Can you be hypo and hyper thyroid?

[jenhha99]

For years now my labs have been showing hyperthyroidism and hyperthyroidism.. I've always been at the high end of normal towards hyperthyroidism my entire life.. then all of a sudden I wasn't... when all of my autoimmune stuff started. The thyroid was the start of things. My pcp put me on medication even though tsh showed hyperthyroidism because I was having symptoms with my ft4 being hypothyroidism... things are only getting worse and still going in opposite directions. Does anyone know what can cause this? I do not have any thyroid antibodies. I did have an enlarged thyroid that went back to normal size once I was started on thyroid medication but my labs are still showing hypo and hyper.

[tattybogle]

A low TSH doesn't always mean you are 'hyperthyroid' . It can mean you are just not producing as much TSH as is appropriate , (usually because there is a problem with the hypothalumus or pituitary ( pituitary makes TSH, hypothalamus tells pituitary how much TSH to make)

If someone not taking Levo has low TSH AND low thyroid hormones (T4 /T3).... then the condition is called Central or Secondary Hypothyroidism. It is not hyperthyroidism.

So when you say ." I've always been at the high end of normal towards hyperthyroidism my entire life.. "

..... do you mean you had 'high end of normal' T4 and/ or T3 levels for most of your life ?

hyperthyroidism is 'very high thyroid hormones T4 and /or T3 ' ( not a low TSH, that is just a by-product of hyperthyroidism , but TSH can also be low for other reasons) .

Your fT4 of 0.7 is below range ... if this is your result after you have been taking Levothyroxine regularly this looks like your dose of levothyroxine is not high enough.

If you give us some more details about your previous test results (with lab ranges) , symptoms , and dose of Levo etc .. we can help you understand what's going on.

[jenhha99 in reply to tattybogle]

My t4 and t3 were always in the normal range and my tsh in normal range but low end... almost at the cut off (and had no symptoms of hypo or hyper) until t4 and tsh decided to do this (and I started having hypothyroidism symptoms) I don't have access to previous thyroid lab results but this result is more of the same of what has been going on.. I take NP Thyroid 60mg now. Labs before taking medication were still low but t4 was more low. With medication it makes my tsh even lower. Ft3 is 3.2 with range of 2.3-4.2I also ended up with high cortisol when this all started. Can that be related to the thyroid issue as well?

[tattybogle in reply to jenhha99]

OK .. so you do not have hyperthyroidism., (and you did not have it previously)

You had a low normal TSH with 'in range' thyroid hormones... which could either be 'perfectly normal' .. or it could have been an early sign of not being able to produce enough TSH .

Then at some point you became hypothyroid (low T4), probably because the TSH (thyroid stimulating hormone) was not enough to stimulate the thyroid to make enough T4 anymore .

When you take replacement thyroid hormone it is usual for the TSH to go lower, that is what we expect to happen .

But we also expect the fT4 to go up ..... since yours has not gone up into the normal range yet, then this shows your dose of thyroid hormone is not enough and needs increasing .

It looks to me like you have central / secondary hypothyroidism .. and in these cases the TSH is always ignored , because its 'broken' .. so when you see a low TSH in someone with central /secondary hypothyroidism it does not mean they are hyperthyroid, and you can't use it to adjust their dose of thyroid hormone .

You have to just look at their fT4 and fT3 levels to adjust their dose of NDT or Levo etc.

( cortisol ... i don't know very much about it, (others on here will do) but i think that when we first go hypothyroid the adrenal system tries to compensate, so high cortisol might be to do with that ? )

[jenhha99 in reply to tattybogle]

Thank you for the help and information.

[tattybogle in reply to jenhha99]

[tattybogle in reply to jenhha99]

it is VERY important that anyone treating you in future is told you had a low /below range TSH at diagnosis (when your fT4 was also low , and before you were treated with any NDT )

If they are unaware of this (central / secondary hypothyroidism~? pituitary hypothalamus problem), they may not realise why the TSH level needs to be ignored in your case... and so they may think your low TSH means you are taking too much NDT , which you are clearly not doing because your FT4 is below range.

