Thyroid problem based on labs?

[Stevemason89]

I've been experiencing worsening anxiety for a few years now. It's at the point where most of the day I'm anxious, with chest tightness, short of breath when I'm quite anxious. I was diagnosed with generalized anxiety disorder/social anxiety disorder. I have had cold intolerance lately, and have had dry skin lately (could be nothing - it is winter). With some knee joint problems.

My labs were: TSH 0.44 (normal range 0.4-4.0 I think) and free T4 1.1 (normal range 0.7-1.7 I think). The labs don't seem overly significant but I wanted to double check. Are my anxiety symptoms mainly psychological? The anxiety is my main concern.
Thanks.

[Barb135]

I think you misunderstood my question.  Thyroid replacement medication isn't only taken when the thyroid is removed; it's taken for hypothyroidism and I, apparently, mistakenly, thought that's what you had.

You tried methimazole in 2009, with bad result and are now back on it; what have you been doing in the meantime?

[McMillanNelson]

Hi Barb, No. I kept my thyroid.  I am on methimozole again now. I tried that in 2009 and had a very bad result. I am doing better on it this time.

I had a Thyroid Uptake and Scan today. I'll post the results here for some advice.

Mac

[Barb135]

Aren't you on a thyroid replacement medication?  

[McMillanNelson]

Hi Steve, Obviously the brain fog is getting the best of me this week I apologize to this thread, I replied to deb62gee  meaning to be talking to Steve.   Barb obviously has some very good advice there as well as deb62gee.

I have had all the Antibodies blood work done that Barb describes and those were "normal"  It took years before I finally went and had a Thyroid Ultrasound and they found nodules and that my thyroid was enlarged.  Since my TSH is always low I am interested in what barb said about possible pituitary issues.  

Does your doctor have a plan for you as to what is next?

[Barb135]

Rule of thumb is to have FT4 at about mid range; yours is at 40%, which isn't horrible, but there's plenty of room for improvement.  You need a Free T3, also, in order to determine what's going on, because the body doesn't use FT4; that has to be converted to FT3 for use by the cells.

I agree that you need to have antibody tests done to confirm/rule out Hashimoto's and Graves Disease.  Graves Disease seems unlikely, since your FT4 is low.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab) to test for Hashimoto's; Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves.

It's important to note that early stages of Hashimoto's can be characterized by periods of hyperthyroidism, and swinging back and forth to hypo and normal.  

Your symptoms (being cold and dry skin) are those, typically, found with hypothyroidism.  Anxiety is a "shared" symptom, since it can be present with hyper or hypo.  Since your TSH is so low, it's possible that you have a pituitary issue, rather than a thyroid issue.  The pituitary produces TSH to stimulate the thyroid; if there's not enough TSH, the thyroid doesn't know it's supposed to produce hormones.

Only further blood work will tell what's going on; get the whole thyroid panel, which includes TSH, FT3 and FT4, since they should all be done from the same blood draw.  Also get the antibody tests.  

[deb62gee]

Hi Steve. No your T4 isn't high. I read that wrong. But since a freeT3 wasn't done, it is difficult to tell where you are at. T4 could be mid range with high T3 and that could make your TSH go down. But TSH can be down one minute and then change, so the other tests might help you more.

[McMillanNelson]

Hi deb62gee, What other symptoms do you have? I agree with Steve. it is possible that you could have an autoimmune or hyperthyroid problem. I am hyperthyroid (Toxic Multinodular Goiter) My TSH is usually very low .2 or lower. TSH fluctuates though out the day but if it is typically low and your FT3 and FT4 are in the normal range you need to look deeper than just blood labs. Often the only way we can get the help we need from our doctors is to very thoroughly document and describe all of our symptoms.  In my case a Thyroid Ultrasound and then a  Nuclear Thyroid Uptake and Scan was needed to determine more precisely  that my symptoms were indeed due to thyroid problems.

Have you had any other tests done?

Mac

[Stevemason89]

Thanks for the reply. Is 1.1 at the high end of Free T4? Isn't the range 0.7-1.7?

I do think I'll ask to get the antibodies tested regardless though. Thanks.

[deb62gee]

Your symptoms could be from being hyperthyroid. Your TSH is low and your T4 is at the top of the range. Think of the ranges like shoes sizes. If you wear a 10 while someone else wears a 7, that 7 won't fit you right and your 10 won't fit them right. Just because you are in "normal" range doesn't mean you aren't hypo or hyper.

You may need less T4. You also need to have your thyroid antibodies checked (Grave's included) and T3 (getting the free numbers has always been supported by most as being the best to do). So, TSH, Free T3 and Free T4 plus antibody testing for Hashi's and Grave's is what you need to have done. In my opinion, anyway. I am not a doctor. Just a long time thyroid patient.

With the symptoms you have, you sound hyper and your blood work says you "could" be, even though your numbers are "in range".