New Thyroid results

[bjo29z10]

These are my old results


08/08/13
TSH   0.009                        0.400-5.300

08/12/13
FT3 5.94                               1.71-3.71
FT4  1.80                               0.70-1.48

These are the results after being on 20 mg of Methimazole for a month. What do you all think? Doc did not do TSH as she said it will be suppressed, and reduced dosage. Thank you.

Nov. 1 (same ref. range as above)

FT4  0.57
FT3  2.47

[goolarra]

TSI (thyroid stimulating immunoglobulin) is the antibody associated with Graves' disease.  Your TSI is well above range, so it's a strong positive for Graves' disease.  Graves' disease is the cause for your hyperthyroidism.  You do have antibodies.  

Your TPOab was less-than 10 (0-35).  Did the doctor also test TGab (thyroglobulin antibodies)?

So, now we know why you are hyper.

Your FT3 and FT4 from August were very high, which was consistent with your hyper symptoms.  Your doctor put you on methimazole, which blocks your thyroid from producing so much FT3 and FT4.  Unfortunately, it's very hard to predict just what a given dose will do to each individual's levels, so the initial dose is a bit of a guess.

In your 11/1 labs, your FT4 has come down a lot and is now under range (hypo).  Your FT3 hasn't come down as much as your FT4, but it's a little low in the range (but still in range).  Basically, FT3 follows FT4.  So, the concern now is that your FT3 will continue downward, and you will start to feel hypo (you may already be).  That's why your doctor reduced your dosage...to allow your thyroid to make just a bit more hormone and get your levels more in the middle of the ranges.

As far as your dose is concerned:  "She put me on 15 mg last Thursday but my HR really dropped and heart beat got weak so I dropped it to 10mg."  Lowering your dose of methimazole allows your thyroid to produce a little more FT3 and FT4.  As FT3 and FT4 rise, HR typically gets higher, not lower.  It also takes some time for methimazole to affect your levels, so it's more likely that lowered HR was the result of the 20 mg you'd been taking for a month as opposed to the 15 mg you took that day.  In effect, it just "caught up" with you then.

Also, it doesn't make sense to respond to new symptoms that you think are from a meds reduction by reducing meds even further.

As much as possible, I'd try to stick with the 15 mg dose your doctor suggested.  Thyroid meds have to be adjusted in small increments.  If you adjust too much at once, you can start flip-flopping from hypo the hyper, and you want to minimize that as much as possible.

Depression is a symptom of hypo.  The brain needs thyroid hormones in order to produce all its chemicals, which keep you emotionally balanced.  I'm willing to bet that once you get to optimal levels, your depression will resolve.  

[bjo29z10]

In April they dx'd me with hypo. Started me on low dose levo. I told them about my symptoms then. Tremors are mostly gone, HR normal. Really I'm just tired, trouble sleeping/staying asleep and depressed. I just feel really alone although I have a very supportive family, so I don't know why I am so depressed.
My symptoms have not really been different (they just improve some) with the exception of having a headache/migraine for 14 months in 2010.  
We dropped my dosage because my concern for my low HR.

TSI 572   (0-139)
TPA  <10   (0.0-35.0)

What does high TSI mean?
Thank you

[goolarra]

Let me back up for a minute, then.  I think I misinterpreted your symptoms.  In April, you were actually feeling quite hypER?  Tremors are usually associated with hyper.  Do you remember if you had insomnia, elevated HR and/or BP, diarrhea, etc?

Also, please list your symptoms from just before you were reduced from 20 mg to 15 mg.  Have you noticed your symptoms changing at all from hyper to hypo?  

[bjo29z10]

Could they have really have made such an error?
I was very tired, dizzy, tremors, feeling off. This all came about after a death in the family and a horrible cold. Before that I was doing pretty good from Feb. 2010. only had a few bad days in that year.
She put me on 15 mg last Thursday but my HR really dropped and heart beat got weak so I dropped it to 10mg.
I am seeing a cardiologist regularly since 2010 and everything has been fine. just seen him in Sept.
I have some strength back, not always dizzy, not loosing weight, but still depressed some insomnia and still tired.

[goolarra]

Well, your FT4 is low now because you were taking too much methimazole.  Methimazole stops your thyroid from producing T4.  

Another question is why your FT4 was so low in April (below range), yet your FT3 was high, at the very top of the range.  You weren't even medicated then.    

By August, both were over range.  Both should rise and fall together, ao at least by August they were doing that.  You were taking 25 mcg levo at the time, but 25 mcg is a very low dose, so it would only marginally have affected your labs.

In your current labs, the balance of FT3 to FT4 looks good.  Both are a bit on the low side, but at least one isn't on the floor and the other sky high.

It's really your April results that have me baffled.  I'm wondering if FT3 could have been a lab error???  You were feeling hypo back then, which you "shouldn't" have been with such a high FT3.  

How long ago did you reduce methimazole and how much?  Are you feeling any different yet?

  

[bjo29z10]

Yes very hyper. I actually went to the ER with a resting HR above 160, short of breath, dizzy, started loosing weight rapidly, tremors, insomnia, body pain, tired, no appetite, just not myself at all (that hasn't changed much). I got so weak it was hard to walk.

