What does TSH 0.39 FT4 19.2 T3 5.3 mean? - Thyroid UK

Thyroid UK

111,447 members129,582 posts

What does TSH 0.39 FT4 19.2 T3 5.3 mean?

Agnes_M
Agnes_M

I have heart palpitations, chronic long term insomnia, restlessness, dry tingly mouth, blurred vision, and more.

30 Replies
oldestnewest

We would need to know reference ranges (in brackets next to the test result), and whether you take any thyroid medications to be able to comment.

Agnes_M
Agnes_M in reply to Cooper27

Thanks TSH 0.39 ( 0.27- 4.2) FT4 19.2 (12.0-22.0) T3 5.3 (3.1-6.8) mean? No meds. I’m 39yrs old. Have Goitre and multiple nodule, a few which are U3. I have a tremor also.

Cooper27
Cooper27 in reply to Agnes_M

Thanks for providing. Afraid I'm out of my depth with these results -TSH seems a bit low, but T4 and T3 look alright. Goitre suggests autoimmune thyroid (Hashimotos), so you may wish to test for antibodies. If your having a hashi's flare, it might explain your symptoms.

Hoping someone more knowledgeable will be along soon to give better advice!

Agnes_M
Agnes_M in reply to Cooper27

Thank you, I’ve added photo of antibody results on my question.

Your blood tests and signs and symptoms suggest you are a little hyperthyroid, presumably from the nodules secreting extra hormone. Cholesterol tends to be reduced in hyperthyroidism which suggests you are just a little hyper.

Have you discussed your symptoms with your doctor? It might be worthwhile putting you on a low dose of anti-thyroid medication or better still a beta blocker such as propranolol which will reduce your thyroid hormone level (T3) a little as well as steadying the heart.

I am a patient not a doctor. I would also make sure they don't go over the top with any treatment, you seem just a little hyper but it would be good to protect the heart and resolve your symptoms.

Agnes_M
Agnes_M in reply to jimh111

Thanks. I’m seeing a specialist for a follow up appointment next week, he originally suspected I may have a pituitary problem. But I’m getting no where fast, and desperate to get to the bottom of what’s going on. I feel like things are getting worse and my symptoms feel scary sometimes and I’m concerned for my heart. I fainted the other day out of nowhere after feeling a little stressed and was kept in hospital over night. I’m worried about the long term consequences of no sleep for the best part of 20yrs. I am puzzled by the high cholesterol as I live like a saint, due to feeling extra rubbish if I don’t. Hardly any processed food, herbal tea/water, lots of fruit and veg, low carb, low dairy (occasional organ yogurt) vegetarian diet, occasional oily fish, some olive and coconut oil, no cakes, pastries etc and gluten free.

SlowDragon
SlowDragonAdministrator

Essential to test vitamin D, folate, ferritin and B12 too

High cholesterol suggests Hashimoto’s (hypothyroidism)

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Next step ...ask for vitamin levels to be tested ...plus Coeliac blood test too

Agnes_M
Agnes_M in reply to SlowDragon

Thanks, I’ve updated the photo to show results for the mentioned blood tests. The glucose test says random but is fasting (around 8hrs). Was suspected coeliac or gluten intolerant due to malabsorption and other symptoms around 10yrs ago. Went on a gf diet straight away and didn’t an endoscopy till many months after so result was inconclusive. Thanks for your help.

SlowDragon
SlowDragonAdministrator in reply to Agnes_M

Sorry can’t read results in photos

As you are strictly gluten free this also strongly suggests Hashimoto’s...and on Strictly gluten free diet TPO antibodies frequently drop back within range

High cholesterol is linked to being hypothyroid

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Come back with new post once you get vitamin results

Agnes_M
Agnes_M in reply to SlowDragon

Thank you, I’ve tried grouping them all together as only allowed one photo. I will write them out. Thanks very much!

I am puzzled by the high cholesterol as I live like a saint, due to feeling extra rubbish if I don’t. Hardly any processed food, herbal tea/water, lots of fruit and veg, low carb, low dairy (occasional organ yogurt) vegetarian diet, occasional oily fish, some olive and coconut oil, no cakes, pastries etc and gluten free.

Cholesterol levels have little to do with what you eat. It's made in the liver and the more you eat, the less the liver makes. The less you eat, the more the liver makes to try and maintain a steady level. However, if T3 is low, the body cannot process and eliminate cholesterol correctly, and it mounts up in the blood.

It certainly has nothing whatsoever to do with the amount of fat you consume. Fat and cholesterol are two entirely different substances and do not magically change into eat other when you consume them.

