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Do I need to worry about my TSH levels fluctuating?

A month and a half ago I had my annual physical and routine blood draw.  My TSH level was .01. A week later the test was done again along with free T4 and free T3. The TSH this time was .03 and the T3 and 4 were in the normal range. My doctor said to do the blood test again in 6 weeks. This time my TSH jumped to 3.47 and the free T4 was below the normal range at 0.8.  My doctor did not have the T3 test done.
I have felt both symptoms of hyperthyroidism and hypothyroidism.
Is this something to be concerned about?  My doctor has not gotten back with me yet on the test results.
1 Responses
649848 tn?1534633700
COMMUNITY LEADER
Some symptoms can apply to either/both hyper and hypo, so it's important to your specific symptoms.  

Second, are you on a thyroid replacement medication, already?  If so, what medication(s) and dosage(s) are you on?  What was your original diagnosis?  If you take a replacement thyroid hormone, had you taken it prior to any/all of the labs?

As for TSH, it can be affected by a lot of different things, other than thyroid hormones, so no, basically, it doesn't matter that it fluctuates, but it's interesting that it jumped from barely measurable to the upper part of its range.  

What was the reference range for the Free T4?  Ranges vary from lab to lab so they have to come from your own report.   What were the actual T4 and T3 results on the second set of labs and were they Free T4 and Free T3 or were they Total T4 and Total T3?  Tests for Free and Total T4 and T3 aren't the same and don't provide the same information.  Did your doctor indicate why s/he didn't order a Free T3 test?  

I'm sorry to ask so many questions, but we can give a more educated assessment, with further information.
6 Comments
I have never had thyroid problems before. I am 67 years old. I am not on any medication because they have not given a diagnosis yet.
The second set of blood test was to see what the levels would be six weeks after the first ones. I don’t know why they didn’t do T3. All they did was free T4.  Free T4 range is .9 to 1.7. The TSH range is .37 to 4.20.   The free t4 was .8.
Actually my heart doctor ran a set Of blood tests a week after the fist labs. I forgot about that. The TSH then was .03, the free T4 was 1.1 and the free T3 was 2.6 on a range of 2.5 to 4.3.
I’m still waiting to hear from the doctor on last readings TSH 3.47 and fT4 .8
When my levels were .01 and .03 I had lost several pounds. I had more bowel movements and I had hand tremors. Since the level has gone up on the TSH and the free T4 going down I have felt bad. I gained a couple pounds back, I’ve been bloated, very fatigued especially by afternoon. And I just feel crummy and shaky.
Have you been tested for thyroid antibodies?  Off the top of my head, it appears that you might have Hashimoto's, which is an autoimmune thyroid condition that ultimately leads to hypothyroidism.  What happens, sometimes, is that the thyroid "spits and sputters" - for a while before finally dying out and no longer producing any hormones at all.  What makes this less likely is that we'd think your TSH should be higher with such low thyroid hormones (when thyroid hormones are low, TSH goes higher to try to stimulate the thyroid and when thyroid hormones are high, TSH goes lower to try to stop hormone production).

None of the labs you've posted indicate that you were hyper at any time, but if your thyroid is sputtering, it might feel like you are, which would explain the hyper feelings and symptoms.  That said, your low  thyroid hormones and low TSH could also be an indication of Central hypothyroidism.   Whereas Hashimoto's is an actual thyroid problem (because antibodies destroy the thyroid), with Central hypothyroidism, the thyroid actually works fine but there's a problem with the pituitary or hypothalamus so there isn't enough TSH to adequately stimulate the thyroid.  

Central hypothyroidism is often missed because doctors look mainly at TSH and of course, your TSH is very low, so the first thought is that you're hyper.  Your thyroid hormone levels tell a totally different story because they're obviously very low - even the ones that are "in range" are too low for most of us to be comfortable.

Whether you have Hashimoto's or Central (or Secondary) hypothyroidism, it will need to be treated with replacement medication.  

I'd recommend that you ask for thyroid antibody tests to confirm/rule out Hashimoto's.  The 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 if only one is done,  you could be misdiagnosed.  

I'd also suggest a thyroid ultrasound to check for nodules on your thyroid.  Nodules are very common in those of us with autoimmune thyroid conditions and are usually nothing to worry about.  In your case, because your levels are fluctuating, it's possible that there's a nodule producing hormones on its own, independently of the thyroid.  Typically, when this happens, it's on a more regular basis instead of fluctuating, but it's always a possibility.

If your doctor doesn't suggest any of these things, ask about them.

Have you had Vitamin B-12, Vitamin D or ferritin tested?  Vitamins B-12 and D are necessary for proper thyroid metabolism.  Ferritin is the iron storage hormone.  Iron is necessary for the conversion of Free T4, which is considered a "storage" hormone to the usable Free T3, which is used by nearly every cell in the body.  

If you've had any of these tested, please post their results and reference ranges, as well.
I have not had any antibody tests done.  I will ask if they don't mention that.  I checked my labs from my annual physical and there were no B-12, D or ferritin tests done.  I do take B12 daily and D3 twice a day.  I don't take any iron.    I can have those 3 checked also.  And see about them testing TPOab and TgAb. I will also ask about the thyroid ultrasound.   If they don't want to run any further tests should I go to an endocrinologist??  Thank you vry much Barb.  I appreciate your responses and knowledge on this.
Vitamin B-12, D and Ferritin are usually not part of routine testing.  They have to be ordered separately, but many of use with hypothyroidism/Hashimoto's are deficient in all 3.  

Why do you take Vitamin D3 twice/day?

It's okay that you're not taking iron right now, as it's best to make sure we need it before taking it indiscriminately.  In addition, there are some types of iron that are better than others.

  If your doctor refuses to order proper testing, I'd advise looking for a different doctor, but there isn't really much need for an endocrinologist, at this point... most endocrinologists I've run across are okay with treating diabetes, but very inept at handling thyroid issues because they tend to think that TSH is the only test they have to look at and if they do look beyond that, at Free T4 and Free T3, they think that anything within reference ranges is good, when that's not the case.  I'm on my third endo and it's turning out to be a disaster.  It's likely I'll end up letting my pcp manage my thyroid again.  Any doctor who tests Free T4 and Free T3 "every" time they order blood work and will work with you in regards to other testing and/or dosing once you get a diagnosis will be okay.
I’ve been taking D3 and calcium twice a day because I have osteopenia.  I probably could take the D3 once a day.  Thanks again for the info.
You're correct in taking calcium twice/day as our bodies can't absorb more than 500-600 mg at one time.  If it's easier to take the Vitamin D with the calcium, it's not a problem; I was just curious.  

Vitamin D is a fat soluble vitamin - which means it needs to be taken with fat in order to be absorbed properly.  I've read that it's best to take it in the evening with a meal containing fat.  I've wondered why it matters which meal it's taken with, so long as it's accompanied by adequate fat for absorption and not taken with medications it might interfere with.  
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