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Low TSH and normal Free T4 normal ?
Ok so I am new to this forum and I do not know what else to do. I am a 37 yr old female. In mid-to late December I felt something wasn't quite right with my body. Didn't pay any mind to it as I figured it was probably the hustling. Until one day I felt over anxious, shaky and full of jitters. I went to one of those Blood Pressure machines and my BP was high and also my heart rate .. Then I felt my heart racing whilst doing simple every day chores. I had a few panic attacks (never had them or knew what they felt like until now). So bad that I was rushed to Emerge. I have zero appetite and I have lost about 10 lbs. Went to see my doc and she did blood work. My TSH came back at .04 and my T4 free came back normal (on the higher side but still normal). I did an ultrasound which indicates a 'normal sized thyroid' with no focal finding. I did a thyroid uptake scan which indicated 'hot gland and increase trapping'and possible warm nodule mid pole'. After my doc got all of the results she referred me to an Endo. He sent me for more blood work for T3 AND T4. Now I'm confused ? With all that results and he could not diagnose me ? Just yesterday I have a sore throat and I forgot to mention hair loss and forgetfulness ...
Results came back ! Confirmed high levels of FT4 and also of FT3. I don't have a copy of it but my endo did show it to me. Also I have to get blood work every two weeks until April when I see him again (unless he sees something in the blood work before April) So I have to take 5 mg of tapazole methozole (think that's the incorrect spelling) three times a day. I still feel a little shaky and anxious but hopefully the meds kick in soon.
*goes... And what he recommended. Until then I just have to deal with it all.. Thanks again for your reply.
Hi again ... My endo didn't say anything else about the beta blockers and I didn't ask. Since my last visit was the first I didn't want to ask him a million questions but on the next visit I will ! Ativan .. is the anxiety pill. It does help with my anxiety. And since this is all new to me I find it helps when I eat on time as I do not have an appetite. I do get heart burn and chest pains off and on. That's why in the beginning of all this before my doc even suspected thyroid, she gave me ANTI reflux medication. I told my endocrinologist and he said thyroid doesn't cause chest pains and to see my doc for that. I also had some stomach cramps but didn't address that with my endo. I have read on this site that hyperthyroidism can cause the body to 'speed up' resulting on those other symptoms. I will ask him about those other tests you mentioned. He didn't tell me he was running the T3 and T4 I looked at the paper he gave me to go to the lab and I saw that he had hand written that in. I also read that with thyroid it can change your menstrual cycle, and that is not the case with me. No change whatsoever. I will let you know how it gpes
Thanks again for your reply. I feel like I'm going crazy. Here are the lab results:- Anti-Tg 284 HIGH normal range less than 40. Anti-tpo 51 HIGH normal range. less than 35. Free Thyroxine ( Free T4 ) 16 NORMAL- normal range 9-19. Thyrotropin (sensitive TSH) 0.04 LOW normal range .32 - 4.00. I am getting the T3 and T4 results sometime this week. I also had an EKG done at the hospital which was normal. My doc prescribed 20mg beta blocker then reduced it to 10mg. I showed it to my endo and he said to stop taking them. Mind you I had only taken the 20 mg twice on two seperate days and didn't like how I felt hence my doc lessen them to 10mg. I showed the endo the 10 mg and he said to stop taking it. My doc also gave me actavan .5mg which seems to help a little with the nervous/weak/anxious feeling. So hopefully I get some answers this week and some medication. How long do you think once given the medication it takes to feel somewhat normal ? And is this a lifelong medication. A co worker told me she had hyperthyroidism and she took pills for 7 years and then stopped because her levels are normal. My family friend has hypothyrodism and take a pill every day for the rest of her life. A friend of mine had hers removed. I guess everyone is different. I am desperate to take or do anything to feel good. I HATE feeling this way all the time. Thanks again for your reply.
1 Comments
So far, your antibody tests are positive for Hashimoto's, so you could be in a hyper phase of Hashi's, but it's possible to have, both, Hashi's and Graves at the same time, with one or the other dominant at any given time.
Did the endo say why he didn't want you to take the beta blocker?
