# How much does time of day effect THS?



## WildMtnHoney (Mar 19, 2015)

I've read that it can, but is it a measurable amount?

I ask because I've had mine tested 4 times in the past month, and it was close to the same for 3 of them, but they were all taken after 1pm. Yesterday I had a draw at 10am, and it was a bit higher.

I'm hoping it's a physiological change (that I have viral thyroiditis and not Graves).

Range from my lab is 0.34-5.6 My results have been 0.04, 0.05, 0.03, and then yesterday 0.15.

My T3 and T4 have only been tested once during all this, and they were both markedly elevated.


----------



## Andros (Aug 26, 2009)

Practice Implications

That there is a circadian rhythm to thyroid hormones is not surprising as the hormonal milieu is associated with diurnal rhythms. Thirty-five years ago, fluctuating TSH levels were demonstrated and found to be at their highest in the middle of the night.1 Current research suggests that TSH serum levels peak at between 2 am and 4 am and decrease to their lowest levels at between 4 pm and 8 pm.2 Thus, the lower afternoon TSH levels found in the current abstract are consistent with previous research. Interestingly, the current abstract also found that higher morning TSH levels were associated with greater variability later in the day. The study's authors also found that FT3, but not FT4, had a positive correlation with the TSH variability. The question they pose is whether a tighter range of TSH (0.4-2.5 mU/L) would be more sensitive in diagnosing hypothyroid patients whom would otherwise be missed using the current reference range (0.4-4.0 mU/L).

http://naturalmedicinejournal.com/journal/2012-12/thyroid-stimulating-hormone-fluctuates-time-day

TSH usually peaks around 2 AM.


----------



## WildMtnHoney (Mar 19, 2015)

Thanks!!

Maybe it is thyroiditis, though - Trab just came back <0.9 (range <1.75) so I'm hopeful.


----------



## Lovlkn (Dec 20, 2009)

Your TSH is low no matter what.

I've read that TSH is highest early in the morning -

going from .03 to .15 is not that big of a jump. The thyroid is always releasing hormone so lab's will change simply due to that.


----------



## WildMtnHoney (Mar 19, 2015)

Gotcha.

Well, one more point for the thyroiditis team, though: TSI came in.

TSI 97% range <=122%


----------



## Lovlkn (Dec 20, 2009)

"normal" is no TSI in the blood.

You may be in the beginning phases of a Graves flair.

Have you only had TSI tested once?

Have you had labs other than TSH run? Such as FT-4 and FT-3?

Ahy ultrasound of your thyroid?


----------



## WildMtnHoney (Mar 19, 2015)

Lovlkn said:


> "normal" is no TSI in the blood.
> 
> You may be in the beginning phases of a Graves flair.
> 
> ...


Well darn it <pout> It was fun in denial 

Yes, I've had other tests, let me go get them...

On 3/19:

FT4 2.14 range 0.89-1.76

TT3 183 range 60-181

they haven't run FT3 at all yet

on 3/24 Ultrasound:

FINDINGS:

The thyroid gland is diffusely heterogeneous with patchy areas of slightly increased blood flow. The thyroid isthmus measures 3 mm AP diameter.

The right thyroid lobe measures 1.9x2.4x3.7 cm. In the inferior right lobe is a 6x6x4 mm heterogeneous, partially cystic nodule with blood flow in the solid components and with a tiny echogenic focus suspicious for microcalcifications.

The left thyroid lobe measures 1.7x2.2x4.7 cm. No discrete nodules are identified in the left lobe.

In right zone VI inferiorly are 3 small nodular foci without fatty hila, calcifications or blood flow, the largest of which measures 6x5x4 mm.

In left zone VI inferiorly are 3 hypoechoic nodular foci without fatty hila, blood flow or calcification, the largest measuring 7x5x3 mm.

In the sternal notch is a 4x4x3 mm hypoechoic nodular focus without a fatty hilum, significant blood flow or calcification.

Scattered normal-appearing neck nodes with distinct fatty hila are identified bilaterally..

IMPRESSION:
1. Diffusely heterogeneous thyroid gland with patchy blood flow suggest the possibility of thyroiditis.

2. 6 mm right lobe nodule has a small cystic component a small amount of blood flow and may have a microcalcification placing it at a slightly higher risk for malignancy.. This is too small to sample and continued ultrasound surveillance is recommended.

3. Subcentimeter nodular foci in the right zone VI, left zone VI and in the sternal notch could represent tiny nodes without visible fatty hila versus nodules. These have no suspicious features. Continued ultrasound surveillance is recommended.

The Endo said I should get a call on Monday or Tues to schedule a RAIU.


----------



## WildMtnHoney (Mar 19, 2015)

One more thought: I had iodine contrast in December for a PE study (all clear!) so they are also checking a random urine sample for iodine - could that really have effects this much later? I should have those results soonish.


----------



## WildMtnHoney (Mar 19, 2015)

Guess that isn't it - results are in: 
Random urine iodine 497 range: 26-705


----------



## WildMtnHoney (Mar 19, 2015)

Ok, me again again!!

Endo just called -- appears that much iodine in my urine sample is WAY too high, and I can't get the thyroid scan 

Now, I did have a CT with contrast back in December, but nothing since, and I thought that was out of your system in days?

I also started eating Nutrisystem foods in mid-February. I noticed the lump in my neck in early-ish March. Could there be ANY relation there? I asked on the NS forum, and the official response was fairly generic: "Since the FDA does not require manufacturers to report if they are using iodized salt, we are unable to provide you an exact percentage. If you are concerned about the amount of exposure, we would recommend looking at incorporating some lower sodium menu items in your meal plan." So I have no clue how much iodine I'm getting from their foods. Of course I am getting a huge delivery TODAY 

For now, my endo is holding off on any meds. She is hoping the tiny rise in TSH, and the slightly elevated sed rate point towards thyroiditis. She wants me in mid-week next week for another blood draw for more tests, to see where things are headed.

I was soooo hoping for answers by then!! i want to know WHY I'm ill, darn it all!!

However, my neck is feeling less swollen internally - it's easier to swallow lately. And the atenolol is helping the pulse a LOT. So I'm feeling some better between those two.


----------



## WildMtnHoney (Mar 19, 2015)

Latest test results, I am more and more positive it's subacute thyroiditis, and that my thyroid has just dumped all the T4/T3 and now there's very little left. I have gained 2 lbs this week.

TSH: 0.03 (0.34 - 5.6)
T4: 7 (4 - 11)
Total T3: 92 (60 - 181)
Free T4: 0.95 (0.89-1.76)

Has anyone had any experience w/subacute? I've heard that it's one of the more "rare" causes (leave that to me!). Did your thyroid ever get back to full functioning? If you were hypothyroid, how long did that last (I've read varying studies)


----------



## WildMtnHoney (Mar 19, 2015)

Been a week and a half, and we ran tests again today. Symptoms are mostly exhaustion, brain fog (getting so bad the kids are teasing me as I drift off mid-sentence, forgetting where I was going), and gained 2 more pounds (ugh).

TSH: 6.16 (0.34-5.6) 
T4: 4 (4-11) 
Total T3: 60 (60-181) 
Free T4: 0.58 (0.89-1.76)


----------



## WildMtnHoney (Mar 19, 2015)

One more!

It seems they also ran antibodies today.

My thyroglobulin has stayed at <1, but TPO antibodies have gone from <28 (3/19/15) to 45 today.


----------

