Hyperthyroidism - new

[Eugenie29]

I had a completely normal set of bloods, including thyroid function at the start of December 18. Then at the start of January, I got a sore throat followed by bad pain in my jaw on both sides and in both ears. GP prescribed antibiotics and said it was an ear infection. 10 days of antibiotics made a difference in one side only. Then I developed breathlessness on the slightest exertion eg doing the washing up, pain in the area of my spleen, was totally exhausted and lost a stone in weight in a month. Back to GP and blood results as follows:

T4 38.1 pmol/L (normal range 10.5-24.5)

TSH 0.01 mU/L (normal range 0.27-42)

The GP said (over the phone) it was hyperthyroidism and referred to Endo. No other treatment has been offered and the Endo appointment is in April. However in the last 2 weeks my symptoms have improved. I have put on 4 lbs, am much less tired and am only breathless if I properly exert myself. I also don’t have any pain. I still feel jittery like I have drunk too much coffee all the time and I still have a tremor.

Questions: is a rapid onset of hyperthyroidism normal?

Could it be resolving itself?

What should I expect at the first Endo appointment?

[SeasideSusie Remembering]

This may not be hyperthyroidism but rather autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed.

When the attack happens, the dying cells dump a load of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. These are called 'Hashi's flares' or 'swings' where you go from being "hyper" to being "hypo". The hyper swings are temporary, and eventually things go back to normal.

Hashi's tends to start with a "hyper" phase.

Before being labelled with "hyperthyroidism" and being prescribed carbimazole - which often happens - make sure all thyroid antibodies are tested.

Thyroid Peroxidase (TPO) and Thyroglobulin (Tg) for underactive - Hashi's.

Thyroid Stimulating Immunoglobulin (TSI) and TSH receptor antibodies (TRAb) for overactive - Graves disease.

[SlowDragon Administrator]

Could be De Quervain's Thyroiditis

nhs.uk/conditions/thyroiditis/

Ask GP to test vitamins and thyroid antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested for autoimmune thyroid disease (Hashimoto's)

Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. . This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all 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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

GP could /should test TSI or TRab antibodies for Graves' disease as well

thyroiduk.org.uk/tuk/about_...

Private testing for suspected Graves - TSI or TRab antibodies

medichecks.com/thyroid-func...

[Eugenie29 in reply to SlowDragon]

Thank you. Also had vitamins tested. D, B12 and Follate were normal but Ferritin was 361 ug/L (normal range 13-150). In December it was 101.

[SlowDragon Administrator in reply to Eugenie29]

So your GP should be investigating very high ferritin - are they?

Possible hemochromatosis?

What were actual results and ranges on vitamin D, folate and B12

[Eugenie29 in reply to SlowDragon]

GP is investigating nothing - just told me not to take any iron supplements- which I wasn’t. B12 was 581 mg/L (range 197-771), D was 119 nmol / L (range 80-150), Follate was 6.2 ug/ L (range 3.8- 9999)

[SlowDragon Administrator in reply to Eugenie29]

Folate is on the low side. Increasing green leaf veg and salad in diet

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may also be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two). Or Jarrow B-right

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

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

endocrinenews.endocrine.org...

Vitamin D is excellent. Do you supplement or been somewhere sunny?

High ferritin is apparently often caused by Graves' disease (didn't know that)

ncbi.nlm.nih.gov/pubmed/288...

[Eugenie29 in reply to SlowDragon]

Thank you. That’s really useful information. I supplement the vit D as 3 years ago I was massively deficient and really ill.

[SlowDragon Administrator in reply to Eugenie29]

When low in vitamin D, after supplementing to improve, we apparently also need higher B vitamins

drgominak.com/vitamin-d/

[Eugenie29]

Positive news. GP has ordered all the blood tests you recommended. Thank you so much for your help!