Can have Graves with normal TSH?

[lookingtosolve]

I had hyperthyroidism in mid 90's after becoming pregnant levelized and taken off all meds. Began symptoms last 2 years, TSH in normal range but suffer intolerance to cold, elevated BP and pulse rate, fatigue and sleepless nights. Can I have Graves with normal TSH. Recent labs below. Also had thyroid uptake after ultrasound that showed possible hyperthyroidism. Have several nodules that have never been Biopsied is it consistant to wait until ranges are abnormal before Biopsy? Could meds have effected the T3 that much in just a week?

Date                                   Test                        Range                       Meds
02/07                                  TSH                         1.343
02/07                                  Prolactin                   6.1 - thought it was menopause so I think this is why this was ran
06/07                                  waiting for info
09/07                                  waiting for info  
03/25/08                              TSH                          1.55
03/25/08                              T3                             4.3
03/25/08                              T4                              1.66 - started on propylthioracil 50mg X4 p/day
04/01/08                              TSH                          3.2
04/01/08                              T3                             1.5
04/01/08                              T4                              1.82 - taken back off eveything and told to wait 3 months to be checked again.

Have been told need to Biopsy to rule out cancer, however, as soon as ranges come back normal am told to wait.

Thanks.  

[GravesLady]

If you have active Graves' your TSH would be suppressed and normally with Graves' comes T3 toxicosis, a classic sign of GD. That is to say, suppressed TSH with high
F/T-4 and even higher F/T-3, out of Lab reference range.
It is not unusual for thyroid levels to go back to normal for a lot of people and especially as well as after pregnancy.
Antibodies can be present, however levels are the determening factor.  Diagnose is not made solely by symptoms alone. Majority of the population shares your symptoms, as well as with a lot of other health conditions . It's just a factor with a busy hectic life.

Thyroid ranges normally do not come with nodules unless hyperfunction and that would also be with a suppressed TSH level. Nodules can be a separate identity to thyroid conditions. So, it would be a good idea to have need Biopsy done to rule out cancer.  I would think that would give you peace at mind to know that you are cancer free.  However, your levels ARE! normal, so why wait.

Doctor Lupo might disagree, so wait for his response, it might be a while before he answers.  good luck!

GL,
Just my personal opinion as a Graves' patient.

[GravesLady]

Hello Nikki,

T3 Toxicosis/Thyrotoxicosis,  is typically seen in Graves' Disease or in any condition that can cause hyperthyroidism such as autologous functioning thyroid adenoma, toxic multinodular goiter, etc.

T3 Toxicosis/Thyrotoxicosis would present exaggerated hyperthyroid symptoms to the dangerous end. Unpleasent symptoms such as rapid heart beat, insomnia and anxiety and can also harm the heart and the bones. Too high T-3 has a risk for dangerous cardiac arythmias and heart attacks.  

Your doctor is wise in testing your TSH every 4th week for 4 months so as to make sure what really is going on with your levels.  However, I hope the FT-4 and FT-3 are checked, as well as TSI antibodies checked.  In people who are hypothyroid, TSI can cause temporary bursts of thyroid hormone, which in turn cause transient hyper symptoms. If TSI levels steadily increase they cause the hypothyroid patient to move into hyperthyroidism and Graves’ disease. If you need to talk or have more questions  you can PM me anytime.

Good Luck!

GL,
Just my personal opinion and experience as a 12 year RAI trested Graves' patient.

[Nikki0407]

Hello!
I was diagnosed with Hashi's 2 years ago.  Since then my TSH has fallen from 3.1 to .001.  My uptake was only 2.6% leading the doctor to suspect thyroiditis.  My question is what are the symptoms of t3 toxicosis?  My total t3 is elevated (222) and my t4 is normal high (1.5).  When I asked my endo about t3 toxicosis, she told me that I would be in the hospital if I had it.  They are just going to check my tsh every 4th week for 4 months to monitor my tsh.  Thank you so much for your help in advance!

Blessings,
Nikki

[lookingtosolve]

Thank you Dr. Lupo, I will continue my 3 month visits as scheduled.

[Mark Lupo, M.D.]

There is no evidence of hyperthyroidism here.  The nodules should undergo FNA biopsy as the labs are normal.  I don't see an indication for PTU with the labs you posted.  The symptoms may suggest hyperthyroid - but there is no objective evidence yet in this case.  TSI & TBII can be tested to see if there is a Graves Immune marker present.

[lookingtosolve]

Thank you for the comments. I am confused as to why neddle biopsy continues to be suggested until the labs come back normal. In the beginning the Endo stated there were two seperate issues going on but after last labs came back chose not to go forward with needle Biopsy, I agree I would rather Biopsy so I know one way or another.

Thank you for the comments, I have learned alot by reading comments, experiences, etc here.

Thanks again and good luck.