High THS but also high free T 3, what does it mean ?

[vouguets]

My daughter who is 27 and has had on going health problems for years (bowel problems, painful joints, exhaustion, severe pmt, anxiety, depression) has just received these results and I don't know what to make of it. If her THS is high that means there's a thyroid problem, but then why is her T3 high and what should she do. For the moment her Dr suggests doing nothing. Would love any advice.

Her prolactin is always high, her cholesterol too.

She's not on any medication and hasn't taken vitamins for at least 6 months.

Thank you

Total cholesterol 2.26 g/l (< 1.9)

Ferritin 41 μg/l (10 à 291)

THS 4.97 mUI/L (0.55 à 4.78)

Free T3 6.54 pmol/l (3.5 à 6.5)

Free T4 18.04 pmol/l (11.5 à 22.7)

ANTICORPS ANTI-THYROPEROXYDASE. < 28 UI/ml (< 60)

Prolactine 29.43ng/ml (2.8 - 29.2 ng/ml)

Vitamin B9 Folate 11.9 ng/ml (>5.39)

Vitamin B12 805 ng/l (211 - 911)

[helvella]

One possibility is high T3 because of high TSH.

That can happen if there is a TSHoma (small benign tumour) in the pituitary. That is putting out more TSH than it should which then signals the thyroid to put out more thyroid hormone.

That could go along with the top of reference interval (range) prolactin.

I am afraid I know little about this - it does tend to be described as being rare. Which is not in itself helpful.

[vouguets in reply to helvella]

Thank you Helvella,

She did have a pituitary glad scan about 18 months ago because of her high prolactin, which was higher at the time. I have heard that pituitary tumors can be too small to detect sometimes.

[helvella in reply to vouguets]

You are right that tiny tumours can be difficult to locate/identify. And to treat.

Did she have the other anterior pituitary hormones checked? ACTH, FSH, LPH, LH, and/or GH.

There is a section on human hormones and where they are made in my Vade Mecum:

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Nor by the fact it is targeted at people interested in thyroid issues. Much of its contents could be of use to many involved in health issues. Things like abbreviations, lists, general reference information.

And do keep up to date. I edit it frequently- sometimes trivially, sometimes extensively. If your copy is more than a few weeks old, please download it again.

In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.

If there is anything you'd like me to add, let me know.

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1P9...

[vouguets in reply to helvella]

I'm not sure if she had the other tests, I will have to check and if not that looks like it could. be a path to follow. In the mean time I will read the section on human hormones. Thank you

[helvella in reply to vouguets]

Information tends not to be widespread - I suggest a look here:

Thyrotropin-Secreting Pituitary Adenomas

Paolo Beck-Peccoz, MD, Luca Persani, MD, PhD, and Andrea Lania, MD, PhD.

Last Update: January 11, 2019.

ncbi.nlm.nih.gov/books/NBK2...

(Please don't think I know anything. Just have an idea where might be a good place to look!)

[vouguets in reply to helvella]

don't worry ! I am very grateful to have ideas of where to look !

[JOY2THEWORLD49]

Hi

The TSH is the important one. It can show normal between .4 - 4.2

But TSH 2.0 would be ideal.

To reduce it down to 2.0 take a little more say 25mcg added starting with 1 a week.

The dosage is worked out your daughters weigh.

Has she had a neck scan? I had a shadow during a carotid arteries scan. Cancer.

The Cholesterol level, cardiac sp wants me at 4.

Triglycirines ?? under 2.

Risk for remaining with a high TSH is AF and irregular heart beat then stroke which happened to me.

Check out my reply to another asking about blood tests etc for thyroid and everything else.

Take careJOY. 73. (NZ)

[tattybogle in reply to JOY2THEWORLD49]

'joy2theworld49'

"..... but TSH 2.0 would be ideal. To reduce it down to 2.0 take a little more say 25mcg added starting with 1 a week."

.if you read the post carefully you'll see that this person does not have a thyroid diagnosis and therefore does not take any thyroxine ... so advising they increase their dose is not appropriate in this case .

"TSH is the important one" .... TSH is not the most important measurement , in fact if looked at in isolation it can be misleading .. all the information including the diagnosis, medication and T4/ T3 levels must be looked at together before the true picture can be understood properly and relevant advice given, especially if the advice involves suggesting adjustments to dosages of thyroid hormone .

"TSH 2.0 would be ideal " ........ TSH 2.0 is not ideal for everyone ( it's not even ideal for people who are 'healthy' with no thyroid problems~ they are often closer to 1.0 ).. ideal TSH level very much depends on the diagnosis and what (if any) thyroid hormone are being taken , and the individuals response to that dose of hormone. eg Some people who take thyroid hormone would fell unwell and be unable to function with TSH @2.0 and would need it lower than 2 in order to feel well.

"Risk for remaining with a high TSH is AF and irregular heart beat then stroke which happened to me." ... i think you may be confusing high TSH levels with high fT4 / fT3 levels here ~ Atrial Fibrillation is generally considered to be associated with excessively high thyroid hormone levels (T4/T3) , not high TSH .

TSH (Thyroid Stimulating Hormone) is not a thyroid hormone , it is a 'message' from the pituitary to the thyroid 'asking' it to produce more T4/T3.

[vouguets in reply to tattybogle]

Thank you for your advice Joy, unfortunately I think Tattybogle is right. I wish it was 'just' straight forward hypo which is what I have and I manage well with NDT but my daughter has never been diagnosed and looking at how high her FT3 is made me wonder what on earth is going on. She has had high prolactin for a while now so I'm going to see if she can be tested for the other tests Helvella suggested ACTH, FSH, LPH, LH, and/or GH.

So worried about my daughter who should be in the prime of her health at 27... but very grateful for all your help ! Thank you !