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-   -   Hyper symptoms after FNA, low TSH & T4 (http://www.healthboards.com/boards/thyroid-disorders/941830-hyper-symptoms-after-fna-low-tsh-t4.html)

Rebeccat4 03-08-2013 09:44 AM

Could I be Hyperthyroid? Confusing labs.
 
Hi,

I've been suffering with hyperthyroid symptoms since giving birth to my 15 month old son. At 8 months post-partum a goiter appeared on my neck, and along with my symptoms, an ultrasound confirmed I have a multinodular goiter, with some very large nodules up to 3cm.

2 weeks ago I had an FNA carried out on my 3cm nodule and have since had worsening of symptoms including restlessness, insomnia, sensitivity to heat, shakiness, increased appetite without weight gain, periods of fatigue, muscle aches, high pulse rate and blood pressure but my labs are in normal range. Results:

Earlier results:
T4: 14.0 (range 10.0-22.0) - low normal
TSH: 0.41 (range 0.10-4.00) - low normal
TPag: were very high normal range (something like 75 in a range of 0-90).

New results:
T4 14.8 (range 10.0-22.0) low normal
TSH 0.16 (range 0.10-4.00) very low normal

Bloods also came back with low red blood cell dist (anemia).

I'm really confused as to why BOTH TSH and T4 are low??? I thought one is supposed to be high and one low? And why am I having Hyper symptoms on supposedly normal ranges? Could such a low TSH be causing my symptoms?

(NOTE: I have a strong family history of hypothyroidism and also my baby son was under consultation for symptoms related to hyperthyroidism - hypercalcemia, irritability, prominent eyes)

I'm so confused. Please help!

midwest1 03-08-2013 09:57 PM

Re: Could I be Hyperthyroid? Confusing labs.
 
I don't know a whole lot about hyperthyroidism, and your case doesn't seem simple. I did some digging around at reputable medical sites to see what I could find out for you.

There's a condition called "subclinical hyperthyroidism" that seems to fit. (Wouldn't call yours a "classic" case, but it's close.) This presents with low TSH and "normal" FT4/3. There wouldn't be "overt" hyperthyroid symptoms, although "nonspecific" signs or symptoms such as malaise, tachycardia, nervousness, and anxiety may be present.

Your MD is mistaken to use the total T4 test to try and diagnose this. Total T4 can appear low, but when the more accurate free T4 test is used, it can be markedly higher - even excessively high. The free T3 test must also be run.

I can't explain your increased symptoms following the FNA. I'm only guessing here - [i]really[/i] guessing - but perhaps the intrusion of the needle into what might be a mildly "hot" nodule caused a surge of T4 to enter your bloodstream... ??? Don't take that as being in any way scientific... LOL

So... Get the [u]right[/u] bloodtests, both free T4 and free T3, and go from there. Hope that helped, at least a bit.

Rebeccat4 03-09-2013 02:39 AM

Re: Could I be Hyperthyroid? Confusing labs.
 
This does help, thank you. The problem will be getting those tests done in the UK, I ve asked for the T3 results previously and they always seem so reluctant but I'm desperate to find out what's going on so I can finally get some rest and relaxation x

midwest1 03-09-2013 10:05 AM

Re: Could I be Hyperthyroid? Confusing labs.
 
I understand the difficulty getting the right tests/treatment in many parts of the world.
If you can't get free T3, at least push very hard to get free T4. It's really the most accurate of the tests.

gloom 03-09-2013 10:28 PM

Re: Could I be Hyperthyroid? Confusing labs.
 
[QUOTE=midwest1;5144097]I can't explain your increased symptoms following the FNA. I'm only guessing here - [i]really[/i] guessing - but perhaps the intrusion of the needle into what might be a mildly "hot" nodule caused a surge of T4 to enter your bloodstream... ??? Don't take that as being in any way scientific... LOL[/QUOTE]

I read as well that as a 'complication' of an FNA and also from hemorrhaging cysts. Both said the condition cleared up in three months. Sort of makes sense, in graves disease, attack by the immune system causes the thyroid to produce more hormone.

midwest1 03-09-2013 10:42 PM

Re: Could I be Hyperthyroid? Confusing labs.
 
Hah! How 'bout that! Maybe I missed a career opportunity in medical research! ;) :D

Rebeccat4 03-10-2013 04:34 AM

Re: Could I be Hyperthyroid? Confusing labs.
 
Thanks for that gloom - I am 100% certain the FNA triggered some sort of reaction, I was just on a constant adrenaline rush the week after, not sleeping, unable to relax, shakiness etc, and the evidence showed by my TSH lowering even more, suggests a surge in hormone has happened. My neck has also swelled up again.

I'm glad to report now that the adrenaline rush feeling is now easing, just 3 weeks on, but I am still struggling with sleep and shakiness and my endo is refusing to see me until another 2 months. The frustrating thing is, I've noted from other posts that the rest of Europe and America seem classify my current TSH level within Hyperthyroid range, but the UK doesn't so I'm not being taken seriously :(

midwest1 03-10-2013 11:08 AM

Re: Could I be Hyperthyroid? Confusing labs.
 
It's not nice to be critical of the health systems in other parts of the world, given how 'broken' the one in the US is (and how it's in imminent danger of failing altogether).
But from everything I've read about thyroid care in the UK... There is a serious backwardness about these particular disorders. It makes me sad how little power a thyroid patient has there... How arbitrary the official guidelines are. I wish I knew something about the methods a UK citizen can use to get what they need from their health system they have so I could advise you about finding better treatment. I would be tempted to gather all my friends and family to stage a sit-in at the endo's office until he concedes to act!

Hugs and empathy from across the pond...


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