Confused about lab results

[Jenn1302]

Hi everyone,

My thyroid has been fluctuating between hyper, hypo and normal for the past 3 years and I have never been on any thyroid medication. 3 years ago I had hyperthyroidism that resolved itself. Last year my TSH was borderline low for a short period of time. Last week I was told I had Hashoimoto's and hypo based on labs that were done about a month ago and 4 months ago. My endo said he was going to run some more tests and probably put me on thyroid replacement meds. Today I was told that the labs came back normal and that I don't need to be on thyroid medication.

Here are my lab results throughout the years:
Before 2011: my thyroid was stable TSH 1-1.7
mid 2011: very low TSH, borderline high Free T4, I had hyper symptoms
mid 2013: borderline low TSH, normal free T4, I had a few hyper and hypo symptoms
Nov 2013 - Mar 2014: TSH 3.8-4.2 mIU/L, free T4 1.0-1.2  (range: 0.9-1.7), I mainly had hypo symptoms but I also had some hyper symptoms
April 2014: TSH 1.7, Free T4 1.2, I still have symptoms

I've also been tested positive for TPO (420 IU/mL) and Tg (83.9 IU/mL). My TSI has never been checked. A recent thyroid ultrasound showed that I have mild diffuse hypervascularity in both lobes.

I'm really glad that my thyroid is normal now, but my thyroid seems to be extremely unstable. I am so confused. Can anyone shed some light? Is there some way to prevent it from fluctuating?

[goolarra]

No, don't give up!  A second opinion is definitely worth it.

While it's often difficult to get treatment with numbers "in range", you have two very much out of range...the antibodies.  Some doctors feel that you should wait until numbers are out of range before treating Hashi's, others will treat earlier, depending on symptoms.

There's a doctor out there for you.  You just have to find him.

[Jenn1302]

Thank you for your informative response. It really helps me understand what is going on. Unfortunately, I doubt that my endo would agree to put me on meds now.

He told me the tests were great and pretty much ignored all the symptoms that he believed I had the week before, as if I never had any symptoms. Then he said that I'm simply one of those people who have thyroid fluctuations with "no symptoms" and told me to come back in 4 months or if I experience thyroid symptoms, such as unexplained weight gain or weight loss.

In reality, my thyroid levels were super stable before all this started (3 years ago) and I did get symptoms when my thyroid started fluctuating. I lost 10+ lbs without trying back when I was hyper.

My endo also said that hypothyroidism doesn't typically cause palpitations and that putting me on thyroid meds was only going to make them worse. I'm thinking of getting a second opinion but I don't know if I should even bother.

My sugar levels are normal and have never been elevated and I have no family history of diabetes.

[goolarra]

I think a comparison of those two labs speaks volumes about what your doctor is looking at.  FT4 was absolutely stable at 1.2, so that didn't change his decision about meds.  The only thing that changed was your TSH, from 3.8 to 1.7.  So, we know he pays little attention to anything but TSH or his decision on meds would not have changed.

TT3 is fairly useless, but it was on the low side, too.  TT3 tells the total amount of T3 in your blood, but most of that is chemically bound and unavailable to your cells.  FREE T3 tells what's available.

TPOab and TGab are both elevated, so we know you have Hashi's.

Heart palps and hair loss can as easily be hypo as hyper.  Brittle nails are typically hypo.  

Dehydration isn't a typical thyroid symptom, either hypo or hyper.  Have you had glucose tested?  Could other meds be contributing to this?

I think it would be fair to say that your symptoms are almost all hypo at this point.

We know you have a thyroid disease.  It's only a matter of time before you're on meds.  I think you'd feel much better on meds now.  Do you think your doctor would consider a trial dose based on symptoms?  

[Jenn1302]

I've never been pregnant.

[Jenn1302]

Thank you for your response.

Here are my labs from March 2014:
T3: 128 ng/dL (range: 80-200).
FT4: 1.2 (range: 0.9-1.7)
TSH: 3.8.
TPO Ab: 420 IU/mL.
Thyroglobulin Ab: 83 IU/mL.

Symptoms:

Hypo:
Very dry skin
Pale skin and dark circles around my eyes
Puffiness under eyes
Constipation (this one is relatively new)
I sleep a lot (more than I used to. 9-10 hours per night) and wake up very tired.
Extremely inflexible muscles.
I also have attention, procrastination and memory problems but these may be related to my ADHD. Back in March I also had muscle/joint pain in the middle of the night. This symptom went away a few weeks ago.

Hyper:
Unexplained heart palpitations.
Very frequent dehydration (I drink a lot of water and gatorade). I drink 2X the amount I used to drink in the past and still stay dehydrated.
Possible skin thinning.

Both?:
Mild Tremor.
I have hair falling out from (scalp, eye lashes and eyebrows).
Brittle nails.

[Pantx]

Have you delivered a baby in the last few years?

[goolarra]

Your April, 2014, FT4 is quite low.  It's at 25% of range, and most of us find that FT4 has to be close to 50% for symptoms to be relieved.  Your doctor should also be testing FT3, which is the test that correlates best with symptoms.  Just being in "normal" range is often not sufficient to make us feel good.

Do you have the results of the labs done a month ago?

Please list your current symptoms.  Many symptoms cross over and can be symptoms of both hypo and hyper.