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Low TSH, Normal T4, T3, Free T4, positive for TPO
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Low TSH, Normal T4, T3, Free T4, positive for TPO

I have had constantly low TSH for the past year now.  My T4, T3 and free T4 are all normal.  My TSH is now .20.  My doctor ran TPO which was positive but thats all I was told.  One of my doctors thinks this needs to be fixed (family doctor), while another one of my doctors (GYN)says there is nothing wrong.
Help?  Not sure which one to believe or what further tests need to be done.  Also, I have low potassium, not sure if that matters.  Any thoughts on this would greatly be appreciated.
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97953_tn?1193367871
No treatment needed at this time.  The positive TPO means you have auto-immune thyroid disease. The low TSH means slightly over-active thyroid.  Would monitor thyroid function every 3 months or as symptoms indicate.  Also would do thyroid ultrasound.  Repeat potassium -- if still low, may need further eval -- but this is rarely linked to thyroid dysfunction.
6 Comments
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Avatar_n_tn
Thank you for your replies.  I thought I had a T3 but after reviewing the labs I have not.

TSH - .20  (.318 - 5.903 normal range)
FT4 - .85  (.58 - 1.65   normal range)
T4  - 7.50 (6.09 - 12.23 normal range)

My symptoms over the past year have been : can't sleep I have been on 3 different RX sleep aids, now on Halcion.  I stay tired all the time, for the past 2 weeks my temp has been in the upper 99's when my temp is usually 97 or right at 98.  I have arm cramps which is why I was tested for potassium and found it was low.  I have borderline glaucoma so my visual field tests are always abnormal.  I forget things a lot. But I blame that on stress.
Thank you again for replying to my questions.

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Avatar_n_tn
Although your TSH is suppressed, it looks to me like your Ft4 and Ft3 are a bit low. The NACB website PDF, page 36, second paragraph says the Ft4 needs to be in the upper 1/3 of the range.
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Avatar_n_tn
Correction, I did not see that you had no Ft3. Please accept my apology for this mistake.
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Avatar_n_tn
TPO is a huge sign.  Because of symptoms, I would listen to your family doctor.  Or find a doctor at acam.org for a third opinion.  There may be an adrenal factor to consider.
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Avatar_n_tn
Since my last post I had a radioactive thryoid scan.  Results were highly hyperthyroidism.  I have been given the options of radioactive pills that will kill the thyroid completely and make me hypo and I will not be able to be around my children or anyone else for 4 days. Or I can have it surgically removed. Which would require an overnight hospital stay.
Which one is safer and more used?  If anyone could tell me the pros and cons of both that would be great.  I am having a major surgery in December and cannot have it until this is taken care of because of thyroid storm which I know nothing about.  I would really appreciate anyone's thoughts on this as I am having a hard time making a decision.
I have a 2 year old son that I haven't been away from for more than 24 hours so that kinda of makes me lean to surgery.
Thanks
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97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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