Aa
Hypo or not...borderline....do I treat?
38yr/Male
About a month back or so I went into the doc for standard blood workup... Suprised after results came back and showed my TSH at 8.95. Well, obviously the doc wanted to see me back. Today I went in and discussed with her and I got a prescription for Synthroid and she sent me in for a round of tests again..the results which just came in...
T3 Free - 3.3 ( Range 2.3-4.2 pg/mL )
T4 Free 1.1 ( Range 0.6-1.6 ng/dL )
TSH - 4.22 ( Range 0.40-4.0 uIU/mL )
Everything seems to have come down to almost normal in 4 weeks. Seems like TSH dropped a bunch with no help at all. I would note that 3 days after my 8.95 test, I came down with a pretty severe sore throat....not sure it could have caused some problems...which messed my first test up?
In either case, my doc still wants me to go on Synthroid even after the current results... 3 months on and then more checks. I am starting at only .25 as I was concerned about getting hyper since I do have anxiety issues at times.
I will probably take the docs advice since things seem high still ( albeit barely ) but...just concerned cuz things dont seem so bad...
Thoughts?
About a month back or so I went into the doc for standard blood workup... Suprised after results came back and showed my TSH at 8.95. Well, obviously the doc wanted to see me back. Today I went in and discussed with her and I got a prescription for Synthroid and she sent me in for a round of tests again..the results which just came in...
T3 Free - 3.3 ( Range 2.3-4.2 pg/mL )
T4 Free 1.1 ( Range 0.6-1.6 ng/dL )
TSH - 4.22 ( Range 0.40-4.0 uIU/mL )
Everything seems to have come down to almost normal in 4 weeks. Seems like TSH dropped a bunch with no help at all. I would note that 3 days after my 8.95 test, I came down with a pretty severe sore throat....not sure it could have caused some problems...which messed my first test up?
In either case, my doc still wants me to go on Synthroid even after the current results... 3 months on and then more checks. I am starting at only .25 as I was concerned about getting hyper since I do have anxiety issues at times.
I will probably take the docs advice since things seem high still ( albeit barely ) but...just concerned cuz things dont seem so bad...
Thoughts?
A TSH of 8.95 could indicate that you are hypo. However, insomnia and weight loss are more often symptoms of hyper.
The best thing you could do right now is to request a repeat of TSH and add in FREE T3 and FREE T4 (different from total T3 and total T4... "FREE" must be specified). Those are the actual thyroid hormones and will give a much better profile of your thyroid function.
Once you get those, you can post them if you'd like, and we'll help you interpret them.
The best thing you could do right now is to request a repeat of TSH and add in FREE T3 and FREE T4 (different from total T3 and total T4... "FREE" must be specified). Those are the actual thyroid hormones and will give a much better profile of your thyroid function.
Once you get those, you can post them if you'd like, and we'll help you interpret them.
I'm just 21 and my TSH was 8.95 the normal rage is at 0.35-4.94
I can't sleep well and I lose weight very quickly
Sometimes I felt like my body is numb when I was sleeping
May I know what can I do to solve this problem?
I can't sleep well and I lose weight very quickly
Sometimes I felt like my body is numb when I was sleeping
May I know what can I do to solve this problem?
I'm sorry if we confused you. I know it's tough to figure out what's going on when this is all new to you. However, you don't sound all that confused to me...you seem to have grasped what we agree on. Have antibodies tested, and then decide what to do about meds. With no symptoms, you have the luxury of time. Your doctor wants you to be on meds, so you have the perfect leverage for getting her to test antibodies (if she's reluctant, as some are)...no antibody tests, no meds...perfect.
TSH is very volatile and even varies intraday and can depend on the time of day the blood was drawn. This is why we advise people to have bloodwork done at the same time of day from one draw to the next...doesn't matter when, just be consistent. TSH, a pituitary hormone, can be influenced by any number of factors in the hypothalamus/pituitary/thyroid feedback cycle, so it's often not a very reliable indicator. FT3 and FT4 are much more telling.
Do you know if the members of your family who are hypo have Hashi's? Hashi's is said to "run in families", which I interpret to mean "it's hereditary, but has not been proven to be so".
I think you have a plan and best of luck with it. Keep us posted...
