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Subclinical Hyperthyroidism suggests Early Graves

I am a 30 year old woman who has been diagnosed with Subclinical Hyperthyroidism suggestive of Early Graves Disease.

TSH 0.205
FT4  1.07
I forget what my T3 and T4 were but they were smack dab in the middle of normal.

I have the same values for 3 years now.  I had a Thyroid uptake and scan with mildly enlarged thyroid and only 1.8% out of normal for 6hour scan and 27% with max normal range of 30% at 24 hours.

Is it possible to stay Suclinical and not convert to Overt Graves Disease?  Can I stay in the state I am in?
13 Responses
Avatar universal
On what basis were you diagnosed with Graves'?

Do you have the reference range on your FT4?  Ranges vary lab to lab and have to come from your own lab report.  I'd also be interested to see whatever else you have for T3 and T4 results if you can dig them up.

I think your doctor is diagnosing based on your TSH and nothing else.

"I have the same values for 3 years now."  A sure sign that this level is probably "normal" for you.  Do you have any symptoms?  Are you taking any thyroid meds?

649848 tn?1534633700
COMMUNITY LEADER
Graves disease is an autoimmune disease and would have to be confirmed by antibody tests - not just being hyperthyroid.  Not all hyperthyroidism is Graves Disease.  Hyperthyroidism can also be present with Hashimoto's, which is another autoimmune thyroid disease.

While Hashimoto's is typically associated with hypothyroidism, early stages are often characterized by periods of hyperthyroidism, often alternating with periods of normal or even hypothyroidism, until finally settling into permanent hypo.

Have you had any antibody tests to confirm either of these diseases?  The tests you need to confirm Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves.  

The antibody tests will tell you right away if you have either of these autoimmune diseases.

We need the reference range for the FT4 you posted, since ranges vary lab to lab and have to come from your own report.   Would be very good if you have an FT3, with range to post.  Total T4 and Total T3 are considered obsolete and not real useful.
Avatar universal
Hi I am not taking any thyroid meds.  I dont have my t3 and t4 on me now but  I can find out. whatever there range was I was in the middle of it.

thyroxine, serum, free T4  1.07  range 0.82-1.77

TSH  0.205 range 0.450-4.500

They diagnosed me with Graves based on my thyroid uptake and scan they said I was slightly elevated at the 6hr scan and high upper limit at 24 hr scan.  No nodules and it was mildly enlarged.
Avatar universal
Hi thanks for responding I did not have a free T3 or antibodies drawn.  I am pushing my PCP because I cant see an endo for 2 months.  She doesnt seem to want to help me order anymore tests.  

My free T4 = 1.07 RANGE : 0.82-1.77
My TSH = 0.205 RANGE : 0.450-4.500
Avatar universal
They shouldn't have diagnosed Graves' without a TSI test, and as Barb mentioned, you should have TPOab and TGab tested as well.  The early stages of Hashi's can resemble Graves'.

Your FT4 is actually on the low side, which could indicate hypo.  If you were in the middle of the T3 and T4 ranges, that's right where you should be.  TSH is the least important of the tests.  TSH is a pituitary hormone, and several steps removed from the actual thyroid hormones.

What about symptoms?  Do you have any?    
Avatar universal
Thanks, I will try to push more for antibodies.

As far as symptoms my hair is thinning but only on the crown area, however its been like that for years and could also be due to extensions in my hair.

i have had 2 episodes of heart palpitations but EKG was normal when I went to ER and was told I had a panic attack.  I dont feel as though I have anxiety or depression unless I am really going through something.  No tremors, sweats, unintentional weight loss, barely have an appetite.  I feel fine really?
Avatar universal
The antibody tests would put your mind at ease.  If you're dealing with an autoimmune disease, then you have to keep an eye on it.  Otherwise, with your midrange T3 and T4 and lack of symptoms, this might just be your normal.  

By far, Graves' is the biggest cause of hyper.  Hashi's is the most prevalent cause of hypo in the developed world.  So, if you rule those out, you know a whole lot more.  

With an FT4 in the lowest quarter of the range, it's very doubtful you are hyper, unless FT3 is high for some reason.  I'd still like to see your T3 and T4 is you can find them.
Avatar universal
Ok, thanks. I will look for T3 and T4 and see if I can get it to you.

I will push for antibodies.  If PCP wont, I will try to ask ENDO when I see him.  I really Pray it's not Graves, that scares me.
Avatar universal
If your palpitation episodes don't happen frequently, a 30 day loop monitor is more likely to catch or detect them. A loop monitor is like a 30 day portable EKG.
Avatar universal
Where do I get a 30 day loop from?
Avatar universal
I got it from a cardiologist. If the cardiologist refuses, you can always seek a second opinion. Also, you may want to get an echo, just to make sure your palpitations are actually caused by your thyroid and your heart.
Avatar universal
* and not your heart
Avatar universal
Sounds good, thank you
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