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TSH w reflex to ft4 = 0.02 What does it mean?
I went to the doctor because I've been having headaches behind my eyes and in my sinus area. I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.
He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating. I don't.
She said I have an overactive thyroid, and requested blood tests to confirm it. They also came back consistent with a hyperthyroid result, but I don't know what tests they did. It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.
I'm curious to know what might be going on, because the doc won't be back for another week. The headaches linger and often I have clear blurry spots in my vision when they begin. It's starting to worry me a little.
I appreciate any feedback about that TSH test result.
Thanks.
He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating. I don't.
She said I have an overactive thyroid, and requested blood tests to confirm it. They also came back consistent with a hyperthyroid result, but I don't know what tests they did. It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.
I'm curious to know what might be going on, because the doc won't be back for another week. The headaches linger and often I have clear blurry spots in my vision when they begin. It's starting to worry me a little.
I appreciate any feedback about that TSH test result.
Thanks.
A TSH of 0.02 does indicate hyperthyroidism. However, the actual thyroid hormones, T3 and T4 are a much more direct and reliable measure of thyroid status. The "TSH with reflex to FT4" is an order to the lab, what it means is "test TSH, and if it's abnormal (which yours was), test FT4 also". FREE T4 (FT4) and FREE T3 (FT3) are the much more important tests. Hopefully, that's what they ran after seeing your TSH. You should request copies of your lab reports and start maintaining your own history.
The other test they should have run is TSI (thyroid stimulating immunoglobulin). TSI is the antibodyy that indicates Graves' disease, which is autoimmune hyper. Graves' and hyper are virtually synonymous.
Symptoms vary person to person. Some people gain weight hypo or hyper, some lose. Typical symptoms of hyper include insomnia (and often fatigure due to insomnia), diarrhea. increase HR and/or BP, anxiety, palpitations and/or tachycardia, etc. However, symptoms change depending on how hyper you might be.
If you request a copy of your blood work, you can post it, and we can help you decipher it. Be sure to get reference ranges as well since they vary lab to lab.
TED (thyroid eye disease) is also a conmplication of hyper...it's the bulging eye look we often associate with it. That could be what's causing your headaches and other eye problems.
The other test they should have run is TSI (thyroid stimulating immunoglobulin). TSI is the antibodyy that indicates Graves' disease, which is autoimmune hyper. Graves' and hyper are virtually synonymous.
Symptoms vary person to person. Some people gain weight hypo or hyper, some lose. Typical symptoms of hyper include insomnia (and often fatigure due to insomnia), diarrhea. increase HR and/or BP, anxiety, palpitations and/or tachycardia, etc. However, symptoms change depending on how hyper you might be.
If you request a copy of your blood work, you can post it, and we can help you decipher it. Be sure to get reference ranges as well since they vary lab to lab.
TED (thyroid eye disease) is also a conmplication of hyper...it's the bulging eye look we often associate with it. That could be what's causing your headaches and other eye problems.
If you're 5'5" and 110 lbs, then you don't have any clue what "gaining weight easily" means! LOL You're height and weight pretty much fit the profile of hyper.
Thanks for the info. I checked the report again and it does have a T4 Free number - 1.7. I'll call the doc on Monday to learn the results of the tests they ordered that confirmed the hyperthyroid. It looks like that T4 free is ok?
Laughing about your comment on my weight. I range from 110 -117. Once I hit 115, I diet until I lose about 5, then watch it slowly increase again. I am motivated because I'm too cheap to buy new clothes!
I am concerned about this other stuff, though. I just haven't felt like myself for awhile, but I can still work out hard and sleep ok, unless my eyes start to hurt.
I appreciate your advice and am looking forward to learning more from you. Thank you!
Laughing about your comment on my weight. I range from 110 -117. Once I hit 115, I diet until I lose about 5, then watch it slowly increase again. I am motivated because I'm too cheap to buy new clothes!
I am concerned about this other stuff, though. I just haven't felt like myself for awhile, but I can still work out hard and sleep ok, unless my eyes start to hurt.
