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Hyperthyroid??

Discussion in 'Hormones' started by Sundancer, Mar 12, 2018.

  1. Sundancer

    Sundancer Senior Member

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    I'll make a thread on this.

    Thyroid hormones are going towards hyperthyroidism.
    TSH = 0.46 ( 0,3-4,2 my former GP used 0,4 – 4,0 mU/l )
    fT4 = 24 ( 12-22 my former GP used 8 – 26 pmol/l )

    so imho it is still within range.

    GP has tested for TSi, that was oke, which I am happy about.

    But still I think there is something going on there. because there is a trend getting TSH lower and fT4 higher.

    The strange thing is, when my health was going south some years ago, I thought that I might be going toward hypothyroid. Mainly because of the eyebrow-thing that I read about.

    Some time ago my eldest sister gave me a childhood-picture of me ( very nice to see myself as being a sixyear-old, with red bows in her tails, a freckly face and her eyes still very squint-eyed ) but a look at that pic showed the eyebrowthing...and yeah, I've always been kinda slow...

    so now I wonder. I don't know anything about the whole thyroid thing, those articles that @pattismith posts are way beyond my head and need my head now for making wise decisions about a bankloan ( which I get :))

    something in me tells me that I may have a problem converting T4 into T3. Am I right in thinking that when that is the case, THS and fT4 go up while the body is not getting enough because of the conversion-thing?

    so the blood looks like hyperthyroid, while the body is hypothyroid???

    the other thing that springs to mind is the fact that my parents have overloaded my body with fluoride as a child. And fluoride applied by a dentist was one of the things that have pushed me over the edge some years ago.
     
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  2. Wonkmonk

    Wonkmonk Senior Member

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    I'd say your results are still in the normal range, but they could be an early stage of a thyroid disease. The possibilities are:
    - Benign goiter (enlargement of the thyroid gland with otherwise "healthy" tissue)
    - Autonomous tissue (tissue not regulated by TSH that produces thyroid hormone continuously)
    - Thyroid cancer (very unlikely, but possible)

    If you wish to be sure, you'd have to do an ultrasound exam of your thyroid, and a scintigraphy. Graves disease is ruled out as far as I understand.

    Your elevated T4 and TSH could also be transient because of a high-iodine diet (lots of fortified salt, fish etc), and no thyroid disease might be present so lowering dietary iodine intake and observing the lab results over the next 6 months might also be an option.

    A T4-T3 conversion issue isn't usually a problem with patients with a functioning thyroid gland. In most cases, it is only a problem for those with primary hypothyroidism on T4-monotherapy. There is sadly no test for a conversion issues, and if a conversion problem was present, there is not much you can do. Theoretically you could take T3 or a natural desiccated thyroid medication (which has a lot of T3), but I don't think any physician would be ready to prescribe additional thyroid hormone when TSH is low. Other than that, the only thing I could think of to improve T3-T4 conversion is selenium.
     
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  3. nanonug

    nanonug Senior Member

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    Do you know what your free T3 levels are? TSH and fT4 alone are not enough.

    What is TSi?
     
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  4. pattismith

    pattismith Senior Member

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    I am not a doc, so all can do is to give you some references:


    "Euthyroidism was defined as thyrotropin level between 0.45 and 4.49 mIU/L and endogenous subclinical hyperthyroidism as thyrotropin level lower than 0.45 mIU/L with normal free thyroxine levels"

    I think you will have to do regular testing of your thyroid panel
     
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  5. Sundancer

    Sundancer Senior Member

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    thanks for answering, I asked GP for repeated testing because of the trend I saw, he then phoned me that the result of fT4 was out of range so that he would test for TSi. Now looking at older bloodwork i see he uses different cutoff-scores then my former doc did.
    Plus my mum had too fast thyroid and was operated on that, she had an enlarged goiter ( it think, that was before i was born, she had a hideous scar on her throat), I suppose that was a benign goiter.
    So I suppose it is still alright ( as you say too)

    I do not yearn to do that, would give me a terrible setback, and GP did not call me so i suppose he will suggest to just regularly check up on THS and fT4.

    the opposite, I'm too low on iodine and because of the trend bloodwork I 've shied away from it.

