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Old 05-02-2013, 08:18 PM   #1
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TSH level is below 0.06 -- likely to be hyperthyroidism?

For the last few months, I have been feeling exhausted during exercise (I run ~7 miles every day) and also a bit shaky in my arms and legs, and I am more anxious/nervous at school than I've ever been before. My resting HR (especially after exercise -- even 2-3 hours afterwards) is often 100+, and I don't think it has been below 85-88 in several months. What usually happens when running is that I will just feel sluggish and slow for the first 20-30 minutes, and after that, I will feel totally exhausted, like I have already tried to run 20 miles. At that point, I usually start taking breaks every few minutes.

I had an appointment with a cardiologist on Tuesday and had blood samples drawn the same day. The next day, I received a call from the lab facility stating that my TSH level was below 0.06. However, they didn't mention anything about T3 or T4 levels (or any other values at all), so I'm not sure if they were in the "normal" ranges or if they just haven't been assessed yet.

Based on my symptoms, do you guys think I have hyperthyroidism? Or is more likely to be subclinical hyperthyroidism? I wasn't sure whether to expect it to be full-blown hyperthyroidism or not since I'm not exhibiting other common symptoms such as eye issues, thin nails/skin, or hair loss (I think)? I also don't have a palpable goiter.

 
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Old 05-02-2013, 11:21 PM   #2
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

Yes, you are hyperthyroid. "Subclinical" means not manifesting symptoms. It's not subclinical.

Has the cardiologist referred you to an endocrinologist? That should be the next step. Just don't allow yourself to be rushed into any treatment without researching it for yourself first. Some endos will rush a patient into radioactive iodine ablation of the thyroid gland right off the bat. IMO, that should only be a very last resort.
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Last edited by midwest1; 05-02-2013 at 11:23 PM.

 
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Old 05-03-2013, 10:40 AM   #3
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

Thanks for responding. I just got off the phone with the cardiologist's office, and they said that all other values (including T3 and T4 -- not sure if the "free" variants were tested). They said that the only value that was off was the extremely low TSH level, which was below 0.06 (not sure how far below -- maybe their equipment can't detect lower levels than 0.06?).

From reading the internet, the phenomenon of a low TSH and normal T3/T4 values indicates that someone has subclinical hyperthyroidism, even if they are symptomatic (as I am). Apparently, if someone is diagnosed with having a TSH level below 0.1, they have severe/grade 2 subclinical hyperthyroidism.

Now the interesting question is how to go about treating it...

To answer your question, I haven't been referred to an endocrinologist -- the cardiologist just told me to go back to my primary care physician (they faxed the results of my blood test to him).

Last edited by Hedgehog25; 05-03-2013 at 10:47 AM.

 
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Old 05-03-2013, 11:02 AM   #4
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

I would not accept a verdict of "normal" on the T4/T3 levels. Were they free levels, or total? Exactly what was the numerical result? I always advise people to get a printout of lab results every time. MDs frequently misinterpret them, or discount individual physiological hormone requirements. Sometimes, they still order the outdated panel of tests that arrives at just an estimate of actual hormone levels.
I wouldn't be satisfied until I got these answers. JMHO
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Old 05-03-2013, 01:21 PM   #5
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

I think more importantly, you need to have your labs done a second time along with a thyroid antibody panel. It's possible that the TSH was a lab error and your TSH is not 0.06.

However if your TSH is actually that low, then there are three main possibilities.

0. Thyroiditis, basically an inflammation of the thyroid for various reasons. Usually clears up by itself, but often over weeks and months.

1. Graves disease. An autoimmune disease where antibodies stimulate your thyroid causing it to produce too much hormones. There are drugs to control this. Antibody tests are indicative.

2. A hot nodule. This is benign tumor that makes thyroid hormones. Various cures for this, surgery, radioactive iodine treatment, and PEI. a radioactive uptake scan can be used to find it.

3. Very very rarely a carcinoid tumor. Like a hot nodule, it's a benign tumor that produces thyroid hormones, but can be anywhere, usually small intestine or lung. But this is really rare.

 
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Old 05-03-2013, 07:03 PM   #6
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

midwest1 -- regarding the lab test, I actually have no idea if the lab tested free or total levels of T3/T4, and I don't even know the specific numbers. When I called earlier today, they said they had faxed the lab results to my family practice doctor and told me to call them if I had anymore questions (I guess they're tired of me calling them every day).

gloom -- this is my question... if the TSH level really isn't that low (they actually said it was below 0.06), then what else could be causing my symptoms? I have been running since 2004, and for some reason, I feel completely exhausted and "fried-out" after just 20-25 minutes worth of running (I used to run for over an hour and feel fine), and this is in addition to the other symptoms such as increased HR.

If it's not a thyroid issue, I just don't know what else it could be. BTW, do you think it is probable that I could have any of the above-mentioned conditions if my T3 and T4 levels (not sure if free or total) are normal?

Also, here's a detail I forgot to mention in my original post. When I first started feeling these symptoms around February (as well as a few weeks prior), I was having random episodes of bizarre nausea. Basically, I would be sitting around somewhere or just standing and talking to someone, and a mild feeling of nausea would hit (like the intermittent nausea you might feel when you haven't eaten anything all day). However, instead of going away after a few minutes, the nausea would intensify to the point that I would have to run off to the bathroom because I honestly would feel like I was about to throw up. However, after leaning over the toilet for 1-2 minutes, I would always stand back up and feel better, except my face would be covered in tiny beads of sweat and I would feel kind of cold. I haven't had one of these episodes in a few months, but I have a feeling they're related.

