Normal T4, High TSH, hyperthyroid symptoms

[becky72]

For several months, even years I have had increasing symptoms of hyperthryroidism--rapid heart rate, trouble sleeping, unexplained weight loss, tremor in my hand--recently I had blood work done to check my thyroid.  My TSH level is high 10.301, my T4 level was .96, in the normal range according to the lab work.  My doctor wants me to take synthroid and has diagnosed hypothyroidism, but I have none of those symptoms.  I have read about "secondary hyperthyroidism" which could actually be a pituitary issue, perhaps an adenoma.  Has anyone come across this scenario before?


This discussion is related to High TSH,Normal T4 T3.

[Rite760]

Hi, I just wanted to say, I am exactly like you with symptoms. My TSH keeps swinging from high to low and back again. But even when it's high, indicating hypothyroidism, I still have all the symptoms of hyper. I've lost nearly a stone over the last few months, I get awful palpitations, sweating, trembling, like you say all associated with hyperthyroid as opposed to hypo! However, the docs always stick to the text book definitions for symptoms don't they. But since coming on this forum, I've been told by a lot of experienced people that often all the symptoms get mixed up and you can suffer hyper symptoms even when hypo! So wait for some replies from the experienced ones here, they will explain it much better for me. Look out for Stella, she is the person who particularly explained this situation to me and is real good on it.

[becky72]

Thanks for your input.  It helps to know I am not the only person who has had this experience!

[estrelinha]

In second secondary hyperthyroidism your TSH would be much higher (if because of adenoma), and your T4 would be much higher too, your free T4 is in the lower side of normal range. Need to check free T3 ant thyroid antibodies (TPO AND ANTI-tG) too. Your right about your symptoms. Ask Dr. Lupo about this.

[estrelinha]

Your TSH is about 10, is it right????

[becky72]

Yeah--it was 10.301.

[becky72]

By the way, have you taken synthroid and if so did it help?

[nursemelissa23]

My son has ALL symptoms it seems of HYPER and his labs keep showing more towards hypo i am told.  He is 6...no lack of energy, eats all the time, skinny as a rail and is in the 96% percentile on his height.  He also has a slight "intention tremor" but the neurologist did every test with everything showing normal in his brain.  Blood work shows elevated TSH, was rechecked after 7 weeks and now its around 8 (so its going up), T3 and T4 normal.  But even the doctors say he has no symptoms of hypothyroidism...rather hyperthyroid symptoms???

[goolarra]

My TSH is 23 and has never gone below about 19 (that I know of).  My FT4 is fairly low at 1.16 (0.6-2.0).  FT3 is on the floor at 1.8 (1.8-4.2).  I have NO hypo symptoms and haven't had in a year and a half..  A few months ago, my endo tried to increase my Levoxyl from 75 mcg to 81.5 mcg.  In about ten days, I was feeling hyper as he//.

TSH is a very poor indicator of thyroid status.  It is a pituitary hormone and affected by many things besides thyroid hormone levels.  I have been diagnosed with "pituitary resistance to thyroid hormone".  My pituitary lacks an enzyme for converting T4 to T3, which causes my pituitary to keep cranking out TSH, no matter what the levels of FT3 and FT4 in my blood..  

When diagnosing and treating thyroid problems symptoms, FT3, FT4 and TSH have to be looked at (and in that order).  My labs looked hypo as can be when I had hyper symptoms.  I just happen to be one of the outliers who feels very comfortable in the very low end of the FT3 and FT4 range.  The minute my FT3 gets up off the floor, I start developing hyper symptoms.  

Secondary hypothyroidism is usually characterized by low TSH.  The pituitary or hypothalmus malfunctions and TSH is not produced, thus the thyroid is not stimulated to produce T3 and T4.  The result is that you are hypo, but your thyroid is healthy and able to produce hormones (if only it had some TSH to help it!).

One of my pet peeves is that people like us, with high TSH and normal FT3 and FT4 (although often low normal), are a bit ignored.  Since so many people have the opposite problem (normal labs, but still hypo symptomatic) and are not comfortable until FT3 and FT4 are in the upper end of the range, we are looked at a bit askance.  It's been frequently suggested to me that I am hypo, I just don't know it or the symptoms are subtle, I just don't recognize them (I was hypo before Levoxyl, and, believe me, I know hypo from hyper).  Some of us just HAVE to be treated according to symptoms.  Everyone has different levels at which they are comfortable.  What we have to do is convince our doctors to treat on symptoms...sometimes that's very difficult.

I'm glad to hear from others out there who share this dilemma.