Abrupt change in my TSH lab result !!

[andix]

Hi,
For the last 2 years, the TSH lab test was part of my routine set of tests.
TSH was always somewhere in the 4.5 - 6.0 range, showing a very mild hypothyroidism (I think). I never took any medicine for this.
A week ago I had another routine lab test ... and to my surprise it showed the following:

TSH = 0.21
TPO = 122      (this is the first time that I see the TPO test on my lab result sheet)
Thyroxine-free = 1.7

How should I interpret these results !!??  I'm a male 52 yo.
What would be the explanation of this "anomaly" ?

Thanks you.

  

[andix]

Thanks goolarra.

I had a thyroid ultrasound last year in August, ... it was normal, no nodules.

[goolarra]

Your TGab is elevated as well as your TPOab, so that confirms autoimmune.  Your FT4 is high in the range, but your FT3 is over the top.  TSH is all but non-existent. All this points to hypER as does your increased HR.  My guess at this point is Grave's, but you'd have to have TSI tested (thyroid stimulating immunoglobulin)...this is the definitive test for Grave's (which is probably in its early stages since your are relatively asymptomatic).  Any other symptoms like higher BP, heat intolerance, anxiety, diarrhea, insomnia, etc.?  Have you ever had a thyroid ultrasound?  Any of your doctors ever told you that you have nodules?  A "goiter"?

I think the TSI is your next step.  Confirm or rule out Grave's.  This is the most likely cause for your levels...the only thing that bothers me is the high TSH readings prior to February.  With only the two FT4 readings and no previous FT3, it makes it a bit more challenging to figure out what's going on!  Anyway, if you test positive for TSI, you will have your answer...Grave's.  If not, then I'd suggest  early stages of Hashi's.

[andix]

Also, forgot to mention that recently I had some sleeping problems during the night ... I wake up after 4-5 hours and then have trouble getting back to sleep ...

[andix]

The ranges are:

for FT3 is 230-420
for FT4 is 0.8-1.8
for TSH is 0.40-4.50

The only thing that I feel different from (let's say) 1 year ago is that my pulse is now at 80-82 (it use to be at 65-70) and I sometime feel a slight "presure" or discomfort with my heart ... other than that I'm ok.

[goolarra]

Do you have the ranges on your FT3 and FT4?

Still feeling well?

[andix]

Hi goolarra,

On Feb 27, 3:29 pm, you wrote a very helpful comment regarding my initial question, with which I opened this thread, and my test results.
I followed up on your advice and I had another lab test with the following results:

Lab Test on March 25:

TSH = 0.04
T3 free = 440
T4 free = 1.6
ThyroGlobulin ABS = 25    (ref range  <20 IU/mL)
ESR (Westergren) = 1    (normal)

What should I make of this in the context of my previous results (see my previous comments) ?
I really appreciate your analysis and advice.

Thank you ... Andix

[goolarra]

Looking better on the FT4...that should definitely get you to the UK.  Let us know how that goes.

[oldie]

FT3 slipped a little from 2.84 to 2.52. But FT4 at 1.83 is for the first time not above the range. TSH up to 0.33. I feel a lot more confident and I can thank you for that.
Best

[goolarra]

Of course, you can.  You know, after being hypo for a while, it often takes FT3 a while to "catch up" once FT4 is up where it should be.  FT4 will be stable, but FT3 continues to rise without further meds adjustments.  It takes some time for the whole system to start working again optimally, including conversion.  Let's hope this is the case with you.

[oldie]

you really are tops. I couldn't hope for clearer counsel. I 'll get results for the latest TSH, FT3 and 4 tomorrow afternoon and i hope you won't mind if I relay them to you
bless.

[goolarra]

I agree it's hard to sort out the symptoms of each and the possible side effects of meds.

At least your FT4 and FT3 are both moving in the right direction if FT4 has gone down since December (still slightly over limit) and FT3 has gone up (still only in the very bottom of the middle third of the range).  

I wouldn't worry too much about being hyper just because your TSH is on the low side.  If you don't have hyper symptoms (once you've sorted those through), then you are not hyper.  Some of us have to have TSH suppressed below range to feel well.  Keep your eyes open for hyper symptoms.

