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High to Low TSH
Six months ago my TSH level was 5.6. Now it is .09. My T4 and T3 levels are within the normal range. I had an iodine uptake with the left lobe showing overactivity and the right lobe showing normal, he called it an asymmetrical thyroid. An ultrasound confirmed no presence of nodules or goiters. My endocronologist sais I'm a mystery and has started me on Thyroid medicine but cannot explain any of the above. He doesn't know why my TSH levels dropped dramatically, he doesn't know why the left lobe shows overactivity and the right doesn't with no hot nodules. Should I be looking for a second opinion. My symptoms range from tiredness to weight gain, to being hot with an abnormally low temperature 96.0. My Dr. said my symptoms mimic both Hyper and Hypothyroidism. Any advice would be greatly appreciated because I am a little concernd. Thank you,
Sorry to greet you that way. LOL!
Welcome to the forum. :o)
Ok, so you have had TSH, Free T4, Free T3 run twice, ultrasound and RAIU.
The ultrasound would say a lot.
Homogenous means "all the same". Your thyroid should be homogenous, the same texture, consistancy, and density throughout.
Heterogenous means "not all the same". It implies irregular density from place to place in the gland.
An ultrasound can measure the thyroid in three dimensions, and detect external or internal abnormalities.
If the gland is homogenous with no abnormalities noted, then thyroiditis is not very likely. If the gland is heterogenous then thyroiditis becomes more suspect.
Six months is a long time, and lots of things can happen in that time. It's possible your TSH could drop 6 points in a month. Or a week.
It's odd that one side is "hot" but you don't have any nodules. That makes me think you are having a spell of thyroiditis, and you will go from hyper back to hypo by the time your doctor gets the results of your antibody tests.
I've never heard of anyone with Grave's where it only affects one side. I'm not saying it never happens, but I don't see how it could or why it would.
The "normal" T4/T3 tests; the lab ranges are very broad for those tests. It is possible (happens all the time) for you to be either hyper or hypo and your Free T4 and Free T3 are still within normal limits. By the time either one goes outside of limits, you are very ill.
It's posible that your Ts showed you hypo six months ago and show you hyper now. Whether your doctor knows the difference is hard to say.
You need to ask your doctor to run several antibody tests.
Thyroid Peroxidase antibodies (TPOab)
Antithyroglobulin antibodies (TGab)
Thyroid Stimulating Immunoglobulin (TSI)
That will either confirm or rule out an autoimmune problem.
Welcome to the forum. :o)
Ok, so you have had TSH, Free T4, Free T3 run twice, ultrasound and RAIU.
The ultrasound would say a lot.
Homogenous means "all the same". Your thyroid should be homogenous, the same texture, consistancy, and density throughout.
Heterogenous means "not all the same". It implies irregular density from place to place in the gland.
An ultrasound can measure the thyroid in three dimensions, and detect external or internal abnormalities.
If the gland is homogenous with no abnormalities noted, then thyroiditis is not very likely. If the gland is heterogenous then thyroiditis becomes more suspect.
Six months is a long time, and lots of things can happen in that time. It's possible your TSH could drop 6 points in a month. Or a week.
It's odd that one side is "hot" but you don't have any nodules. That makes me think you are having a spell of thyroiditis, and you will go from hyper back to hypo by the time your doctor gets the results of your antibody tests.
I've never heard of anyone with Grave's where it only affects one side. I'm not saying it never happens, but I don't see how it could or why it would.
The "normal" T4/T3 tests; the lab ranges are very broad for those tests. It is possible (happens all the time) for you to be either hyper or hypo and your Free T4 and Free T3 are still within normal limits. By the time either one goes outside of limits, you are very ill.
It's posible that your Ts showed you hypo six months ago and show you hyper now. Whether your doctor knows the difference is hard to say.
You need to ask your doctor to run several antibody tests.
Thyroid Peroxidase antibodies (TPOab)
Antithyroglobulin antibodies (TGab)
Thyroid Stimulating Immunoglobulin (TSI)
That will either confirm or rule out an autoimmune problem.
Sorry, new to this foum and I didn't know if AR-10 was a person or a something :) Thanks for your reply. Let's see to answer your questions:
When he said asymmetrical he meant that the left lobe was showing more activity than the right. However that activity is within normal parameters of RAIU, it was at 14.4. No one mentoned an infection in that lobe, just a statement that it was showing more activity. I don't know if the ultrasound showed the lobe homogenous, or heterogenous because I don't know what that is - but I will check into that.
The only NEW medicines I have been taking is a cholesterol medicine - it was a switch from one (can't remember the name) to lovastatin. But I brought this up to my dr. and he said that this wouldn't effect it. I haven't been sick either. And no I haven't had any other tests other than TSH/T4 and T3. I've been reading a lot of information that talks about an antibodies test and I don't know why my doctor didn't test for this, considering he is stumped.
I know it sounds confusing but it sounds like my TSH level is the only thing that is telling me (other than symptoms) that my thyroid is not functioninig properly: T4 and T3 is normal, scans and RAIU are normal, ultrasound is normal so from everything I have read my TSH level should be normal because my thyroid looks normal and has no nodules. Am I missing something or is m doctor missing something?
