Low TSH, high Thyroglobulin, Antibody

[EasyGoinGal]

I just got these test results today.  I have been reading, and it seems it could be Graves.  I'm a bit concerned.
I could use some help.  Thanks

TSH         0.052 LOW 0.450-4.500
Thyroxine (T4) 7.5           4.5-12.0
T3 Uptake   29         24-39
Free Thyroxine Index 2.2         1.2-4.9
T4,Free(Direct) 1.25   0.82-1.77
Thyroglobulin, Antibody 2.4 HIGH           0.0-0.9
Low positive Thyroglobulin antibodies are seen in a portion of the
asymptomatic populations.
Antithyroglobulin antibodies measured by Beckman Coulter Methodology
Reverse T3, Serum     18.3   9.2-24.1
Triiodothyronine (T3)     117   71-180
Thyroid Peroxidase (TPO) Ab  13   0-34
Triiodothyronine,Free,Serum    3.1   2.0-4.4

[Barb135]

I responded on the thread you started of your own... You can access it via the following link:

http://www.medhelp.org/posts/Thyroid-Disorders/Help-with-Hypo-an-Hyper-Symptoms/show/2676572

[SteveHasLupus]

Hi, I was wondering if anyone might be able to help me with, what is suspect, is an autoimmune mediated thyroid disorder. I have been having symptoms of both Hypo and Hyper for years (Extreme heat intolerance, extreme fatigue, weight gain, intestinal upset, edema, quickly elevating cholesterol with no dietary change, resting sudden and persistent resting tachycardia, sweating, extreme sleep disturbances, elevated BP, chronically low vitamin D  for which I take 50,000iu x 3 weekly, brain fog (I can’t remember simple things or, often, what happened moments ago and become agitated when trying, the list truly goes on). I should add that I have SLE (Systemic Lupus). I have been trying to get symptoms under control by treating what is believed to be the underlying cause; however, I have had a growing suspicion that I didn't have just one problem, but rather multiple issues that all require treatment for symptom relief.

Recently, the doctor order a thyroid profile (FT4 1.04 [.89-1.76], Total T3 1.44 [.6-1.81], and TSH .34 [.5-2.5]

Obviously my TSH gave me pause (especially in faced with such normal FT4 and Total T3). Given my existing autoimmune disease, I was thinking the beginning of Hashi or Central (I also have empty sella with suppressed gonadotropins for which I take Testosterone Replacement Therapy, and transient mild prolactin elevation.

This past Monday, by BP starting to rise, it felt as if my heart was going to jump out of my chest, my hands began to shake, breathing became difficult (I would describe it as if my blood suddenly became too thin to carry oxygenated blood). This lasted for 36 hours. Since my doctors don’t really believe this is a thyroid issue, I paid out of pocket to have a profile done with Labcorp. The results are below:

FT4 1.08    [.82-1.72] ng/dl
FT3 4.3      [ 2.0-4.4] pg/ml
TSH .374   [.450-4.50] uIU/ml
TPO 6        [0-34]
TAA  1:5###)

[Barb135]

Your symptoms most certainly sound hypo, but again, I don't know how much that iodine would have affected your TSH.  If all you're having tested is TSH, it's really not telling you much.

It's not unusual for symptoms to get worse, or for new ones to appear, once one starts on a thyroid replacement hormone.  When ones thyroid is not working adequately, the adrenals kick in to help take up the slack, so when one starts on a thyroid replacement, the body has to readjust to the hormones it had been doing without.  That's probably why your hair started falling out.  

Since the thyroid does store iodine, you've probably still got some in your system.  That could be contributing to your low TSH; I'm actually doing some research on that for more information.

Since the results you posted above are a month old, I'd not tell you to go back on the Armour, without retesting FT3, FT4 and TSH.  As I said above, some of the other tests are obsolete and once you've done the antibody tests, they don't have to be done again, unless you want to check TPOab in a few months and see if those antibodies ramped up.

You might try testing vitamin D and vitamin B12.  Vitamin D deficiency can cause some hypo like symptoms and vitamin B12 deficiency causes horrible fatigue, brain fog and easy bruising.

[EasyGoinGal]

You are such an angel to help me.
I am exhausted and cloudy-headed.  I am having an extremely hard time losing weight.  I've had three TSH tests over the last 6 months with basically the same results.
I went to an alternative doctor who prescribed according to my 96 degree body temperature.  He started on 60 mg.   When I returned a month later, my temperature was still around 97, I think, so he prescribed another 60 mg.  It was after this that I started losing my hair and got scared and stopped everything.  My hair is much better, but it has grown in very frizzy.
Do you think I should start Armour again at maybe 30 mg for a month and then go up to 60 if everything is all right?
Barb, you just don't know how much I appreciate this help.  Thanks.