I appreciate your advice and am looking forward to learning more from you. Thank you!
That's pretty high in the range for FT4. Midrange is the "rule of thumb" until we each find where we feel best. FT3 is the test that best correlates to symptoms, so, hopefully, they ran that as well...probably since they already had FT4. Typically, FT3 runs higher in its range than FT4 does in its. So, since your FT4 is pretty much at the top of range, your FT3 just might be over.
I fought my weight all my life...mostly successfully. I'm a half inch taller than you, and the lowest I ever got to as an adult was 125 (I was pretty trim at that). Mostly I went from 140-160...as you say, lose it, watch it slowly go up, lose it, ad nauseum... I'm sure you're still pretty slim at 115. Since I've gotten my thyroid hormones stable, I maintain...a "few" pounds" more than I'd like perhaps, but at least it's not the rollercoaster routine.
Antibody tests will tell you a lot more about what's going on. It sounds like your doctor is on top of it (and you have no idea how much that counts for when it comes to thyroid).
Let us know what you find out...
I fought my weight all my life...mostly successfully. I'm a half inch taller than you, and the lowest I ever got to as an adult was 125 (I was pretty trim at that). Mostly I went from 140-160...as you say, lose it, watch it slowly go up, lose it, ad nauseum... I'm sure you're still pretty slim at 115. Since I've gotten my thyroid hormones stable, I maintain...a "few" pounds" more than I'd like perhaps, but at least it's not the rollercoaster routine.
Antibody tests will tell you a lot more about what's going on. It sounds like your doctor is on top of it (and you have no idea how much that counts for when it comes to thyroid).
Let us know what you find out...
Hi Goolarra,
I appreciate your comments. Thank you for sharing them!
I got the T#, Free result - it is 4.8
The doctor wants to test TSH again and iodide (I think)?
Will these numbers change alot?
Could this be causing my headaches?
Thank you so much for your help!
I appreciate your comments. Thank you for sharing them!
I got the T#, Free result - it is 4.8
The doctor wants to test TSH again and iodide (I think)?
Will these numbers change alot?
Could this be causing my headaches?
Thank you so much for your help!
I found more results on the lab slip -
thyroglobulin antibodies <20
thyroid peroxidase <10
Also, the range for the T3 is 2.3 - 4.2
thyroglobulin antibodies <20
thyroid peroxidase <10
Also, the range for the T3 is 2.3 - 4.2
What's the range on your FT3? Ranges vary lab to lab, so you have to report them with results.
I your doctor is going to test again, he really should test FT3, FT4 and TSH. TSH is pretty worthless without FT3 and FT4 numbers to back it up. Also, since virtually all hyper is Graves' disease, he should order TSI (thyroid stimulating immoglobulin), which is the definitive test for Graves' antobodies.
TSH is volatile. It can change as much as 70% just depending on the time of day the blood is drawn. FT3 and FT4 tend to be more stable.
Headaches are a frequent symptoms of hyper. FT3 ranges vary considerably lab to lab, so I really don't know yet how high your is until I see the range.
I your doctor is going to test again, he really should test FT3, FT4 and TSH. TSH is pretty worthless without FT3 and FT4 numbers to back it up. Also, since virtually all hyper is Graves' disease, he should order TSI (thyroid stimulating immoglobulin), which is the definitive test for Graves' antobodies.
TSH is volatile. It can change as much as 70% just depending on the time of day the blood is drawn. FT3 and FT4 tend to be more stable.
Headaches are a frequent symptoms of hyper. FT3 ranges vary considerably lab to lab, so I really don't know yet how high your is until I see the range.
Hi,
The range for the T3 is 2.3 - 4.2. Mine was 4.8
TSH was 0.02 - range 0.4 - 4.5
T4 was 1.7 - range 0.8 - 1.8
It is the TSI that he is having drawn this week.
The range for the T3 is 2.3 - 4.2. Mine was 4.8
TSH was 0.02 - range 0.4 - 4.5
T4 was 1.7 - range 0.8 - 1.8
It is the TSI that he is having drawn this week.
