Guidance on TSH/Thyroid blood lab results...

[smilas]

I was diagnosed with Hypothyroidism last July 2016 following a near fatal motorbike accident where I cracked my head open and fractured a lot of bones in my skull. I was displaying a goiter and MRI brain scans revealed a slightly enlarged pituitary gland but neurologists said nothing to worry about. The goiter prompted them to do blood results, which suggested Hypo due to TSH reading.

My belief has been that the trauma to my head was more a reason for over producing pit gland functioning, and overloading of Thyroid gland. I have not taken any meds apart from 4 days and stopped because they made me feel worse.

Doctors seem shocked when I walk in and don't believe the blood test results they are holding are mine because they assume with TSH levels that high I should be pretty much incapacitated and unable to function. Aside from:

fluctuating emotions

Muscle spasming on right side neck and shoulder ( where most of the trauma was taken/ fractures to the skull and jaw bone around right ear and damage to inner ear)

Strange taste/smell sensations ( I've lost my taste/smell and hearing in right ear)

Nervousness/ panic attacks/ restlessness morning and night

Energy levels are fine- sometimes a little tired but it's been VERY traumatic year

Symptoms could be related to the accident and trauma of that OR the thyroid?

I've been trying to rebalance things holistically and recently had tests done to show how I'm getting on and if it is working..

Is anyone able to offer any guidance on these latest test results? From what I understand, things re improving??

I've grouped the results in the following format:

test name / value / units / reference range

Previous Results 21 Dec 2016

T3 / 37 / ngdl / 60-200

T4 / 1.4 / mg/dl / 4.5-12

TSH / ^150 / mIUml / 0.30-5.5

FT3 / 1.15 /pgml / 1.7-4.2

FT4 / 0.37 /ngdl / 0.70-1.80

Latest Results 31 March 2017

T3 / 58 / ngdl / 60-200

T4 / 2.1 / mcdl / 4.5-1.2

TSH / 102.40 / mIUml / 0.30-5.5

FT3 / 1.8 / pgml / 1.7-4.2

FT4 / 0.34 / ngdl / 0.7-1.8

Any advice would be really appreciated.

Many thanks

[dang]

Smilas those readings are incredible... it's not often to see a TSH so incredibly high. Your FT4 is practically non-existent and your FT3 the same.

This would indicate this is from your thyroid. If it was a pituitary gland problem that was making your TSH high your readings in FT3 and FT4 would too be high showing the over production. But your thyroid is underproducing and your TSH is high because it's attempting to push your thyroid to produce more.

What medication and dosage did they prescribe you?

I had a high TSH also when I was diagnosed (not as high as yours granted) and I didn't realize anything was wrong with me. I thought I was good and healthy. It wasn't until after receiving treatment and actually feeling good for the first time in 10 years that I realized just how sick I actually was before.

[puncturedbicycle]

Gosh, I'm sorry to hear you've had such a rough year. That sounds like a lot to bounce back from.

Tsh fluctuates all the time, sometimes dramatically. Mine went from 30ish to 5ish on no meds.

No one can tell you what you should or shouldn't do and if you choose to remain untreated then fair enough. Have no antibodies ever been tested? That would lay to rest whether or not this is autoimmune uat which predated your accident and was just discovered by chance when you were in hospital. Or are they saying this is secondary hypothyroidism?

All I can say is that this is a progressive disease and you won't be miraculously cured of it, or at least that is my belief. You can walk around w anaemia or diabetes for many years (and most people do before they are diagnosed) and feel pretty ok a lot of the time but it doesn't mean you're beating the disease and/or healing yourself naturally. You may become very ill if you remain untreated, or you may feel ok for a while and be able to wait it out but hypothyroidism is a hormone deficiency and if you are short of the hormone your whole metabolism will suffer.

My ex was a type 1 diabetic for at least a year (we think) before anyone thought to test him for it. He carried on working a physical job (joiner) and only occasionally fainting on the job, which was odd but his (miserable excuse for a) doctor didn't think to take a urine sample. By the time he was diagnosed in hospital he lost 3st within a week or two and was severely dehydrated.

Not being nosy, but do you know the cause of your accident?

[humanbean]

First of all, I should point out I have no medical training and I'm just making guesses...

The thyroid and the pituitary are not the only organs responsible for thyroid output. The hypothalamus has a big role as well.

The sequence of events as I understand it is :

1) Hypothalamus produces TRH - Thyrotropin Releasing Hormone - in response to thryoid hormone levels in the brain. Thyrotropin is another name for TSH - Thyroid Stimulating Hormone.

