extremely HIGH T3 with NORMAL TSH & NORMAL T4 presented with a thyroid nodule & both hyperthyroid AND hypothyroid symptoms

[katherine636]

For the past 10 years I have suffered from numerous hypothyroid symptoms including constant/extreme fatigue,depression,insomnia,cold intolerance(esp in hands&feet)low body temp,low blood pressure,muscle/joint aches,dry eyes,eye pain with bright lights,memory loss,brain fog,ADD,dry skin,hair loss,etc- I was diagnosed with fibromyalgia, adrenal fatigue &"subclinical hypothyroid" Rx:sleeping pills(for insomnia),small amount of Adderall(in order to function) and a SNRI(for pain and depression)

All my thyroid tests(TSH,T4,T3)always came back normal so I never took any thyroid medicine. Past labs also showed extremely high Cortisol serum level & extremely low Serotonin(not sure of current level)

2 months ago my symptoms worsened(esp depression,insomnia,muscle aches,painful cold/tingling hands&feet-in summer!)+New increased appetite,huge increase anger/emotional upset,trouble swallowing/lump in my throat & chest pains.Dr found enlarged thyroid/nodule,heart arrhythmias,palpitations & mitral valve prolapse(from EKG)

LABS:NORMAL TSH-NORMAL T4-VERY HIGH T3 (Dr repeated labs3x)assumes its a "hot"AFTN (Dx only from TSH/T3/T4 labs) He wants RAI scan I-123 (NOT a RAI uptake scan) so he can verify that its a "hot" autonomous nodule-but I have read that there must be low TSH levels to have an AFTN(my TSH normal past 6months 3/09:1.43 7/09:2.93 8/09:1.84 the numbers changed but might be the different labs used)

Is it common that I still feel all of the hypo symptoms with high T3? I ordered my own thyroid Ab tests-TSHrAb,etc)Dr didnt think were important but I prefer confirmations over guesses so wanted to check for any autoimmune issues/antibodies or possibly pituitary issues/adenoma? Any thoughts on that? Also could the fact I took the birth control pill(Yaz)for years & stopped 3.5 months ago(after reading all the new lawsuits against Yaz) contribute to this in any way?

I am SO GRATEFUL for any advice or insight you might have! Thank you!!!
Katherine (age 34 female)

[Mark Lupo, M.D.]

I meant unclear exactly what kind of thyroid problem -- ie thyroiditis vs hot nodule vs graves vs abnormal labs of uncertain significance......vs possible pituitary issue....

would see an endocrinologist to sort this out.  It is an unusual situation to have consistently normal TSH/T4 and high T3.  

[Mark Lupo, M.D.]

This is a complicated situation - it is unclear if you really have a thyroid problem and I recommend working with an endocrinologist to sort all this out.  Would measure T3 as a free T3 to exclude possibility of binding from estrogen (even though the yaz should be out of system).  This does not seem pituitary.  The I-123 scan is helpful ONLY if the biochemistry shows clear hypERthyroidism.  you cannot have both hyper and hypo at the same time and the symptoms of both are very non-specific so a person can have many of the symptoms (of both) and not have a thyroid problem. The TSH-R-Ab is a good idea, as would be thyroid ultrasound.  Good luck.

[katherine636]

Dr Lupo- Thank you very much for your reply. I am a bit confused as to why you said its unclear if I have a thyroid problem? If I have a large thyroid nodule protruding out from my throat and making it difficult to swallow & my recent labs of Total T3 AND FREE T3 are BOTH abnormally HIGH and my level of thyroglobulin is also abnormally HIGH doesnt that all add up to hyperthyroidism?  Wouldnt the HIGH T3 alone be enough to say my biochemistry IS showing clear hyperthyroidism? (if not than Im definitely confused with the definition of hyperthyroid) Yes, my TSH is normal and that is what is making this complicated... so maybe you are saying you cant be hyperthyroid with normal TSH? Have there ever been cases of HIGH FT3 with consistently NORMAL levels of TSH (not dropping) -does this occur in silent thyroiditis or any other condition?...that is what I am trying to figure out and why I asked if the pituitary could be involved?
With many thanks