Symptoms of hyper but TSH of hypo?!

[Hannah5273]

Hi there. I have Hashimotos and I’ve always struggled with getting the right dose of Levothyroxine/Eutirox. I have been feeling the symptoms of hyperthyroidism- very hot, sweating, racing heart, heart flutters, very hungry, diarrhea. This has been for a number of weeks. However when I had a blood test my TSH was 5.7. So I’m very confused. Any ideas? Thank you!

[SlowDragon Administrator]

When extremely hypo symptoms can be very similar to hyperthyroid

Too much adrenaline trying to compensate for lack of thyroid hormones

Just testing TSH is completely inadequate

With Hashimoto’s low vitamins are extremely common

Are you on strictly gluten free diet?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Ask GP to test vitamin levels

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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[HowCome in reply to SlowDragon]

“When extremely hypo symptoms can be very similar to hyperthyroid

Too much adrenaline trying to compensate for lack of thyroid hormones“

Thankyou, SlowDragon.... been around this board on & off, for a while, and don’t recall learning this, but might explain some things.

Like why i have spells of weight loss, instead of “typical” hypo weight gain. (Hunger is fairly standard too!)

Would you or anyone else care to comment on the idea that hyper symptoms might occur because the thyroid tissue may be breaking down more than normal (under a fresh attack from one or more autoimmune antibodies), causing more thyroid hormone to be released for a few days or weeks?

And does anyone suspect these episodes may be stress-related, and connected with activity of the adrenals? (whether cause or effect - or both??)

Many many thanks (especially for continuing to post all the reminders about best approach to testing etc - SlowDragon and our other Admins & peer supporters.)

[SlowDragon Administrator in reply to HowCome]

High cortisol can be problem when very hypo ...can eventually lead to adrenal exhaustion

High cortisol can increase hunger

health.harvard.edu/staying-...

Have you ever done saliva cortisol test ?

regeneruslabs.com/products/...

cdn.shopify.com/s/files/1/0...

Yes Hashimoto’s swings or flares can cause wide variation in Ft4 and Ft3 levels, not always reflected in TSH

[SeasideSusie Remembering in reply to HowCome]

HowCome

Would you or anyone else care to comment on the idea that hyper symptoms might occur because the thyroid tissue may be breaking down more than normal (under a fresh attack from one or more autoimmune antibodies), causing more thyroid hormone to be released for a few days or weeks?

When the immune system attacks the thyroid (which is what happens with Hashi's), the dying cells release a lot 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'. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds can be adjusted slightly at these times if necessary, but will need readjusting when hypo symptoms return.

Obviously you have raised TSH at the moment, but I don't think anyone can really explain what's going on with Hashi's.

Here are a few links that might be helpful:

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

[Hannah5273]

Thank you very all for your very helpful comments and suggestions. Very much appreciated.