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  • Need help with thyroid labs and Uptake Scan Please

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    Old 04-11-2013, 06:57 PM   #1
    lizbitts
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    Question Need help with thyroid labs and Uptake Scan Please

    Hello, everyone, I really need help understanding what is going on with my lab tests and what is going to happen next.
    Recently had a first visit with Endo because I have a multinodular gland, large 2.9cm mass and other nodules. ( First found out in Sept of 2012) Have just had second ultrasound and everything is stable. Also had FNA back in Sept...although they only biopsied the large mass---came back benign, they did not biopsy the other nodule which is over 1cm.
    Dr. sent me for lab work and called and told me that I now have overactive gland, hyperactive. I have gained 30 lbs in last couple of yrs,also suffer from severe anxiety, heart palpatations, aches and pains in legs and arms. Just feel very tired and exhausted all the time. Anyway he also sent me for the
    radioactive Iodine uptake test and scan which I had done the other day and I will see him next Tuesday to discuss what is going on.
    Here are my lab results:

    TSH t Free T4 TSH result: <0.005 LOW uiU/ml reference: 0.450 - 4.500

    T4, Free (Direct) result: 1.75 ng/dL reference 0.82 -1.77

    Thyroid Stim Immunoglobulin result: 339 HIGH reference: 0 - 139

    Thyroid Peroxidase (TPO) Ab result: 14 IU/mL reference: 0 -34

    Antithyroglobulin Ab result: <20 IU/mL reference: 0 -40
    Siemens (DPC) ICMA Methodology

    Triiodothyronine, Free Serum result: 6.8 HIGH pg/ml referenece 2.0 -4.4


    Now here is the Radioactive Iodine Scan and Uptake report:::

    Procedure: Nuclear Medicine Thyroid Uptake and Scan with Single Determinations

    Clinical History: thyrotoxicosis

    Comparison: None

    Technique: following the oral ingestion of 223 mCi I-123 capsule, nuclear medicine thyroid scans and quantitative uptake was performed.

    Findings:: There is heterogeneous uptake of the radiopharmaceutical in both lobes of the thyroid gland. There is no evidence of any hyperfunctioning nodule. The left lobe demonstrates slightly diffusely diminished activity relative to the right.

    The 24 hr uptake measured 31 %. ( 10 - 30% at 24 hrs)

    Impression: heterogenoeus thyroid gland. No dominant hot or cold nodule is demonstrated. Borderline uptake measuring 31%.

    I am very nervous and just need someone to help me make sense of all of this. It's been a rollercoaster since last Sept. when I was sick for a whole month, made 2 ER visits--had swollen lymph nodes in jaw=and still no answer why...that is when they found mass on thyroid...was suppose to see an Endo in Dec...but had colonoscopy in Nov and came home with cramps--(had 2 precancerous polyps removed)---next day ended up in hospital with appendicitis attack--had open surgery, had to recover and not make my Endo appt...So I just recently saw Endo a couple weeks ago....Sorry, just frustrated as to what is going on and if I have to be on meds. Dr. mentioned that I may need radioactive iodine treatment.... in the meantime I feel like crap, no energy, tired, and taking xanax almost every day for severe anxiety.
    please help!! thank you Forgot to mention that I am up every 2 hrs at night, can't sleep well, toss and turn, and always feel hot....

     
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    Old 04-12-2013, 10:12 AM   #2
    midwest1
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    Re: Need help with thyroid labs and Uptake Scan Please

    In a nutshell, you are hyperthyroid due to Graves' disease.
    Have you been given a beta blocker to help with the symptoms, or an anti-thyroid med to reduce your T4/3? You shouldn't be left hanging like this. Reducing the T4/3 would help loads with the anxiety and foggy thinking that might cause you to make unwise treatment decisions that untreated Graves' patients are prone to.

    These are decisions you do not want dictated to you. Try as hard as you can to understand your condition and to not allow the MD to make all of your choices.

