I got my thyroid results about a month ago - first time ever tested.
My GP initially wanted to test my thyroid because of these symptoms: sudden severe anxiety, trouble sleeping, shakiness, palpitations.
I've also had increased sweating and some diarrhoea (not bad). I've lost some weight too, though I don't eat as much when I'm anxious.
I was 8 weeks pregnant at the time, but have since had a miscarriage.
The GP said all my symptoms indicated hyperthyroidism and was confused when results showed it was hypothyroidism.
My results were:
TSH - 6.09 (range 0.27-4.20)
Thyroid Peroxidase Ab - 252 (range 0-34)
Serum free T4 - 18.1 (range 12-22)
Serum vitamin D - 54 (range 25-125)
Serum ferritin - 122 (range 13-150)
HbA1c - 29 (range 27-47)
I do have another blood test booked in 2 weeks, at which point I will have been taking 25mcg levothyroxine for almost 5 weeks.
For the record, I was taking a prenatal at the time and am not anymore - don't know if this makes any difference to anything.
I'm still having most of the symptoms as above though, which confuses me. I haven't had any of the typical hypothyroid symptoms and anxiety is still bad.
I've been doing research and have scared myself into thinking I might actually have Graves disease (alongside Hashimotos?) I'm just worried and confused and don't know what to think. I don't know if I should be taking the levothyroxine either now that I'm not pregnant?
Honestly, I've got no clue - just scared I may have Graves and am not treating it!
My husband and I were also hoping to try to conceive again in the coming months so I really want to understand what's going on with me and how I should be treated.
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RLG123
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The FT4 isn’t low, but it isn’t over range either. Your TSH is high but there’s no FT3. FT3 is often the source of symptoms.
It’s possible your levels were low & TSH was higher, then something such as Hashimoto’s hyper swing or less likely Graves has causes FT4 & FT3 to rise. TSH tends to lag behind frees. Transient hyper common in early stage Hashimoto’s.
25mcg is a low starting dose, but you next test will help decide next step.
If you did have high thyroid levels this would show & TSH likely showing low. FT4 & FT3 are more important measure though. TSI or TRab need to be tested if Graves was suspected.
Prenatal supplements often contain iodine / iron and aren’t always helpful for thyroid.
Ferritin ok but vitamin D low. Have you tested B12 & folate?
The thing is, you cannot divide symptoms into two rigid columns - on the right, hypo, on the left hyper! That's not how it works. Most of the symptoms cross over and can be symptoms of both hypo and hyper. Which is why we need to do blood tests to clarify.
Weight-loss, anxiety, shakiness, palpitations and trouble sleeping can all be hypo symptoms, too. And not everybody has typical hypo symptoms. In fact, every hypo has their own personal symptom list so there's no reason why you should be like everybody else.
But why would you think you have Graves'? Your FT4 isn't high enough and your TSH certainly isn't low enough. So, far more likely that you're hypo than hyper. And, levels can be strange when you have Hashi's. But, if you did have Graves', the treatment would be anti-thyroid drugs. That's the only treatment there is. And that really doesn't look to be what you need at the moment. So, if I were you, I'd carry on taking the levo until your next blood test, and see what happens.
Oh, and it could be that your FT4 and TSH are high because you're not converting the T4 to T3. But you won't know unless you get your FT3 tested.
The thing is, you cannot divide symptoms into two rigid columns - on the right, hypo, on the left hyper! That's not how it works. Most of the symptoms cross over and can be symptoms of both hypo and hyper.
Endorse. Endorse. Endorse.
Simplistic descriptions of symptoms exacerbate this. A few examples:
Can't sleep - often assumed to be a classic hyperthyroid symptom. Affected me as I became more hypothyroid.
Loss of weight - loss fat and of muscle mass look the same to the scales. But they are very different. With loss of muscle mass occurring in a sizeable number of those who are hypothyroid. While loss of fat is common in hyperthyroidism.