Oops...guess we were typing at the same time up there.
Good...he's doing the right things, then (testing TSI).
Your FT3 is clearly over range. It looks hyper, too. I think you've found your problem.
TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are both within range. They're the markers for Hashi's, so you don't have that (Hashi's is hypO, so we wouldn't suspect it).
I'm quite sure your TSI will be positive. You'll feel better on meds.
Good...he's doing the right things, then (testing TSI).
Your FT3 is clearly over range. It looks hyper, too. I think you've found your problem.
TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are both within range. They're the markers for Hashi's, so you don't have that (Hashi's is hypO, so we wouldn't suspect it).
I'm quite sure your TSI will be positive. You'll feel better on meds.
What is the problem? Is it Graves? Will I gain weight on meds? I work so hard to stay where i am. They will just do meds? I don't have to anticipate anything else?
Thank you so much.
Thank you so much.
Well, of course, you can't know for absolute certainty until you get the results of the TSI, but hyperthyroidism is virtually all Graves'. However, there are other forms of thyroiditis that can cause temporary hyper states, which is why it's important to verify with the TSI.
No, you shouldn't gain weight on meds. Sometimes it takes a little fiddling to get them right, but once adjusted properly, they won't cause you to gain weight. Although we usually associate weight gain with hypo and weight loss with hyper, I, personally, have found that I maintain best when right in the middle...neither hypo nor hyper.
Initially, unless the disease has progressed quite far on diagnosis (and I don't think yours has because you only have a few symptoms), meds are the first line of treatment. Further down the road, RAI (radioactive iodine) or surgery might be recommended. I doubt they'd recommend that for you now, but if they should, I'd definitely ask for meds until you have time to research both thoroughly.
No, you shouldn't gain weight on meds. Sometimes it takes a little fiddling to get them right, but once adjusted properly, they won't cause you to gain weight. Although we usually associate weight gain with hypo and weight loss with hyper, I, personally, have found that I maintain best when right in the middle...neither hypo nor hyper.
Initially, unless the disease has progressed quite far on diagnosis (and I don't think yours has because you only have a few symptoms), meds are the first line of treatment. Further down the road, RAI (radioactive iodine) or surgery might be recommended. I doubt they'd recommend that for you now, but if they should, I'd definitely ask for meds until you have time to research both thoroughly.
Thank you. I've been checking for your answer, so it was nice to read your response. I am confused by this because I don't have many of the symptoms. I had blood drawn for the TSI today, and it appeared that they are checking TSH, FT3 & FT4 again, too. So, I guess I'll know more by the end of the week.
My symptoms are mostly headaches,some double vision, dry & itchy eyes, fatigue, confusion, paper thin fingernails, and dizziness or flushing and also total sudden loss of menstrual cycle after years of predictable monthly cycles. But, I don't have all those symptoms listed first when you see hyperthyroid. So, it just seems unusual that this would be what's wrong. I'll let you know what happens with the TSI.
My symptoms are mostly headaches,some double vision, dry & itchy eyes, fatigue, confusion, paper thin fingernails, and dizziness or flushing and also total sudden loss of menstrual cycle after years of predictable monthly cycles. But, I don't have all those symptoms listed first when you see hyperthyroid. So, it just seems unusual that this would be what's wrong. I'll let you know what happens with the TSI.
I'm glad they're doing that. Re-testing never hurt anything (except for that stab in the arm).
Your levels indicate hyper, but they're not as high as some people's are on diagnosis. Symptoms really do vary person to person. No one has ALL the symptoms...good thing because the list is about as long as your arm!
When I was first diagnosed hypo, I didn't have a lot of the classic hypo symptoms, either. Fatigue is almost universal, but I had energy. However, I almost had narcolepsy...when I sat down for more than about 10 minutes, I fell asleep. But, if I was up and about, I wasn't dragging. I also never was constipated (once again an almost universal symptom). I didn't lose my hair. My main symptoms were back pain/weakness and cold intolerance, and it never occurred to me that the back was totally thyroid related, but it was.
