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Avatar universal

Have you had symptoms of both hyper and hypo?

Has anyone experienced feeling hyper when testing hypo?

I know someone who's doctor told her you can be tired even if you are hyper , not just if you're hypo,  so maybe it goes both ways.

I had my thyroid gland removed 6 yrs ago so I am on Levothyroxine.

It'd been eight months since my TSH was checked and I asked to have a checked again because I was feeling symptoms of hyperthyroidism -having a lot of trouble sleeping and feeling hyper . I have been on my current dose for a while and it had been working for me.

Surprisingly my level was too high  , not too low- 8.6. But then I remembered I had forgotten to take my pill that morning so I was retested two weeks later and it was 5.7.

I know the rannge is 0.3 to 5.0 , yet most doctors want you to be around 1-2 or 1 to 3.

My current doctor said I was so close to normal ( 5.0) that I should just continue on my dose and be retested in six weeks.

I do also have some symptoms of low thyroid -
Being in a fog , difficulty remembering things
Feeling cold
Muscle cramps
Dry itchy skin
17 Responses
Avatar universal
You need to re-train your doctor or find a new one that ia a good thyroid doctor.  

TSH is a pituitary hormone that is affected by so many things that even in the untreated state, TSH does not correlate well with the biologically active thyroid hormones and has a negligible correlation with Tissue T3 Effects, which determine a thyroid patient's status as hypothyroid, euthyroid or hyperthyroid.  After starting treatment, the equilibrium among TSH, Free T4 and Free T3 is affected so much that TSH should not even be used to determine a hypothyroid patient's medication dosage.  Instead, a good thyroid doctor will test and adjust Free T4 and Free T3 as needed to relieve hypo symptoms without being influenced by resultant TSH levels.  In fact, targeting a TSH range to dose you almost assures inadequate medication since most hypo patients taking adequate medication will have suppressed TSH levels.  That dose not indicate hyperthyroidism, unless there are attendant hyper symptoms due to excessive levels of FT4 and FT3.  

So, before further discussion, please post your latest thyroid related test results and reference ranges shown on the lab report.  Also, what is the dosage of T4 med?  If tested for Vitamin D, B12 and ferritin, please post those as well.
Avatar universal
Well this was my PCP, though I usually see an endocrinologist.  I am on 75mcg levothyroxine. My B12 last year was good and so is my Vitamin D (I take 10,000 IU weekly). Ferritin was good but that was 2-3 years ago. I see the Cleveland Clinic considers TSH normal range to be 0.4-5.5. My T3 and T4 were checked but I don't know the numbers- only that they were normal.
Avatar universal
The usual standard of care for hypothyroidism is to test for TSH.  Since the assumption is always that hypothyroidism is "inadequate thyroid hormone".   The TSH test is used as a surrogate for thyroid levels.  If TSH is within range, or if TSH exceeds range, but a followup FT4 test is within range, the patient is told that his test results are within the "normal" range, and his symptoms are not thyroid related.  This is wrong.

The correct definition for hypothyroidism is "insufficient tissue T3 effect due to inadequate supply of, or response to, thyroid hormone".   This definition takes into account the numerous processes and variables that affect Tissue T3 Effect.   A TSH test is totally inadequate as a diagnostic since it has only a weak correlation with Free T4 (or Free T3) and has a negligible correlation with Tissue T3 Effects, which determine a patient's thyroid status as either hypothyroid, euthyroid or hyperthyroid.  

It is very important to note that studies have shown that many patients taking thyroid hormone at a dosage adequate to relieve symptoms will have suppressed TSH levels.  This is a result of taking a full dose of thyroid hormone once daily and that T4 treatment establishes an equilibrium that is quite different from that wih the usual continuous low flow of natural thyroid hormone in the untreated state.  A suppressed TSH in an treated person does not mean hyperthyroidism, unless there are attendant hyper symptoms due to excessive serum levels of FT4 and FT3.  So TSH should never be used to determine thyroid hormone dosage.

Since you have had a TT, it is very unlikely that 75 mcg of T4 is enough to provide adequate FT4 and FT3 levels.   So I am sure that is the reason for your symptoms.  Your doctor is dosing you just to get your TSH within range, and you are suffering the consequences.  

A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting FT4 and FT3 levels as needed to relieve symptoms, without being  influenced by resultant TSH levels.  Symptom relief should be all important, not just TSH levels.  Just because your T4 and T3 were in "normal" ranges does not mean adequacy.   Were they Free T4 and T3 or Total T4 and T3?  Even if they were FT4 and FT3, every person is different and you want your FT4 and FT3 to be optimal for you, not just somewhere within the range, which is far too broad to be functional for many people.  So, ofr now, I'd like to get you to read at least the first two pages of the following link,  and more, if you want to get into the discussion and scientific evidence for all that I have said here.

