High t4/High TSH

[ed2w]

What does it mean when you have a t4 and TSH at the same time?

I was very sick with a hyperthyroid over the summer, I took CArbimazole and it made a massive difference. I reduced my dose to 5mg a day but my last blood test showed high in both which was strange because previously my T4 was high and TSH was low.

[greygoose]

Can you give us the exact numbers and ranges, please. That helps to understand better. Did you not have an FT3 tested? What about antibodies? Have any antibodies been tested? If so, which ones?

[ed2w in reply to greygoose]

when i started in August it was:

TSH - 0.001 (0.27 - 4.2)

T4 - 36 (12 - 22)

November it was:

TSH - 2.3

T4- 16.6

most recent test was

tsh - 3.6 (0.27 - 4.2)

t4 - 19.6 (12 - 22)

Just wandering why it's trending upwards, all my antibodies tests came back negative.

It's a nightmare asking for printouts of those details, my gp can do the basic tests but the endo does all the antibodies and its bureaucratic as hell, but he assured me all the antibodies tests were fine. I'm on 5mg carbimazole.

[ed2w in reply to ed2w]

THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 - 115.00

THYROID PEROXIDASE ANTIBODIES 10.4 IU/mL 0.00 - 34.00

[ed2w in reply to ed2w]

What other antibodies do you think I should ask for again?

[Marz]

Please read through your post of 3 months ago where you had excellent advice and where members suggested you post your results. The very last reply was from diogenes - a Research Analyst involved in Thyroid research - you did not respond.

We still await the results you were going to post three months ago. I appreciate you feel poorly but it is difficult to support you without the information requested by many people last time.

Sounds like Hashi's ... 😊

[ed2w in reply to Marz]

lol 3 months ago, you have a better memory than me

[Marz in reply to ed2w]

No I clicked onto your username before replying ! You can do the same to read the thread and the advice given ...

[ed2w in reply to Marz]

SO what anti-bodies results am I asking for specifically this time? To prove whether it is or isn't hashis? I have been told multiple times that I have no issues with antibodies.

This was in my letter from my endo last month

"The reason I was not prepared to diagnose Graves’ disease as the cause of your hyperthyroidism just yet was that your thyroid autoantibodies are all negative. In other words there is no confirmation of underlying thyroid autoimmunity. Specifically the TSH receptor antibodies were not positive. These are the typical Graves’ disease antibodies."

[greygoose in reply to ed2w]

Oh, you have an intelligent endo! He actually tested for Grave's.

OK, so you don't have Grave's, we won't mention that again.

But, even without high antibodies, you do appear to have Hashi's. Hashi's antibodies come and go - and he did test for both of them, according to the results you've given above - so you cannot rule it out on the basis of one negative blood test. Also, it is possible to have Hashi's, without ever having raised antibodies. And, the proof of that would be an ultrasound, which would show up any abnormalities and/or damage done by the Hashi's.

However, just looking at your FT4 results tells me that you have Hashi's. Those are typical Hashi's results the way your FT4 swings from one extreme to the other. And it will do that even if you're taking carbi.

So, at the moment, you have a high-ish in-range TSH, and a high-ish in-range FT4. BUT, you do not have an FT3 results, which would complete the picture. Lots of Hashi's people have trouble converting, so your FT3 could be low, even when your FT4 is high. And, that would account for the high TSH.

So, what are you taking at the moment?

[ed2w in reply to greygoose]

Awesome thanks, 5mg carbimazole daily. Getting an ultrasound scan this week. Just to clarify when I started the carbimazole within 2 months a lot of my symptoms improved.

[greygoose in reply to ed2w]

Possibly, but now you are hypo. And, as you don't have Grave's, you should talk to your endo about coming off the carbi altogether.

[diogenes Remembering]

Patients who are hyperthyroid on carbimazole have to be very careful about dosage nd its not necessarily a permanent solution. The trouble is that TSH doesn't respond quickly to dose changes so you might think "Oh the medication isn't working" and take more. Then you'll get "boomeranged" into overdosing and your FT4 will drop too much but you still might be hyper with still too high an FT3. I feel that patients on carbimazole have to be closely monitored and just leaving things to work out won't be any good. In short you are in an unstable condition and need close attention by the medics to find an acceptable dose. You also have the problem that the whole underlying thing is a moving feast ie your condition may be worsening and getting out of control even with carbimazole. It's then why RAI or thyroidectomy has to come in.