A problem has come up where one testing lab has different results on
some antibody tests from those of another lab. What is the
appropriate interpretation of contradictory lab tests? As a result,
I’ve got two different diagnoses, and I’m not sure how I should
procede now.
background: I’ve been followed for some time by an internist for a
case of thyroiditis. Though my symptoms have receded, my thyroid
antibodies remain slightly elevated (though far from the maximum), so
he checks them periodically as well as checking physical symptoms and
thyroid enlargement. In the five tests I’ve had in his office, my
antithyroid globulin went from negative (when I first came in) to
1:125 and now is around 1:320, and microsocomal antibodies have been
negative, negative, 1:400, negative, 1:400. TSI, the times it was
tested, was 1:100 and 1:109. Initially, with the negative antithyroid
globulin, he thought it was a viral cause, but now he thinks there is
a long term low-level damage going on that will ultimately lead to
something like Hashimoto’s. Thyroid function itself has been normal,
since my first visit to his office was after my hyper symptoms were
gone (except for the enlarged thyroid).
Two months after my last set of tests, I went to an endocrinologist I
knew for a second opinion (my parents were pressuring me to get one)
about where to go next. The problem is that his lab found no
elevation of thyroid antibodies.
I’d be glad to have this problem fade away (though I’m still perturbed
by the lump & pain in my throat), but he felt that was not what was
happening. He thinks my previous positive results (four positive
tests over the previous year) are lab error. He felt no enlargement
and felt my previous hyper symptoms were simply transient (as the
internist first thought).
He said that thyroid antibodies, once positive, should remain positive
and not fluctuate or go negative. Ignoring his negative results, even
with my previous tests, the microsocomal antibodies are inconsistent
— once turning positive (the third test) they should not have been
negative (fourth test) and then positive again.
At this point I don’t know which lab I should believe, and I don’t
know if I have a continuing thyroid problem that should be followed,
or not. Are the previous postive tests just noise-level fluctuations
(since the maximums of these antibodies are in the thousands)? Are
the levels so low as to be insignificant and effectively negative?
Can measurement of these levels (which cost a few hundred dollars a
hit) be prone to such error? Or do thyroid antibodies actually
exhibit this kind of fluctuation?
Also, I’m reluctant to get into a war of the experts on this. The
internist, who I’ve known for several years, seems to be a supurb
diagnostician and quite on top of everything (I check out everything
he tells me in medical books and on medline). He ran one of the
services at ucla previously and so seems to be well known and
respected in the community. However on the surface of it, the
endocrinologist (who it turns out had been a resident under the
internist) would seem to be the one to go to for thyroid problems.
The endocrinologist, I could tell, did not feel completely at ease and
was somewhat guarded in discussing the interpretations with me, in the
same sentence telling me what a great physician the internist was, but
that his results were wrong, and so there is already some impaired
communication going on. Does it just boil down to how good their
respective labs are?
Any advice observations, information, or advice welcome. Thanks,
Margot Flowers
Flow…@CS.UCLA.EDU
…!(uunet,rutgers,ucbvax,randvax)!cs.ucla.edu!flowers
In article <1991Aug12.214132.2…@cs.ucla.edu> flow…@lanai.cs.ucla.edu (Margot Flowers) writes:
>background: I’ve been followed for some time by an internist for a
>case of thyroiditis. Though my symptoms have receded, my thyroid
>antibodies remain slightly elevated (though far from the maximum), so
>he checks them periodically as well as checking physical symptoms and
>thyroid enlargement. In the five tests I’ve had in his office, my
>antithyroid globulin went from negative (when I first came in) to
>1:125 and now is around 1:320, and microsocomal antibodies have been
>negative, negative, 1:400, negative, 1:400. TSI, the times it was
>tested, was 1:100 and 1:109. Initially, with the negative antithyroid
>globulin, he thought it was a viral cause, but now he thinks there is
>a long term low-level damage going on that will ultimately lead to
>something like Hashimoto’s. Thyroid function itself has been normal,
>since my first visit to his office was after my hyper symptoms were
That’s good, but be aware that you can have thyroid problems that
don’t show up on these antibody tests. I won’t go into details here,
but I was such a person for years–normal T4/T3s, no energy, for
20 years after diagnosed mixed Graves/Hash and transient treatment
with Tapazole(antithyroid) and synthroid. What’s helped? Too complex
to go into here. But watch the situation and watch your subjective
sx.