Can Graves disease be asymmetrical? Only in one lobe?
Thanks to anyone that can help!!
When he said asymmetrical he meant that the left lobe was showing more activity than the right. However that activity is within normal parameters of RAIU, it was at 14.4. No one mentoned an infection in that lobe, just a statement that it was showing more activity. I don't know if the ultrasound showed the lobe homogenous, or heterogenous because I don't know what that is - but I will check into that.
The only NEW medicines I have been taking is a cholesterol medicine - it was a switch from one (can't remember the name) to lovastatin. But I brought this up to my dr. and he said that this wouldn't effect it. I haven't been sick either. And no I haven't had any other tests other than TSH/T4 and T3. I've been reading a lot of information that talks about an antibodies test and I don't know why my doctor didn't test for this, considering he is stumped.
I know it sounds confusing but it sounds like my TSH level is the only thing that is telling me (other than symptoms) that my thyroid is not functioninig properly: T4 and T3 is normal, scans and RAIU are normal, ultrasound is normal so from everything I have read my TSH level should be normal because my thyroid looks normal and has no nodules. Am I missing something or is m doctor missing something?
Can Graves disease be asymmetrical? Only in one lobe?
Thanks to anyone that can help!!
I vote for an automated computer program.... no human could have as much thyroid infomation.... LOL! :-P
Who or what is AR-10?
The who is private.
The what is a question dozens of members have asked themselves. An alien? A psycho nutball? An automated computer program? A doctors nightmare? An idiot pretending to be a doctor?
Nobody knows for sure...LOL!!
Lori mentioned me, because I have been hyper and hypo at the same time, in a way, and doctors spent a lot of time wondering why I couldn't just be like the rest of their patients.
I have a couple of questions. Your doctor said your thyroid was asymetrical. does that mean the left lobe is larger than the right lobe? If so, it may be swollen.
You also said the left lobe showed more activity. Is it possible you had some infection in the left lobe and you were caught at the end of a spell of thyroiditis?
Did the ultrasound report state that the gland was homogenous, or heterogenous? Heterogenous means inconsistant texture or density, such as if there were pockets of infection.
Were you taking any medications, vitamins, or supplements in the last eight months that may have inhibited your thyroid function? Severe illness?
Have you had antibody tests to check for both Grave's and Hashimoto's? I know you said only TSH/T4/T3, but I would think your doctor would have started checking for antibodies.
I know it's a lot of questions, but you are a mystery, so a clear picture of your history will help.
:o)
The who is private.
The what is a question dozens of members have asked themselves. An alien? A psycho nutball? An automated computer program? A doctors nightmare? An idiot pretending to be a doctor?
Nobody knows for sure...LOL!!
Lori mentioned me, because I have been hyper and hypo at the same time, in a way, and doctors spent a lot of time wondering why I couldn't just be like the rest of their patients.
I have a couple of questions. Your doctor said your thyroid was asymetrical. does that mean the left lobe is larger than the right lobe? If so, it may be swollen.
You also said the left lobe showed more activity. Is it possible you had some infection in the left lobe and you were caught at the end of a spell of thyroiditis?
Did the ultrasound report state that the gland was homogenous, or heterogenous? Heterogenous means inconsistant texture or density, such as if there were pockets of infection.
Were you taking any medications, vitamins, or supplements in the last eight months that may have inhibited your thyroid function? Severe illness?
Have you had antibody tests to check for both Grave's and Hashimoto's? I know you said only TSH/T4/T3, but I would think your doctor would have started checking for antibodies.
I know it's a lot of questions, but you are a mystery, so a clear picture of your history will help.
:o)
Lori, thank you for your reply. Who or wat is AR-10? The only blood tests he has done is the TSH level and T4 and T3. I also forgot to mention that during my RAIU test my levels were within the normal parameters - 14.4% uptake in that one lobe. So if all of my tests show I have a normal thyroid - my T4 and T3 are normal, my RAIU is normal, my thyroid scan and ultrasound show no enlargement or nodules, why is my TSH level low? Thanks for your reply and hopefully others will join in.
Jennifer
Jennifer
Hi Jennifer. When reading your post, I immediately thought of AR-10 - with the swinging between hyper and hypo. Go out to his profile and read his journal. I'm quite sure he'll be chiming in here at some point too.
Something is obviously going on to make your levels swing like that. Have you had any blood tests to check your antibodies, or just tsh, T3, T4? I would definitely think your doctor would be wanting a thorough check at this point - which would include checking the thyroid antibodies.
I'm sorry I can't be of more help, but I'm quite sure someone will respond to you soon. Welcome to the community!!!
Lori
Something is obviously going on to make your levels swing like that. Have you had any blood tests to check your antibodies, or just tsh, T3, T4? I would definitely think your doctor would be wanting a thorough check at this point - which would include checking the thyroid antibodies.
I'm sorry I can't be of more help, but I'm quite sure someone will respond to you soon. Welcome to the community!!!
Lori
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