hyper, hypo ?'s

[Blue727]

Is it possible to have hyper symptoms or be hyper with lower TSH, Free T3 and Free T4?  Is it possible that a pituitary problem could cause the hyper symptoms?

I woke up about 5 years ago and complained that my eyes didn't feel normal and to this day they don't.  I feel like my eyes get stuck or that I'm staring, pain behind and above my eyes, pain in the center of my eyes above my nose, nervousness, low self esteem, anxiety, shakiness and when I wake up my eyes feel like they take forever to adjust.  Insomnia, body feels wired most of the time, but I'm tired.  Eyelids feel like they weigh 25lbs. each, appetite varies, as does weight, sweat quite a bit.  The biggest problem is the way my eyes feel.  They almost feel as they don't track together.  I have seen an opthamalogist, but he said everything was fine.

Every thyroid test I have taken has shown to be either slightly below the "normal" range or just slightly above it.  My testosterone has come back low, high homocysteine and low B12.  Thanks!

[HyperT77]

My Edno said it works like this:

Hyperthryoidsim:
TSH is low
T3 & T4 are high

Hypothyroidism:
TSH is high
T3 & T4 are low

The tricky part is that the TSH runs opposite of what the disease actually is.

[chel 81]

Based on all your eye problems your doc should really schedule a brain MRI with and without contrast. It is standard to do both and with your symptoms any insurance company should approve it. If your hormones are all out of whack and your eyes are bothering you that bad it could very well be related to your pituitary or hypothalamus.

Chel

[Blue727]

AR-10,

I wasn't on the Cytomel when I had any of the testing done.  Doesn't it look like I could have some type of hormonal or pituitary problem?

I had an MRI done awhile ago without contrast.  I think to find anything really, it should have been done with contrast.  The MRI showed white matter changes and that's all I know.  I have alot of sinus issues as well and a doctor told me the way my thyroid tests look, it more than likely is a pituitary/hypothalmus problem that is throwing all my hormones out of whack.  What do you think?  Thanks again for all your help!

[AR-10]

Are most of those tests from the same labs?
Say, the last year's worth at least? You've been going to the same clinic or whatever? Are half of them from your GP, and half from your Endo?

Your TSH jumps around a lot. Your Free T4 wanders around a bit, too.

Your Free T3 looked good a year ago. On 6/21/07, everything looked peachy except your Free T4 was WAY low. That's odd.

Your last four tests show TSH dropping, with a rebound on the last test, although only the two middle tests show a Free T4. On the last test your Free T3 is below mid-range, but at least it's there. But they didn't run a Free T4.

That is a lot of weirdness going on, and when you factor in the Cytomel you are taking, your Free T3 should be higher. If your Free T3 was way high, I could understand the other two being low. Too bad you don't have a few more of those to look at.

Maybe on that last test they drew blood after the Cytomel had been metabolized, and your Free T3 was dropping?

I don't know. I think it looks like tests from two labs, which complicate tracking levels, and you definitely need T4 support. I think the Cytomel is a mistake, and you should be on some type of levothyroxine, even if your TSH reads low.

Either your TSH is low because of the Cytomel, or a pituitary problem.

The Estradiol test was looking at your pituitary. Midrange is good. High or low is bad. All the blood tests looking at hormones and your adrenals look good. Your testosterone is a tad low, but...  

All the saliva tests look bad.

I'm on the fence on that one.

Doctors don't trust saliva tests.
Others swear by them.

If it were me, I would ditch the Cytomel, try a normal thyroid med, and if your TSH and your Free Ts don't fall into line soon, ask for further testing on your pituitary.

I wish I knew why you were given Cytomel to begin with. That is not normal therapy proceedure.

You also need to look into the high iron and homocysteine levels. I have no idea what that's about, but neither one should be ignored.

Wish I had something solid to say. all I can do is guess and wonder. Sorry.
  

