# TSH bounces from too high to perfectly normal on its own?



## Unshifted (Apr 14, 2010)

A few weeks ago, I went to the doctor because I felt really tired. He checked my thyroid levels and my TSH was 7.36. Since I was complaining of feeling really tired, plus I get cold easily and my mom has Grave's, the doctor thought it was a pretty standard case of hypothyroid, wrote me a prescription for Synthroid and sent me on my way. I was nervous about going on medication after only one blood test and so I asked for a second. The doctor told me he didn't see a reason but it was my blood and money and so getting another test was fine.

Well, I went in for the results today and the doctor told me he was actually really shocked to see them. They were:

TSH ~ 2.90 (0.34-5.60)
FT4 ~ 0.89 (0.61-1.12)
T3F ~ 321 (230-420)

Anti-Thyroglobulin Ab ~ <20 (<41)
Anti-TOP Microsomal Ab ~ 17 (<35)

Last time:

TSH ~ 7.36
T4 ~ 1.0

So everything was totally normal this time. My antibody tests came back fine, my T3 and T4 levels were fine and my TSH was within a perfectly normal range. The doctor said that this doesn't mean I'm out of the woods and his line of thinking is that my thyroid is sputtering, and we happened to catch it while it was under active. I have been less tired within the past few weeks and so that makes sense, at least symptom wise. He told me that instead of going on the medication, I should monitor my symptoms and come back in 4 months to have my levels re-checked. He thinks my thyroid is slowly dying and I'll eventually need to go on Synthroid but not right now. I'm worried that one of the tests was a mistake, given the drastically different numbers. He said that he considered that but given the fact that I came in with symptoms and my mom has thyroid issues, signs are pointing towards me just having thyroid issues. I guess I'll have to wait and see in 4 months time.

Anyway, has anyone else been through something similar? It's difficult to find information about it because I'm not even sure what to look up, so I figured maybe someone here would have some information. Sorry this is so long! I appreciate you taking the time to read it all.


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## Andros (Aug 26, 2009)

Unshifted said:


> A few weeks ago, I went to the doctor because I felt really tired. He checked my thyroid levels and my TSH was 7.36. Since I was complaining of feeling really tired, plus I get cold easily and my mom has Grave's, the doctor thought it was a pretty standard case of hypothyroid, wrote me a prescription for Synthroid and sent me on my way. I was nervous about going on medication after only one blood test and so I asked for a second. The doctor told me he didn't see a reason but it was my blood and money and so getting another test was fine.
> 
> Well, I went in for the results today and the doctor told me he was actually really shocked to see them. They were:
> 
> ...


Hi and welcome. Antibodies wax and wane and as they do that there are fluctuations in the TSH, Free T3 and Free T4. So,things do get complicated.

You do have a smattering of TPO which would suggest something autoimmune going on and since we have "proof" that your numbers are flying all over the place, we could assume (and it is not good to do that) that you have thyroid disease.

I think you should have more antibodies' tests run.

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

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

I also think that at least a sonogram would be wise. Your numbers are in normal range but I am suspicious. TSH is barely below AACE recommendation of 0.3 to 3.0, FT4 is barely over mid-range and FT3 is below mid-range.

For one thing, symptoms cross over and the other tests that you did not have would be telling. You could have Graves' also and that "typically" waxes and wanes. It is insidious and you do feel tired for even at rest the metabolism is speeding full speed ahead.

Also, have your Ferritin checked. Ferritin is the protein that stores your iron for cellular uptake. That could cause extreme tired and most of us with thyroid disease do have low ferritin. It should be 50 to 100.

Do you feel like you have a goiter? Any trouble swallowing or sleep apnea?


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## Unshifted (Apr 14, 2010)

Thanks for your response, I appreciate it! No goiter, trouble swallowing or sleep apnea. The doctor also felt my neck and said he didn't feel anything strange.

The problem is, I'm 24, without a job or insurance right now. My boyfriend recently lost his job and we moved, and then all of this happened. We're quickly running out of money and I don't know what to do. I'm really worried about having these problems and I really want to get to the bottom of everything but I just...don't have the money to do so =/ It really sucks. Do you think it's absolutely necessary to get those other antibody tests and a sonogram?

I'm a little confused though. Why would you think Grave's is possible when my TSH was high on the first test, and is now in a normal range? (but not very low) I guess I'm just confused as to how Grave's factors in when my numbers are high.

Do you think it's alright to wait a few months to get the tests done, or should it be more of an "do it now" type of thing? I'm totally lost when it comes to this stuff.


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## Andros (Aug 26, 2009)

Unshifted said:


> Thanks for your response, I appreciate it! No goiter, trouble swallowing or sleep apnea. The doctor also felt my neck and said he didn't feel anything strange.
> 
> The problem is, I'm 24, without a job or insurance right now. My boyfriend recently lost his job and we moved, and then all of this happened. We're quickly running out of money and I don't know what to do. I'm really worried about having these problems and I really want to get to the bottom of everything but I just...don't have the money to do so =/ It really sucks. Do you think it's absolutely necessary to get those other antibody tests and a sonogram?
> 
> ...


