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    Old 03-07-2007, 02:59 PM   #1
    Zilct
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    Endo Visit-Strange Labs-Thoughts?

    Hi everyone,
    My name is Liz, I have posted here previously. I am going to put my last two labs out there for reading material and see what others think about my new Endo's thoughts and ideas. Let me preface saying I have had other labs with high TSH, high T3 & T4, so it's been going on a year now. This is not something I believe is lab error, and most labs come to find out, have been run more than once because TSH was high.

    As a result of my visit today, I am in a holding pattern. The way things were descibed to me was that before she settles on PRTH she wants to see if my pituitary just takes longer than normal to acclimate to the thyroid meds. Last year every six weeks my pcp was upping my dose, so maybe it couldn't adjust so fast.But, she even negated this theory a bit when I mentioned after stopping Synthroid in late Nov, within a month, my TSH has gone from 15 to 104. Sounds like my pituitary was working fine then huh?

    I definetly have Hashi's, as my TPO was 393 (reference levels 0-34). But she doesn't feel this is the reason my TSH is high still, even with the meds on board. I have no antibodies for Graves, so no there. When I went hyper that was just a result of too much meds. I am getting an ultrasound of my neck, but her office is scheduled out thru mid April .

    The problem I guess is that upon meds of 75 mcgs Levoxyl, my T4 rose, my T3 stayed the same (high), and my TSH is still high (even though it lowered from <75 to 37). So it looks like to her, if looking at my labs, that Im not even on Levoxyl since it's not supressing my TSH enough. If my TSH was within .35-4 we would just be focusing on me have Hashi's end of story.

    I doubt my TSH is going to fall over the next few months since I am not taking an increase of meds, but anything is possible right. I mean it jummped so much in 30 days after getting off the meds before, so I doubt it just takes longer than 6 weeks to adjust to thyroid medicine.
    Happy reading and thanks in advance!
    Liz


    01/07/07
    Begged a new Endo to see me, TSH 104 I was getting worse. She finally ran
    more tests. After tests rans, 75mcg Levoxyl.

    No meds
    TSH >75 (.3-5.5 uIU/mL)
    FT4 .77 (.8-1.9 ug/dL)
    FT3 4.2 (1.8-4.2 ng/dL)
    TG <.05 (0.5-55.0 ng/mL)
    TRAb 57 (0-40 IU/mL)
    TSH Receptor AB <0.3 (0.0-1.0 U/L)
    TPO 323 (0.0-34)
    LH <.03
    FR Alpha Subunit 0.26
    TBG 39 (13-39 ug/mL)
    FSH 1.0 micIU/ML

    Endo calls me and suggest selective pituitary resistance, as she
    calls it. She realizes I have TPO anitbodies, which means Hashi's, but doesn't feel this is the main issue.

    Labs done 2/21/07

    TSH 37 (.3-5.5 uIU/mL)
    FT4 1.43 (.8-1.9 ug/dL)
    FT3 4.1 (1.8-4.2 ng/dL)
    Calcium 8.8 (8.2-10.2 mg/dL)
    Albumin 3.1 (3.4-5.2 g/Dl)
    TG <.05 (0.5-55.0 ng/mL)
    TRAb 56 (0-40 IU/mL)
    TSH Receptor AB <0.3 (0.0-1.0 U/L)
    TPO 393 (0.0-34)
    LH <.03
    FR Alpha Subunit 0.10
    TBG 39 (13-39 ug/mL)
    FSH <0.3 micIU/ML

     
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    Old 03-08-2007, 10:36 AM   #2
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    Re: Endo Visit-Strange Labs-Thoughts?

    Bumping up for zilct.
    Maybe accessn (Helen) will comment. She's the guru of "strange" labs

     
    Old 03-08-2007, 11:29 AM   #3
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    Re: Endo Visit-Strange Labs-Thoughts?

