hypothyroidism or hyperthyroidism?

[comets]

I have been battling with several symptoms for about a year now. I have seen cardiologist, endocrinologist, neurologist, gestroenterologist, and ENT doctor. None one seem to able to figure out what is wrong with me. My symptom start with have this lump feeling in my throat and chest discomfort. I went to my PCP and she said it might be heartburn and ask me to take Prolisec. I took that but no improvement. Then one night I had palpitation with sweat and kind of a little shortness of breath. My parents took me to ER. And the ER doctor said I have a little low potassium, a little fever (about 101) and infection and also my TSH is very high about 13. The ER doctor diagnose me as hypothyoidism. He gave me some antiboidic for the infection but he said I have to go to see my PCP for the thyroid meds. Then I went to my PCP and also an endocrinologist, they want to test it again to confirm. Then my test come back normal T3 31 T4 total 7.9 Free T4 2.4 and TSH 2.02. They didn't test the antibody or give me any meds for it. Even if the blood test is normal, can I still have thyroid problem? Is there any other test to confirm? I heard hypothyroid usually have slow heart rate, but I have tachy. I also have chest pain and dry skin. I have done holter monitor, echocardiogram, and treadmill test with cardiologist to rule out heart problem. I also did CT chest scan came back normal. I did upper GI and endoscopy and that came back normal too. I went to the ENT doc use a camera insert to my nose, but there is no tumor in my throat. I am tired all the time, no apetite, lost some weight.

[comets]

Thanks so much for your input. I am going to find an endocrinlogist to test it again. I hope that will tell me what's really going on with me.

[criswatk]

Wow you have really been through a lot.  I am not an expert by any means but let me share you my experience.  My TSH is always deemed either normal or slighty hypo.  But I've had two Thyroid uptakes with a scan.  Both uptake results indicated hyperthyroid.  I have way more hyper symptoms (which is sounds like you have as well) than hypo symtems but the TSH does not indicate that I need to be medicated.  The endo said to me that I have Hashimotos (yes I was tested for antibodies and have them) and that it is classic Thyroiditis to have swings from hyper to hypo and confusing symptoms.  But he did not want to treat it because giving me thryoid replacement could send me into a situation where I was hyper for real which wouldn't be good and would  not show the real state of my thyroid. SO - it has been a very long process for me too.

[Mark Lupo, M.D.]

The best way to deal with a situation of an abnormal thyroid lab that becomes "normal" is to follow the labs every 4-6 weeks until a clear trend develops.  Ancillary info would include thyroid antibodies and thyroid ultrasound.  

I try to hold back with thyroid replacement (or anti-thyroid meds) in these situations until it is clear what the trend is doing as starting a med if the thyroid is swinging one way or another often worsens the situation.

The high TSH in the ER suggests hypothyroid.  The TSH of 2.02 is normal but the FT4 you mention is high (at least in my lab it would be).  So the key here is following the trend and working with an endocrinologist specializing in thyroid disease.