Impaired vision. All too often assumed that all who are hyperthyroid tend to Graves' Ophthalmopathy/Thyroid Eye Disease so any eye issues are hyperthyroid. Whereas reality is that only some with Graves' Disease suffer GO/TED, yet many who are hypothyroid have eyesight issues.
Dry eyes often interpreted as due to the increased prominence of the eyeballs in GO/TED - hence hyperthyroidism - even when there is none and the dryness is a hypothyroid symptom.
Heat intolerance often looked at as being due to the higher metabolic rate in hyperthyroidism. And impaired ability to lose heat, e.g. by sweating, in hypothyroidism is entirely missed.
Impaired ability to lose heat, eg by sweating, in hypothyroidism is interesting. helvella. I didn't know that..... and I haven't had to use anything to counteract perspiring for years now. I used to love sunbathing...now if it's over 20, I'm uncomfortable. 24 + horrible.
Aww sorry to hear what you have been going through.
I have no answers but all I can say is I went through something a bit similar end 2022.
I have been Hypothyroid for a few years now and out of nowhere I became quite unwell, weak legs, very fast heart rate, high blood pressure, shivering all over and generally feeling awful. My TSH jumped up high for me at 3.94, it is normally much lower.
A long story which I will cut short.
I found out after testing I actually have Hashimotos after years on Levothyroxine. I saw a private Endo and had a thyroid scan. She said I had gone through a Hashi "flare", my scan showed my thyroid was quite inflamed. Seems my Thyroid had been under immune attack and it dumped a load of Thyroxine into my system leaving me with "temporary hyperthyroid" symptoms. It took about 8 weeks before it settled. In that time my TSH levels were all over the place. I too thought I had Graves disease as the symptoms didn't match Hypothyroid at all. My GP didn't have a clue and just dismissed it.
Anyway, just wanted to share my similar experience and hope you feel better very soon.
I had an Ultrasound scan of the Thyroid by a consultant radiologist.
He said straightaway, left hand side is quite inflamed, other side less so, the surface of the thyroid was rough and he was looking at a typical Hashimotos Thyroid.
I complained (truthfully) of a constriction affecting my breathing and interrupting my sleep, so a GP ordered an ultrasound. Luckily my own GP at the time was on holiday, as referrals were hard to get.
Same here. My Thyroid levels are never stable for long, which is why I stay under private Endo and closely monitored. Strangely I have never had typical Hypothyroid symptoms and I have always questioned whether I was Hypo or Hyper. When people mention their Hypo symptoms on here I think I don't have any of that, I seem to match the Hyper ones more.
Obviously I am not Hyperthyroid but seem to be between symptoms for both!! I put it down to having the Autoimmune version which for me seems to fluctuate so never the same. All very confusing.
Have you taken your temperature when feeling hot? I've practically lived in an ankle-length Sherpa hoodie since last Autumn, so am warmer than usual when it's over 20°C, yet my temperature is 36.1°C. During previous summers I could expect my temperature to drop to 35.3°C quite often.
As others have said, many of us with Hashimotos (myself included) have ‘hyper like’ symptoms when thyroid medication and / or key thyroid vitamins are not optimal.
For me, weight loss, tremor, high anxiety, palpitations and fast pulse meant I even ended up in A and E… but things greatly improved when I followed forum advice to optimise medication/ vitamins.
I also ended up in A&E with same symptoms, all quite scary at the time.
I agree about the vitamin levels. At the time of all these symptoms I was Folate deficient, I didn't know that until this forum suggested getting vitamins tested. I am sure this contributed to my immune system taking a big shot at my Thyroid.
So sorry to learn about your loss, and wishing you well for your next pregnancy.
Do you always have the same brand of levothyroxine? I was very stable on MercuryPharma for some years. Then out of the blue anxiety struck. It took a while for me to realise the levothyroxine brand had been changed several times. It is on my prescription now that I must have Eltroxin, made by the same manufacturer, Advanz, and suiting me very well.
