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TSH w reflex to ft4 = 0.02 What does it mean?
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TSH w reflex to ft4 = 0.02 What does it mean?

I went to the doctor because I've been having headaches behind my eyes and in my sinus area.  I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.

He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating.  I don't.  
She said I have an overactive thyroid, and requested blood tests to confirm it.  They also came back consistent with a hyperthyroid result, but I don't know what tests they did.  It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.

I'm curious to know what might be going on, because the doc won't be back for another week.  The headaches linger and often I have clear blurry spots in my vision when they begin.  It's starting to worry me a little.

I appreciate any feedback about that TSH test result.
Thanks.
Tags: TSH hyperthyroid
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Avatar_f_tn
This is the tricky part about interpreting the TSI test.  The reference range is "<140%", so if your result is <140, you don't have Graves', right?  Nope, too logical, wrong, of course!  The fact of the matter is that people who don't have Graves' don't produce TSI and have TSI of <2%.  The whole gray area between 2% and 140% is where antibodies are active (i.e. you do have thyroid autoimmunity), but symptoms usually don't occur until levels get to around 140%.

Once under treatment for hyper, TSI can be used to monitor response to anti-thyroid drugs (ATMs) and to help predict remission.  Interestingly, levels should fall below 20% before discontinuing ATMs.  (I used to have a really good link for this, but the site seems to have shut down, so I'm paraphrasing from the printout I have.)    
79 Comments Post a Comment
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Avatar_f_tn
A TSH of 0.02 does indicate hyperthyroidism.  However, the actual thyroid hormones, T3 and T4 are a much more direct and reliable measure of thyroid status.  The "TSH with reflex to FT4" is an order to the lab, what it means is "test TSH, and if it's abnormal (which yours was), test FT4 also".  FREE T4 (FT4) and FREE T3 (FT3) are the much more important tests.  Hopefully, that's what they ran after seeing your TSH.  You should request copies of your lab reports and start maintaining your own history.

The other test they should have run is TSI (thyroid stimulating immunoglobulin).  TSI is the antibodyy that indicates Graves' disease, which is autoimmune hyper.  Graves' and hyper are virtually synonymous.  

Symptoms vary person to person.  Some people gain weight hypo or hyper, some lose.  Typical symptoms of hyper include insomnia (and often fatigure due to insomnia), diarrhea. increase HR and/or BP, anxiety, palpitations and/or tachycardia, etc.  However, symptoms change depending on how hyper you might be.  

If you request a copy of your blood work, you can post it, and we can help you decipher it.  Be sure to get reference ranges as well since they vary lab to lab.

TED (thyroid eye disease) is also a conmplication of hyper...it's the bulging eye look we often associate with it.  That could be what's causing your headaches and other eye problems.  
    
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Avatar_f_tn
If you're 5'5" and 110 lbs, then you don't have any clue what "gaining weight easily" means!  LOL  You're height and weight pretty much fit the profile of hyper.  
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Avatar_m_tn
Thanks for the info.  I checked the report again and it does have a T4 Free number - 1.7.  I'll call the doc on Monday to learn the results of the tests they ordered that confirmed the hyperthyroid.  It looks like that T4 free is ok?

Laughing about your comment on my weight.  I range from 110 -117.  Once I hit 115, I diet until I lose about 5, then watch it slowly increase again.  I am motivated because I'm too cheap to buy new clothes!

I am concerned about this other stuff, though.  I just haven't felt like myself for awhile, but I can still work out hard and sleep ok, unless my eyes start to hurt.  

I appreciate your advice and am looking forward to learning more from you.  Thank you!
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Avatar_m_tn
Ft4 range is .08-1.8.  Mine was 1.7.  
Will look for more info from doc office on Mon.
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Avatar_f_tn
That's pretty high in the range for FT4.   Midrange is the "rule of thumb" until we each find where we feel best.  FT3 is the test that best correlates to symptoms, so, hopefully, they ran that as well...probably since they already had FT4.   Typically, FT3 runs higher in its range than FT4 does in its.  So, since your FT4 is pretty much at the top of range, your FT3 just might be over.

I fought my weight all my life...mostly successfully.  I'm a half inch taller than you, and the lowest I ever got to as an adult was 125 (I was pretty trim at that).  Mostly I went from 140-160...as you say, lose it, watch it slowly go up, lose it, ad nauseum...  I'm sure you're still pretty slim at 115.  Since I've gotten my thyroid hormones stable, I maintain...a "few" pounds" more than I'd like perhaps, but at least it's not the rollercoaster routine.

Antibody tests will tell you a lot more about what's going on.  It sounds like your doctor is on top of it (and you have no idea how much that counts for when it comes to thyroid).

Let us know what you find out...  
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Avatar_m_tn
Hi Goolarra,

I appreciate your comments.  Thank you for sharing them!
I got the T#, Free result - it is 4.8

The doctor wants to test TSH again and iodide (I think)?
Will these numbers change alot?
Could this be causing my headaches?

Thank you so much for your help!
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Avatar_m_tn
I found more results on the lab slip -
thyroglobulin antibodies <20
thyroid peroxidase <10

Also, the range for the T3 is 2.3 - 4.2
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Avatar_f_tn
What's the range on your FT3?  Ranges vary lab to lab, so you have to report them with results.