If you get any problems with people saying "your TSH is too low, you can't have an increase in NDT" .. then ask them to refer you for full investigations for central secondary hypo, and tell them that is what you think you have.

[radd]

jenhha99,

Welcome to our forum.

You can not have both hyperthyroidism and hypothyroidism at the same time, and it is usually dominant antibodies that dictate diagnosis and treatment.

Basophils & eosinophils are just types of white blood cells and do not show whether you have thyroid autoimmune disease. For that you will need thyroid antibodies tested; TPOAB & TGAb (Hashi) and TRAb’s (Graves). It is possible to have a mix of both.

Enlargement of the thyroid gland would indicate additional activity going on. If all antibodies have been tested negative then it would be wise to have investigations into pituitary issues as your TSH is so low, and would account for your low level of thyroid hormone.

If you are medicating thyroid hormone replacement, you need a dose raise to bring FT4 higher. It would also be useful to have FT3 levels tested as your results are unusual.

[radd in reply to radd]

Just read your reply to tattybogle.

Medicating NDT which contains a little T3 will lower FT4 levels and TSH. However, if you say you had a low TSH before medicating this would point towards central hypothyroidism (pituitary/hypothalamus issues).

However, the treatment of this hypothyroidism is the same .... thyroid hormone replacement meds. You are under medicated on only 1 grain. Are you able to raise your dose?

High cortisol is associated with low thyroid hormone levels as the adrenals have to compensate, and should reverse once you are optimally medicated. We also need adequate amounts of iron & nutrients to ensure meds work effectively. Have you had these tested recently?

[jenhha99 in reply to radd]

I've not had those tested recently. I can't adjust my medication since I'm only given enough for a month. I am going to start seeing a new pcp who I am pretty confident will listen to me about my body and have an open mind... she may be willing to work with me on my dose. I had seen a endocrinologist at one point who refused to help me. I'm sad I've gained all of this weight from the cortisol and could've been prevented in the first place. My rheumatologist thinks the cortisol is from psychoemotional issues.... you know since I'm female and all.... I've always thought it was related to my thyroid (since they both started acting up around the same time) but wasn't sure how.

Thank you for the information

[radd in reply to jenhha99]

jenhha99,

The weight gain will be from remaining under medicated, hence a slow metabolism and hypo symptoms but yes, the elevated cortisol will certainly have compounded it. I notice your glucose is top end of range so may have a bit of insulin resistance going on too. All this is normal with inadequate thyroid hormones and should reverse once thyroid hormones are optimised.

Central hypothyroidism can be tricky to treat unless your doctor isn't obsessed with the TSH, and understands it will remain low whatever. If you feel CH is your issue then it may be worth printing off some info because not all doctors are familiar with it. Have you ever had any head trauma?

endocrinologyadvisor.com/ho...

[jenhha99 in reply to radd]

I've never had any head trauma. Really odd though that my youngest son is growth hormone deficient which is also a pituitary issue. I will get some information to take with me to the new pcp on central hypothyroidism.

If I'm understaffed correctly you treat the hypothyroidism symptoms and the t4... abs ignore the tsh... it's this correct?

[radd in reply to jenhha99]

jenhha99,

Yes, ignore TSH but even better is to consider both the FT4 & FT3.

Sorry to hear about your son. Have his thyroid hormones been evaluated? If he is prepubertal & receiving treatment there is research showing a lowering of FT4 & FT3 levels.

.

ncbi.nlm.nih.gov/labs/pmc/a...

[jenhha99 in reply to radd]

He sees a pediatric endocrinologist at least twice a year with labs to check his igf1, igfbp3, thyroid labs, abs a left wrist xray at least once every year. He is in puberty now at age 12. Endocrinologist is keeping an eye on his thyroid. She said it is common to have thyroid issues with ghd.He is doing well on gh treatment and so far thyroid is ok.

