High TSH and High T4

[brethor9]

Hi all!

Hoping someone can answer this for me. The last week I have been getting serious symptoms with bradycardia, PVCs, and then Tachycardia, sweating, chest pressure/tightness, severe arm and leg aches. I finally ended up going to emergency. They kept me for observation and checked my heart which was fine. However my vitals were all over the place and my even my oxygen was all over the place. They ruled out, electrolytes, infection, blood clot and heart attack etc. The only thing that came back was a TSH of 5.89 and a Free T4 of 22. I am on 37.5mg of Levothyroxine. My Emerg Dr. was stumped with my symptoms but thinks they ar somehow being caused by my Thyroid. I am also on Hormone Therapy and he wondered if there was a reaction happening between them all. Does anyone know if Estrogen/Progesterone therapy reacts with Thyroid? I should add that for about a month prior I was feeling soooo much better. Now it seems I've crashed for some reason.

[GlowCoach Administrator]

Whats the reference range for the FT4?

Had you not long taken your Levo before the test?

37.5mcgs is a low dose of Levo and unlikely enough to make you well which is choed by your above range TSH.

Basically you probably need a Levo dose increase.

How are your key vitamin levels looking - ferritin, folate, B12 & D3?

What supplements are you taking?

[brethor9 in reply to GlowCoach]

My Endo won't test my Vitamin D or B12 levels even though Ive asked. I don't take any supplememts as I have Mast Cell Disease and react badly to most. The last dose of Levo was 24hrs prior as I ended up in emerg and missed my normal dose. I don't have a copy of the ranges just what the Dr verbally told me. I know for our labs here that level is top of the range and also because I have Graves Disease and when I was hyper my FT4 was high like that.

[GlowCoach Administrator in reply to brethor9]

Then you need to get a printed copy of your results so you know where you are and we can then make recommendations.

Suggest you get a private test run of your vitamin levels. There are many supplement brands out there and some specialise in no additives etc

[brethor9]

Here in Ontario, Canada we can't go to private labs. I can only get bloodwork done through my specialists or GP. I will ask my GP for a copy of the hospital blood work. I'm going to also try to get bloods retested to make sure it wasn't a one off or error.

[Milynda in reply to brethor9]

You should make the request in writing to your GP.

[Litatamon in reply to brethor9]

You can have everything you need tested through a naturopathic doctor in Ontario. If you have coverage the naturopathic doctor will be covered but the blood tests will be out of pocket (they were actively fighting for them to be covered as they are in other provinces' private coverage - BC?).

Or try a doctor at Maple, which is online GPs & specialists. They might do it.

All the best to you.

[Litatamon in reply to Litatamon]

Information about Maple.

Online doctor in Ontario.

[79Sunflower in reply to brethor9]

ALWAYS ALWAYS get your blood work. I say this due to medical malpractice from my own GP..He omitted my thyroid blood work for years which caused massively bad issues like the ones you mentioned above. It was my rheumatologist who caught on..and how poor quality care he was giving me.

[T3sortedme]

it’s well worth checking your T3 levels. In my case, and some others, we have a problem converting T4 (the storage form of the hormone) into T3 (the active form of the hormone that stimulates creation of energy in the cells). If your T3 is low or below the range you may benefit by adding T3 to your T4 dosing. T4 is Thyroxine; T3 is Liothyronine. This is only necessary if your T4 is in range but your T3 is still low. It can be a struggle to get them to test for T3 though - they prefer TSH and T4 readings. Hope that’s helpful.

[Anja83 in reply to T3sortedme]

I agree with this. You can have both high TSH and high FT4 if your FT3 is too low. I had this problem and have to take liothyronine with my levothyroxine to keep things in range.

[KrazyKatMT70]

Both are suggesting you have an overactive thyroid. Many things can cause it. But, thyroid is also a hormone like estrogen and progesterone. You are on a very small dose of thyroid, I’m surprised your Dr didn’t stop the levothyroxine first. But I don’t think it’s high enough to cause those symptoms ! If it started after the hormone treatment, I would look to that first. Why are you on hormone replacement ? I had a total hysterectomy, including ovaries and cervix. And I was 50 and still had regular periods every 28 days. I never had one hot flash. Surgeon said if I started getting them, he would give me hormone replacement. I’m 73 and never got one, EXCEPT when I decided to wean off my Sertraline.Its an SSRI like Prozac. Im on a small dose and figured I don’t need them since it is connected to blindness after age 60. I got like 50 hot flashes a day !! Horrible ! So I went back on them. For some reason after researching it, it can prevent hot flashes ! At 73, I may try again to slowly wean off, aren’t I too old for a hot flash ? LOL

[helvella in reply to KrazyKatMT70]

A TSH result that is over the top of the reference interval usually indicates hypothyroidism. Not hyperthyroidism.

[helvella]

If FT4 indicates hyperthyroid (reference interval is required to know where you are), and TSH is over the reference interval, something is wrong.

It could be interference with the test. But you are reporting multiple issues. Which suggests that the issue is deeper.

One possibility is that you have a TSHoma - a small non-cancerous tumour - which is pushing out too much TSH regardless of the thyroid hormone levels. That can see high FT4 and high TSH together. What conflicts with that is you are dropping into bradycardia.

In my view, you need to see a real thyroid specialist as soon as reasonably practicable.

[BB001]

You might be having problems with thyroid receptor antibodies (TRAb). There are two sorts, stimulating (TSAb) and blocking (TBAb) and they can both be present at the same time.

thyroidpatients.ca/?s=Trab

thyroidpatients.ca/2020/04/...

thyroidpatients.ca/2020/04/...

[Vvap]

Yes, oestrogen/ progesterone therapy reacts with thyroxine replacement. It is usually recommended that you stop HRT if on thyroid replacement.