I your doctor is going to test again, he really should test FT3, FT4 and TSH.  TSH is pretty worthless without FT3 and FT4 numbers to back it up.  Also, since virtually all hyper is Graves' disease, he should order TSI (thyroid stimulating immoglobulin), which is the definitive test for Graves' antobodies.  

TSH is volatile.  It can change as much as 70% just depending on the time of day the blood is drawn.  FT3 and FT4 tend to be more stable.  

Headaches are a frequent symptoms of hyper.  FT3 ranges vary considerably lab to lab, so I really don't know yet how high your is until I see the range.
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Avatar_m_tn
Hi,
The range for the T3 is 2.3 - 4.2.  Mine was 4.8
TSH was 0.02 - range 0.4 - 4.5
T4 was 1.7 - range 0.8 - 1.8

It is the TSI that he is having drawn this week.  
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Avatar_f_tn
Oops...guess we were typing at the same time up there.

Good...he's doing the right things, then (testing TSI).

Your FT3 is clearly over range.  It looks hyper, too.  I think you've found your problem.    

TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are both within range.  They're the markers for Hashi's, so you don't have that (Hashi's is hypO, so we wouldn't suspect it).

I'm quite sure your TSI will be positive.  You'll feel better on meds.
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Avatar_m_tn
What is the problem? Is it Graves?  Will I gain weight on meds?  I work so hard to stay where i am.  They will just do meds?  I don't have to anticipate anything else?
Thank you so much.
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Avatar_f_tn
Well, of course, you can't know for absolute certainty until you get the results of the TSI, but hyperthyroidism is virtually all Graves'.  However, there are other forms of thyroiditis that can cause temporary hyper states, which is why it's important to verify with the TSI.

No, you shouldn't gain weight on meds.  Sometimes it takes a little fiddling to get them right, but once adjusted properly, they won't cause you to gain weight.  Although we usually associate weight gain with hypo and weight loss with hyper, I, personally, have found that I maintain best when right in the middle...neither hypo nor hyper.

Initially, unless the disease has progressed quite far on diagnosis (and I don't think yours has because you only have a few symptoms), meds are the first line of treatment.  Further down the road, RAI (radioactive iodine) or surgery might be recommended.  I doubt they'd recommend that for you now, but if they should, I'd definitely ask for meds until you have time to research both thoroughly.    
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Avatar_m_tn
Thank you.  I've been checking for your answer, so it was nice to read your response.  I am confused by this because I don't have many of the symptoms.  I had blood drawn for the TSI today, and it appeared that they are checking TSH, FT3 & FT4 again, too.  So, I guess I'll know more by the end of the week.

My symptoms are mostly headaches,some double vision, dry & itchy eyes, fatigue, confusion, paper thin fingernails, and dizziness or flushing and also total sudden loss of menstrual cycle after years of predictable monthly cycles.  But, I don't have all those symptoms listed first when you see hyperthyroid.  So, it just seems unusual that this would be what's wrong.  I'll let you know what happens with the TSI.  
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Avatar_f_tn
I'm glad they're doing that.  Re-testing never hurt anything (except for that stab in the arm).  

Your levels indicate hyper, but they're not as high as some people's are on diagnosis.  Symptoms really do vary person to person.  No one has ALL the symptoms...good thing because the list is about as long as your arm!  

When I was first diagnosed hypo, I didn't have a lot of the classic hypo symptoms, either.  Fatigue is almost universal, but I had energy.  However, I almost had narcolepsy...when I sat down for more than about 10 minutes, I fell asleep.  But, if I was up and about, I wasn't dragging.  I also never was constipated (once again an almost universal symptom).  I didn't lose my hair.  My main symptoms were back pain/weakness and cold intolerance, and it never occurred to me that the back was totally thyroid related, but it was.

The TSI will tell you a lot more (let me know).  Of course, if your heart rate, BP, eyes, etc. are not being affected, and you don't want to go on meds, you don't have to until (if) your levels get high enough to make you want to.  There's also no reason not to try meds to see if they do relieve your symptoms.  
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Avatar_m_tn
Hi goolarra,

I received more test results back today, but not the TSI.  

TSH = 0.01 (range 0.4-4.5)
T4, Free = 1.5  (range 0 .8-1.8) (last time it was 1.7)
T3, Free 4.8 ( range 2.3-4.2)

I guess it's still hyper, disappointed that the TSI result isn't there.  I think the office may not have ordered the tests properly.  
Does the consistency in the TSH & T3 mean anything?
Thanks
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Avatar_f_tn
The TSI might take a little longer to come back, unless, of course, you don't think they actually ordered it???  I hope they didn't mess up and not order it.

The consistency of the T3 and TSH means it wasn't a fluke or a lab error, and your results really are hyper.    
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Avatar_m_tn
Hi,
The TSI came back in normal range.  It is 48 the ref range is <140%.
What does that mean?  The doc left a msg saying that I'm a little overactive and he can talk with me about it tomorrow.
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Avatar_f_tn
This is the tricky part about interpreting the TSI test.  The reference range is "<140%", so if your result is <140, you don't have Graves', right?  Nope, too logical, wrong, of course!  The fact of the matter is that people who don't have Graves' don't produce TSI and have TSI of <2%.  The whole gray area between 2% and 140% is where antibodies are active (i.e. you do have thyroid autoimmunity), but symptoms usually don't occur until levels get to around 140%.

