Hypothroidiam to Hyperthyroidism

[quietjrsygirl]

I have been hypothyroidism for years, last Novemeber my readings were high and I was boosted up to 200 mcg. Now while trying to get my bp under control I went to hyper, where my TSH is 0.060, 2 months ago was 0.089. I have been activily going to the gym 2-3 times a week since February and have only lost 10 pounds. I do have a nodule(beign) 1.4 cm on my thyroid. I am very tired by 4 or 5 at night and have to push myself to stay up until 8. I don't feel like I have any other symptoms of either one. Hair loss is my normal dead hair loss, bowel movements are my normal, just can't lose the weight. Changed my diet for my blood pressure, cut out salt and quit smoking, all of this since February. How can I go from hypo to hyper and then don't have any energy or unable to lose weight?

[Barb135]

Before you can go much further, you need to get the tests I recommended above for thyroid function.

Hyperparathyroidism has a different set of symptoms than hypothyroidism. While the parathyroids are located right behind the 4 corners of the thyroid gland, their function is completely different. The only relationship the parathryoids (most people have 4 of them) have with the thyroid is their location in the body.

Your symptoms more closely match those of hypothyroidism.  IMO, you should get the tests recommended above to confirm/rule that out, before you go further.

[Sandy11241957]

also forgot to mention about 6 years ago I was having symtoms of tingling, and feeling like pins and needles were pricking my legs, and then I started to get spots on my arms, I had a platlet problem and they thought I had Pernicious anemia, (dont pay attention to my spelling), and th cancer doctor drilled a hole into my hip and got bone marrow to examine, they found out my bone marrow was severely iron defient. I had to go on very high doses of iron for 4 months before I was back to normal.

[Sandy11241957]

thanks for the info. Also I forgot to mention that my father had a tumor on his parathyroid and had to have it removed when he was in his 50s. He is long gone now but his doctor told him at that time it could be hereditary. I have been checked before for this issue but not in recent years. It was always a blood test. Is there something else I should be looking for?

[Barb135]

The first problem I see is that you are getting only TSH tested annually; you aren't getting Free T3 and Free T4 tested.  FT3 and FT4 are the actual thyroid hormones, with FT3 being the most important because that's the one actually used by the individual cells.  FT4 is a storage hormone and must be converted to FT3 so the cells can use it.

High cholesterol, GERD, constipation, depression, brain fog are all symptoms of hypothyroidism.  It would appear that even though your TSH levels have been good, your actual thyroid hormone levels may be too low.

Always get FT3 and FT4 tested every time you get TSH.  TSH is a pituitary hormone and does not correlate with hypo symptoms, even though doctors swear by it as the gold standard in thyroid treatment. Once a person is on replacement hormone treatment, TSH often becomes useless.  

I also don't see that you had antibody tests done, to determine whether or not you have Hashimoto's Thyroiditis.  Hashimoto's is an autoimmune disease in which the body sees the thyroid as foreign and produces antibodies to attack it. The attack can progress over a period of many years.  As the antibodies destroy healthy thyroid tissue, they produce less and less hormones, until finally there will be no more healthy tissue and no more hormones.

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  You need to have them both because some people have only one, some the other and some both.  

You should also keep in mind that TPOab can be present in small amounts in other autoimmunes, including RA.

If your doctor refuses to do FT3, FT4 and the antibody tests, you should look for another, asap, because this one will keep you ill, as has been the case.

[Sandy11241957]

I have had hypothyroidism since 1993 when it was discovered. I had a goider and weight gain, and exhaustion. Synthroid medication was the solution then. Fifteen years later I have begun to have problems, had a vaginal hysterectomy, and then went through what doctors called depression. And then I began the problem not sleeping, racing mind wouldnt let me sleep2002. I was put on wellbrutrin for depression, seroquel for sleep, even though it is usually used for other things, nothing else would work for me I tried them all. 5 years ago I began blood pressure problems and high cholesterol, triglycerides, even though I eat correctly and am active, I even began working with a trainer to get in shape. I was feeling pretty good then. At that time I went on linsynopril for blood pressure but didn't do anything with high cholesterol and triglycerides as I wanted to see if the extra excercise and diet change would help. I take 200mg of synthroid daily and keep my tsh between 2.0 and under which has worked for years. I check my TSH yearly and have been doing great. But a year ago, I began to have constipation on and off. Dr. says lack of fiber in diet but I hadn't changed my diet and I think I eat enough fiber. Was starting to have belly pains across my upper abdomen just below my rib cage. I went to my doctor and told her I just don't feel right. So she ordered a CT ultrasound to check liver, pancreas, and kidneys. This was on a Wednesday, and by Friday I went to ER because the pains were getting worse and I started passing blood in stools.Dr thought it could be hemroids (never had them before but since I was having constipation he thought it could be. Never had pain with stools before. Dr gave me meds and they did blood work but nothing showed up and sent me home. Saturday worse and I ended up passing more blood, kind of clotty and abd pains. Did a CT abdomen, had a colonoscopy, (nothing), did an EGD and the doctor said I had Ischemic colitis and needed to take a fiber tab, so I took it for couple of months did ok, still not feeling quite right. Muscle cramping on calves, and feeling stiff. I quit taking the fiber pill and nothing changed there for several months. Having muscle cramps now, and joint pain.  But went to the doctor cuz I thought I had a UTI, they found blood in urine, put me on meds, did the usual routine, got uti again, put on meds, did culture but nothing showed up, went to urologist, did scope nothing unusual, said sometimes people have traces of blood in urine and nothing wrong, did a recheck and still show traces of blood but nothing done. Never had that problem before. So I have been suffering on a continual increase. Went to the doctor again and asked for a RA test. Came back 69, so sending me to a Rhuematoid coctor. I have a knee that has no cartilage left in it and need a total knee replaced but can't as the ortho dr wont touch me until I get cleared from a RHuematoid dr. Been waiting to see him for 3 months. In the process of waiting, I recently went to the doctor to get med checked, and liver functions done, thyroid tested. Liver functions tests came back normal, but the TSH came back 10.88 which is the highest number I have ever had. d(the higher the number the more hypo you are). Now I know what is going on. The doctor asked me if I have been taking my thyroid medicine regularly, I told him I have missed a dose here and there as I can't seem to remember anything. I also have brain fog and that has been worse too. I told him I have this feeling of inflamation, my joints ache so bad and that is getting worse. Told him I went to my massage therapist and she asked me what is wrong with your muscles, you are stiff as a board. He rodered a CK on me but phoned me back and said my labs are ok. That is when I got on the intranet to research my symptoms and found this sight. I am hoping someone can help me. What tests do I need to have? And does anyone have any answers? Oh yea, in the passed I have mentioned to the dr. that I have researched my symptoms on the internet and they tell me, that is my first problem, leaving me to believe it is all in my head.*****! I work at a hospital in patient registration for the last 14 years, I ride horses, garden, and manage the books in my family farm, so I am not lazy, not stupid, and not crazy. But when they find out you are taking depression meds they treat you that way or that is how it makes me feel. Help!!!!!!!!!