>gone (except for the enlarged thyroid).
did you evever hear a dx of Graves from any of them?
>by the lump & pain in my throat), but he felt that was not what was
>happening. He thinks my previous positive results (four positive
>tests over the previous year) are lab error. He felt no enlargement
>and felt my previous hyper symptoms were simply transient (as the
>internist first thought).
What is "transient"? This whole PP doesn’t sound right. Four
false positive tests?? Yes, labs are different. But why doesn’t
the endocrine guy run HIS tests over a couple times?
>He said that thyroid antibodies, once positive, should remain positive
>and not fluctuate or go negative.
That’s not my experience, or the experience of a lot of
people I know who have thyroid disease.
>Also, I’m reluctant to get into a war of the experts on this. The
>internist, who I’ve known for several years, seems to be a supurb
>diagnostician and quite on top of everything (I check out everything
>he tells me in medical books and on medline). He ran one of the
>services at ucla previously and so seems to be well known and
>respected in the community. However on the surface of it, the
>endocrinologist (who it turns out had been a resident under the
>internist) would seem to be the one to go to for thyroid problems.
>The endocrinologist, I could tell, did not feel completely at ease and
>was somewhat guarded in discussing the interpretations with me, in the
>same sentence telling me what a great physician the internist was, but
>that his results were wrong, and so there is already some impaired
It really does sound political to me. Suggest you get a third and
fourth opinion. Important thing *may* possibly not be what the
MD is ‘called’ (endocrine or internist) but yrs of experience in
dx and with this sort of illness. I don’t have much desire to go
to a (<35 or 40 yrs) young physician for this sort of complex
problem. Realize that endocrinology is really not well understood.
What you have is really immuno-endocrine = two poorly-understood,
just-beginning-to-be-explored fields. Why they call it the
practice of medicine, and all that.
I mean, center yourself in your body experience. Do you feel OK?
Tired/depressed/sleepy/foggy/constipated/dry skin/overweight/etc?
Or the opposite? If you feel OK, why bother with it all. Don’t fall
into the trap that Western medical types sometimes do, of using
lab tests to DO the dx instead of *guiding* the dx. The only
point of all this medical treatment is to feel OK and be alive.
In article <26…@well.sf.ca.us> ath…@well.sf.ca.us (Susan Nordmark) writes:
>In article <1991Aug12.214132.2…@cs.ucla.edu> flow…@lanai.cs.ucla.edu (Margot Flowers) writes:
>>He said that thyroid antibodies, once positive, should remain positive
>>and not fluctuate or go negative.
>That’s not my experience, or the experience of a lot of
>people I know who have thyroid disease.
I’ve got a different question about how to interpret and handle
inconsistent lab results. I’m still curious for more information
about the accuracy of antibody tests and whether or not thyroid
antibodies can go negative after being positive, but here’s the same
problem in a new area:
Can severe allergies go away? Now I’m being told I’m not very
allergic to bees even though several years ago I ended up in the
hospital with severe beesting reaction and subsequently tested as
dangerously sensitive to beestings and yellowjackets. More recently I
decided to look into desensitization (because my house is surrounded
by yellowjackets), and an allergist gave me the set of sensitivity
tests again (bees, yellow jacket, white-faced wasp, yellow-faced wasp,
and something else). This time I tested sensitive only to one of the
wasps, even though to my knowledge I’ve never been stung by a wasp to
develop sensitivity. In spite of my previous beesting reaction (I
brought in copies of my records), this allergist said I was not
sufficiently sensitive to beestings or or yellow jacket stings to
warrant desensitization. Can allergic sensitivity change this
drastically or are these tests subject to major error?
Thanks for your help,
Margot Flowers
Flow…@CS.UCLA.EDU
…!(uunet,rutgers,ucbvax,randvax)!cs.ucla.edu!flowers