The TSI will tell you a lot more (let me know). Of course, if your heart rate, BP, eyes, etc. are not being affected, and you don't want to go on meds, you don't have to until (if) your levels get high enough to make you want to. There's also no reason not to try meds to see if they do relieve your symptoms.
Your levels indicate hyper, but they're not as high as some people's are on diagnosis. Symptoms really do vary person to person. No one has ALL the symptoms...good thing because the list is about as long as your arm!
When I was first diagnosed hypo, I didn't have a lot of the classic hypo symptoms, either. Fatigue is almost universal, but I had energy. However, I almost had narcolepsy...when I sat down for more than about 10 minutes, I fell asleep. But, if I was up and about, I wasn't dragging. I also never was constipated (once again an almost universal symptom). I didn't lose my hair. My main symptoms were back pain/weakness and cold intolerance, and it never occurred to me that the back was totally thyroid related, but it was.
The TSI will tell you a lot more (let me know). Of course, if your heart rate, BP, eyes, etc. are not being affected, and you don't want to go on meds, you don't have to until (if) your levels get high enough to make you want to. There's also no reason not to try meds to see if they do relieve your symptoms.
Hi goolarra,
I received more test results back today, but not the TSI.
TSH = 0.01 (range 0.4-4.5)
T4, Free = 1.5 (range 0 .8-1.8) (last time it was 1.7)
T3, Free 4.8 ( range 2.3-4.2)
I guess it's still hyper, disappointed that the TSI result isn't there. I think the office may not have ordered the tests properly.
Does the consistency in the TSH & T3 mean anything?
Thanks
I received more test results back today, but not the TSI.
TSH = 0.01 (range 0.4-4.5)
T4, Free = 1.5 (range 0 .8-1.8) (last time it was 1.7)
T3, Free 4.8 ( range 2.3-4.2)
I guess it's still hyper, disappointed that the TSI result isn't there. I think the office may not have ordered the tests properly.
Does the consistency in the TSH & T3 mean anything?
Thanks
The TSI might take a little longer to come back, unless, of course, you don't think they actually ordered it??? I hope they didn't mess up and not order it.
The consistency of the T3 and TSH means it wasn't a fluke or a lab error, and your results really are hyper.
The consistency of the T3 and TSH means it wasn't a fluke or a lab error, and your results really are hyper.
Hi,
The TSI came back in normal range. It is 48 the ref range is <140%.
What does that mean? The doc left a msg saying that I'm a little overactive and he can talk with me about it tomorrow.
The TSI came back in normal range. It is 48 the ref range is <140%.
What does that mean? The doc left a msg saying that I'm a little overactive and he can talk with me about it tomorrow.
Hi Goolarra,
Thank you so much. This IS confusing.
So, you are saying that I have an earlier case of Grave's?
And, it can go into remission?
But, it could also progress to the point where the TSI number is higher and would be accompanied by more symptoms, or it could improve with medication.
What if I just waited to see if it got better on it's own?
What should I ask the doctor when he calls me tomorrow?
Thank you,
Theresa
Thank you so much. This IS confusing.
So, you are saying that I have an earlier case of Grave's?
And, it can go into remission?
But, it could also progress to the point where the TSI number is higher and would be accompanied by more symptoms, or it could improve with medication.
What if I just waited to see if it got better on it's own?
What should I ask the doctor when he calls me tomorrow?
Thank you,
Theresa
Yes, that's what I'm saying. You do have autoimmunity, and it could progress or it could go into remission.
If you can tolerate symptoms at the moment, and (and this is very important) your elevated levels aren't contributing to thyroid eye disease (TED) or any other health problems, you can wait as long as you're comfortable. However, higher levels of thyroid hormones can have some nasty effects on the body, so do monitor very closely.
I think I'd ask the doctor what the up side of meds is and the down side of doing nothing. Would meds really increase your chances of remission? Could waiting compromise your health in any way (TED, HBP and/or tachycardia/palpitations, osteoporosis, etc.). I'd be expecially concerned about TED because of your headaches, etc.
Let me know how the call goes...
