Known Graves, suppressed TSH, normal T3/4

[Ally1234567]

Hi Everyone,

I have a question about TSH;

I was diagnosed with Graves 4 years ago, I had a baby 1 year ago and my TSH has been suppressed for the past 6 months. Initially my T3 and T4 were mildly elevated but not enough for treatment.

The past 2 blood tests show my TSH is suppressed but my T3 and T4 are normal.

Sorry I don’t have exact numbers so not sure how helpful this is.

But I wondered if anyone knew why my TSH would continue to be suppressed but T3 and T4 are normal?

As a side note, I had very aggressive gestational diabetes during pregnancy and my HBa1c is borderline for pre diabetes since pregnancy. Just interested if anyone knows a link?

We‘d love to have another baby in the future and I’m bit confused as to why my TSH isn’t normalising. Consultant isn’t worried and is happy to discharge me back to GP?

many thanks for reading,

Ally

[PurpleNails Administrator]

Q) why my TSH would continue to be suppressed but T3 and T4 are normal?

A) Simply the TSH isn’t reliable. This could be due to down-regulation of HPT axis (Hypothalamic-Pituitary-Thyroid). (The technical term) It often occurs after being hyper, the TSH takes a prolonged time to recover, & can stay suppressed of low longer term.  In some cases of longer term untreated low TSH, it can be permanent.  I have been euthyroid (carbimazole) for over 4 years, TSH still undetectable.  

Q) I had very aggressive gestational diabetes during pregnancy and my HBa1c is borderline for pre diabetes since pregnancy. Just interested if anyone knows a link?

A) Elevated thyroid increases blood sugar in some cases.  With thyroid / insulin / blood glucose the interaction can be unpredictable.  I’m my case it pushed me to type 2 but reversed it once thyroid under control / lower carb diet. 

[Ally1234567 in reply to PurpleNails]

Hi PurpleNails,

Thank you, really appreciate your very detailed answer. It’s really interesting about the TSH being unreliable and perhaps it’s taking time to recover and reflect in the bloods.

Interesting about blood sugars and elevated thyroid levels, makes perfect sense as I guess everything is heightened and systems stressed when hyper. They certainly feel linked to me, can’t really explain it other than I feel different these days to how I did pre graves diagnosis, everything is out of whack!!! I will monitor my carb intake more closely and try to delay this from developing

Thank you so much

[pennyannie]

Hey there again Ally :

You were diagnosed by Graves antibodies circulating in your blood, though not at a high enough level to justify treatment and there is no way of ridding your blood of these antibodies.

These antibodies tend to cleave onto the TSH Receptor sites within the body causing constant stimulation to the TSH which results in a close to zero TSH and the consequence of which is usually a T3 and T4 over range and rising.

Normally speaking a low TSH reading generally sees high over range T3 and T4 readings - and should this happen, it's likely an AI disease, either Hashimoto's or Graves and the next step is to analyse the blood further to know which AI disease antibodies are positive and then this is when treatment with an Anti Thyroid drug would be suggested, if Graves is diagnosed, and deemed ' life threatening ' .

The anti thyroid drug - Propylthiouracil - PTU for short - is generally prescribe when the patient is pregnant.

It is essential to monitor on T3 and T4 results and ranges as the TSH is not a reliable measure of anything - though sadly thought by many - to be the only blood test necessary.

I have Graves and had RAI thyroid ablation so my thyroid has been totally disabled and I now need to take full spectrum thyroid hormone replacement every day and liken it to having been flipped from automatic to manual and need to take a measured dose of full spectrum thyroid replacement everyday in order to function.

So now I am still with Graves antibodies in my blood and my TSH low, supressed but without a thyroid to stimulate - so the cause is still there - but now there is no effect - as I 'm now without a thyroid and classed as primary hypothyroid.

The cause of my illness is likely still here - Graves antibodies stuck on my TSH receptor sites but it's effect on my thyroid ( at least ) is negated - as my thyroid is been burnt out and disabled in situ - though I do not recommend for one minute RAI treatment and if push comes to shove a thyroidectomy has to be the cleanest and most precise, safest treatment option.

Obviously, now you are aware of this disease you are concerned but please don't overthink things - are you dealing with any symptoms now ?

Many people have mild symptoms and Graves which can burn themselves out without any intervention - some people on this forum have an Anti Thyroid drug in their medicine chest and can sense when things aren't quite right for themselves,, and just take a low dose AT drug to off set symptoms to get them through a stressful period in their lives.

Look to the Elaine Moore website which I think I've already shared - I learnt a lot about myself and of the triggers I lived through before my Graves diagnosis though 10 years too late and after I'd had RAI thyroid ablation, a treatment I deeply regret.

elaine-moore.com

[pennyannie in reply to pennyannie]

NIKEGIRL

[SlowDragon Administrator]

Important to test vitamin D, folate, B12 and ferritin levels too ..at least annually