I am a 31 year old male and have been having strange symptoms of muscle twitches, headaches, heat sensativity, fatigue, palpitations. sometimes feeling of sunburn on my legs and night sweats for the past 2 years. MS was ruled out originally by my GP . I also have a benign thyroid nodule.
I have had a thyroid blood test which shows
T3 level 7.8pmol normal range 3.5 - 6.5
TSH 0.12 normal range 0.49 - 5.23
T4 12.3 normal range 11.5 - 22.7
Thyroid peroxidase ab 36.3 normal 0.0 - 59
I have seen an Endo after a 5 month wait and they said the dont feel my symptoms match my blood test but said i have slight hyperthroidism so not to start medication as could make me hypo. Only given beta blockers
I feel i have been getting slowly more ill and more symptoms every month for the past couple of years. Not sure what to do. I feel i have symptoms of hyperthyroidism and thought this was the answer to what i have been dealing with. I dont want to be ill. Does this blood test match my symptoms with anyones experience. Thank you
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Dan2115
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Thyroid symptoms, whether hyper or hypo, are a very personal thing. We all have our individual list of symptoms. Doctors are wrong to say that whatever symptoms you have don't match your blood test results because there are no hard and fast ruls. And so many symptoms can be either hypo or hyper. But, doctors, in general, just don't know that much about thyroid.
What you need now are antibody tests:
TPO antibody and Tg antibodies for Hashi's - aka autoimmune thyroiditis.
TRAB and TSI for Graves'.
Probably not Graves' because your TSH would be out of sight, and your FT3 a lot higher than that. But, you could have Hashi's where levels jump around unpredictably, but end up hypo. I'm surprised the endo didn't do any of them.
Thank you for the reply the reasoning from them for not doing antibody test was that they think the large thyroid nodule is causing the hyperthyroidism. I suppose i was upset because they said i dont have symptoms of hyperthyroidism after i told them my symptoms. They plan now is just to monitor the nodule
Do they have any real reason to think that about the nodule? Have you had an ultrasound?
I'm not hyper myself, but from what I've read those could very well be hyper symptoms. I woud suggest that your next step would be to get private testing, if you can, and get your nutrients tested: vit D, vit B12, folate and ferritin. Could be some of your symptoms are nutritional deficiencies.
TPOab (Thyroid Peroxidase antibodies) signifies autoimmune and can appear with Graves but not always.
TGab (Thyroglobulin antibodies) is another thyroid antibody.
If all antibodies are negative you should have an uptake scan (or nuclear scan) to determine if that nodule is “toxic” or autonomously hyper function. This type of scan will show what areas are functioning within your thyroid. Ultrasounds Don’t do this, they determine size & health of thyroid.
T3 driven hyper with nodules isn’t rare.
Graves tend to go very high very quickly, nodules can increase slowly over years.
Transient hyper does occur, eg with early stages of hashis, but your levels & symptoms have been rising for a long time. & TPO is negative. Hashimoto’s causes autoimmune damage & that could be visable on ultrasound image.
Your doctors should be finding out !why! you have hyper and unless they can be certain it is transient this should be treating it. Doctors should be well aware high FT3 is not good for your health.
Doctors are right that an antithyroid would likely reduce your FT4 so significantly before FT3 was in the normal range you would likely suffer hypothyroid symptoms but there are methods to deal with that.
Doctors focus on TSH & FT4 they think FT3 isn’t important. but to patients it often they most important measure.
So you doctor should be considering “block & replace” considering your hyper symptoms.
You take a blocking dose of carbimazole (anti thyroid) to block all thyroid function, then restore levels by taking levothyoxine (L-T4) this keeps your levels stable & your body converts a quantity to FT3. Hopefully a sufficiently good level without having disproportionate high FT3 - which is what you issue is currently.
Are you taking propranolol? Or another beta blocker?
You may find FT3 reduces significantly on propranolol.
I have a 5cm hyper nodule, no autoimmune. I had FNA and told nodule benign, but function results were missed, I was almost another year before treatment began.
Graves tend to go very high very quickly, nodules can increase slowly over years.
I had similar FT3 to you when diagnosed although my FT4 was just over range & TSH suppressed, I later found out abnormal results were missed near 5 years before.
Have folate, ferritin, B12 & vitamin D been tested ? As often low with abnormal thyroid.
I had migraines & an excessive eye twitch when diagnosed & introduced magnesium which resolved it. As low magnesium can be factors with migraines & muscle twitching as well as hyper (I was also diagnosed type 2 diabetic within a year of being diagnosed).
I use a powdered citrate magnesium in a drink at bedtime.
You could also try l-cartinine which can lower FT3.
Hello! I do hope soon you'll feel better and hopefully the wonderful answers given to you so far can lead you to help rectify what ails you. I myself have Hashimoto's. and do agree about magnesium need
It's very fascinating what all the human body needs. Personally, I like magnesium bis- glycinate as it does not need stomach acid to be absorbed. And most of us are very low in stomach acid -partly from food intolerances. Here's some info. amymyersmd.com/article/form...
Just to add doctors make the silly mistake of assuming all patients will respond the same. For example the fT3 reference interval is 3.5 - 6.5. This means 95% of presumed healthy people will have an fT3 between 3.5 and 6.5. It may be that your natural level is e.g. 4.0 and so your fT3 is now nearly twice as high giving you all these symptoms. Someone else's natural fT3 may be 6.0 and so they may not even notice an fT3 of 7.8.
You have the symptoms, they are largely consistent with hyperthyroidism and you have abnormal hormone levels. It's not good to have a low TSH, it can stay permanently low leading to problems in the future. I would ask for some medication to suppress your thyroid, if you find yourself becoming hypothyroid you can reduce it or stop taking it.
There's a good amount of evidence that TSH stimulates T4 to T3 conversion, especially in tissues that rely on T3 locally converted from T4. So, you don't want TSH suppressed for a long time as if often fails to recover.
Your medical history resembles mine. I had miserable number of years with my thyroid fluctuating between hyper and normal and was given beta blockers then carbimazole. My nodules grew bigger and bigger and when I experienced compression in my neck, the left part if the thyroid was removed but only after private consultations and scans . Then, my right part became overactive and one of the nodules grew very big, Biopsy, done privately, showed follicular lesions that had a probability of up to 30% of being cancer but the endo and the surgeon told me that they did not think it was cancer so I sjouke not have surgery. Eventually, one of gyro nodules grew so big that it started to affect my swallong. Another private consultation secured a swallowing test that showed my swallowing pipe being cranked from it . This was then the criterion for surgery. I had total thyroidectomy in April of this year and am starting to feel normal, taking 125 mcg of levothyroxine and devoting about 1.5h to self care each day , which involves mediation with breathing, walking , careful diet and stretching exercises. I found iodine-rich foods create hot flushes and sweating. I strongly recommend slowing down , taking care of yourself , but also sticking to your guns when talking to specialists as they are reluctant to take action. Insist on scans and tests. I found NHS consultations very superficial and practically useless. This is not the criticism of the NHS but the awful underfunding they have to endure, and not being able to talk to your preferred doctor/specialist . Research the specialists and see them privately, if you can, and insist they do something about your symptoms. Carbimazole is just a temporary fix. We accept doctors’ tendency to do nothing far too easily. All the best!
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TSH, FreeT4 & Free T3
TSH 144 and no symptoms at all? 
T3 and hypo symptoms 
Low TSH, normal T4 and T3
Suppressed TSH, on T3 trial
