# HELP! TSH and free T3 high and free T4 low!



## jackpot13 (Jul 10, 2011)

Help! I need all the help and advise I can get. Went into a-fib again 2 days ago. Been almost a year. Converted on its own by the time I got to the ER. Been feeling a mixture of hyper and hypo past few weeks. Very tired sleeping alot no energy. Crabby irritable but most of all my muscles are killing me! I am so sore sometimes I can't hardly walk. I feel anxious for no reason lately then the a-fib. Was diagnosed with Hashi almost 3 years ago with high TPO. Goiter was found after my first bout with a-fib. Had another episode 1 year and 9 months later then again 11 months later. I have not been treated for hypothyroid. My TSH is always at the high end of "normal". The biggest concern is that is im treated I might go into a-fib again. The strange thing is my labs. How can this be?
TSH 9.59 (0.49-4.67)
FREE T4 0.81 (0.61-1.60)
FREE T3 4.16 (2.50-3.90)
Anyone have any idea what is going on? How can something like this be treated? I'm tired of feeling like crap every day! Thanks for listening!


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## bigfoot (May 13, 2011)

Did they ever run other specialized tests, such as TSI (Thyroid Stimulating Immunoglobulin)? Not to be confused with TSH. The TSI test would give clues to something like Graves' or Hashitoxicosis. Also, your Reverse T3 should be tested. And have you seen a cardiologist and/or an endocrinologist?

The fact that you were diagnosed with Hashimoto's years ago, and have suffered through all sorts of weird symptoms, and nobody began treatment or sent you to someone who could understand what was going on, speaks volumes. Hashi's can also give you hypo/hyper swings while it attacks the thyroid, causing thyroid hormone to be dumped into your system, so you wind up with both hypo AND hyper symptoms.


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## jackpot13 (Jul 10, 2011)

Thanks for your reply. My Dr called today after confering with another Dr to try and figure out why my free t4 is over converting to free t3. She asked if I was under alot of stress and I am always under stress at work. Sometimes I feel so anxious or frustrated with things but always blamed it on my thyroid. Maybe it's just my personaity and it's having a negative effect on my thyroid function. Is that possable? I do have the antibodies as I will list below so I know I have an attack going on. I have a multi nodular hyper vascular goiter with no focal lesions. I feel like I swing back and forth and am in a hyper mode right now. Anxious slight chest pain. No irregular heart beats though so thats good. My last episode of afib was a couple weeks shy of a year ago and the one before that was 21 months prior. So only 3 times in as many years but still worrisome. Sorry this is so long winded! Havnt had antibodies done in almost 2 years but here they are. Oh ya and didnt have a free t3 done with first 2 episodes of afib. I asked for it this time though. Thanks for your help.
10/25/1011
TPO 1412 (<10)
Thyroid Ant 27 (<116)
Thyroglob 1 (<4)


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## bigfoot (May 13, 2011)

Okay... I'm no expert on this stuff, but your TPO Antibodies were up over 1,000 when last tested, you have a goiter, and atrial fib. occurrences. Not only that, but your Free T3 is up over the high end. Umm, something is going on here.

I really hope your doc isn't just looking at your TSH of 9.xx and saying, "Well, gee, you're just hypothyroid", ignoring this mountain of other data. You may be one of the folks who are walking around with both Graves' disease AND Hashi's. Or, you could be dealing with so-called Hashitoxicosis (aka Thyrotoxicosis).

I would press your doc(s) for answers and ask for a referral to a good endo in the area who significantly deals with thyroid issues (not just focused on diabetes), or likewise, an astute ENT. Not only that, but a consult with a cardiologist. Can you share any other details about the ultrasound results? Size of nodule, and so forth? I know other members here are pretty skilled in roughly interpreting them.

Honestly, is it possible for stress to affect things, causing anxiety? Absolutely. But this stuff doesn't usually happen in a vacuum. Ask your doc for a cortisol test; ideally urinary free cortisol over 24-hrs., or else a salivary cortisol test over 24-hrs. If you could get one that breaks up the day/night into 4 collection periods, even better! You could be dealing with adrenal gland dysfunction (either over- or under-active) here, too.

They should be leaving no stone unturned with this stuff. Docs love to blame your "mood" for everything, and toss a script for a magic pill at you. While people certainly can have standalone mood problems, or anxiety, depression, and so forth -- it is a little bit of a coincidence that much of what you are dealing with is happening at the same time as these endocrine issue(s).

Other labs to inquire about would be sex hormones (estrogen, testosterone, SHBG, etc.), Vitamin D-25, Vitamin B-12, Celiac disease, gluten sensitivity (not the same as Celiac test), Lyme disease, H. Pylori, etc.


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## jackpot13 (Jul 10, 2011)

Thanks again for your response. I go back to my Dr in 4 weeks and will have labs done again. I will ask for these extra tests. Did I mention I was a diabetic. I also quit smoking on Thanksgiving day. Went almost cold turkey. Only took 3 days of cutting down then quit. Gained 17 lbs in about 2 months after that. Felt starving all the time. LOL Do you think there is a connection to quiting smoking so fast? I went to a cardiologist after my first episode of afib. Wore a halter monitor and had an echocardiogram both were normal. Here is my ultrasound results. 10/29/2010 It's been over two years ago and I know it has grown since then.
The gland appears diffusely heterogeneous and enlarged with slightly lobular contures but no discrete focal lesions. Doppler images show diffuse hypervascularity. Dimensions are measured to be 5.1 x 2.2 x 1.8 cm on the right. and 5.9 x 2.1 x 2.2 cm on the left. Impression: A large hypervascular, heterogeneous thydoid compatible with changes of multinodular goiter.

