# Subclinical Hyperthyroid with Symptoms, But Opposite Labs



## AlwaysTheOpposite (Apr 18, 2017)

Hi All!

Endo recently diagnosed me subclinical hyperthyroid which makes sense with my symptoms, but not really my blood work. So while I'm working on getting a second opinion, I thought I would get some thoughts from people who have been through this before!

Long story short, I've had two thyroid nodules for at least 10 years, but never had any problems with them or feeling lousy. Ultrasound once a year and blood work and I was good to go. Last year, my nodules decided to more than triple in number after the birth of my son in January and I started having all sorts of hyperthyroid symptoms that have not abated since, and my blood work is no longer in my normal range. However, just from looking at my free T3s and T4s you would think I was hypothyroid previously and it should be getting better now.

From 2005-2015 my TSH ranged from 1.0-2.1 (RR 0.4-4.5) and Free T4 0.7-0.9 (RR 0.8-1.8) and Free T3 1.48-2.63 (RR 2.3-4.3) so my free Ts have always been low and it never bothered me at all.

Here are my recent labs (same reference ranges as above):

October 2016

TSH: 0.52

Free T4: 1.0

No Free T3 done

February 2017

TSH: 0.36

Free T4: .96

No Free T3 done

April 2017

TSH: 0.52

Free T4: 1.1

Free T3: 3.1

At the very beginning of my thyroid journey I had all my thyroid antibodies tested and they all came back negative. I'm considering asking my endo or a new endo to rerun them just to confirm I haven't developed an autoimmune disease in the meantime, although I really think this is all related to my nodules. Current hyperthyroid symptoms are 35lb weight loss in last 6 months with no change in appetite or exercise regimen, heart palpitations, panic attacks, insomnia, losing gobs of hair and a lovely inability to sit still. No radioiodine uptake scan as of yet as my endo also believes it's just from the proliferation of nodules although I'm considering also asking for that just as confirmation as well.

Had largest and only nodule over 1 cm biopsied in October and it came back a benign adenoma. So as of last week I'm now on 5 mg methimazole twice a week to get my TSH back up to my norm and maybe get my Free Ts back down into my normal range even though I think most would consider them hypothyroid. Personally I think this twice a week thing is worthless though. I feel good the day I take it, part of the next day and then by the following day, my anxiety is worse than normal. I'm considering asking my endo for a beta blocker, but despite all my hyperthyroid symptoms, my blood pressure is always steady at 105/70 and I'd rather it not go much lower. I just seem so backwards as compared to everyone else with my labs and symptoms.

Thanks for reading my diatribe if you made it to the end! And any thoughts would be appreciated!


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## joplin1975 (Jul 21, 2011)

I would definitely get your antibodies tested again -- especially TSI.

It's very likely you have a "hot" nodule(s) which are over-producing thyroid hormone. I think a radioiodine uptake scan would be a really, really good idea.


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## Lovlkn (Dec 20, 2009)

> So as of last week I'm now on 5 mg methimazole twice a week to get my TSH back up to my norm and maybe get my Free Ts back down into my normal range even though I think most would consider them hypothyroid.


You are hypo based on your frees and unfortunately your doctor is treating you based on your TSH which he obviously thinks is hyper. TSH lags by up to 6 weeks so again - useless to figure any dose by.

Insist on the TSI and thyroglobulin antibodies tests. They might also throw in a TPO antibody which will show if it's autoimmune.

Then top it all off with the fact you already have diagnosed nodules - which could be the cause.


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## AlwaysTheOpposite (Apr 18, 2017)

Thank you both for your thoughts! I have an appointment with a new endo on May 1st so we'll see what happens. I'm actually ok with my current endo treating by TSH and not free Ts. All my symptoms point to hyperthyroid even though my free Ts are higher now then they have really ever been. And back then I felt 1000x better than I do now. Maybe I'm just overly sensitive to changes in my free Ts. I guess that would be an interesting question for the new endo.

I'll definitely insist on retesting the gamut of my thyroid antibodies, it certainly can't hurt. Thank you again!


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## AlwaysTheOpposite (Apr 18, 2017)

Hi Ladies!

