Thyroid

I keep being told I have Hoshimoto, but my tests, in my eyes don't reflect that.  I don't know enough about this disease I guess.  Here are my numbers if someone could please tell me what they really mean I would appreciate it.
Antibody 60.7 (0-.60)
Anti Thyroglobulin 35.2  (0 - .60)
TSH .044 (0.450 - 4.500)
Free T4  1.12 (0.82 - 1.77)
Free T3  3.1  (2.0 - 4.500)

Creatinine, Serum  1.06  (0.57 - 1.00)
eGFR   59  (>59)  mL/min/1.73

With the TSH being low, I would think that I would be Hyper.  I also have 8 nodules, 4 on each side that are continuing to grow and the overall size of the thyroid is growing.

Thanks

[FTB4]

The fact that your labs are in range does not mean you do not have thyroid issues that are causing you to feel like crap, as some MD's would like to beleive, They do not take into account how you feel and have tunnel vision
sometimes. Your Free T3 and Free T4 do look good, although if you have nodules on your thyroid, the nodules can produce thyroid hormone in addition to the thyroid itself, this would cause you to be on the Hyper side.
this could be why your TSH is supressed. If your MD is not addressing this issue, I would try another MD or an Endocrinologist that is good with thyroid and not just Diabetes.  Good Luck FTB4

[hyperhypo218]

I see an Endo and the only thing she seems to be concerned with is the TSH.  She says it is in the normal range so there is nothing to worry about.  This is the 3rd Endo I have had.  They all seem to be the same around here, if the numbers are ok, I am ok.  She wants me to have a sleep apnea test.  I know I don't have it, once I fall asleep, I sleep through the night, I wake up tired and feel tired all the time.  I have dry skin, dry brittle hair and nails that break at the drop of a dime.  I have pain and muscle spasms in my throat and my ears itch all the time even though I am on allergy meds.  In two years I went from completely clear arteries in my heart to having a heart attack and stent.  I have gained 40 pounds in the last 6 months with exercise and rabbit food.  My ankles and hands are swollen all the time even though I am on a BP med that also has a diuretic.  My cardiologist says that the swelling is from the thyroid, my Endo says that isn't possible because all the numbers are good.  Oh....those numbers were from when I was on 25mcg of Synthroid.  I was taken off it and my T3 and T4 hasn't been tested since.  I am so frustrated I don't know which way to turn anymore.  Seems that doctors just want your money and don't want to treat the patient.

[thelma201]

I have yet to see an Endo that treated my hashi/hypo properly.

25mcg is a very low dose of synthroid. why were you taken off? You have pretty classic hypo symptoms.

[goolarra]

I'm confused about a couple fo things.  You said your endo is only concerned with TSH (many of them have that problem).  She says that it's in the normal range so there's nothing to worry about.  However, you post your TSH as 0.044 (0.45-4.5), which is BELOW range.  Is that a typo?

Also, you report the range of your two antibody tests as (0-.60).  Should that be (0-60)?

[hyperhypo218]

She said my numbers were good and that it was such a low dose I didn't need it.  What does she think was keeping the numbers stable, her good looks  LOL

[hyperhypo218]

She doesn't consider that out of range, face palm.  No, it wasn't a typo.  I feel so much better when my TSH is 1. something.  Below that and everything hurts, heart palpitations that scare the heck out of me since the heart attack.  

The antibody tests were hand written about 3 years ago and have not been tested since that point so I am not sure of them.  I just know that they were out of range and that is why they labeled me Hashi.

[hyperhypo218]

Do you go to an internist instead of an Endo?  I am at a loss, I hurt 24/7 and feel like crap.  I just want to feel good again and not be in pain.

[goolarra]

Ooookaaaay...not out of range?  Does she understand math?  Probably a pretty good indication that you might need a new doctor...

As far as your antibody tests are concerned, the usual range on TPOab (the one you've labelled "antibody") and TGab (anti-thyroglobulin antibody) is 0-60, not 0-0.60.  If the correct range is 0-60, then I would consider your results to be distinctly "borderline".  On diagnosis of Hashi's, many of us have antibody counts in the hundreds or even thousands.  Both TPOab and TGab can be somewhat elevated in other autoimmune conditions.  

TSH is low, indicating hyPER, as you said.  However, neither FT3 or FT4 is high,  TSH is a very poor test of thyroid status.  You have to question it seriously if it's not supported by corresponding FT3 and FT4 levels.  Your FT4 is only at 32% of range, and 50% is the rule of thumb for FT4.  Your FT3 is at 44%, and the rule of thumb here is upper half to upper third of range.  Those number would give most of us hypo symptoms.

I really think you need to have FT3, FT4 and TSH tested again to see where your levels are now since you stopped the 25 mcg Synthroid.  At the same time, I'd have TPOab and TGab re-run and clear up any misconceptions that might surround them.  

In early stages, Hashi's can be characterized by swings from hyper to hypo and back again.  Perhaps that's what you're experiencing.  

