# Normal-High TSH, High free T4, and normal free T3



## leopardi (Jul 7, 2014)

Hello,

I am new in the forum. I've been looking at messages from the board for a long time and I finally decided to register in order to present my case, which has me quite worried, and see if someone can help me with what's going on. I apologize in advance for any mistakes in my english writing as I'm spanish and do not have an immaculate english level.

I'm 21 and male. My GP ordered a blood test last month, and I must say it's the first one I take on my life (that I can remember of, maybe I took one while being a kid but can't find the results anywhere). I had been feeling tired and had swollen lymph nodes and an irritated throat which had been lasting (and still does a bit) for months. On this first test everything appeared normal except my TSH (8.43; normal lab range 0,55 - 4,80) and Free T4 (1.9; normal lab range 0.8 - 1.8). I don't know if that can be relevant but my potassium iodide was at the low limit at 3.5 (normal lab range 3.5 - 5.2).

Now, thyroid problems run in my family, my father and her mother (my grandmother) having both hypothyroidism for years and both being medicated, so at first, not really knowing about thyroid levels, I wasn't that surprised to hear that something was wrong with my thyroid. I started to worry, however, when doing a little bit of research and seeing that my levels were incongruent in matching each other for a common diagnosis, being my free t4 too high for hypo, and my tsh too high for hyper.

I realized then that I'd been having hyper symptoms for years which I ignored thinking they were a cause of my nervous nature and very frequent severe anxiety problems, which I keep having: I remember sweating a lot, specially my hands, for more than 5 years now, and being sensitive to heat, as well as having diarrhea frequently. However, I am also sensitive to cold and had seasons of both depression and feeling numb, and had pain in my joints for years, as well as dizzinness which my father has had sometimes as an hypo, and which I've read are common symptoms of hypos.

I therefore went to an endocrinologist which ordered another blood test arguing that the results were incongruent. He also examined me phisically and didn't finf a goitre nor any palpable or swollen mass in my thyroid. A scan of my thyroid confirmed I do not have nor a goitre nor any nodule, and the size of my thyroid gland is normal. The blood test results which I took a week after the first one were as follows:

-TSH 4.1 (normal lab range 0.550 - 4.800) [My TSH had decreased a half! I don't know if that is relevant, but I have to say that I didn't sleep the day I took my first blood test, and that I slept only 3 hours the day I took this second test. On both blood tests I was also on a daily dose of supplemental C Vitamin which my ENT prescribed for the problems of my throat that I mentioned before].
-Free T4 1.9 (normal lab range 0.8 - 1.8) [This thus remained the same level than before, mildly elevated].
-Free T3 3.8 (normal lab range 2.3 - 4.2) [I did not take this test before but this appears to be in the normal range, opposite to my FT4].

My anti-TPO (thyroperoxidase) was normal at <10 (normal lab range <35), and so were my anti TSH at <0.8 (normal range <1.5) and my anti thyroglobulin antibody at <20 (normal lab range 0 - 40).

This, which was taken now approximetly a month ago confused me even more both because of my drastical decrease of TSH and the difference between my FT3 and FT4. I am now awaiting to come back to my endo for him to interpret this results. I've been doing a bit of research (sadly, because I am a huge hypochondriac and this is getting me a bit mad) and found that these results are common in people who suffer from a TSH secreating pituitary adenoma. However, I've also read that nearly 90% of people who present with that condition have a goitre, which I do not, and also high free t3 level, which I do not.

I too have been having occasional tremors lately, and feeling a bit out of breath when getting upstairs, although I haven't done any kind of exercise for a long time and I'm having doubts on whether these could be symptoms of my weakness or even my recurring anxiety increased by me preoccupation of having a TSH-oma.

I was wondering if anyone has been through similar experiences or levels, or if anyone could help me figuring out what can be going on with me. I apologize for such a long, long entry and wish you all a good health and strenght in your fights with your thyroid conditions.

Thank you very much in advance!


----------



## Andros (Aug 26, 2009)

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

TBG (thyroxine binding globulin) up, hypo............down, hyper
http://www.nlm.nih.gov/medlineplus/ency/article/003374.htm
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

Welcome to the board. That thyroid is behaving erratically to be sure and something is afoot!

Antibodies! There are stimulating, blocking and binding antibodies to the receptor sites which cause the kind of incongruent numbers you and the doc are seeing.

For that reason, I am listing a battery of antibodies' tests which should sort through this conundrum of yours.

By the way; your command of the English Language is totally awesome!

Not too keen on the swollen lymphs and painful throat. Ultra-sounds sometimes cannot be the best tool depending on the situation.

What lymph nodes are swollen?


----------



## leopardi (Jul 7, 2014)

Hello Andros,

First of all thank you very much for the very quick answer and the info you provided!

So, can a low presence of antibodies in the blood be the cause of my TSH and Free T4 results and therefore of my symptoms? Why does the lab indicate a "normal range" in which my results are included if the presence of antibodies is not normal? I've seen that normally these results are given in a percentage figure and haven't been able to find any conversion patterns (my TSi is in U/L and both my anti-TPO and my anti thyroglobulin antibody are in Ul/mL), so I couldn't find any other's people numbers to compare.

I have two swollen lymph nodes in my neck, one just over the hyoid bone, and another on the right side. My ENT is not concerned about them as they are relatively little, soft, and mobile.

Thank you again!


----------

