I'm somewhat active over on the pernicious anemia forums but have a question over here pertaining to TSH. For years before being diagnosed with pernicious anemia and still now I have had symptoms of hypothyroidism. I had numerous labs done (thyroid panel) but my tsh was always is 3.0-3.9range in the past. I was told I was borderline back in those days. In March 2016 my GP tested again and I got a tsh of 8.280. My t3 reverse was 22, thyroid peroxidase antibody (anti TPO) was 4, anti thyroglobulin was <1, free triiodothyronine 3.59, and thyroxine free 1.07. I was told at that point I had hypothyroidism and was offered synthroid but politely declined as she said treating it wasn't necessary since everything else besides tsh was fine. Fast forward May 2016 and my tsh was down to 4.080, thyroxine free 1.09, triiodothyronine 2.98, again no treatment, it had come down to that level on its own. I had labs done last week tsh 2.510, t4 1.27, triiodothyronine 3.5. I'm not really sure what to make of these results. My tsh is normal and so is everything else pertaining to thyroid. As for other health problems I do have pernicious anemia with atrophic gastrtis and a pending neuroendocrine cancer diagnosis because of excessively high gastrin levels and tumor marker chromogranin a.
Does anyone know why my tsh would have been elevated for a few months? Would that still be considered hypothyroidism? Do GPs base hypothyroidism off of labs, symptoms or both? Can any other conditions (besides thyroid disease) elevate tsh levels?
Sorry this was so long. Thanks in advance!
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Ashley8
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Firstly, your TSH is not 'normal'. It is 'in-range'. For a doctor, that means the same thing. For the patient, there is a world of difference! At 2.5, your thyroid is struggling. Over 3, you were hypo. What causes it to go up and down like that? Well, it could be that you did the tests at different times of the day. But, if that's not the case, if you always do your tests early in the morning, and fasting, then I would say you have Hashi's.
And, that wouldn't be surprising. You know you have Pernicious Anemia, which is autoimmune, and once you have one autoimmune disease, others are likely to follow - or be there first. The fact that you had one negative antibody test, proves nothing. Antibodies fluctuate all the time. And, some people with Hashi's never even develop high antibodies, they are diagnosed by an ultra-sound scan. So, that would be my guess.
There are other things that can cause the TSH to rise, such as illness and starvation. But, doubtful over such a long period of time. It would have been helpful if you'd given ranges for the Frees, because the results are meaningless without the ranges. But, they do look consistantly low.
I understand. As far as symptoms go I pretty much have them all except weight gain. My first symptom or sign of illness was excessive hair loss.
The results I posted above are the only tests that were run by my doctor pertaining to thyroid. If my levels are in range at the moment would I want to be on synthroid or could that cause hyperthyroidism? I'm sorry I'm asking so many questions - I'm still pretty new to this and just thought about all of this today after getting my updated thyroid lab results. Should I ask about an ultrasound of thyroid? I see my doctor again next week and trying to compile as much information as possible. Thanks!
Actually, there are over 300 symptoms of hypothyroidism, so it's rather doubtful you have them all.
Ask all the questions you like! We all have to start learning somewhere.
No, if you are hypo, you cannot 'cause hyperthyroidism'. No amount of thyroid hormone replacement (levo, etc.) can cause the thyroid gland to start over-producing. It doesn't work like that. Taking levo has no such effect on the thyroid, because the thyroid is slowly dying. It cannot come back to life.
You could, of course, be over-medicated. But it's very doubtful if you would become over-medicated straight away. Just because your levels are in-range, doesn't mean they're optimal. It's where in the range they fall that is important - something that doctors can't seem to get their heads round!
Do you have the ranges for the above results? Ranges are often rather wide, so you will feel totally different if your result is at the bottom, to how you would feel if it were at the top.
It would be a very good idea to ask for a scan, considering how long this has been going on.
Wow! I didn't know there were so many symptoms. I have the common ones; very fatigued, cold sensitivity, dry skin, constipation, and I'm so stiff and sore in the joints everyday. Doctor thought years ago I may have had lupus due to symptoms and positive ANA test with speckled pattern and 1:40 titer but no diagnosis there.
Thank you for clearing that up about if you can get hyperthyroidism or not on meds. I used to read this woman's blog years ago who said she started out with Graves' disease but ended up with hypothyroidism later.
Here are my ranges from my lab
T3 Reverse 8-25 ng/dL
Thyroid peroxidase antibody (anti TPO) <9 IU/mL
Anti thyroglobulin Ab 0-1.0 IU/mL
Free triiodothyronine 2.18-3.98 pg/mL
Thyroxine free 0.76-1.46 IU/dL
TSH 0.340-4.82
When I see my GP next week I'll be sure to ask about the ultrasound. Knowing how doctors are I won't be surprised if she says no as she told me the last time I saw her that my results were "normal", I definitely don't feel normal though.
The above link takes you to the main website of Thyroid UK. Have specifically linked you to the Signs and Symptoms. There is also a section explaining blood test results and what constitutes Hypo. Good luck with your GP
They are very narrow ranges, which is unusual. Your FT4 has always been around mid-range - much better on the last one.
Your FT3 is only just under mid-range. So, they have been euthyroid. It's just your TSH that has swung about a lot. But, you didn't answer my question : were all the tests done under the same circumstances - i.e. early morning and fasting? TSH is highest early in the morning, and drops throughout the day. It also drops after eating. So, if you don't always do it at the same time, it will swing around. But, even at the lowest, it still shows a struggling thyroid.
Yes, it is perfectly possible for someone who started out with Grave's - although, was it really Grave's? Were the antibodies tested? - to end up hypo. But, it can't work the other way around. The thyroid cannot just suddenly come back to life and start churning out excess hormone.
I ask if the antibodies were tested for the lady with Grave's, because doctors tend to jump to conclusions and think that any low TSH is automatically due to Grave's. It isn't. It could be Hashi's, which starts out as a false hyper phase, and then goes hypo.
But, although the TSH is low, and the Frees high, it isn't really hyper. What is happening is that the immune system is attacking the thyroid, and the cells are dying off. As the cells die, they release their store of hormone into the blood stream, so that blood levels soar, and the TSH therefore dips. That's why it's always so important to always test antibodies, but doctors just don't understand that. Just a little aside, there. lol
Thank for the analysis. It's super helpful to someone like me who is still learning
I'm so sorry i forgot the part about fasting or not! Every time I do my lab work I always do them fasting as I get blood work done right after I wake up, I do however wake up in the afternoons though because I work on the overnight shift so I sleep a great portion of the day. Typical timing would be wake up around 2pm, no eating get labs done around 3pm.
Ah thank you so much for explaining about that! Many thanks for the info I have no idea what her labs were- I don't think she mentioned in her blog.
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