# "Temporary" hyperthyroidism, low TSH?



## marilano

I was having symptoms like unintended weight loss, heart palpitations, shortness of breath, sleep problems, and fatigue. I'm a woman in my late 50's. My primary care doctor checked my TSH level and it was .06. But my free T4 was normal, at 1.4. The one previous test I'd had for thyroid antibodies (TPO AB) about 2 years ago showed it was elevated, at 482. I looked up the symptoms of hyperthyroidism and Graves disease and have most of them (e.g. intolerance to heat, irritability and nervousness, etc.). Hashimoto's thyroiditis and thyroid cancer run in my family. I used to think I was hypothyroid, since I had many symptoms of that and have always seemed to have a very slow metabolism. My primary care dr. was going to refer me for a nuclear scan, but I'd had spinal injections recently using contrast material, so the doctors in nuclear medicine said I have to wait at least another month. So, on my request, she referred me to an endocrinologist. The endo. said she wasn't concerned about my low TSH level and thought that it might be a temporary, maybe due to a virus (although I haven't been sick). She did an ultrasound which didn't show anything remarkable. She doesn't think I need a nuclear scan. She said to get my TSH and T4 checked again in a month. But meanwhile, I feel lousy. I'm wondering if I have autoimmune thyroid disease and if it could be making me hyperthyroid now even if I was hypothyroid in the past. Should I just wait for a month and see how the TSH is then? Should I insist on the nuclear scan? My thyroid doesn't seem to be enlarged.


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## Andros

marilano said:


> I was having symptoms like unintended weight loss, heart palpitations, shortness of breath, sleep problems, and fatigue. I'm a woman in my late 50's. My primary care doctor checked my TSH level and it was .06. But my free T4 was normal, at 1.4. The one previous test I'd had for thyroid antibodies (TPO AB) about 2 years ago showed it was elevated, at 482. I looked up the symptoms of hyperthyroidism and Graves disease and have most of them (e.g. intolerance to heat, irritability and nervousness, etc.). Hashimoto's thyroiditis and thyroid cancer run in my family. I used to think I was hypothyroid, since I had many symptoms of that and have always seemed to have a very slow metabolism. My primary care dr. was going to refer me for a nuclear scan, but I'd had spinal injections recently using contrast material, so the doctors in nuclear medicine said I have to wait at least another month. So, on my request, she referred me to an endocrinologist. The endo. said she wasn't concerned about my low TSH level and thought that it might be a temporary, maybe due to a virus (although I haven't been sick). She did an ultrasound which didn't show anything remarkable. She doesn't think I need a nuclear scan. She said to get my TSH and T4 checked again in a month. But meanwhile, I feel lousy. I'm wondering if I have autoimmune thyroid disease and if it could be making me hyperthyroid now even if I was hypothyroid in the past. Should I just wait for a month and see how the TSH is then? Should I insist on the nuclear scan? My thyroid doesn't seem to be enlarged.


Hi! I do believe that your Primary Care doc has the right idea. A nuclear scan will show stuff that a sonogram won't and it is very important to rule out cancer as well.

You can be hypo for years and then turn hyper. It has happened to many of us here. Myself included.

We do recommend some antibodies' tests.

The lab tests listed are helpful when it comes to sorting things out.

TSH, FREE T3, FREE T4, TPO (antimicrosomal antibodies), ANA (antinuclear antibodies), TSI (thyroid stimulating immunoglobulin) and Thyroglobulin Ab as well as thyroid binding inhibitory immunoglobulins (TBII.)

You can look all of the above up here so you know what they are for........
http://www.labtestsonline.org/

Understanding your thyroid Tests
http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm

The TSI would be very important because it is only present in hyperthyroid.

Have you had any antibodies' tests?


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## Lovlkn

> Hashimoto's thyroiditis and thyroid cancer run in my family.


I would recommend having the scan for this reason alone.

You have a low TSH which says something is happening and unless you have the scan you cannot be sure it's not cancer, especially since it runs in your family.


