Low TSH

[Alex311]

Hello

Anyone with low TSH, but normal T3 and T4?

[SeasideSusie Remembering]

Yes, but I have a diagnosis of hypothyroidism and take thyroid hormone replacement.

Do you have a diagnosis and on any thyroid meds?

[Alex311 in reply to SeasideSusie]

No. They just said low TSH. And high antibodies. Insomnia like crazy. Suspected hyperthyroidism sub clinical

[SeasideSusie Remembering in reply to Alex311]

Alex

Do you have a copy of your results?

If not please obtain a printed copy of them from your surgery, if in the UK you are legally entitled to your results but don't accept verbal or hand written ones, get a printed copy then post your results, including the reference ranges which will be next to the result on the print out (ranges vary from lab to lab). They should look like (example only):

TSH: 2.5 (0.27-4.20)

Thyroid disease cannot be diagnosed by TSH alone, FT4 and FT3 must also be taken into account,and preferably thyroid antibodies, this will separate hypOthyroidism from hypERthyroidism.

Also useful to have thyroid antibodies tested as well, particularly in the case where hypERthyroidism is mentioned.

Thyroid Peroxidase (TPO) and Thyroglobulin (Tg) antibodies typically raised in autoimmune thyroiditis [known to patients as Hashimoto's] which is the most common cause of hypOthyroidism but often starts with a transient period of hypERthyroidism.

Thyroid Stimulating Immunoglobulin (TSI) and Thyrotropin Receptor Antibodies (TRAb) typically raised in Graves Disease (overactive thyroid).

[Alex311]

They only tested for TSH. It was undetected for few months. I requested for Antibodies and they were high. 2 years ago I had the same episode. Was sent to endocrinologist and there T3 and T4 were normal. And they didn’t do anything. Let me go home continue suffering. With antidepressants in my hands. Those did not help

[SeasideSusie Remembering in reply to Alex311]

Alex

So that the member you are replying to gets notification of your response, you need to click on the blue REPLY button directly below their message. You have, in effect, replied to yourself by using the "add a comment" box

Antibodies are 182. Thyroid Peroxidase

What is the reference range for this? We usually see three on here, <34, <50 or <60.

It would seem that your TPO antibodies may very well be raised and possibly indicative of Hashimoto's.

It would be in your best interest to get full thyroid/vitamin testing and if you are in the UK then we have recommended private labs.

Comparable full Thyroid and Vitamin test bundles as follows:

Medichecks ADVANCED THYROID FUNCTION medichecks.com/products/adv...

Check this page for details of any discounts: thyroiduk.org/getting-a-dia...

or

Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk...

Check this page for discount code thyroiduk.org/getting-a-dia...

Both tests include the full thyroid and vitamin panel. They are basically the same test with just a few small differences:

Blue Horizon includes Total T4 (can be useful but not essential). Medichecks doesn't include this test.

B12 - Blue Horizon does Total B12 which measures bound and unbound (active) B12 but doesn't give a separate result for each. Medichecks does Active B12.

Total B12 shows the total B12 in the blood. Active B12 shows what's available to be taken up by the cells. You can have a reasonable level of Total B12 but a poor level of Active B12. (Personally, I would go for the Active B12 test.)

Blue Horizon include magnesium but this is an unreliable test so don't let this sway your decision, it also tests cortisol but that's a random cortisol test and to make any sense of it you'd need to do it fasting before 9am I believe.

Both tests are available as a fingerprick test to do at home or they can be done by venous blood draw arranged at extra cost. If you want to do a fingerprick test I have some tips I can post for you, please ask if you would like me to.

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[radd]

Alex311,

Welcome to our forum.

As SeasideSusie has said your antibody results will give a clearer idea of which condition you are suffering as symptoms & thyroid hormone levels can mimic both conditions. Do you have any other symptoms apart from insomnia?

[Alex311]

Yes. All of them: shaking, jitter, feel like can’t relax at all

[Alex311]

Antibodies are 182. Thyroid Peroxidase

[radd in reply to Alex311]

Alex311,

Although your thyroid hormone levels are 'normal', it sounds like your doctor might be misguidedly reading your low TSH as subclinical-hyperthyroidism.

