I am a 28-year-old man (90 kg). I had a total thyroidectomy 8 years ago due to papillary carcinoma. Recently, I had a knee surgery and during a subsequent blood test, my TSH level was checked and found to be 4.5. However, I had taken my medication (euthyrox 150mg) on the morning of this blood test. Therefore, the test was repeated and in the new test, the level was seen as 22. My T3 and T4 levels are within normal ranges (4 and 16). I have my check-ups every year and last year there were no issues in both blood tests and ultrasound results. What do you think could be the cause of this situation? My doctor's appointment is in 4 days, but I am very curious about this situation.
Edit: Added lab results
FERRİTİN 136.0 ng/mL 30 - 400
FOLATE 2.68 ng/mL 3.89 - 20
VİTAMİN B12 479 pg/mL 197 - 771
Vitamin D (25-hidroksi) 33 ng/mL 30 - 150
TSH 22.20 µIU/mL 0.27 - 4.2
T4 16.40 pmol/L 11 - 22
T3 3.78 pmol/L 3.1 - 6.8
TİROGLOBULİN <0.04 ng/mL 3.5 - 77
AntiTg 13.3 IU/mL 0 - 115
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If you could add the last results and ranges (different labs use different ranges) we'll be able to comment more fully, I suspect you understand that a raised TSH means your body is asking for more and you are likely under replaced
One possibility - and I have no idea why this would fairly suddenly occur - is antibodies to TSH.
A TSH antibody can attach itself to a molecule of TSH forming something called macro-TSH. Then, when a TSH test is done, the result looks high.
The best first step is for the TSH test to be redone on an analyser that is not susceptible to this issue. Or for it to be checked that the analyser that did your test is itself not susceptible to this issue!
Thank you for your answer. My last normal ranged test was 1 year ago. The previous test( not hungry and took my pill) was 2 weeks ago. 4.5 with the pill 22 without the pill.
Most are well when TSH is under 2, FT4 in top 3rd of range & FT3 the active thyroid hormone is in top 50% of range.
Your TSH (thyroid stimulating hormone) is a hormone (from the pituitary) to signal the thyroid to increase production. As you have no thyroid you are reliant on replacement.
So the feedback loop says you need more hormone. Are the FT4 & FT3 levels good in range (optimal) or low in range? Please add lab ranges as they vary.
Recommended thyroid test are taken early in morning, fast overnight & delay dose until after draw. As this gives consistent results.
Key nutrients help Levo to work well have folate, ferritin, B12 & Vitamin D been tested?
I was going to say exactly what PurpleNails and greygoose (below) said! Taking your medication (which is T4, the inactive hormone) won’t influence your lab results as T4 has a long half-life in the body (unlike T3, the active hormone), so the very high TSH shows that you’re undermedicated. Your D3 and folate are also very low! How much T4 are you taking?
Get the test done again just to be sure. Do you have any hypothyroid symptoms? I noted that your weight hasn’t changed but without knowing your height, I don’t know if you’re the right weight and also weight in itself is not the best way to look at it, as muscle weighs more than the same amount of fat so the body composition is also important to know.
If your repeat blood test shows high TSH again, then you’d need to increase the amount of T4 you take, and retest 6 weeks later as that’s how long it takes for T4 to show up in the blood. If no change is detected after 2 increases, then you might have conversion or absorption issues. Low D and folate won’t help as they are both needed to convert T4 into FT3. Are you taking supplements? You also need 200mcg of Selenium as well, and make sure you take Zinc and Magnesium (3 hours away from any thyroid meds as Mg binds thyroid meds!!)
If you have conversion or absorption issues, you might want to consider adding in some T3 (liothyronine aka tri-iodothytonine).
Your FT3 is dire! As are most of your nutrients. The TSH doesn't surprise me - although it is possibly a little excessive. I agree with helvella, you need retesting in a different lab to be sure.
