High TSH but normal free t4. Help please?

Hormones
1

For sometime I have had panic attacks and frequent infections of chest and ears and viruses.Last April things moved on quickly and I was covered in painful itchy blisters, neuropathic pain, vertigo and feeling shut down. I was covered in bruises. Ambulanceman reported an ischaemic looking ECG and took me to A and E.

The only findings wee raised TSH with normal freet4 and nomal Thyroid peroxidase abody. Also raised basophil and eosonophils. They said hypothyroid but my GP says no as no autoantibodies?

I am still suffering-eyebrows gone, no energy, dry wrinkled skin and 3 more courses of antibiotics for chest and throat infections. Any ideas, anyone? Also sight got really bad and joints ache ++

 

2

Hi clare, symptoms indicate hypothyroidism. However, these symptoms can also be the same for other medical conditions. Having said this, your situation is similar to mine: high TSH, normal T4, hypothyroid symptoms. The key to finding out what was wrong with me was to do a T3 test. This was low, indicating my body wasn't converting the available T4 to T3. So getting a T3 test done may be the answer for you. (Your T4 and TSH also need to be done from the same blood test so you can compare where all three results are in their respective ranges). In your situation I would go and see my GP, take a list of symptoms, explain you've got classic hypothyroid symptoms and ask him whether something else is going wrong in the process, then explain you think your body might not be converting T4 toT3 - something that adding T3 to the list of things checked in the blood test will show up.

It will help you understand his response if you know what the process is regarding your thyroid. So I'll have a go at explaining, though Shelley is much better at doing so than me. She's brilliant and will no doubt respond when she gets chance - thanks in advance Shelley smile

Step 1: When your body needs more thyroid hormones, your pituitary gland sends out Thyroid Stimulating Hormone (TSH) asking your thyroid to produce more thyroid hormones (T1, T2, T3, T4 and calcitonin). The important ones here are T3 and T4.

Step 2: In response your thyroid produces the thyroid hormones.

Step 3: T4 has to be converted to T3 before it can be used by the cells in your body.

Step 4: your body's receptor cells receive the thyroid hormones.

Any one, or more, of these steps can go wrong. Stress is particularly good at messing them up, particularly steps 3 and 4. (Google ' reverse T3'wink.

So the key question to your GP is could one if the other steps in the process be going wrong? If he doesn't agree it could be, ask 'i'm obviously unwell, what else could it be?' Ask him to check your vitamin and mineral levels. Specifically: iron, ferritin, vitamin D, vitamin B12, potassium, magnesium, selenium, calcium. If he isn't doing what you need him to do, ask to be referred to an endocrinologist (a doctor who specialises in hormones). Good luck!

3

Thank you for your detailed response.

 

4

By the way get your GP to check your platelet count. Low platelets means you will bruise easily. Though what you had sounds more than this.

5

You're welcome. I hope it gets you the treatment you need. smile

6

Your antibodies will only be high if your immune system is attacking your thyroid. So it's not immune related hypothyroidism, hence my thought that something is going wrong further along the process. Another thing you can try are: seeing a different GP. Some are more knowledgeable about thyroid issues and GPs vary in whether they are willing to work collaboratively with you to find the answer. So in summary, book an appointment with your GP and have another go, or (and this would be my preferred option) see a different GP and follow the ideas in my previous post.

7

Clare - How high was your TSH?  In addition to doing a thyroid peroxidase antibody (TPO ab) check, did your GP also check your antithyroglobulin (TgAb) ?  ONE type of hypothyroidism (called Hashimoto's Disease) results in either your TPO ab being out of range (high) or your TgAb being out of range, or both being out of range.  Your doctor needs to check BOTH.  These tests are only to diagnose one type of hypothyroidism (Hashimoto's).  You can still be hypothyroid due to other causes (damage to your thyroid, for ex.).  - Joe

8

hi clare are you on levo for thyroid disorder.x

9

No only TPO. Free T4 13PMOL/L and TSH 6.29. Low sodium and high basophil count. Platelets and liver and kidney function ok. Not anaemic.I do have Antiphospho lipid Syndrome so auto immune is more likely with me as I have raised anticardiolipin levels. Than for replying.-Clare

10

No but think I should be. High TSH and normal free t4. Very symptomatic-eyebrows half gone, arm hair gone, skin dry and wrinkled.