I'm not familiar with a drug called Actavan... are you sure that's the correct spelling or could it be Ativan, which is used to treat anxiety?
I'm not sure what type medication, if any, the endo will give you. With your FT4 at 70% of its range (recommended is 50% of the range), you won't need replacement hormones right now and if he didn't even want you to have a beta blocker, I can't see him giving you anti-thyroid med, either. It's all going to depend on the results of the new tests you get, since you don't, currently, have a Free T3 test to go with the TSH and Free T4. Your Free T3 could be quite low, indicating a completely different problem than what we think or it could be high, confirming hyperthyroidism.
I do hope he's testing for FREE T4 and FREE T3, as opposed to just T4 and T3, which indicates Total T4 and Total T3, which are not the same tests and don't give the same information. Whenever being tested, be sure to specify that want the Free T4 and Free T3...
It's true that some people stay on anti-thyroid med for many years and others end up having their thyroid removed. It all depends on the situation. Since most hypothyroidism is caused by Hashimoto's, which destroys the thyroid, most people that are hypo end up on replacement thyroid hormones for life, because we can't live without them.
As to how long it will take for you to feel better once on medication, that will depend entirely on what your doctor decides to do. Be sure to let us know the results of your new tests, with the reference ranges, when you get them and we can help determine what a further course should be.
Do make sure you ask for the TSI test I mentioned in my original post, so you can confirm or rule out Graves Disease. If you have only Hashimoto's, you may be swinging to hypo, but with a hyper functioning nodule that may not be the case until the nodule is gone.
Did the endo say why he didn't want you to take the beta blocker?
I'm not familiar with a drug called Actavan... are you sure that's the correct spelling or could it be Ativan, which is used to treat anxiety?
I'm not sure what type medication, if any, the endo will give you. With your FT4 at 70% of its range (recommended is 50% of the range), you won't need replacement hormones right now and if he didn't even want you to have a beta blocker, I can't see him giving you anti-thyroid med, either. It's all going to depend on the results of the new tests you get, since you don't, currently, have a Free T3 test to go with the TSH and Free T4. Your Free T3 could be quite low, indicating a completely different problem than what we think or it could be high, confirming hyperthyroidism.
I do hope he's testing for FREE T4 and FREE T3, as opposed to just T4 and T3, which indicates Total T4 and Total T3, which are not the same tests and don't give the same information. Whenever being tested, be sure to specify that want the Free T4 and Free T3...
It's true that some people stay on anti-thyroid med for many years and others end up having their thyroid removed. It all depends on the situation. Since most hypothyroidism is caused by Hashimoto's, which destroys the thyroid, most people that are hypo end up on replacement thyroid hormones for life, because we can't live without them.
As to how long it will take for you to feel better once on medication, that will depend entirely on what your doctor decides to do. Be sure to let us know the results of your new tests, with the reference ranges, when you get them and we can help determine what a further course should be.
Do make sure you ask for the TSI test I mentioned in my original post, so you can confirm or rule out Graves Disease. If you have only Hashimoto's, you may be swinging to hypo, but with a hyper functioning nodule that may not be the case until the nodule is gone.
COMMUNITY LEADER
Hi there... Really, until we see those labs, there isn't a lot we can tell you, except that the medication you take for Hashimoto's isn't really "for Hashimoto's", it's for the resulting hypothyroidism, since that's what ultimately happens when one has Hashimoto's.
Hashimoto's destroys the thyroid, so eventually, it can not produce enough of the hormones our body needs to function properly. The medication given is replacement thyroid hormones, which, at this time, you may be producing too much of, so you wouldn't want to take more...
With Graves Disease, they can give anti-thyroid medication, but that may not help with a hyper functioning nodule. Often, the recourse, if thyroid removal, but that will depend on a variety of factors and isn't something to worry about, at this point, because it looks like you have Hashimoto's, with your elevated TPOab and TgAb (could you post the actual results, please, with reference ranges?).
You may be given beta blockers to control heart related symptoms, such as rapid heart rate, palpitations, etc. This will be something to discuss with the endo.
Both hyper and hypo can produce the symptoms you describe, so once we see the results of your tests, we can be more helpful.
