My 23 years old sister who doesn’t have any history of thyroid illness, has recently had odd thyroid test results indicating she has overactive (hyper) thyroid. She has recently recovered from COVID. I’ve seen some reports indicating there may be a link between COVID and acute thyroid disease - does anyone have experience of this?
I’d love to hear your thoughts on the lab test results she received - see below:
TSH: <0.01 mU/l (range: 0.5 - 3.6)
Free T3: 6.9 pmol/l (range: 2.6 - 5.7)
Free T4: 20 pmol/l (range: 9 - 19)
TSH receptor /Antibodies - <1.5 IU/l = normal (range: normal at under 2.9)
Ferritin: 29 ug/l (range: 13-150)
Red blood cell count: 5.3 (range: 3.85-5.2)
She has her GP appointment tomorrow. I’m worried about her being prescribed medication to suppress the thyroid in case this is acute and temporary and the levels will naturally go down in time.. What should she ask for as next step - more tests? To check for Grave’s disease /investigate acute thyroiditis etc? Any thoughts and advice on how to best approach this would be super helpful!! Thank you x
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PastelOak
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It could be subacute thyroiditis which is the term for thyroiditis that lasts a few months. It is worth asking for a TRAb test to rule out Graves’.
In either case it would be a good idea to start her on a beta blocker such as propranolol to protect her heart and lower her T3 levels. It’s not good to remain in a hyperthyroid state as it causes anxiety and can be harmful.
It looks like her TRAb was ‘normal’. Agree with the propranolol though to manage the symptoms, as the thyroid levels aren’t currently very elevated. The important thing then would be to retest , maybe in 4-6 weeks. I’m a bit surprised they didn’t at least test TPO - presumably this could be Hashi”s.
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
They didn’t test TPO/TG…it could be Hashi”s but it could also (for example) be a ‘hot’ nodule. It’s good to see that they’ve ruled Graves’ out so early, but as you say, there could still be an autoimmune cause.
TSI Or Trab is the test run for suspected Graves & if positive is accepted as evidence of It.
It’s really unusual to see this antibodies tested and not TPO & TG. Especially outside of of hospital specialists.
But looks like TRab has been tested -
TSH receptor /Antibodies - <1.5 IU/l = (<2.9)
It’s negative which means Graves isn’t likely & Graves levels typically go extremely high so it more likely a transient rise from thyroiditis.
Checking for TPO & TG antibodies & monitoring levels will important, if levels appear to be continuously rising ask for scan.
If symptoms are severe, temporary propranolol could help, I’d recommend a low a dose as possible - to ease symptoms (start slowly& increase) and reduce slowly.
I was given higher dose & told to stop abruptly - made me quite Ill triggering migraines.
They’ve (pretty much) ruled out Graves’ disease as the TRAb (tsh receptor antibody test) was negative. Your sister’s thyroid levels aren’t much over range so she may not need anti thyroid medication at this stage, but the important thing is to establish what is causing the thyroid levels to be so high. There is some information about this here:
It may be a temporary condition, in which case it will likely resolve itself over several weeks. In the meantime, a beta blocker called propranolol may help manage symptoms and potentially help reduce thyroid levels (although not to the extent that anti thyroid medication would achieve).
Other causes could include a thyroid nodule or a hyperthyroid stage of a predominantly hypothyroid autoimmune disease.. More tests will be needed to diagnose these, but at present there may not be any treatment (other than perhaps propranolol) required.
I don't know about the effects of actual Covid. But just to say I went through a few weeks of being 'hyper' after my Pfizer booster. I'm positive that was what caused it, and it resolved on its own. I've read other similar reports.
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