    I advise people against RAI (radioactive iodine) ablation treatment in most cases, because I wouldn't choose it for myself after reading up on it. Understand that it will destroy your thyroid gland and make it unable to provide your body's supply of thyroid hormone. You will be dependent on an MD to decide what dose your body needs, and the amount he'll want to provide - in most cases - will be less than your body really needs. Those of us who have primary hypothyroidism are all too aware of the pitiful treatment most MDs provide to us. It isn't much different for patients whose glands don't work for other reasons.

    Now... All that said... Your gland has very large lumps and bumps that are worrisome. Something needs to be done about them. (At least, I would want something done about them.) They are too large to be sure aren't cancerous, even with biopsy monitoring. But as a layperson, I'm unsure what would happen if you did take RAI for the Graves'. That is, I'm unsure if the cancer risk would disappear along with the gland's function. I haven't read about that aspect of RAI; but if it were me, I would want to be absolutely sure about that cancer risk following RAI ablation. Could it be that the RAI would actually increase the risk? I don't know, but the question seems valid in my mind. If the cancer risk doesn't subside or if it would increase, the argument for surgical removal seems far more sensible.

    As you can see, given this information, I'm not sure what my own decision would be, so I can't offer a strong opinion about what you should do. All I will say is that you should do your homework and an "extra credit" paper before you decide on RAI. If the endo seems at all pushy about it, get other opinions. RAI is a permanent solution to what is usually a temporary condition. [Graves' can go into lengthy periods of remission if the right treatment is done with anti-thyroid drugs and a beta blocker. It can be done without permanently destroying the thyroid gland.]
    Your nodules are the "monkey wrench" in your particular situation.

    Your next step should be the anti-thyroid med and beta blocker, if you aren't already on them.

    Wishing you the best of luck with whatever you decide.
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    Old 04-12-2013, 11:21 AM   #3
    lizbitts
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    Re: Need help with thyroid labs and Uptake Scan Please

    Thank you so much for your response. No I am not on any type of meds for this thyroid...I am on high blood pressure meds, xanax (for several yrs now, on and off) have very high cholesterol but no meds for that--can't tolerate the statins. Also have low vitamin D--taking 2000 mg per day. My first appt with this Endo was a couple weeks ago and he never asked me about symptoms---just quickly looked over ultrasound results and FNA and said to have another ultraound again in Sept for the mass and nodules. But he sent me for lab work, and then called me a few days later to tell me I was overactive thyroid and sent me for scan. Now I will be seeing him for second time this coming Tuesday, taking my husband with me. When we talked over the phone the Endo did say I may have to be treated with the radioactive iodine. But I have same questions as you mentioned....concerned about the mass and other nodules. I have been reading many books and searching on internet and especially on these healthboards. At least he sent me for the lab work and called me. I am very confused and just want help to get this resolved. For past few years my spouse would think I was crazy to to my high anxiety . I am 58 yrs old, and just so tired of going back and forth to drs. Guess I have a lot of research and thinking to do here. I will let you know how my appt goes with endo and what he suggests. thank you for your help!!!!

     
    Old 04-13-2013, 04:49 AM   #4
    gloom
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    Re: Need help with thyroid labs and Uptake Scan Please

    I think that way I'd see it is.

    This is the issue

    >Thyroid Stim Immunoglobulin result: 339 HIGH reference: 0 - 139

    It's an antibody that stimulates the thyroid causing it to produce excess hormone. It's present and above range. That's a good sign of graves disease.

    TSH is a pituitary hormone that controls how much hormones your thyroid is supposed to produce. It's very low, as you'd expect if your T4 and T3 were high.

    And your T4 and T3 thyroid hormones are high. This is what's likely causing some or all of your symptoms.

    Looks like you have a diagnosis that's pretty solid. If he prescribes drugs to suppress your thyroid I'd probably take him up on that. If he wants to do RAI ablation first thing, I'd get a second opinion.

    Good Luck.

     
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