I was really hoping some knowledgable person could help me understand whats going on. I have been diagnosed with: suspected thyrotoxicosis and multinodular goitre. My latest results are as follows: elevated FT4 (19.1 pmol/L) and FT3 (6.6 pmol/L( with suppressed TSH (0.01 mlU/L). Neutrophil counts are within the normal range. Requested the measurement of anti-TSH receptor antibodies (TRab). However I have not received any antibody results as yet? These bloods where taken in March.
From the above results, can somebody tell me how I can understand how normal/abnormal my results are?
Thanks so much.
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melross
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As fuchsia-pink says, we need the ranges to know how abnormal they are. Ranges vary from lab to lab, so we need the ranges used by your lab. But, if they are the most common ranges we see on here, you are far from thyrotoxicosis. I'm afraid that doctors tend to panic when they see a low TSH like yours, and 'diagnose' drastic conditions without taking other levels into consideration. I rather doubt you have Grave's, but it's good that your doctor is testing for them. Most don't bother. But he also ought to be testing for Hashi's: TPO antibodies and Tg antibodies. A multi-nodular goitre and those levels smack more of Hashi's than Grave's.
Thanks for your reply grey goose. As I said to fuschia-pink , I don’t have the ranges as I received the results in a letter so I assume the consultant lifted this info from the lab information minus the ranges.
OK, so Hashi's is an autoimmune disease, where the immune system attacks and slowly destroys the thyroid. It is diagnosed by testing Thyroid Peroxidase (TPO) antibodies and Thyroglobulin (Tg) antibodies.
Contrary to popular belief, it is not the TPO/Tg antibodies themselves that attack the thyroid:
"When lymphocytes infiltrate the thyroid gland, mistakenly taking it for a foreign bacteria invader, they damage the thyroid gland and release thyroid peroxidase &/or thyroglobulin into the blood stream. These don't belong outside of the thyroid gland so antibodies are developed to mop them up.
The antibodies are a result of the attack on the thyroid gland, the antibodies don't cause the attack."
After every immune system attack on the thyroid, the dying cells release their stock of thyroid hormone into the blood stream, causing the levels of the Frees to shoot up - FT4 to around 30 something, FT3 around 11/12 - and the TSH therefore drops to suppressed.
There is no knowing how long these high levels will persist, but eventually, they will drop by themselves as the excess hormone is used up or excreted, and not only will you become hypo again, but slightly more hypo than before, because there is now less thyroid to make hormone.
(NB: A Hashi's 'hyper' swing is not true hyperthyroidism in that your thyroid is over-producing thyroid hormone. It's physically impossible to 'go hyper' if you are basically hypo. The thyroid cannot regenerate itself to the point of over production of hormones - or even normal production. Very few doctors appear to know that.)
Therefore, it's very important that your doctor does not reduce your prescription, because you’re going to need it again! If you start to feel over-medicated at that point - some do, some don't - the best thing is to stop levo for a few days, then, when you feel hypo again, start taking it again. It's very important to know one's body, and how it reacts.
There is no cure for Hashi's - which is probably one of the reasons that doctors ignore it - apart from the fact that they know nothing about it, of course!
However, between the 'hyper' swing, and the descent back into hypothyroidism, there can be a phase - quite a long one, sometimes - of normality, where the person is neither hypo nor 'hyper'. This is where people sometimes start talking of having 'cured' their Hashi's, by whatever means. But, it doesn't last. Eventually, you will go hypo again.
But, there are things the patient can try for him/herself to help them feel a bit better:
a) adopt a 100% gluten-free diet. Hashi's people are often sensitive to gluten, even if they don't have Coeliac disease, so stopping it can make them feel much better. Worth a try. Some say that going gluten-free will reduce antibodies – I’ve never seen conclusive proof of that, but, you should be aware that even if you were to get rid of the antibodies completely, you would still have Hashi's, because the antibodies are not the disease. It is not the TPO/Tg antibodies that do the attacking.
b) take selenium. This is not only reputed to reduce antibodies, but can also help with conversion of T4 to T3 - something that Hashi's people often find difficult.
c) the best way to even out the swings from hypo to 'hyper' (often called Hashi's Flares, but that doesn't really sum up the way it works) is to keep the TSH suppressed. This is difficult because doctors are terrified of a suppressed TSH, for various false reasons, and because they don't understand the workings of Hashi's. But, TSH - Thyroid Stimulating Hormone (a pituitary hormone) - tries to stimulate the thyroid to make more hormone, which also stimulates the immune system to attack. So, the less gland activity there is, the less immune system activity there will be, meaning less attacks, gland destruction slowed down and less swinging from hypo to hyper and back.
Endos always seem to send out results without ranges. I don't know if this is some kind of deliberate ploy, or if they just don't realise - or possibly think that the patient is too stupid to understand and so it doesn't matter anyway. But, it is impossible to interpret results without the ranges.
When were these labs done? Before you started carbi? Or since you've been on it? Your endo really should not have put you on carbi without the antibody results.
Did you have an ultrascan that showed the multi-nodular goitre? Was it said at the time that the scan revealed any traces of Grave's?
The lab results were done in April this year, before I started the Carbizamole.
Long story but I changed consultants. This issue has been ongoing for some time. Approximately a year ago I had scan which highlighted the nodules on my Thyroid. I was told by another consultant that I didn’t have Graves, but as far as I understand I didn’t get tested for Graves. It was myself, this time around who insisted on the antibody tests. Which interestingly I haven’t received the results of yet. I was under the impression they were carried out in April along with the above results and before I was prescribed the medication.
If those labs were done before you started carbi, I'm willing to bet you don't have Grave's. Whatever the ranges, those FT4/3 results just aren't high enough to be Grave's - the TSH is suppressed, yes, and that's enough to send some doctors/endos into a panic and 'diagnose' Grave's, but a suppressed TSH on its own does not automatically mean Grave's. It can be suppressed for all sorts of reason. The Frees, on the other hand, do not say Grave's.
So, if I were you, I'd be chasing those antibody tests/results, get tested for Hashi's, and have a very serious talk with your endo about the carbimazole. You don't want to take it if you don't need it.
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Please help with my results 🙏 
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