[Barb135]

Iodine is, typically, contraindicated in those with Hashimoto's, which, according to your elevated TGab, you have, even if your doctor didn't diagnose it.

I'm confused about your Armour dosage.  One grain is 60 mg; 30 is 1/2 grain.  On what basis were you prescribed the Armour?  Why did you stop taking it?

Armour has both T3 and T4 in it.  It takes 4-6 weeks for a dosage change of T4 to reach full potential in your blood.  It could also take more than 2-3 weeks for it to be completely out of your system.  

I'm not sure if the iodine could have had something to do with driving down your TSH, but I suspect it would.  

"However, in certain circumstances, excessive consumption of iodine can actually inhibit the synthesis of thyroid hormones, thereby leading to the development of goiter (enlargement of the thyroid gland) and hypothyroidism. Excessive iodine intake may also cause hyperthyroidism, thyroid papillary cancer, and/or iodermia (a serious skin reaction)."

I know iodine is stored in the thyroid, but I'm not sure exactly how long.

Nodules are common with both Hashimoto's and Graves, but I see no reason to suspect Graves Disease, since your FT3 and FT4 are both relatively low.  Your Free T4 is at 45% of its range, rule of thumb is for it to be about mid range; your Free T3 is also at 45% of its range, rule of thumb is for it to be upper half to upper third of its range.  These are "targets" that we advise people to shoot for when on medication.

Another thing to keep in mind is that TSH can fluctuate greatly throughout the course of a day.  

Just for your information, T3 Uptake, Thyroxine (T4) (also known as Total T4), Free Thyroxine Index and Triiodothyronine (T3) are all considered obsolete, so you could save your money on those.

All of that said, all of the tests you listed above are pituitary hormones and to get a clear picture, you'd really need them all, but now I'm not sure you do.

Now that I know you were on the iodine and Armour, before I'd advise further pituitary hormone testing, I'd advise you to wait a while longer, taking nothing, then retest TSH, Free T3 and Free T4 to see what those levels are.  

What, if any, symptoms do you have?

[EasyGoinGal]

I was on one grain of Armour and then prescribed 2 grains, (60 mgs.) because of a body temperature around 96.  Some time ago, my hair started falling out.  The only thing I took was the Armour, so I stopped and started taking biotin, selenium, folate, and it improved.  Around the same time, I took 2% Lugols iodine, 2 drops working up to 12 drops at one drop every 2 weeks, with the companion nutrients.  I got my first low TSH test results, then did these labs.  I also have 3 thyroid nodules, but my imaging 6 months ago was fine.  I stopped taking Lugols and Armour 2-3 weeks before the labs.  I am now taking nothing.  

I looked at HealthCheck but didn't find what I was looking for.  I did find the following tests and prices at PrivateMDlabs.com.  They use LabCorp.
GH      $52
IGF     $72
Prolactin  $47
ACTH  $52
LH      $47
FSH    $47
Would there be one or two tests that would be the most important to get?  
Thanks for your help

[Barb135]

Typically, other hormones that the pituitary produces would be tested to make sure they are within normal ranges.  Those would be Growth Hormone, Prolactin, Luteinizing Hormone (LH), Folicle Stimulating Hormone (FSH), ACTH and IGF-1.  Those are hormones that the pituitary produces in order to stimulate the other endocrine glands, such as adrenals, pancreas, reproductive organs.

I just looked at the Direct Labs site and there's a comprehensive female hormone panel that has those tests included.  The panel is $395.  

Have you ever looked at healthcheckusa?  Their tests are often less expensive.

Because TSH fluctuates greatly throughout the day, more than one test is typically needed.

You aren't on any thyroid replacement hormones, are you?

[EasyGoinGal]

Hi Barb,
I did read about that.
However, I am having trouble finding a test for the pituitary.
I often use Directlabs.org, but I don't see anything there.
How do I find out if my pituitary is producing TSH to stimulate the thyroid?
Thanks

[Barb135]

Elevated TGab indicates Hashimoto's.  You'd have to have elevated TSI to diagnose Graves Disease.  

Your TSH is the only test that indicated hyperthyroidism; your Free T3 and Free T4 actually indicate beginning hypothyroidism.

You could have a pituitary issue.  If the pituitary doesn't produce TSH to stimulate the thyroid, the thyroid won't produce thyroid hormones.