    I wonder about the T3 levels but GP will not test that, has to do with insurance, I wonder whether it would give me useful info when i let that test by myself. I mean, when fT3 would be low, that would give a hint in the direction of conversion issues. But first I need to have more info. ( well, maybe he will test them the next time he comes to visit me, I think he's busy now, with all the small kids and elderly people having the flu)

    I think it's also how i deal with GP, I do not know him very well yet, I think he does believe that I'm ill. We are starting to have a ' working relationship' and I should not overplay my hand so to say.

    I do not get that, according to his lab, my thyroid-numbers are out of range, he then tests for TSI ( which happily is negative) and then does not do anything else?
    Nobody will prescribe me anything, but when things are off I prefer to know and then see what i do.

    I just started taking selenium, so that's OK, thanks for mentioning, will keep it up.

    Plus, I now wonder whether the use of B12 ( since three months) may have it's influence too, sugar was a bit too high too, and that has been regulatly low for years.

    Also I read that L-carnitine can have a lowering affect on the thyroid-function, it's one of the sups standing in the cupboard waiting for it's time. Maybe I should try that somewhat faster then I planned.
     
  6. Sundancer

    Sundancer Senior Member

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    nope...insurancethingie...
    autoimmune thingies ( antibodies) that make the thyroid work faster, as far as I understand. This is all a pretty ungraspable thing to me
     
  7. Sundancer

    Sundancer Senior Member

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    thank you @pattismith , that is my own conclusion too. I hope my thyroid soon will go back to a more desired range of functioning.
     
  8. nanonug

    nanonug Senior Member

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    Well, that sucks!

    Oh, got it, Thyroid-Stimulating Immunoglobulin.
     
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  9. Wonkmonk

    Wonkmonk Senior Member

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    That, however, would in my view be a good reason to do the additional thyroid tests. If you are on a low-iodine diet and your TSH is still so low and fT4 so high and TSH and fT4 are rising over time, that is an indication that something could indeed be wrong and it should be taken seriously.

    This would for example be entirely consistent with automonous thyroid tissue or - though very unlikely - thyroid cancer.

    Both conditions are much better treatable if discovered early.

    I think wait and observe is still an ok strategy at this point in time, but if the fT4 is still so high and TSH so low in the next 3-6 months while on a low-iodine diet, it would in my view be appropriate to do ultrasound and scintigraphy.

    Btw, there is no downside of doing ultrasound right now. It has no side effects. Scintigraphy is also very safe, but it involves radiation, so one would only do it if there is a clear need to do it.
     
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  10. Wonkmonk

    Wonkmonk Senior Member

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    These are autoantibodies that bind to the TSH-receptor and thereby act similarly as if they were actual TSH (thyroid stimulating hormone), so the thyroid gland gets overactivated even if TSH is very low. Even if there is too much thyroid hormone and the TSH is 0, the autoantibodies still activate the TSH-receptors and the thyroid gland produces additional thyroid hormone. Treatment is difficult and total thyroidectomy is often required.

    If Graves Disease is ruled out, that's very good news, but I'm not sure all relevant antibodies have been checked here, so maybe an endocrinologist should have a second look to make sure it's definitely not Graves.

    More info on the antibodies are here:

    https://en.wikipedia.org/wiki/Graves'_disease#Pathophysiology
     
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  11. Sundancer

    Sundancer Senior Member

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    well, in a week or two I will ask GP to come visit me again. Then ask waht he plans to do ( or not) In the mean time I have some stressing things to do which are really to much for me, but must be done.

    Ultrasound is what they do when you're pregnant isn't it? thats OKe to me

    Scintigraphy , I think they put some radioactive fluid in the body...I do not want that. I get very ill from anything chemical. Can use regular medication, happy I do not swoon anymore when someone wears perfume but still get ill from it fast. Even the dental radiation is to much for me, I prefer not to after I found that out.

    But it's so good to have some information, I am happy that it is not autoimmune, and what it is, well, we have to find out. ( but i do have a sort of hope that it'll go away, all by itself...one may hope isn't it:redface:
     
  12. Sundancer

    Sundancer Senior Member

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    I'm pretty sure he tested for TSI only ( and did not call me with the results as he promised)
    i'll put of the computer now, thanks all!
     
