# TSH = yoyo, FT3 & FT4 "Within Ranges"



## fullofbones (Oct 26, 2011)

A little introduction: Back in 2008, I got a TSH test done because I went to the ER with unexplained heart palpitations. They got this:

2008-05-21:
TSH: 6.2 (0.35 - 5.5)
FT4: 1.54 (0.71 - 1.81)
FT3: 3.7 (2.3 - 4.2)

2010-01-12:
TSH: 2.88 (0.35 - 5.5)
FT4: 1.15 (0.71 - 1.81)
FT3: 3.2 (2.3 - 4.2)

2011-10-21:
TSH: 3.82 (0.4 - 4.0)
FT4: 1.04 (0.58 - 1.64)
FT3: 2.6 (2.3 - 4.5)

The 2011 numbers were obtained after I got a 6.73 (0.4 - 5.5) on a yearly CHC wellness check at the end of September. So it seems my TSH is just all over the place.

But either way, I pushed the high TSH numbers into a visit to an endocrinologist. He palpitated my neck and said I had a goiter, at about 25% inflammation. He's running a couple of antibody tests now (I think anti-TPO and another one).

It seems the endo I went to is a "by the numbers" guy, because he said all my numbers are normal. All of them. Just because they fell within the (old) ranges. When I asked "But didn't the AACE suggest reducing the level to 3.0 back in 2002?" He said I was just splitting hairs, and that being just a little over wouldn't be symptomatic. He may be right about that, but it seems suspicious based on the wild fluctuations I keep experiencing.


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## Andros (Aug 26, 2009)

fullofbones said:


> A little introduction: Back in 2008, I got a TSH test done because I went to the ER with unexplained heart palpitations. They got this:
> 
> 2008-05-21:
> TSH: 6.2 (0.35 - 5.5)
> ...


Your FT3 is in the basement on your most recent labs. You must feel pretty badly right about now?

Here is what might be going on:

There are binding, blocking and stimulating antibodies and immunoglobulins probably at play thus skewing the numbers on the thyroid panel.

The bad guys are fighting the good guys in an attempt to right the body. Well, it looks good on paper but meanwhile the patient is usually very very unwell.

Here are some suggested labs to get to the bottom of it all and by the way; thank you so much for the ranges.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

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://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html


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## fullofbones (Oct 26, 2011)

My results for TPO-Ab and Tg-Ab came back:

Tg-Ab (0-0.5 units) : 0.1
TPO-Ab (0-100 units) : 17

So, back to the drawing board, eh?


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## Andros (Aug 26, 2009)

fullofbones said:


> My results for TPO-Ab and Tg-Ab came back:
> 
> Tg-Ab (0-0.5 units) : 0.1
> TPO-Ab (0-100 units) : 17
> ...


It appears that "stuff" is going on as you should have none of the above 2 tests.

What is your plan and what has your doctor had to say?


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## fullofbones (Oct 26, 2011)

Andros said:


> It appears that "stuff" is going on as you should have none of the above 2 tests.
> 
> What is your plan and what has your doctor had to say?


In his notes (which he mailed to me, using the actual USPS) he noted how they were within range. But I also remember our discussion when he first suggested Hashi's. He said then, that a lot of people will have a low level of antibodies that irritate the thyroid and cause it to get inflamed, and that this is not necessarily a problem. That was when he said my thyroid was probably about 25% inflamed.

Because I was within ranges, he was reluctant to give me any T4 at all, but he did it anyway. I got the impression he was doing it to shut me up, but after my tests came back, he called and prescribed T3 to take "until the T4 starts making me feel better." So I'm baffled at the mixed signals.

I have to say I've been having classic Hashi symptoms beyond all this, though. Most of the time I'm freezing cold with hands that could make ice shiver, but occasionally and without warning, I'll have almost the exact opposite. A couple days ago, for about two hours, I was so hot my feet were actually sweating. Right after that? Ice cold.

This makes me suspect his original diagnosis was correct, but that makes me wonder about the scale. Those antibody tests are pretty low, aren't they? Reading through these boards, there's people with numbers in the hundreds or even thousands. I barely register. It doesn't seem to add up. I'm going to do some more research, but I'm not entirely certain what my next move is.


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## bigfoot (May 13, 2011)

Somewhat low? Yes. Low enough to ignore? I don't know about that. But it certainly is one more puzzle piece to fit together. (My TPO Ab and TG Ab are much higher, but my endo was quick to point out that there was no point in re-testing them as time goes on. So it sounds like you either have the antibodies, or you don't.) Not to mention your TSH appears like it is on a roller coaster over time. Looks like your pituitary is alternating between yelling and screaming at your thyroid to crank out more hormones. That can't be a good thing.

Thankfully your doc is willing to even try giving you thyroid meds. And the fact that he is giving you T3 in the meantime until the T4 kicks in is a good thing, too. He is obviously knowledgable about thyroid issues. I wonder if you would benefit from taking a small amount of T3 in the long-term, along with the T4. A lot of folks have had success with this. I think the hardest part is getting docs to attribute signs & symptoms to things like Hashi's. I can't tell you how many times I've heard the, "Well, your numbers are fine, so that doesn't explain what you're going through." But darn near every single anecdotal piece of information from anyone who has (or knows someone with) thyroid issues will tell you the complete & total opposite.


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