If you can tolerate symptoms at the moment, and (and this is very important) your elevated levels aren't contributing to thyroid eye disease (TED) or any other health problems, you can wait as long as you're comfortable. However, higher levels of thyroid hormones can have some nasty effects on the body, so do monitor very closely.
I think I'd ask the doctor what the up side of meds is and the down side of doing nothing. Would meds really increase your chances of remission? Could waiting compromise your health in any way (TED, HBP and/or tachycardia/palpitations, osteoporosis, etc.). I'd be expecially concerned about TED because of your headaches, etc.
Let me know how the call goes...
Thank you, Goolarra.
Doc called. In his opinion, the TSI test was negative. He is concerned about TSH, T3 & T4. He wants me to have a thyroid u/s and follow up with endo.
He said it could be a case of thyroiditis - a virus of the thyroid?
T
Doc called. In his opinion, the TSI test was negative. He is concerned about TSH, T3 & T4. He wants me to have a thyroid u/s and follow up with endo.
He said it could be a case of thyroiditis - a virus of the thyroid?
T
I'm glad he'll be referring you to an endo. I have a feeling your current doctor may be a bit out of his league.
Thyroiditis is kind of an all-encompassing term. It refers to any inflammation of the thyroid, so it covers the whole gamut from hypo to hyper. There are a couple of types of "temporary" thyroiditis (i.e. they are not autoimmune), and both are characterized by an initial hyper phase, usually followed by a return to normal and then a hypo phase/. Although usually temporary, both can can last up to a couple of years and both can become permanent. I don't think they apply to you because of your TSI count, but if you'd like to do some research, they're called DeQuervain's thyroiditis and silent thyroiditis. DeQ's usually follows an upper respiratory infection.
Will you have to wait long to see an endo?
Thyroiditis is kind of an all-encompassing term. It refers to any inflammation of the thyroid, so it covers the whole gamut from hypo to hyper. There are a couple of types of "temporary" thyroiditis (i.e. they are not autoimmune), and both are characterized by an initial hyper phase, usually followed by a return to normal and then a hypo phase/. Although usually temporary, both can can last up to a couple of years and both can become permanent. I don't think they apply to you because of your TSI count, but if you'd like to do some research, they're called DeQuervain's thyroiditis and silent thyroiditis. DeQ's usually follows an upper respiratory infection.
Will you have to wait long to see an endo?
The endo office can't get me in until 10/1. I'm a little bummed. Some days I feel great, but today I had headaches again and was exhausted. I am a naturally high energy person, so the difference is very noticeable.
I also did my own little experiment and enjoyed three days of eating desserts, ice cream sandwiches and some chips. I gained 4 pounds, so I'm not having that benefit of losing weight at all. I still have to watch my diet like crazy. In fact, I've thought for quite some time that it can't be normal for a person to gain weight as easily as I do. I spend so much time working to keep in shape, that it doesn't make sense - even though I am in my late 40's now.
I am disappointed that I have to wait so long, because just when I start feeling good, I end up with a day like today and it frustrates me.
Thanks.
I also did my own little experiment and enjoyed three days of eating desserts, ice cream sandwiches and some chips. I gained 4 pounds, so I'm not having that benefit of losing weight at all. I still have to watch my diet like crazy. In fact, I've thought for quite some time that it can't be normal for a person to gain weight as easily as I do. I spend so much time working to keep in shape, that it doesn't make sense - even though I am in my late 40's now.
I am disappointed that I have to wait so long, because just when I start feeling good, I end up with a day like today and it frustrates me.
Thanks.
I've always been able to put on lbs without any trouble. Since I've been on thyroid meds is the first time ever I've actually maintained. Before that, the pounds slowly crept on, then I'd lose them, and the whole cycle would start over. In order to lose weight, I really had to struggle...I couldn't eat more than 1,000 calories a day, and I swam of played racquetball six days a week. The years never improved that scenario any!
I know it's a long wait, but 10/1 will be hear before you know it. Let me know how it goes...
I know it's a long wait, but 10/1 will be hear before you know it. Let me know how it goes...
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