Newly diagnosed subclinical hyperthyroidism

[MaMaMeMo]

Hi

My 18 year old daughter has recently been diagnosed with subclinical hyperthyroidism. Her main symptoms are heightened anxiety, poor sleep, panic attacks, fast heart rate (especially during night wakings), hot flushes (especially at night), fatigue and hair loss to name a few. She is currently being monitoring every 3 months and not medicated.

Could anybody offer any advice as to what I should be asking the doctor - this is all new to me and I am at a loss trying to digest all the information. We are waiting for the results of her latest blood tests (3 months after the last test).

Her results are as follows:

FT4 (range 7.85-13.6pmol/L)

1 Aug 24 - 15.1

30 Aug 24 - 13.8

TSH (range 0.38-5.3MLU/L)

1 Aug 24 - 0.23

30 Aug 24 - 0.35

Se thyroid peroxidase Ab < 4 (range 0.00-24.9IU/Ml)

Vit D 71 nmol/L (range 51-374 nmol/L)

Ferritin 23 ug/L (range 3.2-75.10ug/L)

Vit B12 516 ng/L (range 179-719ng/L)

Any advice would be much appreciated.

[PurpleNails Administrator]

welcome to forum.

Ask for folate & TG antibodies to be tested. TPO antibodies are in range but sometimes TG are positive without raise TPO. Transient hyper common in early stages of autoimmune thyroiditis (Hashimoto’s)

continuous hyper usually, quickly shows as unreadable (<0.01) TSH & significantly elevated FT4 & FT3. It is called subclinical because some of the markers are within range. This doesn’t mean she won’t have symptoms - which sometimes doctors overlook because the numbers are concerning “enough”.

Any continuous raised FT4 & FT3 requires treatment. The cause should be invested first.

Ferritin very low, how is her diet ? Veggie/vegan? See if doctor will test an iron panel. She may need to supplement, but needs to confirm iron deficient first.

Vitamin D low too, try a supplement with k2 & magnesium co factors.

[MaMaMeMo in reply to PurpleNails]

Thank you for the quick reply.

She is not veggie/vegan but does not like meat apart from chicken and diet could be better - she's not a food lover. She currently takes a Vitamin D3 supplement but not one with k2 and magnesium so will try and change to one that includes them.

As is the case these days, it's very difficult to get an appointment with her GP. I think it's probably in her best interest to push for a face to face GP appointment to discuss next steps. I would very much like to go clued up on what tests to ask for and question any dubious results.

Thanks again for the info.

[SlowDragon Ambassador]

These results more likely early stage autoimmune HYPO called hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid type symptoms and test results before becoming increasingly hypothyroid

Very Low ferritin level is more likely when hypo than hyper

Low ferritin can cause fast heart rate

Request full iron panel test via GP

Meanwhile significantly increase iron rich foods in diet

ideally she needs TG antibodies tested - but NHS won’t test as her TPO antibodies are negative

Significant minority of hashimoto’s patients only have high TG antibodies

And she needs ultrasound scan of thyroid

[MaMaMeMo in reply to SlowDragon]

Thanks for this - interesting as her Aunt is hypo and I thought her symptoms were more hypo than hyper. I’m thinking that the GP we spoke to may not be very clued up on all of this and has not looked at the bigger picture.

Thank you both for your info - I’m still trying to get my head around it!

[tattybogle]

The thing is , at this point there is not much more they can practically do apart from watch and wait to see what happens next . if hypo develops they can treat with levothyroxine ,,,if hyper develops they can treat with antithyroid drugs ( usually carbimazole), but neither of these options is appropriate ( yet) with those results. The latest result should hopefully be more enlightening , so let us know what they are when you get them.

Sometimes propanolol is prescribed while waiting to help with the heart / anxiety symptoms , but not always .. and i dont know the reasoning around when this is offered and when it isn't.

[MaMaMeMo in reply to tattybogle]

Thank you.

Propranolol was briefly mentioned so I’d be interested to know if anyone has had any success with it controlling anxiety and palpitations.

I shall post with the updated results when we get them.

Grateful for all your comments 😊.

[tattybogle in reply to MaMaMeMo]

My daughter (26 ) has just been prescribed it a few wks ago .... not for thyroid , although

"?hyperthyroid symptoms" is why she originally went to doctors , panic attacks , insomnia, anxiety , dry retching first thing in the mornings ,talking 10 to the dozen while physically shaking , weight loss , pulse a bit fast, BP a bit high, everything about her screamed 'hyper' ,,, but her thyroid results appear fine :

in june TSH 0.61 [0.57 -3.6] fT4 12.8 [7.9-14] which is 80% through range .

now 5 months later :

TSH 0.56 [0.27 -4.2] fT4 18.6 [12-22] 66% through range fT3 5 [3.1 -6.8]

Thyroid antibodies were also normal TPOab 10 [ <35]

so her thyroid levels seem pretty stable., T4 and T3 are nowhere near high. GP has ordered more tests and prescribed propanolol to try in the meantime ( which did concerned me a bit as i know it can be very difficult to wean off this later on )

However .. the result was astonishing .... literally a different ( better) person came downstairs the next morning.... calm ,,, slept well .... she's been on them for about 3 weeks ,,, so far no problems ,,, everything is easier to manage .. apparently people at work can tell if she's forgotten to take one.

i know propanolol will lower conversion of T4 to T3 ( T3 is the 'active' thyroid hormone) , but since her T3 is quite good that should not be a problem.

I don't know what will happen next ..., or what is actually causing the problem, but she is definitely doing much better with the propanolol than she was without it. So it's probably worth discussing .

However , it does still worry me that if / when she tries to come off it , it could be very difficult.

[MaMaMeMo in reply to tattybogle]

Thank you - your daughter sounds very much like mine. She talks 10 to the dozen, finds it very difficult to hold focus, hyper fixates on silly things - all those things you would associate with a typical teen.

Maybe propanolol should be a consideration although I think she’s quite reluctant and ultimately it’s her decision.

[Regenallotment Ambassador in reply to MaMaMeMo]

Those symptoms describe the teenage me, Pat yourself on the back for helping her seek answers. I was in my late 40s when I figured it all out. Wishing you all well 🌱

[MaMaMeMo in reply to Regenallotment]

Thank you 😊

[SlowDragon Ambassador in reply to tattybogle]

tattybogle

I was on propranolol 20 years with Hashimoto’s (more on my profile)

It is possible to get off (but needs to be done carefully, systematically and slowly)

Strongly recommend you get your daughter FULL thyroid including TG antibodies and vitamin testing

[MaMaMeMo in reply to SlowDragon]

Thank you .

[FallingInReverse]

Just a parallel thought from my own experience with my 18 year old.

My daughters story isnt like your story - but for any girl in her teens with thyroid issues, it is absolutely worthwhile to keep an eye on thyroid PLUS monthly cycles and sex hormones.

Our thyroid and sex hormones are intertwined in complex ways, symptoms can overlap and it’s sometimes hard to identify the root cause and therefore how to address.

The teen years are so volatile for girls, 18 theoretically is when it should all start to stabilize. If it hasn’t - as for my daughter - we are exploring things concurrently.

[MaMaMeMo in reply to FallingInReverse]

This is interesting as one of the main reasons for the investigations was due to heavy, long and painful periods.

Good luck to you and your daughter 🤞.