Hyperthyroid, then went hypo and now levels are normal?

[blogntog]

2 years ago my levels were mildly hyper so of course, we did the antibodies test which came back negative, but on ultrasound, my thyroid was completely colorful so the doctors diagnosed me with graves. I got that under control with diet and lifestyle changes and thyrosoothe along with supplements.

Then I had twins and about 7 months after their birth, my TSH shot up ti 45.77 the other levels were off too but I can't remember the numbers (I was hypo) because my TSH was so high, I went on a medication this time, it was nature thyroid 1 grain 65mcg. that brought my TSH down to 3.07 in 6 weeks. My doctor wanted to see my TSH lower, so he increased the dose to 1.5 grain 90mcg after about 4 weeks, I began getting really bad stomach pains so I stopped taking the meds, on day 4 of no meds, I went into the ER where they did a TSH and I was at 1.85... I'm now seeing a new doctor, and he is puzzled as to why both antibodies tests came back negative, and why my thyroid has flipped from hyper to hypo?

My question is - have any of you dealt with this and what was your outcome?

I had an ultrasound done today, these are the scans;

[IMG]http://i64.tinypic.com/n4tyd4.jpg[/IMG]

[IMG]http://i67.tinypic.com/rtnm37.jpg[/IMG]

[IMG]http://i66.tinypic.com/2njhfg1.jpg[/IMG]

[gimel]

Pleases post your thyroid related test results and reference ranges shown on the lab report from 2 years ago.  Also, same for recent tests.  What symptoms did you have 2 years ago and what symptoms do you have now?

[blogntog]

I just received the radiologist report and that says that my thyroid is normal size and that there are no nodules or masses, so I guess everything is just fine now. Hopefully, it stays like this, thank you for your help!

[gimel]

I really didn't provide any help, so I just wanted to mention that you should read about postpartum thyroiditis.   I am also dubious about the first diagnosis of Graves', based on a "colorful" ultrasound, that then went away due to "diet and lifestyle changes".

At any rate, are you still taking the NatureThroid?  Are you still having symptoms?  

[blogntog]

I am still taking the nature thyroid, my thyroid symptoms have subsided completely, but I have really bad stomach pain when taking the medication, so I'm wondering if I should even be on it =/ this is all really confusing.

When I was diagnosed with graves, I took thyrosoothe, went on an anti-inflammatory diet and also took l-carnitine, b complex and vitamin D.

[gimel]

Can't even venture an opinion without knowing your test results and their reference ranges from before and after starting the med.   Even more importantl what symptoms did you have before starting on the med?

[blogntog]

I order my own labs and my previous doctor orders them each place is different, some do t3 free, some do t3 uptake etc. I ordered my own labs in July because I was very tired despite sleeping 12+ hours per day. I was working out when I was awake and dieting, but the baby weight was not coming off which is rare for me (mom to 7 here and I lose the weight each time, so this was a big red flag) So I did the labs, and that is what gave me a 45.77 TSH. In 2016, my symptoms were weight loss of 15+ pounds per month, eye disturbances, insatiable appetite, tremors and anxiety. I received the radiologist report for my most recent ultrasound, that came back clear of anything so this just has me stumped.

I am now also having very severe stomach pain which I think is a reaction to the NP Thyroid, so I'm not sure if I am to keep taking it or stop? I just moved and don't have insurance or a doctor so I'm kind of flying blind on this one. In addition to these labs, I have had TSI which came back at zero.


2017 Labs

6 months postpartum

TSH:          0.02 (L=0.35  H=4.67)
T3 Free:     5.84 (L=1.45    H=3.48)
T4 Free:     2.00 (L=0.70    H=1.48)

3 months later
TSH                                9.20
T3 Uptake:                     26          reference range   22-35%
T4 Thyroxine, Total        4.4         reference range   4.5-12
Free T4 Index (T7)         1.1        reference range    1.4-3.8


2018 Labs

1 month post partum - February (normal)

TSH    1.32                  0.30 - 3.00
Free T3    3.6              1.8 - 4.8
Free t4     0.88           0.80 - 1.90

6 months post partum - July (abnormal)

