I am currently under investigation for Graves' Disease. I have been subclinical hyperthyroid for most of the last year. My bloods since February have stated "Abnormal" but my most recent has come back borderline and I don't really understand why. My bloods have been:
February 24 : TSH 0.1 (0.35-4.94) T4 11.3 (9-19) T3 4.7 (2.9-4.9) ABNORMAL
March 24: TSH 0.1 (0.35-4.94) T4 11.7 (9-19) T3 4.8 (2.9-4.9) ABNORMAL
July 24: TSH 0.09 (0.35-4.94) T4 12.5 (9-19) T3 4.6 (2.9-4.9) ABNORMAL
September 24: TSH 0.1 (0.35-4.94) T4 12.4 (9-19) T3 5.5 (2.9-4.9) from Consultant at Hospital
October 24: TSH 0.12 (0.35-4.94) T4 11.1 (9-19) T3 5.2 (2.9-4.9) BORDERLINE
(all bloods taken approx 0900)
The Endocrinologist I saw tested for antibodies which came back negative but he has said this doesn't rule out Graves'. I have a thyroid uptake scan booked in for the 28th. He was happy with my vitamin levels which he had access to already. I am not currently on any treatment. I'm thinking with my latest tests I've tipped over from subclinical to overt? I have read that a higher T3 then T4 is indicative of Graves' disease. I have also had a hemithyroidectomy in 2021 so only have the right side remaining. I have another appointment with him in November to go through the results of my uptake scan but I would like to go in to the appointment with a bit of a better understanding of everything so I can ask the right questions.
Thank you in advance for any replies!
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KCH651
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Hello and thanks for your message, sorry to see you haven't had a reply yet. I am going to ^bump this message by replying and tag PurpleNails for support.
Your uptake scan going to tell you more as it will show where your thyroid is functioning. The pattern and density of uptake will allow specialist to pinpoint if thyroid, (the remaining side after surgery) is entirely over active (graves) or of its a nodule or group of nodules hyper functioning. If antibodies are negative & your prior surgery was for nodules, my guess would be nodules.
Disproportionately high FT3 does occur with Graves (10-15%) but it’s even more common with nodule/s. Your increase also appears to be developing gradually over time which more telling of nodules, although you have less thyroid capable of producing.
I have a nodule this is what occured with me. It can take a very slight elevation in FT3 especially to lower TSH. once your TSH has been low it tends to remain low for a period & if low for a prolonged time it tends to stay low for a long time too.
I'm not 100% sure which he tested, it doesn't state in my letter. It only says the antibody test came back negative but this does not rule out Graves'. I had all my nutrients tested with my GP in July as in Feb some were at the lower end of the scale and they had improved with taking B Complex and higher D with K2. I don't have these to hand to share unfortunately.
When I had my Hemi in 2021 they only did TSH, T4 and T3 twice and then I was subclinical from what I understood. They found nodules on both sides and FNA was inconclusive. I know I have a 22x19x29 nodule on the remaining side, the last ultrasound I had on that was Feb 2023.
Thank you for sharing your experience. It is helpful to hear other peoples stories. I haven't really been given any information about nodules from the hospital. The endocrinologist was sure it was Graves'. I have my scan in just over a week so hopefully I'll get a better understanding of what's going on then I still don't fully understand the levels so trying to get my head round it all still! Thank you again.
Your endocrinologist and GP have been blinded by your slightly under-range TSH. In my opinion you probably have Hashimoto's Thyroiditis (know to many patients as Hashi's) or Ord's Thyroiditis rather than Graves' Disease.
Hashi's is an autoimmune condition in which the immune system starts to see the thyroid as an enemy which must be destroyed. During the process of destruction (which can take many years) the thyroid will swell and the patient develops a goitre.
Ord's is an autoimmune condition in which the immune system starts to see the thyroid as an enemy which must be destroyed. During the process of destruction (which can take many years) the thyroid shrinks and there is no goitre.
In both Hashi's and Ord's the destruction of the thyroid can come in waves. When the cells of the thyroid are destroyed, any thyroid hormone contained within those cells is released into the body and bloodstream. If the thyroid is still in the early stages of destruction there can be a lot of damaged cells and hence a lot of thyroid hormone released into the bloodstream. This can make patients have blood test results that show a very low TSH, higher than normal Free T4 and higher than normal Free T3, which makes doctors think that the patient has "subclinical hyperthyroidism". But once this process of destruction has happened the cells of the thyroid do not regenerate, and eventually, even when the immune system is destroying the thyroid there will be too little thyroid hormone in the body/bloodstream/thyroid and the patient will become permanently hypothyroid.
In a healthy person with a healthy thyroid and no autoimmune damage going on, the cells of the thyroid produce thyroid hormone in healthy amounts, but they are not destroyed in the process.
In someone with true Graves' Disease or hyperthyroidism the amounts of Free T4 and Free T3 found in testing are dramatically higher than the results that you have. Also in Graves' TSH will be extremely low - often below the ability of the test machine to be able to measure. So, in Graves' Disease your Free T4 might be as high as 60+, and your Free T3 might be as high as 50+, and your TSH might be less than 0.001.
Whatever you do, do not agree to a thyroidectomy or RAI which involves drinking something radioactive. You are likely to become hypothyroid, you are not hyperthyroid.
In both hypothyroidism and hyperthyroidism a common effect is for patients to have very low levels of nutrients and this can be one cause of the symptoms in both cases. This is why asking people to get vitamin D, Vitamin B12, Folate, and Ferritin tested, and optimised if they are not optimal happens so frequently on the forum. Think of it this way...
Patient A has hypothyroidism but all nutrient levels are good.
Patient B has hypothyroidism and Vitamin B12 deficiency and iron deficiency.
You would definitely feel better if you were Patient A, rather than Patient B.
...
pennyannie has a lot of info on hyperthyroidism and Graves' Disease. You can find her posts and replies here :
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I still don't fully understand the levels so trying to get my head round it all still! Thank you again. 
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