Can you help me reading this lab results?

[Meriam881]

In June I was diagnosed with subcute thyroiditis.This is a temporary thyroiditis supposed to resolve on its own and had two phases hyper then hypo then normal.I was hyper then went hypo and my doctor said after hypo I was supposed to be normal.I take Levo 50.Since a week I felt the symptoms of hypo began to subside as the fatigue markedly decreased.I thought that the hypo ended then I will go to euthyroid phase.But I began to experience the hypo phase once more.I have a slight fever,sweating a lot and feel hot all the time.Today I ran thyroid panel and the results are:

TSH 2.21 ( Ref 0.4-4.2)
Free T4 0.85 (Ref 0.8-1.9)
Free T3 3.43 (Ref 2.6-5.4)

The Results appear normal.But I feel like hyper.I notice that My FT4 is in the  lower end of normal? Do you need to increase my dose?

[Barb135]

Not all subacute thyroiditis goes away... sometimes it's Hashimoto's, which is autoimmune and is permanent.  Have you been tested for thyroid antibodies to determine if you have Hashimoto's?  Your symptoms (hyper, hypo, hyper, etc) sound exactly like beginning stages of Hashimoto's.  

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both because they're both markers for Hashimoto's and some of us have one or the other and some have them both.  

Just because labs are "in range" doesn't mean they're adequate; both your FT4 andFT3 are low in the ranges.  Most of us tend to feel best with Free T4 in the mid-range and Free T3 in the upper half to upper third of its range.   As  you can see, your FT 4 is on the floor of the range and your FT3 is only at 30% of its range.  

Some symptoms can apply to both/either hyper and hypo.  The feverish feeling could be because you have inflammation and simply feel "ill".  IMO - yes, you need a higher dose of medication.

[Meriam881]

Thank you for your reply.My doc tested me for hashi and the results are:

Anti-Thyroglobulin  Ab (ATG): 27 IU/ml

Normal (less than 40 IU/ml)

Anti-Microsomal Ab (A-TPO): 29 IU/ml

Normal (less than 34  IU/ml)

I have also low grade fever for months and severe neck pain.So,based on the results and medical history,My doc confirmed subcute thyroiditis.

I will speak with my doc about increasing my thyroxine.

[Barb135]

There are other possible scenarios as well...

There's no time-frame for subacute thyroiditis to resolve; it can take a year or more and if you were diagnosed in June, you could have a ways to go yet.  It may still go away on its own, even several years from now.

There's also no time-frame for subacute thyroiditis to convert to Hashimoto's; that can happen at any time - also several years from now or even after the subacute thyroiditis has seemingly resolved.  

A thyroid ultrasound would be in order, as some people can be diagnosed with Hashimoto's, based on thyroid characteristics, even with absent antibodies.  It's possible the antibodies simply haven't ramped up yet.  An ultrasound would also determine if you have nodules, which are common with Hashimoto's.  

The important thing will be to maintain adequate thyroid hormone levels to alleviate symptoms while you have thyroiditis.  You should also ask your doctor to continue to test antibodies periodically, so if they become elevated and your subacute does turn into Hashimoto's, you'll know it.

In the meantime, things you can do to help yourself are to make sure your Vitamin B-12, Vitamin D, and Ferritin are all in optimal ranges since these vitamins/minerals are all necessary for the proper metabolism of thyroid hormones.  If you haven't had these tested, I'd recommend you do so.  Feel free to post the results and reference ranges, here so we can help interpret them, since "in range" isn't the same as optimal. Selenium is also necessary for proper metabolism of thyroid hormones and aids in the conversion of Free T4 to the usable Free T3, plus it's been shown to help reduce thyroid antibodies.    

[Meriam881]

Thank you very much.I read that sub cute thyroiditis may take a year or more to resolve.Also,there is a possibility of recurrence.Some patients may end hypo for ever.But I did not read that Subcute thyroiditis may turn into an autoimmune disease because its cause is viral and before my diagnosis,I suffer from a bad upper respiratory infection.

I had an ultra sound which reveal mild diffuse enlargement of thyroid. But,fortunately,there is no nodules or cyst.

You are right about supplements and minerals.I have a very weak immune system.I thought my weak system is the main reason that allow the virus to attack my thyroid and made it inflamed in this way.

Unfortunately My doc is reluctant and always saying it is a temporary thing and I do not need to take any supplements or do extra tests.But I will do these tests on my account and post the results.

Thank you very much for support.

[Barb135]

Studies are showing that Hashimoto's may be triggered by a variety of viruses.  It may be a different virus for each of us.  None of us really knows which virus (or what else) may have triggered our Hashimoto's.

Yes, I recommend getting tested for the vitamins/minerals; many doctors don't realize the link between those and thyroid health... nor do they always understand the link between subacute and Hashimoto's Thyroiditis...