TSH is very volatile and even varies intraday and can depend on the time of day the blood was drawn. This is why we advise people to have bloodwork done at the same time of day from one draw to the next...doesn't matter when, just be consistent. TSH, a pituitary hormone, can be influenced by any number of factors in the hypothalamus/pituitary/thyroid feedback cycle, so it's often not a very reliable indicator. FT3 and FT4 are much more telling.
Do you know if the members of your family who are hypo have Hashi's? Hashi's is said to "run in families", which I interpret to mean "it's hereditary, but has not been proven to be so".
I think you have a plan and best of luck with it. Keep us posted...
Wow what a great set of responses! I'm totally confused on this now. A couple of comments though.....The sore throat I had was something I just assume was something I caught and not something that was anything I attributed to some other cause like Hashi's...
I guess for now what I will do it ping my doc about getting the antibody checks...its weird that the TSH dropped so much and it could be that Hashi's is the problem...and would explain why sometimes I am up and sometimes I am down....hrm....Get the antibodies test...see what it says...wouldn't hurt....if wasn't positive...maybe wait a bit more and retest the all again...and go from there. I will talk to my doc and get her thoughts... As hypo runs in the family, it wouldn't suprise me if I had it...but my tests are a bit inconsistent which worries me....dont wanna get on the drugs and never know what would happen if I just rode it out a bit.
I will update after I talk to the doc...see what happens....
I guess for now what I will do it ping my doc about getting the antibody checks...its weird that the TSH dropped so much and it could be that Hashi's is the problem...and would explain why sometimes I am up and sometimes I am down....hrm....Get the antibodies test...see what it says...wouldn't hurt....if wasn't positive...maybe wait a bit more and retest the all again...and go from there. I will talk to my doc and get her thoughts... As hypo runs in the family, it wouldn't suprise me if I had it...but my tests are a bit inconsistent which worries me....dont wanna get on the drugs and never know what would happen if I just rode it out a bit.
I will update after I talk to the doc...see what happens....
Well, I have to say, koyuk, that you are getting both sides of the argument here...obviously a subject of some controversy and one that depends on your own personal philosophy of when you should start taking meds (of any kind, not just thyroid).
Anxiety and sore throat Hashi's symptom?...maybe. However, anxiety can have a multitude of causes and so can sore throat (bacterial, viral, etc.). These are certainly not the most "classic" Hashi's symptoms. Some Hashi's symtoms are almost universal...fatigue and/or drowsiness, weight gain, dry skin and hair, lowered HR and BP, constipation, intolerance to cold, etc. If you look at the "long" list of symptoms, most healthy people are going to be able to come up with several with absolutely no thyroid problem...you have to analyze symptoms carefully including onset and relief to know what's really hypo for you.
I agree, antibody tests are in order...as I said, wait a few months and have those done with your repeat FT3/4 and TSH. No argument there. I just don't think that the antibody tests have to be done yesterday as long as you are asymptomatic. Waiting three months to retest without starting meds will give you time to see if this situation is going to resolve without meds. Once on meds, your labs will be "medicated" labs, and you won't know if the situation would have resolved on its own or if it's the meds doing it.
Probably the biggest complaint we hear on the forum is from people who have "normal" TSH and lower range frees. Their doctors refuse to treat them. They have hypo symptoms. We always tell them that the frees are more important than TSH and advise them that they need to be on thyroid meds to raise their frees and alleviate their symptoms. On that, I'm sure Tamra and I will agree. Your labs are the flip side of the same coin. Your frees are right in the middle of the range, but your TSH is a bit high. So, why would we all of a sudden apply a double standard to your situation? Frees are more important than TSH...your frees are not even close to borderline...you're asymptomatic...monitor your labs and symptoms, but don't treat based on nothing but TSH. We rail against treating on nothing but TSH all the time, what makes this situation different? That's exactly what's happening here.
Also, research both sides of the question on when to start treating Hashi's (if that's what you have). Some argue that it's best to start before symptoms appear and labs fall out of range, others argue that it does more harm than good.
With your labs, I wouldn't start meds before antibody testing...I might not start even with positive antibodies (don't know...it was never an option for me...my Hashi's was clear and symptomatic before diagnosis). Research both sides of the argument.,
Anxiety and sore throat Hashi's symptom?...maybe. However, anxiety can have a multitude of causes and so can sore throat (bacterial, viral, etc.). These are certainly not the most "classic" Hashi's symptoms. Some Hashi's symtoms are almost universal...fatigue and/or drowsiness, weight gain, dry skin and hair, lowered HR and BP, constipation, intolerance to cold, etc. If you look at the "long" list of symptoms, most healthy people are going to be able to come up with several with absolutely no thyroid problem...you have to analyze symptoms carefully including onset and relief to know what's really hypo for you.
