Confused!

[farranccc]

Hi everyone. I posted recently after a blood test indicated a low tsh at 0.2. but T3 and T4 within range. I had never had a thyroid test or any issues that I thought were thyroid related up until that point and am not on medication. Another blood test again showed T3 and T4 within range but TSH down to 0.07

I was referred to an endocrinologist who repeated the tests and antibodies and all were ok except the TSH has now dropped to 0.06.

He has now suggested we wait 4 weeks and try again as it could be silent thyroiditis.

What else could be causing this? Is it potentially a pituitary gland problem? Would I know about it if the had a non-thyroidal illness?

Any help would be warmly welcomed.

[SlowDragon Administrator]

You need vitamin D tested and ferritin

Also thiamine - can be low if stopping alcohol

alcohol.addictionblog.org/t...

[farranccc in reply to SlowDragon]

Hi slowdragon - this has been going on for about 6 months before I decided to take a break from drinking.

Any thoughts about what else could cause this?

Thank for your reply

[SlowDragon Administrator in reply to farranccc]

you could try taking a good quality vitamin B complex, this would improve all B vitamins including thiamine

Your B12 is a bit low anyway and may benefit from improving

Vitamin D tests - NHS postal kit £29

vitamindtest.org.uk

All thyroid tests should be done as early as possible in morning and fasting if you want highest TSH result

7pm is about lowest time of day for TSH

TSH daily variation

healthunlocked.com/thyroidu...

[greygoose]

If it were a pituitary problem, I would expect the Frees to be lower. However, it might just be the onset of a pituitary problem, perhaps, and the Frees might fall with time. So, your endo is right to 'wait and see'. At the moment, you are not hypo, so treatment for that is not necessary.

For me, the next step should be antibody tests. For both Hashi's and Grave's.

What time of day was the blood drawn?

[farranccc in reply to greygoose]

Thanks Greygoose.

I had the antibodies tests and both were negative. All of the blood tests were taken in the afternoon, the last of which was about 7pm.

Would a non-thyroidal illness be obvious? Would I know I had something wrong? Is there anything else that it could be?

Thanks again

[greygoose in reply to farranccc]

Which antibodies did you have done, exactly? Results and ranges? Your doctor may have said they were negative but that doesn't mean they were. We always like to see the numbers.

TSH is highest in the middle of the night, so we always advise people to get their blood drawn as early in the morning as possible. A TSH done in the afternoon is going to be low. And, if you want to be able to compare tests, they all need to be done at the same time of day.

I really don't know what you're saying about a 'non-thyroidal' illness. What are you thinking about? I gather you're worried because your TSH is low, right? I don't know of a non-thyroidal illness that would cause your TSH to be low. If you had a virus, for example, your TSH would more than likely raise, because your conversion would be affected and the FT3 drop. I think your TSH is low because you are having it tested at the time of day when TSH is lowest. Try having it done early in the morning.

[farranccc in reply to greygoose]

Thanks again greygoose. I am not sure which antibodies or results but I’ll ask.

I suppose now that I have had afternoon tests anything in the morning will be higher. If it is in range then would it mean I was ok?

Re the non-thyroidal illness question I read somewhere that low TSH could be caused by an underlying condition but it doesn’t sound like that is the case? I was worried that I could have something nasty causing the result and I wondered if I did whether I would know about it (i.e. by being really poorly)

Is there anything else I should be really worried about that can cause this?

Cheers

[greygoose in reply to farranccc]

If you have an early morning test, your TSH will be higher, yes. But, you can't go by the ranges because they are too wide, and, despite the range, you are hypo when your TSH hits 3.

I'm afraid I don't know of any condition that causes your TSH to be low, apart from Grave's - but that is hardly non-thyroidal!

Why did you have this thyroid test, anyway?

[farranccc in reply to greygoose]

Hi again greygoose - the Dr originally did the thyroid tests as I was having a few strange symptoms; increased urination frequency, slow heart rate and tingling roof of mouth.

Do any of those things sound familiar?

Cheers

[greygoose in reply to farranccc]

Not for me personally, no. Although I believe slow heart rate is a hypo symptom. For the tingling in the roof of the mouth, I would want my B12 tested. And yours is low, so that could be the cause of that.

[farranccc in reply to greygoose]

That is what the endo said about low heart rate but he also said that a low TSH is a hyper symptom.

This is confusing stuff!

[greygoose in reply to farranccc]

Well, yes, I suppose that's one way of describing it. But, there are other reasons for having a low TSH. To be hyper, you also have to have FT4/3 well over-range. So, when you get a situation like that, you do other tests to confirm or refute the hypothesis. And, those other tests are the antibody tests. The problem is, when making a diagnosis, some endos like to skip some of the steps and end up giving people the wrong medication.

[farranccc in reply to greygoose]

What are the main other reasons for a low TSH? Especially if antibodies and FT4/3 are within range?

I worry that people are holding something back. Is there anything ‘nasty’ that can cause it?

[greygoose in reply to farranccc]

Well, IF antibodies are in range, one would have to go with the pituitary theory. And, there are tests for that, if he cares to do them - but most endo prefer to hypothesis and 'suspect' things.

But, certainly Hashi's could be the reason for a suppressed TSH, as could Grave's.

[farranccc in reply to greygoose]

Hmmm pituitary doesn’t sound good if that is the cause. What would be the required test?

From what I have read it is usual that any pituitary tumour is non-cancerous but different and sometimes dangerous to treat?

[greygoose in reply to farranccc]

Yes, a pituitary tumour is normally benign. But, it doesn't have to be a tumour. Have you had any sort of bang to the head? Or heavy bleeding/hemorrhaging?

The pituitary produces a lot of other hormones besides the TSH. So, he should test a couple of those, do an ACTH and/or a pituitary scan.

Anyway, as I said before, I think that if it were the pituitary, the Frees would be lower. My money is on Hashi's.