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Thyroid (Expert Forum)
Could this be Graves? Opinion on TSI tests?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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Could this be Graves? Opinion on TSI tests?
by IrisT, Mar 20, 2007 12:00AM
Dear Doctor Mark:
Based on info below, my questions are:
1. In your opinion, could this be Graves disease? Possibly Silent Thyroiditis concomitant/moving into Graves? What points toward/against a Graves diagnosis?
2. Do you consider TSI-Ab definitive for Graves even if levels are under 125%? I've read conflicting info.
3. I've read in clincial literature that dopaminergic agents can affect T-hormone tests. Is it possible that the longtime medications I've taken, Wellbutrin and Adderall, both of which affect dopamine, might be skewing my tests numbers?
***PATIENT INFO***
Female, 41
History of depression (10+ years); Dx w/Adult ADD (~5 years); carpal tunnel (surgery, both hands); past history of anemia.
Daily Rx meds: Wellbutrin-XL 30 mg; Adderall-XR 20 mg.
Family history heavy in thyroid & autoimmune disease, including hypoT, Graves, Lupus, CFS, MS, Rhuematoid Arthritis.
Patient symptoms: goiter (painless), fatigue, low energy, low libido, dry skin, mild hair changes, pretibial rash/lesions (past 2+ years), recent menstrual changes (lighter flow), irritability, insomnia (trouble falling asleep), recent itchy rash on torso (6 weeks), recent eye changes: dry/gritty, light sensitive, and orbital protrusion (confirmed by doc).
GOITER INFO
Complex cold nodule left lobe, 1.9 x 2.8 cm.
FNA: "benign colloid adenomatoid nodule"
RAI-U (range 15-30%): 6-hr 8.9%; 24-hr 19.6%
All T hormone tests are Euthyroid (lab results below). Sorry post is so long, and thank you in advance for any response.
Based on info below, my questions are:
1. In your opinion, could this be Graves disease? Possibly Silent Thyroiditis concomitant/moving into Graves? What points toward/against a Graves diagnosis?
2. Do you consider TSI-Ab definitive for Graves even if levels are under 125%? I've read conflicting info.
3. I've read in clincial literature that dopaminergic agents can affect T-hormone tests. Is it possible that the longtime medications I've taken, Wellbutrin and Adderall, both of which affect dopamine, might be skewing my tests numbers?
***PATIENT INFO***
Female, 41
History of depression (10+ years); Dx w/Adult ADD (~5 years); carpal tunnel (surgery, both hands); past history of anemia.
Daily Rx meds: Wellbutrin-XL 30 mg; Adderall-XR 20 mg.
Family history heavy in thyroid & autoimmune disease, including hypoT, Graves, Lupus, CFS, MS, Rhuematoid Arthritis.
Patient symptoms: goiter (painless), fatigue, low energy, low libido, dry skin, mild hair changes, pretibial rash/lesions (past 2+ years), recent menstrual changes (lighter flow), irritability, insomnia (trouble falling asleep), recent itchy rash on torso (6 weeks), recent eye changes: dry/gritty, light sensitive, and orbital protrusion (confirmed by doc).
GOITER INFO
Complex cold nodule left lobe, 1.9 x 2.8 cm.
FNA: "benign colloid adenomatoid nodule"
RAI-U (range 15-30%): 6-hr 8.9%; 24-hr 19.6%
All T hormone tests are Euthyroid (lab results below). Sorry post is so long, and thank you in advance for any response.
Doctor's Answer
by Mark Lupo, M.D., Mar 20, 2007 12:00AM
, Mar 20, 2007 12:00AM
This is not hyperthyroidism -- ie consistently normal thyroid hormone and TSH levels.
The uptake is low-normal, suggestive against thyroiditis which has very low uptake.
I have not seen convincing evidence about adderall or wellbutrin causing thyroid problems.
One can have Graves with a normal TSI. But there is no current evidence that you have graves. Would add TBII as another antibody related to thyroid eye disease. All the other antibodies are negative.
The complex nodule appears benign, needs ultrasound observation.
Would test for other auto-immune issues as well -- ANA for starters.
The uptake is low-normal, suggestive against thyroiditis which has very low uptake.
I have not seen convincing evidence about adderall or wellbutrin causing thyroid problems.
One can have Graves with a normal TSI. But there is no current evidence that you have graves. Would add TBII as another antibody related to thyroid eye disease. All the other antibodies are negative.
The complex nodule appears benign, needs ultrasound observation.
Would test for other auto-immune issues as well -- ANA for starters.
MOST RECENT LABS--MARCH 2007:
TSH 0.95 (.4-5.5)
fT4 1.3 (.8-1.8)
fT3 275 (230-420)
T-3Uptake 31% (22-35%)
TPO-Ab <10 (<35)
Tg-Ab <20 (<20)
TSI-Ab 107% (<125%)
Additional tests for Calcium, Vit B-12, and Magnesium were normal/unremarkable; Iron Total was low-normal; Ferritin was LOW:
Iron Total 47 (35-175)
Ferritin 8 LOW (10-232)
PREVIOUS LABS--FEB 2007:
TSH 0.84 (.3-5.6)
FT4 0.9 (.6-1.1)
T3, Total 107 (60-181)
T4, Total 9.5 (4.5-12.5)
Reverse T3 0.31 (0.11-0.32)
Other:
Estradiol 155 (Testosterone 29 (20-76)
Progesterone 8.5 (3-28)
Cortisol 8.4 (3-17)
DHEA 145 (130-980)
Iodine 62 (40-92)
PREVIOUS LABS--FEB 2005
TSH 0.64 (.49-4.67)
FT4 1.2 (.7-1.9)
Estradiol 82
LH 3.93
THANK YOU, DR MARK!
Gratefully,
Iris