With your symptoms and your other health issues, I'd get a second opinion as soon as possible.

[hyperhypo218]

I am going to request all test when I go to her again.  I have my 4th ultrasound tomorrow and will see her after that.  One of the numbers concerned them because it was way out of range.

The test my PCP did was just TSH and it was 0.25  He sent me to an Endo

My first numbers were :
TSH .53  (.35 - 5.50)
T4  .96  (.60 - 4.20)
T3  2.78 (2.30 - 4.20)

They did an ultra sound at that time and found 3 nodules.  2 on the right and one on the left.

They put me on 25 mg of Synthroid and 3 month later the results were:
TSH  1.680  (0.450 - 4.500)
Free T4  1.19  (0.82 - 1.77)
They didn't do T3

The last complete test while on Synthroid was:

TSH + Free T4  1.060  (0.450 - 4.500)
Free T4  1.12  (0.82 - 1.77)
Free T3  3.1 (2.0 - 4.4)


While I was on the medication my numbers were all very good and I felt great.  As you can see....I was hyper then normal and now hyper again after stopping the Synthroid.  

The nodules went from 1 and 2 to 4 and 4 with the largest being 1.0 and 1.2 one on each side.  It will be interesting to see how much they have grown as at that point I couldn't see a lump and now it is visible.  At that point there was no throat pain/spasms and now I have it daily.  I have trouble swallowing and feel like someone is chocking me.  I was put on the Synthroid to control the growth of the nodules...obviously it didn't work well.

Depending on tomorrows results and her action or inaction, I will be looking for yet another doctor.

[hyperhypo218]

the TSH was tested 9 months after stopping the Synthroid and it was .044 so it is back down farther than when this process started 3 years ago.

[goolarra]

You really have not gone from hyper to normal to hyper.  TSH can be affected by any number of variables other than FT3 and FT4 levels.  Your TSH is obviously not tracking FT3 and FT4 levels.  Remember that TSH causes NO symptoms.  It's your FT3 and FT4 levels that cause symptoms.

Look at those labs again, and let's forget TSH and just concentrate on FT3 and FT4.  Remember that many of us find that FT4 has to be midrange and FT3 upper half to upper third of range before hypo symptoms go away.

Original, unmedicated (you were hypo)
T4  .96  (.60 - 4.20) ***this range is wrong; upper limit should be around 1.80
T3  2.78 (2.30 - 4.20)

Now the two on 25 mcg (still hypo)
Free T4  1.19  (0.82 - 1.77)
They didn't do T3

Free T4  1.12  (0.82 - 1.77)
Free T3  3.1 (2.0 - 4.4)

And most recent labs (still hypo)
Free T4  1.12 (0.82 - 1.77)
Free T3  3.1  (2.0 - 4.500)

If those are correct, your FT3 and FT4 didn't change at all between the last two labs.  Only your TSH changed.  So, there is no explanation there as to why you felt well when on meds and don't now.

If you look back to your original labs, FT4 was actually higher (more hyper) when you were on meds than when you weren't.  The one FT3 on meds was also higher, making you more hyper on meds than off once again.

Your symptoms sound hypo as well.

[hyperhypo218]

I felt better because I didn't have as much muscle pain...still there, just not as bad and I didn't have the anxiety.    I failed to mention, I have Fibromyalgia and Osteoarthritis really bad too.  I seem to feel better slightly hyper if I am understanding you.  If I were more hyper perhaps I would have energy and a concentration level higher than a 2 year old.  I used to love to sew and could sew all day, heirloom sewing that takes steady hands and concentration.  I can't even think about starting now.  The sewing was before this thyroid thing started 3 years ago.  Granted, I'm almost 57 and feeling the age creeping up, but I want to feel 40 again when I had more energy and less pain.  My ankles, shoulders, elbows, knees, hips....and so on hurt so bad.  My PCP doesn't believe in Fibro so he won't do anything about it except give me Cymbalta.  I'm on 30 mg because anything over that makes me nutty and I have bad (suicidal) feelings.  I have anxiety, not depression and he just wants to treat depression, not anxiety or gives me stuff that supposedly treats both and I have a bad reaction to them.  Xanax is the only thing that helps and he won't give it to me because it is addictive.  Why is it that all the things that make ya feel better are addictive or illegal?  LOL

[goolarra]

No, what I am saying is that you have NEVER been hyper.  The only thing in your labs that indicates hyper is your TSH.  TSH is a very poor indicator of whether we are hypo or hyper.  It often has to be ignored, especially when it does not accurately reflect FT3 and FT4 levels, which yours does not.  TSH causes NO symptoms.  If FT3 and FT4 are the same, as they are in your last two sets of labs, then TSH is meaningless.  

"Granted, I'm almost 57 and feeling the age creeping up, but I want to feel 40 again when I had more energy and less pain."  Don't we all!  LOL  Oh, gee, while we're at it, let's go fo feeling 20...

However, the upshot of all this is that you felt better on 25 mcg.  Perhaps that would be your best argument for convincing your doctor to put you back on it.