I'm assuming that your FT4 of 11.6 (4.5-12.0) was on the same draw as your TSH of 2.55 from this month? If so, then a couple of things seem off. First, your FT4 is right at the top of the range, which is considerably high of the midrange guideline. So, we know your thyroid is working (too hard?). This could be giving you some hyper symptoms: *low grade fever
*intermittent and sustained hypertension
On the other hand, with FT4 so high, we'd expect your TSH to be much lower than it is. This is a contradiction that might be explained by your FT3 level, which they didn't test. It could be that you aren't converting FT4 to FT3 as you should. I think a good next step would be to have all three (TSH, FT3 and FT4) tested on the same draw.
Conversion of FT4 to FT3 can be impacted by the presence of disease. The body slows conversion of FT4 to FT3 when it needs to go into "hibernation mode" (slow down) to fight disease and heal.
Your TGab is a little elevated, but we often see TGab, on diagnosis of Hashi's in the high hundreds, or even thousands. I would consider yours a borderline result. TGab can be somewhat elevated with other autoimmune diseases. Did they test TPO (thyroid peroxidase) antibodies, too? They are the other marker for Hashi's.
Have they only tested TSH? No T3 or T4?
My TPO was 2, with ref range <9 IU/mL
T4 was 11.6 with ref range 4.5-12.0 mcg/dL
I don't see a T3 measured here. I don't think I have Hashi's either. I think it's probably some other autoimmune disorder, but it's been so hard to pin something definitive down, despite the fact that on some days, I wake up with my eyes swollen nearly shut.
I used to have insulin resistance myself. I didn't have PCOS* because I don't eat a lot.
To quote Dr Lustig: "the one thing we know, categorically, that can mitigate chronic metabolic diseases is reduction in calories"
Those metabolic diseases - heart disease, lipid problems, hypertension, type 2 diabetes, dementia, cancer, polycystic ovarian syndrome, non-alcoholic fatty liver disease. I have none of these diseases.
My kidneys aren't too fond of me which I found out when I had subacute kidney failure taking magnesium for three months straight. One of my first signs my kidney wasn't handling the magnesium well was fluid retention. Then my nails turned half white half red (lindsey's nails) to name but two symptoms. I can take magnesium but not daily like that. Insulin resistance is not nice to kidneys.
I also had asthma from magnesium deficiency and a long list of other symptoms (insulin resistance excretes more magnesium from the body). Physical and mental stress also uses up more magnesium as does eating sugar, drinking coffee, taking certain medications..it's quite a long list.
You can reverse insulin resistance. A good article on this is from Lara Briden's article Reverse Insulin Resistance in 4 Easy Steps. You have to be careful of magnesium of course with your kidneys not up to scratch.
*Patient UK - Polycystic Ovary Syndrome...
"Women with PCOS have what is called insulin resistance. This means that cells in the body are resistant to the effect of a normal level of insulin. More insulin is then produced to keep the blood sugar normal. This raised level of insulin in the bloodstream is thought to be the main underlying reason why PCOS develops. It causes the ovaries to make too much testosterone. A high level of insulin and testosterone interfere with the normal development of follicles in the ovaries. As a result, many follicles tend to develop but often do not develop fully. This causes problems with ovulation - hence, period problems and reduced fertility.
It is this increased testosterone level in the blood that causes excess hair growth on the body and thinning of the scalp hair.
Increased insulin also contributes towards weight gain."
I don't have insulin resistance. That has nothing to do with the discussion at hand, but I will say I'm not a textbook PCOS case. It doesn't run in my family. I am 5'1 and I weigh 118 lbs. I'm what's called a "lean" PCOSer. I eat healthy and exercise regularly. I've gained about 5 lbs in the past year and a half, which comes from edema that seems to be triggered by oral contraceptives (another clue that makes doctors suspect autoimmune issues).
