Hypothyroidism/hyperparathyroidism

[Mr_Black]

Dr Lupo,

I am a 24-year-old male. I have been suffering from anxiety, depression and insomnia for the last 6 months. The symptoms have gradually worsened and now include apathy, lack of concentration, chronic fatigue, severe anxiety on waking (almost like night terrors), and periods of cold intolerance, loss of appetite, difficulty swallowing, nausea and diarrhoea. I sometimes also get palpitations. The symptoms are periodic – I am more or less fine for up to 2-3 weeks and then I lapse back into the above symptoms for a week or so. My grandmother on my mother’s side has very severe hypothyroidism, which is now being successfully treated with thyroxine, and my aunt (also on my mother’s side) has now been diagnosed subclinically hypothyroid.

I have now been referred to an endocrinologist on the basis of the following 3 blood test results (in chronological order):

TSH (mu/L): 6.74, 7.74, 10.67
Free T4 (pmol/L): 19.0, 17.2, 19.7
Serum calcium (mmol/L): 2.61, 2.57, 2.72

My doctor is concerned that I may be developing hypothyroidism (due to rising TSH) and also possibly hyperparathyroidism (due to borderline high serum calcium), but he's confused by the consistently normal Free T4. I have been tested for thyroid antibodies (TPOab and Tgab) which were both normal – I do not have the exact figures. I am under the impression that my endocrinologist will be testing my PTH. I don’t have a goiter but nor has my thyroid been palpated or checked for nodules. I’m not on any form of medication at the moment.

I'm desperate for some advice regarding my appointment with the endocrinologist. Are there any other blood tests or scans that I should request? Am I likely to receive some form of treatment (e.g. levothyroxine) with these test results? I have read about hypercalcemia and am terrified at the possibility of cancer – my grandfather has recently been diagnosed with terminal lung and pancreatic cancer.

Many thanks for your time.

[Mr_Black]

Many thanks for your swift response; this information is most appreciated.

[Mark Lupo, M.D.]

You have most likely subclinical hypothyroidism.  An endocrinology consult is a good idea, no additional testing yet.  Levothyroxine may be discussed, particularly with your symptoms, but is not absolutely indicated.