I also have a mix of symptoms, some of which are more typical hyper. But I was very hypo when first diagnosed with a TSH of 110. I had severe hunger, anxiety, not sleeping at night, palpitations so I was a bit confused as well.
If too much cortisol is a cause of your problems then the most likely outcome is Cushing's Disease or Cushing's Syndrome (they aren't the same thing - they have different causes) :
A way that cortisol can cause problems in hypothyroidism is that, if it isn't picked up for a long time, the body increases cortisol output to cater for the lower thyroid hormone output. If the adrenal glands are good at producing cortisol and can keep it up for a long time then levels of cortisol might be high. I am convinced that it is high cortisol that makes tolerance of Levo difficult for many people in the early months and years after diagnosis (but I'm not a doctor so I could be wrong). The adrenal glands have to reduce their output once Levo is started and sometimes it can take a long time.
Another possibility is that the adrenal glands might struggle to produce the amounts of cortisol demanded of them and can end up producing too little.
Neither of the above scenarios are a cause of Cushing's or Addison's, they are just causes of too much or too little cortisol.
Since cortisol is one of the stress hormones it can cause symptoms associated with anxiety and stress when too high or too low.
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It would be worth asking your doctor for a 9am blood test for cortisol (timing is important). If you get one of these done ask for the result and the reference range.
In addition, or instead of the blood test, it would be worth doing a four-part saliva test for cortisol but doctors don't do these and we have to pay for them ourselves. Several companies offer them but some are better than others. If this interests you ask for more info before spending any money.
An example of the output of a saliva test is given and discussed in this thread :
The above link is quite old now and some of the links might not work - but it is just an example of what you could expect with a saliva test.
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Another possible cause of anxiety, sweating, and other symptoms associated with thyroid disease is poor nutrient levels. Ferritin (iron stores) and serum iron (iron level in the bloodstream) can be wildly different - both high, both low, one high and the other low. There are other iron-related tests that are helpful e.g. transferrin saturation, and TIBC (Total Iron Binding Capacity) The best way of testing all these is with an iron panel. This is the one that many of us do with fingerprick testing :
It could be hypo symptoms. I had the almost exact symptoms: i was stable with hashimoto for many years, with no symptoms at all. I was with a dose of 900 mcg levo weekly. My doctor thought it was a good idea to lower it to 700 to see if i can get off it completely. Then hell broke loose: i had a lot of anxiety, palpitations, i couldn't sleep for more than 2 hours, i lost around 35 kg in a month! No doctor had any idea what was going on and even my labs did not indicate so many symptoms (i had a tsh around 4, when previously i was around 1. The rest were similar). When i understood that i could not find any solution i tried increasing my dose myself. I couldn't tolerate the increased dose and at start my symptoms were worse. Only after i remained on an increased dose for around 4 months, then my symptoms almost resolved. I still have issues finding the correct dose, but all of these symptoms are 90% resolved. In short, i am not trying to tell you that its definitely hypo symptoms (although your labs seem to indicate it). Your doctor will decide this. But it definitely may be hypo symptoms. And i am proof of this.
Exactly the same as Buddy195 I experienced tremors (still do to some extent) and often hot rather than cold with high TSH. Also lost a lot of weight before being diagnosed, probably due to the Thyroid stores being released due to the attack.
I remember hearing somewhere that pregnancy affects the TSH result and it isn't reliable. Has anyone else heard this and can provide research links? My GP dropped my Levothyroxine from 200mcg to 50mcg after I gave birth because my TSH plummeted to unmeasureable. I felt dreadful until TSH recovered and dose was increased a few months later.
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Need Advice Please 
Increased anxiety…
I’m fine. Really?
Thyroidectomy or not? Thyroidmegaly and multi modular goiter. 
methinks it's time to add some T3......thoughts ?
