Was i Hypothyroid or did i have euthyroid sick syndrome.

[Angelic69]

Hi again still trying to work out this thyroid stuff. This article

msdmanuals.com/en-gb/profes...

I will right what it states in case the link fails as sometimes it does..

Diagnosis

TSH

Serum cortisol

Clinical judgment

The diagnostic dilemma is whether the patient has hypothyroidism or euthyroid sick syndrome. The best test is measurement of TSH, which in euthyroid sick syndrome is low, normal, or slightly elevated but not as high as it would be in hypothyroidism.

Serum rT3 is elevated, although this measurement is rarely done.

Serum cortisol is often elevated in euthyroid sick syndrome and low or low-normal in hypothyroidism due to pituitary-hypothalamic disease.

Because tests are nonspecific, clinical judgment is required to interpret abnormal thyroid function test results in acutely or chronically ill patients. Unless thyroid dysfunction is highly suspected, thyroid function tests should not be ordered in these patients.

Treatment

Treatment of underlying disorder

Treatment with thyroid hormone replacement is not appropriate. When the underlying disorder is treated, results of thyroid tests normalize.

My question is was i hypothyroid or euthyroid at the beginning of all this thyroid mess. I felt that the replacement thyroid hormones from the start were making me feel ill with graves like symptoms like what i am having now. So may hypothyroid diagnosis came from a TSH of 6 which then gradually increased after taking the levothyroxine. So what is the verdict i say you.

[greygoose]

As you have Hashi's, you were - and probably still are - hypo. Euthyroid Sick Syndrome would not give you high Hashi's antibodies.

[Angelic69 in reply to greygoose]

Ive read it to understand it differently, i was under the impression that you could have an incorrect false high Tsh if you had an underlying chronic condition or an acute temporary stress factor which would correct it self in due course. They diagnosed me with Autoimmune before they checked for Hashis, they must be able to tell another way.

[greygoose in reply to Angelic69]

They can tell from an ultra-sound. Did you have an ultra-sound?

Are you absolutely sure they didn't test for antibodies? As you've never asked for a copy of your test results, how would you know?

Did your high TSH correct itself? Or did it start to come down after you started levo?

[Angelic69 in reply to greygoose]

They did do an ultra sound but after auto immune was diagnosed, a good while after.

They have done antibodies now but not at the first blood draw which they diagnosed me by, unless they did but didn't say that they had. I did have a copy of it and im pretty should it wasn't until the third or four blood draw the checked antibodies.

My initial TSH was about 6, after levothyroxine either 25/50 mcg for the first 4-6 weeks it had gone up to the teens, i think it was about 16, then i was having real bad reaction to the medication, similar to what im having now in fact. It creeped upto about 20s before it came down.

[greygoose in reply to Angelic69]

If you have copies of your blood test results, why have you never posted them? As I said, it's difficult to say anything helpful without seeing them.

My initial TSH was about 6, after levothyroxine either 25/50 mcg for the first 4-6 weeks it had gone up to the teens

That certainly does sound like Hashi's. And proves that you did not have Euthyroid Sick Syndrome.

A bad reaction to levo would not be the cause of your TSH rising.

[Angelic69 in reply to greygoose]

I have posted bloods, dont know why they can not be seen on prior posts.

When i was first diagnosed i was given a leaflet about hypothyroidism. I remember reading that there were several ways in which i could have thyroid disease. One was to have my thyroid gland surgically removed which i had not had done. Secondary was that i had chemo therapy which had destroyed my thyroid gland, again which i had not had and lastly the autoimmune version which was the only option left so thats what i had.

I thought it very odd that my TSH went up after starting thyroid replacement hormone, levothyroxine, i assumed that my body had stopped making its own thyroxine as it was receiving a replacement but the replacement wasn't as good.

[SlowDragon Administrator in reply to Angelic69]

Frequently GP starts people on too low a dose levothyroxine

Levothyroxine doesn’t “top up” a failing thyroid output....it replaces it

Hence more modern thinking suggests starting at higher dose...but many find it difficult to tolerate starting too quickly ...but majority still need to increase dose upwards until on full replacement dose

NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

[SlowDragon Administrator]

Post from 3 years ago here confirms high Tpo antibodies...aka Hashimoto’s

healthunlocked.com/thyroidu...

Hashimoto’s frequently gets worse after quitting smoking

Suggest you get full thyroid and vitamin testing if not been done recently

For full Thyroid evaluation you need TSH, FT4 and FT3 plus EXTREMELY important to test vitamin D, folate, ferritin and B12

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

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

Come back with new post once you get results