Last month, i was having a friendly chat with a doctor friend when he asked if i was growing a goitre, i laughed it off and said it can never be me, he waved it off too saying maybe that's how my neck was. I was disturbed by this so i went to my gp and asked him to write out test for my thyroid, though he dismissed this because he said i didn't look like i have a goitre, but i insisted. When my result came out it was frustrating.TSH- 2.3 IU/L (0.4-4.2) Normal
T3- 19.6 ug/dL (0.5-2.0) over the range
T4 -1.4ug/dL (4.0-11.0) below the range
Before the test results i was fine but now that i have been on carbimazole 30mg daily for about 2wks now i am beginning to feel ill. My symptoms are gritty eyes, pain in my joints, sharp pain on the right side of my neck and constipation.
Please is my result really consistent with hyperthyroidism seeing that my TSH is normally and my T4 low. I'm so scared, what can i do?
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Happy-b
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When thyroid levels become high the TSH is usually low if not undetectable eg(<0.01) but your TSH is in range & actually a little higher than what most healthy people are placed at.
The T4 & T3 - do you know if this is Total or free (unbound) levels.
You need to know the free T4 & T3 and normal FT4 and very high FT3 is very unusual, you would still expect to see very low TSH even in mildly elevated FT3.
From the sound of it, the doctor has started you on carbimazole without investigating why you are hyper.
Hyper can be transient so it’s very important antibodies are checked to tell you if you have autoimmune either attacking (Hashimoto’s) or stimulating your thyroid (Graves).
Graves causes continuous hypEr, Hashimoto’s can cause transient, but ultimately you become hypO thyroid. Carbimazole hastens the drop in levels.
Are you due to have another thyroid funtion test soon? . See if Free T4 & Free T3 can be tested & thyroid antibodies-
Also important to test folate, ferritin, B12 & vitamin D.
Where do you live? There are private blood testing options if Doctor can’t test everything on thyroid uk web site. I can add link but if elsewhere won’t be relevant.
Being well before starting medication but unwell now is a sign your levels have been lowered too much. Your symptoms sound hypothyroid especially constipation.
Please speak to doctor about gritty eyes. You may need to see a specialist. Try to find *preservative free* eye drops or eye wipe or eye gels this will help.
Do you have a swelling 1 side of neck? or is it painful without swelling? Look at the base of your near near to collar bone. Tip your head back and take large gulps of water. The thyroid moves when swallowing but it is not visible. Sometimes swelling show up when doing this.
I have a large nodule which become apparent when doing this & hot (hyper) nodules can be known to cause T3 dominant hyper.
Thank you for your response. You have been really helpful.Yes my gp booked me for another thyriod tests next 2 weeks. I will request for antibodies testing too, and begin search for a good endo specialist.
Apparently my nodule is not very visible but i can see my thyroid move when i swallow and look into a mirror. I don't know if my high levels caused the goitre or my goitre caused the spike in my T3.
Do you take any nutritional supplements? Especially supplements that contain biotin?
Your GP obviously doesn't know that much about thyroid because with unusual results like that - and they are very unusual - the intelligent thing to do would have been to do a retest, including antibodies. Especially as you don't have symptoms, and he didn't even think there was a problem to begin with. Where do these doctors keep their brains?!?!
Thank you for your response. No I don't take any supplement yet. And yes, most doctors don't know much about the thyroid. I would have been done for if i allowed my gp convince me not to take the test. He didn't write further tests or advice to take any supplement.
No, in general doctors don't know much about thyroid, but yours appears above average ignorant.
You don't actually know that you would have been 'done for' without the test. Because you don't know why the levels were they way they were. Could be laboratory error - it happens - which is why a second test should have been done. Including antibodies to see if this is some sort of Hashi's activity. If the results were the same, and antibodies negarive, then an ultrasound would be in order to see if you have a hot nodules producing hormone. And, at the same time, a referral to an endo to get Graves' antibodies tested.
But, your GP did none of that. Instead, he prescribed antithyroid drugs which might be quite the wrong treatment. It's knee-jerk reaction to the high FT3 without any kind of logical thinking.
Exactly! I Will follow through another test in the next 2wks as slated, this time i hope my results with be less odd. Also i will insist on antibody tests and probably an ultrasound tooWill be sharing updates here as things progresses.
Welcome Happy-b, we are a very friendly & supportive group; so rest assured that you will receive great advice from forum members.
As others have said, I would 100% get your antibodies checked, either through your GP/ endo or privately if necessary.
I was diagnosed Graves (hyperthyroidism), but (thanks to advice from this forum)private antibody tests actually showed I have Hashimotos (hypothyroidism). I had so many ‘hyper’ symptoms but was actually ’hypo’.
Graves Disease (hyperthyroidism) needs to be confirmed via positive TRab or TSI:
TRab
TSH receptor antibodies
TSI
Thyroid-Stimulating Immunoglobulin
TPO & TG antibodies may be Graves or Hashimotos.
TPOab
Thyroid Peroxidase antibodies
TGab
Thyroglobulin antibodies
I also have Thyroid Eye Disease (TED) which started out as grittiness/ dryness then moved to pain/ swelling around eyes. If mild- moderate TED is suspected a 200ug selenium supplement is advised for 6 months. Studies have shown that this can be hugely beneficial. As others have said, preservative free drops like HycoSan or Hyloforte are essential to alleviate dry eye symptoms.
hi Happy-b if you felt fine before the bloods then I would of done a re-test of your bloods, also make sure anti-bodies are tested. As your results are so off so out of range especially as you said you feel well.
I also went to my GP with a suspected goiter and had above range FT3 and below range FT4 (with suppressed TSH). The FT3 test and other tests ruled out a problem with the pituitary, which can cause low FT4 with low TSH. I was diagnosed with Graves based on anti-bodies. As well as the goiter, they found a nodule on my thyroid, but seems to be benign.
I started on Carbimazole, but it caused my FT3 to drop very rapidly (within a few weeks, even when dose was reduced to 5mg/day) and I went very hypo.Am now on "block and replace" taking 40mg Carbimazole and 25mcg Levo (plus 200mcg selenium, and eye drops, as I thinknwas suggested above). FT3 levels are still high, but almost in range.
No idea if "block and replace" will work for you, but might be something you can suggest to your endocrinologist?
The last few months have been a bit of a roller coaster for me. Energy levels have gone up and down week by week.
I have found that rest, avoiding any exersion in the hottest weather, and eating well have helped.
The endocrinologists still do not have an answer for why my FT3 is so much higher than FT4. They have retested the samples in different labs, and have just sent a blood sample off to another lab to see if there is a genetic element?
Thank you for your response highroid and i am sorry about how your last couple of months was as I can easily relate. It's very unusual for a high T3 and low T4 as i was told, and most endo are very much clueless about it. I hope we'll get to find specialists with answers and better treatment options for us soon enough.
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