Sick euthyroid?

[toworryornottoworry]

For the past two months I have been very sick and recovering from Salmonella poisoning, my yearly physical just so happened to be during the time I was sick and was on a 17 day course of Septra DS, I also took 7 days of flagyl prior to them knowing what was wrong. All the blood work came back normal except for an elevated TSH of 8.03. I am a 21 year old male with no family history of thyroid issues whatsoever. I had my physical done by a clinic doctor who jumped to conclusions and put me on 50 mcg of synthroid.

I decided not to take the medication after reading all this info on the internet on sick euthyroid and how a transient rise in TSH is fairly common in patients with prolonged infections or illnesses. So I went in for a retest with this information a week later and was speaking to a new doctor who agreed that during infection it could rise and said we will look at my free t's to confirm this. Upon new results my TSH had already dropped (was 3 days off of antibiotics and officially tested negative) to 5.55 (.3-5.0) my free t4 was 17 (12-22) and my free T3 was 5.0 (2.0-5.7). We also checked my antibodies and they came back negative. The doctors then agreed that it was due to infection and we will retest in two months to make sure everything is back to normal.

I wanted to know your opinions on this, does my thyroid seem fine with these results? Have you heard of infections/antibiotics transiently raising TSH levels?

[toworryornottoworry]

Thanks goolarra, you have been awesome with giving me some guidance and things to bring up with my doctors. My doctors do not seem concerned at all and say that it takes time for TSH to drop after illness (remember my original blood test with the highest rating at 8.03 was less than 4 weeks ago). It was actually my idea to get it retested so soon together twice in a row because I wanted to make sure my TSH was not fluctuating back up and at least making small improvements. I am going to have it retested in either November or December to give it enough time to recover as my doctor said it usually takes about 2 months for it to drop after illness.

That is interesting about the pituitary is my doctor said that is what we would be looking at with my thyroid hormone levels so regular if I didn't have this illness prior. Any good sites for info on that?

Also one other thing I read was that gut bacteria can affect the results as well, I was on 24 days of antibiotics including the infamous flagyl and just started some probiotics so perhaps once I get my healthy bacteria and digestive enzymes back in order that will also decrease the TSH.

[goolarra]

The currently recommended range for TSH according to AACE is 0.3-3.0.  Many labs and doctors have been very slow to adopt the new range.  So, your TSH is still a little high, but defintiely moving in the right direction.

Your FT4 is even higher than it was initially, so no worries there about being hypo.  FT3 wasn't tested, but your first FT3 was right up there in the range.

It might not be a bad idea to keep an eye on this for a while.  I see no hypo issue here at all and glad you went with your gut and didn't start meds.  My only remaining concern is that your TSH doesn't seem to be dropping all that fast considering how high your FT4 is, and it's going up further.  I'd monitor that to make sure no pituitary issue is involved.  Just be sure to have FT3, FT4 and TSH tested and verify that TSH is consistent with FT3 and FT4.    

[toworryornottoworry]

Got retested a week after my 5.55 results, my TSH is now 4.53 (.35-5.00) and my free T4 was 19 (12-22) antibodies negative.

[toworryornottoworry]

Bumping this thread up to get some more opinions, anyone else experience elevated tsh levels during sickness?

[toworryornottoworry]

Thanks so much goolarra, that is what I thought the problem was as through my research I have found that the levels I am at are what medicated people thrive to reach for. Any other opinions, comments would be appreciated.

[goolarra]

Your FT3 and FT4 levels look perfect.  Yes, your thyroid looks fine.  Infections, antibiotics, trauma, stress, surgery, etc, etc can all cause a transient rise in TSH.  I think your doctor's plan of re-testing one more time just to make sure is excellent.  (BTW, your doctor is also a keeper since he recognized the efficacy of FT3 and FT4 testing.)