[Blue727]

Here's my results over the years:

10/12/05:
TSH:   1.20                    Range:  0.40 - 5.5 MU/L

2/21/06:
Free T4:   0.91               Range: 0.59 - 1.17 ng/dL
TSH:        0.94               Range: 0.35 - 4.82 uIU/mL
T-4, Total:   6.4              Range: 4.5 - 12.0 MCG/DL
T-3 Uptake: 34.6            Range: 25.0 - 35.0% Uptake

8/15/06:
TSH:   1.11                    Range: .34 - 4.82 uIU/mL

10/12/06:
TSH:   1.20                    Range: 0.40 - 5.5 MU/L

6/21/07:
T-3, Free:    377               Range: 230 - 420 PG/DL
T3, Reverse:   0.19           Range: 0.11 - 0.32 ng/mL
Free T4:   0.73                 Range: 0.75-1.85 NG/DL
TSH: 1.39                        Range: 0.50 - 5.00 uIU/ML

Here are the saliva test results;
7/17/07:  
fTSH:    57             Normal
fT4:       0.25          Normal: 0.17 - 0.42 ng/dl
fT3:       0.27          Borderline Low 0.21 - 0.27 ng/dl

TPO Positive in Saliva results.

E2 (Estradiol): 9 Male (20-49 yrs, I'm 28 yrs old): 1-3 pg/ml, Male (50-85
yrs): 1-5 pg/ml

P1 (Progesterone): 30         28yr. old Male (adult): 5-95 pg/ml
TTF (Free Testosterone): 34 Male (20-30 yrs and I'm a 28 year old male):
60-110 pg/ml

Cortisol (By Saliva Testing @ CanaryClub);

Time:                      Outcome:       Normal Ranges for my age(28yr. old male):
7:00-8:00 a.m.    6  Depressed       Range:   13 - 24 nM
11:00-Noon       4    Depressed       Range:   5 - 10 nM
4:00-5:00 p.m.   3    Normal            Range:    3 - 8 nM
11:00-Midnight   5    Elevated          Range:    1 - 4 nM
Cortisol Burden:   18                       Range:     23-42

DHEA: 4            Range: Normal 3-10 ng/ml

My morning Cortisol blood test was 19.3 (Range: 4-22 MCG/DL)

Antibodies test was negative in blood.

8/7/07:
TSH: 1.80           Range:     0.50 - 5.00 uIU/mL

9/12/07:
Free T4:   0.75    Range:     0.71 - 1.85 NG/DL
TSH:   1.27         Range:     0.50 - 5.00 uIU/ML

1/19/08:
Free T4:   0.66    Range:     0.71 - 1.85 NG/DL
TSH:        0.17    Range:    0.50 - 5.00 uIU/mL

1/30/08:
TSH:   0.95         Range:    0.50 - 5.00 uIU/mL

Estradiol, Serum <32

Estradiol Reference Ranges:
Male: <=54   Not sure what the Estradiol tests mean.

It goes on to say no pediatric reference range established.

T-3 Uptake: 40.31 High Range: 25.0 - 35.0%    
T-4, Total:     5.7         Range: 4.5 - 12.0 MCG/DL

Free Thyroxine Index:      2.30         Range: 1.12 - 4.20

T-3, Total:     93       Range 60 - 181 NG/DL

Testosterone, Total:         393             Range: 241 - 827 NG/DL

[AR-10]

Your Free T3 should be somewhere between 310 and 370, and 370 would be better.

Your Free T4 should be between 0.9 and 1.4, with the higher number being better. But the lower number would be acceptable if the Free T3 was toward the higher end.

Your TSH should be somewhere between 0.8 and 2.2, with 1.0-1.5 being preferred.

If all three were low, I would suspect pituitary problems. If it's not that, it's a deficiency of something or several things interfering.

Google "B-12 and folic acid" and see what you find.
Then google high iron and see what you find.

[Blue727]

I had a doctor (over the internet) tell me they didn't think it was thyroid, pituitary, hormonal or endocrine related, as they thought I could just be a person who's numbers ran on the low end.  I guess I could settle for that if I felt worth a ****.

I only had 4 B12 injections before my numbers shot up to over 1,200 and the doctor took me off of them.  I think the low B12, high iron and homocysteine plays a part in what's going on, but I really believe there is something pituitary/hypothalmus/thyroid related.  I know if your pituitary or hypothalmus is off, it can make you have any number of 100's of symptoms and with my thyroid numbers being that low there must be something wrong.

Can you tell me, based on the ranges below, where I should be at ideally?  What number should I be at for each to have normal thyroid function?  Do you think if I'm in the lower end of each that it is more than likely a pituitary/hypothalmus problem?

Free T3:                          Range: 230 - 420 PG/DL
Free T4:                          Range: 0.75-1.85 NG/DL
TSH:                              Range: 0.50 - 5.00 uIU/ML

Thanks!

