Reading one of the posts earlier today, a well-informed contributor answered a request for help with the ‘fact’ that high TSH means an under-active thyroid. To set the record straight that is not true in all cases. I have non-suppressed TSH (4.6), along with fT4 at 33, and T3 at 6.8. Although the reasons are rare (adenoma, thyroid hormone resistance), there are cases. And we usually keep being misdiagnosed, because doctors fail to look beyond ‘high TSH=hypo’. I’m hyperthyroid at present.
“A high TSH indicates an under-active thyroid” - Thyroid UK
Reading one of the posts earlier today, a well-informed contributor answered a request for help with the ‘fact’ that high TSH means an under-active thyroid.
There are various ways in which thyroid disease can present itself and most of the contributors on here would - at least to begin with - describe the most common presentations, which are Hashimoto's Thyroiditis (Hashi's) for hypothyroidism and Graves' Disease for hyperthyroidism.
But that last sentence is an over-simplification. For example, Hashi's usually starts as "temporary hyperthyroidism" then becomes hypothyroidism later. And people with hyperthyroidism which isn't caused by Hashi's usually develop this condition as a result of toxic nodules in the thyroid or Graves' Disease.
From the reading I've done, based on your results my first guess might have been atrophic thyroiditis which is rare - very few people come here and mention it or the results that underlie it, doctors would very rarely have the knowledge to diagnose it, and the people who come to this forum are the desperate and the undiagnosed.
From what you say it sounds as if you have two conditions in one thyroid, which doesn't sound like fun. Resistance to thyroid hormone comes up quite often, adenomas get mentioned occasionally.
Just out of curiosity, where was your adenoma found? Has it been removed? If not, why not?
For what it is worth, there is a thread on atrophic thyroiditis with a couple of links you might find of interest :
And you might find this website helpful :
Thanks for these helpful comments, humanbeam. I’ll follow up those links.
I had an MRI scan last December which did not show up an adenoma, so my consultant is now thinking about a genetic mutation (possibly inherited) for which I am being referred to Addenbrookes in Cambridge. Sadly, I have no appointment yet, but my bloods have now been similar for almost two years. I’m very much in the dark, so any advice is gratefully received.
I was going to say ...have you considered Covid....but if had odd results for two years ...that’s unlikely
Have you had thyroid ultrasound scan?
Essential to test vitamin D, folate, ferritin and B12 too
I’ve had scan and MRI, but not tests for Vit D, folate and B12. I had ferritin tests two years ago and they were high, but GP seems to have put this down to the diabetes which was diagnosed two weeks later.
Also ....just noticed you are on propranolol....how much propranolol
Propranolol significantly affects thyroid hormones
Came across this article yesterday
A patient on a regimen of 400 mg/day of propranolol hydrochloride was observed to have elevated thyroxine (T4) and free T4 levels with a normal thyrotropin response to protirelin. This led us to study the prevalence of hyperthyroxinemia in 14 consecutively treated patients with hypertension on daily doses of propranolol of 320mg or more. Four of 14 patients had elevated serum T4 levels. As a group, the patients on propranolol therapy had higher serum T4 levels, free T4 indices, and triiodothyronine levels than did healthy controls. The use of high-dosage propranolol may be associated with euthyroid hyperthyroxinemia and be a source of diagnostic confusion. All patients receiving therapy with high-dosage propranolol should undergo protirelin testing before one can conclude that their elevated thyroid hormone levels are due to hyperthyroidism.
I was stuck on low dose propranolol 20 years, despite being hypothyroid.....caused no end of complications (more on my profile)
Propranolol lowers PTH hormones too
This can mess with vitamin D and magnesium levels
Drugs that may decrease PTH include cimetidine and propranolol.
Propranolol and thyroid hormones
I’m on low dose- 10mg three times a day. I was prescribed it because of the anxiety, shakiness, sweating caused by the thyroid problem. It has been very effective in reducing the symptoms. I asked my Consultant in September if I could come off them, but she said not before I’ve seen a specialist at Addenbrookes- I’m having my first meeting in Cambridge next week.
How long been on metaformin
Sweating, especially at night, can be due to low B12
Low vitamin levels can significantly affect thyroid levels
Have you tried low carb diet for diabetes
And/or gluten free diet for thyroid issues
Anxiety can be linked to gluten intolerance
Obviously essential to test all four thyroid antibodies
I’ve been on metformin for two years this month.
So similar time frame to add thyroid results
My diabetes diagnosis led to thyroid test, initially only tsh. The result led GP surgery to think all was okay. It took another 7-8 months of rapid weight loss before I got them to investigate further. Only then did it become clear that I was ‘unusual’.
When did rapid weigh loss start...... before all diagnosis or after starting on metaformin/propranolol
Hashimoto’s frequently starts with transient hyperthyroid results and symptoms and can cause weight loss too
We see many Hashimoto’s patients misdiagnosed as Graves’ disease if all antibodies not tested
(nearly happened to me too 28 years ago....GP assumed Graves I had lost lot of weight....fortunately he was on the ball and tested for Hashimoto’s too)
Anxiety is extremely common hypothyroid symptom too
My weight loss started just before my diabetes diagnosis. So it was believed that the diabetes caused the loss. I’m not so sure, as I have no doubt that there was a problem with my thyroid at the same time. The issue was compounded by the fact that I was initially diagnosed as T2 diabetes and given another medication (dapagliflozin) in addition to metformin which was quickly withdrawn in May 2019 when it was suggested I might not be T2. I was continuing to lose weight throughout this time and only stabilised it when I saw a dietician who told me to ignore a ‘diabetic’ diet as I was becoming malnourished. I had to increase my calorie intake dramatically.
Is your diabetes type one or type 2.?
Type one is autoimmune. Having one autoimmune thyroid disease makes others more likely
Have you had BOTH TPO and TG thyroid antibodies tested for Hashimoto’s (autoimmune hypothyroidism)
And TSI or Trab antibodies tested for Graves’ disease- autoimmune hyperthyroidism
Metaformin can significantly reduce B12 levels and folate
Why were you originally prescribed propranolol?
I am “probably” LADA, according to consultant. This (at the moment) basically means I have autoimmune diabetes, but am not in need of insulin yet. I’m taking metformin to help lower blood sugar levels.
I’m sure I’ve had all the relevant thyroid tests, but I’ll have to check my medical records going back well into 2019.
See my previous answer as to why I’m taking propranolol.
Strongly recommended getting FULL thyroid and vitamin testing done privately if GP won’t do all tests needed
We need OPTIMAL vitamin levels
Vitamin D at least around 80nmol and around 100nmol maybe better
Folate and ferritin at least half way through range
Serum B12 at least over 500
Active B12 over 70
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 .
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
Medichecks Thyroid plus antibodies and vitamins
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
Also vitamin D available as separate test via MMH
Or alternative Vitamin D NHS postal kit
Graves Disease antibodies test
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Can have slightly raised TPO/TG due to Graves
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
Link about Hashimoto’s
Link about Graves’ disease
List of hypothyroid symptoms
Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private
I noticed you mentioned being diabetic.
If you haven't already seen it then you might find this website and forum well worth investigating :