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    Old 03-15-2004, 03:20 AM   #1
    Jennie Coburn
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    Jennie Coburn HB User
    Question THYROID-T4 vs Catscan

    [SIZE=3][COLOR=DarkSlateBlue][SIZE=2] I have a strong family history of hypothyroidism and have many of the symptomes. Because of this, I have an annual Thyroid test. Do not know the type of test. Results were always negative.
    Recently had a T4 test which was reported to me as positive with a high reading (? numbers). Medication was discussed by the doctors and they decided to do a Catscan first to verify the T4 test and have a look at the thyroid gland as enlargment is visible. The scan was reported as neg T4 but the gland itself contained cysts.
    My question:
    1) Can a Catscan somehow measure levels of hypothyroidism?
    2) Does the scan rule out the high numbers on the T4?
    3) What would be the significance of the cysts?
    I am to see an Endocrinologist next month and would like to be more knowledgable than I have been in the past.
    Thank you for any help anyone can give me.
    Jen :confused

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    Old 03-15-2004, 05:43 AM   #2
    Join Date: Nov 2003
    Location: Florida
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    MauraL HB User
    Re: THYROID-T4 vs Catscan

    I think you should get copies of you annual thyroid test as well as a copy of the radiologist's report for the scan. If you want to be knowledgable about your situation before you see the endo, you first need to know exactly what tests you had and what the results were. You do not seem to be very clear about what those things are.

    Uptake scans are commonly used to assess overall thyroid function and to see whether nodules are hot or cold. You are given some radioactive contrast material that your thyroid takes up (123-iodine in an oral dose or else technitium 99 by IV) and then your thyroid is scanned to see how active it is and whether the nodules are hot or cold or normal. As I understand, it's more accurate when confirming hyperthyroidism than for hypothyroidism since hypos can have mixed results--low, moderate, or high uptake. Get a hard copy for your files and read what the radiologist had say about your scan results. Just being told that the test was "negative" does not mean anything unless you know what they were trying to check in the first place (hyperactivity, hypoactivity, hot nodules, cold nodules, etc.).

    Also, you need to be sure what annual test you've been getting--a TSH or a T4 or both? TSH and T4 have an inverse relationship, and when one is high, the other is low. You could be getting a T4 every year, but the TSH is a much more common screening and monitoring test because it's the first hormone level to get abnormal when thyroid disease is developing. If the TSH was high, then it would appear that you are heading hypo, but if the T4 was high, then it would appear that you are heading hyper. So you see how crucial it is that you know exactly what test you have been getting and also to know the exact value and the lab's reference range. Get hard copies of the lab reports; don't call the office and ask for someone to tell you about the test because office staff frequently don't understand the tests and will just tell you it's normal or high or low or whatever.

    What was the medication you discussed--a replacement hormone like Synthroid or Levoxyl or an antithyroid drug like MMI (Tapazole/methimazole) or PTU? That would help to determine whether you are going hypo (high TSH) or hyper (High T4).

    About 50% of the population have nodules or cysts--these are clumps of abnormal thyroid tissue that are usually harmless. Sometimes they can be "hot" meaning they overproduce hormone and make you hyper. Occasionally they can be cancerous, but this is rare, and it's more common when there is a single nodule, not when there are many nodules.

    Autoimmune thyroid diseases run in families, but you can wind up with a hyper disease or a hypo disease even if most family members are hypo. And since you do appear to be developing some type of thyroid disease, you should get educated ASAP. A good book for beginners is Thryoid for Dummies by Dr. Alan Rubin (it's available all over the place, and in one book in the Dummies' series as you probably guessed). It's easy to read and all the basics are covered.

    Please get copies of your past labs and uptake interpretation and post them. I'm really curious to know what exactly your tests and results are. People here can help you understand the tests and give you good advice, but you have to know exactly what tests you had first.

    Also--you are entitled to copies of your medical files--including all test results--by law. Sometimes you have to sign a waiver, but you cannot legally be refused copies. In order to feel well, you'll need to have copies of everything and record how you feel when your thyroid hormones are at any given level; that will help you to know how much of any drug you need to feel well. This would be especially useful since you have been getting thyroid tests for years, and you can look back and see where the levels were before you became symptomatic. When you know what the results were when you felt good, you know how to juggle the meds to get you back to that point.

    The lab reference ranges are very broad, but you will only be free of symptoms when your FT3 and FT4 (thyroid hormones) are at a point on the range that corresponds with your personal genetic set point; it is not enough to be anywhere in the reference range even though many medical people will tell you that "you're labs are normal, it must be something else." That happens a lot because so many doctors are out of their depth with thyroid disorders. It's a good thing you're going to an endo since he or she will have better sense of what is going on.

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