helvellaAdministrator

There is a flowchart of what odd lab results mean, available here:

thyroidmanager.org/algorith...

You can see that elevated FT4 and elevated TSH together are given two possibilities: Resistance to Thyroid Hormone (RTH) and TSH-oma. This link:

setdem.co.uk/spr/Presentati...

Is a "How to tell the difference" for medics.

But before being too committed to those possibilities, it is possible that you should look at the options for ** normal ** T4 and elevated TSH - which include interference from various medicines or illnesses.

And your Graves history might allow for other possibilities.

Rod

siskin in reply to helvella

I have the RTH and TSH-oma results, do you know what the TSH-oma means please?

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helvellaAdministrator in reply to siskin

It is some form of growth which produces excess TSH.

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siskin in reply to helvella

Thanks Rod

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nobodysdriving

As TSH is a 'pituitary' hormone I think the correct thing was done: to refer you to a 'specialist'.

are you on any other medication apart from thyroxine?

helvellaAdministrator in reply to nobodysdriving

100% agreed.

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Suzy03871

I am on b12 injections for pernicious anaemia, folic acid for folate deficiency been on these for over a year & propanolol for migraines but have been on this for 3 years

helvellaAdministrator in reply to Suzy03871

Propranolol could be significant. It is known to reduce the rate of conversion of T4 to T3. But if you have not changed dose and have been stable on it for a long time, that seems less than likely.

Nothing else, I assume? (You'd have said if there were. )

Other possibilities include:

Test oddities. Sometimes specific things interfere with the test itself and give too high a result. An example is having antibodies to TSH (which is rare). Ideally another sample would be tested at a lab which uses different technology for performing the test.

A recent illness - possibly nothing you are aware of.

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Totoro in reply to Suzy03871

Helvella is right, propanolol is used for patients with Graves (overactive thyroid) specifically because it reduces the conversion of T4 to T3.

It would be worth asking the specialist about taking propanolol when also taking levothyroxine. If you are taking both I would always ask for a T3 blood test to be done.

Have you changed how you take your levothyroxine? Time of day? With food? With other medication that might have things like calcium that would absorb it?

Totoro x

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Suzy03871

I was on propranolol again as I have menstrual migraine, the reason for taking it is to try to prevent the migraines. I have always taken my medication as soon as I get up & always wait an hour before having breakfast. The only thing I can think of thats different is the change of colour of the box of the levothyroxine. Started feeling unwell about 8 months ago & the last 4 to 5 month gradually feeling worse. I don't take added supplements other than folic acid for my folate deficiency & I get my b12 injections every 12 weeks.

Jackie

Hi, I suspect your body is not converting the T4 ( thyroxine) to T3, it is common. Try to have a Free T3 test, if below range, then change some of the T4 to less and some T3. T3 lowers the TSH besides being a great help with all the thyroid symptoms.

Best wishes,

Jackie

ladydawny

pooling due to low serum iron? Other nutritional problems stopping thyroid hormone getting in cells?

Just a thought, get an 'iron study'. It doesn't show up as anemia

hugs Dawnx