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Symptoms of Hyperthyroidism but latest labs are in "normal" range?

I am hoping someone here can help me get an idea of what might be going on in terms of possibly having a thyroid disorder. Back in February I started to get palpitations and anxiety out of nowhere. I went to my GP and we went through all cardiac tests to rule out any heart issues (EKG, echo stress test, echocardiogram, event monitor). All of these test came back normal. She checked only my TSH and it was at 0.78 mU/L (range 0.45 - 4.50 mU/L). She said it was in normal range so did not do any additional thyroid tests.

As time went on, my palpitations got worse and I was having 3 panic attacks a day. In addition, I had significant weight loss of 15 pounds in less than a month, insomnia, heat intolerance, sweaty hands and feet, tremors, muscle wasting, muscle tightness/cramps, and shortness of breath. So I went back to my GP and she finally ran more thyroid tests. I had the following results showing an elevated T4 free (June 5th):

T4 free 1.20 ng/dL  (range 0.61 - 1.12 ng/dL)
T3 free 2.73 pg/mL (range 1.70 - 3.72 pg/mL)
Thyroglobulin Antibodies <1 IU/mL (range < OR = 1 IU/mL)
TPO  1 IU/mL (range <9 IU/mL)

She did not repeat TSH at this time. She said it looks like hyperthyroidism and referred me to an Endo. While waiting for my Endo appt (about two weeks after the initial lab results) some of my symptoms started to improve (palpitations less often, panic attacks subsided, insomnia improved), but I still had other symptoms such as sweaty hands/feet, shortness of breath, muscle weakness weight loss.

The Endo I saw was almost dismissive of my symptoms and said thyroid was not enlarged. He looked on ultrasound and said no nodules or cysts, but it did look like my thyroid was being attacked by my immune system. He ran more bloodwork and these were the results (June 21st):

TSH                  0.42 ulU/ml      (range 0.30 - 3.00)
Free T3             3.9 pg/ml         (range 1.5 - 4.1)
Free T4             1.12 ng/dl        (range 0.80 - 2.00)
Anti-TPO Abs   <10.0 lU/ml      (range 0.0 - 35.0)
Anti - TG Abs   <20.0 lU/mL     (range 0.0 - 40.0)
Total T3             110 ng/dl         (range 65.0 - 185.0)
T3 Uptake          25.6%             (range 25 - 40)
Total T4              7.8 ug/dL        (range 4.5 - 12.5)
FTI                     2.00                (range 1.13 - 5.00)

He basically said all my labs are in normal range and to follow up with my GP. He didn't really give any more explanation for what could be going on. Even though the severity of my symptoms have improved, I still feel terrible. I still have muscle weakness, tremors, shortness of breath, elevated heart rate when I wake up and just don't feel like myself. Has anyone been through something like this? Should I find another Endo? I'm just so confused and feel like this is really a thyroid issue. Any advice on how to deal with these symptoms (I tried metoprolol for a week and it made me feel worse)?
2 Responses
649848 tn?1534637300
Just because your thyroid labs are in the normal range, doesn't mean they are good for you...  In the June 5 labs, your FT4 was actually above range, and so your thyroid was over producing, at that time, even though your FT3 was only at 51% of range.  In the June 21 labs, your FT3 was at 3.9, which is 92% of its range; that's pretty high even though it's still in range and it took quite a jump in the 16 days between the 2 labs.  Since FT3 is the hormone that's actually used by individual cells, it's easy to see why you might have hyper symptoms.

Since the endo said it appears that your thyroid is being attacked by your immune system, that means you have, either, Hashimoto's or Graves Disease... Your TPOab and TgAb are, both negative, and those are that antibodies for Hashimoto's, but that doesn't mean you don't have Hashimoto's, since some people are diagnosed with it, based on characteristics of their thyroid gland.  I'm pretty much appalled that the endo didn't do further testing to find out exactly what's going on.

There's another antibody test that "should" have been done, called Thyroid Stimulating Immunoglobulin (TSI) that's used to confirm/rule out Graves Disease; that should have been done, so you'd know and if you don't have Graves Disease, you have Hashimoto's...

Some people with Hashimoto's have periods of hyper in the early stages that often alternate with hypo or even normal.  This alternation can go on for years, before enough damage is done to the thyroid and one finally settles into permanent hypo. You should try to get your doctor to order the TSI test to confirm/rule out Graves Disease.

There are other beta blockers that can be used to control the rapid heart rates.  

You try magnesium to help with the muscle aches/pains and you might try controlling symptoms with diet.  There are some foods, called goitrogens that are supposed to interfere with thyroid hormone production... you could step up your intake and see if that helps.  Those foods include the cruciferous vegetables such as cabbage, cauliflower, broccoli, brussels sprouts, kale, bok choy, radishes and others.  Soy also disrupts thyroid hormone production and is not recommended for those that are hypo, so it might be an option.

I'm not a doctor and my first recommendation is to find a new doctor if your current one refuses to order further testing (the TSI test, specifically).  You might also request that TPOab and TgAb be repeated in a few months, in case they just haven't ramped up yet...

Also, for future reference, Total T4, Total T3, FTI and T3 Uptake are considered obsolete and really don't give much information, so they're pretty much a waste of money...
Thank you so, so much for your response! I am very frustrated with the endo I saw so I'm going to find another one and make sure that they run the TSI test that you mentioned. I had never heard of that one.

I had mentioned to him about trying another beta blocker and he basically didn't want to prescribe another one because he said he prefers Metoprolol. Hopefully the next endo I go to will actually listen. These symptoms have been so tough to deal with. Some days I can't function and I have a 2 and 5 year old to take care of. I just want to get better.

Thank you for the recommendation on the foods. I have cut out processed foods, dairy, wheat/gluten and that seems to have helped. I will try incorporating more of the veggies you suggested.

Thank you again for your response. When I got the lab results and he said everything was normal, it made me feel like maybe I was going crazy even though my gut is telling me that something isn't right!
649848 tn?1534637300
What dosage of the Metoprolol are you on?  Perhaps it's too high and you simply need a lower dose.  Doctors don't always get it right the first time, even though they like to think they do.  

However, it you don't feel comfortable with that doctor, don't stay there - get a different one.
I was on 12.5 mg once a day. I just felt so sick while taking it. I am definitely getting a second opinion and hope the next Endo is more open to different options in terms of beta blockers and additional testing.
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Queensland, Australia
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