Because typically the Graves' patient goes through hypo and hyper cycles until the hyper becomes dominant. I have seen this a thousand times in others and my own self as well.

Yes............you have to do what you have to do here. Many of us are in a Pickle with health care and otherwise.

We are here for you. Do your best and let's see what happens. This is a mess; never thought I would live to see our country is such bad trouble. Just keep on sending jobs to other countries. Way to go America! Dumb and dumber. What did they think would happen?

Aaaaaaaaaaaaaack; sorry for the rant. It is because I feel bad for you and others as well.


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## Unshifted (Apr 14, 2010)

Hmm...this is all so confusing  Thanks for your help though.

So the only way to know if I have Grave's or not is to get the other antibody tests? Are there any that are really important in the diagnoses of Grave's? Like I said, I don't really have a lot of money at this point and so I'd like to get as few as possible, but I don't want to undermine my health in doing so. What tests do you think are really important?


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## Lovlkn (Dec 20, 2009)

Unshifted said:


> Hmm...this is all so confusing  Thanks for your help though.
> 
> So the only way to know if I have Grave's or not is to get the other antibody tests? Are there any that are really important in the diagnoses of Grave's? Like I said, I don't really have a lot of money at this point and so I'd like to get as few as possible, but I don't want to undermine my health in doing so. What tests do you think are really important?


You need to listen to your doctor and just keep an eye on your symptoms. At this point your last labs were within normal range and not too far off optimal so if you are feeling good wait. Chances are if you tested for antibodies with somewhat normal thyroid labs then the antibodies tests would be normal as well.

There is a chance you might be experiencing some normal thyroid fluctuations - stress can have effects on your entire body and since you don't have the $$ don't stress about it.


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## Andros (Aug 26, 2009)

Unshifted said:


> Hmm...this is all so confusing  Thanks for your help though.
> 
> So the only way to know if I have Grave's or not is to get the other antibody tests? Are there any that are really important in the diagnoses of Grave's? Like I said, I don't really have a lot of money at this point and so I'd like to get as few as possible, but I don't want to undermine my health in doing so. What tests do you think are really important?


The "clinical" criteria for Graves' as per Dr. Robert Graves are.............

Exophthalmos, goiter, pretibial myxedema and thyrotoxicosis. You are a college student so you know that in this case clinical means "you see it" or by observation.

Therefore, if you have 3 out of the 4 above, you are considered to have Graves' and treatment can commence on a budget.

However, you could have just hyperthyroidism, Hashimoto's and even cancer causes hyperthyroid so............................ you see? It "is" worrisome.

Like yourself, I know what it is like to have financial constraints so you just have to do what you can do. I wonder if you can find a free clinic in your area???

This is a very very convoluted autoimmune disease no matter how you cut the cake.


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## Unshifted (Apr 14, 2010)

Hmm I was worried about cancer, of course. Wouldn't my white blood cell count be out of whack if I had cancer, though? I had it tested and it was totally normal.


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## Andros (Aug 26, 2009)

Unshifted said:


> Hmm...this is all so confusing  Thanks for your help though.
> 
> So the only way to know if I have Grave's or not is to get the other antibody tests? Are there any that are really important in the diagnoses of Grave's? Like I said, I don't really have a lot of money at this point and so I'd like to get as few as possible, but I don't want to undermine my health in doing so. What tests do you think are really important?


TSI (thyroid stimulating immunoglobulin) which would rule in or rule out hyperthyroid.

The TSI Test 
TSI, which stands for thyroid stimulating immunoglobulin, is the antibody responsible for hyperthyroidism in Graves' disease. TSI are also known as stimulating TSH receptor antibodies or stimulating thyrotropin receptor antibodies because of their ability to stimulate the TSH receptor on thyroid cells. Acting in place of TSH, these antibodies stimulate thyroid cells to produce excess thyroid hormone. TSI also contribute to the related eye disease, Graves' ophthalmopathy. TSI is used to diagnose Graves' disease, to monitor response to anti-thyroid drugs and to helping predicting remission. While the normal range is <130% activity, individuals who are normal do not produce TSI and have levels <2% activity. Individuals with levels between 2 and 125 %, which indicates thyroid autoimmunity, do not generally develop symptoms of hyperthyroidism until levels rise. Therefore, levels much lower than 125% are necessary to predict complete remission. Levels, which are close to 100% activity generally rise when patients stop taking anti-thyroid drugs. Ideally, levels would fall to at least 20% before anti-thyroid drugs are safely withdrawn. The reference range is <130% activity or an index of <1.3 for tests that measure the increased activity caused by adding patient serum to a test solution of thyroid cells. 
http://graves.medshelf.org/Lab_Tests

This way,you would know if you need to take medication for hypothyroid or not.

Sending hugs,


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