Test Results Query - Hyperthyroidism?

[Curious123]

Hi everyone. I currently don’t have a diagnosed thyroid disorder. I’ve been feeling a bit wiped out/exhausted and just not right. I got a blood test privately to check my iron panel and both my iron and thyroid were out of whack. Note there is a LOT going on in my life right now (excluding Covid).

TSH: <0.01mIU/L (0.27-4.2)

Free Thyroxine: 29.8pmol/L (12.0-22.0)

Iron: 30.5nmol/L (6.6-26.0)

TIBC: 44umol/L (41-77)

Transferrin Saturation: 69% (41-77)

Ferritin: 344ug/L (13-150)

I spoke to my GP and they have ordered a Blood test to check my TSH today but I don’t think it includes the antibody tests. I have a history of iron deficiency requiring iron infusions so the rising ferritin (it was 182 in early June 2 months ago) is unusual for me.

I was wondering:

1. Does the above test confirm hyperthyroidism or would you need multiple tests in that type of range to support that?

2. Can high stress cause a hyperthyroid result? My ESR was only 6mm/hr (1-20).

3. Can the high ferritin be linked to the thyroid result (cause or effect)?

My dad does have Graves’ disease and I have PA so believe I am at a higher risk for a thyroid issue, but hoping not! Thanks in advance for any insight.

[greygoose]

1) No, it doesn't confirm hyperthyroidism - and certainly not Grave's. You would certainly need more testing to confirm anything:

a) FT3, for a start. That is the most important number. Your TSH can be suppressed, and your FT4 over-range, but your FT3 still not be high enough to make you well.

b) if you suspect Grave's, you need to test for Grave's antibodies: TRAB or TSI.

c) as these results could also suggest Hashimotos Thyroiditis - which starts with a 'hyper' phase - then you need Hashi's antibodies tested, too: TPOab and TgAB. In fact, that FT4 looks more like a Hashi's 'hyper' phase result than a Grave's result. Hashi's - aka Autoimmune Thyroiditis - is an autoimmune disease that slowly destroys the thyroid. But, with Hashi's, it isn't true hyperthyroidism, and the high levels will come down by themselves. And, over time, as more and more of the thyroid is destroyed, you will become hypo.

2) Not sure about that.

3) High ferritin can be linked to inflammation - possibly caused by Hashi's or any other thyroid problem. To know if you have high levels of inflammation you need the CRP tested.

[Curious123 in reply to greygoose]

Thanks. I know my CRP was tested a month ago but I guess a lot can change in a month. My ferritin did rise 70 points in that time. Per my response to Nanaedake below I have historically had a few AB tests which came back negative but something may be happening now. The follow up TSH is on NHS. Do you know if they will test anything else automatically in the lab if the TSH comes back suppressed again? Is there any more information on Hashimotos? I have heard of it before.

[greygoose in reply to Curious123]

Yes, if your ferritin rose that much in that time, it could well be that your inflammation levels also rose.

Difficult to predict what an NHS lab will do, they're a law unto themselves. Sometime they do test other things if the TSH is suppressed.

A brief rundown of Hashi's:

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."

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

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.

You can have Hashi's without ever having an over-range antibody result.

[Curious123 in reply to greygoose]

Thank you for the information greygoose, very helpful.

[greygoose in reply to Curious123]

You're welcome.

[Nanaedake]

You need to have TSH, FT4 and FT3 tested at the same time. The lab should really have done FT3 the first time as that would have been most helpful. I hope they do it this time. To diagnose hyperthyroidism you would need TSI and TRab doing but this is done at the hospital.

[Curious123 in reply to Nanaedake]

Thanks, it was a set package blood test as I was after a full iron panel and the thyroid tests came with it. I was a little surprised they were so far out. My TSH historically sits between 0.5-1.3 (Lower when I’m iron deficient) and free thyroxine around 17-20. I have had TG (15 range <60) and TPO (<28 range <60) tested twice before, latest Jan20 (results in brackets). Perhaps they have now started kicking off. I am GPC positive, IF negative for my PA diagnosis which runs a risk of thyroid issues.

[Nanaedake in reply to Curious123]

You haven't got elevated thyroid antibodies for Hashimotos but without an ultrasound you can't categorically rule it out. However, I would expect the next step is to check FT3. It might mean repeat tests if result is borderline. Then if elevated, check TSI and TRAb for Graves disease but you will need a referral to the hospital Endocrinology dept for that.

[Curious123 in reply to Nanaedake]

I guess those antibody tests were performed 7 months ago so things could have changed. I had an ultrasound of my thyroid last year randomly as a GP thought it looked enlarged. All that came out of it was a borderline large right side. No nodules or anything else.

[Nanaedake in reply to Curious123]

Antibodies are unlikely to fluctuate much since they are in normal range but if thyroid was enlarged it could be worth checking again.

More importantly, get all 3 thyroid hormones checked to make sure FT3 is not elevated above lab range.

[Curious123 in reply to Nanaedake]

Results are in and FT3 is elevated so off to the endocrinologist for me.

[Nanaedake in reply to Curious123]

Make sure they now check TSI and TRAb antibodies as well as TPO and TgAb. Check vit D too. Google to find out who you are being referred to. If possible, try to get referred to a thyroid specialist, not a diabetic specialist. All the best and let us know how it goes.