  13. Wonkmonk

    Wonkmonk Senior Member

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    Correct, it's exactly the same just at the throat instead of the womb. With the ultrasound, they can determine if your thyroid gland is enlarged or not, if it is homogeneous (inhomogeneous would be a sign of disease), and if there are nodules in the thyroid gland.

    If nodules are present, the Ultrasound cannot establish if the nodules are toxic or nontoxic, and that's an important thing to know because the treatment implications are very different. Ultrasound cannot identify autonomous tissue (not regulated by TSH) either.

    So if your lab tests continue to to be high and even rising, despite a low-iodine diet, scintigraphy will probably be needed.

    This is very good news, but I think it's important to double-check if all relevant thyroid autoantibodies have been tested (I think TSi alone is not sufficient).
     
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  14. BadBadBear

    BadBadBear Senior Member

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    I also thought about thyroid nodules causing highly variable symptoms. Ultrasound test is safe to have and will show if nodules are present.
     
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  15. Wonkmonk

    Wonkmonk Senior Member

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    But if nodules are present, ultrasound won't help in finding the right treatment option.
     
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  16. pattismith

    pattismith Senior Member

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    I agree with it, ultrasound would be an excellent thing to do.
     
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  17. pattismith

    pattismith Senior Member

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    Sundancer likes this.
  18. BadBadBear

    BadBadBear Senior Member

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    Could also be viral infiltration of thyroid causing hyper (subactute thyroiditis, etc.).
     
  19. Sundancer

    Sundancer Senior Member

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    thanks all, much information to digest

    hmm...good question

    • Sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase- I'm slender, lose weight after prolonged crashes but have been on weight now for many months, so i think NO
    • Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations) YES - I do have irregular heartbeat and palpitations. That started some months after the initial bedridden crash. to be honest, I started smoking again at the time...( think thats something like one and a half year ago) and until now have not been able to stop.... Since I use B12 the heartproblems have lessened enormously. Frequency in rest now 80, palps and arythmia lesened form 24/7 to sometimes ( but still every day, with PEM it worsens) Last two months heart-frequency in rest is about 80.
    • Increased appetite - NO
    • Nervousness, anxiety and irritability - not really, sometimes ME symptoms flare up awfully in the night, that sometimes scares me, but that's not anxiety
    • Tremor — usually a fine trembling in your hands and fingers - NO
    • Sweating - Yes, but only in the night, I regularly wake up in the night and then have headsweat, when it gets worse the sweating spreads to the body. But not/arely in the daytime. I have suffered from sort of " hot flushes" but different from the normal ones that jump up onto you. These are slow in coming and slow in going. The amount of warmth-flushes has diminisehd the last year or so. So I think that counts as a NO
    • Changes in menstrual patterns - not relevant anymore
    • Increased sensitivity to heat - YES, but also to cold, I've thought this is a MY thing. My temperature must be above 20 and under 24 or I'll get ill.
    • Changes in bowel patterns, especially more frequent bowel movements - NO
    • An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck - don't think so
    • Fatigue, muscle weakness yes.....well...Ive ME, so thats not surprising, little progress since B12
    • Difficulty sleeping yes.....much better since B12
    • Skin thinning - maybe, but no. I'm aware of many changes in my body since I crashed, but this was not one of them. Very sensitive membranes though, that's getting better now with the B12
    • Fine, brittle hair yes.....but have had that for many, many years. I had that at the time that my former GP checked my thyroid because I had signs that could point to hypothyroid...that's about ten years ago.
    so, It not an overwhelming yes
     
    Last edited: Mar 17, 2018
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  20. Sundancer

    Sundancer Senior Member

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    Viral infiltration???

    I'm not aware of viruses to be honest, but at the same time I've never been checked on it and do not know any doctor who would do that for me.
    Maybe there is a herpesvirus wandering around in my body.

    looking at subacute thyroiditis...well? I don't remember having had pains there, I do sometimes have throat-sores, but that's PEM-related and definitely throat, not thyroid ( have looked where that thing sits, much lower then I thought.)

    so for now it remains mysterious.

    first I have to get back on my feet again, I had quite a bit of too much emotional/cognitive and physical overload the last weeks. I sleep very bad and feel exhausted. Next week I'll sign the papers for the bankloan. After that I will call GP to ask what ideas he has ( if any....)
     
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