Thyroid Cancer / Nodules & Hyperthyroidism Forum
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Hyperthyroidism and Symptoms

Hi Dr. Mark,

I was diagnosed with hyperthyroidism a little over 1 month ago.  My bloodwork showed that my TSH = .178, T3 Uptake = 25, and T4 Free Direct = 1.24.  I'm currently taking 20 mg of Methimazole and 75 mg of Toprol XL (just for the past week.  For the 2 prior weeks, I was taking 10 mg of Methimazole and 25 mg of Toprol XL).  My endocrinologist is telling me that my labs "aren't that bad", so she doesn't quite understand why I continue to have some of the symptoms that I'm experiencing (I feel quite anxious all of the time and have a hard time in certain settings (meetings, going to lunch with friends, etc.) I also feel shaky all of the time, dizzy, have significant neck pain which is causing tension headaches, pressure in my ears, etc.  Is this normal?  Should the Methimazole and Toprol help with these symptoms (given more time), or do I need to address these separately (such as taking anxiety medication, or muscle relaxants for the neck pain)?  I obviously would prefer not to be loaded up on medication, but I haven't really seen any relief with the current medication I'm on.
30 Responses
97953 tn?1440868992
I agree that your labs are less severe than your symptoms, but every individual is different.  It takes the methimazole 2-4 weeks to have a significant effect, so hopefully with the higher dose you will lower your thyroid levels soon to the point your symptoms abate.

The toprol is great for lowering heart rate, but some of the older beta-blockers (propanolol or atenolol) may be better for the shakiness -- would consider trying that before adding anti-anxiety meds (although I do sometimes use xanax, etc in graves patients initially as we are waiting for the anti-thyroid treatments to work).

Did your doc check the Free (or total) T3?  The T3Uptake is a different test (not used much anymore, but still part of the "thyroid panel").  Often Graves patients will make much more T3 than T4, so checking it may help draw a parallel between your labs and your symptoms.

If the levels "normalize" completely and you still have symptoms, ask your doctor to help you look into other causes.
Avatar universal
Also, just to add...

My endocrinologist told me I most likely have Graves disease.  She did not perform an anti-body test.  However, she did notice that my thyroid was enlarged.
Avatar universal
Hi tvfan,

I also have Graves. However, you should get your Dr to test for AB to make sure that's the reason why your thyroid is overactive. Dr Mark posted the test's name on a posting below, so you can walk into your Dr's office knowing what to ask for. Although I'm not a Dr, I believe a TSH of 0.1 is still somehow low, but wait and see what Dr Mark has to say about it. Mine is always b/t 0.6 and 1 (when I feel the best).Also, based on my experience, once my thyroid got under control, it took me a while to go back to who I use to be, I had no energy at all, muscle weakness, and got weak very easily. It lasted for a few months, until everything got back to normal again. Hope this helps. AR1281A
Avatar universal
Can you post the range for that Free T4?  That would not be hyper by some ranges...and so I'm wondering if your doc is just going by the TSH.  
Avatar universal
Thanks for the info!  Always nice to know that I'm not the only one going through this.

According to the lab results, the normal range for T3 Uptake is 24 - 39, and the normal range for T4 Free Direct is .61 - 1.76.
Avatar universal
Well it's good I'm not a doc..cause with your symptoms, I would have suspected hypo. That social anxiety thing was a big hypo one for me..as well as some awful neck pain.  But it is true that hyper and hypo symptoms can be quite similar.

Your T3 Uptake is low.  Hmm...that's an outdated test in ways..but Dr.Mark can tell you if that indicates T3 is low.  I'm not sure what that test indicates.  A better test is the newer Free T3 test that tells you what your actual active thyroid hormone is.  

Your Free T4 was not over the range...although it is over the midpoint of the range.  

Did they check you for TPO thyroid antibodies to see if you have Hashimoto's?  I would want that test too.  

So I'm a bit confused that they assumed hyper just on the TSH and it wasn't indicated by the Free T4.  

So let's see what the doc here thinks about those labs.

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