Easy bruising and hoarse voice.Skin rashes .fine,fine hair.and frequent chest and ear infections and had 4 courses of antibiotics since June. thanks-Clare

11

hi claire you sound very much like me but ive been hypothroid nearly 24 years and my doctor wouldnt supply me with ndt so i took the chance and im on ndt now 6 days and i can honestly say i havnt felt this well in years,you need to see a more understanding doctor who can help you,im trying to get to see a endo but my doctor wont budge im not giving up im seeing him on 25/9/15 hoping he will support me in taking ndt the only other option is to go private and thats costly,dont give up hope see another doctor ,xx karen

12

For info: I'm seeing private endo in UK. Cost £200 first visit, £90 subsequent visits.

13

Hello Clare:

My name is Shelly and I am a Nurse and I live in the USA.  I have an autoimmune condition called Hashimoto's Thyroid Disease.

The way the thyroid works was excellently explained by Barbara.  Thanks Barbara!

I will add:  In a person without thyroid disease our thyroid gets a signal that  the level of T4 is low, (like a sensor), and then it makes a signal hormone called Thyroid Stimulating Hormone (TSH ) and it will make more T4. T4 should be converted by the thyroid into T3.

Now we need T3 which is a useable hormone by the body. This hormone supplies you with energy and is what they call a "useable hormone".  It is used by the cells in the body.

Symptoms you list above are of Hypothyroidism, many include: gaining weight, feeling cold, feeling tired & sleepy, having low energy, having no periods or infrequent ones, dry skin, brittle nails, hair falls out, brusing easy, feeling depressed, &  low pulse. There are more but these are most common.

Now the trick is having all the blood work done to confirm all this.  Some of the blood work done, TSH level, T3 and T4 levels, mineral panels, that include Sodium, potassium, calcium, magnesium, ferritin, and iron levels.  Also a Vit D. level is very important as many of us with thyroid disease have a relationship with low Vit. D. Also a CBC (Complete Blood count), and WBC (White Blood Cells count).

Thyroid Disease is sometimes a family trait, and it can also come from a virus called Epstein-Barr Syndrome, (EBV), for short.  Also it can happen after a period of stress on the body.  It can happen during pregnancy and after pregnancy. Also other disease conditions can damage the thyroid like Lupus, and cancer.

Since you say you have had a lot of infections recently and your basophils and eosonophils are raised, it may be due to the infection but after you are over that, I suggest they run that blood work again.  It means the white blood cells are raised and that is not a good thing.

You  seem to have a weaker immune system as you have had repeated infections.  Having lot's of infections in the respiratory area may have weaken your lung tissue and make you prone to them.

Once you will start on replacement thyroid medication you will feel better and your hair will grow back. It can take a while, some take longer.  My hair came back on my head in about 8 weeks. Eyebrows take longer. The medication will take a while to build a proper level in the body, and it can take about 4-6 weeks in most of us.

You will need to build up your immune system.  This is just a suggestion, please wash your hands frequently, eat healthy foods including vegtables. If able eat some strawberries each day, a good source of zinc and helpful to the immune system. I would also suggest a very good multivitamin with iron.  Please drink lot's of water and no soda products.  Please stay away from anyone with a COLD virus as you do not need repeats of this.

Any questions, just ask.  many of us have been where you are and can give you good advice.

XO, Get Well, Shelly

14

You are very kind. The bruising is awful with me and the doctors have seen it and been alarmed-still no help. I have to stick my nails with glue to repair huge splits at times. Had Epstein Barr-Mononucleosis. x

 

15

Hello Clare:

Please do have your iron level checked.  If you can eat Jello it does help build nail strength and also use a nail hardener Nail Polish that is available in some beauty stores. 

Let us know how you are doing and once you get on thyroid replacement meds many of the symptoms will subside.

Stay well, Shelly

16

Hello Clare:

If you had EBV and you have a weaker immune system, I would say it seems more like Hashimoto's Thyroid Disease. It is treatable and I have had it since 1987 and I am on Cytomel (Liothyronine)  pure T3 as I do not convert T4 into T3 well.

I am now 54, and feeling the best I ever have. It gets better with treatment.

XO, Shelly

17

Clare, I've just had an idea...ask your doctor to put you on a trial of 25mcg of thyroxine. NICE guidelines suggest this for someone with high TSH and normal T4.

18

Hi Shelley, I'm trying to work out how much liothyronine is normal to take if I have to switch from NDT (currently paying for NDT myself). How much liothyronine per kg is recommended? Thank you.

19

Hello Barbara:

It comes in increments like 5mcg, 10 mcg, etc... how much NDT do you take now and are you going to stop NDT or add to it?  So PM me your weight etc...always go smaller dose and then add to it, if T3 is low.

I know some people who take 5mcg and stay or lower their NDT or Levo.

Shelly

20

Erm, my last post assumed you were in UK.