But, your cholesterol is only slightly elevated. Absolutely nothing to worry about. Even high levels of cholesterol do not cause heart attacks or strokes. High cholesterol is a symptom, not a disease.

I, too, think you have Hashi's, and that you are coming down from a Hashi's 'hyper' swing. But, you are not hyper anymore. Your levels will probably go down even further, and your TSH rise. If you have uncomfortable palps, etc. a beta blocker might be a good idea, but not propranolol as that will affect your conversion, which doesn't need reducing any further.

Is this the first thyroid blood test you've ever had? If not, what were the other like?

jimh111
jimh111 in reply to greygoose

I suggested propranolol because it reduces T4 to T3 conversion. Agnes has insomnia, restlessness and a tremor all of which indicate hyperthyroidism. It's probable her nodule is autonomously secreting hormone causing mild hyperthyroidism. In the longer term she will prossibly develop hypothyroidism but it's too soon to tell. It depends on the nature of the nodule and whether its secretion increases over time or tails off.

Previous blood tests with low normal TSH, fT4 and high normal fT3 would be consistent with autonomously secreting nodules.

Ideally carbimazole and another beta blocker might give more prefect results but I suspect it would be too difficult to get the carbimazole dose at the right level as it is rather crude in the way it works. Hence my suggestion of propranolol as she would be taking just one medicine and it is easier to titrate.

Cholesterol is a rough marker for thyroid status, it varies a lot between individuals. I thought I saw some numbers for cholesterol (or a comment saying it was a little high) but don't see them now. Perhaps Agnes amended her post.

greygoose
greygoose in reply to jimh111

It's probable her nodule is autonomously secreting hormone causing mild hyperthyroidism.

That is always a possibility. But, surely if that were the case, it would show up in the blood test. As it is, her FT3 is not that much over mid-range.

Previous blood tests with low normal TSH, fT4 and high normal fT3 would be consistent with autonomously secreting nodules.

Indeed. But, do we have those previous blood tests? We haven't actually seen them, have we? And you didn't know about previous blood tests when you wrote your reply, and you didn't ask. But, in any case, her FT3 is not high now.

jimh111
jimh111 in reply to greygoose

You're correct on both points. Her combined fT3 and fT4 are high when viewed toghether along with signs and symptoms of hyperthyroidism. I suggested propranolol because it will reduce T3 a little and so normalise the overall hormone level. It's a gentle approach that should correct what appears to be mild hyperthyroidism (at least at the moment). The other advantage is that propranolol reduces type-1 deiodinase (D1) which supplies circulating T3. It doesn't affect D2 which regulates local or intracellular T3.

We now know previous blood test results and they are consistent with autonomous secretion. Agnes's fT3 is not high when viewed by itself but I always advocate that TSH, fT3 , fT4 must be interpreted as a single system, they are not independent. For example, low normal TSH, fT3, fT4 is abnormal and usually associated with quite severe hypothyrodism. Similarly, high normal fT4 and just above average fT3 is not normal, especially when accompanied by signs and symptoms of hyperthyroidism.

I'm trying to suggest a gentle way of treating the signs and symptoms of what appears to be mild hyperthyroidsm and it propranolol would be a first choice because it protects the heart and reduces circulatinig T3 levels a little.

greygoose
greygoose in reply to jimh111

I agree that TSH, FT4 and FT3 should be interpreted together. But, what those results suggest to me is that she's coming down from a Hashi's 'hyper' swing. The FT3 has gone down, but the TSH is lagging behind, as it does. And, what she says about her previous results would appear to support that view. And, if that is the case, the FT4/3 levels will continue to drop - probably revealing poor conversion.

However, I'm never happy when people tell me that this is high and that is low, I like to see the actual numbers. Because it's amazing how distorted people's views of their own lab results can be.

jimh111
jimh111 in reply to greygoose

It was the 'chronic long term insomnia, restlessness' and 'I have a tremor also.' comments that suggested persistent mild hyperthyroidism. So, treat the current hyperthyroidism, protect the heart and relieve symptoms now. The nodules may get worse with higher hormone levels and more drastic treatment needed or they may burn themselves out leading to hypothyroidism but for now there is hyperthyroidism with symptoms that have been around for a long while (insomnia for 20 years).