I agree, antibody tests are in order...as I said, wait a few months and have those done with your repeat FT3/4 and TSH. No argument there. I just don't think that the antibody tests have to be done yesterday as long as you are asymptomatic. Waiting three months to retest without starting meds will give you time to see if this situation is going to resolve without meds. Once on meds, your labs will be "medicated" labs, and you won't know if the situation would have resolved on its own or if it's the meds doing it.
Probably the biggest complaint we hear on the forum is from people who have "normal" TSH and lower range frees. Their doctors refuse to treat them. They have hypo symptoms. We always tell them that the frees are more important than TSH and advise them that they need to be on thyroid meds to raise their frees and alleviate their symptoms. On that, I'm sure Tamra and I will agree. Your labs are the flip side of the same coin. Your frees are right in the middle of the range, but your TSH is a bit high. So, why would we all of a sudden apply a double standard to your situation? Frees are more important than TSH...your frees are not even close to borderline...you're asymptomatic...monitor your labs and symptoms, but don't treat based on nothing but TSH. We rail against treating on nothing but TSH all the time, what makes this situation different? That's exactly what's happening here.
Also, research both sides of the question on when to start treating Hashi's (if that's what you have). Some argue that it's best to start before symptoms appear and labs fall out of range, others argue that it does more harm than good.
With your labs, I wouldn't start meds before antibody testing...I might not start even with positive antibodies (don't know...it was never an option for me...my Hashi's was clear and symptomatic before diagnosis). Research both sides of the argument.,
Goolara has a good point. If you are not a Hashi, then your frees are about mid-range. However, you have already had some Hashi symptoms (sore throat and anxiety). If you get your Hashi antibody tests now rather than later, and your TGab and TPOab comes back negative, then Goolara's advice is good. If you are a positive for Hashi, then please consider listening to your endo's advice and take thyroid hormone.
Even though TSH, a pituitary hormone, isn't the tell all for thyroid, 8.95 is still way above the current standard of 3.0. Because Hashis swing up and down in the earlier stages, your TSH and frees can't be the only tools used to determine if you have an underlying auto-immune condition. The antibody tests are definitely in order.
10 percent of Hashis don't have positive antibodies, so if you just are not feeling well over these next few months, then a thyroid ultrasound would be the next step. My ultrasound revealed four nodules. They were leaking hormone and causing me anxiety. After the thyroid hormone, those nodules shrunk and no longer gave me those hyper symptoms.
:) Tamra
Even though TSH, a pituitary hormone, isn't the tell all for thyroid, 8.95 is still way above the current standard of 3.0. Because Hashis swing up and down in the earlier stages, your TSH and frees can't be the only tools used to determine if you have an underlying auto-immune condition. The antibody tests are definitely in order.
10 percent of Hashis don't have positive antibodies, so if you just are not feeling well over these next few months, then a thyroid ultrasound would be the next step. My ultrasound revealed four nodules. They were leaking hormone and causing me anxiety. After the thyroid hormone, those nodules shrunk and no longer gave me those hyper symptoms.
:) Tamra
I just can't agree with TamraW on this one. I believe there's a difference between the "ideal" levels for someone on meds with a diagnosed thyroid disease and someone who has not been diagnosed with a thyroid disorder, never mind a disease, and is not on meds.
Yes, the recommendation for those of us on meds for FT4 is midrange, FT3 is upper half to upper third. However, for the population at large, about 50% of people with a normally functioning thyroid are going to fall within one standard deviation each side of midrange. Koyuk is right at midrange on both. According to population statistics, these are almost "perfect" numbers.
I think that we, on meds, often have to have FT3 and FT4 higher because we no longer have "on demand" thyroid hormones. We get our thyroid hormones once or twice a day, so we have to have a little surplus to compensate for the "unnatural" timing of input of thyroid hormone to our bodies.
Koyuk's doctor is reacting to TSH...period. Treating on the basis of TSH, when TSH is "abnormal" is just as big a sin as not treating when TSH is "normal". Koyuk's doctor is ignoring FT3 and FT4, only looking at TSH.
I still maintain that I'd give it a few months, retest with antibodies, and go from there.
