Hyperthyroidism

[Luna95]

Hi I'm new and I have hyperthyroidism, my endo is intending to start me on carbimazole due to my symptoms of sweats and weight loss. GP has asked me to come in and discuss bloods and why endo is coming to this conclusion. Diagnosed hypothyroid 2010 taking 150 of levo

Thanks

Dec 17

TSH 6.2 (0.2 - 4.2)

FT4 13.7 (12 - 22)

TPO antibodies 904.5 (<34)

TG antibodies 257.3 (<115)

Nov 17

TSH 0.03 (0.2 - 4.2)

FT4 25.6 (12 - 22)

Other results

Dec 17

Ferritin 28 (15 - 150) iron stopped 2016

Folate 2.39 (2.5 - 19.5) folic acid restarted Dec 17

Vit B12 208 (180 - 900) having B12 injections

Vit D total 34.6 (deficiency) taking 800iu D3

Testosterone 1.9 (0.5 - 1.7)

DHEA 2.1 (2.8 - 7.5)

Cortisol 270 (140 - 700)

FSH 4.5 told indicative of polycystic ovary syndrome

LH 6.9 told indicative of polycystic ovary syndrome

Lactate dehydrogenase 298 (<200)

Red blood count 4.46 (3.8 - 5.8)

White cell count 7.14 (4 - 11)

MCV 77.5 (80 - 98)

MCHC 386 (310 - 350)

MCH 28.1 (28 - 32)

Haemoglobin 116 (115 - 150)

Platelets 250 (150 - 400)

Sodium 143 (120 - 145)

Potassium 4.3 (3.0 - 5.0)

[cjrsquared]

It would be extremely unusual to go from hypothyroid requiring 150mcg of levothyroxine to hyperthyroid. Have you ever had thyroid peroxidase antibodies tested? If they are raised you have hashimoto’s disease, an autoimmune disease which slowly destroys the thyroid. During hashimoto’s flare ups, antibodies can destroy a larger part of the thyroid which causes a temporary flood of thyroxine into the system as these thyroid cells die. This simulates hyperthyroidism but is an extremely temporary situation. You then swing back into hypothyroidism often requiring an increase in medication.

If you post your blood results with the ranges I’m sure people may be able to advise more.

[Luna95 in reply to cjrsquared]

TPO antibodies 904.5 (<34)

TG antibodies 257.3 (<115)

[cjrsquared in reply to Luna95]

Positive for hashimoto’s. Do you also have recent thyroid function blood test results? Has anyone investigated other causes for sweats and weight loss?

[Luna95 in reply to cjrsquared]

Thanks thyroid results added, I have had the following tested for sweats and weight loss

Ferritin

Folate

Calcium

B12

Vit D

Full blood count

Cortisol

Autoimmune profile

Electrolytes

Reproductive profile

DHEA

Tumour markers

[greygoose in reply to Luna95]

Would you care to add the results to those, too?

[Luna95 in reply to greygoose]

Done

[greygoose in reply to Luna95]

Why was your iron supplement stopped? It's still much too low.

Folic acid is not the right thing for you to be taking. As you are having B12 injections, you should also be taking a B complex, because the Bs all work together, and need to be kept balanced. If you get one with at least 400 mcg methylfolate, that will bring your folate up nicely, without resorting to folic acid, which is not easily absorbed.

Your D3 dose is much too low, and will not raise your levels. You should be taking at least 5000 iu a day, I believe - if I'm wrong on that, someone please correct me.

[Luna95 in reply to greygoose]

Hi my iron was stopped because in 2016 I had an infusion which boosted ferritin to 189 (15 - 150) but MCV hardly moved up from mid range. Haemoglobin remained low in range and iron remained low in range. Haematology was worried I would have iron overload. Can post full results post infusion if needed.

[greygoose in reply to Luna95]

But that was 2016, it's now nearly 2018, and your ferritin is now much too low. They should be looking at it again and taking action.

[Luna95 in reply to cjrsquared]

Results added

[greygoose]

Oh, that doesn't sound right! I think you should go in and discuss it with your GP! It often happens that GPs know more about thyroid than endos, because endos are usually diabetes specialists who know next to nothing about thyroid - although the myth persists that endos know all about all hormones! They don't.

It is not possibly for an under-active thyroid to suddenly go over-active. That just doesn't happen, I don't care what symptoms you have! You could be over-medicated, but in that case, you would just reduce the levo, not start taking carbimazole, that is very wrong!

Sweats could be due to being hypo, or over-medicated, or just a coincidence. You don't put someone on carbi just because they're sweating! Or, the weight loss could be due to being on the right dose. But, we would have to see the results of your blood tests to understand. Do you have them? If so, post them on here. But, don't take the carbi!

[Luna95 in reply to greygoose]

Thanks results are added

[greygoose in reply to Luna95]

Ah, OK! So, you have Hashi's, and in November, you had a Hashi's flare - aka Hashi's 'hyper' swing - where after an immune attack, the dying cells dumped their stores of thyroid hormone, into the blood, causing levels to temporarily rise. You can see that by December, the excess hormone has been used up/excreted, and you are back to being hypo again. You certainly do not want to take carbi!!! You need and increase in levo.

I'm afraid that, for some unknown reason, endos/GPs have never quite understood antibodies/Hashi's, and what it does, how it works. As soon as they see a suppressed TSH they start to panic, and rush around like headless chickens, without any thought as to why it might be suppressed. For them, all suppressed TSHs indicate hyperthyroidism, whether it does or not.

So, now you can explain it to your witless endo, as I've explained it above. I think that's simple enough for them to understand.

[Luna95 in reply to greygoose]

Thanks