Low TSH--Normal variation or more assessment?

[mariedc]

21 year old female.  Just got back labs by fax.  TSH is 0.24.  Was 2.54 six months ago.

Thanks in advance for any help.

Here is the history:

5/14
TSH 0.24 (0.27-4.2)
Free T3 2.7 (2.5 - 4.3)
Free T4 1.49 (0.83 -1.62)

11/13  
TSH 2.54  (0,7-5.7)    
Total T3 326  (80-210)  
Total T4 10.6 (4.5-12)

3/13  
TSH 1.9  ( 0.4-4.5)      
Total T3  93  (76-181)  
Free T4 1.1 (0,8-1.8)

8/12  
TSH 0.4  (0.5-4.3)      
Free T3 3.8 (2.3-4.2)    
Free T4  0.9 (0.8-1.8)

7/12  
TSH 0.9 (0.4- 4.7)      
Free T4 0.8 (0.6-1.8)

2/12  
TSH 2.0  (0.5-4.3)      
Free T3 3.1  (2.3-4.2)    
Free T4 0,9 (0.8-1.8)

7/11  
TSH 0.6, (0.5-4.3)      
Free T4 1.0(0.8-1.8)

[flyingfool]

Hypo can make a person suceptible to allergies, anxiety and prone to infections etc.

Hyper and Hypo can often have similar symptoms so it gets confusing.

I tend to agree with goolarra that it seems like it is possible the Hashi's may be going on with the swings between hyper and hypo.  So the antibody tests for Hashis as well as Graves (TSI test) would seem to make a lot of sense.

If the SSRI drugs seem to be no help, I'd recommend consideration to eliminate them.  These may have withdrawl symptoms.  It is common for Dr's to prescribe antidepressants instead of dealing with the thyroid.  Low thyroid can produce depression, mood swings and anxiety.  Some people find that once their thyroid levels are balanced, then they no longer have anxiety or depression or the symptoms are reduced.

All the hormones are interconnected.  So changing one will change the others.  So I would suggest that concentration on a single hormone to focus on.  And I suggest that Thyroid may be the one to deal with, and continue monitoring the reaction when changing the dosages of thyroid.

Sex hormones, thyroid, cortisol (adrenals) seem to be the key ones.

I would recommend that retesting should be done with CONSISTENT tests at a frequent cycle of about 6 to 8 weeks.

ALWAYS demand to get the following:

TSH - Screening test at best but no Dr will accept not testing for this so just get it tested

Free T4 - NOT, NOT NOT "total T4" but FREE T4.  Free T4 measures the actual hormone that is "free" from being attached to a protein which makes the hormone unusable.

FREE T3 - Again NOT "total". Your body ONLY uses the Free T3 hormone that is not attached to a protein.  So demand that the FREE T3 is tested each and every time.

Since her sex hormones seem out of balance it may make sense to regularly test for these as well (Testosterone, Progesterone & Estrogen).

[goolarra]

Estrogen can cause more thyroid hormones to bind to protein and become useless to cells.  I just noticed that in her labs from 11/13, TT3 is well over range, but by 5/14, FT3 (FT3 is the unbound portion of TT3) is very low in the range.  Back in 3/13, TT3 was low, so it's kind of all over the place.  Of course, there's also 14 months time in there.

Has anyone ever tested your daughter for thyroid antibodies?  Her current labs could suggest Graves' disease (autoimmune hyperthyroidism).  TSI (thyroid stimulating immunoglobulin) is the test for Graves'.  Hashimoto's thyroiditis is ultimately autoimmune hypo, but early stages can be characterized by swings from hypo to hyper, which might explain the variability of her levels.  TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's.  Those are all simple blood tests, and Graves' and Hashi's together account for, by far, the vast majority of thyroid dysfunction.  So, that's where I'd start.

Beyond that, I notice that her reproductive hormones are off.  Both thyroid hormones and reproductive hormones are controlled by the master endocrine gland, the pituitary.  So, if the antibody tests don't yield any useful information, I'd have a tendency to have a look at pituitary function.  When FT4 is low, TSH should be high.  If you look back to 2011-12, her FT4 never got above 20% of range, yet her TSH was only briefly above 2.0.  I would expect her TSH to be higher with FT4 that low.  When thyroid hormones are too low because the pituitary doesn't produce enough TSH to stimulate thyroid hormone production, it's referred to as secondary hypothyroidism, which is actually a pituitary dysfunction.

Any meds changes between 11/13 and 5/14?

[mariedc]

Thank you for responding.

For my daughter.  She takes low dose oral contraceptives for hormonal problem.  (Don't know which of estrogen or progesterone are low dose in this type of pill.)

She has frequent heart palpitations (up to 180 bpm) and cardiologist suggested testing thyroid. Has anxiety 5 or 6 SSRIs have failed to help.  Chronic insomnia.  Sometimes has night sweats and dizziness/fainting episodes.  

Takes Allegra for allergies, risperidone to see if helps anxeity, lamictal for epilepsy, and spironalactone for hormone issue (high testosterone).  Also Zofran for chronic unexplained nausea and vomiting (2 years). Takes Vitamin D for deficiency--latest result 60 from 27 six months ago.  No thyroid meds.

[goolarra]

How do you feel?  Do you have hyper symptoms?

Are you taking any thyroid meds?  Do you take any meds containing estrogen?  Any other meds or supplements?