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TSH w reflex to ft4 = 0.02 What does it mean?

I went to the doctor because I've been having headaches behind my eyes and in my sinus area.  I'm tired much more than I used to be, my fingernails have become paper thin, and I feel like I'm having a harder time focusing. My eyes get so dry at night that I have to wake up and put drops in them.I don't have an appetite, but I gain weight easily. (I am female, late 40's, 5'5", 110 lbs) I exercise vigorously most mornings.

He did this blood test: TSH 2 reflex to ft4 - the result was 0.02.
He is on vacation, but the nurse called to ask if I have heart palpitations, or excessive sweating.  I don't.  
She said I have an overactive thyroid, and requested blood tests to confirm it.  They also came back consistent with a hyperthyroid result, but I don't know what tests they did.  It confused me because I don't lose weight easily and I don't have a big appetite - I thought those were the main symptoms.
She said they will monitor it and have me tested in another 2 weeks to see if they number stays the same.

I'm curious to know what might be going on, because the doc won't be back for another week.  The headaches linger and often I have clear blurry spots in my vision when they begin.  It's starting to worry me a little.

I appreciate any feedback about that TSH test result.
Thanks.
Best Answer
Avatar universal
This is the tricky part about interpreting the TSI test.  The reference range is "<140%", so if your result is <140, you don't have Graves', right?  Nope, too logical, wrong, of course!  The fact of the matter is that people who don't have Graves' don't produce TSI and have TSI of <2%.  The whole gray area between 2% and 140% is where antibodies are active (i.e. you do have thyroid autoimmunity), but symptoms usually don't occur until levels get to around 140%.

Once under treatment for hyper, TSI can be used to monitor response to anti-thyroid drugs (ATMs) and to help predict remission.  Interestingly, levels should fall below 20% before discontinuing ATMs.  (I used to have a really good link for this, but the site seems to have shut down, so I'm paraphrasing from the printout I have.)    
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Avatar universal
Hi Goolarra,

I appreciate your comments.  Thank you for sharing them!
I got the T#, Free result - it is 4.8

The doctor wants to test TSH again and iodide (I think)?
Will these numbers change alot?
Could this be causing my headaches?

Thank you so much for your help!
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Avatar universal
I found more results on the lab slip -
thyroglobulin antibodies <20
thyroid peroxidase <10

Also, the range for the T3 is 2.3 - 4.2
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Avatar universal
What's the range on your FT3?  Ranges vary lab to lab, so you have to report them with results.

I your doctor is going to test again, he really should test FT3, FT4 and TSH.  TSH is pretty worthless without FT3 and FT4 numbers to back it up.  Also, since virtually all hyper is Graves' disease, he should order TSI (thyroid stimulating immoglobulin), which is the definitive test for Graves' antobodies.  

TSH is volatile.  It can change as much as 70% just depending on the time of day the blood is drawn.  FT3 and FT4 tend to be more stable.  

Headaches are a frequent symptoms of hyper.  FT3 ranges vary considerably lab to lab, so I really don't know yet how high your is until I see the range.
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Avatar universal
Hi,
The range for the T3 is 2.3 - 4.2.  Mine was 4.8
TSH was 0.02 - range 0.4 - 4.5
T4 was 1.7 - range 0.8 - 1.8

It is the TSI that he is having drawn this week.  
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Avatar universal
Oops...guess we were typing at the same time up there.

Good...he's doing the right things, then (testing TSI).

Your FT3 is clearly over range.  It looks hyper, too.  I think you've found your problem.    

TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are both within range.  They're the markers for Hashi's, so you don't have that (Hashi's is hypO, so we wouldn't suspect it).

I'm quite sure your TSI will be positive.  You'll feel better on meds.
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Avatar universal
What is the problem? Is it Graves?  Will I gain weight on meds?  I work so hard to stay where i am.  They will just do meds?  I don't have to anticipate anything else?
Thank you so much.
Helpful - 0
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