Drastic shift from hyper to hypo

[DariaR]

Over the last six weeks my lab work has shown a drastic shift from a non-detectable tsh (less than .03) to now 6.84.  t3/t4 were in normal ranges, but are now hypo range too.  I've been working with a Doctor of Oriental Medicine, who has made significant changes to my diet and treats me every two weeks with acupuncture.  I also had a strange swelling of my thyroid (goiter)  last month when I was on a business trip - extremely painful to swallow. The swelling and pain went away within a couple days.  

(Note - I've had Grave's since 2006.  I've been on PTU for that entire time and this is the first drastic change.)

But with the drastic change, I'm just trying to piece together what might have happened.  My doctor was trying to force me into surgery, so now I'm waiting to meet with a new endocrinologist.  I've been told to quit my PTU completely, but I'm afraid that this will throw me hyperthyroid again, rather than decreasing in steps.  Any similar experiences or suggestions?  

Thanks in advance!

[DariaR]

Thanks.  I'm on 50mg PTU 3 times a day, which my endo told me to quit for a week and then go back to 50 mg 2x/day.  I'm hesitant because the last time I went off completely I went extremely hyper and had to "start over" on getting levels back in order.  Wondering if stepping down gradually over a couple weeks would be a safer bet?

I appreciate the information!

[Barb135]

I see a lot going on, so I'll try to explain one thing at a time....... First off, your TSH is over range, indicating hypo, as you know.... but TSH is not the complete answer.

Total T3 is pretty much obsolete and gives limited information. You really  need to be tested for Free T3.  

Free T4 is actually below range, so considering that you have no FT4 to convert to T3, I'd guess that your FT3 might be below range as well, especially considering that your TT3 is on the floor......

Here's how it works -- your pituitary gland senses that you need thyroid hormone, so it puts out TSH to stimulate the thyroid to produce T3 and T4 hormones.  In your case, with Graves, your thyroid kept pumping out hormones, even though the pituitary told it to stop (thyroid gone wild).. Even while you've been on the PTU, the Graves antibodies have continued to attack and destroy your thyroid.  It looks like they've destroyed enough of it, so it's no longer pumping out hormones and you've gone hypO (not enough hormones).

Are you still on the PTU?  I don't know your dosage, but you need to either cut back or stop it.  Extreme fatigue applies to either hyper or hypo, but you are obviously hypo; weight gain is a hypo symptom.

Try to get another TSH, Free T4 and add Free T3......  Free T3 is the hormone that's actually ready and available to be absorbed into the cells for immediate use, so that's the most important.

I've tried to make it simple, but somehow, it never really turns out that way.  We just keep working at it, one step at a time.

[DariaR]

My most recent lab results has these levels:

T3 (total) 70 (60-180 range)
TSH 6.84 (.45 - 4.5 range)
T4 Free .5 (.6 - 1.6 range)

My only real symptoms right now are extreme fatigue and some weight gain.  

Thanks for anything you can share!

[Barb135]

Please post your most recent lab results - we see the TSH is 6.84 (high), but need to know the levels of your free T3 and free T4.  If you're only testing T3 and T4, then most likely they are for "total" which is pretty much obsolete and of little value.

Along with  T3 and T4 (hopefully "frees") results, please post the reference ranges, which will be listed on your lab report.  Reference ranges vary from lab to lab, so must come from you own report.

What symptoms do you have?