TSH going up, normal T3

[lily82]

Hi

I went to see an endocrinologist who went over my test results.

My results back in 2009 (was tested due to period changes)

Free T4 16.5 pmol/l (9.8 - 23.1)

TSH 0.73 mu/L (0.35- 5.50)

My test results in November 2017 were

TSH 3.41 mu/L (0.30- 4.40)

Free T4 level 10.9 pmol/L (9.0-19.1)

My results in February 2018 were

TSH *4.57 mIU/L (0.27 - 4.20)

FREE THYROXINE (FT4) *11.4 pmol/L (12.00 - 22.00)

TOTAL THYROXINE(T4) 73.4 nmol/L (59.00 - 154.00)

FREE T3 4.8 pmol/L (3.10 - 6.80)

THYROGLOBULIN ANTIBODY <10 IU/mL (0.00 - 115.00)

THYROID PEROXIDASE ANTIBODIES 11 IU/mL (0.00 - 34.00)

He did some explaining but I've forgotten what he said (suffering with memory issues at the moment), about what certain levels mean if they go up and down.

He said that it was 'odd' that my T3 was good, but my TSH was rising. What does that indicate?

He's sending me for blood tests to do further monitoring.

I don't have Hashimotos as I don't have any antibodies, and he says it's unlikely to be a pituitary issue. What else could be causing this? (He's also looking into the possibility that I'm going through premature peri-menopause as well)

Could someone explain what this all means, please?

Thanks

[greygoose]

What was his conclusion after the February test? Did he diagnose you? Because you are hypo. Your TSH is over-range and your FT4 is under-range. What more does he want?

Your FT3 isn't quite mid-range. I'm not sure I would call that 'good', given the other levels. It's probably your high TSH driving conversion, but that can't keep up forever because your FT4 is so low. Soon, you'll have nothing to convert. Is he really going to let you get that ill before he does something?

Pity you forgot his explanations, I would have loved to have heard them! Could do with a good laugh after the day I've had!

[lily82 in reply to greygoose]

I've only now seen an endocrinologist, the tests were done through the GP. They refused to refer me, so I went private (endo also works on NHS). So he's likely going to refer me back to the NHS if he thinks I need treatment.

[greygoose in reply to lily82]

You do need treatment. You are hypo.

[jimh111]

It's not odd that fT3 is good when TSH is rising and fT4 low. This is how it works, as TSH goes up the thyroid converts more T4 to T3 in an attempt to preserve T3 levels since T3 is the active hormone. Your endocrinologist is lacking knowledge, this is about par for the course. You need to receive thyroid hormone treatment.

[lily82 in reply to jimh111]

I think he meant that it was 'odd' as in, this isn't healthy. So is sending me to be re-tested.

[jimh111 in reply to lily82]

Oh, I misunderstood. A retest is a good idea. Your low antibody counts show you don't have autoimmune hypothyroidism. It's possible you have thyroiditis that is causing hypothyroidism as your fT4 is low. However, this can work itself out and spontaneously recover so a retest is a prudent step. If your fT4 hasn't recovered I would ask for a trial of levothyroxine, perhaps 50 mcg, more than 25 mcg as it's too little to notice a difference.

[lily82 in reply to jimh111]

No worries.

I've been ill a lot with infections-I've had chronic untreated Rheumatic Fever (was misdiagnosed several times by GP as having allergies)- waiting to see infectious diseases and a cardiologist. So I've had a lot of episodes of major inflammation and ill health. He asked a lot about my general health. Can infections cause/ trigger thyroiditis? My thyroid levels were fine when they were taken 9 years ago, and that's around the time my periods became more frequent.

I'm also wondering if premature menopause can affect the thyroid, as that's something he's looking into. Having all my hormone levels tested at the same time.

When I was younger, 11+ I had a lot of symptoms of overactive thyroid- and I was having hair loss/ thinning, longer than 10 years ago. That's when the Rheumatic Fever started. Yet now, I've got the opposite symptoms.

[Angel_of_the_North in reply to lily82]

More likely being hypo has contributed to premature menopause. All sorts of things can effect the thyroid, including pesticides and herbicides, infections and head injuries.

[SlowDragon Administrator in reply to lily82]

Google suggests there may be link between rheumatic fever and Hashimoto's

Ask for ultrasound scan of thyroid

[lily82 in reply to SlowDragon]

Oh thanks!

It wouldn't be surprising. If Rheumatic Fever damages the heart and brain, no reason that it wouldn't damage the thyroid too.

[SlowDragon Administrator]

You need vitamin D, folate, ferritin and B12 tested

Ask GP to test if endo hasn't done them

Or Private tests are available.

Thousands on here forced to do this as NHS often refuses to test vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting. This gives highest TSH and most consistent results. (Patient to patient tip, GP will be unaware)

Is this how tests were done

[lily82 in reply to SlowDragon]

Thanks.

He's testing my vitamin D levels.

My folate, ferritin and B12 is fine.

[SlowDragon Administrator in reply to lily82]

Can you add actual results and ranges on folate, ferritin and B12

These need to be optimal, not just somewhere within range

[lily82 in reply to SlowDragon]

I was having super heavy and frequent periods for years, which is why they tested my ferritin and thyroid levels. I haven't had a proper period for the past 6 months, and the endo is doing more tests to find out why.

Ferritin 45 ug/L (15-300)

Folate is 20. 7 ug/ L (2-20 ug/L)

B12 259 ng/l (130- 900)

I have been supplementing with B12 and iron, despite being told these levels were 'normal'. I've been taking high doses of B12.

[SlowDragon Administrator in reply to lily82]

Ferritin needs to be minimum of 70 for good thyroid

But essential to test iron not just assume that low ferritin is also low iron.

B12 is far too low, anything under 500 is likely too low

When supplementing B12 also recommended on here to supplement a good quality vitamin B complex too, one with folate in rather than folic acid

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Apparently about 20% with Hashimoto's never have high antibodies

An ultrasound of thyroid might reveal more

thyroidpharmacist.com/artic...

[lily82 in reply to SlowDragon]

Thanks for the info

I'm hoping that the ferritin levels have sorted themselves out by now, as I was having very heavy and frequent periods. Maybe it was just a temporary thing, as my previous ferritin levels were OK.

And thanks for the heads up about the biotin.

[Angel_of_the_North]

Well, it's not *that* odd. Generally, the body does what it can to keep you going and one of the signs of hypo is that FT4 drops and FT3 stays relatively good as the body is putting all its energy into converting what little T4 you have into T3 so you don't die. You are very undermedicated and need an increase in levo. Or if you are not medicated, you should be.

[lily82 in reply to Angel_of_the_North]

Would that be why I feel like I'm running on empty? I also feel an absolute wreck, mentally. I can't cope with anything.

[Angel_of_the_North in reply to lily82]

Very likely.