My husband was diagnosed with hypothyroidism almost 11 years ago. He's been on Thyroxine and getting tested periodically. Lately my husband exhibits strange symptoms of paranoia and extreme fatigue. Our family doctor prescribed exercise but that didn't help. To make a long story short. After two weeks of pleading with the doctor, he finally sent my husband for some thyroid tests. I didn't get to go with him but vaguely remember seeing names like total T3/T4 and glucose fasting test etc. There were a few other tests done at the same time but I was not sure if they had anything to do with his thyroid condition.
Anyway, when we returned to the doctor's office today he told us that my husband now had hyperthyroidism. We asked him how bad it was and he said "Your number is 26.5. Normal readings range from 5 to 25." He didn't explain any further but to send my husband back for another test in the lab. He's one of those old school doctors who never likes to explain anything. So we thought we could come home and look it up. But after a few hours we couldn't quite figure out what that 26.5 number was. Could it be the sum of all the tests?
In the states, the reference ranges are determined/based by the number of reported cases, and most are outdated, due to the fact, that there are so many more cases then they ever imagined, this is a problem that we have to deal with, and I am sure Canada is no different, TSH is a Pituitary Hormone, and is not even a thyroid hormone, but as it is a Thyroid Stimulating Hormone, when the body has a low level of thyroid hormone (Free T4) the pituitary located in the brain, send a signal (TSH) to the thyroid to stimulate it into secreting more T4 into the system, then the body converts this T4 to T3, and T3 is the hormone that the body needs to function. Many MD's just rely on treating by TSH alone, and that is a huge mistake, you can be well within the reference range of TSH and be very symptomatic, and if your husbands TSH is at that level, then he is Hypo, not Hyper, unless the range they gave you is for Free T3, in that case he would be Hyper or Overactive. I am not familiar with the ranges in Canada, so it is hard for me to comment, if you have each lab result (Free T3 Free T4 and the TSH) with the reference ranges for each, please post them for more info and comments from members here. Good Luck FTB4
Thank you for your information. I am pretty sure the rating system here in Canada is similar to that in the States. The "normal range" that the doc mentioned (5 to 25) really baffles me.
It's not a common practice here for a patient to receive a copy of the test results so I don't have all the numbers with me. I suppose we can ask for it next time when we go to see him on the 16th of this month. He doesn't want to see us any sooner than that.
The burning question is... If my husband's current condition is hyperthyroid, why should he be taking Synthroid? His original dose for his hypothyroidism was 0.15mg. When we went to see our doctor yesterday, he decided to lower the dose from 0.15 to 0.125. What difference does that make? Most importantly, why should a patient with overactive thyroid take thyroid replacement?
Your right it does not make any sense to prescribe a synthetic hormone when a Hyper situation has been diagnosed. I never heard of a 5-25 range in thyroid either. In the states the MD by-law has to give lab results to patients if requested. and here Synthroid is dosed as MCG not MG. Here tha TSH ranges used varies from one MD to another, some use an outdated range of 0.5 to 5.5, or some by newer standards of 0.3 to 3.0 the higher the TSH
a TSH above the range would indicate Hypo and below would indicate Hyper, this is due to the Pituitary, when it senses a low thyroid hormone, it increases the TSH, when it senses enough hormone the TSH decreases, so one works the opposite of the other. Again try and get the test results to post. Best Regards FTB4
Doc believes my husband has Hashimoto's because of the sudden change from hypo to hyperthyroid. He is not willing to do anything drastic until my husband goes to see a thyroid specialist. I don't think he had any intention of lowering the Synthyroid dosage until I questioned him about the effects Synthyroid on hyperthyroid patients. A drop from 0.15 to 0.125mg seems more like a compromise than a solution to me.
Anyway, our doctor should receive hubby's last test results in a couple of days. Hopefully we will get to see him sooner than scheduled. I definitely will ask for a copy of all the results then will post the numbers here.
I doubt it, but it is possible there is a different standardized test there. I have seen it with the RT3 testing. (reverse t3). Some tests range 5-25 or something like that, others range 150-250. But it is confusing because if someone has an elevated thyroid stimulating hormone count (tsh) it means they are LOW thryoid. If a person has a low tsh count, it means they are HIGH in thyroid. Its like learning chinese.!
The 5-25 range, looks like it might be a either a Total T4 or Total T3 test, rather than TSH. High levels of either T4 or T3 would indicate hyerthyroid; however, Total T4 and Total T3 are considered pretty much outdated and of little use; much better if you could get the doctor to test for FREE T3 and FREE T4.
If I remember correctly, Canada uses similar TSH ranges to ours in the US.
If your husband has Hashimoto's, it's possible/probable that he has nodules, as well. Sounds like your doctor suspects that the nodules are producing hormones independently, which happens quite often. This could cause it to seem like your husband is over medicated, which is why your doctor only decreased the dosage instead of stopping the med completely, since the nodule(s) could stop producing hormones at any time, which would throw him back to hypo.
Do you have any idea what the blood sugar levels were? Paranoia and fatigue can also be symptoms of diabetes.
