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What do my tests mean?? Hashimotos?

Hi all. I've recently gone to a doctor (initially to check my iron levels as I'm vegetarian) due to chronic fatigue, weakness, chronic foggy head, headaches, etc. However other symptoms I've experiences was weight gain followed by weight loss, loss of hair, extreme dry/red eyes, etc.
My doctor tested my thyroid and found normal TSH levels, normal T3 levels, and heightened free T4 levels which did not make sense to her, so she ordered the test again. It came back similar:

Free T4 1.80 (.82-1.77 ng/dL)
T3 153 (71-180 ng/dL)
TSH .96 (.45-4.5 uIU/mL)

Although my TSH is in the normal range, from what I've researched it is on the low end and not optimal. My free T4 is definitely heightened. What does this mean?? My doctor at first said my hyperthyroidism, but then later mentioned she is considering if it is Hashimoto's... but I thought Hashimotos was hypothyroidism. I'm just really confused. She wanted me to go to an endocrinologist but I'm in grad school and my insurance doesn't cover it. Anyone have any ideas what these levels indicate? Could it be Hashimotos?

Thank you in advance!
5 Responses
649848 tn?1534633700
COMMUNITY LEADER
Your hormone levels indicate hyperthyroidism, not hypothyroidism, but you could have Hashimoto's; you could also have Graves Disease, although you can't know that from these results.  Hashimoto's and Graves are autoimmune conditions and in order to find out if you have either (or both), you have to have the right antibody tests.  

Although Hashimoto's is known to be associated with hypothyroidism, early stages can be characterized by stages of hyperthyroidism, alternating with hypo or even normal periods.  

To determine if you have Hashimoto's, you need antibody tests, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).   The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).  

It would be a good idea to have Vitamin B12, Vitamin D and Ferritin tested.  Many vegetarians are deficient in vitamin B12 because its main source is animal sources such as meat, dairy, eggs, etc.  Plant sources of B12 are extremely difficult to absorb.  Vegetarians/vegans usually have to supplement B12 in order to maintain adequate levels.  B12 deficiency can cause symptoms you describe, though it won't typically affect weight.  Vitamin D is necessary for proper metabolism of thyroid hormones, as is Ferritin, which is the iron storage hormone, so it would be a good idea to go ahead and get a complete iron panel, as well.

Many of these tests can be ordered online, without a doctor's order, at far less expensive rates.  If you're interested, we can tell you how to do that.
3 Comments
Thank you for all this info!! I am so lost and googling info is only telling me so much.  I had full blood work done and that's how they saw my thyroid levels, everything seemed in normal range. My results did show I am on the verge of macrocytosis, where by red blood cells would be too large indicating a possible deficiency in B12. My doctor wasn't worried and said a multivitamin would do but I am now taking an iron and B12 supplement to be on the safe side. All others were in optimal range. I'm not sure Ferritin was tested... I might need to check on that.

I am interested in how to order these tests online. My doctor doesnt seem to know a lot about thyroid disorders and being in grad school and I'm really struggling if I can afford a specialist at the moment unless it's absolutely necessary.

One question - if I simply had hyperthyroidism why would my TSH levels be in the "normal" range? I guess that's why my doctor is confused... she keeps saying my test results don't make sense.
I had severe B12 deficiency with normal blood cell size. I believe this is due to my love of vegemite lol which is high in folate.
Red_Star - I had severe B-12 deficiency with the obvious larger than normal blood cell size and although doctors caught the large blood cell size, they missed the B-12 deficiency and blamed the blood cell size on a variety of other things - one accused me of being an alcoholic, saying alcoholism is the "only" thing that causes blood cells to be larger than normal...
1756321 tn?1547095325
I've had both types of Hashitoxicosis. I have Hashimoto's thyroiditis but my labs were weird lol when Graves antibodies showed up as well. My labs showed subclinical hypothyroidism with only the TSH slightly above the range at 6 and I was very hyperthyroid.  I read a blog entitled Hashitoxicosis: Does It Really Exist? YES and here is an excerpt..

"Here's what stumps doctors most when you are dealing with Hashitoxicosis - your labs.  Due to this constant cycling of hypo to hyper from minute to minute and hour to hour, the net effect of these changes is a zero sum game - normal labs."

The leakage hyperthyroid symptoms of active Hashimoto's thyroiditis are milder symptoms compared to Graves. My symptoms of Graves also caused pretibal myxedema and eye symptoms such as red eyes and light sensitivity.

***

"It should be pointed out that, especially in the US literature, the term ‘hashitoxicosis’ is sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves’ and Hashimoto’s disease.2 In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease.

Hashitoxicosis is most likely to present in the early stages of autoimmune hypothyroidism."

Touch Endocrinology -
Hashitoxicosis – Three Cases and a Review of the Literature
2 Comments
This is actually very interesting, I am new to all of this so I didn't know this was a thing. I do have basically a 50/50 mix of hypo and hyper symptoms. That's why I went in to my PCP to see if I was hypo and my tests came back possibly hyper.
I have extreme fatigue, brain fog, I'm constantly cold (and i live in 80 degree weather year round), and I went through 4 months of intense weight gain (which is super abnormal for me... I can NEVER gain weight).
Then at the same time I have heart arrhythmias, anxiety, slight tremors, and pressure behind my eyes that make me very dizzy, and I also went through a 2 month period of extreme weight loss.
The weight gain...arrrrg lol
Avatar universal
Looks hyper to me. I felt horrible when my FT4 was high. Could be Hashimotos, Graves, neither or both. Your doctor should check your antibodies (TSI for graves, TPO and TG for Hashimotos). You could try asking your PCP to run these tests and explaining that your insurance doesn't cover an endocrinologist. You may want to double check with your insurance, I've never heard of a plan that doesn't cover endocrinologists.
2 Comments
Thank you! I actually did double check and there was some miscommunication and I am seeing an endo next week. I'm not sure why they didn't run my FT3 levels...

Would you mind if I asked what your symptoms were with high FT4 levels?
Jenn1302, what were your symptoms when your ft4 was high? were you thyroid meds? which ones and what dose? how high was your ft4? sorry for all the questions my recently my ft4 has been very high and ft3 low :(
Avatar universal
You probably want to ask them to check your FT3 levels too.
649848 tn?1534633700
COMMUNITY LEADER
You need to insist on having the antibody tests I mentioned above in order to determine exactly what you have... without them, you can't tell for sure what condition(s) you actually have.  

It's good that you've been referred to an endo, but remember, not all endos are good thyroid doctors as many actually specialize in diabetes rather than thyroid.  Be sure to advocate in your own behalf.
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649848 tn?1534633700
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