Yes, the recommendation for those of us on meds for FT4 is midrange, FT3 is upper half to upper third. However, for the population at large, about 50% of people with a normally functioning thyroid are going to fall within one standard deviation each side of midrange. Koyuk is right at midrange on both. According to population statistics, these are almost "perfect" numbers.
I think that we, on meds, often have to have FT3 and FT4 higher because we no longer have "on demand" thyroid hormones. We get our thyroid hormones once or twice a day, so we have to have a little surplus to compensate for the "unnatural" timing of input of thyroid hormone to our bodies.
Koyuk's doctor is reacting to TSH...period. Treating on the basis of TSH, when TSH is "abnormal" is just as big a sin as not treating when TSH is "normal". Koyuk's doctor is ignoring FT3 and FT4, only looking at TSH.
I still maintain that I'd give it a few months, retest with antibodies, and go from there.
I am so glad that my post helped you. It took a long time to remember some of those symptoms because I wrote them back in the brain fog days. :) Tamra
Koyuk, you are 38, and I will be 38 in a few months. I don't feel well with thyroid levels as low as yours. My mom is 75. For her, your levels would be normal. For those in our age group, usually we need to be in the top 1/3 of the range. You still have some room to go up, so I agree with your endo to treat you with low level thyroid hormone.
You say that you don't feel that bad, but compared to what? My suggestion is to get the Hashimoto's antibody tests now rather than later.
Here's a wonderful article explaining why people with Hashi need preventative treatment even if their levels are 'normal':
http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm
:) Tamra
You say that you don't feel that bad, but compared to what? My suggestion is to get the Hashimoto's antibody tests now rather than later.
Here's a wonderful article explaining why people with Hashi need preventative treatment even if their levels are 'normal':
http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm
:) Tamra
Do you have hypo symptoms? If not, I agree with you that your FT3 and FT4 look good at the moment (they're both right at midrange, not even close to borderline), and I'd be concerned about starting treatment. My inclination would be to re-test in three to six months and have antibodies tested at that time to determine if you are in the early stages of Hashi's. Of course, if you do become symptomatic in the interim, it would be best to go in for re-testing at that point.
Your TSH is a bit high, but TSH is a pituitary hormone and not nearly as important as the two thyroid hormones, FT3 and FT4.
Your TSH is a bit high, but TSH is a pituitary hormone and not nearly as important as the two thyroid hormones, FT3 and FT4.
It is like reading my medical history...thank you for listing that. I for one feel less crazy when I read all those symtoms and realize they can be attributed to the thyroid. Makes the puzzle all come together.
Uh oh, sore throat and fluctuation TSH! You'd better get the TGab and TPOab antibody tests for Hashimoto's. I have it. Yes, the throat gets sore as the antibodies swell up the thyroid. I would fluctuate from normal, to hyper to hypo and all over the chart. Some weeks, I'd feel like I was recovering, then my thyroid nodules would leak hormone, and I'd go crazy hyper. Then the antibodies would eat another chunk of thyroid and I'd go hypo. Crazy!
I didn't start feeling better until I took my Synthroid. And, I had to keep bumping up every month. Now, I'm on 150 Synthroid and 5 Cytomel. Many of us need a T3 drug like Cytomel added to our Synthroid to relive ALL of the other hypo symptoms like constipation and sore legs. If you do have Hashi and you don't get on some thyroid hormone, you will get worse. I wouldn't doubt that you do have Hashi, the leading cause of hypothyroidism in the US and developed countries. If so, you need a thyroid ultrasound to determine if nodules are causing you to go hyper. The thyroid hormone shrunk my nodules, so I don't go hyper anymore.
Also, at some point, get those adrenals checked. Sometimes they can burn out trying to do the work of the thyroid.
Next, if you have Hashi, get those vitamins, particularly D3 and B12 checked. Hashis tend to be low in that area.
Finally, if you have Hashi, an auto-immune disease, be aware that some things can triggger that antibody attack (sore throat and swelling in neck and pain in ears) . For me, it's stress, caffeine, gluten and sugar. For others it can be different.
Below were my symptoms prior to treatment.