People mistake polycystic ovaries with polycystic ovarian syndrome. You can have polycystic ovaries as a result of hormonal imbalances that are caused by insulin resistance- this is NOT PCOS. If you reverse and/or treat the insulin resistance, then you reverse and/or treat the polycystic ovaries. Far too many doctors mistake the two conditions because they can look very similar. Polycystic ovaries can also occur in women who do not have insulin resistance, too- but those women will usually have normal hormonal profiles.
Polycystic Ovarian Syndrome, on the other hand, is actually a pituitary gland malfunction that results in marked hormonal imbalances (high androgens) that can never be fixed without medication. Even with medication, you can only mediate hormones- not fix the pituitary problem. The moment you come off medication, it will return. No amount of diet control or exercise will remedy it.
I'm amazed at how knowledgeable you are!
"Conversion of FT4 to FT3 can be impacted by the presence of disease. The body slows conversion of FT4 to FT3 when it needs to go into "hibernation mode" (slow down) to fight disease and heal."
^ This I did not know. That's a great observation. Do you know if that happens in the presence of any disease? Can it also happen in the presence of autoimmune disorders?
To add to this mystery, in some Feb of 2015 labs:
*MCHC was 35.5, which the lab classified as High (35.5)
*RDW Coeff of Var was 10.7, which the lab classified as Low
*Microglobulinuria was detected
Some medical literature states that high MCHC levels and microglobulinuria is often present in autoimmune hemolytic anemia. But it doesn't say anything about thyroid levels.
I'm assuming at this point that the abnormalities are not inherently thyroid related (though I will consult with my doctor). Do you agree?
Oh! I should also add that my brother has had hypertension since he was 19 (he's 27 now), and also has the same episodes of periorbital swelling that I do, just as randomly as I do.
His episodes are also triggered by the same things- stress, loss of sleep, sickness.
Conversion slows in the presence of any disease, including other autoimmune diseases. It also slows during starvation, malnutrition (including starvation dieting), trauma, surgery and in response to certain meds.
I did miss one thing. Your T4 test isn't a free T4, it's a total T4. Total T4 tells the total amount of T4 in the blood, but much of that is chemically bound and unavailable to cells. Free T4 tells what's available. Next time, ask for free T4. It's a much more telling test.
I agree that the abnormalities are not necessarily thyroid related. With your T4 quite high, we know that your thyroid is working. However, the contradiction between your high T4 level and your TSH needs resolution.
It's interesting that there may be a genetic connection. Autoimmune diseases do run in families, and it's often different AIs. Stress, physical or psychological, is probably the number one factor precipitating the onset or exacerbation of AI disease. Has your brother had thyroid blood work?
The slowed conversion factors are interesting! My family has always had fast metabolisms, so I eat quite a bit- and healthy foods. I often need to eat before bed so that I don't wake up to my stomach eating itself. So it's definitely not starvation. I haven't had any trauma, never had surgery in my life, but I am on meds to treat PCOS; spironolactone, finasteride, and ortho tri-cyclen LO.
I also take a vitamin D supplement because I am deficient (forgot to mention that as a clue to autoimmune disorder).
My brother hasn't even seen a doctor, let alone had any blood work done, despite my imploring him to go. If he does, I will be sure to ask him to have his thyroid panel done, with free T4. Would free T3 be a good idea too?
Free T4 is what I will ask for next time! The rash and swelling around my eyes at the time of the blood test miraculously disappeared yesterday, so I doubt we'll get any new clues now.
But I do feel some lymph pain now on the right side of my neck, and my sinuses (which my immunologist says are chronically inflamed) are making it painful to wear glasses.
I didn't know that different autoimmune diseases could run in families. Very interesting...I'm still waiting for my doctor to give me the next step to take in unraveling the mystery. Once he tells me what to do, I will try to keep everyone updated!
You might try googlong "finasteride and thyroid hormones". There are lots of articles. I found this one had a lot of good thyroid information:
In fact, some of it is better than what I see directed at thyroid specifically.
Vitamin D has to be present in cells in sufficient quantity (not just on the floor of the range) for thyroid hormones to get into cells. How low is your D? How much are you taking?