Once under treatment for hyper, TSI can be used to monitor response to anti-thyroid drugs (ATMs) and to help predict remission.  Interestingly, levels should fall below 20% before discontinuing ATMs.  (I used to have a really good link for this, but the site seems to have shut down, so I'm paraphrasing from the printout I have.)    
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Avatar_m_tn
Hi Goolarra,
Thank you so much.  This IS confusing.
So, you are saying that I have an earlier case of Grave's?
And, it can go into remission?
But, it could also progress to the point where the TSI number is higher and would be accompanied by more symptoms, or it could improve with medication.
What if I just waited to see if it got better on it's own?
What should I ask the doctor when he calls me tomorrow?
Thank you,
Theresa
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Avatar_f_tn
Yes, that's what I'm saying.  You do have autoimmunity, and it could progress or it could go into remission.  

If you can tolerate symptoms at the moment, and (and this is very important) your elevated levels aren't contributing to thyroid eye disease (TED) or any other health problems, you can wait as long as you're comfortable.  However, higher levels of thyroid hormones can have some nasty effects on the body, so do monitor very closely.

I think I'd ask the doctor what the up side of meds is and the down side of doing nothing.  Would meds really increase your chances of remission?  Could waiting compromise your health in any way (TED, HBP and/or tachycardia/palpitations, osteoporosis, etc.).  I'd be expecially concerned about TED because of your headaches, etc.  

Let me know how the call goes...  
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Avatar_m_tn
Thank you, Goolarra.
Doc called.  In his opinion, the TSI test was negative.  He is concerned about TSH, T3 & T4.  He wants me to have a thyroid u/s and follow up with endo.
He said it could be a case of thyroiditis - a virus of the thyroid?
T
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Avatar_f_tn
I'm glad he'll be referring you to an endo.  I have a feeling your current doctor may be a bit out of his league.    

Thyroiditis is kind of an all-encompassing term.  It refers to any inflammation of the thyroid, so it covers the whole gamut from hypo to hyper.  There are a couple of types of "temporary" thyroiditis (i.e. they are not autoimmune), and both are characterized by an initial hyper phase, usually followed by a return to normal and then a hypo phase/.  Although usually temporary, both can can last up to a couple of years and both can become permanent.  I don't think they apply to you because of your TSI count, but if you'd like to do some research, they're called DeQuervain's thyroiditis and silent thyroiditis.  DeQ's usually follows an upper respiratory infection.

Will you have to wait long to see an endo?


  
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Avatar_m_tn
The endo office can't get me in until 10/1.  I'm a little bummed.  Some days I feel great, but today I had headaches again and was exhausted.  I am a naturally high energy person, so the difference is very noticeable.

I also did my own little experiment and enjoyed three days of eating desserts, ice cream sandwiches and some chips.  I gained 4 pounds, so I'm not having that benefit of losing weight at all.  I still have to watch my diet like crazy.  In fact, I've thought for quite some time that it can't be normal for a person to gain weight as easily as I do.  I spend so much time working to keep in shape, that it doesn't make sense - even though I am in my late 40's now.  

I am disappointed that I have to wait so long, because just when I start feeling good, I end up with a day like today and it frustrates me.

Thanks.
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Avatar_f_tn
I've always been able to put on lbs without any trouble.  Since I've been on thyroid meds is the first time ever I've actually maintained.  Before that, the pounds slowly crept on, then I'd lose them, and the whole cycle would start over.  In order to lose weight, I really had to struggle...I couldn't eat more than 1,000 calories a day, and I swam of played racquetball six days a week.  The years never improved that scenario any!

I know it's a long wait, but 10/1 will be hear before you know it.  Let me know how it goes...  
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Avatar_m_tn
The doc ordered a thyroid u/s - all was normal.  He wants me to repeat thyroid screen in 6 weeks and says he is hoping the endo can take me sooner because he's not comfortable treating me.
I've been having these blurry floating circles in my left eye, usually followed by a headache, but today I took Advil and the floater resolved with no headache.  It seems that this happens most often after I complete a really tough workout.
I think I'm starting to have other symptoms, too - I think signs that my body is not absorbing fat, so maybe I will eventually lose some weight.  
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Avatar_m_tn
I saw endo today.  He thinks I have mild Graves.  He ordered more bloodwork with a scan to follow depending on results.  He says minor chance it is thyroiditis, but most likely Graves.  He was surprised my resting heart rate is 60, but that's because I am an athlete.  He thinks they will end up treating me with a low dose of meds.  Any thoughts?
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Avatar_f_tn
Glad to hear you didn't have to wait until 10/1!

Yes, I agree with him..."mild" case of Graves'.  Having a mild case of Graves' is a little like being a little bit pregnant, either you have it or you don't.  However, he's also right that your antibodies are still on the low side, below where most start experiencing symptoms.  Graves' can go into remission and sometimes does for years.

I'll be interested in the results of your further tests and scan.  Any idea what he ordered?

