Test and symptom help ! At a loss

[PittyKitty]

I have a rather large goitre .

I am currently unmedicated as my last results were considered “normal “

I don’t feel normal however and my endo is very confused regarding my results generally .

My tsh is 0.041 mU/L

Free T4 7.9 pmol/L

Free T3 6.3 pmol/L

I had radioactive iodine in 2006

Thanks in advance

[greygoose]

Can you add the ranges to those results, please? Otherwise, they're meaningless. Ranges vary from lab to lab so we need those that came with your results.

[SlowDragon Administrator]

Was test done early morning

You need vitamin D, folate, ferritin and B12 levels tested too

Thyroid antibodies

TSI or Trab antibodies for Graves’ disease

TPO and TG thyroid antibodies for Hashimoto’s (and Graves)

Plus ultrasound scan

[pennyannie]

Hello PittyKitty and welcome to the forum :

So I'm guessing you had RAI thyroid ablation for Graves Disease in 2006 and were you put on T4 - Levothyroxine then, or have you been unmedicated all this time ?

When did this goitre start to appear ?

Your levels do not look normal to me - though I'm guessing what the ranges were :

Is the goitre restricting your wind pipe and causing issues with your breathing and eating ?

We need more information :

[PurpleNails Administrator]

Were you regularly tested after your treatment? Is this a sudden unusual result or has FT3 been steadily rising?

It’s quite unusual not to become hypothyroid after treatment.

Were you ever taking levo?

Your TSH is low, but if you were previously hyper before treatment or taking carbimazole the TSH often becomes sluggish and remains low. In any case the TSH can’t re relied on.

Like others have said we need lab reference range to interpret accurately but by most ranges we see the FT4 is low for FT4, but FT3 is high - which is the quite unusual.

What is your endocrinologist suggesting? More tests?

Your neck is not too dissimilar to mine the swelling seems to be slightly to one side. - I have a nodule which hyper functions. FT3 can often be disproportionately higher if nodule is autonomously functioning.

Once we know more of your history & lab ranges we can advice more.

[PittyKitty in reply to PurpleNails]

As my results from the endo without context are not really helpful I took a medichecks test this week. I was diagnosed with acquired hyperthyroidism in 2006 and had radioactive iodine .

I had perfect blood work until 2016 after having treatment for another condition ( blemomycin for a large vascular malformation, basically low level chemotherapy )

I then grew the goitre and my bloods went weird .

I have had 2 MRI’s and my pituitary gland is okay .

I am not medicated as the endo cannot explain my results , I am awaiting surgery and have been for 2 and a half years . I have breathing and swallowing difficulty and have been admitted to a&e with food stuck in my throat .

I have attached my recent medicheck results .

I am at a loss as to what and why I have bloods like this .

Test results

[SlowDragon Administrator in reply to PittyKitty]

Possibly a hot nodule making Ft3

Have you had ultrasound scan recently

Get GP to organise

Also vitamin D, folate, ferritin and B12 need testing

[PittyKitty in reply to SlowDragon]

I had an ultrasound in December 2021 , no suspicious nodules but lots of nodules but my goitre was described more as a “globule “ in that they said it was lots of indistinct masses merged together . Everything is on the right side of my neck and into my chest .

Thank you for the recommendation for testing .

I will do that asap . I am so tired of being told your tests are weird and that’s enough for my endo’s because there is no obvious cause they don’t seem to want to find the actual cause .

[PurpleNails Administrator in reply to PittyKitty]

Those are very unusual results, what is your doctors plan?

Usually the thyroid produces mostly T4 and a small quantity of T3. Most T3 is converted from T4 and is usually lower in % than FT4 eg a healthy FT4 would be 55% and FT3 45%.

Low conversion eg high FT4 of 80% and low FT3 of 20% can be a common issue as poor nutrients and gene variants can contribute to reducing conversion.

Disproportionately high or dominant FT3 is seen with hyper conditions, eg borderline high FT4 very high FT3, but it’s extremely unusual to have under range FT4 over range FT3 at diagnosis.

I have only seen results like this when the patient is given Carbimazole (anti thyroid medication) and both levels have dropped from both being over range or If someone Is taking T3 (lio) replacement.

If you were to be given antithyroid medication now your FT3 production would be blocked but so would FT4. To address the issue you would need a “block & replace” regimen.

Higher dose of carbimazole / PTU to completely block function but a replacement dose of T4 (levo) to raise your FT4 and hopefully balance FT3. That might address the abnormal levels but what needs to be urgently determined is the cause of your issue & usual results.

Is endocrinologist arranging a ultrasound scan of thyroid? Ask for an addition Radioactive iodine “uptake” scan to look a function of thyroid.

TGab & TPO are negative but TSI and Trab should also be tested.

I think your levels may have been low for some time since the RAI. The body can prioritise FT3 levels to compensate if levels are low, but you either have autoimmune issue affecting the way FT3 is produced/converted causing it to rise. Possibly a nodule secreting high levels of FT3 (which would also explain the swelling).

Were nutrients tested?

As you replied to me I was notified of results but others may miss. You can get others to view by starting new post stating Low TSH FT4 - High FT3.