[AR-10]

The Cytomel alone could theoretically make you hyper and hypo every day. Or hyper and euthroid. How severely depends on the dose.

Taking Cytomel with no definite thyroid diagnosis, and without compelling reasons NOT to take a T4 med is risky and likely to cause problems.

Your homocysteine levels should be addressed.
B-12 and folic acid, in the correct proportions.
Your doctor has some odd priorities. This has serious implications for you heart.

Your iron is high. How that affects absorbtion and conversion of vitamins and minerals or other metabolic processes should be looked at, and the iron glut resolved.

[Blue727]

Here are some of my blood results for potassium, etc...

Results:           Reference Range/Units:
Glucose 80
Bun 4 L                      6-24 mg/dL
Creatinine 0.8            .6-1.3 mg/dL
Sodium 138               136-145 mmol/L
Potassium 3.8            3.5-5.0 mmol/L
Chloride 105               98-107 mmol/L
CO2 30                      21-30 mmol/L (This test is either over the range or just right at it.)
Anion Gap 7               3-12
Calcium 9.3                8.4-10.3 mg/dL
Total Protein 6.8          6.1-8.1 g/dL
Albumin 4.3                 3.1-4.7 g/dL
Globulin 2.5 L              2.7-3.9
A/G Ratio 1.7             .8-1.8
Alkaline Phos 112       50-136
ALT/SGPT 52             30-65 U/L
AST/SGOT 23            15-40 U/L
Total BILI 1.2 H           .0-1.1 mg/dL
Iron 215 H                   25-156 ug/dL
IBCT 247 L                  250-450 ug/dL
%SAT 87.0 H              13.0-45.0

GLYCO 5.1
Est. Mean BLO 84

I am not being treated for B12.  Would the Cytomel help me at all without any other form of thyroid medication?  Could my symptoms be associated with hypothyroidism?  When I sent my test results to the pituitary unit at Oregon Health and Science, they wanted to see me within 2 weeks, but it's around $7,000.00 or something and I'm uninsured and unemployed.  Thanks!

[AR-10]

A high homocysteine level is treated with B-12 and folic acid.
Low B-12 can cause a high homocysteine level.
Why isn't the doctor treating you for that?

Why would the doctor put you on Cytomel if your T4 is low? That doesn't make any sense.

What is the hydrocortisone for? Adrenals?


"If TSH is low and thyroid hormone levels are normal, the most likely cause is subclinical hyperthyroidism."

Your hormone levels are not normal. They are low. Starting an anti-thyroid drug would make your hormones lower.

[stella5349]

I could be subclinical hyperthyroidism BUT our T's would have to be out of range too if classically Dx that.

Where is the treatment going with the low B12? Low B12 can mess up alot and give you symptoms that look like hyperthyroidism - Google B12 deficency and read it. I would run a potassium level too.

Chek out the adrenal thoughts AR mentioned - they can wreck havoc on the TSH levels If they are functioning abnormally.

[Blue727]

This is a statement I found, which I thought was interesting;

"If TSH is low and thyroid hormone levels are normal, the most likely cause is subclinical hyperthyroidism."

At this point, after trying the thyroid medications, could it do any harm to try anti-thyroid medication to see if it helps?

[Blue727]

I started on Cytomel and Hydrocortisone, but notice nothing at all, even when I quit taking them or miss them.

Having everything low, except the homocysteine is of some concern for me, but I don't know how to get help.

One doctor wants to start me on Testosterone (started me on Cytomel and Hydrocortisone), but I think the pituitary/hypothalmus needs to be tested/scanned as well as the thyroid, as I don't just want a bandaid.  Shouldn't someone be trying to find out why I'm always low or low "normal" in thyroid tests, Testosterone, morning cortisol (which is rather high at night), B12 and high in homocysteine?

Could all my symptoms I listed be from Hypothyroid or the pituitary?

Thanks!

[AR-10]

It's possible the pituitary could cause all three levels to be low, but your symptoms should be hypo symptoms, not hyper.

To truely be hyper your Free T4 and Free T3 would have to be high normal or above.

Have you had your adrenal glands checked?
Something is not right. A few blood tests would tell you a lot about the pituitary and then maybe a scan. Same with adrenals.

Are you taking medicine?