I think you'd overall feel better on a low dose of meds.  Your antibodies are still on the low side, so you could go into remission.  With Graves', symptom relief isn't always the only important thing.  TED is an issue, and your headaches, etc. concern me.  Of course, a good eye doctor, experienced in TED, can give you a lot more information on what's going on.  You'll have to monitor antibodies and FT3 and FT4 levels regularly while on meds.  What are your thoughts?
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Avatar_m_tn
Hi Goolarra,

I'm so confused.  The latest bloodwork had my T3 & T4 in the normal range for the first time in 3 months:

TSH 0.03 (0.4-4.5)
T3, Free 3.2 (2.3-4.2)
T4, Free 1.1 (0.8-1.8)

I guess that means he is questioning if it is thyroiditis?  He wants me to have bloodwork done in 4 weeks and schedule a re-check.  If it shows high T3 & T4 like previous tests, he will have a scan done.  I spoke with the receptionist, but based on what he told me, he thinks I have Grave's, but is holding tight to see if all my numbers my go back to normal.

I was almost hoping for Grave's diagnosis today.  I've been shaky a lot lately, mostly in the morning.  I thought that treating this might help with my shakiness.  

Thanks,
Theresa
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Avatar_f_tn
It is confusing.  

It could be a temporary thyroiditis...most of them are characterized by an initial hyper phase, followed by a return to normal and then a hypo phase.  The hypo phase can be lengthy, but it usually resolves spontaneously.  However, that still doesn't explain the TSI.  It could also be that you're going into remission.

Have your symptoms changed at all since your labs fell back into range?

Will he test TSI again in a month to see what that's doing?  I think that would be a really good idea.
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Avatar_m_tn
I've been really shaky in the mornings after I eat.  I wake up at 3am now, and I used to sleep well.  The headaches have resolved.
He says he doesn't believe in testing TSI - he thinks it's a lousy indicator.
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Avatar_f_tn
I'm sorry you're having to put up with symptoms for so long.  However, with your current labs, treating for Graves' would be difficult.  Midrange is the target for FT4, and yours is currently below that considerably.  Upper half to upper third of range is the rule of thumb for FT3, and you're below that as well.  If you'd been hypo or were on replacement meds for hypo, I'd say you could use an increase.  

I'm glad to hear the headaches have resolved.  Hopefully, the other symptoms will resolve, too.  Hang in there.  Thyroid diagnosis can be a trying process.

Have you had glucose levels checked?
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Avatar_f_tn
What is TSI. I have lived with Hashi's for 15 years and have never heard of the TSI test?
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Avatar_f_tn
Your information is not correct and your terminology is not American. Know lab or doctor in the states refer to the TSH as a TSI. They also do NOT say FT3 or FT4.
People if you want up to date advise on the thyroid go to Dr. Kent Holtorfs website. Also, go to About thyroid.com.
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Avatar_f_tn
TSI and TSH are not the same thing.  TSI (thyroid stimulating immunoglobulin) is a test to determine if you have the antibodies that cause Graves' disease (autoimmune hyperthyroidism).  TSH (thyroid stimulating hormone) is a pituitary hormone that tells your thyroid to produce more thyroid hormones.  

Perhaps you have never heard of TSI because you have Hashi's, not Graves'.  

FT3 and FT4 are very commonly used abbreviations for FREE T3 and FREE T4.  Go into any lab in the country, and they will know what FT3 and FT4 are.

What of my information do you think is not correct (please be specific as I like to correct any errors I might make)?  I'm American born and bred, so I don't quite know how my terminology could be "not American".  
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Avatar_m_tn
Hi,

Latest test results:

TSH 0.39
TSI 28
T4 1.0
T3, Total 102
T4 Total 5.6

I don't have the ranges as the nurse read those levels to me.  She said everything is normal except the TSH, but that is improving.  She wants me to follow up with endo.  Is this more indicative of thyroiditis or Graves?

Theresa
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Avatar_f_tn
Your TSI has gone down a bit, so that makes it look a little less like Graves'.  

FT4 (the range on that is usually around 0.8-1.8) is lower than it was last time, which indicates hyper even less than your last one.  Midrange is the target for FT4, and you're considerably below.  Total T3 and total T4 are considered obsolete tests and of limited usefulness.  However, both of those, for what they're worth, look low as well (guessing at the ranges).

I'd follow up with an endo.  He might have a different perspective on the TSI.  Refresh my memory...have you had TPOab and TGab tested?

Any change in symptoms?
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Avatar_m_tn
Hi Goolarra,

Yes, I have had a change in symptoms.  My eyes are not so dry anymore and I don't have the headaches.  I see the endo this week, but maybe I don't have to go back.  The change in my T4 & T3 is really interesting to me.  It has gone from too high to almost too low.  But, my TSH is now in the normal range.  Does this all mean that whatever my issue was is now resolved?

Latest lab work - 9/25/12:
TSH 1.80 range 0.4 - 4.5
T4, Free 0.8 range 0.8 - 1.8
T3, Free 2.5 range 2.3 - 4.2

This is what things looked like in July & August:
T3, Free 4.8  range is 2.3 - 4.2.  
TSH was 0.02 - range 0.4 - 4.5
T4, Free was 1.7 - range 0.8 - 1.8

What do you think?
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Avatar_f_tn
Sorry, don't kill the messenger, but I really think you're in the process of going hypo.  You're in a transitional "normal" phase of swinging from hyper to hypo.  I'm really beginning to wonder if you don't have Hashi's.  Hashi's can be characterized by an initial hyper phase where the thyroid kind of "burns out" and then becomes hypo.  Also, early stages of Hashi's can be characterized by swings back and forth from hyper to hypo.