I'm just suggesting treat the current symtoms and see if it gives relief. Hopefully the specialist will be able to give more information next week.

greygoose
greygoose in reply to jimh111

Well, I've said what I think. I'm not going to argue about it. I suppose the only way for the OP to find out is to try. :)

Agnes_M
Agnes_M in reply to greygoose

Hi, over past tests my TSH fluctuates between 0.4 and 1.36 (0.27-4.2) Whilst my T4 stays constant at 11 (12.0-22.0), this is I think why the endo suspected a pituitary related problem. On both occasions that my T3 has been tested it has been 5.3 (3.1-6.8).

jimh111
jimh111 in reply to Agnes_M

I don't think it is a pituitary problem as TSH stimultes throid secretion and conversion of T4 to T3 (endocrinologists always overlook the latter). If there was a pituitary problem your fT3 would be lower.

Most likely your nodules are producing excess hormone, they usually pump out T3 consistent with your slightly higher fT3 that lowers TSH with less stimulation of the thyroid and hence lower fT4.

It's qute possible your thyroid will progressively fail in time but for now I would treat your minor hyperthyroidism, gently, and not overdo it. See what the specialist says but if they have no idea suggest the nodule is secreting T3 leading to lower TSH and T4.

I would avoid any drastic actions such as aggressive medication treatment. Also removing the thyroid with surgery or radioiodine is not appropriate unless they suspect the nodules may be cancerous or cause swallowing difficulties.

Agnes_M
Agnes_M in reply to jimh111

Thank you :)

greygoose
greygoose in reply to jimh111

So, how do you treat a nodule to stop it producing hormone?

jimh111
jimh111 in reply to greygoose

I'd be tempted not to treat it unless there's little choice. If it is causing pain, obstructing breathing or vocal cords or cancerous you have to use RAI or surgery. If it's just producing too much hormone (especially T3) you can reduce hormone levels with carbimazole or propranolol.

It will probably burn itself out in time and perhaps Agnes will become hypothyroid. If it gets worse and causes physical problems, or hormone levels can't be controlled with anti-thyroid drugs then you have to revert to RAI or surgery.

Agnes is getting cardiac symptoms and concerned about her heart. It will probably be temporary but there is a need to address her (probably) short-term hyperthyroidism. Hyperthyroidism causes structual changes in the heart and also affects the electrical stucture leading to atrial fibrillation (AF). Apart from the health issues and distress there are financial consequences of AF. If you need to take tablets for the heart it can be difficult to get health insurance or holiday insurance, at the very least it becomes expensive. Agnes may become hypothyroid in the future but there are multiple reasons to control her (mild) hyperthyroidism at the moment.

greygoose
greygoose in reply to jimh111

Thank you.

"It certainly has nothing whatsoever to do with the amount of fat you consume. Fat and cholesterol are two entirely different substances and do not magically change into eat other when you consume them."

Many doctors don´t know that. I was recently told to switch from full fat to low fat products after my triglycerides came back slightly out of range. The doctor wanted to refer me to a dietician but I said no, knowing fully well what she would say...my father has a heart condition and was referred to one, and she told him to avoid butter and choose margarine instead...when I read about what margarine contains, I cannot understand that anyone would want to consume that...!

Oh, I know! Doctors can be so anti-fat. I had one once have a hissy fit in the surgery when I said I ate butter. He went absolutely bananas, and told me I was 'blocking my arteries'! Silly man.

Little story about margarine. It was first invented in the US to feed turkeys. The turkeys all died, so they decided to market the margarine to humans, as a 'healthy' alternative to butter! Unbelievable!

High triglycerides is usually caused by high levels of carbs, not fats. You might like this picture :

twitter.com/lowcarbGP/statu...

So true...my triglycerides levels have always been well in range (<75 where they should be) until last year when they spiked to >150...at the same time, my blood sugar and insulin levels rose and a 24 h saliva test showed slightly elevated cortisol levels throughout the day...cortisol is known to raise blood sugar which in turn raises insulin. Not that most doctors would know that, of course...so what you´re saying is absolutely true. Looking back, I realise that I had increased cravings which made me eat more fast carbs than usual and boom...triglyceride levels doubled in no time without any increase in fat intake. My doctor wanted me on Crestor but there was no way I was going to take that.

I’ve had other tests, it usually shows low end TSH and low end T4. I’ve only had a couple over T3 but both in high/normal range. Thanks, any idea about how to lower cholesterol then if not through diet?

greygoose
greygoose in reply to Agnes_M

You don't need to lower cholesterol. It isn't a problem. It isn't even very high according to the results you posted. And, the do say, the higher your cholesterol, the longer you live! Do you know what cholesterol is?

greygoose
greygoose in reply to Agnes_M

Oh, and when I asked about previous blood tests, I thought you might give the actual numbers: results and ranges. Just saying 'high' or 'low' doesn't give us much information. :)

You may also like...