Taking your levo just before the test will have no effect whatsoever on the TSH level, because the TSH doesn't move that fast. What it will affect is your FT4, so you have a false high FT4, there. So, it's possible that in reality it's as low as the FT3. In which case, the TSH is spot on.
Results that are shared are without med in the morning. When I got tested with med it was for the after knee surgery and they only checked TSH levels, no results of ft3 and ft4. That 4.5 result with the med (approx 4 hours after taking it) made me suspicious and went in to blood test for that I shared.
Well, that's as maybe, but I was talking about the TSH of 22.2. As your FT3 is so low, that is probably a correct TSH. But would be good to have it retested in a different lab, just to be sure.
Having a blood test four hours after taking levo will not have any effect on the TSH. The TSH cannot move significantly in four hours.
OK, so the FT4 result above has not been affected by taking levo before the test, but even so, it's not very high. You are under-medicated. And your conversion isn't brilliant but that could be down to your very low nutrient levels.
Recommendation for low risk carcinoma (with or without RAI) is to keep TSH at or below the lower limit of normal range, or 0.1 to 0.5. (ATA 2015) At seven years out it's likely OK to let TSH be a bit higher but not much. As others have already pointed out, your FT4 and FT3 levels are way too low - optimizing them will likely bring TSH into the desired range. Make sure your doctor/s understand that for a thyroid cancer survivor, the "normal" range for TSH is irrelevant.
As your thyroglobulin antibodies are positive, is your Tg being tested using mass spectrometry? TgAb interferes with the Tg test and can give falsely low or high results. Are you still getting annual ultrasounds?
I dont trust the tsh as a test it can do funny things. It looks like you are under medicated but how are you? Do you have any symptoms? Do you know your pulse and temperature? I agree with other saying you conversion does not look good and your vits are too low re above but your body will let you know if you are ill or getting ill soon enough.
You've mentioned your dose hasn't changed since previous decent blood tests. A person's need for thyroid hormone can change over time. In my experience it is common to have a handful of changes over a lifetime just as a result of ageing and normal changes in the body. It could also be caused by lifestyle changes, change in excercise, work, diet, stress levels, other illness, etc. Or caused by nothing you can observe. Hormones are just like that.
You're freeT3 is very low. From the way you describe it it's possibly been this kind of level for a long time? As other mention, most people need it close to the top of the range and yours is scraping along near the bottom. Sometimes it takes a while for the body to react, or symptoms to appear. Or for us to realise we have symptoms because thyroid symptoms such as tiredness, not coping with stress, and a myriad of small symptoms like digestive issues, etc, can creep up on us.
Your vitamin levels are quite poor. This is extremely common when thyroid hormone is under medicated, as being hypothyroid trashes our vitamin levels. These can all be worked on and there is a lot of discussion on the forum about how to raise vitamin levels. Doctors are often no help with vitamins, so needs to be done using over the counter items. It is quite slow work, and can often take a year or more to get to good levels.
I have also had a thyroidectomy due to cancer, and so have many others on the forum!
Oops, forgot to mention that your changing TSH level is a bit of a mystery. As others say, not something we expect to be changed by when you take your pills, as TSH is produced by the pituitary in response to its assessment of your thyroid level. It is a second hand message that takes time to change. Until freeT4 and freeT3, which are direct measures of the levels in your blood.
It does have a natural circadian cycle through the day, so that could explain a bit of variation. Or different machines can sometimes give quite different results.
But the good news is it doesn't really matter. Because TSH is by far the least important of the three tests in a thyroid panel. All it really does is serve as a flag that your hormones are very low. It can't tell us much more than that. There is also quite a bit of variation between people in how high TSH will go in response to low hormone levels, so the actual number doesn't mean too much. It is basically your body complaining it doesn't have enough hormone, and as we know in the rest of life, people will complain different amounts and it is not closely related to how much hardship they have.
Unfortunately doctors will often take TSH the most seriously, and try to use it to tell us everything about dose. It's much better to see all three blood tests to guide a new dose. And symptoms of course, which are the most important of all.
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