Thanks again you have been most helpfull! It's nice to know someone cares enough to take the time to talk to those of us who dont know what is going on and are scared. You are a Blessing.


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## bigfoot (May 13, 2011)

I would push for a new ultrasound ASAP, and then follow-up ultrasounds yearly afterwards to keep an eye on things. If your doc doesn't think you need it, demand it. Especially since it's been over two years since the last one and you have been dealing with all of these signs & symptoms.

No sweat -- anytime! A couple of years ago (wow, that flew by) the only thing I knew about the thyroid was that it was located somewhere in my neck, LOL. Have had to learn a lot since, some the hard way.

hugs6


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## jackpot13 (Jul 10, 2011)

OK have new thyroid us report. It has grown but keep in mind it has been almost 3 years since my last one. Right thyroid is 5.9cm x 2.6 cm x 2.1 cm. left side is 6.3 cm x 2.4 cm x 2.5 cm. Previously there was a hyperechoic nodule about the inferior right thyroid which measured 1.1 cm x 1 cm x 1.4 cm. Today it measures 1.5 cm x 1.9 cm x 1.4 cm. Thyroid isthmus today is measured at 1.3 cm thickness. Previously is was measured at 8 mm in thickness. Color flow images show hyperemia throughout. 
Impression: Enlargement of nodular density noted about inferior right thyroid. It may merely be adjacent to thyroid rather than within it. The nodule does not show hyperemia on color flow imaging to suggest parathyroid adenoma.
Enlargement of the entire thyroid gland since last exam with persistent marked heterogeneity and hyperemia constant with Hashimoto's thyroiditis. Does anyone know what this means. It this a large thyroid? I feel a tightness in throat and getting hoarse. Any info would be awesome!!! Thanks in advance!!


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## jackpot13 (Jul 10, 2011)

OK so I finally went to a Cardiologist. Had a echocardiogram which was normal and wore an event monitor for 2 weeks. The monitor showed I have PAT which is sudden atrial tachacardia. Mostly happens when laying down. May be a vagal nerve thing but he wont rule out my thyroid. Heres my question. I have an appointment with my endo on sept 9th. I think I am going to talk to him about having a TT. I have been feeling like crap for 3 years now. I have never been treated mostly because my freeT3 is at the high end of normal or just over and they are afraid because of my arrythmias. For the past 3 months my voice has been getting hoarse. I feel short of breath and although I don't feel like im choking when I swallow I do have to nod my head down to swallow sometimes. it,s hard to explain. I guess I just feel like my thyroid is never gonna get any smaller and I am still not being treated. Now I am getting other issues so I might as well have it out and be done with it. What do you all think? Am I being crazy??


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## Andros (Aug 26, 2009)

jackpot13 said:


> Help! I need all the help and advise I can get. Went into a-fib again 2 days ago. Been almost a year. Converted on its own by the time I got to the ER. Been feeling a mixture of hyper and hypo past few weeks. Very tired sleeping alot no energy. Crabby irritable but most of all my muscles are killing me! I am so sore sometimes I can't hardly walk. I feel anxious for no reason lately then the a-fib. Was diagnosed with Hashi almost 3 years ago with high TPO. Goiter was found after my first bout with a-fib. Had another episode 1 year and 9 months later then again 11 months later. I have not been treated for hypothyroid. My TSH is always at the high end of "normal". The biggest concern is that is im treated I might go into a-fib again. The strange thing is my labs. How can this be?
> TSH 9.59 (0.49-4.67)
> FREE T4 0.81 (0.61-1.60)
> FREE T3 4.16 (2.50-3.90)
> Anyone have any idea what is going on? How can something like this be treated? I'm tired of feeling like crap every day! Thanks for listening!


If you have not been tested for TSI, you need to be. And Trab.

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

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

If you have not had an ultra-sound to check for cancer, you really should. The antibodies and cancer are 2 reasons that you could have weird numbers like that w/high FT3 and high TSH.

You could very well be hyperthyroid, not hypothyroid.


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## Andros (Aug 26, 2009)

jackpot13 said:


> Help! I need all the help and advise I can get. Went into a-fib again 2 days ago. Been almost a year. Converted on its own by the time I got to the ER. Been feeling a mixture of hyper and hypo past few weeks. Very tired sleeping alot no energy. Crabby irritable but most of all my muscles are killing me! I am so sore sometimes I can't hardly walk. I feel anxious for no reason lately then the a-fib. Was diagnosed with Hashi almost 3 years ago with high TPO. Goiter was found after my first bout with a-fib. Had another episode 1 year and 9 months later then again 11 months later. I have not been treated for hypothyroid. My TSH is always at the high end of "normal". The biggest concern is that is im treated I might go into a-fib again. The strange thing is my labs. How can this be?
> TSH 9.59 (0.49-4.67)
> FREE T4 0.81 (0.61-1.60)
> FREE T3 4.16 (2.50-3.90)
> Anyone have any idea what is going on? How can something like this be treated? I'm tired of feeling like crap every day! Thanks for listening!


If you have not been tested for TSI, you need to be. And Trab.

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

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

If you have not had an ultra-sound to check for cancer, you really should. The antibodies and cancer are 2 reasons that you could have weird numbers like that w/high FT3 and high TSH.

You could very well be hyperthyroid, not hypothyroid.

I am sorry you ended up in the ER like you did. That had to be scary!


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## jackpot13 (Jul 10, 2011)

Yes I had an ultrasound 2 months ago. The results are in a previous post. I guess I feel like it doesn't matter whats going on hyper or hypo cancer or not I just want it out! I am tired of feeling like crap in some way every day. I am not being treated. Eventually I will be hypo and on meds the rest of my life. The goiter will only get bigger and be more bothersome so why not put an end to it now. Sorry just so frustrated. Thanks so much for listening.


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