I am a 35 year old male with many symptoms consistent with hyperthyroidism. I am frustrated with still no diagnosis yet from my physician as labs keep coming back normal. Symptoms are feverish (hot facial feeling), nervousness, anxiety, fatigue, loss of appetite, widespread muscle cramping and parasthesia, and fasciculations, and occasional heart palpitations to name a few. It feels like I am jittery all of the time and my nervous system is amped up. When this first occurred 5 years ago my bloodwork showed my TSH and T4 levels were 2.27 and 1.18 respectively, well within range. I have always thought and still do that this is an endocrine issue, probably thyroid related. Symptoms have gotten better and worse over years and even went 6 months mostly symptom free. 1) How accurate is the test and is it possible to have hyperthyroid with normal TSH & T4 results? 2) Are there any possible differential conditions that could explain these symptoms?