Thanks in part to your confirmation, I went ahead and had all my antibodies run again and got my RAIU results back this morning. Fortunately, all my antibodies came back normal (TPO, TSI, TRab, the works), so no Graves or Hashi's. My RAIU did come back significantly elevated at just over 81% with at least two over functioning nodules.

So I'm back on my methimazole and now atenolol after I showed up at my last endo appointment with a pulse of 130+ and no I didn't run there.  Now I'm waiting for my next endo appointment to discuss next steps. With the number of nodules I have (7) and a clearly over-functioning thyroid I'm sort of leaning towards just having it removed, go hypo and deal with the fact that it will probably take awhile to get on an adequate dose of thyroid meds. I don't know if I have the time, energy, or patience to try to find a decent methimazole dose especially when its unlikely that these nodules will either disappear or get better over time, so in the grand scheme of things I would just be dragging out the inevitable, surgery. I'm not really interested in ablating my thyroid. Is this realistic?

Thank you again!


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## Lovlkn (Dec 20, 2009)

Sounds like a good plan.


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## jenny v (May 6, 2012)

Agreed, that might be your best course of action.


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## AlwaysTheOpposite (Apr 18, 2017)

Hi Ladies,

I'm back yet again, this time sans my thyroid. After some deliberation, I went ahead and had it removed 10 days ago. It's kind of weird that I will absolutely, 100% be stuck taking levothyroxine for the rest of my life, but I'm certainly not the first, nor will I be the last. And it's not like I was probably ever going to get off the methimazole anyway, but still weird. My final pathology was consistent with a multinodular, toxic thyroid. No signs of cancer or autoimmune issues fortunately.

But back to my original intent! All things considered, I feel pretty decent, I'm on 100 mcg of levo daily which is what I would guess is a starter dose for someone without a thyroid. My only issue is I still feel rather hyper, I'm still having heart palpitations, some mild tremors, and my insomnia is even worse. This just doesn't seem right. Maybe I'm just jumping the gun and this is just part of the normal hormonal balancing act I'm going to be on now for awhile, but I wanted to get the opinions of others who have been through it and how long it took to level out.

I have my post-op appointment with my surgeon tomorrow and will see what he has to say too.

Thank you!


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## Lovlkn (Dec 20, 2009)

Be sure to request both FT-4 and FT-3 lab's at every draw.

If you have not had your Vit D, B-12 and Ferritin levels checked along the way - you would consider running them.

You will adjust to life without a diseased thyroid. I was sick for so long I can honestly say I didn't know what "normal" was post op. I took longer than most to find my set dose as I deliberately moved slow on dose changes. I found out post op I was low in Vit D, B-12 and Ferritin and feel once I addressed those that adding Cytomel and dialing in my doses became a bit easier.


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## joplin1975 (Jul 21, 2011)

Everything Lovlkn said...but also remember you are only 10 days out. That's a really short amount of time.

Some people who are hyper take a short break from Levo after surgery (a week or so) to let things kinda "settle" down before starting meds. You could ask your doctor about skipping a dose or two.


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## jenny v (May 6, 2012)

I felt totally hyper for about two weeks after surgery, so it's not uncommon. You could always back down your dose until the symptoms even out and then start back up again.


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## AlwaysTheOpposite (Apr 18, 2017)

Thank you all!

I know my vitamin D is good, I had it checked the week before my TT and it was 63. I'm religious about supplementing it since I'm really pale and burn easily. I'm also on calcitrol at the moment and eating Tums like the disgusting candy that they are since my parathyroid hormone was a whopping 3 after my TT. So I would imagine if they aren't back in order already, they will be soon. I should know more this afternoon actually.

I have not had B-12 or ferritin run recently, other than my toxic nodules, I've been pretty healthy overall, I'll definitely keep them in mind though if this wonky phase continues past my next blood draw. I go back for TSH and free Ts in 4 weeks.

I have not been very good about taking my atenolol since my surgery, so my surgeon thinks that is probably the main reason I'm still having heart palpitations and insomnia. Which in hindsight makes total sense, I'll start weening off that in another couple of weeks, rather than basically going cold turkey like I did. I've probably shocked my system enough recently.


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