[jenhha99 in reply to radd]

Thank you for this information

[pennyannie]

Hello Jenhha and welcome to the forum :

I believe NP thyroid was recalled in 2021 because certain batches, on analysis, were found not to be containing exactly what was stated on the bottle/tub ?

When taking any form of NDT the TSH generally goes low suppressed, the T4 can go low, but the T3 should be proportionately higher than when taking T4 monotherapy.

With NDT you does to the relief of symptoms and not a blood test or range.

The blood tests and ranges were introduced alongside Big Pharmas launch into thyroid hormone replacement medications on the back of NDT in around the 1950s.

NDT has been used successfully for over 100 years to treat hypothyroidism and long before the " science " of the blood test and you simply dose up in 1/4 increments, up or down, to relieve symptoms and use the ' ranges ' as a guide and on a daily basis monitor pulse, blood pressure and daily temperature until you find stability.

Do you have a diagnosis of a thyroid auto immune disease - maybe Hashimoto's?

This could also explain you feeling as though you are both hyper and hypo as this AI disease can cause erratic thyroid hormone production due to antibodies attacking your thyroid.

[jenhha99 in reply to pennyannie]

I've been getting this from my pharmacy. I was on Armour thyroid but they weren't able to get it so I was switched to NP and I've been on it for over a year now. I just had a refill not too long ago.

[pennyannie in reply to jenhha99]

Well one would hope these batches are AI and ok and so looking back up it appears you don't have Hashimoto's but maybe Central Hypo so once diagnosed, yes, ignore the TSH and concentrate on T3 / T4 levels.

[jenhha99 in reply to pennyannie]

Is there somewhere that I can purchase the medication without a prescription?

[pennyannie in reply to jenhha99]

Yes - I shall PM you :

[jenhha99 in reply to pennyannie]

Thank you

[radd in reply to jenhha99]

jenhha99,

Be careful self-medicating because you are brand new to the forum, haven’t actually had a CH diagnosis, appear a little muddled with both hypo/hyper/autoimmune labs and symptoms.

Your FT4 is low but FT3 is unknown, and there are numerous other reasons for meds not working effectively such as low iron, high cortisol or unmanaged autoimmune disease.

Obviously if there are missing thyroid hormones they require replacing but there is a protocol that will make your journey easier if followed and that would be to ensure T3 levels aren’t already high and address these other factors first or alongside your med increases.

Also because you are thinking CH, you may need tests conducted to eliminate any issues with other pituitary hormones. If you wanted to discuss with a private endo who members have had positive experiences with regarding their thyroid problems there is a list available from [e-mail] who is the charity that run this forum.

[jenhha99 in reply to radd]

I actual have other autoimmune conditions which is what I was referring to earlier. My thyroid antibodies are negative. My symptoms have always been hypothyroid symptoms when my thyroid started having contraindicated labs. My ft3 is 3.1

I plan to try to get a primary that will work with me first before trying to self dose. Maybe try another endocrinologist also....

Screenshot of lab values

[pennyannie in reply to jenhha99]

Jenhha :

So, your T3 is already around 40 % through the range but your T4 is just under the range - is that correct ?

[jenhha99 in reply to pennyannie]

Yes that's right

[pennyannie in reply to jenhha99]

Can you tell us what other AI issues you are dealing with ?

I think you maybe better placed to start a new post, giving a fuller history of what's going on and to include on the same page/post all 3 blood tests results together the TSH, T3 and T4 all together so forum can see them in relation to each other.

[jenhha99 in reply to pennyannie]

I have relapsing polychondritis abs undifferentiated connective tissue disease with scleroderma, sjogren's, Ra, reynauds, and fibromyalgia symptoms.

[pennyannie in reply to jenhha99]

Thanks Jenhha :

But other than me, this new information may not be seen by other forum members :

As I'm out of my depth I think your best option, is to write a 2nd post detailing your health issues, and update your profile page, so people have a better understanding of all you are dealing with and include your TSH, T3 and T4 results and ranges on the second post so it's all together for considered opinion.

[jenhha99 in reply to pennyannie]

Thank you. I will try to get another post with it all together today.