Thyroid problem

[Chaitali1998]

I'm  a  41-year-old  lady.

At  present,  my  T3=1.40,  T4=10.21  and  TSH = 0.01.

What  does  it  all  mean ?

What  should  be  the  best  course  of  option  for  me ?

Is  there  a  permanent  cure  to  my  problem ?

What  kind  of  diet  and  exercise  will  help  in  my  case ?

Thanks  and   Regards.

Chaitali  Das

[Chaitali1998]

Thank  you  very  much  for  your  detailed  explanation  and  guidance.

Thanks  and   Regards.

Chaitali  Das

[Barb135]

You need to get thyroid antibodies tested.  It looks like you might have Hashimoto's Thyroiditis, which is, typically, associated with hypothyroidism, but can be characterized by swings from hyperthyroidism to hypothyroidism, in the early stages.

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyrglobulin Antibodies (TGab).  Those tests will determine whether or not you have Hashimoto's, and you do need them both.  You should also get Thyroid Stimulating Immunoglobulin (TSI), which is the definitive test for Graves Disease, just to be sure.  It's rare, but some people do get both Graves and Hashimoto's.

Unfortunately, you're being tested for Total T3 and Total T4, which are considered obsolete and of little value.  Can you try to get Free T3 and Free T4 whenever you get tested in the future?  The "Free" hormones are those that are unbound by proteins and are available for conversion (FT4) and use by the individual cells (FT3), whereas Total counts both bound and unbound hormones.  

TSH is a pituitary hormone and is an "indicator" at best; it should  not be used alone for diagnosing/treating a thyroid condition. I should also note, that your lab is using an outdated reference range for TSH.  Accepted range is 0.3-3.0, so many of the readings you thought were "OK" were really hypo, because your T3 and T4 were low in the ranges, then, also.  This further supports the idea that you're swinging hyper to hypo.

If you have either/both Hashimoto's and/or Graves, which are both autoimmune diseases, in which the body determines that the thyroid is foreign and produces antibodies to destroy it, your thyroid will eventually stop working.  At some point, your thyroid will become permanently hypo (under active) and you will be reliant on thyroid replacement med.

Another thing that could be happening, is that you could have nodules on your thyroid that are producing hormones, periodically, independently of the thyroid, which could be causing the periods of hyper.

Also, sometimes, just before the thyroid stops producing hormones, it will "spurt" larger amounts of hormones.  You should be testing, at least quarterly, to keep a close watch on what's happening.

You should get a thyroid ultrasound to determine whether or not you have swelling/inflammation in  your thyroid and if you have nodules.

No, there is no permanent cure for your problem.  If you have an autoimmune disease, you will always have it.  Typically, when one is hyper or has nodules leaking hormones, either the thyroid is removed or destroyed using RAI.  Either of these will leave you permanently hypo and dependent on thyroid replacement hormones.  

In some cases, a procedure known as "block and replace" is used.  With block and replace, the hormone production is blocked with an anti-thyroid med, such as the Neomercazole, then hormones are replaced with a med, such as Levothyroxine, which is a T4 thyroid replacement hormone.

You should get the antibody tests, mentioned above, along with a thyroid ultrasound to determine exactly what's causing your problem, then go from there.  Also, try to get the Free T3 and Free T4 tests done every time you have a TSH.

A healthy diet and moderate exercise are the best for everyone.  The only need to change diet is if you are allergic or intolerant to a specific food; then you should eliminate it.

[Chaitali1998]

I'm  a  41-year-old  lady.  At  present,  my  Total   T3=1.40, Total  T4=10.21  and  TSH = 0.01.

Reference  Ranges  for  the  Lab  in  India   where  testing  was  done :  Total  T3=0.6-1.81 ng/mL,  Total  T4=3.2-12.6 µg/dL, TSH=0.35-5.5 µIU/mL.