Thyroid
TSH 45.770                                 High uIU/mL 0.450 - 4.500 01
Thyroxine (T4) 3.6                    Low ug/dL 4.5 - 12.0 01
T3 Uptake 21                               Low % 24 - 39 01
Free Thyroxine Index 0.8       Low 1.2 - 4.9
Thyroperoxidase < 10.0  IU/mL         0.0 - 35.0
Antibodies (ATA


7 months post partum after starting 1g 65mcg NP Thyroid - August  (slightly abnormal) - the doctor bumped my NP Thyroid to the 1.5g 90mg

TSH 3.01               HIGH 0.30 - 3.00
Free T3   3.1                       1.8 - 4.8
Free T4   0.65       LOW   0.80 - 1.90


Last week (normal, they didn't run t3 & t4) - I stopped taking the NP thyroid (1.5g 90mg) 4 days before this test because of the severe stomach pain.

TSH:  1.85

[gimel]

Before I forget, the lab tests for T3 Uptake, Total T4, and Free Thyroxine Index are outdated and not very useful compared to Free T4 and Free T3.  If it were me I would refuse to pay for those old labs in the future.   Insist on Free T4 and Free T3.

Since your first, hyperthyroid set of lab results at 6 months postpartum, all the rest are indicative of being hypothyroid and in need of med increase; however, hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone".   So it is not just the levels of thyroid hormone, but the effect of numerous other processes and variables that affect TISSUE T3 EFFECT.  Some of the more important of these are cortisol, Vitamin D, B12 and ferritin.  

And your August labs were not just slightly abnormal, but significantly low.   When taking NDT, Free T4 is best around mid-range, with Free T3 in the upper part of its range.   D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

Since there is no direct measure of TISSUE T3 EFFECT, indirect measures are required.  The best indicator of thyroid status is signs/symptoms that occur more frequently with hypothyroidism than otherwise.  These then are supported by expanded testing for Free T4 and Free T3, and the others I mentioned above.  

Hypothyroid patients have reported having reactions to raising NDT or T3 meds due to low cortisol or low ferritin.  Your stomach pain is not one I would normally relate to this issue, but it is the best idea I have at the moment, since it seemed to start with the increase in dosage.  Before going further on that, do you have any other symptoms?  

  

[blogntog]

Thank you so much for this information, so right now all of my symptoms have subsided except for the stomach pain =/ my hair was recently thinning but when I changed the medication back to the 1g instead of the 1.5g that subsided.

So is it possible for a person to have just hypothyroidism that is not from an autoimmune disorder? Does that ever go away or is it permanently a part of who I am?

So next, I'll have them do more labs and see what those come back as. It's just so hard because this is something that I think about constantly. I do know that I have the genetic mutation that makes it hard for me to absorb vitamin D, do you know what it is that I am supposed to take in conjunction with that to help the absorption? I thought it was rosemary or something, but I'm not sure.

Thank you again for all of your help!

[gimel]

Yes, autoimmune disorder is called primary hypothyroidism.  There is also central hypothyroidism, which is a dysfunction of the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.   Most doctors seem to think that primary is the only type and that central is rare.  Central is a rarity only because doctors typically only pay attention to TSH and overlook it.  There are also various types of thyroiditis.  You can also become hypothyroid due to diminishing Free T3 levels with age.  Hypothyroidism is not just inadequate thyroid hormone.  Instead it is correctly defined as insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone.    So it is not just thyroid hormone levels, but it is also affected by many other processes and variables.  If you want to read more about all this, click on my name and then scroll down to my Journal and read at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   If you use the link to the paper, note on page 7 the diagram of the main parts of the thyroid system and you will see it is much more involved than just a test for TSH.  

If you cannot absorb Vitamin D, or other, you can ask your doctor for weekly injections.

[Jenn1302]

I would push to have the antibodies done again. TPO, TG and TSI. When was the last time your doctor checked your antibodies?

[blogntog]

They checked them in July when my TSH was off the charts haha

[Jenn1302]

I read somewhere that there are rare cases where people have Hashimoto's but their antibodies are negative. Does anyone know anything about this?