high ft3, normal ft4 & normal tsh, please help

[james6161]

Hi.

I recently visited the doctor and these are the results that I received.

TSH 1.98 (0.35-4.94) mU/L
T4 Free 14 (8-22) pmol/L
T3 Free 5.73 (2.63-5.69) pmol/L

Through research online I suspected I might be hyperthyroid. I am 26yo male, 6" 3, 70kg. Have classic symptoms, always hungry and eat a lot but never gain weight(ever). Heat intolerance is a big one for me. Flushing of the face,chest and neck occurs especially during sport.

Can someone interpret my results for me here? Would be highly appreciated.

Best
James

[goolarra]

If your doctor is amenable, you might also request TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) to see if you're in the early stages of Hashi's.  While Hashi's is ultimately hypo, early stages can be hyper or swing between the two.

If none of that turns up a cause, don't forget the ultrasound.  Your doctor may suggest it anyway.

[Red_Star]

My two reasons for serious adrenal insufficiency was severe vitamin B12 deficiency and being very hyperthyroid for two months. Both conditions really taxed my adrenals badly.  At my worst my pupils were fluctuating in the light so fast it was less than a second between fluctuations plus I could draw the back of a spoon across my belly and a white line appeared and spread over 2 inches.

When I had untreated B12 malabsorption, I used to be bitten badly by mosquitos and was covered in bites. These bites always turned into large itchy white lumps. The lumps would eventually go down but it could take up to 4 months for the red spots to heal. I didn't connect the reaction to mosquito bites to low cortisol though. Interesting.

[james6161]

this is interesting http://www.researchgate.net/publication/228534742_The_effects_of_maximal_aerobic_exercise_on_cortisol_and_thyroid_hormones_in_male_field_hockey_players

[james6161]

I think what I speak of above is also known as Adrenal fatigue (cortisol). If anyone can speak on any connection here that would be great. Thanks

[james6161]

Thanks for the response people. I only had TSH, FT4 and FT3 tested on the day i visited. Should there be any other important tests to get done? I forgot to add that the only other out of range reading was Calcium. Just above the top of the reference range.

I am also going to ask the doctor to test my cortisol levels. I recently read online that a low cortisol level can cause symptoms very similar to Hyperthyroid/Graves. I do know that my skin reacts entirely different to others when bitten by midges/gnats. I get these very large and itchy swollen lumps. I read somewhere that if your cortisol levels are low this can happen.

I will be visiting the doctor again early next week. I will ask about the FT3 Toxicosis, possible TSI test and cortisol test. Anything else anybody thinnks should be brought up? Thanks again great to get feedback

[Red_Star]

"T3 toxicosis is caused by iodine deficiency or compensatory increased hormone production or faster peripheral T4 to T3 conversion or relapse after subtotale thyroidectomy or increased hormone production in the early stages of thyrotoxicosis or elevated T3 concentration in Grave’s disease, multinodular goiter or the autonomously functioning solitary thyroid nodule
(Davis, 2009; Rehman et al., 2005).  T3 toxicosis occurs in 5 to 46% patients with toxic nodules (Davis, 2009)." - Excerpt from Syndrome of isolated FT3 toxicosis: A pilot study.

[goolarra]

TSH is pretty much right where it should be.  FT4 is at 43% of range.  The target for FT4 is somewhere around 50%, so you're definitely in the ballpark, but not at all high.  FT3, on the other hand, is above range, which could be giving you some hyper symptoms.  

By far, the biggest cause of hyper is Graves' disease, which is an autoimmune disease.  It's not the exclusive cause, but it's close.  I don't think your TSH is low enough for this to be Graves'.  To be sure, your doctor should test TSI (thyroid stimulating immunoglobulin), which is the antibody marker for Graves'.

Another possibility is a toxic nodule (also called an autonomous nodule).  There are many different kinds of thyroid nodules, so if you read about them, be sure they're discussing toxic nodule and not another variety.  A toxic nodule is like a mini-thyroid within the thyroid.  It puts out a high volume of FT3, but it is not under pituitary control; it's indiscriminate.  This would show up on a thyroid ultrasound.

FT3 is the test that correlates best with symptoms.  FT4 doesn't correlate as well, and TSH not at all.  So, the most active (FT3) is on the hyper side.