Drs Appointment - what to ask ?

[Spudley]

Hi All,

I posted the other week about the results of a private blood test

TSH 2.4

Free thyroxine 30

Free t3 6.4

Antibody 10.6

Peroxidase antibody <9

I am suffering from nearly all symptoms of hyperthyroidism but the TSH appears to be normal ? Just wondered what questions / tests I should ask for at docs ? I have been trying to do some research and haven’t found anything where free t4 is high without a decrease in TSH . Can you have hyperthyroidism with normal TSH ?

Thanks for any help/ advice you can give

[jimh111]

Occasionally the TSH assay can give false results due to interference with the assay although it usually gives more weird numbers. Your symptoms and fT3, fT4 clearly show hyperthyroidism so your doctor should send you to an endocrinologist for specialist care. In the meantime your GP should prescribe something to calm down your thyroid (e.g. carbimazole) and possibly a little beta blocker to protect your heart. If they are not experienced in handling hyperthyroidism they should telephone an endocrinologist to get advice on treatment whilst you wait for an appointment.

It's not clear what 'Antibody' is. You will need to be tested for TSH receptor antibodies (TRAb), the endocrinologist will do this.

[Spudley in reply to jimh111]

Thank you so much for your reply ! I have been to doctors with symptoms before but they ( and I ) thought it was all caused by anxiety but I always felt there was something else going on ! I couldn’t tackle the anxiety until I knew for sure there wasn’t another explanation if that makes sense ! I really have felt at times like I was going mad I even thought I was menopausal due to symptoms !

I was just worried that as TSH was normal they would say I’m just been anxious and reading too much into the results, the t3 was in the normal range according to results but it was near the upper range of 6.8 ?

I think I need to push for a referral to endocrinologist for some more tests and some answers/ treatment

[greygoose in reply to Spudley]

Doctors always thing everything is down to anxiety! Don't know what that says about their own levels.

Personally, I would suspect Hashi's, here, rather than Grave's. So, would want to get my TPO antibodies tested. Your GP can do that. I don't believe he can test for TSI or TRAB - Grave's antibodies. And, if you have Hashi's, carbimazole would be the wrong treatment, because your thyroid won't need 'calming down'. It's under attack from the immune system, and being slowly destroyed.

But, that is all conjecture without the antibody tests. So, you do need to get those done as a matter of urgency.

[Spudley in reply to greygoose]

Hi many thanks for your reply , my blood test covered TGab and TPOAb ( I think ) and these were both normal ?The report I had on bloods said no sign of autoimmune thyroid disease.

I know what you mean about assuming anxiety but to be fair that was the first symptom ( and weight loss )

The reason I had a private blood test was because I thought they would just tell me it wa anxiety without looking for a cause if you know what I mean !

Thanks again

[greygoose in reply to Spudley]

I don't think a blood test can show anxiety. But, both hypo and hyperthyroidism can cause it, rather than the anxiety causing your other problems. Doctors don't seem to understand that. Anxiety is a symptom, not a disease.

So, both the TPOab and the TgAB were below the top of the range (normal is not a word we use here, because it's subjective)? It's much, much better if you give us the actual numbers - results and ranges - rather than using words like 'normal', 'high' and 'low', because those are just opinions.

[Spudley in reply to greygoose]

Hi apologies I’m new to all this and getting confused with some of the abbreviations etc my results said this :

Thyroglobulin antibody 10.4 ( 0-115)

Thyroid peroxidase antibody <9 ( 0-39)

From looking at the info on the blood test I had I think this is the TGab test and TPOAb but I’m just guessing !!

[humanbean in reply to Spudley]

You're right.

TPOAb = Thyroid Peroxidase Antibody

TgAb = Thyroglobulin Antibody

This link explaining acronyms and abbreviations you might come across with a thyroid condition is useful - it was written by helvella , one of the admins here :

dropbox.com/s/og3lmxa1dqadb...

[greygoose in reply to Spudley]

Yes, exactly. And they are low. But, that still doesn't rule Hashi's out completely, I'm afraid.

Anyway, next step, you need to get your TRAb or TSI tested, and to do that, you're probably going to need a referral to an endo. But, ask your GP, anyway, see what he says.

[Spudley in reply to greygoose]

Many thanks , I will have to see what GP says, I’m just worrying that they will say there is no problem as TSH was 2.4 so we’ll within range and just leave it at that ! To be honest I’m so fed up of all the symptoms ! But glad I now know some of the questions to ask .

[greygoose in reply to Spudley]

He might well say that, because your TSH is neither hypo nor hyper. And, all they really know about it the TSH. They don't understand the FT4/3. In which case, you have to insist on further testing at a later date. Things can change drastically in a very short time, so you need to be followed, whatever he says when you next see him. Something is not quite right, that's obvious, but what it is, we can't really know, at this point.

Oh, you could ask for an ultrasound of your thyroid. That might give some results.

[jimh111]

Anxiety is a primary symptom of hyperthyroidism. Weight loss is a primary sign of hyperthyroidism. You can rule out autoimmune hypothyroidism from your antibody results. There can be many reasons for your thyroid flaring up, TRAb antibodies is just one and the test is usually done by an endocrinologist. You need a referral to an endocrinologist and some action taken to lower your thyroid hormone levels now so they don't continue causing you distress and to avoid any complications arising from your current hyperthyroid state.

[Spudley in reply to jimh111]

Well had docs appointment today and things are moving in the right direction ! They want to do their own blood test but say if it is still high they will prescribe medicine and refer to specialist.

Thanks everyone who took the time to reply much appreciated