilize to the levels they were at before I started having thyroid issues?

 
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Old 08-06-2013, 10:46 PM   #10
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Re: Do these lab results mean that I don't have Graves' Disease?

no not necessarily, thyroiditis also takes the time it needs.
I'm inclined to assume Graves though, if I look at your TSH. Then again, no teling for sure till we have the antibody results.
If you need it, really no use in taking you of tapazole. but dosing properly is a must!

 
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Old 08-06-2013, 10:54 PM   #11
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Re: Do these lab results mean that I don't have Graves' Disease?

At some point, don't most Graves patients go off Tapazole and take radioactive iodine because of the toxicity of Tapazole? That's the main thing I'm worried about long-term.

Also, since you mentioned my TSH level -- when I got my very first blood test done after I first started experiencing hyperthyroidism symptoms, the TSH was the same value (<.006) back then as well. The T3 uptake was 46 (normal 24-39) and the Free T4 was 6.11 (normal 0.82-1.77).

So with that being said, could my TSH still be low because it just hasn't had time to "catch-up" with the other values? Or is a lagging low TSH (such as in my case) a sign of Graves disease?

In other words, if I did have thyroiditis, would the TSH have gone back into normal range along with the other values by now?

 
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Old 08-06-2013, 11:48 PM   #12
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Re: Do these lab results mean that I don't have Graves' Disease?

TSH in general needs more time to catch up. I would not assume you don't have Graves until you have antibody results, till then it really is guessing.

I understand your worries (been there myself) yet radioactive iodine is more toxic then tapazole. The thing with tapazole (or other thyroid blockers) is that toxicity in most cases is associated with too high of dosage. Unfortunatley all too many doctors don't seem to realize that. Important is also to keep an eye (definitely in the beginning) of the liver values to see how they are doing. Yet normally at this point your dosage should be reduced.
Also good to read around, a well informed patient is always a plus. There is some good information on this board also to be found in that regard. You'll quickly learn blocking therapy in cases of graves is more recommended for the wellbeing of the patient then radioactive iodine. it's not a quick fix contrary to what some doctor might make one wanna belief.

 
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Old 08-17-2013, 10:32 PM   #13
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Re: Do these lab results mean that I don't have Graves' Disease?

Okay, so here's an update on my situation. I went to my appointment with my FP doc on the 15th, and he remarked that while my FT4 and T3 Uptake values looked better, he said that the TSH should be higher. To be more specific, my TSH value before I started taking Tapazole was <.006, and on my most recent lab report (blood sample was taken after having taken Tapazole for about 8 weeks), the value was still <.006. I mentioned to him that I had heard that the TSH value tends to take a while to "catch up" with the other values, but he said the TSH value should have stilled budged somewhat. Is this accurate?

Either way, he decided to refer me to an endocrinologist who purportedly treats many hyperthyroid patients. Does anyone know what I can expect the endo's plan of action to be? Do you think he is going to order a radioactive iodine uptake scan?

Since I haven't been tested for Graves antibodies yet, I'm pretty sure that the endo will want to test me for them. But I was also curious about what else to expect him to want to do... ? If he suggests taking radioactive iodine or undergoing some other treatment intended to destroy my thyroid, should I find another endo?

Thanks...

 
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Old 08-29-2013, 02:22 PM   #14
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Re: Do these lab results mean that I don't have Graves' Disease?

Ok first off ...from now on MAKE SURE they test - Free T4 & Free T3 (not T3 uptake)- at every blood test (if it turns out you have Graves) and make sure YOU keep these test results yourself written down (the results AND that lab's normal ranges because these differ from lab to lab) to help you analyze & figure it all out. Dose by "how you feel" and if you are like most people you will want to keep these -FT4 & FT3 in the upper third of the normal range to feel best.

Also, YOU are correct about your TSH and you need to find a doc who knows this. It can take a VERY long time for your TSH to budge (It took a year and 3 months for mine to go from <.001 to .06 even after my Graves was stabilized). If you have Graves then your TSH will never be like a normal persons TSH and that is just fine. What you will then keep track of is Free T4 and Free T3.

And if it turns out you do have Graves then don't despair because most people go into remission once treated CORRECTLY. There are discrepancies in the numbers but most of the studies I can find show about 40% STAY in remission. A much larger percentage than that go into remission but it may come and go for them but often many years apart. But you should keep in mind there is a good chance for you to recover.

So yes get tested for the antibodies -TSI (thyroid stimulating immunoglobulin) etc... to see why your TSH is suppressed and NO of course you would not want to consider any permanent interventions at this point. They can do an ultrasound if there are more questions but radioactive iodine uptake scans are considered inconclusive and unnecessary. And any doc who goes straight to radioactive iodine ablation or thyroidectomy for a new Graves diagnosis alone would be crazy.

It will be beneficial to take good care of yourself and if you are aware of healthy changes you can make in your lifestyle/habits. I was diagnosed with Graves around 2years ago. For me it was mostly extreme stress and learning how to deal with it. Taking yoga, not being such a perfectionist, putting my healthy needs up there with the rest of my family has helped. Eating/drinking healthy with needed nutrients, Staying well hydrated, sleeping regularly, finding out if you have sensitivities to something such as gluten, changing to NON-fluoridated toothpaste, reducing or eliminating soy (especially hydrogenated soybean oil) are all things to look at and more. If you have Graves you would typically take anti-thyroid medications like the Tapazole you are taking or PTU, continue to test your blood (adjusting your dose to keep you feeling good and the FT4 & FT3 in upper-range of normal), trying to eventually... slowly.... weaning yourself off the meds while continuing to get blood tests. I have to say I went down to a quarter of a PTU pill a day but if I stopped all together it kept coming back. Then I finally dwindled down to a quarter of a pill every 3 days and it kept in check. Eventually I was able to stop but I admit I have the smallest stress in my life and it comes back. I am still working on it and I hear that if you stop too early you are less likely to have success so I might be rushing things a bit. I am allergic to Tapazole and PTU is a lot harder on your liver so I hate taking it. Anyway, I wish you the best of luck!! Let us know how it goes and if you want help post your labs here

 
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Old 09-05-2013, 06:31 PM   #15
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Re: Do these lab results mean that I don't have Graves' Disease?

jlajet, thanks for posting and providing such valuable information. I will take your advice into consideration!

I have another update regarding my hyperT condition; my endo wanted to test for TSI antibodies on my most recent blood test (taken about 2 weeks ago), and the lab's highest end of the "normal" range is something like 130, and my value was around 730. So basically, he said this means I have Graves' disease. He said my case didn't seem to be "that bad," though.

How bad is that value compared to other patients'? Do I have much of a chance of entering remission?

Also, on the day I got the blood test done, he told me to stop taking Tapazole entirely (does this make any sense whatsoever?). But after a little over 1.5 weeks of not taking any Tapazole, I could feel myself rapidly turning hyperT again and had to take 5 mg earlier today. Before I stopped taking the Tapazole, I was beginning to feel good on 5-6 mg/day, so I will probably start taking that much each day and will see how I feel.

Also, on my blood test, alkaline phosphatase was elevated at around 240. Does this mean I'm damaging my liver by continuing to take Tapazole? Would it be worse to take radioactive iodine at this point?

The doctor wants me to get a thyroid ultrasound as well as a radioactive uptake scan in a few weeks, and after that he'll decide on a treatment direction.

 
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