Normal TSH. But Slightly Elevated T3 and T4

03-23-2009, 06:38 PM

Hello:

Family doctor ordered thyroid tests because of rapid pulse. TSH, T3 , and T4.

He said he wanted to rule out hyperthyroidism. No other signs of thyroid disease, afaik. Tendency towards very high anxiety.

Results came back odd:

TSH: 1.25 [lab norms 0.35--5.50]

T4 : 11.9 [lab norms: 4.5--10.9]

T3, Total : 192 [lab norms: 60-181]

I'm wondering what might cause those elevated thyroid levels in the presence of a normal TSH?

He said that in Graves disease, the T4 reading would have been much higher than the elevated result I got above. T3 would have been a bit higher as well.

He wanted to repeat the T3 and T4 , but this time measure the level of Free T3 and T4. In the above test, the T3 and T4 were bound.

My question is:

What might cause elevations in T3 and T4 [bound] as shown above, in the presence of a normal TSH?

Thanks in advance:

Ira

PS: I now find the rapid pulse only upon awakening from bad dreams. or in Dr. 's office. Otherwise, its in the 70-80 beats /minute range.

03-23-2009, 08:37 PM

You may well find that the free T results will be completely within normal range. The total tests simply aren't that accurate... can vary up to 20% in either direction.

Higher concentrations of thyroid binding globulin cause elevated total T4/T3. A few things that increase TBG - heavy aspirin use, estrogen-containing meds, pregnancy. There have been reported instances of high TBG running in families. As long as the free Ts are in optimum range, there need not be any worry about high totals.

03-23-2009, 09:01 PM

Thanks , Midwest:

It's somewhat reassuring.

Don't use aspirin, or estrogen and I'm male; but it seems there's some variability in results of those particular T3 T4 tests

Out of curiosity, if the Free T3 and Free T4 results should come back elevated as well, what might those mean in conjunction with a normal TSH?

I'm a bit panicked over the results so far. Might help to have some perspective as to possible implications.

Thanks in advance

03-24-2009, 03:59 PM

If the free Ts came back high and TSH stayed in the same 1.25 area, the next suspect would be a pituitary or hypothalamus problem... but those are somewhat rare.

Since you don't mention any other symptoms besides occasional rapid pulse, I doubt high levels of thyroid hormones are to blame. HyperT carries a long list of symptoms, and people who have it have up to 10 or even more.

Would be interested to know how the new tests turn out, if you care to report back.

03-24-2009, 05:00 PM

Thanks Midwest:

Will let you know how those new tests came out. Should get them either tomorrow or Friday.

The doctor vaguely did mention something about a possible pituitary test or scan on the phone when he first told me about those odd results. Sounded like he just wanted to be thorough, but I couldn't tell for sure. It sure did scare me. But when I later came in to the office to do the Free T3 Free T4 and a repeat of the TSH, he said that if these continue to show T3/T4 elevation, he would run some radioactive iodine assay(?) to further assess the thyroid. Didn't sound like he had a specific thing he was looking for. So I'm wondering if such further probing into the thyroid issue makes much sense. My current doctor recently replaced my previous doctor, so he knows me from only two brief visits.

If you don't mind, what is the name of that overall pituitary/hypothalamus scan? The one he may have had in mind in that earlier phone conversation? I might remind him of it if the new tests are still skewed to see if he still thinks those are advisable.

I do take a low-dose of benzodiazepine, which I'm currently tapering from and recently began Trazodone as an anti-depressant/ sedative. Not sure if changing dosages of these meds may be affecting either thyroid or test results. Vaguely recall that decreasing a benzo can cause episodes of tachycardia..

Thanks again Midwest, for taking the time.

03-25-2009, 12:38 PM

Sorry, I'm not sure what tests are used for pituitary. I think it's MRI... but not sure.

Try not to be so worried. In the scheme of things, thyroid stuff is usually very treatable and not at all dire.
Let us know.

03-25-2009, 01:21 PM

Hello ira,

I too am going to be very interested in your free t results. I have resistance to thyroid hormone coupled with clinical hyperthyroidism. I have normal to even sometimes high TSH levels with high normal to elevated free thyroid hormone levels. I'm always on the lookout for others. It's pretty rare but it looks like you've been doing your research so I'm sure you've run across it. It can be a fairly benign disorder or it can be a royal pain in the arse at times but it is controllable with proper diagnosis and treatment.

The scan he's talking about is an MRI which is necessary to rule out the very rare possibility of a pituitary tumor which is actually quite treatable so don't panic over that. There's also a blood test that they can do called an TSH alpha-subunit which is often elevated in the presence of a pituitary tumor.

