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  • Test Result Interpretation??

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    Old 02-23-2009, 11:57 AM   #1
    Bardda1
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    Test Result Interpretation??

    Hi
    My husbands primary care doc has been testing his TSH only for years. If it was low, he upped his Methimazole, if it was high, he cut off his Methimazole. He has never had a normal TSH. Finally he was able to see Endo and these are the results:

    Thyroid Stimulating Immunoglob 265 (0-129)
    TSH 0.006 (0.450-4.500)
    Thyroxine T4 Free, Direct 1.21 (0.61-1.76)
    Thyroxine T4 10.1 (4.5-12.0)
    Immunoglobulin A, Qn, Serum 179 (70-400)
    Thyroid Peroxidase TPO Ab 59 (0-34)
    Triiodothyronine, Free 4.1 (2.3-4.2)
    PTH, Intact 33 (15-65)
    Cortisol-AM 10.5 (4.3-22.4)

    Endo said the other tests besides TSH were going to tell him what the problem is, but his appointment isn't for another two months. So.....any interpretations? He seems to have both Hyper and Hypo symptoms, some of them are becoming quite worrisome.

    Thanks!

     
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    Old 02-24-2009, 03:47 PM   #2
    GravesGirl73
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    Re: Test Result Interpretation??

    Well, it seems he has Graves disease with a low tsh and positive tsi. The tsi is suppressing the tsh. (the antibodies for Graves) His Free t 4 is a little low but not bad, his Ft3 is at the top of the range(high) Graves patients need a steady dose of methimazole, lowering the dose as the FT 3 and 4 go down, but not stopping it all of a sudden. I have been on it 2 years steady and am going hypo on a real small dose, but if you get off it suddenly you can get hyper again. All Graves antibodies (the tsi and TRab) have to be low to stop. Either that or block and replace can be tried. There are studies that show the longer you are on meds the better. Four years is best.Then check antibodies to see where you're at.

     
    Old 02-25-2009, 07:00 AM   #3
    mkgb
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    Re: Test Result Interpretation??

    Your husband has Graves disease, but he also has Hashimoto's. Your husband will eventually go hypothyroid, because the Hashimoto's is working a killing off the thyroid even as the TSI are stimulating it for their own amusement.

    Low TSH is expected given the TSI level.
    Thyroxine T4 Free, Direct 1.21 (0.61-1.76) This is 52% of normal. This is optimal in range and GOOD. If he goes much lower he will begin to get the mental hypoT symptoms.

    Immunoglobulin A, Qn, Serum 179 (70-400)
    This is good as well. Shows his immune system is up and running effectively.

    Thyroid Peroxidase TPO Ab 59 (0-34) This is a positive indicator of Hashimoto's thyroiditis.

    Triiodothyronine, Free 4.1 (2.3-4.2)
    He is 94.7% of normal range. He has mild T3 toxicosis going on. VERY common in early Hashimoto's and Graves patients. This is often a response to fatigued adrenals and a need for cortisol supplementation.

    PTH, Intact 33 (15-65) This result is good. Parathyroid hormones show parathyroids are well.
    Cortisol-AM 10.5 (4.3-22.4)
    This is low. Around 8 am the cortisol level should be closer to 80% of normal range. Your husband is at 34%. As the day goes on levels drop further. If your husband takes a 24 hour saliva cortisol rhythm test... I bet that he will come back low in after 12 pm and through the evening. Some cortisol supplementation would probably help here.

    Get an ACTH run. If the ACTH is high then his pituitary gland recognizes the fatigue/deficiency and is trying to get the adrenals to cooperate.. but the adrenals are unable to meet the demand.

    MG
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    Old 02-26-2009, 04:41 PM   #4
    Bardda1
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    Re: Test Result Interpretation??

    Thanks very much for your replies. One question...what do you mean by "If he goes much lower he will begin to get the mental hypoT symptoms"? What would the treatment usually be for Graves and Hashimoto's? It's been over 5 weeks and he has yet to even get a phone call from the doctor regarding these tests so I very much appreciate your interpretations.

     
    Old 02-27-2009, 07:37 PM   #5
    GravesGirl73
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    Re: Test Result Interpretation??

    Hi! What she means is a lot of the times people get depressed if the FT4 falls too low,and also brain fog,etc..
    His doc might keep him on a low dose of the Methimazole if the FT3 gets much higher. I don't see a tsh level, did he have that? Does he have symptoms of hyper or hypo?

     
    Old 02-28-2009, 09:52 PM   #6
    mkgb
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    Re: Test Result Interpretation??

    That is what I meant. In many cases the treatment is to keep the Graves in line until the thyroid burns out. When the thyroid dies off the treatment of the Hashimoto's inspired hypothyroidism using T4 or T4/T3 supplementation begins.

    MG
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