Should I have my liver tested again? Why would my FT4 be so low? What else can I do or request from my doc?

[goolarra]

A large part of conversion happens in the liver.  There are many lesser sites throughout the body, but the lion's share of FT3 comes from the liver.  Conversion is technically a thyroid issue, but a metabolic issue.  Your thyroid produces much more T4 than T3.  A little of that T4 is immediately converted IN the thyroid, but the rest (about 80% of the total FT3 in your body) comes from conversion outside the thyroid.  

Sorry for all the questions, but how did you feel just before the doctor started you on methimazole?  With both FT3 and FT4 over range, were you feeling hyper?

[bjo29z10]

I felt pretty much the same I am now. Just not right, tired, depressed, ect....
Yes I have had an ultra sound and an uptake (74.5%). Thyroid is slightly enlarged.
My liver is fine. I have been dealing with this since 2007. Went undiagnosed until May because doc's were stuck on depression and anxiety. I have been to 2 neuro hospitals and a multitude of doc's in many fields. No one ever thought to check FT3-FT4 until I went to endo. I am extremely healthy in every other area but my thyroid.
What does the liver have to do with thyroid? Sorry for the dumb questions just trying to learn as much as possible. I will go get my test results to find out if my doc tested me for TSI and will post when I get them.
I do believe I have had this much longer. Looking back I started having trouble after the birth of my 2nd son who is now 12.  Thank you.

[goolarra]

A swollen thyroid (goiter) isn't the cause of thyroid hormone levels going off, rather both the swelling and the thyroid levels are a response to some kind of inflammation in the thyroid.  

TSI (thyroid stimulating immunoglobulin) is the antibody associated with Graves' disease.  Nothing can be done about any of the antibodies, but if you know you have one or both autoimmune diseases, it gives you a lot more idea what you can expect in the future.

Did you have an ultrasound?

I've read that hyper converting is possible, but I have to say that I've never heard of anyone who had it.  Do you have any liver issues that you know of?  How did you feel in April when your FT4 was so low and your FT3 was so high?  Did you feel hypo?

[bjo29z10]

I was on 25mcg levo. Yes I was on the levo at the time of the 2nd draw. My thyroid is swollen, could that be this cause and if so what causes that?

I know she did TPO and TGab not sure about TSI. What does that show? What can be don about it? I just so desire to feel like myself again. Yea 4.2 is right. Could I just be hyper converting, if there is such thing? My doctor really listens to me and seems to be on top of things, she has been helpful but like I said I am usually a wreck while with her.

I will get the labs and post them probably Mon.

Thank you so much, I feel so alone and scared in all of this! I just wish I had someone I could talk to and cry with.

[goolarra]

I can see where you'd be confused because your labs are a bit confusing and contradictory.

Back in April, your FT4 was very low; it was just below the bottom of the range, which would usually indicate hypo.  However, at the same time, your FT3 was 4.2, which is the very top of the range, and that usually indicates hyper.  That 4.2 is correct, right?

How much levo were you taking after these labs?

By August, both your FT3 and FT4 were above range, indicating hyper.  Were you still on levo immediately before those labs?

Did your doctor test for all three antibodies:  TSI, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies)?

Although it is possible, hyper without antibodies is really quite rare.  It would be interesting to know what your doctor suspects is the cause of yours.

    

[bjo29z10]

I asked her if I could have hyperthyroidism w/o antibodies and/or nodules, she said yes, that was about it. I am usually a wreck while at my appt. so I don't always think to ask all questions even when I write them down and take the list with me. I was originally dx'd hypo back in April then went hyper-

April, 2013

TSH 1.71                                    TSH 0.34-4.82
FREE T4 0.69                                FT4 0.77-1.61  
FREE T3 4.2                                FT3 1.8-4.2  

Are these hyper or hypo. I was not medicated at the time of testing, started levothyroxine then went hyper July/August. I am so confused by all of this! I am scared! What else can I do?

[goolarra]

You were tested for TSI, the antobodies associated with Graves"?  Has your doctor indicated what might be causing your hyperthyroidism if it isn't graves'?

You were hyper, and you started taking methmizole.  Methimazole stops your thyroid from being able to produce too much hormone.  However, if you stop taking it, your thyroid is going to go right back to producing too much again.  So, you are only bordering on hypo because you were a little overmedicated.  It can take time and a few adjustments to find our correct dose of thyroid meds.

Your FT3 is a little low, but it's not too bad yet.  However, your FT4 is currently so low that if your FT3 keeps following it down, you would eventually start feeling hypo.

[bjo29z10]

I have been dx'd with hyperthyroidism. Antibodies test fine, no nodules. I am exhausted but have been through all of this. Sometimes  my heartbeat is weak. I do feel better but not 100%, but will continue to pray and believe the Lord for this. Are you saying I am now hypo? Is my FT3 too low?

[goolarra]

Your FT4 was above range in August.  Now, it's below range.  Your doctor is probably shooting for about midrange, which is why she reduced your meds.

Your FT3 is also low in the range now.  

Have you had any hypo symptoms yet?

Have you been diagnosed with Graves'?