I'm glad to hear you'll be in the UK where they have Cytomel.  T3 is tricky with your heart issues, but I still think you need to drop you levo and add a tad of Cytomel.  I hope you can get in to see a doctor who will take your whole health picture into account and advise you on the Cytomel situation in light of your heart issues.

If you see any hyper symptoms, by all means call your local doctor about cutting back on the levo just a little bit.  Barring that, I don't see why you can't wait until you get to the UK and have some more options open to you.

[oldie]

so good of you to answer quickly
FT4   1.91   (0.71-1.85)
FT3    2.84   (2.0-4.43)
TSH   O.14   (0.49-4.67)
These are from Feb 2. FT4 has dropped and FT3 risen since De9
My symptoms (I can go two weeks or three with none when the cardios leave me in peace and stop`pressing for angio)- dizziness, nausea, intermittent ( light) shortnes) of breath when inactive but never during or after hard excercise, slight, intemittent sinking feeling in heart area,  heat flushes, fatigue, general malaise - could be caused by CAD, thyroid, medication (Levo 125, Coreg, Lipitor 40, Propfanone 150 p/day, Vastarel 150 2/day. Niacin 1000, fish oil 1200.) Neither the doctors nor myself can ascribet hem to a particualar cause. I couldn't in point any of them as a hyper sign
The possibility that I've swung to hyper on top of this  is too much. I'll be in UK at easter. They have cytomel. There is none here in Guatemala and they are drowning me in Levo. Maybe I could wait three weeks more? best to you and all

[goolarra]

Hi Oldie...haven't heard from you in quite a while.  Do you have FT3 and FT4 results and ranges?  Do you have any hyper symptoms?

[goolarra]

As I said, your elevated TPOab indicates autoimmune thyroid disease, Hashimoto's thyroiditis (hypo) or Grave's (hyper).  With your currently low TSH and FT4 of 1.7 (almost topped out in the range), we might assume hyper.  However, since you are basically asymptomatic, we can assume that you are most likely in the very early stages.  Hashi's can include a very early phase of hypER, followed by a "permanent" hypO.  Also, early phases of Hashi's often contain swings from hypo to hyper.  As the antibodies attack the thyroid, it doesn't just stop working suddenly.  Instead, one day it functions on the low side, the next day just right, and the next too well, etc.

FT3 is the test that correlates best with symptoms, followed by FT4, and TSH almost doesn't make it onto the list.

You should probably have FT3, FT4 and TSH all run on the same blood draw.  FT3 will help distinguish between Hashi's and Grave's.  TSI is the test that confirms or rules out Grave's.  A thyroid ultrasound would give a lot of information on your thyroid's physical makeup and indicate if something there might be causing your lab results.

Your TPO is not all that high (as TPOab often goes into the thousands).  However, you have nonetheless tested positive, and that's all that's really important.  

The tests I mention above will let you know exactly what you're dealing with, and then you can check out the different treatment options and decide how best to monitor your condition..

[oldie]

My TSH (lab range 0.49-4.67)

sept '09    1.41
nov    "      0.09
dec    "     1.38
feb   '10     0.14

I have been so taken up with CAD problems I didn't see an endo. Do I look hyper or a yo yo? I'm still on 125 Levo

[andix]

and here are all my TSH results:

Dec2007        TSH = 4.4
March2009     TSH = 5.48
May2009        TSH = 5.91
Feb2010         TSH = 0.21

[andix]

I had the T4-free taken only twice at the same lab with the normal range of 0.8-1.8 :
May_2009   T4-free = 1.3
Feb_2010    T4-free = 1.7

Regarding symptoms: not anything special,... perhaps a slight tendency of gaining weight (I'm currently 5' 11'' with 203 pounds) ...

[goolarra]

The currently accepted range for TSH is 0.3-3.0.  You're right 4.5-6.0 results indicate hypo.  TSH of 0.21 indicates hyper.  However, TSH is a very poor diagnostic of thyroid disease.  Free T3 and free T4 (free thyroxine) are much more important.

Elevated TPO antibodies indicate an autoimmune thyroid disease.

What is the range on your FT4 of 1.7?  Ranges are lab specific and have to come from your own lab report.

Do you have hyper symptoms?  Did you have any hypo symptoms when your TSH was elevated?