Hyperthyroidism / Hypothyroidism

[christopher2013]

Hey,

I regularly overheat, excessively sweat, feel tired a lot and urinate more than usual. I therefore have some of the core "hyper" symptoms.

However, I have recently had a blood test to check my TSH level, which came back at 5.27 (range 0.35 - 5.00). My serum free T4 level was also checked, and came back at 13.70 (range 9.00 - 30.00).

My T4 is therefore in the range, but my TSH level is slightly elevated. Is this suggesting that I have "hypo"?

Last year (12 months ago), I had my TSH level taken, which was 1.39 (range 0.35 - 5.00). It's shot up by 3.88 this year.

I'm interested to know why my TSH has shot up to 5.27, but my "hyper"-like symptoms have got worse over the last 12 months!

Really looking forward to hearing your thoughts.

Christopher

[goolarra]

I was under the impression that your doctor might be reluctant to order FT3.  If he will, that's even better because insurance will pay for it.

Usually the first step in diagnosing toxic nodule is a thyroid ultrasound...relatively cheap, non-invasive, painless, etc.  If a suspicious nodule were found, a nuclear scan might be ordered to confirm, but the U/S, by itself, might be conclusive.  

No, I wouldn't suggest toxic nodule at this point.  Without FT3, that's kind of a shot in the dark.  It was just one of the examples I came up with where people can have TSH and FT4 that look "normal", or even a bit hypo, but feel hyper.  A high FT3 could indicate toxic nodule, but low FT3 wouldn't.  

It's always a good idea to check vitamins and minerals.  Be sure that among your tests is D (deficiency is becoming rampant), B-12, iron/ferritin.  All those contribute to the metabolism of thyroid hormones.

If you do have FT3 tested, be sure they run the whole panel...FT3, FT4 and TSH...on the same blood draw.  I think FT3 results will give you a much better idea in which direction to head.

[christopher2013]

Hi goolarra,

Thank you for your reply once again. I would order an online test if necessary, but I am sure that my doctor will send me for a T3 if I ask.

I do not appear to have the symptoms of Hashi's, but am interested to know how I can go about testing for a toxic nodule? Would this be a scan or a blood test?

I definitely do not have the symptoms of hypo, but have around 70% of those for hyper. From your experience, would you suggest that a toxic nodule may be the cause here?

I am going for a blood test to check a range of vitamins, bone profile and glucose too (to rule other causes out).

Thank you.

[goolarra]

There are a couple of conditions (that I can think of at the moment) where FT4 and TSH can be in range, but you can still have hyper symptoms.  The early stages of Hashi's can be characterized by swings from hypo to hyper.  As the thyroid cells are attacked by antibodies and die, they dump hormone into the bloodstream.  Some people can literally experience this swing from one day to the next.

Another possibility is a toxic nodule or toxic adenoma.  Nodules are very common and come in many varieties, so if you research this, be sure to research "toxic nodule", "toxic adenoma" or or "autonomous nodule".  A toxic nodule is kind of like a little thyroid within your thyroid.  It produces T4 and T3 (mostly) on its own, independent of your thyroid, and it doesn't need TSH to stimulate it, so it's under no pituitary control.  

Another possibility, as Crybaby2006 suggested above, is that your FT3 is low.  Symptoms often "cross over", and you can experience the same symptoms whether hypo or hyper.  

Without FT3, FT4 and TSH, as a bare minimum of testing, it's very hard to narrow possibilities down.  Would you consider ordering an online test (don't require a doctor's order), if your doctor is unwilling to cooperate?

[Crybaby2006]

That is exactly why I went in to see my doctor!  Because my TSH and FT4 were in range (TSH was close to suppressed and my FT4 was at the very  top of range) my endo sent me to my primary care dr and said it was not my thyroid.  My PCP performed all kinds of tests, head to toe.  She also ran my first FT3 and found out that it was my thyroid all the time.  All other test were good with the exception of low D and low Ferritin.  Went right back to endo.

With a low T3, symptoms of anxiety and depression are common.  The anxiety part manifested itself causing a lot of sweating and headaches for me.  I have posted my blood work and it is very possible to have symptoms like having both hyper/hypo same time.

Please have your FT3 check ASAP.  My endo added T3 to my existing T4 and my sweating has become less, as well as, my headaches are once a week instead of everyday!  In fact you should have all the bloodwork as recommended by many on this forum.  Vit D, iron, ferritin, B-12, and especially the Free T3.  You may have to insist or find a another endocrinologist.

Good luck and keep us posted with your progress.  

[christopher2013]

Hi goolarra,

Thank you for your detailed response. To answers your questions:

- The doctor has said that my thyroid is probably not the cause of my problems, and has not ordered a FT3, ultrasound, checked for nodules or ordered antibody tests.

In terms of my symptoms, my main issue is overheating and excessive sweating (my tolerance to heat is terrible). I also get frequent headaches, headrush and feel dizzy/light-headed in warm environments.

Is it possible to have "hypo" but have "hyper" symptoms (I don't seem to have any of the "hypo" symptoms listed online).

Thank you again for your help.

[goolarra]

Your FT4 is low in the range.  It's 22% of range, and the rule of thumb for FT4 is 50% of range.  Many of us find that hypo symptoms persist until FT4 is close to 50%.  So, both your FT4 and TSH are suggesting hypo.

What we don't know is what your FT3 is doing.  There are some conditions in which FT4 and TSH can be relatively "normal", but FT3 is high.  Did your doctor order FT3?  Have you had a thyroid ultrasound?  Has a doctor palpated your thyroid to check for nodules?  Have you had antibody tests?

TSH is very volatile.  It can vary as much as 70% just by the time of day the blood was drawn.  

Any other symptoms?  Weight gain/loss?  Increased/lowered BP and/or HR?  Diarrhea or constipation?  Fatigue due to insomnia or fatigue despite a good night's sleep?  Increased/decreased appetite?