I just found this regarding TSI and Hashi's:  

"Thyroid-stimulating immunoglobulins (TSI) can be detected in the majority - some estimates say as many as 75 to 90 percent - of Graves' disease patients. The higher the levels, the more active the Graves' disease is thought to be. (The absence of these antibodies does not, however, rule out Graves' disease.) Less commonly, some people with Hashimoto's disease also have these antibodies, and this can cause periodic short term episodes of hyperthyroidism."

Your FT3 and FT4 have taken a nosedive.  FT4 is now on the floor of the range, and FT3 isn't far from it.  FT4 should be close to midrange, and FT3 should be in the upper half of range.  

I'd keep the appointment with the endo, and I'd ask him to order TPOab and TGab to see if you have Hashi's.  That huge change in such a short time needs explaining, and if the cause is autoimmune, you're going to be needing an endo at some time in the not-too-distant future.  

Both silent thyroiditis and DeQuervain's thyroiditis can also be characterized by an initial hyper phase followed by a temporary hypo phase.  TPOab and TGab are not elevated in these conditions, so these antibody tests distinguish Hashi's from silent and DeQ's.

If you have Hashi's and only swing hyper on rare occasion, it could explain why you put on a few pounds now and then.  
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Avatar_m_tn
Very interesting.  Thank you.
At least it explains the weight thing.  I don't eat much at all, and I know it's not normal to eat as little as I do and not lose weight.  I will keep the appointment and request the labs you suggested.  I am so grateful for your guidance.  Thank you so much.
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Avatar_m_tn
The did said I have thyroid iris and put me on a slowly increasing dose of  synthroid. He says this will probably br a hypo situation for 6 months. He did not mention any of those other tests. I got nervous and didnt ask about Hashis.   Should I follow up and ask?  I have been so tired all the time. I've gained 5 pounds in 4 weeks.
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Avatar_f_tn
I'm assuming he thinks you have one of the temporary types of thyroiditis I mentioned above (silent or DeQuervain's).  He thinks the hypo phase will last about six months (which is a guess...it can be a short few weeks or a long couple of years).  

The treatment is the same for any hypo, whether it's temporary thyroiditis or Hashi's.  He's started you on Synthroid (and is increasing slowly, which is good), which he would have done no matter the cause.  Antobody testing (TPOab and TGab) would simply make you more confident of whether this was truly a temporary state.  If I were you, I'd request antibody testing with my follow up labs.  There's no reason for it to be done immediately.

It takes Synthroid a while to build in your blood and start relieveing symptoms.  What did he start you on, and how long ago did you start.  Feeling any better yet?  
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Avatar_m_tn
Hi Goolarra,

He is having me break 75mg pills in half for 2 weeks, then take half of 88 mg for a week, then half of 100 mg.  I'm only on day 3, but this fatigue is getting worse.  I am exhausted and have to take a nap just to get through the day.  It is crazy.  I'm wondering how long it will take to fight this overwhelming and worsening fatigue?  I also have an extremely sluggish digestive system now, which is not resolving either.  

I appreciate your help so much.  I will ask him for the antibody testing when I go back in early November.  I don't know why I got so nervous about asking before.
Thanks.
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Avatar_f_tn
That's a good increase schedule...you don't want to move too fast.  Believe me, hypo is better than hyper (overmedicated)!

It takes T4 meds 4-6 weeks to reach their potential in your blood.  So, for the first couple of weeks or so, we often feel worse since blood levels are still low.  Also, other systems (often the adrenals) have taken over and attempted to make up for thyroid deficiency, so the whole body has to rebalance.  It seems like its the meds doing it, but it isn't.  You might try magnesium for the digestion (constipation?).  Magnesium is water soluble, so what your body doesn't used gets flushed out.  It helps many with the gut issues.

Let me know how it goes...
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Avatar_m_tn
Yes, constipation.  It's crazy the difference between being hyper and hypo.  In hindsight, I think this has probably been going on for a few years, cycling on and off at times.  No improvement in symptoms at all.  Hopefully over the next few weeks.
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Avatar_m_tn
I am exhausted by 3 everyday. Can I do anything to combat it? It's draining and it's getting worse.
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Avatar_f_tn
You've only been on meds since the 4th, is that correct?  So, I'm assuming you're still breaking a 75 in half and taking 37.5, and you've only been on meds for a little over a week.

