Overactive despite 'normal' TSH levels?

[roxydoggy]

Hi everyone,

I'm a 22 year old female who lives a pretty healthy lifestyle – eat pretty well and was going to the gym 5 times a week.

I have had heart palpitations (ectopic beats) for five years now but the docs have checked out ECGs and blood tests and said I'm fine – my TSH levels were always a little hypo (around 6) but not high enough for any medication and I felt good, give or take the palpitations.

Eight weeks ago I was at a spinning class after a two week break. My heart rate suddenly shot up to 200bpm and was flying up and down from 90 to 180 and back down again. I felt like I was going to pass out and my limbs went numb. Long story short: paramedic called an ambulance, went to hospital, normal ECG, normal bloods, normal chest X-ray – just a high heart rate of 140/150bpm that wouldn't come down for 4 hours until I took beta blockers prescribed by doc.

I had several more of these episodes, two more times were pretty bad where I went back to hospital. The most recent time concerned them so they kept me in for two days. Anyway, bloods, ECG, echocardiogram looked normal, as did the 7 day cardiac monitor I'd had on so they let me go home. The 7 day cardiac monitor showed a heart rate of 190bpm at one point (I hadn't exercised), but it was normal sinus rhythm.

I've been so unwell the last eight weeks since the first episode. Fast heart rate in the mornings when I wake up (I'd say around 130bpm), episodes of fast heart rate, very fatigued, weight loss of 7kgs (15 pounds), swollen throat, weird tightness across my back... the list goes on!

So my TSH levels were always sub-clinical hypo, but since I've been unwell my TSH levels have been 'normal' on two occasions – once was about 1 and once was about 2.

I did ask for my T3 and T4 levels to be checked out but since the TSH levels were normal the lab refused.

Could I have hyperthyroidism or perhaps thyroiditis of some sort even though my TSH levels are considered normal? Is my 'normal' a little hypo and now the TSH levels have gone down I'm feeling unwell?

Thank you so much in advance for your help.

Lara

[roxydoggy]

That's really helpful, thanks!

[gimel]

Based on what I read in this link, there may be some connection.  

http://www.mdjunction.com/forums/hypothyroidism-discussions/general-support/2848243-swollen-lymph-nodes-sore-throat-dying-thyroid

[roxydoggy]

Thank you so much for getting back to me.

My GP is pretty useless but I'm seeing a really great cardiologist next Wednesday so hopefully he can put me in for the tests I need.

Can the swollen glands be related to the thyroid? I'm confused because all of my blood tests have shown no infection. I've also got a weird little lump right underneath my chin on my neck – seems a bit far away from my thyroid gland to be connected?

Thanks again.

[gimel]

I was going to ask since when did labs make decisions about whether or not to do certain tests, instead of a doctor.  Then I noticed that you were in the UK, and I now understand.  It is very unfortunate for UK patients that the NHS has taken the position that TSH is the only test required to evaluate thyroid status.  Worse is their position on when to treat.  

If you have the time and interest you might get some good insight from this link to a presentation to the Scottish Parliament, in support of some petitioners who were not satisfied with the NHS protocol for diagnosis and treatment of hypothyroidism.

http://www.scottish.parliament.uk/S4_PublicPetitionsCommittee/General%20Documents/PE1463_C_Dr_Henry_Lindner_07.03.13.pdf

You might also be interested in this advice given by a fellow UK member who was finally successful in getting the necessary testing and treatment after much frustration with the NHS usual approach.  

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

So, in your case you need to be very assertive in telling the doctor that you have gone through very threatening conditions with your pulse rate going sky high.  You have other symptoms that are frequently related to hypothyroidism.  Your TSH has gone from 10 down to 1 and 2.  All these things point to the possibility of having thyroid problems and that you need to be thoroughly evaluated.  You need to be tested for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and Total T4), along with TSH.  You also need to be tested for the possibility of having Hashimoto's Thyroiditis.  Two tests are required for that, Thyroid Peroxidase antibodies and Thyroglobulin antibodies.   Those are frequently listed as TPO ab and TG ab.  In view of your TSH fluctuating so much, it would also be a good idea to do an ultrasound test on  your thyroid area to check for nodules.  

Only by pushing the doctor to get these tests done will you be able to adequately diagnose what is going on with your health.