My wife had a fatty liver so was referred to a liver specialist.
The liver specialist did tests on the thyroid too and found
Free thyroxine 37.4, TSH <0.01 so he referred her back to the GP to treat for hyperthyroidism
and to be referred to the NHS endocrine service.
The GP rang her the other day and asked her if she wanted to take carbimazole as he warned her that it could cause liver problems. She had no clue if the right thing to do was to take this as he is the doctor but he seemed to placing the decision on her. She said yes she would take it.
She is waiting for the referral date for the endocrine service.
She is now nervous about taking the carbimazole as she is awaiting results of her liver MRI and an appointment with the liver specialist in July and is worried that carbimazole might possibly damage her liver.
She has looked at the list of hyperthyroidism symptoms on this website and as far as she can tell has none of the symptoms that are listed for hyperthyroidism. Her heart rate is 70 so is low, but she also takes a beta blocker called propranolol for migraines so this probably slows it down.
My question is Free thyroxine 37.4, TSH <0.01 a severe and urgent hyperthyroidism?
Given that my wife has no symptoms could she wait till she sees the endocrine service and not take the carbimazole, in order to not risk her liver, or is with these levels of TSH and free thyroxine is it urgent that she takes the carbimazole now, even though she has no symptoms.
Thank you
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Jogey
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GP can request TPO, (Lab will test TG if positive) a specialist might have to arrange TRab or TSI.
TPO & TG appear with both Hashimoto’s & Graves. TRab & TSI confirm Graves.
It is also recommended folate,ferritin, B12 & vitamin D be tested. Many use private blood test by a finger prick test at home / via post to get a full picture I 1 go. Would likely be quicker too.
I take propranolol for migraine prevention. I wasn’t offered treatment initially as the migraines were infrequent, but when I was diagnosed hyper I was given 40mg x3 daily.
Propranolol is often prescribed temporarily along side antithyroid (carbimazole & PTU) because it have the affect of lowering FT3 slightly.
The specialist stopped mine abruptly after 2 month & made me very unwelll as it should never be halted in that way always gradually reduced.
List of companies offering different options, some packages include thyroid function, key nutrients and thyroid Antibodies. Others basic function only. some also have discount codes available.
You order test online the kits arrives via post sample taken by finger prick (extra fee for private venous draw). Complete test early in week (to avoid weekend delays) & track sample back by post - results usually available online quite quickly.
Ideally test just before 09.00. fast overnight, (those who take thyroid replacement should time it to delay dose until after). Remember to leave off biotin 3-5 days before. Biotin has potential to interfere with test process & skew results.
The results are at odds with what your wife is experiencing so another set of tests are needed to make a comparison. Who knows what could have gone on in the testing process? I think the doctor should have done this as a matter of course. As PurpleNails says if you get a kit you can have other things tested at the same time giving you a wider picture.
I think a number of things need to be established.
Approximately how old is your wife?
Is she taking any other medicines? Or supplements?
Such a high FT4 (and correspondingly low TSH) would be rare without symptoms. You need to be sure there is no assay interference. One way of doing this is to get a new assay done in a lab which uses different technology (e.g. one might use Roche and another Abbott).
And she needs Free T3 done. (FT4, FT3 and TSH need to be done on the same sample to endure that they indicate her state at the time of blood draw.)
Are you in a position to get these done privately (assuming GP isn't in a position to get them done, or not speedily)?
I am very glad you are asking now - and not many months down the road.
My wife has rheumatoid arthritis, fibromyalgia and osteoarthritis in her spine as well as fatty liver. She also has migraines. She is also very overweight.
In addition to the medications below she also takes ibuprofen for the pain.
Medications:
Kevzara (sarilumab) biologic injection for rheumatoid arthritis
Propranolol 40mg tablets
Amitriptyline 10mg tablets
Hydroxychloroquine 200mg tablets
Methotrexate 2.5mg tablets
Omeprazole 20mg gastro-resistant capsules
Folic acid 5mg tablets
The GP has referred my wife to the endocrine service at the local hospital presumably to be thoroughly checked out, but I don't know how long it will take.
She is concerned about the following:
1) If as you say a free thyroxine of 37.4 is very high, how come she has no symptoms? As you say, perhaps it is a testing error.
2) Her liver is being investigated for fatty liver and she has an appointment at the end of July with the liver consultant. Could her liver be damaged if she takes the carbimazole in the meantime.
3) If a score of 37.4 for free thyroxine is very high and a THS of <.01 is very low, then is it very risky for her not to take the carbimazole tablets immediately. Could it be dangerous not to take them straight away?
A complication is we are going on holiday abroad very soon for a couple of weeks so it is difficult to arrange tests.
If her FT4 really is 37.4, then I suspect either she is not converting to T3 or the T3 she does get from conversion is insufficient. That is why an FT3 test is absolutely essential. But we might see that high as well.
And you really can't get anywhere without being sure that the assay is good.
If carbimazole were to reduce T3 (that is, it reduces T4 and even the limited T4 to T3 conversion reduces further), then I can't see it as being a viable approach and yes, I would be concerned it could make things worse.
But, if T3 is also high, then things are much more difficult to explain.
Definitely interference is high on my list. If no medicine seems to be directly implicated, antibody interference must be considered.
helvella - Factors that interfere with thyroid tests
A summary of factors known to interfere with thyroid tests.
Remember, my blog only reports what I found and what those researchers found. The number of factors that interfere keeps rising as new ones are identified! Not being on the list doesn't exclude a medicine, especially one that is less commonly used.
I rang the hospital who told me the GP has referred my wife for an urgent referral to the endocrinology service and she should be seen within four weeks. They then rang me back and said that they had an appointment tomorrow which is before we go abroad! So hopefully in the specialist hospital endocrinology department my wife will point out to them that she has no symptoms of hyperthyroidism but has this very high free thyroxine result and they will have the capacity to sort out whether this is a test error or not.
Thanks for all this, helvella and to everyone else who has responded.
Quietly go through all the information you have got - and try to prepare.
Ideally, she would have a blood test before the appointment so that FT3 (etc.) are available and up to date. Is there any possibility of ringing and asking if that can be arranged? Or are there not enough hours...
She saw her a consultant endocrinologist yesterday and he thinks she probably has Graves disease but he has done comprehensive tests and will contact us with the treatment plan soon. Thanks to all of you for all your help
I have a fatty liver and Hashimotos Hypothyroidism, I would avoid anything that could cause further damage to my liver.
But if you are only going to start taking it you need to first find out what your liver enzymes are at? Then after taking it for a little bit have your liver enzymes tested again. This will give you an idea of the effect of the drug.
Also remember that you can heal your liver if you stop taking anything effecting it and eat the right diet. The decision is all yours, hope this helps.
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