I  was  diagnosed  with  Hyperthyroidism.  Brief  History  is  as  follows:

27-Jul-2005:  Total T3= 1.02,  Total  T4= 5.7,  TSH=7.18  (TSH  High, No  thyroid  medication  taken),
14-Sep-2005: Total T3= 0.89,  Total  T4= 6.1,  TSH=5.99  (TSH  High, No  thyroid  medication  taken),
23-Nov-2005: Total T3= 0.99,  Total  T4= 6.4,  TSH=4.31  (No  thyroid  medication  taken),
26-Sep-2007:  Total T3= 3.56,  Total  T4= 22.6,  TSH=0.01 (TSH  too  LOW.)
10-Oct-2007:  NEOMERCAZOLE  5  mg  tablets  STARTED,  1-1-1,  3  times  a  day,
19-Jan-2008:  Total T3= 0.76,  Total  T4= 3.9,  TSH=23.14  (TSH  too  high.),
29-Jan-2008:  NEOMERCAZOLE  5  mg  tablets  STOPPED,   as  TSH  is  too  high.
29-Mar-2008: Total T3= 0.99,  Total  T4= 5.9,  TSH=4.77 (All  OK. No  thyroid  medication  taken),
28-Jun-2008:   Total T3= 1.14,  Total  T4= 7.1,  TSH=2.16 (All  OK. No  thyroid  medication  taken),
18-Jan-2009:   Total T3= 1.22,  Total  T4= 8.3,  TSH=3.29 (All  OK.  No  thyroid  medication  taken),
16-Jan-2010:   Total T3= 1.13,  Total  T4= 6.87,  TSH=4.19 (All  OK.  No  thyroid  medication  taken),
13-Oct-2010:   Total T3= 1.72,  Total  T4= 13.57,  TSH=0.01 (TSH  too  LOW.  Hyperthyroidism  Recurrence.),
27-Oct-2010:   NEOMERCAZOLE  10  mg  tablets  STARTED, 1-0-1,  2  times  a  day.
18-Dec-2010:   Total T3= 0.61,  Total  T4= 3.20,  TSH=37.44 (TSH  too  high.),
24-Dec-2010:   NEOMERCAZOLE  10  mg  tablets  STOPPED  and    NEOMERCAZOLE  5  mg  tablets  STARTED, 1-0-1,  2  times  a  day.
16-Feb-2011:   Total T3= 0.98,  Total  T4= 4.83,  TSH=7.26, (TSH  High, NEOMERCAZOLE  5 mg  tablets  CONTINUED, 1-0-1,  2  times  a  day.),

30-Jun-2011:   Total T3= 1.19,  Total  T4= 7.60,  TSH=3.52, (All  OK, NEOMERCAZOLE  5 mg  tablets  CONTINUED, 1-0-1,  2  times  a  day.),
03-Jul-2012:   Total T3= 0.78,  Total  T4= 7.00,  TSH=2.98, (All  OK, NEOMERCAZOLE  5 mg  tablets  STOPPED.),
01-Nov-2012:   Total T3= 0.88,  Total  T4= 7.18,  TSH=3.45, (All  OK.  No  thyroid  medication  taken.),
27-June-2013:   Total T3= 1.40,  Total  T4= 10.21,  TSH=0.01, (TSH  too  LOW.  No  thyroid  medication  being  taken  at  present.),

What  should  be  the  best  course  of  option  for  me ?

Is  there  a  permanent  cure  to  my  problem ?

What  kind  of  diet  and  exercise  will  help  in  my  case ?

Thanks  and   Regards.

Chaitali  Das

[Barb135]

We need to know the reference ranges for the T3 and T4.  Ranges vary lab to lab and have to be posted with results.

We also need to know if they are Free T3 and Free T4, or if they are Total T3 and Total T4.  Free and Total aren't the same thing.

Have you been diagnosed with a thyroid condition?  Are you currently on a thyroid medication?  If so, which medication, what dosage and for how long have you been on it?

When you've answered these questions, we'll be able to further assist you.