There's not a lot you can do (except take a nap).  It just takes meds a while to build in your blood.  Are you generally healthy?  Tolerating the meds well so far?  If so, you might ask your doctor if you can speed up the increase schedule a bit.  However, be aware that increasing faster can give you hyper symptoms.  In my personal experience, I'd rather avoid the hyper symptoms and take the nap!  LOL

When I was hypo, I wasn't fatigued (I had energy) as much as I was almost narcoleptic.  As long as I kept moving, I was okay, but when I sat down at my computer or rode in the car, I couldn't stay awake.  It will turn around.  Time and patience...  
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Avatar_m_tn
Thanks.  Yes, I am generally very healthy.  And, I am still breaking the 75 in half.  I haven't noticed any difference at all, as if the medicine is having no impact on anything.  The endo told me to take the entire 75 for now.  I guess I'll see if that helps. Now that I've experienced both hyper and hypo, for me, the hyper was easier to deal with.  So, maybe my hyper wasn't significant.  I do like that with hypo my eyes are back to normal and I don't get the headaches, though.  I can sleep better at night, which is good because I'm exhausted during the day!
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Avatar_f_tn
Don't be discouraged because you haven't seen a difference in a week.  It takes longer than that for meds to kick in.  It's really not unusual at all for people to feel slightly worse for a while.  Upping your dose to 75 ought to help.  Hope you start feeling better soon...  
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Avatar_f_tn
.hello... I havent been dx with thyroids as such. But I had a blood test which the lab said evidence of hyperthyroidism retest in 3 months. I had a retest and lab then said borderline hyperthyroidism refer to endo. I had my blood taken again prior to seein endo and apparently they normalised so endo said I will never have thyroid troubles , the previous were possibly due to inflammation that cleared up and sent me packing. However I think I actually have signs of Hypo, unable to lose weight, I do have B12 deficiency and Vit D and Ferritin deficiencys so find it hard to separate symptoms. I am under the impression Thyroids can go hand in hand with these other autoimmunes .
my results were
TSH.= 0.04 lab range (0.4-4.0)
T4 = 22.0 lab range (9-25)
T3= 5.9 lab range (2.8-7.5)
the retest was
TSH = 0.02 lab range (0.4-4.0)
T4 = 23.1 lab range (9-25)
T3= 6.4 lab range (2.8-7.5)
then endo test =
TSH = 1.62
T4 =13.6
T3 =4.6
Thyroid Peroxidase Antibody = 21.3 lab range 0-50
My question really is was the endo correct and I wont get Thyroids .?
thank u
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Avatar_f_tn
sorry I think I hijacked your post. my 1st time here so please 4give me x
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Avatar_f_tn
I'm a little confused;  were those results on meds or not?  Last I recall, you were taking levothyroxine...

B-12, D and ferritin deficiencies can all have symptoms that mimic hypothyroidism.  In addition, D and ferritin are necessary for the proper metabolism of thyroid hormones.  

Your latest labs, before you went to the endo, certainly don't look hyper anymore.    
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Avatar_f_tn
I'm so sorry about my post above.  I just realized how totally confused I was!  I thought that was posted by tgstock. Except for the first paragraph, though, the rest of my post applies to you.

If you were hyper due to inflammation, be aware that "temporary" thyroiditis often starts with an initial hyper phase and is followed by a temporaty hypo phase.  However, this hypo phase can be quite long.  Your TPO antibodies are negative for Hashi's, so it looks like you don't have autoimmune thyroid disease.  If you start to feel hypo, see your endo again.  If necessary, and you do go into a hypo phase, he can give you meds to make you feel better through it.  
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Avatar_f_tn
Thank you very much for your response. im sorry i unintentionally hijacked the post. I will watch my sympyoms. x
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Avatar_m_tn
HI Goolarra,
I have more bloodwork results, and I'm interested in your thoughts.  I go to the endo again on Friday.  He had me start taking 75mcg of Synthroid of Synthroid since 10/12.

Here is my latest bloodwork - 11/8/12:
TSH 1.37 (range .4 - 4.5)
T4, free 1.0 (range 0.8-1.8)

Here is a history:
      7/18/12   7/31/12   8/29/12   9/25/12   11/8/12 (Synthroid 75 for 3.5 wks)
TSH  0.02      0.01       0.03         1.8          1.37*
T4,Fr 1.7        1.5          1.1         0.8          1.0*


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Avatar_f_tn
Well, you're definitely moving in the right direction.  FT4 is back up a little, TSH is down a little.  How are you feeling?  Do you still have hypo symptoms?
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Avatar_m_tn
No, I'm feeling better.  Some trouble sleeping, even though I am tired.  But overall, much better.  Does that mean I'm on the right dose?  You asked about glucose tests - never had that done.  Next appt is Friday.  Should I still ask for the TPOab and TGab?
Thanks.
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Avatar_f_tn
Your FT4 is still a little low in the range; many of us find it has to be around 50% of range.  However, that really depends on how you feel.  If you feel good and don't have any lingering symptoms, then I wouldn't do a thing.  Of course, we don't have an FT3, but once again, how you feel is the most important.  There is plantly of room in your labs for a little increase if anything still bothers you.

Please refresh my memory and save me from having to read through what has become a long thread...have you had TPOab and TGab tested before?  Sorry, i also don't remember why glucose was an issue???
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Avatar_m_tn
Hi Goolarra,

I have thyroiditis.  I've been taking Synthroid.  Yesterday, I started to feel flushed.  I was quickly exhausted and went to sleep.  This happened twice, really uncomfortable flushing causing me to feel faint.