Hashimoto's destroys the thyroid, so eventually, it can not produce enough of the hormones our body needs to function properly. The medication given is replacement thyroid hormones, which, at this time, you may be producing too much of, so you wouldn't want to take more...
With Graves Disease, they can give anti-thyroid medication, but that may not help with a hyper functioning nodule. Often, the recourse, if thyroid removal, but that will depend on a variety of factors and isn't something to worry about, at this point, because it looks like you have Hashimoto's, with your elevated TPOab and TgAb (could you post the actual results, please, with reference ranges?).
You may be given beta blockers to control heart related symptoms, such as rapid heart rate, palpitations, etc. This will be something to discuss with the endo.
Both hyper and hypo can produce the symptoms you describe, so once we see the results of your tests, we can be more helpful.
COMMUNITY LEADER
What are your actual T4 and T3 results and were they Free T4 and Free T3 or were they Total T4 and Total T3? They aren't the same tests and don't give the same information. If you have those reports, please post those results, along with the corresponding reference ranges, which vary from lab to lab and have to come from your own report(s).
A warm nodule indicates one that might be producing thyroid hormones independently of the thyroid. That could account for your T4 being at the top of its range. It doesn't have to over range to cause adverse symptoms.
Did, either, your primary doctor or the endo do any antibody tests to determine whether you have Hashimoto's or Graves Disease? Thyroid nodules are very common with, both, Hashimoto's and Grave.
The tests you need to diagnose Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, because some of us have one or the other and some have both.
The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).
Your symptoms indicate hyperthyroidism and so does your TSH, but without the T4 and T3 (preferably Free T4 and Free T3), we can't know for sure.
Graves Disease is the most common cause of hyperthyroidism, but it's quite common for those with Hashimoto's to have periods of hyperthyroidism in the early stages. These periods can, often, alternate with periods of normal or hypothyroidism. It's also not unusual to have a hyper-functioning nodule that produces hormones independently of the thyroid. There isn't any way to control a hyper-functioning nodule.
A warm nodule indicates one that might be producing thyroid hormones independently of the thyroid. That could account for your T4 being at the top of its range. It doesn't have to over range to cause adverse symptoms.
Did, either, your primary doctor or the endo do any antibody tests to determine whether you have Hashimoto's or Graves Disease? Thyroid nodules are very common with, both, Hashimoto's and Grave.
The tests you need to diagnose Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, because some of us have one or the other and some have both.
The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).
Your symptoms indicate hyperthyroidism and so does your TSH, but without the T4 and T3 (preferably Free T4 and Free T3), we can't know for sure.
Graves Disease is the most common cause of hyperthyroidism, but it's quite common for those with Hashimoto's to have periods of hyperthyroidism in the early stages. These periods can, often, alternate with periods of normal or hypothyroidism. It's also not unusual to have a hyper-functioning nodule that produces hormones independently of the thyroid. There isn't any way to control a hyper-functioning nodule.
2 Comments
Hey Barb ! Thanks for your response. My results for the T3 AND T4 that my endo had me go for is in ! I will know when I see him at my next appt next week. I looked over my paperwork and I do not see anything for T3 and T4 that my GP sent me for. However I noticed that my ANT-TG and ANTI-TPO is High. I only saw my endo once that's after my GP referred me. And that's when he had me go do more blood work for the T3 AND T4. So maybe he will have a better picture once those results are in. Omg there isn't a way to control a hyper functioning nodule ? So what can be done ? Would medication for graves disease or hasimoto help the nodules. I feel so weak ..I just want to feel somewhat normal again.
Hey Barb ! Thanks for your response. My results for the T3 AND T4 that my endo had me go for is in ! I will know when I see him at my next appt next week. I looked over my paperwork and I do not see anything for T3 and T4 that my GP sent me for. However I noticed that my ANT-TG and ANTI-TPO is High. I only saw my endo once that's after my GP referred me. And that's when he had me go do more blood work for the T3 AND T4. So maybe he will have a better picture once those results are in. Omg there isn't a way to control a hyper functioning nodule ? So what can be done ? Would medication for graves disease or hasimoto help the nodules. I feel so weak ..I just want to feel somewhat normal again.
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