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TSH fluctuations
I have my TSH tested every year or two because I often display symptoms of both hyper and hypothyroidism. My numbers fluctuate anywhere from 1.5-5.5. I know 5.5 is only slightly elevated and only tested that high once. I’m wondering if it is possible I am suffering from thyroiditis despite testing within normal ranges. Is this disparity normal?
No on the question on TSH in the afternoon. My advice is to forget about TSH. Read my paper in the following link and you will understand why.
https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf
My expectation is that most, if not all, your symptoms are related to being hypothyroid. You will not make any progress until you push to get tested for Free T4 and Free T3, even if TSH is in range. In addition, it is important that Vitamin d is above 50 ng/ml, B12 in the upper part of its range, and ferritin should be over 100.
Give your doctor a copy of the link and ask to be tested and treated clinically, for symptoms, along with FT4 and FT3. If the doctor resists, you will have to find a good thyroid doctor that will do so.
https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf
My expectation is that most, if not all, your symptoms are related to being hypothyroid. You will not make any progress until you push to get tested for Free T4 and Free T3, even if TSH is in range. In addition, it is important that Vitamin d is above 50 ng/ml, B12 in the upper part of its range, and ferritin should be over 100.
Give your doctor a copy of the link and ask to be tested and treated clinically, for symptoms, along with FT4 and FT3. If the doctor resists, you will have to find a good thyroid doctor that will do so.
7 Comments
Last tests done, which are several years old now, VIT d 45 (though it has dropped below normal range 30-100), b12 538 then 812 (200-1100) ferritin 39 (16-154)
It would be good to re-test all three of those when you are able to get tested for Free T4 and Free T3. All those are important for a hypothyroid patient to feel well. Do you think you can get all 5 done?
I got one of the at home tests for TSH, ft4&3, plus antibodies. My doctor is very resistant to ordering tests when past results show “normal”, I’m pretty sure she has labeled me as a hypochondriac. I just found out my grandmother has hashimotos. If my antibody tests come back positive I have something concrete to show my doctor. Thank you for your help, it has been quite insightful. Any other advice would be appreciated!
I’m so anxious about the results I’m ready to drive to the lab right now!
When you have results, please post them along with reference ranges shown on the lab report, so we can advise further.
Do you if blood disorders like thalassemia, where RBCs are recycled more frequently, and we have a lack of mature cells, can affect blood results? My mind is on overdrive thinking about all the things that could affect it. I just read that it can lower ESR https://www.aafp.org/pubs/afp/issues/1999/1001/p1443.html
The thalassemia trait raises my RBC, RBW, lowers MCV, MCH, MCHC.
The thalassemia trait raises my RBC, RBW, lowers MCV, MCH, MCHC.
Lowers hemoglobin too..
As a diagnostic, TSH is useful only when at extreme levels. This is because TSH has only a weak correlation with thyroid hormones, and a negligible correlation with hypothyroid symptoms, which are the best indicator, which should be evaluated along with the active thyroid hormones, Free T4 and Free T3. Assuming you have not been tested for Free T4 and Free T3, as a start please tell us about all your symptoms.
3 Comments
Looking back there was actually a six year interval. I thought it was only two! Anyway
I am a 36 year old female. I have struggled with IBS as long as I can remember. I alternate between constipation and frequent and loose stools. Always nauseous, occasional vomiting.
My weight fluctuates significantly, usually 20-30 at a time within a year with no lifestyle changes.
My period consistencies change as well, I will go from having two periods in a month, to reliable, then being consistently late (when I was younger I would go months without it.)
I’ve had hand tremors for as long as I can remember, though I was told by my parents it was genetic.
I am always fatigued. Always.
I get periods of night sweats, sometimes extreme where I have to change a couple times a night.
I’ve gone through periods of extreme insomnia, and other times I sleep 10 hours a night and it feels it’s not enough.
I broke my finger last fall and it didn’t heal, they say it may never as it seems my circulation is bad.
I have no happy medium with temperature, I get cold very easy, but suffer from heat exhaustion easily.
The biggest issue is my mental health. Because of this I tend to get pushed aside. Doctors acknowledge some issues but blame most on my anxiety and depression.
I also have thalassemia trait, which should have no symptoms. But I do have elevated RBC and occasionally low blood pressure.
I am currently in what I would describe as a flare up, but TSH is at 1.56 and I believe ft3&4 are normal. Have not gotten antibody test but got a mail order one.
I am a 36 year old female. I have struggled with IBS as long as I can remember. I alternate between constipation and frequent and loose stools. Always nauseous, occasional vomiting.
