My doctor is stumped

[bethfay]

I just had a well check-up last week and my doctor called me back because my TSH level was so high he thought it must have been a bad test.  Second test showed the same results:

TSH  142
Total T4  3.5
Thyroid peroxidase ab  124

EVERYthing else in my blood work is great - cholesterol, CBC,electrolytes fine  - and all other functions and tests are good too (xrays are good, BP fine,etc).  I have no typical symptoms of hypothyroidism like fatigue or overweight, etc.  I am in excellent health so far as I know with no complaints.  I have no history of thyroid disfunction or abnormal test results in the past.  I am 52 years old and went into menopause about 2-1/2 years ago (with no particular problems).

The doc has put me on Synthroid (112 mcg daily) for now and we have scheduled an ultrasound for the thyroid and MRI to look at brain and pituitary.

He mentioned that TSH can be secreted from other distant locations possibly, like the breasts or lungs ("ectopic" secretion he called it).  I know that hypothyroidism is relatively common and treatable, but the reaction of the doctor and the extremely high TSH number has me a bit spooked.

What in the world could be going on to cause this?

[ChitChatNine]

Hi,

WELCOME to our Community!

Did they do tests for autoimmune disorder antibodies?  I get confused interpreting bloodwork so don't mind me LOL.  

I would probably seen an endocrinologist if the TSH is that high and see what he/she has to additionally offer.  Your doc should be ok with it .. they get touchy.

Keep in touch and let us know how you do on the Synthroid.

C~
partial 1/07
Synthroid 75mcgs
TSH around 1.8-2.0

[Brigee]

The thyroid peroxidase test measures the level of an antibody that is directed against thyroid peroxidase (TPO). A presence of TPOAb in the blood reflects an attack by the body's immune system on thyroid tissue. A positive thyroid peroxidase test may signal chronic thyroiditis.  In your case, since your TSH is also high, these test results would indicate hypothyroidism and a possible autoimmune condition known as Hashimoto's.  

First of all, it is not all that unusual to have no symptoms.  I didn't.  I also went in for a routine annual check-up about thirteen years ago, and everything was fine, except my TSH was 50, and my TPOAb level was the highest my doctor had ever seen.  She couldn't believe I had none of the typical symptoms of hypothyroidism.  But, as I later learned, it can take years for Hashimoto's to develop to the point where so much of your thyroid tissue has been compromised that you actually start to have symptoms.  

What is the lab's range for the Total T4?  I ask that because labs use different measurements for these tests.  My endocrinologist doesn't order that test, as he says it is not a good way to measure the T4 in body.  He orders Free T4 and Free T3 tests (the two main thyroid hormones), as that tells us how much of those hormones are circulating in my system and available for my body's use.  

My TSH has been as high as 98, when we had to change my medication several months ago, and I had NO symptoms during that time.  In fact, I felt good.  My endocrinologist was amazed.  (BTW, I am also 52 and went into menopause two years ago.)  It is a bit unusual to have a TSH as high as yours and not have symptoms, but it does happen.  While my doctor wants to keep me somewhere within shouting distance of a normal TSH number, he is much more symptom oriented.  He says the main goal is to keep me feeling good.  

So, that brings me to another point.  Sometimes, in their eagerness to get our numbers in a so-called "normal range," doctors go a bit overboard.  The thyroid can be a touchy litte critter, and sometimes you have to go really slow with it.  I don't know how long you've been on the Synthroid, but the 112mcg MIGHT be a little too high to start.  A lot of people do much better if they are started on a low dose which is gradually increased over time.  But you might do fine on this dose.  Everyone is different.  

Personally, I was started on 100mcg of Synthroid in the beginning, and I developed symptoms of HYPERthryoidism within about four weeks, even though my TSH was in the "normal range," and we had to cut my dosage back.  It was simply a case of too much (thyroid hormone) too fast.  I just wanted you to be aware of that possibility.

Don't get overly concerned about your doctor's reaction.  I'm sure it's just because he has rarely encountered a TSH number that high.  My endocrinologist didn't get particularly excited about my TSH of 98 a couple of months ago when I was transitioning from one thyroid med to another, because I was feeling fine and had no symptoms.  

So, take a deep breath and try to relax.  When is your ultrasound and MRI?  

Brenda  

[Barb135]

Your high TSH could indicate hypothyroidism, but without additional thyroid tests - Free T4 and Free T3, it's hard to say.  TSH is a pituitary hormone and not indicative of what the thyroid is doing.  

The high TPOab indicates Hashimoto's Thyroidism and the ultra sound will confirm that........

Starting out at 112 mcg synthroid might not be the best choice as it's best to start meds on a lower dose and increase gradually to prevent throwing you directly into hypERthryoidism.........

You need to get Free T4 and Free T3 tests also, since they are the actual thyroid hormones.  

[goolarra]

Brigee gave you some excellent information.

I also have a high TSH with no symptoms.  When I was diagnosed hypo, my TSH was 64.  When TSH came down to the mid-forties, I was symptom-free.  Since being on thyroid meds, my TSH has never been below the high teens.  Last spring, I was diagnosed with pituitary resistance to thyroid hormone.  My pituitary lacks the enzyme for converting T4 to T3.  So, it just keeps cranking out TSH since it is not getting proper feedback from the thyroid hormones..  

I agree that you should get FT3 and FT4 done as soon as possible.  If these are in range, and you are symptom-free, that would indicate a possible pituitary issue.  

I also think your Synthroid dose is high for starting out, especially if a pituitary issue is suspected.  I've also gone hyper with too high a starting dose, too rapid increases, and a TSH of 23!  If you are over 50 or have been hypo for more than a few months or have a heart arrhythmia, the recommended starting dose of Synthroid is 12.5-25 mcg.  If you have any hyper symptoms, speak to your doctor right away.  

[bethfay]

Thanks so much to all of you for your comments.  The ultrasound and MRI are this coming Wednesday (3 days from now) so I should know more shortly.  It makes me feel a lot better to know that there are other folks out there that have had goofy test results with no symptoms.  I'm not a worrywort but of course an anomalous situation like this does tend to make one think all kinds of things ...

I too was kind of taken aback at the high dosage level of Synthroid to start off, but perhaps the doc is trying to see if the TSH will react quickly as more of a diagnostic thing early on.  Based on your comments I certainly will ask him about keeping the dosage lower once there is (hopefully) more info regarding the actual state of the glands.  If anything, I would characterize my typical metabolism as tending more towards the hyPER rather than hyPO anyway, so I sure don't need to get sent "off the deep end" :)

Thanks again for all your support.