You will see from my previous posts that my endo had suspected Graves’ disease due to low TSH (<0.01). However, my recent results have shown I am negative for both TPO and TRab. They have also shown the following results:
T3: 1.5 (1.3 - unsure)
T4: 19 (12-22)
He doesn’t know what has caused the drop in TSH but has given 2 options for next steps:
1. Do nothing and have regular (2 monthly checks) to see if thyroid rectifies itself.
Or
2. Take anti thyroid medication of propylthiouracil to see if this gets my levels back within range.
I have several concerns:
- Will starting medication mean I am going to be on meds for the rest of my life?
- I’ve heard it can make you hypo then it’s more meds to rectify this?
- What’s the likelihood the thyroid will rectify itself? He couldn’t even tell me what’s suppressing the TSH levels.
I don’t want to be on medication forever or worsen this condition.
Any advice would be much appreciated
X x
Written by
Babymagic37
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It’s very different to you results previously posted.
How many weeks between tests?
TSH (<0.01) by no means confirms Graves.
Do you have previously healthy TSH levels? The TSH itself might be not responding normally.
Your FT4 isn’t above range, and your FT3 was very slightly above range once but is now within range?
An anti thyroid doesn’t directly raise the TSH. it works by lowering what the thyroid can produce, so your FT4 & FT3 (which are in range) will be reduced (reduced by enough - you will be hypothyroid) - as your aren’t high over range a low dose is likely to make you hypothyroid.
If FT4 & FT3 are kept low enough for long enough your TSH *might* rise. On the other hand if your like me and many of us - it won’t, I’ve never had a normal TSH result even when kept low for months.
If you are negative for autoimmune your specialist should be looking for cause. It might be an odd “once off” or transient, potentially recurring or continuous issue.
Unless continuous I wouldn’t start on an anti thyroid. Especially is the cause in unexplained.
Doctors never recommend antithyroid it as a long term treatment, It’s always intended as a stop gap measure and if the issue didn’t resolve naturally a permanent treatment is recommended either radioactive iodine or surgery.
PTU is better option during pregnancy but is considered to have risks. Being hyper is riskier so the treatment risks out weigh them.
Monitor your thyroid levels they may settle.
If they don’t you need a ultrasound scan to look for nodules.
Ultrasounds don’t tell you the function throughout thyroid. So if they suspect an area is over functioning you need a uptake CT scan.
Just testing TPO antibodies is inadequate for Hashimoto’s
There are two antibodies involved with Hashimoto’s. TPO and TG - Thyroglobulin antibodies
NHS refuses to test TG antibodies unless TPO are positive. Significant minority of Hashimoto’s patients only have high TG antibodies
You need to test FULL thyroid and vitamins
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
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 when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis) or with Graves’ disease
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 just 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
I don't think anyone has asked you this question, yet, but what time of day was the blood draw done? Doctors don't seem to realise that TSH is highest before 9 am, and drop sharply after that until it is at its lowest around midday. Then, it starts to rise again. So, the time of day you get your blood taken is very important.
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