Optimal thyroid numbers the same for hypo and hyper?

[Mstiles]

Can anyone comment on this in a general way? I’ll post my numbers today, have been feeling too crummy to wade through all those numbers.

[Clutter]

Mstiles,

No. TSH may remain suppressed for months/years in hyperthyroid patients but some doctors think hypothyroid patients are overmedicated when TSH is suppressed (not something I agree with).

[Mstiles in reply to Clutter]

My endo said 4.0 TSH was “a good number” to aim for when I was diagnosed with Graves. It was 0.01.

[Clutter in reply to Mstiles]

Mstiles,

It's not the TSH which makes you feel anything at all. With TSH 4, FT4 and FT3 are usually low and that makes one feel hypothyroid (overmedicated if you are taking anti-thyroid drugs). Hypothyroid patients usually feel well with TSH 0.2 - 1 and FT4 and FT3 in the upper range.

I'm hypothyroid and my TSH has been <0.01 for 5 years but FT4 and FT3 are within range so I am not overmedicated.

[Mstiles in reply to Clutter]

Do you know of any documentation that would apply to those with Graves about optimal TSH, Free T4 and free T3 numbers? I’ve seen posts on this site that support these numbers for hypo patients that folks can take to their doctor but nothing for hyper patients.

Thank you Clutter

[Clutter in reply to Mstiles]

Mstiles,

No, I don't. The same principle surely applies though. High TSH with low FT4 and FT3 due to Carbimazole blocking thyroid production will make you feel hypothyroid.

If you can dig out your recent thyroid results and ranges I can advise whether you appear to be overmedicated.

[Valarian]

Hi Mstiles,

what stage are you at with your treatment, and are you on ‘block and replace’ (eg Carbimazole plus levo) ?

I’m on titration, and at themoment, my endo really only seems interested in getting my FT3 and FT4 levels within range, and seeing if they will remain stable. The TSH gets tested every time, but it’s still low, and he doesn’t seem bothered by that.

[Rocca]

Hi Mstiles, sorry you are feeling crummy.

I was hyperthyroid at the beginning of the year. First I was diagnosed with Graves' but it is now confirmed not Graves' but thyroiditis. I then went hypo on inappropriate treatment with Carbimazole.

My GPs and endocrinology have been using the same standard lab reference range to assess my blood test results in both situations.

The first endocrinologist I saw said they weren't worrying about the TSH, they were paying attention to the free T4 and T3.

Hope you feel better soon.

[Mstiles in reply to Rocca]

Hi Rocca,

Thank you for your kind reply, it really helped! I’m trying to figure out whats going on with me, glad you have good doctors. How did they finally deduce it was thyroiditis not Graves?

[Rocca in reply to Mstiles]

Hi,

I tested positive for TPO antibodies but negative for TSI antibodies. I asked the endocrinologist at my latest appointment why I was given Carbimazole before TSI antibodies were checked for, because I was annoyed about that. She said that the TSI test takes six weeks to come back and as i was pretty ill at the time of diagnosis, and as a majority of hyperthyroid cases are Graves' , I was given Carbimazole as an 'educated guess' it seems. They did wait two weeks to see if my T3 and 4 levels came down but they didn't and I must admit I was pretty desperate for treatment.

Anyway, the other way to distinguish is with a thyroid uptake scan but you have to have it before starting Carbimazole, because that affects uptake. I wasn't given one, I don't think they are offered as standard but I feel I should have had one, because guessing led to the wrong diagnosis for me.

Also, once on Carbimazole I went hypo very quickly indeed and my TSH shot up, which isn't characteristic of Graves'. I have to say I did feel better for taking Carbimazole because all my hyper symptoms went away.

The other thing I was given in the interim was Propranolol beta blocker which was great. Gave me chest tightness initially (hence it's not good for asthmatics) but calmed my poor heart down and reduced my anxiety. What are your actual blood results and when did you get your diagnosis? Have you been offered a beta blocker? What are your current symptoms?

Again, I'm sorry you're feeling bad, I know what it's like.

[Mstiles]

Thanks Rocco. I tested positive for both TSI and TPO antibodies, but at that point I had no clue what was going on and the endo didn’t even comment on that. Had an ultrasound but after I had started Methimazole and a beta blocker. The endo said “Graves” and that was that. Now I’ve got both hyper and hypo symptoms

I will post my numbers and everything later today , finally have everything and feeling good enough to post everything

[Rocca in reply to Mstiles]

It's great you've got all your blood test results. I was given good advice on here to get and keep all results.

Sorry you've got both hyper and hypo symptoms going on. I have a friend with hypothyroidism and it was interesting to note that we shared some symptoms in common including anxiety and muscle weakness even though we were at opposite ends of the spectrum.