[Barb135]

Low TSH doesn't necessarily mean you are hyper.  TSH causes no symptoms.  Symptoms correlate best with Free T3, and it seems that you aren't getting tested for that.  

Is that T4, Free or Total?  If it doesn't specify "free" or FT, on your lab report, then it's total.  It appears to be free, but I've never seen a range like that.

At any rate, Free T4 can't be used directly, so must be converted to Free T3, which is the actual hormone that enters the individual cells and gives us energy, controls body temp, heart rate, etc.  Some of us don't convert adequately, and need to add separate source of T3.  

Rule of thumb is that FT4 should be approximately mid range and FT3 should be in the upper 1/3 of its range.  Your FT4 is 64%, which is higher than recommended.  Going just by that, and your symptoms, I'd guess that maybe your FT3 would be on the low side and that you could benefit from a separate source of T3.  Of course, a T3 med should never be added without testing FT3 first.

Typically, when a T3 component is added, the T4 med is decreased by 25 mcg for every 5 mcg of T3, since T3 is about 4 times more potent than T4.  

You should first ask your doctor to test Free T3 (do make sure it's FREE T3) and see what your level is, then you'd be able to go from there.  If FT3 is low in the range, you could add a T3 med; if it's high in the range, that would indicate that you are truly hyper and the decrease in med was warranted.

Fatigue/tiredness are symptoms of both hyper and hypo, so without adequate testing, there's no way to know which it is.

If your doctor refuses to test FT3 or to add T3 medication, you should be prepared to find another, even though you did say this is a "new" doctor.  Some people have had to go through several, before finding one who will test adequately and treat according to symptoms AND Free T's, not simply react to TSH.  My TSH typically, stays at < 0.01 and I've never been hyper, since I've been on thyroid medication.

[quietjrsygirl]

My TSH 0.060 range 0.465-4.680 done 6/13/12
              0.089 same range done 4/6/12
My T4 1.69 range 0.78-2.19 done 6/13/12
            1.51 same range done 4/6/12
My TSH back in February was 2.4 with the same range. I didn't get the T4 done then.
Last one before that my TSH was 4.7 which the doctor increased me to 200 mcg, I believe that was done in Nov. I can't find the copy for that one to get the T4
Since my TSH which is 3rd generation testing, has been so low my new doctor has decreased my doseage 2 times. Now I am at 175 mcg, but still feel tired

[Barb135]

By "readings", I assume you're referring to TSH?  Is that the only thing that's being tested? You should also be getting Free T3 and Free T4, every time you have a TSH test. TSH is a pituitary hormone and is not necessarily indicative of actual thyroid hormone levels, especially once one is on medication.  My TSH has been < 0.01 for nearly 5 years, since I've been on medication and I've never been hyper.

Free T3 and Free T4 are the actual thyroid hormones that are produced by the thyroid.  Free T4 can't be used, directly; it's considered a pro-hormone, or storage hormone; it must be converted to Free T3, which is the hormone used by the individual cells.

Many of us find that we don't convert the FT4 to FT3 adequately, so we have to add a source of T3 medication, which can be in the form of a synthetic T3, a compounded T3 or a desiccated porcine hormone, which contains both T3 and T4

Also, many of us find that we must keep FT3 in the upper 1/3 of its range and FT4 at least mid range, in order to feel well.

If you have current labs that you can post, please do so and be sure to add reference ranges, since these vary lab to lab and must come from your own report.  That will allow us to better assess your testing and treatment, and comment more fully on your situation.