Advice needed - hypothyroid symptoms with normal TSH

[kindred7]

Hi there,

I was diagnosed with Hashimoto'sin 2007, after a TSH, t3 and t4 test. I don't remember the results for the t3 and t4 but my TSH levels were over 14. I went on synthroid 100 mcg, until 2011 when I started to get hyperthyroid symptoms on it. My resting heart rate went up to 130. My diastolic BP was elevated (from the usual 60-70 to 90, which isn't much but it was a change). I would wake up from sleep with very disruptive palpitations, hitting 140/ minute. After getting some tests done, it turned out I no longer needed the synthroid. As soon as I stopped it, my palpitations stopped, the anxiety went down and BP went down as well.

I'll be honest my thyroid wasn't managed very well, and I don't have a good excuse. I didn't see a doctor for a few years and since I didn't have symptoms, I thought it wasn't something to worry about.

Fast forward to last year, I had a heavy period (was another symptom of thyroid problems for me) that led to severe anemia. Months after this, I am still struggling with shortness of breath and severe fatigue. Heart tests are normal so far. My low normal BP spiked (diastolic) to 108/110, whereas systolic went up to 135ish which isn't much. I have been reading diastolic hypertension can be caused by thyroid problems.

I am losing my hair like it's breaking off at the roots. My pillow is covered in hair every morning. Huge clumps of hair fall out when I comb/wash my hair. I am getting severe cramping in my legs and feet, hands as well. I am also having memory issues, having trouble remembering names and just getting very absent minded. (Head MRI was fine a few months back so it's not neurological). These are symptoms I had before my Hashimoto's diagnosis as well, besides feeling very cold.

Recent blood tests showed a Vitamin D deficiency. Vit B12 was 350. MCV, MCH were low. And RDW was high. My ferritin is 38.

Hb is back up from a 5 to 12.8. My TSH was normal (1.1 at one lab) and 2.9 at another lab, so the t3 and t4 tests were cancelled. But I have been very symptomatic, and I understand these symptoms could be from the deficiencies perhaps, but they're just very similar to what I've experienced in the past with thyroid disease.

I am on metformin for well controlled t2 diabetes (a1c 4.8-4.9), and I have read metformin can lower TSH in diabetics. In your experience, is it possible to have thyroid issues, especially after a Hashimoto's diagnosis years back, but have a normal TSH?

I am going to persuade the doctor to get the t3 and t4 done. But they don't seem to think thyroid issues are possible with a normal TSH. So it's been rough.

Thank you for reading and any comments/thoughts are welcome.

p.s. my red and white blood cell are elevated.

[kindred7]

Forgot to mention I am on a low carb (20-30 grams total/day) gluten free diet.

[Treepie]

Consider getting private testing for the range of thyroid hormones and vitamins.

[Angel_of_the_North]

It's not your TSH that's important, but your actual thyroid hormones. So you need to get and post your Free T4 and free T3 results, and TPO and TG antibodies to see if you have Hashis (autoimmune thyroid disease). If you are in the UK you are entitled by law to a FREE printout of your results. However, the aim for a patient on thyroxine is for TSH to be under 1. Ferritin is is too low to utilise thyroid hormones correctly (needs to be >=70). Metformin will make you deficient in vit B12 unless you are supplmenting (B12 should be over 500 to avoid neurological damage) and that can account for many symptoms, as can vit D deficiency. What is your GP doing about vit D deficiency?

[kindred7 in reply to Angel_of_the_North]

I m in canada. Once the TSH comes out normal, the t3 and t4 orders get cancelled. The doctor hasn't provided a justification for it, which would allow the testing to proceed. I was giving a Hashis diagnosis in 2007, and I am assuming it was from an antibodies test. My latest TPO was in range.

I was taken off synthroid in 2011 after getting hyperthyroid symptoms. I haven't taken it since. I read recently that ferritin needed to be at least 70. If I hadn't signed up to review my results online, I wouldn't have found out for at least a month that my B12 (which is technically in the normal range..supposedly) is low. Met lowers B12 and also TSH. The GP hasn't contacted me about any of this, but I have booked an appointment.

I am currently on 1000IU Vitamin D3, 150 mg Polysachharide Iron (Feramax), B12 1000mcg, 500 Mg of magnesium. Meds: bisoprolol 2.5 mg (for tachycardia and diastolic hypertension which resolved after the first dose), metformin 250 mg twice a day, cetirizine hydrochloride for allergies (take a few days aweek)

thanks for your very helpful post. I have only started learning that my ferritin and b12 are in fact low, despite what's stated on the lab results. I am going to push for t3 and t4 testing once again and opt for private testing if it's nota pproved despite my Hashi's history.