I didn't take any Synthroid today.  I'm on an 88 dose.  I go back to doc in January.
Bloodwork history below:

Here is a history:
      7/18/12   7/31/12   8/29/12   9/25/12   11/8/12 (Synthroid 75 for 3.5 wks)
TSH  0.02      0.01       0.03         1.8          1.37*
T4,Fr 1.7        1.5          1.1         0.8          1.0*
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Avatar_f_tn
Your FT4 is still on the low side.  Flushing isn't usually a symptom of hypo.  Do you have and blood pressure issues?    Could menopause be a factor?
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Avatar_m_tn
Thanks.  Maybe menopause is a factor.  I'm 47.  I have very low blood pressure.  I quit taking the meds for 2 days just to see if it would help.  Also, had blood drawn yesterday.  Doc said that we no longer test T3.  
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Avatar_f_tn
It's likely peri-menopause is a factor at the very least.  I started noticing changes a good ten years before the actual event (or non-event).    

Your latest FT4 was quite low.  Drop in BP is a symptom of hypo, so if yours tends to run low anyway, that might be what's making you feel faint.  

Ugh...no longer test T3?  Things do not get better...

Post your new results when you get them.  Merry Christmas!
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Avatar_m_tn
Hi,
Got my latest results:
TSH range: 0.4-4.5
T4, free (0.8 - 1.8)
T3, free  
7/18/12   7/31/12   8/29/12   9/25/12   11/8/12            1/16/13 (note below)
TSH  0.02      0.01       0.03         1.8          1.37*     1.42
T4,Fr 1.7        1.5          1.1         0.8          1.0*       1.2**
*Synthroid 75 for 3.5 wks
**The 1/16 T4  note: the current lot of free T4 reagent available produces results that are approx 9% higher than previous reagent lots.
1/6/13 NOTE: I quit taking Synthroid on 12/23 - thought I was feeling too hypo.  My doc appt was supposed to be last week, but I had to cancel and they can't reschedule till April.

Your thoughts, please?
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Avatar_m_tn
I meant to say in my previous note that I was feeling 'hyPER', so I quit taking the 88 synthroid that I had been on for a month.  Still haven't had any - so these 1/16 test results are without the synthroid.  The lab noted that the current lot of free T4 reagent produce results that are 9% higher than previous lots.
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Avatar_f_tn
You stopped taking Synthroid on 12/23, so most, but probably not all, of it was out of your system 3.5 weeks later when you had your labs on 1/16.  I've seen that note about the current lot of the reagent on other people's labs...yet another element to add confusion...ugh.

Anyway, your FT4 has gone up (even considering the 9%, it's gone up a little) to 1.2 despite discontinuing meds.  Of course, we have no idea how high it had been just before you discontinued, which is some 6 weeks since the 11/8 labs.  It most likely spiked in between and then dropped again.

How are you feeling now, and how have you been feeling since discontinuing?  Did it take long to stop feeling hyper?  Have you had hypo symptoms return at all?

    
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Avatar_m_tn
Hi. I just got the results from a 12/24 test. That will give you a better picture.  

TSH was 0.15. T4 was 1.5. That was right after I quit taking Synthroid.

Now, a month later, I'm starting to feel exhausted again and I've lost my appetite. So confused. Lost weight but I haven't been eating muc so it's not a surprise. Any problems with stopping and starting Synthroid?
Thank you.
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Avatar_f_tn
So, it had spiked up before you stopped taking it and has since gone down.

It is really good that you had labs right when you discontinued.  Now, we know that FT4 of 1.5 is a little too high for you, and 1.2 is a little low (this may have dropped a little further since the draw), and 75 mcg is a little too much.  I suspect that you should probably have cut back a little rather than stopping altogether.

The only real problem with starting and stopping Synthroid is the time it takes to build in your system.  If you start taking it again (I'd recommend you ask your doctor about a slightly lower dosage), it's going to take 4-6 weeks to build before you know how you feel and you can repeat labs to reflect the full impact of the change.  

The last time I was hyper (overmedicated), my endo advised me to discontinue meds for three days, then resume at a lower dosage.  Ask your doctor about that.  It worked really well for me.  Most of the hyper symptoms went away during the three-day hiatus, although they continued at a much more tolerable level for a couple of weeks after.  
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Avatar_m_tn
Hi,
I've been breaking my 88 Synthroid in half - getting roughly 44/day depending on how precisely the pill broke.  
Last TSH (2/20)was 1.7
(3 weeks of breaking in half)
TSH range: 0.4-4.5
T4, free (0.8 - 1.8)
T3, free  
7/18/12   7/31/12   8/29/12   9/25/12   11/8/12            1/16/13 (note below)
TSH  0.02      0.01       0.03         1.8          1.37*     1.42
T4,Fr 1.7        1.5          1.1         0.8          1.0*       1.2**
*Synthroid 75 for 3.5 wks
**The 1/16 T4  note: the current lot of free T4 reagent available produces results that are approx 9% higher than previous reagent lots.
1/6/13 NOTE: I quit taking Synthroid on 12/23 - thought I was feeling too hypo.  
2/20/13: Note - taking 44 per day for 3 weeks.