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

Vitamin D should be at least 50 ng/mL. B12 in the upper end of its range, and ferritin should be at least 100.  You will find all that in the link also.  I doubt that 10,000 IU D3 per week is enough.  We really need to know the actual results for those three plus your T4 and T3 results.  Can you get those so that we can advise further?

Avatar universal
My question was whether others have had symptoms of hyperthyroidism when they were actually hypothyroid.
Avatar universal
What symptom do you think is hyperthyroid?
Avatar universal
Having trouble sleeping and feeling hyper. Possibly anxiety.
1756321 tn?1547095325
I have had symptoms of both hyperthyroidism and hypothyroidism. My last lot of labs I had done I was hyperthyroid when bloods were taken (excessive sweating, tachycardia, high blood pressure etc etc). But hyperthyroid symptoms had only showed up the day before so only the TSH had dropped while free levels were still in my sweet spot.

When Graves antibodies showed up for two months and I was very hyperthyroid, my labs showed hypothyroidism on paper. Both antibodies (both Hashi's and Graves) mess with the lab results. My thyroglobulin serum however was high due to too much thyroid hormone in the blood.

In your case however, based in labs and symptoms, you look hypothyroid. Just to add, I am more exhausted and fatigued when I'm hyperthyroid.

Avatar universal
Sleeping problems are a frequent symptoms of  hypothyroidism, along with other possible hormonal issues, depending on age.  Anxiety is also a well known problem with hypothyroidism.   Hyper with hypo symptoms are sometimes reported for example from the effect of Hashi's on the thyroid gland, but with your TT history, and treatment regimen there was no way I could imagine hyper symptoms along with your hypo symptoms.  That is why I gave you such a long answer to your short question.   There are a lot of things I thought you should be aware of in order to make sure your doctor treats you adequately, or else find a good thyroid doctor, which is not necessarily an Endo.  Most Endos follow the same standard of care that is not working for you.  You need a doctor that will treat clinically, as described.  
Avatar universal
Thank you!
Avatar universal
You are very welcome.  I also just thought that if you are interested, I have knowledge of a few doctors in your area that are recommended  as good thyroid doctors.  
Avatar universal
Sure-who?
Avatar universal
I just sent you a PM with info.  To access, just click on your name and then from you personal page click on messages.  
Avatar universal
Hi friend, I certainly can relate.  I had TT 6 years ago.  A few times I was opposite of hormone levels, if test revealed hypo, I had hyper symptoms, when test revealed hyper, I had hypo symptoms.  Then I discovered my system does not like elevated FT3.  My system prefers FT3 below min ref range, TSH mid.  Even if test reveals normal TSH, if my FT3 is slightly elevated from min ref, I am hyper.  Labs and med dosing is very tricky for TT patients.  Such as right now my labs revealed normal TSH, but my FT3 was slightly elevated.  I'm experincing hyper symptoms, nerves, shaking, severe insomina, etc.....  Feels like I drank 50 cups of caffeine.  Wishing you well.      
649848 tn?1534633700
COMMUNITY LEADER
gimel has provided excellent advice and information.  I'd just like to add that TSH, neither causes nor alleviates symptoms.  In addition, some symptoms "cross over" and/or apply to both hyper and hypo.  There were times when I was at my most hypo that I had several symptoms  that are, typically, considered hyper (palpitations, pounding heart beats, insomnia and anxiety).  We get used to thinking these are specifically hyper symptoms, when they aren't. Fatigue/tiredness is another symptom that applies to either/both hyper and hypo, as well as many other conditions.
Avatar universal
To supplement the good info from Barb, I wondered if you have had any cortisol tests?  Also, please post your thyroid related test results and reference ranges shown on the lab report.  If tested for Vitamin D, B12 and ferritin please post those as well.  
Avatar universal
I found out the lab doesn't test T3 or T4 if TSH is abnormal because they think that's what's causing your symptoms. If TSH is normal then they'll check the others too.
Avatar universal
Wow!  Talk about being misguided.  They really should be testing Free T4 and Free T3 every visit, not TSH.  Based on the erroneous belief that hypothyroidism is only related to thyroid hormone levels, TSH is supposedly an accurate surrogate for thyroid status; however, it has only a poor correlation with FT4 or FT3, and a negligible correlation with Tissue T3 Effects, which determine a patient's thyroid  status as either hypothyroid, euthyroid, or hyperthyroid.  

If you want to see just how badly TSH correlates with FT4 and FT3, take a look at the graphical data in Ref. 30 on page 23 of the link I gave you above.  With any given TSH value you can only predict FT4 or FT3 levels within a very broad range of values, which likely even exceed their reference ranges.  So what is the value for a TSH test as a diagnostic?  There is no way TSH can be used effectively to either diagnose a patient's thyroid status, or be used to determine thyroid medication dosage.  
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