Thyroid Peroxidase antibodies (TPOAb) are Hashi antibodies so you are most likely in the early stages of hypothyroidism and suffering a Hashi attack which will make thyroid hormones fluctuate and TSH will correlate to these fluctuations.

Both Hashimotos (hypothyroidism) & Graves (hyperthyroidism) are autoimmune diseases which in the early stages can mimic each other and it is important to get the right diagnosis for the right treatment.

Unfortunately it is possible to have both Hashi & Graves at the same time as one condition may drive the other but you will not receive any meds (for either disease) on these results so your doctor will want to monitor you with further TFT's hopefully in a few weeks.

Meanwhile the best you can do for yourself is read about Hashimotos and switch to a gluten free diet to calm an overactive immune system. I hope you feel better soon.

.

Your Thyroid Gland

thyroiduk.org/how-your-thyr...

.

Hashimotos

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

[pennyannie]

Hello Alex and welcome to the forum ;

Do you have any other information there like a TSH, T3 and T4 blood test results and ranges as well as the full details of this and any other antibody readings and ranges ?

For considered opinion we do need as much information as possible to say anything sensible.

[Alex311]

TSH is undetected

[PurpleNails Administrator]

Sub clinical hypEr is when the TSH is under range or suppressed or undetectable often shown as <0.01 but the thyroid hormones FT4 & FT3 remain in range.

If the FT4 & FT3 rise above range the cause of the hyperthyroidism must be determined.

There are 2 autoimmune conditions, (and 4 types of thyroid antibodies) It’s doubtful all antibodies were tested. Likely, just TPO. Antibodies fluctuate and can’t be treated they only assist in diagnosis.

TPO) and Thyroglobulin (Tg) are positive with Hashimoto's/autoimmune thyroiditis which can begin with transient hyper but ultimately hypo. (Can also be elevated with Graves)

If Graves (continuous hyper) is suspected you must be tested for Thyroid Stimulating Immunoglobulin (TSI) or TSH receptor antibodies (TRAb).

If your levels exceed the range and you test positive for TSI or Trab there is an anti thyroid medication which lowers production of new hormone which can manages the levels. Taking while your levels are in range will render you hypothyroid and this can be equally difficult.

Your levels certainly need frequent monitoring. Has your doctor scheduled repeat tests?

You also refer to a similar episode 2 years ago, did you have thyroid tests between these episode? You need to compare results.

Obtain printouts of your results via reception (don’t ask doctor) or arrange online access for GP records.

Don’t accept verbal or hand scribbled notes you need a printed copy with ranges (ranges vary between labs so essential). They shouldn’t ask why but if they do try to resist just say they are for your records. You are legally entitled to them.

It’s really important to see how your levels trend from now. As you have positive TPOab, even if your FT4 & FT3 do rise above range it’s likely temporary and they will naturally decline until you require replacement thyroxine.

As well as TSH, FT4, FT3 & antibodies it’s important to test ferritin, folate,B12 & vitamin D, have these been tested?

My TSH was suppressed many for years before sufficiently high FT3 and FT4 were detected. Although mine was due to a hyper nodule and I was negative antibodies.

[SlowDragon Administrator]

You need TSI or Trab antibodies tested for Graves’ disease (autoimmune HYPERthyroid)

High TPO can be due to both Hashimoto’s (autoimmune HYPOthyroid ) or due to Graves’ disease

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms (known as Hashimoto’s swings) before becoming increasingly hypothyroid as thyroid is destroyed

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

Low vitamin levels are extremely common with both Hashimoto’s and Graves’ disease

Improving low vitamin levels can significantly improve symptoms

Gluten intolerance is common with BOTH Graves and Hashimoto’s

Are you in the U.K.? Frequently we have to test privately to make progress

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

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 .

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

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

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

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Graves Disease antibodies test - requires private blood draw

medichecks.com/products/tsh...

Good info on Graves’ disease

ncbi.nlm.nih.gov/pmc/articl...

healthunlocked.com/thyroidu...

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-...

[Alex311]

Vitamin D is low

[Alex311]

I’m in Canada

[shaws Administrator]

Did you have blood drawn at the earliest possible. Fasting (you can drink water).