These symptoms slowly appeared and worsened after birthing an infant (who was also premature)
Hypo problems:
Mild weight gain even while dieting
Extreme fatigue in the morning and throughout the day/napping
GERD/Heartburn/chest pain
constipation Abdomen swells for no apparent reason
Depression
forgetfulness/brain fog
Neck/jaw pain/swelling/pressure
Scratchy voice
Very cold feet and hands and sometimes a feeling like ants are biting my feet
Endometriosis (2 years ago – cured after one year of birth control)
Irregular/heavy periods and menstrual-like cramping in between periods
Voice is sometimes hoarse
Knee/joint pains – finger swelling and pain
Rash or scaly skin on neck, hands, chest, chin, nose, right armpit down to waist
Dry, gritty eyes
Chills
Muscles in legs sometimes go wobbly and weak when I am standing
Body temp ranges 97-97.5
Hair clumps in shower
Decreased sex drive
Aches all over body like the flu
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps
Hyper Problems:
Weight loss when not dieting
GERD/Heartburn/chest pain
diarrhea
anxiety
Abdomen swells for no apparent reason
Neck/jaw pain/swelling/pressure
Scratchy voice
Migraines, dizziness and back of neck/head pain
Ear pressure/pain
Rash on back of head
Voice is sometimes hoarse
Sore eyes
Hot flashes
Night throbbing/pounding in ears that wakes me
Toe nails feel painful and brittle
Tingling feet/hands/lips
Shaky hands
Stabbing pain below right ribcage
Pain in kidney and lower back area
Increased thirst, urination and a feeling like I have a bladder infection
Blood pressure changing
Feeling like heart is beating fast
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps
Increased sex drive
:) Tamra
I didn't start feeling better until I took my Synthroid. And, I had to keep bumping up every month. Now, I'm on 150 Synthroid and 5 Cytomel. Many of us need a T3 drug like Cytomel added to our Synthroid to relive ALL of the other hypo symptoms like constipation and sore legs. If you do have Hashi and you don't get on some thyroid hormone, you will get worse. I wouldn't doubt that you do have Hashi, the leading cause of hypothyroidism in the US and developed countries. If so, you need a thyroid ultrasound to determine if nodules are causing you to go hyper. The thyroid hormone shrunk my nodules, so I don't go hyper anymore.
Also, at some point, get those adrenals checked. Sometimes they can burn out trying to do the work of the thyroid.
Next, if you have Hashi, get those vitamins, particularly D3 and B12 checked. Hashis tend to be low in that area.
Finally, if you have Hashi, an auto-immune disease, be aware that some things can triggger that antibody attack (sore throat and swelling in neck and pain in ears) . For me, it's stress, caffeine, gluten and sugar. For others it can be different.
Below were my symptoms prior to treatment.
These symptoms slowly appeared and worsened after birthing an infant (who was also premature)
Hypo problems:
Mild weight gain even while dieting
Extreme fatigue in the morning and throughout the day/napping
GERD/Heartburn/chest pain
constipation Abdomen swells for no apparent reason
Depression
forgetfulness/brain fog
Neck/jaw pain/swelling/pressure
Scratchy voice
Very cold feet and hands and sometimes a feeling like ants are biting my feet
Endometriosis (2 years ago – cured after one year of birth control)
Irregular/heavy periods and menstrual-like cramping in between periods
Voice is sometimes hoarse
Knee/joint pains – finger swelling and pain
Rash or scaly skin on neck, hands, chest, chin, nose, right armpit down to waist
Dry, gritty eyes
Chills
Muscles in legs sometimes go wobbly and weak when I am standing
Body temp ranges 97-97.5
Hair clumps in shower
Decreased sex drive
Aches all over body like the flu
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps
Hyper Problems:
Weight loss when not dieting
GERD/Heartburn/chest pain
diarrhea
anxiety
Abdomen swells for no apparent reason
Neck/jaw pain/swelling/pressure
Scratchy voice
Migraines, dizziness and back of neck/head pain
Ear pressure/pain
Rash on back of head
Voice is sometimes hoarse
Sore eyes
Hot flashes
Night throbbing/pounding in ears that wakes me
Toe nails feel painful and brittle
Tingling feet/hands/lips
Shaky hands
Stabbing pain below right ribcage
Pain in kidney and lower back area
Increased thirst, urination and a feeling like I have a bladder infection
Blood pressure changing
Feeling like heart is beating fast
Enlarged lymphnodes in neck and armpit
Legs feel heavy and swollen at times
Pain in the soles of my feet like muscle cramps
Increased sex drive
:) Tamra
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
