General Medicine

» Hermelinda - Assistance with next steps

I recently received teh following thyroid test
Thyroglobulin AutoAB 106 H
TSH .81
FT4 .92
FT3 2.33

my symptoms are foggy brain, ringing in my ears, tiredness, scant menstrual cycle, low estradiol, progesterone (menopause range), cold hands, pain in right side of thyroid and starting to feel fullness in neck. Right thyroid lobe larger than left and nodule found in left lobe.

This has been going on for about 4 years.

How do i determine what I have so I can start treatment?

-- posted by Hermelinda

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» Elaine Moore - Assistance with next steps

In response to Assistance with next steps posted by Hermelinda:
Hi Hermelinda,
Many doctors would start treatment with thyroid replacement hormone based on your actual thyroid hormone levels being borderline and your symptoms. Some doctors would also start you on replacement hormone to help reduce the size of your nodule.
TSH is a pituitary hormone that regulates thyroid hormone levels and also thyroid cell growth. The idea of using replacement hormone is to reduce TSH, which in turn, could reduce the growth of your nodule.

A good endo would also be suspicious of your TSH level since it's not as high as it ordinarily would be with borderline low thyroid hormone levels. This suggests two things: 1) you could have central hypothyroidism or thyroid hormone resistance as well as autoimmune hypothyroidism. In these instances, your pituitary doesn't respond to low thyroid hormone levels the way it should (by increasing TSH production). 2) you could also have blocking TSH receptor antibodies. These antibodies contribute to hypothyroidism in a condition known as autoimmune atrophic thyroiditis, and they falsely lower TSH levels. I explain how this occurs in my last reply (number 62 I think) in the Graves' disease discussion topic.

You might want to look for doctors that follow the views of Dennis Wilson in Wilson Syndrome or Broda Barnes or Dr. Shames. Many of these endos understand how lab results can be misleading.

A good endo would also have done a fine needle aspiration biopsy on your solitary nodule or at least performed repeat ultrasounds to see if there is an increase in size.

Hypothyroidism causes goiter as the cells enlarge in their efforts to trap more iodine and produce more thyroid hormone.
Best, Elaine

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» Hermelinda - Assistance with next steps

In response to Assistance with next steps posted by daisyelaine:
Thank you for the information. Is there a specific test I can request to rule whether I have Graves or blocking TSH receptor antibodies or autoimmune atrophic thyroiditis?

My endo did want to see me in 6 months to evaluate my nodule. She thought it was too small to perform needle aspiration.

hermelinda

-- posted by Hermelinda

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» Elaine Moore - Assistance with next steps

In response to Assistance with next steps posted by Hermelinda:
Hi,
You can have a test for blocking TSH receptor antibodies using the thyrotropin (TSH) blocking antibody (TBA) test. Or you can have a total level of TSH receptor antibodies, which measures the total of both stimulating and blocking TSH receptor antibodies. If you're hypothyroid you shouldn't have stimulating antibodies. Blocking antibodies are usually the culprit in atrophic thyroiditis.
I'm glad you're having your nodule re-evaluated in 6 months. Best, Elaine

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» jamyrogers - I agree, where do we start

I have had Hashi for a few years. Now my tsh receptor antibody of TBII is 20, o-14 range. Friedman, my Dr is lowering thyroid meds to keep me in line range wise, but I have a rage inside that keeps exploding. I feel bad and my eyes hurt. He doesn't seem worried about the Graves but my friends that have kived through this say it creeps us then slams you. What do you say?

-- posted by jamyrogers

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» Elaine Moore - I agree, where do we start

In response to I agree, where do we start posted by jamyrogers:
Hi,
I agree with those who feel that hypothyroidism should be avoided at all costs because the thyroid gland steps up its activity in an effort to prevent hypothyroidism when it threatens. This increased activity includes increasing cell size to trap more iodine (which causes goiter) and increased thyroid antibody production.
The antibodies, in turn, work to either promote inflammation, destroy the gland, or in the case of blocking antibodies, they prevent TSH from reacting with the thyroid cell receptors.
I'm more inclined to follow the guidelines showing that symptoms are the most important indicator of thyroid status. Lab tests are good guidelines, and in this sense FT4 is the best thyroid function test although if FT4 is prevented from reacting with your body's cells, even this level can be misleading.
Those of us who've become hypothyroid after ablation for hyperthyroidism often talk about Graves' rage. The only times I've had Graves' rage were when I was hypothyroid. Studies document that the sudden swing from hyper to hypo is likely to bring on violent mood swings. I can vouch for this. Best, Elaine

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