Can a hashi hyper swing really last a year? And where do I do go from here? Which specialist should I see?

[Amber-sky]

I do hope someone can shed light on my situation prior to my follow up with the GP later this week. I have updated my profile and I’d ideally like a better understanding of what is going on in order to discuss what next steps are best taken and whom I should appoint or be referred to.

My main symptoms are anxiety and fatigue / weakness in legs (particularly when playing sport) which I know isn’t normal for me.

I was diagnosed with Hashimoto’s 2 years ago and a scan confirmed slight goitre and burnt out thyroid. I was started on 50 and an increase to 75mcg thyroxine normalised bloods etc. But then appeared to come the hashi hyper swing, that has already lasted a year, and thyroxine reduced accordingly.

I now haven’t been taking any thyroid medication since November 2024, about 6 months.

My GP is trying to help and took various bloods recently, one of which, Serum triglycerides is very low ( as below ). Could this be the main reason for my fatigue? I also don’t understand how my T4 is low in range but my T3 is over range.

Last blood test taken 18 March 2025 (11.45am. Should have been early morning but the only app. I could get).

TSH .12 mIU/L (.35 - 4.94) -5.0%

Free T4 (fT4) 11.3 pmol/L (9 - 19) 23.0%

Free T3 (fT3) 5.6 pmol/L (3.0 - 5.4) 108.3%

T4:T3 Ratio 2.018 

Serum Triglycerides  .39 nmol/L (.55 - 1.9) -11.9%

My GP is trying to help and will listen but I think is out of her depth. I’m fortunate that I can go private if needed, so should I ask to go back to the endocrinologist I saw previously, or a neurologist ( a suggestion from the GP that I don’t really agree with ) or perhaps look into functional medicine instead?

Is it all about getting my vitamins tested and optimised accordingly? If so who’s best to do this rather than me tinkering about with them and getting nowhere.

Apologies for all the questions, I have been researching and trying to understand this myself but it’s a minefield and I’m starting to go round in circles!

NB I’m GF, non coeliac, take HRT and vit D. Previous blood tests and history are on my profile.

Thank you

[greygoose]

Serum triglycerides is very low ( as below ). Could this be the main reason for my fatigue?

I shouldn't think so. Trigliycerides do not cause symptoms, as far as I know. Could be you're low on iron/ferritin. That would make you very fatigued. Or perhaps it was a bad idea to stop the levo completely, perhaps you need your FT4 higher. Do you know how well you convert?

Why would you want to see a neurologist? Do you have neurological problems? Be very careful of functional doctors. They don't know any more about thyroid than any other sort of doctor, but tend to have weird ideas!

I also don’t understand how my T4 is low in range but my T3 is over range.

Because of the Hashi's swing, I would imagine. Not all the cells that are destroyed in the attack contain T4. Some of them just contain T3, so the T3 rises, but the T4 stays where it is.

Is it all about getting my vitamins tested and optimised accordingly? If so who’s best to do this rather than me tinkering about with them and getting nowhere.

That's not all there is to it, no. But it is essential to have optimal nutrient levels for various reasons. But I'm not sure there's anyone you can see about it. Doctors know nothing about about nutrition, although they pretend they do! And I find dieticians/nutritionists a bit iffy and don't really seem to know much about it. You're better off getting private testing and then posting your results and ranges on here, and the knowledgeable people on here can help you far better than anyone else.

[Amber-sky in reply to greygoose]

Thank you Greygoose. Full update from Sept 2024 now on profile and below.

Thyroglobulin Antibodies (TgAb) 68.2 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 106 IU/mL (≤ 34)

C-Reactive Protein (CRP) .168 mg/L (0 - 3) 5.6%

Folate - Serum 20.9 ug/L (7 - 35) 49.6%

Vitamin B12 150 nmol/L (37.5 - 187.5) 75.0%

Vitamin D 115 nmol/L (50 - 250) 32.5%

Ferritin 93.9 ug/L (30 - 264) 27.3%

[Jazzw]

Your profile mentions a Medichecks private blood test from a handful of weeks ago:

8.30am 20 Feb 2025 medichecks. 0mcg Levo

TSH .464 mIU/L (.27 - 4.2) 4.9%

Free T4 (fT4) 13.7 pmol/L (12 - 22) 17.0%

Free T3 (fT3) 5.6 pmol/L (3.1 - 6.8) 67.6%

T4:T3 Ratio 2.446 

Which, as I’m sure you’ve realised, is at odds with your NHS test.

You weren’t hyper at that point (and not on any thyroid hormone replacement).

Could you afford another private thyroid blood test and include ferritin, Vit D, folate and B12?

[Amber-sky in reply to Jazzw]

Thank you Jazzw. My latest full test from medichecks from September 2024 is

Thyroglobulin Antibodies (TgAb) 68.2 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 106 IU/mL (≤ 34)

C-Reactive Protein (CRP) .168 mg/L (0 - 3) 5.6%

Folate - Serum 20.9 ug/L (7 - 35) 49.6%

Vitamin B12 150 nmol/L (37.5 - 187.5) 75.0%

Vitamin D 115 nmol/L (50 - 250) 32.5%

Ferritin 93.9 ug/L (30 - 264) 27.3%

[SlowDragon Administrator]

not had any vitamin tests since 2023?

I would also look at new ultrasound for possible hot nodule

mayoclinic.org/diseases-con...

[Amber-sky in reply to SlowDragon]

Thank you SlowDragon. My vitamins from September 2024 are

Thyroglobulin Antibodies (TgAb) 68.2 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 106 IU/mL (≤ 34)

C-Reactive Protein (CRP) .168 mg/L (0 - 3) 5.6%

Folate - Serum 20.9 ug/L (7 - 35) 49.6%

Vitamin B12 150 nmol/L (37.5 - 187.5) 75.0%

Vitamin D 115 nmol/L (50 - 250) 32.5%

Ferritin 93.9 ug/L (30 - 264) 27.3%

Also is it possible to still have a hot nodule as I used to be hypo?

[SlowDragon Administrator in reply to Amber-sky]

Vitamin levels look good

Your antibodies confirm hashimoto’s

But you have has high results a long time

Have you ever tested TSI or Trab for Graves’ disease

It’s possible to have both

Treatment then is block and replace

[Amber-sky]

Apologies as I did have an advanced thyroid test in September 2024 but didn’t post full results as in range, or maybe I was just being lazy. Now updated on profile and below.

Thyroglobulin Antibodies (TgAb) 68.2 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 106 IU/mL (≤ 34)

C-Reactive Protein (CRP) .168 mg/L (0 - 3) 5.6%

Folate - Serum 20.9 ug/L (7 - 35) 49.6%

Vitamin B12 150 nmol/L (37.5 - 187.5) 75.0%

Vitamin D 115 nmol/L (50 - 250) 32.5%

Ferritin 93.9 ug/L (30 - 264) 27.3%

[tattybogle]

maybe GP could consider prescribing propranolol ?

its something they often prescribe to help ease the symptoms of hyperthyroidism while waiting for endo referral ... and it has the rather useful added effect of lowering the body's rate of conversion of T4 to T3 .... so it should in theory help with the anxiety and lower your fT3 a bit .

it's almost certainly the highish fT3 levels that are causing the anxiety and weakness.

[Amber-sky in reply to tattybogle]

Thank you tattybogle. I will discuss this with the GP and it’s looking like a referral to the endocrinologist is the way forward.