Can you have hyperthyroidism with a Serum TSH level of

[jointpain]

Can you have hyperthyroidism with a Serum TSH level of 0.37mU/L normal range 0.35 to 5.50 mU/L or does the 0.02 make all the difference? What symptoms would be telling?

[PurpleNails Administrator]

it’s possible to be either hyper or even hypo. The TSH is a signal from pituitary to tell the thyroid to increase/ decrease levels. So it doesn’t tell you what they thyroid levels are.

you really need you thyroid level tested FT4 & FT3.

Sometimes the lab will only test FT4 if TSH outside normal range.

Have you have thyroid tested before? You may just have a naturally low TSH.

[Lalatoot]

To know if you were hyperthyroid you would need to measure the thyroid hormone levels TSH is the hormone sent by the pituitary gland to stimulate the thyroid. It doesn't tell you how much that thyroid is actually producing though . You would need to measure free t4 and free t3 for that.

Now high levels of thyroid hormones can be caused by hyperthyroidism and by the initial stage of hypothyroidism.

So to be sure which one you had you also need to check thyroid antibodies. TrAb antibodies would confirm hyper.

[tattybogle]

*Note

some things from your recent post on the other forum may be relevant to thyroid results / symptoms ..so i've linked it here so others can see if anything is relevant to their replies healthunlocked.com/myelopat...

Weak legs. ( can be symptom of hyperthyroidism)

recent bang on head/ fractured scull (can affect TSH level )

PurpleNails

[jointpain in reply to tattybogle]

Thank you so much for your answer, I looked back and my TSH levels were over 1 and a bit a few years ago, so maybe it is the head fracture causing it, if I ever see a GP that is in a mind to listen I'll ask.

[PurpleNails Administrator]

Blood loss & a blow to head can cause issues with pituitary.   

Low TSH causing thyroid to lower function, central or secondary hypothyroidism. As the issue is caused by the broken signal not the thyroid itself. 

Sounds like a possibility as you had a very serious injury.  

Early states of autoimmune thyroiditis can also cause transient hyper.  You also have pernicious anaemia & gluten issues these are common with autoimmune issues affecting thyroid. 

Ask for full thyroid function & thyroid antibodies to be tested:

TPOab (Thyroid Peroxidase antibodies) 

TGab (Thyroglobulin antibodies)   Both signify thyroid autoimmune 

If hyper Graves suspected

TSI - Thyroid-Stimulating Immunoglobulin (signifies hyper Graves) 

TRab - TSH receptor antibodies (TRAb) (signifies Graves) 

This page compares common hypo / hyper symptoms.

thyroiduk.org/if-you-are-un...

[jointpain in reply to PurpleNails]

Cor Blimey, I looked at some of what you listed, and never thought there was so much information on such a subject. It's going to take me a while to get to a point where I'm phoning the GP over this. It's taken seven weeks to get an appointment with a trauma osteopath for the thumb and wrist that was smashed in the bicycle accident, and four and a half weeks since I left hospital now. So CT scan on head on Sunday osteopath on Monday to see if they can fix my hand. Shame the consultant surgeon didn't listen to me showing him how swollen my hand was in hospital!

[PurpleNails Administrator in reply to jointpain]

Do you have any hypo / hyper symptoms?

When you speak to doctor I would keep it very simple, say 1 or 2 symptoms make you think you have a thyroid issue. State your last TSH was very low could it be repeated?

There may even be a time limit for retesting imposed by lab and the lab may only repeat TSH and not test further if in range.

 GPs can’t request all antibodies only specialist can request TRab or TSI.

In some cases they can only request TPO if TSH above range FT4 below range.

When it comes to thyroid it can take time to become apparent & have a diagnosis. So if it some weeks until function can be tested again don’t be too worried,  unless obvious & serious symptoms develop which would send you to Accident & emergency deterioration of thyroid tends to be extremely gradual. 

There is another option if are or become worried.  You can get a full picture in 1 go, with private companies offering blood test options.

See  List of companies offering different options, some packages include thyroid function, key nutrients and thyroid Antibodies.  Others basic function only.  some also have discount codes available.

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

You order test online the kits arrives via post sample taken by finger prick (extra fee for private venous draw). Post back and results available online quite quickly.  

[jointpain in reply to PurpleNails]

Hi, you asked Do you have any hypo / hyper symptoms? I suppose I do, but they are from both lists! The Serum free T4 was about mid normal range at 13.4 out of 7.00-17.00 and from past printouts have been give or take 1 or 2 for 11 years. In that 11 years the TSH levels have been between 1 and 3 it's only this last one that was so low. So I'm believing that it's a blip caused by the accident. The symptoms could be from the cervical spinal stenosis, Which I was being treated for until the professor retired and said get referred again if thing change. Which I have asked to be. Just in case it's what a GP first thought, MS. Thank you all again.

[tattybogle]

0.37 is within that '95% population range' of [0.35- 5.5]

95% population ranges are made by removing the top and bottom 2.5% of results from a group of healthy people used to make the range.

so 2.5% of healthy people will have their 'usual' TSH a bit lower than 0.35 (on that range)

so your TSH result in itself is not a concern.... and it wouldn't necessarily be any concern if it was 0.30 or 0.27 either .

When someone is properly hyperthyroid (enough to give significant/ dangerous symptoms) then you would usually expect their TSH to be very, very low (or completely supressed) eg 0.001 or <0.05

TSH (Thyroid Stimulating Hormone) is not the problem , it's just 'a messenger' .

The thing that causes the symptoms/ and dangers of hyperthyroidism is not the TSH , it is "too much thyroid hormone" ~ (T4 and T3)

when T4/T3 levels are too low the TSH rises from it's 'usual ' , to 'ask' the thyroid to make 'extra' T4/T3.

when T4/T3 levels are right , the TSH level goes down to its 'usual'.. it 'stops asking' the thyroid to make 'extra' T4/T3.

if T4/T3 levels are way too high (hyperthyroid) , then the TSH goes down to more or less "0 " to try to stop the thyroid making any T4/T3 at all.

Usually the GP /lab will not usually bother to measure T4/ or T3 if the TSH is within the 95% population range .

if your 'usual' TSH level was more like 2 or 3... then TSH of 0.37 could indicate your levels of T4 / T3 are very slightly too high for you for some reason...

symptom of hyperthyroidism include:

a consistently faster heart rate than usual

increased frequency of bowel movements.

feeling hotter than usual

sweating more than usual

insomnia

feeling more anxious than usual.

being physically 'jumpy' when startled

a 'very fine tremor' in the fingers of the outstretched hand , (arms held straight out in front, palms down)

[jointpain in reply to tattybogle]

Thank you, a great deal of information, of which I'm hoping the blip in TSH levels is caused by blood loss, from skull fracture and spleen rupture. I'll ask the GP when I can.

[tattybogle in reply to jointpain]

you've been in the wars a bit ,, and thyroid is an extremely sensitive /finely tuned system , lots of things can affect it temporarily .. hence thyroid blood results from hospital / acute illness never count for diagnostic purposes .... levels can appear to go wonky for a while , complicated adjustments are made by the HPT axis to compensate for whatever just happened ...then settle back down .

you appear to have just dropped your precision altimeter on the hangar floor ...so be aware of what symptoms to look for out the windows , , but i wouldn't trust the instruments for while yet

Hope you get your thumb fixed soon.

[jointpain in reply to tattybogle]

Thank you