Help with results

[ICE187]

This is a female friend of mine. She is in her 30s. She has had a large goiter for 2 years along with a lot of hypo/hyper symptoms. 2 years ago, a doctor wanted to remove her thyroid, but she freaked out and refused. Now, her goiter is much larger. Her new doctor said he doesn't see anything wrong with it. These are her recent test results. I hope they are clear enough to read. Any info would be greatly appreciated. No other blood tests or imaging was done. She has severe sweating issues, weight loss, increased appetite, pains, fatigue, depression, mood swings, splitting nails and more.

[PurpleNails Administrator]

That’s little hard to read clearly.

Might be easier if you write out results including ranges.

Does the size of thyroid impact breathing, swallowing, voice of cause pain? I think she needs a scan.

Thyroid surgery is usually suggested if the thyroid hyper functions or physical size impact health.

I see TSI was tested was this over range?

The symptoms sound hyper.

[ICE187 in reply to PurpleNails]

TSI looks to be 89. 140% baseline. That was the copy she texted me. I just asked her for a better picture. She does have issues swallowing and her voice is raspy.

[PurpleNails Administrator in reply to ICE187]

Well 140% of baseline suggest that 40% above the max range. Or a 140% increase in comparison to a previous result - but this is not a normal way of presenting & interpreting results. Not one I’m familiar with.

TSI usually have a upper expected limit eg Range <0.56) or (0 - 0.56) below is negative - above is positive.

A positive level would confirm autoimmune condition called Graves and that can cause prolonged period of hyperthyroidism. It can also wax and wane so it possible to go in remission (function normally), then for example stress can trigger it again.

Did she have thyroid function tested 2 years ago? does she know if the function was normal when investigated before? Has she ever had anti thyroid medication?

[ICE187 in reply to PurpleNails]

She has never had anti thyroid meds. 2 years ago, her doctor never mentioned any blood results. He biopsied her thyroid and said he needed to drain it. He drained it and her thyroid gland grew larger. He wanted to remove it then. Sounds strange to me that now that her thyroid is much bigger, it looks normal to a new doctor. Just looking at her when she swallows, you can clearly see it. When she tilts her head back, it looks like a baseball moving up and down.

[Angel_of_the_North in reply to ICE187]

It says LESS THAN (<) 140% baseline, so perhaps they don't do anything until it exceeds this.

[ICE187 in reply to PurpleNails]

TSI <89. (140% baseline)T3 free 3.2 (2.3-4.2) range.

Thyroid Peroxidase 1 (<9 iu)

Thyroglobulin Antibodies <1 (< or =1 iu)

T4free 1.1 (0.8-1.8)

TSH 0.96 no range given.

[PurpleNails Administrator in reply to ICE187]

Sounds like cystic nodule? The fluid is drained and cells tested. Thyroid cysts have high probability of refilling with fluid and nodules can grow quite fast.

From your description of movement when swallowing it sounds like thyroid nodule. I have a colloid hyper nodule and the description is exactly how I would describe it.

Was the biopsy not carried out under ultrasound? Were the biopsy results not discussed?

The doctor is saying no issue with thyroid as TSH, FT4 & FT3 are all in range.

I think the antibodies are not reported correctly. Those ranges for TPO & TG do not look right. Very low.

[ICE187 in reply to PurpleNails]

No ultrasound. She has been going from doctor to doctor trying to get answers. I agree with the antibodies. It looks strange to me.

[SeasideSusie Remembering in reply to PurpleNails]

PurpleNails

I think the antibodies are not reported correctly. Those ranges for TPO & TG do not look right.

We have seen those TPO and Tg antibody ranges before, they are not UK ranges. The OP is in the US so possibly the friend is as well, but wherever the friend is based then those ranges would be correct.

[PurpleNails Administrator in reply to SeasideSusie]

I understand that ranges vary

I did not understand the TSI <89. (140% baseline). Can anyone explain further?

Thyroid Peroxidase 1 (<9 iu)

if range is <9 and result is 1 — it would be a negative result.

Or Is the result <9 (which I’ve seen many times as test minimum) and range possibility missing? (& 1 is the number of results)

Thyroglobulin Antibodies <1 (< or =1 iu) Strange to have a range of 1 but test not able to read below 1.

The ranges & results aren’t clear.

[SeasideSusie Remembering in reply to PurpleNails]

PurpleNails

I did not understand the TSI <89. (140% baseline). Can anyone explain further?

I've not seen that before and don't know anything about TSI antibodies and ranges, so can't work that one out.

Thyroid Peroxidase 1 (<9 iu)

if range is <9 and result is 1 — it would be a negative result.

That's what I understand and I'm sure that's correct.

Or Is the result <9 (which I’ve seen many time as test minimum) and range possibility missing? (& 1 is the number of results)

No, I believe 1 to be the result and <9 to be the range, the <9 is in brackets which is how ranges always tend to be shown.

Thyroglobulin Antibodies <1 (< or =1 iu) Strange to have a range of 1 but test not able to read below 1.

I agree, certainly not as clear as the way UK results/ranges are shown.

[ICE187 in reply to SeasideSusie]

Yes, she is in the U.S. I had sent her the info you all have provided. You are all awesome.

[SlowDragon Administrator]

She needs vitamin D, folate, ferritin and B12 levels tested

Low vitamin levels common with thyroid disease

[ICE187 in reply to SlowDragon]

I told her to get this test done.

[PurpleNails Administrator]

I found this walkinlab.com/products/down...

To convert to nmol/L, multiply the result by 18.5.

TSI (THYROID STIMULATING

EZ IMMUNOGLOBULIN)

TSI

<89

<140 % baseline

Thyroid stimulating immunoglobulins (TSI) can engage the TSH

receptors resulting in hyperthyroidism in Graves' disease

patients. TSI levels can be useful in monitoring the

clinical outcome of Graves' disease as well as assessing the

potential for hyperthyroidism from maternal-fetal transfer.

TSI results greater than or equal to (>=) 140% of the

Reference Control are considered positive.

So look like negative TSI result <89 being test minimum.

It’s calculated by lab as %. (Just to confuse us)

[helvella Administrator Thyroid UK in reply to PurpleNails]

I've got a section on various calculators which cover a wide variety of requirements in my Vade Mecum.

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Nor by the fact it is targeted at people interested in thyroid issues. Much of its contents could be of use to many involved in health issues. Things like abbreviations, lists, general reference information.

In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.

If there is anything you'd like me to add, let me know.

Not everything is in this one document - my major medicines document is still separate!

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1P9...

[Suecoo66]

She should ideally have an ultrasound on it

[ICE187]

Thank you all for the help.