Many doctors don't think it's necessary to provide copies of lab reports; even at that, I *never* leave the doctor's office without a copy of my latest report. That way I know exactly what tests were done and what the results were. I know your medical system is different from ours, but I would think if you insist on copies of the reports, the doctor will give them to you.
Thanks for your reply. I believe total T3/4 were what the doctor ordered a couple of weeks ago. Out of date could be his style because he's pretty "old school". When we get to see him again I definitely will ask for a copy of the report.
I understand Hashimoto's can cause the thyroid go up and down so I didn't really expect the doctor to completely stop the thyroid medication. But I did expect him to lower it a lot more than that. I am sure he wanted to play it safe and let the specialist deal with my husband's situation. It's just painful for me to watch him suffer for another week.
I want to ask my husband to take only 1/2 a pill for a few days to see if his condition will improve. Think it's too risky?
I know you don't like to see your husband suffer, but I can't tell you that it's okay for him to only take 1/2 of his pill. Small changes in thyroid med are usually preferable. Keep in mind that it can take several weeks for a dosage change to take effect, and he's only been on the lower dosage less than a week. If you really think cutting his med even further, is warranted, call the doctor back and try to get his blessing. If your husband gets worse, by all means go the nearest ER and get immediate treatment.
Reading back over your first question, you said the doctor *thinks* your husband has Hashimoto's - did he not do the antibody tests to confirm that? He should also do antibody tests to confirm/rule out Graves Disease; some people have both, which could cause your husband to swing back and forth also.
Often it's nodules producing hormone independently; other times the thyroid can "sputter" prior to "dying" (completely stopping production of hormones) that cause the swings. Without proper testing (or knowing what tests were actually done), you really have no way of knowing what's going on. Your doctor could be doing all this testing (if he hasn't already), along with an ultrasound to confirm/rule out nodules, while you wait for the upcoming appointment with the endo; then you could take all the information with you. That would save time and get proper treatment started more quickly.
Insist on testing for TSH, FT3, FT4, antibodies - TPOab, TGab and TSI, plus an ultra sound. I know your medical system is different from ours, so you might have some difficulty getting all those, but try to stick to your guns.
Yes, he did the antibody test a week ago. It was the day after our meeting with doc telling about hubby's hyper condition. I am sure our doctor has the results already but he was very adamant about not seeing us again in 10 days. So we will try to call to make an appointment to see if he will meet with us this week some time. There is no other appointments made for further testing. Doc did mention ultrasound but it didn't sound like he wanted to order it himself. I clearly remember what he said "I don't want to do anything drastic until you see a specialist". When we get a copy of the report we will find out exactly what kind of tests had been done. So for now, it's all a waiting game.
You're correct about our medical system. Doctors here are like gods. Most of us are too worried to challenge them. This one has been our family doctor for about 5 years. Half of the people in Calgary live without a family doctor. This has been a national problem. We're lucky to have one (regardless how good - or not - he is) because we must have a doctor's referral to see any specialist. Without a family doctor means you will be waiting forever to get proper treatment. Not that we didn't have to wait but at least we will be on the list.
I already have some conflicts with our family doctor while dealing with my menopausal problems. It was another story but to make it short I had to stop questioning him because I didn't want to risk losing him for my family's sakes.
Okay, we have just returned from the doctor's office. I am very disappointed with our meeting. Nonetheless, we got a copy of the test results. The 26.5 was indeed a reading for the free T4. Reference range is 10 - 25, not 5 - 25 like what the doctor said last time. His total T3 and TSH were both within normal range. We also have the Thyroid Peroxidase Antibody test result. Can't say we're surprised. Reference range for this is 0.0 - 34.0 and hubby's reading was 100.9 H kIU/L. So there's a lot of antibodies all right and Doc said hubby has Hashimoto's for sure. Since he now knows it's Hashimoto's doc decides not to send hubby to a thyroid specialist. All he wants hubby to do is to wait for another 5 weeks taking the same 0.125mg Synthroid. To deal with paranoia he prescribes anti-anxiety (Ativan 1mg) and anti-depressant (Paxil 20mg).
As I was sitting there listening to the doctor and what he wanted us to do, my heart continued to sink. So now he's taking more thyroid for his hyperthyroid condition, plus anti-anxiety and anti-depressant to mask the symptoms that might caused by having too much thyroid. I just think something is really wrong with the whole picture. Of course I am not a doctor but I know my husband and his family. Depression was never found in his family history and I am pretty sure his paranoia a result of physical illness - could be his thyroid. Now, we are trying to wait out his hyper condition meanwhile creating a different problem - the possibility of Ativan/Paxil withdrawal - in the future. All our doctor wants now is for him to take all these synthetic drugs for another 5 weeks then go for another blood test. "Hope it will work" was all he said.
My husband has gotten to the point where he can't let me go out of his sight. I was in the bathroom this morning and he came to tap on my door, just wanted to know where I was. Of course he knew where I was but he had to make sure that I was really in the bathroom. It has been going on for 4 weeks and I am so exhausted that I am about to collapse. I can't even go to my room to cry because he will be following me.
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