can you flip from hyper to hypo without autoimmune disease?

[Knackeredandcross]

What could cause a switch from hyper to hypo without tpo or tg antibodies please? Both sets of antibodies have been tested numerous times and are never raised so I’m curious if something else could be going on.

Thanks in advance 🙏🏽

[tattybogle]

can you clarify what you mean by 'hyper' ?

[Knackeredandcross in reply to tattybogle]

going from having t3 above range with elevated tsh to normalised t3 in range but still with tsh still higher than should be. Results went from tsh 5 (0.27-4.2) and t3 7.3 (3.1-6.8) to tsh 2.86 (0.27-4.3) and t3 5.5 (3.1-6.8). Endo originally said hyper but now that’s clearly no longer the case but I don’t know why this has happened. No meds. Thank you in advance

[tattybogle in reply to Knackeredandcross]

not you then ?

[Knackeredandcross in reply to tattybogle]

No. It’s my daughter. We’ve been testing her for months trying to work out why she has such fatigue and weight gain. Initially she looked to be hyper but her t3 seems to be normalising but her tsh isnt and I can’t see what’s going on. I was hoping someone with more knowledge had an idea how I can help her. Her tsh has always fluctuated from around 3-5 no matter what we do but her t4/t3 are always normal to high.

[tattybogle in reply to Knackeredandcross]

....... thinking .....

....... has endo checked TRab (Thyroid Stimualtin Hormone Receptor antibodies) fluctuations in TRab blocking/ stimulating antibodies can cause unexpected shifts.

...... high TSH at the same time as high T4/T3 can be pituitary growth called 'TSHoma' ... this over produces TSH even when T4/T3 normal , which then stimulates thyroid to make too much T4/T3 ? ..... but i don't think TSHoma's just 'get better' by themselves though , so this wouldn't explain why her results now ok again.

.... Negative TPOab / TGab cannot completely rule out hashimoto's .. it is possible to have it and not find antibodies. there are research cases where they looked at thyroid tissue and found clear evidence of it without any history of antibodies.

[Knackeredandcross in reply to tattybogle]

thank you for that. She has an appointment with her endo tomorrow so I’m trying to gather as much info as possible so as not to waste the appointment.

She hasn’t had Trab tested, do you think I should discuss that with him? And mention the possibility of serum negative hashis? I’m so desperate for her to be well

[tattybogle in reply to Knackeredandcross]

yes mention them all , see what he says .... , if it is hashi's with no antibodies , then it is still treated the same meaning there is not a lot they can do until her results show there is a need for replacement thyroid hormone , which they don't seem to currently. i haven't had look back at her other result though .

i suspect "watch and wait to see what happens to her results next" is going to be necessary , which is obviously not what you want to hear cos you want to 'do something' to get her better .... but sometimes that's the right/ only thing to do when it's not clear what the issue is.

[Knackeredandcross in reply to tattybogle]

thank you, I will do. Her first test which revealed the high t3 was last December and we have tested every 6 weeks since then. I’ll attach that first test for you to see. Since then her t3 has come down and remained in normal range but her tsh has always stayed around 3. We have found this week that she has had a long standing stomach infection so once that’s treated we may have a better idea of what symptoms, if any are left.

First results

[Jaydee1507 Administrator]

Is this advice for someone else because you are on meds?

There is a percentage of people who are seronegative for Hashi's so swings are possible without antibodies.

[Knackeredandcross in reply to Jaydee1507]

yes, it’s for my daughter. We’ve been testing her for months trying to work out why she has such fatigue weight gain. Initially she looked to be hyper but she seems to be normalising but her tsh is t and I can’t see what’s going on. I was hoping someone with more knowledge had an idea how I can help her. Her tsh has always fluctuated from around 3-5 no matter what we do but her t4/t3 are always normal to high.

[Jaydee1507 Administrator in reply to Knackeredandcross]

Has she had her key vitamins checked because thats the best way you can help her.

Possibly also trialling removing gluten from her diet also.

This condition is so hard in the early stages, especially if there are no antibodies to give a further pointer.

An over range FT3 is unusual though.

[Knackeredandcross in reply to Jaydee1507]

we always check her key vitamins and they aren’t great despite supplementing. We have sorted her b12 but have had barely any joy with iron and folate. We found out this week that she has had an h/pylori infection, possibly for the last 3 years (repeated misdiagnosis) and that may have led to a stomach ulcer which are waiting to find out about. But that could explain her lack of absorption of vitamins? Do you think if we could sort out her iron and folate that her tsh would normalise more? I’ll attach a pic of latest results below.

Latest results

[Jaydee1507 Administrator in reply to Knackeredandcross]

How much folate is she taking? Looks like she could add another 400mcgs.

Her D3 could be increased slightly aiming for 100-150.

Improving vitamins tends to raise TSH.

Her ferritin really isnt that bad, just a bit short of optimal but a way off deficient.

The early stages of Hashi's can take years so just maintain optimal vitamins, possibly get an ultrasound scan to see if theres any visible dange to her thyroid. Very frustrating I know.

[Knackeredandcross in reply to Jaydee1507]

also, forgot to say. Her high t3 test also had a high tsh so initially we were thinks THR but the endo wanted to wait until her next test and it had come down by then. She did trial gluten and dairy free but felt absolutely no different and it made no difference to her results. She also tested negative for coeliac.

[DippyDame]

Have you been taking any medication that contains iodine?

[Knackeredandcross in reply to DippyDame]

no, she only supplements with iron, vitD/k2, folate, zinc, magnesium and probiotics

[SlowDragon Administrator]

H Pylori and Hashimoto’s disease are often linked

thyroidpharmacist.com/artic...

drhedberg.com/hashimotos-th....

drhagmeyer.com/dr-hagmeyer-...

[Knackeredandcross in reply to SlowDragon]

thank you for that, I hadn’t read that before! Very useful information for when she starts treatment 🙏🏽 I will mention it to her endo