    Hi midwest, Thanks for watching my back again. I really, really appreciate your bringing some of these to my attention. I'm having a little trouble keeping up with it all.

    Hi liz, Fancy meeting you here. Looks like we're still waiting for a second opinion - je46324 where are you? It's looking weirder and weirder and I can't get my head wrapped around it. Any thoughts?

    Helen

     
    Old 03-08-2007, 03:42 PM   #4
    je46324
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    Re: Endo Visit-Strange Labs-Thoughts?

    Have we ran into each other before? The FR alpha subunit is a test i have only seen once before, I dont even know what it is. Actually you do have graves antibodies present but does not necesarrily mean at this time they are active. The TRab and TSH receptor antibodies test are essiantly the same thing, but since they are listed different and give 2 different results they were probably run useing 2 different methods. In some methods animal TSH receptors are used and since they are slightly different chemically from our TSH receptors the antibodies we carry in our blood will not attack them so even though we really have them the test will be negative. Since one of these tests does show you have them a more specific antibody tests could shed a little more light on the situation. The more specific tests are called a TSI (TSH receptor stimulateing immonglobulin) and a TBII (TSH receptor blocking immunoglobulin), these more specific tests will tell you exactly what the graves antibodies are doing. TSH receptor antibodies (graves antibodies)are usually just assumed to cause hyper, but the TSH receptor blocking antibodies if they are in high enough levels will cause hypo, they will actually keep the TSH from doing its job and can cause TSH to build up slightly in the blood but they themselves do not stimulate the thyroid to produce more hormone...the TSH stimulateing antibodies actually do the exact opposite.


    From what i know about the TRab test i would think that at the level you show its not likely that it would have a signifacat effect on your labs, so it probably is just flucuation from Hashis. If you talk to K9mom she could probably tell you more about the graves angle and if at those levels they could be affecting you, all the above i wrote is about the total extent of my knoweldge.

     
    Old 03-08-2007, 05:20 PM   #5
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    Re: Endo Visit-Strange Labs-Thoughts?

    That analytical mind does look a bit familiar

    With no range and the result, I assumed it is actually the tsh alpha subunit. The marker for a TSHoma. I might be wrong but I can't find anything else it could be. For her age, it would be a normal result and the molar ratio would be just fine.

    I'm also having trouble figuring out those binding proteins. Is that normal to see the TBG at the top of the range when the albumin is low? Is that a compensatory mechanism going on?

    Liz, when are your next set of labs being done? Do you know what labs are being ordered on the next go round?

     
    Old 03-08-2007, 05:32 PM   #6
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    Re: Endo Visit-Strange Labs-Thoughts?

    Hello-

    Yes TRAb (I came in possitive on this one and right under range for TSI) will show autoimmunity if possitive. Rule of thumb is **ANY** TSI present means autoimmune graves disease. Normal humans do not carry TSI. It is just a little more precise.

    Nikki
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    DX. Toxic Multinodular Goiter (now growing rapidly) & Hyperthyroid from autoimmune Graves Disease

     
    Old 03-09-2007, 06:56 AM   #7
    Zilct
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    Re: Endo Visit-Strange Labs-Thoughts?

    The next set of labs is being run end of April. It will contain TSH,FT3,FT4, Cal, albumin-I think that's it since now we know all the other stuff I have or don't have. The holding pattern right now is mainly to see if my TSH will aclimate and get into line.
    Thanks all, you are great!!
    Liz

     
    Old 03-09-2007, 07:38 AM   #8
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    Re: Endo Visit-Strange Labs-Thoughts?

    Hi liz,

    What je46234 said about the blocking antibodies does make sense. Any chance you can see if you can get the TBII (TSH receptor blocking immunoglobulin) and if they're doing that, throw in a tsi. With your IgE level what it is, it really doesn't look like it's graves, but who knows with you. You got almost every other antibody in the book. It would be interesting to see what those other ones are.

    Take care,
    Helen

     
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