2) Pituitary produces TSH in response to TRH.

3) Thyroid produces thyroid hormones, mainly T4 and some T3, in response to TSH.

In your case, it would appear that one or more of the following may be happening :

1) Your hypothalamus is recognising your thyroid hormone levels are too low, so is producing lots of TRH, or your hypothalamus is over-producing TRH independently due to damage.

2) Your pituitary is recognising your TRH levels are high, so is producing lots of TSH, or your pituitary is over-producing TSH independently due to damage.

3) Your thyroid is unable to respond adequately to TSH no matter how high it gets. It could be damaged by your accident or could have been unhealthy before the accident happened. You may have high thyroid antibodies, which you should get tested if you haven't had them measured. You mention a goitre, I don't know anything much about them - never had one myself.

I think you should be pushing your doctors for more investigation of your pituitary and investigation of your hypothalamus.

How you are keeping going with such low levels of thyroid hormone I really don't know. Have you got symptoms which suggest high cortisol and/or adrenaline levels? Have you got high testosterone levels?

Maybe your gut works extremely well and you haven't yet developed nutritional deficiencies that are common with hypothyroidism. If/when you do your health may decline.

But as I said... I'm only guessing...

[Clutter]

Smilas,

Your TSH is high because your FT4 and FT3 are very low, not because of your head injury. The pituitary gland issues thyroid stimulating hormone (TSH) to stimulate the thyroid to produce T4 and T3. When the pituitary detects sufficient circulating T4 and T3 TSH stimulation is reduced.

Your goitre probably developed to try and make your thyroid produce more hormone and as that was happening prior to your accident your head injury won't have anything to do with your TSH and thyroid levels. In any case, a head injury usually results in insufficient TSH being produced, not too much.

It is surprising that you are not symptomatic with such low FT4 and FT3. Nevertheless you need thyroid hormone replacement because without it you may suffer damage to the heart and kidneys and other organs, and if it is allowed to continue for long the damage may be irreversible. Panic attacks and lack of energy are not uncommon hypothyroid symptoms. Most people need TSH 1.0 or lower with FT4 in the upper quadrant and FT3 in the upper third of range to feel well. You can see how far off your results are.

It's not uncommon to feel a bit worse when you first start taking Levothyroxine. The adverse reactions should subside within a couple of weeks.

thyroiduk.org.uk/tuk/about_...

[smilas in reply to Clutter]

Thank you for your message. Is the difference in ranges between previous Dec 2016 results and most recent March 2017 blood test not suggesting improvement in T3 T4 TSH AND FT3 levels though?

The only results still low is ft4

Everything else seems o be stabilising more in the reference ranges, does it not?

[Clutter in reply to smilas]

Smilas,

I don't think you can consider the drop in TSH and slight rise in FT3 to be sufficient improvement to continue to refuse thyroid replacement. Without sufficient T4 to convert to T3 your FT3 level will drop unless TSH rises again.

[smilas in reply to Clutter]

This is all so confusing... I thought TSH needed to come down not rise again?

T3 has risen from 37 to 58 which according to ref range is just below the required healthy range of 60.

Ft3 is now within range too.

T4 is still slightly low but has risen from 1.4 to 2.1 in 3 months which also suggests improvement?

TSH has dropped by a third too

[Clutter in reply to smilas]

Smilas,

TSH does need to come down, all the way to 1.0! It rose because FT4 and FT3 were too low, below range. The TSH 150 in Dec whipped your FT3 into range which is why TSH dropped to 102 in March. Without FT4 improving there won't be sufficient T4 to convert to T3 so FT3 will drop below range again and TSH will rise again. What you are calling improvements are so insignificant they can hardly be called improvement.

In the UK we just concentrate on Free T4 and Free T3 which are unbound to proteins and give the best indication of available T4 and T3 levels. Yours are dire and need to be at a minimum half way through range but ideally in the upper ranges.

[puncturedbicycle]

There is someone here who had a traumatic head injury and has a lot of knowledge about how it can affect glands, metabolism etc. Maybe someone here?

healthunlocked.com/thyroidu...

More info here: healthunlocked.com/thyroidu...

As usual the pitiful search tool reveals little of use so I did a google site search. For whatever reason some of these results aren't just TUK but by all means see if you find anything helpful here: google.co.uk/search?q=%22tr...

I'll have a look in my inbox and see if I can figure out who it was I chatted w about it.

[silverfox7]

I can remember reading that a head trauma upsets bloods but I can't remember why and how though

[Silver_Fairy]

headinjuryhypo.org.uk/