In my opinion, a basic thyroid panel should always include FT3, FT4 and TSH. FT3 is the test that correlates best with symptoms. Be sure your doctor orders FT3 for you next time, too.
It is strange, but I know a family in which one member has Hashi's and pernicious anemia, another has type I diabetes, and a third has lupus.
The thyroid-finasteride link is fascinating. I'm looking more into that now. I wonder if maybe the finasteride could be causing this problem...I do have kind of a "moon face" that doesn't occur when I'm not on medications.
I've also read that spironolactone can also cause thyroid issues. My doctor has ordered a thyroid ultrasound, which I should be able to schedule next week, as soon as I get his orders in the mail.
I really don't think it's hypothyroidism though. I am a thin person who doesn't tend to easily gain weight. Hopefully it's nothing like cancer. I'm still hooked on the autoimmune possibility.
I don't think it's hypothyroidism, either. Your FT4 is way too high for that. If anything, at the moment, you would be on the hyper side. However, many meds affect the deiodinases, which are the enzymes that catalyze the conversion of T4 to T3. So, it's possible that even with high FT4, your FT3 is low, which would give you hypo symptoms.
What is your doctor looking for with the U/S?
I'm not sure what my doctor was looking for, but they did find a small "nodule" on the ultrasound today. I have no idea what that means, but the radiologist said it sounded like I was "dancing around" hyperthyroidism. He said he didn't think my nodule was cancerous, but now I'm beginning to wonder.
I've had a dry cough all summer, and my voice is hoarse. I noticed my nails getting flaky and brittle too, though that seems to have somewhat resolved. My immunologist said I have chronic rhinosinusitis, which I chalked up to allergies. A few days ago, I got a really sore sort of pain right underneath my tongue, and in my neck where my lymph node would be. It seems to have gone away though. However, for the past 2 weeks, I've felt like I got punched in the nose. It's BAD, like, the worst sinus pain I've ever had in my life. It comes and goes, though. So I don't know what to make of that. I almost went to the walk-in but didn't end up going. Allegra and antihistamines don't touch it.
Is that thyroid-ish? I don't know what to make of any of this now, it's really confusing. At this point I don't even care what the diagnosis is, I just want to get treated.
Nodules are very common. Depending on their characteristics, they are usually just watched for changes. One cm is the magic number that will make your doctor order an FNA (biopsy).
That kind of sinus pain isn't a classic thyroid symptom. Typically, thyroid generates less acute sinus issues, like chronic PND.
I think you really need to see what your FT3 is doing.
Well, according to the report, it's "In the midpole, there is a 1 x 0.4 x 0.8cm fairly uniform hypoechoic nodule without internal vascularity."
It's good that there's no vascularity, of course. I'm a little peeved though, because the radiologist didn't remark on whether or not there were microcalcifications. Nor did he say anything about the margins, or whether or not you could see a complete or partial halo.
My PCP today told me that my submandibular lymph nodes on both sides are swollen. I went in because my right eat felt blocked, but she said it looked fine. She remarked that the feeling could be coming from another swollen lymph node.
If it weren't for my lymph nodes I wouldn't be worrying. My immunologist is supposed to call me on Monday to let me know what I should do.
If you have questions, you might try giving the imaging facility a call. I did that a while ago after my husband had a CT. At first, I was told that there was no one there who could talk to patients, but I pressed on and finally got someone to fire up the images and give me more detail. For $2,000+, you ought to get more than a discrimination value.
As a follow-up, I was diagnosed as having Hashimoto's Disease by my endocrinologist as a consequence of the tgab levels.
Since the original posting, I've had two ultrasounds, both of which detected the tumor, but it hadn't grown from September to February. I do still have unexplained lymph discomfort nearly all the time, but I suspect it may have something to do with a faulty "glymph" system (new discovery of lymphatic system in the brain).
I was also recently diagnosed as having narcolepsy with cataplexy, which explains my uncontrollable fatigue and even some other weird problems I didn't even realize I had.
With all that going on, it's no wonder you were hard to diagnose.
Are you being treated for Hashi's? I'm not familiar for the treatment for narcolepsy.