Inconsistent TSH, T3, T4 Levels

Hi, I'm new to this site.  I had a general health physical 4 months ago, and I was informed that my Thyroid test came back abnormal.  I had it retested 2 months later, and they told me that the results were better, but they wanted me to retest a third time.  The third test still came back abnormal.  Basically, the doctor told me that she couldn't figure out why my Thyroid levels are fluctuating inconsistently.  She is referring me to an endocrinologist.  She did mention that it may be Subclinical Hyperthyroidism.  Any advice, education, or support would be greatly appreciated.

[Barb135]

Please post the actual results of your thyroid tests, as that will help us better assess your situation.  Be sure to include reference ranges from your lab report, since ranges vary lab to lab and have to come from your own report.

You should have TSH, Free T3 and Free T4 results.

Has your doctor done any antibody tests to see if you have either Graves or Hashimoto's?  Have you had a thyroid ultrasound to check for nodules, swelling or inflammation?

Since many things can influence TSH, which in turn stimulates the thyroid, there could be a number of reasons for your fluctuating levels. We'll try to help you figure it out.

Do you have symptoms of hyperthyroidism?  If so, which ones?

[Junie007]

Thanks for responding, Barb.  I actually don't know the values of my results at this time, but I'm sure I can call the office and get them.  I know that they did order TSH, T3, and Free T4 blood tests.  I don't think any antibody tests have been done, and I have not had a thyroid ultrasound performed either.  

With regard to symptoms, the following are what I experience (not on a daily basis): Anxiety/nervousness, frequent loose bowel movements, difficulty sleeping, periods of changes with my vision, irregular heartbeats, fatigue, menstrual fluctuations, occasional night sweats, and clammy skin.

[Junie007]

Hi Barb, I picked up the results from my labs, and the values are as follows:
On 10/01/12,  TSH 0.439
                     T4, Free (Direct) 1.30

On 11/28/12,  TSH 2.800
                     T4, Free (Direct) 1.79
                     T3 178

On 02/21/13,  TSH 2.540
                     T4, Free (Direct) 2.08
                     T3 162

[Junie007]

I forgot to include the reference ranges:
TSH 0.450 - 4.500
T4, Free (Direct) 0.82 - 1.77
T3 71 - 180

[Barb135]

Your symptoms certainly coincide with a diagnosis of hyperthyroidism; I'm surprised that your doctor didn't order a Thyroid Stimulating Immunoglobulin (TSI), which is the definitive test to confirm/rule out Graves Disease and she should also have done Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab), which would confirm/rule out Hashimoto's Thyroiditis.

Graves Disease is associated with hyperthyroidism and Hashimoto's is, typically, associated with hypothyroidism, but can be characterized by periods of hyper, swinging to hypo, even with periods of "normal" in between.  

It's unfortunate that your doctor ordered Total T3, rather than Free T3, which is the hormone actually used by the individual cells.  Next time you have blood work, you should ask them to make sure they do FT3, not TT3.

Do you know how long it will be before you can get in to see an endo?  Is your doctor prepared to prescribe anti thyroid meds if your symptoms become too uncomfortable?

[Junie007]

A local Endocrinologist would not be able to see me until mid-June.  However, there is another Endocrinologist located about 70 miles away that is able to see me in mid-April.

Thank you so much for advising me on various labs that can certainly be helpful in ruling out specific disorders associated with abnormal Thyroid levels.  Most importantly, a correct diagnosis, with an effective treatment plan is what I expect from a medical professional that specializes in such disorders.  I'm willing and want to be educated by individuals such as yourself to help me differentiate and recognize certain symptoms that would indicate a definitive course of action to correct my Thyroid function and/or potentially uncover any condition that may be directly or indirectly  associated with these abnormalities.  Your knowledge, advice, and explanations are greatly appreciated!!

[Barb135]

The best thing you can do is research and learn all you can about thyroid disorders, so you can advocate for yourself.  

Unfortunately, we've seen too many people left ill, by the very "medical professional that specializes in such disorders"....... Just because one is a "specialist" doesn't mean s/he's "good" at what s/he does.  Many endos specialize in diabetes and are pretty slim on thyroid knowledge.  Others treat simply by a "standard of care" and as long as they've gone that far, they've done their job, whether they've actually helped the patient get well or not.

When it comes to thyroid care, you have the doctors who treat only TSH and you have the ones who go by reference ranges only, assuming that if the patients labs fall within a specific set of numbers, the patient should be well.

Research is your best friend.  We're happy to help you in any way we can.

[898_1]

It is not uncommon for thyroid levels to fluctuate, however the next logical step is checking for the antibodies in the blood (TPO, TG, TSI) which may help to pinpoint a root cause

[Gibbon1]

898_1 is spot on. Thyroid antibody tests should be next step.  Might see if your doctor can order those now, rather than wait for the endocrinologist to order them in two or three months from now.

What's sort of interesting is your TSH and T4/T3 seem to be tracking each other.  Usually they move in alternate directions.