Thyroid issues

[pena122849]

I had a thyroidectomy due to benign multi-nodular goiter in 2008, and have been taking levothyroxine since.  I continually run a low body temp of 96-97, am always cold, sluggish, overweight, tired, etc.. I have been diagnosed with fibromyalgia, idiopathic hypersomnia, ongoing anemia issues and now have unexplained hives for the last 3 months.  My dermatologist requested labs in February: hemoglobin 11.0, hematocrit 33.4, RDW 20.0, MCH 23.8, MCV 72.6, and TSH 0.21.  The dermatologist said to see my primary care doctor asap, because of TSH levels, which were causing the hives.  My primary care doctor disagreed.  I went to an allergist and an endocrinologist and had more labs done in March:  hemoglobin 11.1, hematocrit 34.1, RDW 22.2, MCH 24.5, MCV 75.3, TPO 12, thyroglobulin antibodies <1, and TSH 0.74.
My primary care doctor and endocrinologist both say I am hyperthyroid, based on the TSH levels.  This is totally baffling to me as I feel totally the opposite, clinically.  The allergist thought I might have an auto-immune problem, causing the hives, but said the lab tests were negative for that.
I am trying a different form of levothyroxine (gluten free) and taking it at night, to prevent fewer issues with other medications that I take.  I am also trying a different form of iron (dessicated liver) for better absorption.  I am due to have my labs repeated next month, but I would like some guidance as to the possible causes for my varying thyroid levels and TPO.  If anyone could assist I would appreciate it.

[Barb135]

You need to have Free T3 and Free T4 tested, along with that TSH... just because your TSH is low, doesn't mean you are hyper.  TSH is a pituitary hormone that stimulates the thyroid and since you have no thyroid, who cares about TSH?  It's not unusual for TSH to be very low when one is on a thyroid replacement hormone (mine stays at < 0.01 - 0.01 all the time and I've never been hyper).  

We do need to have the reference ranges for the tests, though, since ranges vary lab to lab and have to come from your own report.

What brand of levo are you taking?

When you get your next labs done, insist on Free T3 and Free T4.  

The TPO isn't that important - Thyroid Peroxidase is an enzyme used to produce thyroid hormones - you have no thyroid and can't produce your own hormones anyway, so there would be no reason to worry that.  I'm sure the test performed on you was actually TPOab, which would be the antibody test. TPOab is, typically, used to diagnose Hashimoto's Thyroiditis, but again, since you have not thyroid it's a rather moot point.  TPOab is, however, often present in small amounts in other autoimmune diseases, which is probably what they were looking for.  Keep in mind, though, that you can have other autoimmune diseases without having elevated TPOab or TgAb, which are both thyroid antibodies.

It looks like your RDW is elevated, which indicates that you have either a vitamin B-12 or folate deficiency - most likely B-12... get those checked asap... you very possibly have Pernicious Anemia, which is also autoimmune.  

It looks like your MCH and MCV might also be elevated, but without the reference ranges, I can't tell for sure.  If so, that would fit right in with a vitamin B-12 issue...

You said you're taking iron, currently... have you had a recent ferritin test or iron panel?  If so, please post those results, with reference ranges, as well.

[Shanna_83]

I agree with you!