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Avatar universal

TSH w reflex to ft4 = 0.02 What does it mean?

I went to the doctor because I've been having headaches behind my eyes and in my sinus area.  I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.

He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating.  I don't.  
She said I have an overactive thyroid, and requested blood tests to confirm it.  They also came back consistent with a hyperthyroid result, but I don't know what tests they did.  It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.

I'm curious to know what might be going on, because the doc won't be back for another week.  The headaches linger and often I have clear blurry spots in my vision when they begin.  It's starting to worry me a little.

I appreciate any feedback about that TSH test result.
Thanks.
Best Answer
Avatar universal
This is the tricky part about interpreting the TSI test.  The reference range is "<140%", so if your result is <140, you don't have Graves', right?  Nope, too logical, wrong, of course!  The fact of the matter is that people who don't have Graves' don't produce TSI and have TSI of <2%.  The whole gray area between 2% and 140% is where antibodies are active (i.e. you do have thyroid autoimmunity), but symptoms usually don't occur until levels get to around 140%.

Once under treatment for hyper, TSI can be used to monitor response to anti-thyroid drugs (ATMs) and to help predict remission.  Interestingly, levels should fall below 20% before discontinuing ATMs.  (I used to have a really good link for this, but the site seems to have shut down, so I'm paraphrasing from the printout I have.)    
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Avatar universal
No, I'm feeling better.  Some trouble sleeping, even though I am tired.  But overall, much better.  Does that mean I'm on the right dose?  You asked about glucose tests - never had that done.  Next appt is Friday.  Should I still ask for the TPOab and TGab?
Thanks.
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Avatar universal
Well, you're definitely moving in the right direction.  FT4 is back up a little, TSH is down a little.  How are you feeling?  Do you still have hypo symptoms?
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Avatar universal
HI Goolarra,
I have more bloodwork results, and I'm interested in your thoughts.  I go to the endo again on Friday.  He had me start taking 75mcg of Synthroid of Synthroid since 10/12.

Here is my latest bloodwork - 11/8/12:
TSH 1.37 (range .4 - 4.5)
T4, free 1.0 (range 0.8-1.8)

Here is a history:
      7/18/12   7/31/12   8/29/12   9/25/12   11/8/12 (Synthroid 75 for 3.5 wks)
TSH  0.02      0.01       0.03         1.8          1.37*
T4,Fr 1.7        1.5          1.1         0.8          1.0*


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Avatar universal
Thank you very much for your response. im sorry i unintentionally hijacked the post. I will watch my sympyoms. x
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Avatar universal
I'm so sorry about my post above.  I just realized how totally confused I was!  I thought that was posted by tgstock. Except for the first paragraph, though, the rest of my post applies to you.

If you were hyper due to inflammation, be aware that "temporary" thyroiditis often starts with an initial hyper phase and is followed by a temporaty hypo phase.  However, this hypo phase can be quite long.  Your TPO antibodies are negative for Hashi's, so it looks like you don't have autoimmune thyroid disease.  If you start to feel hypo, see your endo again.  If necessary, and you do go into a hypo phase, he can give you meds to make you feel better through it.  
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Avatar universal
I'm a little confused;  were those results on meds or not?  Last I recall, you were taking levothyroxine...

B-12, D and ferritin deficiencies can all have symptoms that mimic hypothyroidism.  In addition, D and ferritin are necessary for the proper metabolism of thyroid hormones.  

Your latest labs, before you went to the endo, certainly don't look hyper anymore.    
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