I'm so confused, and the doc can't see me till April.
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Avatar_f_tn
Am i missing it, or are your 2/20/13 labs not there?
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Avatar_m_tn
On 2/20, all that was tested was TSH. It was 1.7. They did a whole panel of tests because I've had no appetite. Since it was my reg doc who ordered them, I guess he forgot T4. My appetite has returned. I think it was stress. tSH is on the rise again.
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Avatar_m_tn
Sorry.
TSH on 2/20 was 1.7
T4 was not tested.  Family doc ordered CBC.  I had lost my appetite, and was really weak.  I think it was stress.  It seems to be returning now.
Still taking half of the 88 Synthroid.  Still fatigued, but feeling better than when I quit taking it.  This is very confusing.
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Avatar_f_tn
Ah, sorry, I saw the TSH of 1.7, but I thought at least FT4 would have been tested.  Unfortunately, that doesn't give us a lot to go on.  

Perhaps your thyroid is recovering, but you're not yet at the point where it's totally recovered.  It's so hard to say with just TSH available.

Do you think you could request a retest with FT4 added in?  Looking at your labs, FT4 just doesn't track TSH.  On 8/29, with FT4 of 1.1, your TSH is 0.03.  Yet on both 1/16, with FT4 hardly different (when factoring in the reagent change), your TSH is 1.42.  So, TSH is pretty useless.

Perhaps you'd feel better with a very slight increase.  You could ask your doctor about going to 50 mcg.  I think you really have to medicate on symptoms.  Try 50, retest, then perhaps go to 62.5 if 50 isn't enough???    
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Avatar_m_tn
Hi
The test results came in the mail today. I noticed it was a TSH w reflex to FT4. Is that different than TSH? The value was still 1.7. Yes. I will ask for follow up testing. Taking the 44 by breaking 88 in half is not very precise. I really need to take the right pill in order to sort out the correct dose. I'm going to follow up as you suggest.
Thank you
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Avatar_f_tn
TSH w/ reflex to FT4 is an instruction to the lab.  It means "test TSH, and if it's not in reference range, test FT4 as well".  Since your TSH was in range, they didn't test FT4.  The TSH test is the same, whether with reflex or not.

Splitting pills is an acceptable practice.  T4 is so slow acting, that a little more one day and a little less the next doesn't change anything drastically.  I've split lots of pills when I am increasing.  What I do is just make sure to take both halves of the same pill on consecutive days.  Any variation in dosage in each half will be flattened out that way.
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Avatar_m_tn
Hi Goolarra,

Thank you for your help.  Latest is TSH 1.34 (range 0.4 - 4.5)
T4, Free 1.3 (range 08 - 1.8)

I've been taking 50mcg Synthroid.  Starting to get very tired again.

History:
TSH range: 0.4-4.5
T4, free (0.8 - 1.8)
T3, free  
7/18/12   7/31/12   8/29/12   9/25/12   11/8/12            1/16/13 (note below)
TSH  0.02      0.01       0.03         1.8          1.37*     1.42
T4,Fr 1.7        1.5          1.1         0.8          1.0*       1.2**
*Synthroid 75 for 3.5 wks
**The 1/16 T4  note: the current lot of free T4 reagent available produces results that are approx 9% higher than previous reagent lots.
1/6/13 NOTE: I quit taking Synthroid on 12/23 - thought I was feeling too hypo.  
2/20/13: Note - taking 44 per day for 3 weeks.
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Avatar_f_tn
Well, your FT4 is right on the money...it's exactly midrange.

Were those top labs from 2/20/13?  You were on 44 at the time and increased to 50 afterwards?

If you're feeling tired, you really have to take a look at FT3.  With FT4 so picture perfect, the answer almost has to be in your FT3 (if it's thyroid related).

I'm sure I must have asked before, but do you know your vitamin D, B-12 and iron/ferritin levels?
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Avatar_m_tn
Thank you.  I don't know the vitamin levels.  I'm switching back to my reg doc.  The endo said the 44 was too low for me.   The top labs were from 4/23/13 - earlier this week.  I feel much better, just getting tired and lost my apetite again.  Could be allergies.  Endo thinks I blame anything on thyroid, even things that aren't related.  I am going to ask my fam doc for help.  He will test T3 if I ask.  I'll also ask him to do those vitamin levels.  I'm glad you are weighing in on my latest test levels.  I think that means that the 50mcg might be a good does.  
The endo diagnosed me with sub-acute thyroiditis.   Don't know if he's right, but it's been going on for almost a year now.  I think I'll be stuck taking Synthroid forever now.
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Avatar_f_tn
Be sure he tests FREE T3.  There's a total T3 test as well, and you don't want that one.

In terms of FT4, 50 mcg looks really good for you.

Before I was diagnosed with Hashi's, my "theory" was that I had DeQuervain's thyroidititis, which, like sub-acute, is "temporary".  My endo said that, although usually temporary (they can become permanent), they can last a couple of years.  I tested positive for both TPOab and TGab, however, so Hashi's it is!

Anyway, do get your FT3 level checked just to make sure it's adequate.  Keep in mind that many people find FT3 has to be in the top half to top third of the range.  
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Avatar_n_tn
I'm 60 years female and my last test tshw/reflex free t4 was 0.51 what this mind
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Avatar_f_tn
That's a "normal" TSH.  However, are you having symptoms?  If you are, then further testing would be in order.  TSH is often very unreliable.
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