Hello, I am looking for some explanation on the above diagnosis.
I got bloods done last week which showed my results as having low white blood cells, a high iron % as well as the below thyroid hormones:
TSH <0.01
Free T4- 67
Free T3-20.5
Can someone please explain what these mean? Especially TSH?
I have been admitted into hospital for a few days and just been discharged. The on-call Endocrinologist advised an immediate treatment plan to start:
- Start Carbimazole 40mg od
- Start propranolol 10mg tds
- ECG to rule out AF
- Follow up bloods in 2w
- Urgent Endo referral
I am a front line emergency services worker and I am feeling so unwell. High heart rate, tremor, vomiting, shaking, dizziness, rapid weight loss. I am currently signed off sick for 2 weeks - only got a week left but I am concerned I am not going to feel better in a week.
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Creammaxwell
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Your sick note can be extended - so please do not not worry on that score.
The Carbimazole is an anti thyroid drug which will semi-block your new daily T3 and T4 thyroid hormone production and slowly your T3 and T4 will start to fall back down into the ranges and your symptoms resolve.
The AT drug is then titrated down as you don't want your T3 and T4 falling too far through the ranges as then you will experience the equally disabling symptoms of hypothyroidism.
Your body is in a heightened state - your immune system is upset, raging and angry and you are likely very uncomfortable and you need to rest and have as little stress as possible.
Do you have the PIL for the Carbimazole - I remember as my white blood cell count was 4 and at the bottom of the range when diagnosed Graves and told to go immediately to A& E should I develop a sore throat - but do not worry as there is an alternative Proplythiouracil - PTU for short.
The beta blocker - Propranolol will also help by slowing down the conversion of T4 into T3 - as it's the high T3 causing the horrible symptoms.
Do you have there any antibody readings - generally written as TPO - Thyroid Peroxidase - Tg AB - Thyroglobulin : : TR ab - Thyroid Receptor blocking : : TSI - Thyroid Stimulating :
and ranges or a measurement sign - ?
This looks like Graves Disease and the antibody test is the medical evidence and confirmation of which antibody is over range and proof of why the medication has been prescribed.
Graves is a auto immune disease generally diagnosed when your immune system starts to attack your thyroid and the thyroid is a major gland and the controller of all your bodily functions - from your physical through to your mental, emotional and psychological well being, your inner central heating system and your metabolism.
The symptoms are diverse, multi-organ, with some symptoms seeming just a bit ' odd ' but Graves is considered life threatening if not medicated.
It can be a roller coaster of symptoms, emotions and cognitive function -
but hang on in there as it does get better.
Are your eyes involved - dry, gritty, constantly watering, or light sensitive - just ensure any lotion, potions or drops you use are Preservative Free - even those prescribed.
Graves is a poorly understood and badly treated Auto Immune disease as everybody's journey with Graves is unique to them - but stress and anxiety are common triggers -and as to why your immune system has turned and started attacking your body rather than defend it is the 64 million $ question ?
When with an overactive thyroid the TSH is generally sat down at 0.01 - and fully suppressed as the antibodies are ' sitting on ' your TSH receptor sites driving down the TSH which in turn drives up your own thyroid hormone production.
There is no way of removing these antibodies but naturally, given enough time, they may reduce as your immune system response calms down and then your TSH will respond and start to rise through it's range - not sure my TSH ever recovered - we are all different.
High iron is common when the body is so inflamed - I'm sure this will resolve as your body calms down and your symptoms relieved - and since it's been high lighted I'm sure the relevant tests will be run in due time.
The most well rounded of all the research I did is that of Elaine Moore - via her website and books - elaine-moore.com
The TSH Receptor antibody - TR ab - is positive at 4.80 with ( > ) under 1.7 being the cut off level and that means that you have a diagnosis of Graves Disease.
Biotin is known to influence the assays used in some laboratories who undertake blood test and cause false readings - do you take any supplements containing biotin ?
I would imagine this is a reminder to medics to check with the patient as to their use of biotin.
We can all read everything you reply - so please don't stress writing the same information more than once.
Well - work will have to make alternative arrangements - no one chooses to be ill - and I'm afraid it will take you a good few weeks to feel more able.
Considering you work on a' front line emergency service ' I would suggest you talk this through with your company and consider ' standing down ' in the short term until you are well medicated and your T3 and T4 levels stable in the ranges.
How long have you been ' on the front line ' - is there a possibility of a desk job in the mean time ?
Though know you probably don't want to read this thought :
The TSH (thyroid stimulating hormone) is a pituitary hormone which signals your thyroid to produce, a healthy TSH is eg under 2.
Something has caused your FT4 & FT3 (the thyroid hormones) levels to rise so the feedback mechanism is signalling the thyroid to lower.
The opposite occurs with low FT4 & FT3 and TSH rises to reflect that the thyroid must work harder to make more hormone.
<0.01 is currently undetectable as it’s below the test limitation.
It’s likely to be due to autoimmune & antibodies should been tested to confirm the cause. (There are other reasons). Graves the most common cause of continuous hyper is stimulating your thyroid. The is also autoimmune thyroiditis which causes autoimmune damage to thyroid, initially this can cause a transient rise before declining to under active.
Do you have the lab ranges, ranges vary but by most ranges your levels are quite high.
It might take a little longer than 2 weeks to feel recovered, because it’s a shock when levels rise & then are brought down. Once levels are back on range and your in the right adjusted dose to keep your levels from bouncing is can take time for symptoms to resolve.
The TSH can also stay low or down regulated long after the FT4 & FT3 are “normal” so doctors must look at FT4 & FT3 to ensure these are in the right range.
Having abnormal thyroid level can cause nutrients to be affected. Important to also test B12, Folate & vitamin D.
About Thyroid antibodies:
TPOab (Thyroid Peroxidase antibodies)
TGab (Thyroglobulin antibodies)
If Graves’ disease is suspected this MUST be confirmed with positive
Above high reference limit; TSH receptor antibody > 1.7 U/L is positive
Recent high dose biotin ingestion can cause false positive results See tinyurl.com/Biocheminfo for information about biotin
Can you tell me what these means? Is this the antibody which means I might have Graves’ disease? My doctor has not been particularly helpful at telling me the cause and I am waiting to see an endocrinologist to explain to me what the cause is.
It does feel like work are not being particularly supportive to my awful symptoms and not being able to be there. I am sleeping about 15-18 hours a day at the moment and can barely eat.
That’s a positive level of TRab. As it’s over the normal limit.
These measure antibodies affecting thyroid receptors & include stimulating, which is why your levels are high there are also include neural & blocking antibodies.
This is evidence of Graves and now you have the ranges you can see just how high your levels are.
FT4 67 (11-22) 509.09% or 5x normal range
FT3 20.5 (3.1 - 6.8) 470.27% over 4x normal range.
You need to rest & should not be doing anything strenuous or stressful.
It will take few weeks to start feeling normal again, but you will feel a lot better. I found that the beta blocker (propranolol) helped me a lot while I waited for the carbimazole to take effect.
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