My weight fluctuates significantly, usually 20-30 at a time within a year with no lifestyle changes.
My period consistencies change as well, I will go from having two periods in a month, to reliable, then being consistently late (when I was younger I would go months without it.)
I’ve had hand tremors for as long as I can remember, though I was told by my parents it was genetic.
I am always fatigued. Always.
I get periods of night sweats, sometimes extreme where I have to change a couple times a night.
I’ve gone through periods of extreme insomnia, and other times I sleep 10 hours a night and it feels it’s not enough.
I broke my finger last fall and it didn’t heal, they say it may never as it seems my circulation is bad.
I have no happy medium with temperature, I get cold very easy, but suffer from heat exhaustion easily.
The biggest issue is my mental health. Because of this I tend to get pushed aside. Doctors acknowledge some issues but blame most on my anxiety and depression.
I also have thalassemia trait, which should have no symptoms. But I do have elevated RBC and occasionally low blood pressure.
I am currently in what I would describe as a flare up, but TSH is at 1.56 and I believe ft3&4 are normal. Have not gotten antibody test but got a mail order one.
The blood tests they have been doing have been TSH with FT3&FT4 reflex cascade. The results I have access to only show my TSH level.
I see now. Reflex means they only test FTs if TSH is off. So only had my FT4 tested once, when my TSH WAS 5.15 (.4-4.5) and my T4 was 1 (.8-1.8)
Results are in! Tsh 10.1 (..4-4.5) ft4 .9(.8-1.8) tpo negative. Two weeks ago my TSH was 1.54. Is it possible to switch from hyper to hypo that quickly?
2 Comments
Pretty upset my ft3 wasn’t tested even though I requested it. Assuming they didn’t do it be cause my ft4 was in range.
Seeing a doctor tomorrow to discuss further testing. What should I request besides ft3? Vit d, b12, ferritin, anything else? I believe my iron, b12, and ferritin levels are also affected by thalassemia trait. Should be fun sorting this all out.
Still waiting for results. Granted it’s been a long time since I’ve been tested, but can you have hashimotos without the presence of inflammation markers such as CRP, ESR, ANA?
6 Comments
You don't have to have Hashi's to be hypothyroid. There is also central hypothyroidism, which is a pituitary issue where it does not produce enough TSH to adequately stimulate the thyroid gland.You should express your displeasure about not being tested for Free T3., and ask for it again. FT3 is the thyroid hormone that largely regulates metabolism throughout the body. Having adequate FT4 does not assure adequate FT3. Conversion of of T4 to T3 does not always occur as needed, since conversion is affected by a number of things, including ferritin level.
My doctor said it is not necessary to do anything else but the TSH and I believe him. It is just a difference in opinion
mkh9
You should not just accept that. The doctor is incorrect. The active thyroid hormones are Free T4 and Free T3. Free T3 largely regulates metabolism throughout the body. Without adequate T3 effect a person is hypothyroid. TSH is inadequate as the sole diagnostic because it doe not correlate well with Free T4 or Free T3, and has a negligible correlation with hypothyroid symptoms, which are the source of patients' complaints. Because of these reasons, TSH is useful as a diagnostic only when it is at extreme levels. If you want to confirm what I have said, please read a paper I co-authored in the following link.
https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf
https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf
Your doctor is WRONG. I agree with gimel. My (previous!) doctor only wanted to test TSH and if “I didn’t feel well” would be willing to increase T4. I don’t convert T4 to T3 (efficiently? At all?) and need to know T3 and FT3. I also need T3 as a medicine and giving me synthroid /levothyroxine WILL NOT HELP ME.,
Most doctors have followed the “standard” for low thyroid for decades an ignore patients thyroid symptoms. I got a new doctor who has thyroid problems, too, and is better at treating them. Sad that is what it takes. I have shared the above paper with my old doctor. She ignored me, like she ignored all my symptoms… which have gone away with T3
Most doctors have followed the “standard” for low thyroid for decades an ignore patients thyroid symptoms. I got a new doctor who has thyroid problems, too, and is better at treating them. Sad that is what it takes. I have shared the above paper with my old doctor. She ignored me, like she ignored all my symptoms… which have gone away with T3
Thanks for the feedback. Glad you are getting some help and have improved so much.
Just curious. What were your FT4 and FT3 levels before and after adding in T3 med? What are your current dosages of T4 and T3?
Just curious. What were your FT4 and FT3 levels before and after adding in T3 med? What are your current dosages of T4 and T3?
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