do I have subclinical hyperthyroidism?

Hi,I've been suffering with mad sweating,heart palpitations, extreme tiredness for at least 4 years -can't remember exactly when I started but 4 years ago is the first time I asked the Dr to check my thyroid. In all that time my tsh has never gone above 0.4 but has always been above 0.1. The lab always reported this as normal so no further testing was ever done. However, I read that if it is between 0.1 and 0.4 then T4 should be checked so I insisted the Dr's requested it from the lab and it has come back as 16 pmol/L which is normal. I've read that a low tsh and normal T4 means that I've got subclinical hyperthyroidism. Is this correct and if so should I request treatment or further tests off the Dr? Also my tsh was 0.19 3 weeks ago and yesterday was 0.36. Is it normal for it to jump up by that much in 3 weeks? Thanks for your help

[helvella Administrator Thyroid UK]

TSH can jump that much and more within a day!

The significance of the TSH-FT3 circadian rhythm

By thyroidpatientsca on July 31, 2020

thyroidpatients.ca/2020/07/...

Daily Rhythms of Thyroid Hormones + TSH

healthunlocked.com/thyroidu...

Please make sure you get not just your results, but the reference intervals used. Labs vary. The reference intervals (ranges) vary - with Free T4, the variation is such that a result which would be near top of range at one lab could be bottom of range (or below) at another lab.

[Hidden in reply to helvella]

OK thank you.My Dr's lab for tsh classes it as normal when it is between 0.1 on 5.0

I've read that normal is 0.4 to 5.0

Is the lab wrong to use 0.1 and therefore classing my tsh as normal when it should in fact be low?

[helvella Administrator Thyroid UK in reply to Hidden]

The reference intervals for TSH tend to be closer among laboratories than for many other tests. Given that the difference between 0.1 and 0.19 isn't that great, we are unlikely to be dramatically wrong.

But for Free T4 we might see 7-14 from one lab, and 12-22 for another. Hardly any overlap. So a result of 19 could be way over the range, or reasonably high within range. Very different interpretations.

I often post the text and link below because it is one of the best papers about reference intervals - normal ranges.

Because it comes from the medical world, written by medics and published in the British Medical Journal, it should be convincing to healthcare professionals.

It is also written in a way that is reasonably accessible to many patients, at least with a bit of careful reading.

The normal range: it is not normal and it is not a range

Abstract

The NHS ’Choose Wisely’ campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the ’normal range’. It is often assumed that a result outside this limit signals disease and a result within health. However, this range is correctly termed the ’reference interval’. The clinical risk from a measured value is continuous, not binary. The reference interval provides a point of reference against which to interpret an individual’s results—rather than defining normality itself. This article discusses the theory of normality—and describes that it is relative and situational. The concept of normality being not an absolute state influenced the development of the reference interval. We conclude with suggestions to optimise the use and interpretation of the reference interval, thereby facilitating greater patient understanding

►Health is a relative and not an absolute state.

►The reference interval acts as a comparator for the patient’s blood result. It is not the arbiter of whether disease is present or not.

►Natural fluctuations in a blood result can occur.

►Comparison of a result against the reference interval should be informed by the clinical suspicion made beforehand.

Freely accessible here:

pmj.bmj.com/content/postgra...

[Hidden in reply to helvella]

Yes, unfortunately, because the lab says 0.1 - 5.0 is normal for tsh, then my result of 0.19 is classed as normal. But everywhere I read on the Internet says the test range should be 0.4 - 5.0 for normal, in which case my result would be classed as abnormal and warrant further investigation given my symptoms. As it is the Dr just sees normal and thinks everything is OK.

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

You need FULL thyroid including thyroid antibodies and vitamin testing

Also request ultrasound scan of thyroid for nodules

Are you in U.K.

Autoimmune hyperthyroid disease - called Graves’ disease is diagnosed by high TSI or high Trab antibodies

Autoimmune hypothyroid disease - called Hashimoto’s, usually diagnosed by high TPO or high TG antibodies. Hashimoto’s frequently starts with transient hyperthyroid results and symptoms….these can last some time

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested for Hashimoto’s (and can be slightly raised with Graves’ disease)

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common with any autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally before 9am

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

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

List of private testing options and money off codes

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

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

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/wp-content/up...

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors

[e-mail]

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...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test

medichecks.com/products/tsh...

Good info on Graves’ disease

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

healthunlocked.com/thyroidu...

[Hidden in reply to SlowDragon]

Thanks for all this info. It's very helpful. Yeah I wish the Dr would just do all the blood tests but I had to really push for them to check my T4 because they didn't consider my tsh as low because the lab said it was normal. Nhs trying to save money I presume.Thanks for the tip on when to get tested. I will do that from now on.

[humanbean]

I've been suffering with mad sweating,heart palpitations, extreme tiredness for at least 4 years

I would first suggest you get proper testing for thyroid and basic nutrients as outlined by SlowDragon. Optimising nutrient levels can make a huge improvement in our feelings of "wellness".

For example, from my personal experience, having low iron and ferritin (iron stores) gave me palpitations but improving my levels of iron reduced the severity and frequency of the problem enormously.

If improving nutrients doesn't help or your levels are okay...

One thing that could be causing these issues, which is often associated with thyroid disease but could occur without thyroid disease too, is high or low cortisol. Symptoms for both can feel similar to the patient so it can't be "guessed" if this is relevant to you or not it would need to be tested.

Symptom lists : paulrobinsonthyroid.com/sym...

Doctors might do an early morning cortisol blood test around 9am or before, if you ask. Some of the private testing companies will include blood cortisol testing in their thyroid test bundles.

Another option (which those of us who get one have to pay for privately - no doctor required and no NHS doctor will do this) is a saliva cortisol test. You are provided with four small vials which you have to spit into at certain times throughout the day and you then freeze them and send them off to a lab through the post.

This is an example of the kind of output you might get :

healthunlocked.com/thyroidu...

It is important that any such test you do includes a test for DHEA. Many of them don't so be careful.

The best two tests that I know of (that do include DHEA) are :

regeneruslabs.com/products/...

gdx.net/uk/product/adrenal-...

For information on how to deal with different testing companies see this link and what the requirements are :

thyroiduk.org/help-and-supp...