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## marilano

Thanks for the replies and advice. I'm hoping my primary care dr. didn't cancel the order for the nuclear scan once she referred me to the endocrinologist (who didn't seem to think I needed one, since the ultrasound didn't show anything). The only thyroid antibody test I've ever had (and that was about 2 years ago) was the TPO AB, which was 484, whereas normal is under 30. Many years ago, I had a positive ANA (at one point, a couple of doctors thought I might be in the early stages of lupus, but thankfully, I don't seem to have it). I was dx'ed with fibromyalgia about 10 years ago, but have wondered whether many of the symptoms of that could have been caused by hypothyroidism. I'm in Kaiser, so it's not always easy to get all the tests one asks for, but I'll try to ask for some of the ones that have been suggested. The endocrinologist only wants to retest the TSH and free T4. marilano


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## marilano

Thanks for all the info. and suggestions. The latest results: my TSH is up from .06 to .29 (which Kaiser considers normal), TSI of 145 and TPOab of 494, and T4 still normal at 1.0. My dr. apparently cancelled the nuclear scan (or RAIU--I wasn't sure which she'd ordered), since my TSH is "normal." She and the endocrinologist seem to think I'm just slowly developing Hashimoto's or have subclinical hyperthyroidism. Because of my high blood pressure not being totally well controlled, and my pounding heart lately, my dr. just put me on a very low dose of Atenolol (which made my heart rate too slow the last time she'd tried it), and I know that's sometimes also given for mild hyperthyroidism. (I'm also on HCT for the high blood pressure.) I'm wondering whether I have Hashitoxicosis. Any advice or further info.? TIA for any replies


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## Andros

marilano said:


> Thanks for all the info. and suggestions. The latest results: my TSH is up from .06 to .29 (which Kaiser considers normal), TSI of 145 and TPOab of 494, and T4 still normal at 1.0. My dr. apparently cancelled the nuclear scan (or RAIU--I wasn't sure which she'd ordered), since my TSH is "normal." She and the endocrinologist seem to think I'm just slowly developing Hashimoto's or have subclinical hyperthyroidism. Because of my high blood pressure not being totally well controlled, and my pounding heart lately, my dr. just put me on a very low dose of Atenolol (which made my heart rate too slow the last time she'd tried it), and I know that's sometimes also given for mild hyperthyroidism. (I'm also on HCT for the high blood pressure.) I'm wondering whether I have Hashitoxicosis. Any advice or further info.? TIA for any replies


Wow!!! Not sure I am pleased with this. For one thing, we see hyperthyroidism with thyroid cancer. And it would be very very important to see the rate of uptake as well as being able to look for any suspicious nodules, vascularity or other irregularities within the thyroid gland.

TSH is not a reliable rule of thumb for hyper. Your doctor should have run FREE T3 and FREE T4 w/ TSH.

You could have Hashitoxicosis or you could be having thyrotoxicosis due to just plain hyperthyroid or even Graves'.

Here is info on those blood tests (the FREES.)
Understanding thyroid lab tests.....http://www.amarillomed.com/howto

Your TSI (thyroid stimulating immunoglobulin) is very high; as you no doubt already know, you should have no TSI. When TSI is present, the patient usually has Trab as well.

Here is where you can look up these things..........
http://www.labtestsonline.org/understanding/conditions/thyroid.html

If you are not happy w/ how your doc is handling this, perhaps doctor shopping would be in order?

You cannot be feeling at all well! I am worried.


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## GD Women

TSH tells if a person is hypo or hyper and is the best indicator. FTs tells if autoimmune, which autoimmune and few other illness as well tells.

The antibodies that predominate determine what current thyroid disease a person will have, that is, people with a combination of different thyroid antibodies, the antibodies that predominate determine what current thyroid disease a person will have or has.

However, about 5-10% of healthy people test positive for TPO antibodies, so the presence of these antibodies doesn't always indicate that there is an autoimmune disorder.

It is impossible to say if you are Hashitoxicosis without knowing your FTs and their Lab ranges.

With your TSH and T-4 on the low end, I would suggest to keep having your levels checked on a regular bases in case of and to catch any changes.

Keep us up dated!


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