Also, for the last few years, my weight has held steady at 161-162 pounds, but about a month-and-a-half ago, I stepped on the scale and was astonished to see that I weighed 149 pounds. About two weeks later, it was 149. When I was weighed at the family practice doctor's office last week, I was 147. Today and yesterday, the scale was "blinking" between 145.9 and 146. How could I be losing weight like this when my exercise routine hasn't intensified in at least 5 years (in fact, I'm actually running about 10 minutes less per day since I feel so exhausted when running)?

Also... what is the deal with experiencing these symptoms, yet having "normal" T3 and T4 levels? And if I do have some form of hyperT, is it unusual that my hair isn't falling out, my nails aren't thin/cracked, and I don't have a palpable goiter?

 
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Old 05-04-2013, 04:55 PM   #7
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

Quote:
If it's not a thyroid issue, I just don't know what else it could be. BTW, do you think it is probable that I could have any of the above-mentioned conditions if my T3 and T4 levels (not sure if free or total) are normal?
Oh sure, especially if you are pushing yourself exercising hard, just means you hit the wall sooner than someone who is more sedentary. The deal is, what you need now is more investigation and someone with experience with thyroid disorders. Low

TSh is an indication that your pituitary thinks your thyroid hormone levels are/were too high, even though your T4/T3 were in the 'normal' range. All of you symptoms are compatible with being hyperthyroid. As I said the big two are thyroiditis and graves disease.

You should ask at least to be retested and an antibody panel. Preferably a referral to an endocrinologist. Me, I'd bump the workout down a notch too.

 
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Old 05-04-2013, 07:07 PM   #8
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

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Originally Posted by gloom View Post
Oh sure, especially if you are pushing yourself exercising hard, just means you hit the wall sooner than someone who is more sedentary. The deal is, what you need now is more investigation and someone with experience with thyroid disorders. Low

TSh is an indication that your pituitary thinks your thyroid hormone levels are/were too high, even though your T4/T3 were in the 'normal' range. All of you symptoms are compatible with being hyperthyroid. As I said the big two are thyroiditis and graves disease.

You should ask at least to be retested and an antibody panel. Preferably a referral to an endocrinologist. Me, I'd bump the workout down a notch too.
Thanks for the advice. Oh, I have definitely toned down the exercise -- mainly because I feel like I've had no choice but to do so. From when I started running in late 2004 up until February 2013, I was able to run and run as much as I wanted (I might have felt sluggish for the first 15-17 minutes, but then I would get "in the mode" and feel great). Now, my entire runs feel like those first 15 minutes from start-to-finish. The symptoms are especially noticeable in the heat, and I haven't been able to run to the top of a steep hill without having to take a break at the top. I have tried "pushing through" the fatigue/exhaustion, but then I usually feel like I'm going to throw up and end up dry heaving on the side of the road. Also, I will sweat as if it's 98 degrees with 90% relative humidity even though it might only be 81 degrees with 40% humidity. I live in the southeast where it does get super-humid during the summers, so it will be interesting to see what happens in a few weeks when it really is 98 degrees and 90% humidity.

I'm curious about something -- if my pituitary is sensing that my T3/T4 levels are too high even though they're within what is considered normal ranges, does that mean that my T3/T4 levels are too high for me personally (even if they might be ideal for 99% of the population)? Otherwise, how could I be experiencing symptoms of hyperT?

I forget to ask about something else earlier -- has anyone ever experienced a strange feeling of nausea that seems to be emanating from just below the sternum? Sometimes I will drink water or bend over (or even just press right below the sternum/xiphoid process) and it will make me feel nauseous. I will also get a nauseating feeling that seems to emanate from that area (as well as my stomach) if I try to push myself through running without taking breaks.

Sorry for the long post -- this is my last question. What do you think is actually making me feel fatigued/sick during running? Am I actually burning significantly more calories to do the same distances that I've been running for years?

 
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Old 05-06-2013, 08:02 PM   #9
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

Well, this is weird -- today, I went out for my run and actually felt not too bad. I wouldn't say I was energetic, but the tiredness/exhaustion never reached that "critical point" where I have to stop exercising. I did take a break at the top of a hill just to be precautious, though. I was still kind of tired and exhausted, but it was more of a feeling that I would be totally exhausted any minute now, even though that moment never came. But again, I still never really felt in the mode like I used to feel, although I definitely didn't feel as bad as I've been feeling over the last few weeks. I also haven't been as randomly shaky in my arms and legs today.

A cold front passed through over the weekend and it was only 61 degrees throughout much of the day (and not humid at all), but could pleasant weather really stifle all the symptoms of hyperT? My symptoms are definitely worse during the heat and humidity, but shouldn't they be more noticeable even in pleasant weather? For what it's worth, I first started experiencing my hyperT symptoms in February when it was also very cold and dry, so maybe today was just a fluke.

 
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Old 05-06-2013, 09:27 PM   #10
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

If you had thyroiditis it supposedly gets better over time, just saying.

 
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Old 05-06-2013, 09:33 PM   #11
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Re: TSH level is below 0.06 -- likely to be hyperthyroidism?

Quote:
Originally Posted by gloom View Post
If you had thyroiditis it supposedly gets better over time, just saying.
Here's something else that's weird. I first started noticing these symptoms in late January/early February. On March 20th (I remember these dates because of other events at the time), I suddenly felt better -- like I was completely back to normal. I continued feeling better until March 30th, and at that point, I started feeling exactly like I had felt during running since late Jan/early Feb (when I first started noticing the symptoms).

So I thought it went away at first, and then it came back. Do you know if thyroiditis tends to come-and-go like that?

 
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