Over range FT4 and normal TSH (no medication)

[Elsa1509]

Hi

I have Hashimotos and High TPO and TgAB antibodies. I have never been on any thyroid meds. I had two episodes of thyroiditis 22 years ago after my daughter was born. I’ll have a multinodular gland.

I had a fasting am thyroid test 3 days ago arranged by my GP due to the following symptoms:-

Low grade intermittent fever for 5 days

Extremely weak leg and arm muscles

Significant palpitations especially after any exertion

Excessively warm

Neck, shoulder and back pain

Pain in my thyroid

Significant hand tremor

High BP (159 over 110) at one point

Anxiety and feeling flat (unlike me)

Nausea

Emptying bowels 2 or 3 times a day

Results:

TSH 1.61 (0.34 to 5.70)

FT4 19.8 ( 7.50 - 15.10)!

Normally my TSH is 1 or below!

My FT4 can range from low, to middle range.

I have to be retested in 2 weeks and if FT4 still high then referral to endo.

Any thoughts on these results and symptoms? Thank you so much !

[greygoose]

Looks like your building up to a Hashi's flare, when the dying cells dump their stocks of hormone into the blood stream. Your FT4 could go higher and the TSH lower. But, difficult to predict results when you have Hashi's, because they can jump around all over the place. Unfortunately, doctors/endos do not understand this, and think you've 'gone hyper', totally ignoring the fact that this is physically impossible.

If it is a Hashi's Flare, the levels will eventually go down by themselves, and you will be hypo again. So, resist any pressure to put you on carbimazole unless the numbers go significantly higher. Because once you're on that stuff, they don't want to take you off again.

[Elsa1509 in reply to greygoose]

Thank you so much Greygoose. My low grade fever seems to have passed but I am still getting some hyper symptoms. I thought it could be subacute thyroiditis given the fever and the intermittent pain in my gland. Also I thought it could be one of my 5 nodules playing up! (all gleaned from the internet!)

I have had Hashi flares before (weight loss, panic attacks, racing heart etc) but this episode feels different.

I had a nasty throat virus at the end of Feb so my thoughts were post viral subacute thyroiditis this time.

Also i’ve Never been tested for Graves so was wondering if it could be that?

Also careering towards the menopause ...... 😬

Gosh the thyroid can be complex - at least there are amazing forums like this to refer too! And yes, I will be very wary of any anti thyroid drug being recommended!

Thanks once again.

[greygoose in reply to Elsa1509]

Be careful of symptoms, so many of them cross over and can be either hypo or hyper.

As a general rule, nodules don't cause problems.

post viral subacute thyroiditis would give you low Frees and high TSH, I think.

Those results do not suggest Grave's, but if you can get tested for it, why not.

It can be extremely complicated!

[Elsa1509 in reply to greygoose]

Thank you! It will be interesting to see what the thyroid is doing in a couple of weeks. Thanks once again !

[greygoose in reply to Elsa1509]

You're welcome.

[SlowDragon Administrator]

Have you had vitamin levels tested recently?

Are you already on strictly gluten free diet

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Gluten free diet may reduce hashi flares

Low vitamin D at this time of year is very likely, unless supplementing

[Elsa1509]

Thanks SlowDragon. The only thing I have been really low on in the past is iron. Recent blood tests showed good Vit D (99mol), folate at the very top of the range (!) and B12 at 450.

I have been gluten free for several years but am a big dairy fan (I live on cheese, natural yoghurt and milk). It’s one of my few pleasures as I hardly drink.

I ocassionally supplement with probiotics.

I am prone to a slightly low white cell count and low potassium (has been under range).

I have had a few periods of severe stress recently and a small knee operation so I am wondering if this upset my thyroid (well the inflammation!)

It was just strange to me how the TSH was at 1.61 and the FT4 over range. Even the GP was a bit flummaxed! He said my thyroid may well be going overactive and the TSH will follow!

Thank you!