Tuesday, December 30, 2008

Blood Work, ER and More!

Last evening I decided to go to the ER. The pain started to move more to my back. The wait wasn't too bad despite how busy it was and I was happy with the doctor. At least he didn't call me a heroin addict!

Everything was checked. More X-rays, blood work, and an EKG. He said it was a muscle and to give it another 4-7 days to get better. That's what I'm going to do. I may even cancel my voice lesson for Monday. If it is a muscle apparently I really messed mine up. It has been 13 days today with this chest pain and it still hurts. At least I know it is NOT my lungs, a blood clot, heart problems or a broken rib. I am much more relaxed about it since I know I won't be dropping dead from it.

Today I got my blood work results from Dr. Goldstein and it is not good.
T4- 6.5 (lower than optimal but within lab normal range)
FT3- 2.6 (lower than optimal but within lab normal range)
TSI- <20 OK
TPOAb -<10 OK

With a completely clean thyroid ultrasound and this blood work, it looks like my pituitary isn't working. I'm not completely sure how it all works yet (still researching) but this will quickly cause my thyroid to become hypo. When a hypothyroid is caused by the pituitary it is called Secondary or Central Hypothyroidism. This is exceedingly rare, but with my history of diabetes insipidus doesn't really surprise me. I found a website that said, "Central hypothyroidism is a rare disorder with a prevalence of 0.0002% to 0.005%". If this is referring to the US population, (if I did my math right) that means 600-15000 people have been diagnosed with it. Remember diabetes insipidus is also rare at about 1 in 25,000 people. That is about 12,000 people in the general public. For comparison, primary hypothyroidism (including the autoimmune ones) has a prevalence of 0.8% or about 2.4 million people.

There is another test that can be performed to accurately diagnosis this and that is called a thyrotropin-releasing hormone stimulation test. This will help to distinguish between tertiary (hypothalamus defect) or secondary (pituitary defect) hypothyroidism. An absent or blunted response means secondary. An exaggerated response means tertiary. I don't know if Dr. Goldstein is up for this challenge. I will also need EVERY pituitary hormone checked including LH, FSH, ACTH, PRL, GH etc. Since I had a MRI back in February, I'm not concerned about a tumor. However this does worry me a little because the part of the pituitary that controls the anti-diuretic hormone is on the opposite side where TSH is controlled. That means my entire pituitary gland is being affected. Either it is a large tumor or the mercury after all.

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