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Sputtering TSH, Normal (but dropping) FT4, advice?

Greetings,



I was diagnosed with Celiac back in March of this year. I have been gluten-free for almost 3 months and while I am beginning to have better days, its been quite a battle. After 6 months of bouncing around to various doctors and receiving a plethora of blood tests, I finally ordered my own IGA antibody test and hit the mark with Celiac. However, while in pursuit of this diagnosis, I had my thyroid tested a number of times as well and received some peculiar results. I wanted to provide those numbers for the more experienced individuals who may be able to interpret my results as I am perplexed by them.



* Note that the reference ranges listed are the same for all.

TSH - (0.4 - 4.5)

FT4 - (0.8-1.8)

FT3 - (2.3-4.2)

TAB(glu) - <1 or =1

TAB(per) - <9



Actual Results (blood NOT drawn at a consistent time)

11/16: TSH = 5.22 FT4 = NA FT3 = NA TAB(glu) = NA TAB(per) = NA
01/17: TSH = 2.48 FT4 = 1.2 FT3 = NA TAB(glu) = NA TAB(per) = NA
02/17: TSH = 7.54 FT4 = 1.2 FT3 = 3.3 TAB(glu) = NA TAB(per) = NA
02/23: TSH = 2.72 FT4 = 1.0 FT3 = NA TAB(glu) = <1  TAB(per) = 1


I understand that stress can cause a fluctuation in your TSH, however I have also read that oscillating TSH can be an early sign of thyroid problems. I have not attempted to schedule a meeting with an endo because the last test showed no issues, especially with the antibodies. Does anyone have any advice on this matter? All help is appreciated.
2 Responses
649848 tn?1534633700
COMMUNITY LEADER
It's unfortunate that you didn't do the Free T3 every time you did the TSH and Free T4, since Free T3 is the active hormone that's used by nearly every cell in your body.  If we had Free T3 results for each set of tests, we'd be able to see if it were coming down, as well as the Free T4, but I think we'll assume it is...

That said, your latest Free T4 is very low in the range, at only 20%.  Most of us feel best with Free T4 about mid range and Free T3 in the upper half to upper third of its range.  

You're correct that TSH can fluctuate - not only from stress, but from a variety of other things as well.  It can actually fluctuate by as much as 75% over the course, of a single day, so it's always best to try to be consistent in the timing when you have it tested.  TSH tends to be higher in the morning than later in the day, so if you can tell us what time these tests were done, that might be helpful.  

I'm not sure about your antibody tests.  Are the TAB(glu) Thyroglobulin Antibodies and TAB(per) Thyroid Peroxidase Antibodies?  If so, just for information, the proper abbreviations are TgAb for Thyroglobulin Antibodies and TPOab for Thyroid Peroxidase Antibodies.    

Even though your antibody tests are negative, you could still have Hashimoto's, as some people are diagnosed, based on ultrasound results that show specific characteristics. You should ask your doctor to order a thyroid ultrasound. An ultrasound will also tell you whether you have nodules and/or a goiter (swollen/inflamed thyroid).

Last, but not least, could you please list your symptoms.  
3 Comments
Barb,

Thank you for the wealth of information. The symptoms portion is confusing because of the difficulty I have differentiating celiac symptoms from hypothyroidism symptoms that I have researched. Overlapping symptoms seem to be brain fog, fatigue, sensitivity to light, slightly impaired night vision, constipation, depression/apathy, and restless leg. The only ones that I couldn't find consistent with celiac are bleeding/irritated gums, premature gray hair, speech issues (trip over my words sometimes), and a strange sensitivity to cold (it always seems as though I am colder than other people around me, fingernails turn purple, etc). While I have had symptom relief (partial, not complete) since going GF, the things that have hung around that are significantly off putting are the depression and fatigue.
Well, it actually looks like you could have more things going on... You're right about the things in common between celiac and hypothyroidism.  Bleeding gums happen with hypothyroidism, as does cold intolerance, which is a very common hypo symptom.

I wonder if you've had Vitamin B-12 tested?  Premature graying is a symptom of B-12 deficiency, as is brain fog/difficulty concentrating, which could take in that tripping over words.  B-12 deficiency also causes a very profound fatigue/exhaustion.  It can also contribute to depression. Since fatigue and depression are also symptoms of, both, celiac and hypothyroidism, if you were deficient in B-12, as well, you'd have a triple whammy there.  I had a double with Pernicious Anemia and hypothyroidism and it was horrible.

Vitamin D deficiency can also contribute to some of these symptoms, as well, so if you haven't been tested for that, I'd advise doing so.

There's also ferritin to consider.  Ferritin is the iron storage hormone.  Iron is necessary for the conversion of the T4 storage thyroid hormone to the active T3 thyroid hormone.  It's also necessary for proper production of red blood cells that carry oxygen throughout the body. Iron deficiency can also cause fatigue.

If possible, I'd recommend getting B-12, vitamin D and ferritin tested in case deficiencies are contributing to your symptoms.  
During two of those tests listed about my results for B12 were 770 then 640 (300-800 scale) consecutively. Also my Vit D was 35 (30-100). No doubt my levels have dropped further as these were taken when my symptoms first appeared. I had these symptoms shortly before these tests were taken so I am not sure if I can contribute my symptoms to these values. I am seeing an endo at the end of next month, it has been almost 4 months since my blood work was last done, I may be deficient by now.
1756321 tn?1547095325
When I had normal thyroid function my TSH was always hovering around 1.4 to 1.6 mU/L (many TSH tests over the decades).  When Hashimoto's thyroiditis showed up my TSH finally rose into the 2's and both thyroid antibodies - TPOAb and TgAb were positive. My endo tested me for celiacs too.  I was thankfully negative. I already have 4 autoimmune diseases and no more need apply thank you very much!

The August 2012 study entitled "Clinical Significance of TSH Circadian Variability in Patients with Hypothyroidism" (Sviridonova MA, et. al) showed an average morning TSH level in the subclinically hypothyroid group was 5.83 mU/L and in the afternoon was 3.79 mU/L; 73% TSH circadian variability.  

The average morning TSH level in the hypothyroid group taking levothyroxine was 3.27 mU/L and in the afternoon was 2.18 mU/L; 64.7% TSH circadian variability.  Morning: 8 - 9 am. Afternoon: 2 - 4pm.

***

"The prevalence of autoimmune thyroid disease in patients with celiac disease is four times greater than that in the general population, and this may be due to the common genetic predisposition" - Beyond Celiac - Celiac and Thyroid Disease


3 Comments
Its because of the connection between auto immune disorders that I am worried, hopefully and endo trip will clear this up.
The only real connection between autoimmune conditions is that once you have one, you're more likely to get another (or more).
I have read the gene linked to both celiac and hashi's is CTLA4  (cytotoxic T-lymphocyte associated protein 4). "Mutations in this gene have been associated with insulin-dependent diabetes mellitus, Graves disease, Hashimoto thyroiditis, celiac disease, systemic lupus erythematosus, thyroid-associated orbitopathy, and other autoimmune diseases."
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