High TSH and high T4

[susandenning]

Hi,

I am a 32 year old with Hashimoto's.  My thryoid dosage was dropped twice about two years ago since my T4 levels showed that I was hyperthyroid.  This seems to have destabilized my thyroid levels, as my TSH and my T4 have never been normal at the same time since then.  My most recent lab tests showed that both my TSH and my T4 were elevated.  I had a negative mono test (due to a super high TSH) and also an MRI which was negative for a pituitary adenoma.  I have been bouncing back and forth between an endocrinologist and my primary care, due to the endocrinologist was refusing to order any lab tests other than a TSH.  I was wondering if anyone might have an idea what could cause both tests to be high at the same time?

Thanks,

Susan

[gimel]

It would help members respond if you would post the last few rounds of your  thyroid test results and their reference ranges shown on the lab reports.

[goolarra]

Yes, please do post labs.  

Also, when your FT4 levels showed that you were hyper, how did you feel?  Did you feel hyper?

[susandenning]

Hi, thanks for getting back to me.  In answer to your question, yes, I think I was showing some hyper symptoms back when my dosage was originally lowered.  My cardiologist noticed that my heart rate was a little fast.  Also, lowering it seemed to help me sleep longer without waking up at night.  I'm not sure about now though.

My lab results are as follows.

January 2012 - TSH 5.58 - T4 1.36
October 2011 - TSH 8.49 - T4 1.34
August 2011 - TSH 55.1 - T4 0.72 (this was the TSH that prompted the negative mono test, and a change back to levoxyl)
June 2011 - TSH 11.1 - T4 1.50 (changed to armour)

[susandenning]

The reference ranges the lab was using were 0.61-1.27 for T4 and 0.40-4.6 for TSH.

Susan

[goolarra]

It's unfortunate that your doctor doesn't test FT3...we're missing a huge piece of the puzzle here, since FT3 correlates best with symptoms.  

Except for your August, 2011, labs, your FT4 has been consistently above range, but it has been fairly stable..

How much Levoxyl do you take?

TSH can be influenced by any number of factors in the hypothalamus/pituitary/thyroid axis.  We don't know what your FT3 is doing.  It's possible that your TSH is reacting to low FT3 levels (if you don't convert well).  However, TSH typically doesn't correlate with FT3.

There are other pituitary issues, besides tumors, that can cause TSH to remain high.  I have what's called "pituitary resistance to thyroid hormone".  I'm euthyroid, but my TSH always hovers around 20.0.  The pituitary converts T4 to T3 for its own use.  My pituitary lacks the enzyme (5'-deiodinase) that catalyzes the conversion of T4 to T3.  As a result, my pituitary is starved for T3, and it thinks the rest of my body is also (it's not...I convert fine peripherally).

I'm not saying that's what you have, just offering it as an example of "other things that can go wrong).

Are you currently feeling like you need another decrease?

[flyingfool]

Yes Free T3 would be nice.

But what I'm suspicious of is Reverse T3.

If the T4 is being converted into RT3, then there is little T3 free and available and your pituitary would recognize that your body's cells do not have enough Thyroid and thus crank out TSH in a vain attempt to respond.

Just a thought.

[susandenning]

Hi, thanks for your replies.  No, I don't feel as though I need another decrease.  I thought it was interesting that you both mentioned T3.  I went back and checked my T3 results, and they were all within normal range (2.76 on 12/21/11, 3.34 on 08/05/11, and 3.11 on 06/06/11). I had an appointment with my internist on the same day (the 13th), and she wanted to change me from 175 levoyxl to 60 armour and 100 levoxyl, as she does think that I have some kind of a T3 conversion issue (even though my T3 results have always been normal).  So, it sounds like I am on the right track.  I will definitely make sure that I get my T3 checked next time my labs are checked.

Susan

[Barb135]

When asking for the T3 test, make sure you specify FREE T3, otherwise they will do total, which is not the same test and doesn't tell you anything.