Blood Test "Normal" with Hyperthyroid symptoms

[HelpfulHusband]

My Wife was treated diagnosed with and treated for Grave's disease about 2 years ago. She came off her medication (methimazole) due to an apparent remission (she started experiencing hypo symptoms that disappeared after going off medication).

For about the past 18 months of being of meds she's felt fine.

We recently moved, and her symptoms started back up (early Dec)
- Weight loss (~10 lbs)
- Depression
- Anxiety
- Irritability
- Mood Swings
- Fatigue
- Achy joints
- Nausea (including vomiting a few times).
- Slightly distended right eye (though this could be left over from her first symptoms/treatment)


The numbers the nurse just confirmed over phone (two tests):
FT3 - 100 (60-181) - Dec 16
TSH 1.07 (.35 to 5.5) - Dec 23

After getting a second blood test run, her Endo has stated that she doesn't have thyroid issues anymore based on the tests. Hurray!

Except all the symptoms are still here and she's extremely frustrated (as am I). Any ideas for next steps? I've got a call in to our Endo for advice, and we'll be looking for a new GP (we're new in town).

[goolarra]

TSI really should not be that high.  My endo has said that he likes to see TSI in the 40-50 range before he says "remission".  However, you have also been through a stressful time, so the antibodies could also go back down once your lives calm down again.  However, in the meantime, I think it's worth doing some more testing.  Let me know how it goes...

[HelpfulHusband]

The T3 was quoted by whoever answered the phone when I called (not sure if it was receptionist or...?). I don't see any numbers or references that line up to that T3 100, so not sure what they were talking about.

Your last comment though makes a lot of sense and is helpful though...she went into remission a little under 2 years ago so if it's coming back she is certainly due. We've got another doctor lined up so I'll try and make sure he's willing to retest the full spectrum so we can get some trending as you suggest. She's been very day-to-day so to me as a lay-person it would make intuitive sense at least that she could be pre-"grave's relapse" and starting to show symptoms.

Appreciate everyone's help...if nothing else than a sanity check that her long list of thyroid-esque symptoms could be thyroid symptoms even if our doctor says she is "normal".

[HelpfulHusband]

Sorry - I either misheard or was misquoted by the PA over the phone...T3 was not tested. The results I posted yesterday are the full results we got round one. The only thing tested the second round was TSH which came back a little bit higher (~1).

[goolarra]

I agree that TSI is relatively high.  Although the reference range on the test is 0-122, the fact of the matter is that people who don't have Graves' have TSI of less than 2.  122 is where most people start experiencing symptoms...most, but not all.  Some will experience them with lower TSI.

However, TSH is still looking okay, and FT4 is only a little high at 66% of range.  

Above you posted a T3 on 12/16 and TSH on 12/23.  When were these latest labs drawn?  No T3 this time?  Was T3 the only thing tested on 12/16 and only TSH on 12/23?  

[Jenn1302]

Your Thyroid Stimulating immunoglobulin may be in range, but it's still relatively high. This can cause symptoms.

[HelpfulHusband]

ok, got the official results...here they are:
TSH - 0.66 (0.35-3.74)
ALT -  21 (12-78)
Free T4 - 1.18 (0.64-1.46)
Thyroid Stimulating Immunoglob - 98 @ <=122

[goolarra]

A couple of questions:

Is that a FREE T3 test or a total T3 test?  The range you give is more typical for TT3 than FT3.  

Was FT4 tested?

What about TSI to see if she's still in remission?

[Red_Star]

I was very hyperthyroid clinically but my labs showed subclinical hypothyroidism. I had both Hashimoto's thyroiditis and Graves antibodies together which did weird things to my labs lol. Thyroglobulin serum was elevated due to hyperthyroidism.

My doctor wanted me to start anti thyroid medication but I wanted to wait to see if it improved (I was under immense stress which was the clear trigger of the Graves antibodies) and hyperthyroid symptoms resolved once the stress was removed. Moving house is listed as the 3rd most stressful life event after death and divorce.