Toxic goiter with normal lab values; is it possible?

[roukounasGK]

Hello everyone! I'm new here but it's very helpful to know that other people have similar issues to myself. I wanted to ask you your opinion or private experience on a strange case which is happening to me.

I have had hashimoto for 20 years now, and I am on levo without any issues or symptoms (it was diagnosed quite early).

Around 7 months ago, my endo decided that I should try to reduce my levo medication, since newer studies suggest that it is not so helpful on hashimoto and I was quite stable on my lab results for years.

Have you heard before that levo is not so helpful?

After 3 months from reducing the medication from 1,25 mg to 1 mg, my tsh was increased (but well within normal) from 1,8 to 2,7. My endo suggested that I was well within range (0.5-4.3) so I should remain with this medication.

After a while, I got sick with dizziness, palpitations, low grade fever for around 2 months. I had tons of tests. No one could find what it was, and it got well by itself.

Afterwards, I had a painful lump on my thyroid, like it was swollen and inflamed. And since then I have the classic hyperthyroidism symptoms, i.e. palpitations, dizziness, heat intolerance, jittery, flushed red face etc. I performed the classic thyroid tests and TSH was still 2,7.

So my Endo sent me away as something psychological, and that I should consult with a psychologist!!! Even though he also agreed that I have an enlarged inflamed thyroid, he suggested that this should not cause any issues and it may happen.

So I would be interested to find out from your experience is if it is possible to have hyperthyroidism symptoms with such a normal TSH of 2.7?

And if so, then can it be caused by the reduction of levo?

And if so how can I be sure? Is there any additional testing?

I'm sorry for the long post, but I wanted to present as much information as possible, so that it may help others with similar issues.

[Angel_of_the_North]

I would ask to increase your levo back to what it was. Very few healthy people have a TSH over 2.5 and most are around 1.2. There was no reason to reduce it and you have gone from being well to being ill - QED. You are not a personal experiment for your doctor - I'd find a new one with more of a clue. knowing your actual thyroid hormone levels would be useful, too

[roukounasGK in reply to Angel_of_the_North]

Hey angel_of_the_north,

Thank you very much for your reply. I tend to agree with you that I should go back to my first dosage. However it seems very strange that such a slight increase would cause so strong symptoms. I mean if my tsh was for example 4, or 0, 7 i.e. within range but close to the limits I would understand it. The 2,7 seems a very slight increase, so I wondered if it is indeed on my mind. This is the reason I asked here.

My lab tests are:

Initially, prior to cutting my dosage down:

Tsh: 1,84 (0, 5 - 4,5)

Ft3: 3,01 (1,8 - 4,4)

Ft4: 1,26 (0,93 - 1,7)

After 3 months of cutting down my dosage and just prior to getting sick:

Tsh: 2,78 (0, 5 - 4,5)

Ft3: 3,2 (1,8 - 4,4)

Ft4: 1,23 (0,93 - 1,7)

Now after 2 months of illness (not sure if it was a virus or a thyroid issue) and another 2 months of swollen inflamed thyroid I am almost the same with the above.

[Angel_of_the_North in reply to roukounasGK]

Everyone has their own sweet spot, and , to be honest, your results weren't great before the reduction, The dose reduction is the only major change you've made, so seems like the first thing to try. For many people with autoimmune thyroid disease (hashis) allowing TSH to rise provokes an attack. The rise in TSH might sound small, but it is a rise of 23.5% in the range. It will probably take a quite a few months to get back to your original stable state.

[roukounasGK in reply to Angel_of_the_North]

It is either the dose change, or the illness I passed through. we are not sure if it was a virus or a thyroid issue from start, but I remember I have read somewhere that a virus can trigger toxic goiters. So maybe the dosage change had nothing to do with my symptoms, and I had a strange virus which triggered everything.

This is the reason I'm asking here if it is possible to have such symptoms with a tsh of 2,7: so that I can determine whether the dosage change had to do with my symptoms or the virus (if it was indeed a virus).

On any case, there is nothing else to do other than try to change my dosage and see where it goes.

Thank you for your help; I assume from your answer that you indeed consider it possible to have such symptoms with such values, so my question is answered!