Low TSH on no meds - should I be concerned or not?

[treevee]

Hi

I have been poorly since contracting Lyme disease in the summer so have been thinking if thyroid problem could be at the root of my fatigue and other symptoms, or at least hindering my recovery (symptoms like extreme fatigue, brain fog, anxiety, weird eyesight, tinnitus, dry skin and so on). I do not take any thyroid meds. Looking over my thyroid tests from the GP in the past and more recently I have found these results:

30/08/2019 TSH 0.07 (0.2-5.5 miu/L) and T3 5.2 (3.1-6.8 pmol/L)

25/11/2020 TSH 0.09 0.2-5.5 miu/L)

18/12/20200.2 0.2-5.5 miu/L) T4 16 10-24.5 pmol/L

The GP isn't worried about my TSH being so low, and the lab wouldn't test for antibodies so I've recently had Medichecks done and the results are below. Please note I did all the tests as suggested, early in morning, no Biotin. I am on B12 injections and have been supplementing with Vit D. I'm a 57 year old woman (not sure if that has any relevance!)

CRP HS <0.3 mg/L (Range: < 5)

Ferritin 83.60 ug/L (Range: 13 - 150)

Folate - Serum 19.05 ug/L (Range: > 3.89)

Vitamin B12 - Active >150 pmol/L (Range: > 37.5)

Vitamin D 95.10 nmol/L (Range: 50 - 175)

TSH X 0.13 mIU/L (Range: 0.27 - 4.2)

Free T3 5.03 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 18.300 pmol/L (Range: 12 - 22)

Thyroglobulin Antibodies 10.100 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies <9.0 kIU/L (Range: < 34)

So it doesn't look like any problems overall I don't think and the only thing unusual is that low TSH.

I am wondering if I should be concerned about this low TSH or not? Maybe adrenal fatigue is actually my issue and that's what I'm looking at next I think, but putting this one out to the hive minds on here.

Might I just also say, I have found this forum incredibly interesting and helpful while I've been going through this process of chasing answers.

Many thanks for this

[jimh111]

If your Lymes disease caused severe symptoms it's possible you had non-thyroidal illness (NTI) or 'low T3 syndrome'. This can lower TSH and T3 levels but your fT3 is fine.

It's just possible you have elevated Graves' antibodies (TRAb) as these can cause a low TSH except your fT3, fT4 are perfectly normal.

Your symptoms could be hypo, hyper or not thyroid so it's difficult to diagnose. I'd be wary of taking thyroid hormone as lowering your TSH further would impede its recovery. On the other hand your symptoms are consistent with hypothyroidism.

The above is not very helpful but I'm just laying out the issues. The best advice I can give (I'm a patient not a doctor) is to try and persuade your doctor to run a TRAb test to check for Graves' antibodies. This at least would rule out one possibitlity and would explain the low TSH.

[treevee in reply to jimh111]

Thanks Jim, and it's also weird as my TSH was low in 2019 and I had Lyme in 2020...

[jimh111 in reply to treevee]

So you can rule out NTI. Did you have these same symptoms in 2019?

[treevee in reply to jimh111]

no, these are recent onset.

[jimh111 in reply to treevee]

Could be a different pituitary problem or just a consequence of Lyme which may resolve in time. I don't know anything about Lyme so don't know if there are longer term effects.

[SlowDragon Administrator]

Definitely get TSI or Trab antibodies tested to check for Graves’ disease

You could have a “hot nodule” making thyroid hormones....another possibility

Ask for thyroid ultrasound scan

Or get one privately £150 approx

If TSH was low prior to Lyme it suggests not Lyme related

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

Graves Disease antibodies test

medichecks.com/products/tsh...

[treevee in reply to SlowDragon]

Thanks. Is it possible to get TSI / TRab checked through any of the independent labs?

[SlowDragon Administrator in reply to treevee]

Last link above...via Medichecks

I think it has to be private blood draw....not DIY finger prick test

[SlowDragon Administrator in reply to treevee]

Could be looking at central hypothyroidism

Central hypothyroidism

academic.oup.com/jcem/artic...

ec.bioscientifica.com/view/...

Ever had head trauma ....been knocked unconscious, or whiplash

Or massive blood loss after giving birth - Sheehan syndrome

[treevee in reply to SlowDragon]

I did have mild whiplash once many many years ago at about age 20... no massive blood loss after giving birth though.

[SlowDragon Administrator in reply to treevee]

Well you don’t need to have had every possible trigger

Whiplash could be a trigger on its own....but that’s likely too long ago

[treevee in reply to SlowDragon]

OK, many thanks for your help, do let me know if you have any further thoughts!

[treevee in reply to treevee]

Another thought. Would the ultrasound rule out all of these possibilities if it was normal?

[SlowDragon Administrator in reply to treevee]

It wouldn’t rule out Graves’ disease or central hypothyroidism

It would probably rule out Hashimoto’s and hot nodule

[Lizzo30]

Hi have you ever heard about stevia and it's effect on lyme disease? Apparently in a laboratory test tube stevia can kill lyme disease so it really worth looking into ? It seems Germany is the leader in curing lyme disease by stem cell therapy but it is costly . Are you in US ?

[treevee in reply to Lizzo30]

Hi yes I drink 6 cups of cistus tea every day with Stevia in it, thank you. No I'm in UK.

[treevee]

UPDATE 09/04/21 SlowDragon thank you so much for your advice, I have literally just come back from my thyroid scan.

Medichecks TRab Graves antibodies test was clear (below range). However US scan has shows a large cyst/nodule on one side of my thyroid. Unbelievable as the GP felt the thyroid a few weeks ago and said he couldn't feel anything! What next is my question. What are the options open and what will likely happen re referrals and so on? I'd be grateful for all and any advice as to where to go/what to do next!

Also another thought - can this be explaining my symptoms of fatigue, palpitations, weird eyesight stuff and so on?

[SlowDragon Administrator in reply to treevee]

Perhaps/probably a “hot nodule “

mayoclinic.org/diseases-con...

Nodules that produce excess thyroid hormone — called hot nodules — show up on the scan because they take up more of the isotope than normal thyroid tissue does. Hot nodules are almost always noncancerous.

[PurpleNails Administrator in reply to treevee]

Do you have any recent results. I might be a good idea to see where your levels are at this point in time.

I have a large solitary hot nodule (5cm) and the levels can increase very slowly. In my case I had normal FT4, supressed TSH and slightly above range FT3 it took 4 years before the FT3 to reach almost double the norm. I wasn’t informed or monitored at the time, I discovered all this well after the fact.

If your levels are elevated then yes fatigue, palpitations very typical, any hyper symptom.

I have eye issues too, but I’m not finding endocrinologist any help as they simply say that without autoimmune antibodies, eye issues are not related.

An ultrasound can detect nodules but can’t verify if they are hyper functioning or not.

An radio uptake thyroid scan can show the thyroid activity, different conditions have distinct patterns. If your levels are high you should be offered this to confirm hyper functioning nodule.

[treevee in reply to PurpleNails]

Hi there.

Thanks for your reply PurpleNails. These results are recent (less than 4 weeks ago). I already have an appointment with a private endo booked in for two weeks time (one of the ones recommended by ThyroidUK here in the South West), but I obviously also need to speak to my GP and I’ll ask for a parallel referral to the same man on the NHS, hopefully now on the path to getting some answers. Well, that’s not necessarily a given but will try best to get some!