low TSH normal t3 and t4

[Haybrookie]

I have been having fatigue, anxiety and weakness for a while now. Blood tests came back this week with 0.03 TSH but normal t3/t4 although both were in the higher end of the range. I have a history of swinging hyper/hypo and have diagnosed nodules. Currently not medicating. Could this result explain my symptoms? Other vitamins all normal. Iron and ferritin almost low enough to be out of range. Have a history of high antibodies but they were not tested this time.

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[Haybrookie]

sorry my t3 is actually above the range but t4 is normal

[greygoose]

You have a history of swinging hyper/hypo.

You have a history of high antibodies but they were not tested this time.

You have Hashi's, and that's how it behaves. You don't need to retest the antibodies once you've had a positive result, because antibodies fluctuate all the time but the Hashi's never goes away. The actual level of the antibodies is irrelevant.

Can't comment on the FT4/3 without seeing the numbers. But it sounds like it's your low ferritin/iron that's causing the symptoms. TSH doesn't cause symptoms. But high FT3 might.

[Haybrookie in reply to greygoose]

Serum iron level 12.0 umol/L [9.0 - 34.0]

Serum transferrin level 2.3 g/L |2.1 - 3.6]

Transferrin saturation index 21 % [15.0 - 55.0]

Serum ferritin level 34 ug/L [20.0 - 275.0]

Serum free triiodothyronine level 6.0 pmol/L

Serum free T4 level 17.8 pmol/L 19.0 - 20.0]

Serum TSH level 0.03 mu/L [0.35 - 5.0];

[PurpleNails Administrator]

Can you add actual results with lab range?

(Ranges vary between labs, so needed with every result)

TSH, ft4 & ft3? & What thyroid antibodies have been tested?

There are many thyroid antibodies -

TPOab (Thyroid Peroxidase antibodies)

TGab (Thyroglobulin antibodies)

TRab (TSH receptor antibodies - measures stimulating, neural & blocking antibodies)

TSI (Thyroid-Stimulating Immunoglobulin)

Have you had an ultrasound scan of thyroid diagnosing nodules? What was full report? Obtain of you don’t have copy. Ultrasounds don’t show actual function of thyroid (uptake scan are used for that if doctors suspect hyper nodules / negative autoimmune ). As you have autoimmune, fluctuating levels likely to be put down to that.

[Haybrookie in reply to PurpleNails]

I didn’t have a scan I don’t think but was palpated by my endo and written in his letter that there were nodules

[Haybrookie in reply to PurpleNails]

no antibodies were tested this time. In the past it has been TPO which have fluctuated over the years

[PurpleNails Administrator in reply to Haybrookie]

So likely Hashimoto’s referred to as “autoimmune thyroiditis” (GPs just refer to under functioning thyroid)

Can cause transient hyper from the autoimmune damaged thyroid cells release hormone stores.

TPO antibodies is the immune system clearing up a thyroid enzyme which aren’t usually circulating. They can fluctuate greatly. Once positive it’s a diagnosis.

Ultimately the FT4 & FT3 will naturally drop & (TSH will rise). This stage is when replacement is required as thyroid cant produce enough. It’s why drs go by thyroid level (often TSH alone) & just say TPO can be sign of future hypo.

[Haybrookie in reply to PurpleNails]

So do I need to be medicated as hyper or hypo? Or nothing at all?

[PurpleNails Administrator in reply to Haybrookie]

I would say you need careful monitoring, at least every 2 months to see if your levels decline.

Doctors do tend to diagnose hyper (eg Graves) based on low TSH & give anti thyroid medication, that would not be a good approach if your levels are going to naturally drop ( they would drop very quickly).

If dr suggest treatment (carbimazole or PTU) to lower thyroid level insist TSI & or TRab antibodies are tested first. Especially while FT4 & FT3 are not significantly over range.

[HealthStarDust in reply to PurpleNails]

I agree with this. You need careful monitoring at this time.

[Haybrookie]

Serum iron level 12.0 umol/L [9.0 - 34.0]

Serum transferrin level 2.3 g/L |2.1 - 3.6]

Transferrin saturation index 21 % [15.0 - 55.0]

Serum ferritin level 34 ug/L [20.0 - 275.0]

Serum free triiodothyronine level 6.0 pmol/L

Serum free T4 level 17.8 pmol/L 19.0 - 20.0]

Serum TSH level 0.03 mu/L [0.35 - 5.0];

[HealthStarDust]

May you explain your history with hypo and hyper. Do you mean you experience hyperthyroidism without medication?

[Haybrookie in reply to HealthStarDust]

Yes I had a hyper thyroid event due to treatment for Lyme disease in 2015. It resolved when I stopped the treatment and ever since then I am prone to being a bit hypo but also react badly to hypo meds. Last time I took t3 I had a mass increase in my prolactin and had to stop it. I then managed to control my thyroid with metavive

[HealthStarDust in reply to Haybrookie]

Thank you for sharing.

[calej]

I also have normal T3 and T4 with low TSH and high TRAb. I have been without meds for more than 1 month now and I FEEL GREAT! I'm trying to find out how to make all my values normal so my doc will be happy. I basically know how to balance my thyroid but can't put my finger on these values.