hyperthyroidism - blood test result - what to ask doctor

[Adam10]

My stepdaughter in Philippines has hyperthyroidism. Her recent blood test shows THS of 0.24 UIU/mL against a reference range of 0.4-5.5. So her TSH is below the minimum. Her FT4 is 2.46 ng/dL reference range 0.8-2.0. So, her FT4 is above the maximum. No other test was made.

Her total daily medication dose is: 20 mg of Inderal (hydrochloride) and 7.5 mg of Tapdin (Methimazole) antithyroid, in part doses morning and evening.

The Tapdin is for when she is tired, suffers fast breathing and has shaking hands

I would be grateful for any comments and suggestions for what she or her mother should ask the thyroid doctor at a consultation this Friday.

[PurpleNails Administrator]

Firstly she needs to ask what is the cause of the hyper.

When TSH low & FT4 elevated it may be transient and caused by autoimmune damage to thyroid causing a rise.  Ultimately the damage cause lower function.  This is called autoimmune thyroiditis or hashimotos .  

Anti thyroid will hasten the drop in levels. 

Continuous hyper from another thyroid issue also autoimmune often causes undetectable TSH levels and FT4 often 3 times normal range.  This is called Graves. 

The Tapin anti thyroid needs to be taken as consistently as possible.  The inderal (called propranolol in uk) is a beta blocker & will help with symptoms but not route source is symptom.   Often intended to be taken temporary but needs to be reduced slowly when stopping.  

TSH & FT4 isn’t complete thyroid test.   See if FT3 (the active thyroid hormone) , and thyroid antibodies can be tested.

TPOab (Thyroid Peroxidase antibodies) 

TGab (Thyroglobulin antibodies)   Both signify thyroid autoimmune affecting thyroid - can be either under active or over active. 

 If hyper Graves suspected this can be confirmed by 

TSI - Thyroid-Stimulating Immunoglobulin (signifies hyper Graves)

 TRab - TSH receptor antibodies (signifies Graves).

Also important to test folate,,ferritin, B12 & vitamin D.