Do I have Graves?

[kvmj]

These tests were done October, 2017 after being taken off Methimazole for 8 weeks.

Dexamethasone, Serum 195 (ng/dL), Adults baseline: <30

ACTH, Plasma 1.7 L, 7.2-63.3 (pg/mL)

Cortisol - AM 0.9 L, 6.2-19.4 (ug/dL)

DHEA-Sulfate 25.3, 20.4-186.6 (ug/dL)

Calcium, Serum 9.4, 8.7-10.3 (mg/dL)

Vitamin D, 25-Hydroxy 47.9, 32.0-100.0 (ng/mL)

Protein Electrophoresis, Serum: Protein, Total, Serum 6.9, 6.0-8.5 (g/dL)

Albumin 3.7, 2.9-4.4 (g/dL)

Alpha-1-Globulin 0.3, 0.0-0.4 (g/dL)

Alpha-2-Globulin 0.9, 0.4-1.0 (g/dL)

Beta Globulin 0.9, 0.7-1.3 (g/dL)

Gamma Globulin 1.0, 0.4-1.8 (g/dL)

M-SpikeNot Observed

Globulin, Total 3.2, 2.2-3.9 (g/dL)

A/G Ratio 1.2, 0.7-1.7

Tests performed July, 2017 while on 10mg Methimazole daily:

RBC MORPHOLOGY: PLT ESTADEQUATE, ANISO1+, 1+ Ovalocytes A, NONE SEEN

Thyroid Stim Immunoglobulin 37, 0-139 (%)

Thyrotropin Receptor Ab, Serum 0.64, 0.00-1.75 (IU/L)

Thyroid Peroxidase (TPO) Ab 17, 0-34 (IU/mL)

Thyroglobulin Antibody <1.0, 0.0-0.9 (IU/mL)

I have 2 nodules on the right hand side of my thyroid which, if ablated, would cure me. I have not been offered an ablation, however. Instead, I have been strongly encouraged to take the radioactive iodine. I am currently on 10 mg. of Methimazole.

Currently: TSH <.01, .34-5.6, T4 .93, .58-1.64, T3 4.5, 2.5-3.9

Thanks for your input.

[humanbean]

Cortisol - AM 0.9 L, 6.2-19.4 (ug/dL)

Can you remember what time of day your blood sample was taken for the above tests?

if it was quite early - around 8am - 9am - then your cortisol level suggests you have severe adrenal insufficiency. This is a serious condition and would require you to get properly tested and treated as soon as possible, because (depending on the cause of your condition, which might not be Addison's Disease - there are other possibilities) an illness or a sudden shock or an accident could cause you to go into something called an adrenal (or Addisonian) crisis.

en.wikipedia.org/wiki/Adren...

en.wikipedia.org/wiki/Addis...

en.wikipedia.org/wiki/Adren...

Your original question was "Do I have Graves'", and as far as I can tell the answer is no. But with your adrenal problems I don't know what other test results could have been affected by the adrenal insufficiency.

See a doctor to discuss your results, and ask why your cortisol result didn't trigger any investigations. Insist on being properly tested and investigated.

[humanbean in reply to humanbean]

Hidden knows more about cortisol problems than me. She may be able to help, if she is around.

P.S. I've just noticed your ACTH is very, very low too, and this is also a seriously worrying result!

P.P.S. In your shoes I wouldn't suggest agreeing to RAI while your cortisol and ACTH levels need such urgent investigation. Once your adrenals and/or pituitary are adequately investigated and treated you won't know what effect that will have on anything else. So don't make any sudden decisions on permanent treatment for your thyroid. You shouldn't be forced into taking RAI anyway.

[kvmj in reply to humanbean]

Thanks for your thoughts on RAI. They made it sound so simple, but I've read about a lot of problems from people who took that route.

[kvmj in reply to humanbean]

The tests that I took in July were done in the afternoon. The ones I took in October were done fasting at about 8 am. I was pretty close to dead in March of last year. I was aware that I was tachycardic for a long time and ended up with congestive heart failure and A-fib. From the first of March til the middle of April I took prednisone. I saw steroids listed as a cause of adrenal insufficiency. Then again, 6 months had passed before these tests were run.

I have been seeing an endocrinologist. I brought up my cortisol level and he dismissed it as nothing serious. He's the one who told me I have Grave's. It's been a year or better since these tests were run. Maybe they should be run again.

We don't have enough endocrinologists where I live and it's hard to even get an appointment with him much less talk with him.

[Angel_of_the_North in reply to kvmj]

Your antibody results suggest that you don't have Graves, but I would be concerned about the cortisol and ACTH results.

[humanbean in reply to kvmj]

I have been seeing an endocrinologist. I brought up my cortisol level and he dismissed it as nothing serious. He's the one who told me I have Grave's.

An endocrinologist who dismisses a cortisol result that is massively under range and who diagnoses Graves' Disease when all your antibody test results are in range is not worth seeing. Just because your TSH is low doesn't mean you have Graves' Disease. You could be hyperthyroid for other reasons - your nodules are a possible cause for your over range T3, and this would then lead to the low TSH. And hyperthyroidism is NOT always the same as Graves' Disease. See this link.

tpauk.com/main/article/caus...

Currently: TSH <.01, .34-5.6, T4 .93, .58-1.64, T3 4.5, 2.5-3.9

TSH < 0.01 (0.34 - 5.6)

T4 0.93 (0.58 - 1.64)

T3 4.5 (2.5 - 3.9)

I can't tell from the results you've given whether they are Total T4 or Free T4 and Total T3 or Free T3.

Total T4 and Total T3 are really not very informative. Free T4 and Free T3 are far more helpful.

[kvmj in reply to humanbean]

Free T4 and Free T3 have never been tested. Anything else that I should ask to have done? (This forum has been invaluable.

[humanbean in reply to kvmj]

If you read the first two posts in reply to this thread it gives you a list - the same list applies whether you are hypothyroid or hyperthyroid :

healthunlocked.com/thyroidu...

I would also suggest getting more information on your iron levels - it doesn't appear to have been tested in any way at all. The four iron tests required are mentioned in the next link.

A more expensive and extensive list can be found here :

stopthethyroidmadness.com/r...