I do have a lot of information on it along with the various other disorders that can cause those types of lab results. But without the Free thyroid hormone levels, there's really no place to start yet.

I've been dealing with some other medical issues lately so I haven't been around the board much but I'll keep an eye on this thread and await your results. Please keep us posted.

Helen

03-25-2009, 04:19 PM

Thank you so kindly, accessn and Midwest for taking the time.

The Dr.s office called and the report showed all three tests to be within normal range: TSH , Free T4, Free T3.

He had also run some re-uptake test [don't recall the exact name]. But it too came back within normal range.

So those odd results earlier this week were due to an artifact of the protein-bound measurements. He explained that this often occurs on account of birth control pills. In my case, it was just an artifact, and he said I ought to ignore those earlier skewed readings. The Free T4 and FreeT3 are the accurate readings.

PS: I've learned a lot about thyroid function/ conditions from this board over the past couple of days. Prior to this I was quite naive about it.

There's something about the existing protocol for hyperthyroidism which baffled and upset me. I realize this is essentially a support group for people with thyroid conditions. But I'd like to know if it's ok for me to post here about this specific question /issue concerning the commonly used protocol for hypertension and/or Grave's?

Thanks again for the support and education:

Ira

03-25-2009, 04:49 PM

How normal? Very top of normal or midrange normal? Did you get the numbers? Ask for a copy of your labs. You should always do that so that you've got a complete set of your medical records should the need ever arise. I'm actually sometimes "normal".

Ok, why if it was an artifact of the protein bound measurements was the t3 uptake normal? Just thought I'd stir the pot here. I think that's the test you're referring to when you say re-uptake. It's supposed to detect abnormalities in the numbers of thyroid transport proteins. Not to say it couldn't just be a problem with the way your proteins handle the hormones. It still could be what they call an abnormality in thyroid hormone transport. A benign condition but one that's often hereditary so it's important to know about it so that the right thyroid hormone function tests are performed on your family members. That way they don't get thrown into a tizzy either.

You don't think we were all naive at some point??? My first question when I was asked how long I'd had my goiter 15yrs ago was "what's a goiter?". Boy, did I ever learn.

Hey, this is a board for learning about thyroid conditions. Anyone can ask questions. The more questions there are, the more people are able to learn. Ask away. Someone around here usually knows the answer.

03-25-2009, 05:44 PM

Hi again:

"Ok, why if it was an artifact of the protein bound measurements was the t3 uptake normal? Just thought I'd stir the pot here. I think that's the test you're referring to when you say re-uptake."

The re-uptake test was run along with the second battery of tests, which all came out normal. Not that earlier one.

After the secretary told me the results were all normal, I asked to speak to the Dr. to be sure I can disregard those earlier results. He was emphatic that no further testing was warranted for this. He then told me he had run that reuptake test as well. It too was normal. He very briefly explained what likely caused those earlier results and was confident enough in the normalcy of the second set to tell me that no further testing is needed here.

It's quite a trip to get there, so I didn't get a copy of the actual results. Will do so when I go there next time and post them here. I'll also ask family members I'm in touch with if any such equivocal readings have shown up on their tests-or those of other relatives- as well. I've not heard of any thyroid conditions in my family, but I'll ask about unusual test findings.

Thanks again
Ira

03-25-2009, 06:16 PM

You see, I'm not positive of what your re-uptake test was. I do know what a t3 re-uptake test is. It's run in conjunction with a total t4 to measure the number of thyroid hormone binding proteins to give a number to calculate an estimated free t4 measurement. It's the old-fashioned way of doing thyroid hormone tests but it's also sometimes now used to look for binding protein abnormalities. I told you, I'm just stirring the pot.

I do that sometimes. I spent over 25yrs on the trail of an elusive diagnosis and then 15yrs trying to convince the docs what it actually is. It was too rare to be considered. They were finding it easier to label me "atypical antibody-negative graves" and sent me on my merry way to await for my TSH to drop so they could administer RAI. In the meantime, I got screwed. That's the other medical problems I referred to. Long term, untreated hyperthyroidism can cause some major problems. Now, they know what I have but I also look at what it caused. I don't want to see that happen to anyone else.

I don't trust doctors as far as I can throw them. I wanna see my results and I wanna look up what they mean. I'm not satisfied with their answer until I know for sure that they are right. That's the way I am now.

I'd love to see your results when you get them. You have a good plan of action there. Just keep digging. You'll find your answers.

03-25-2009, 06:28 PM

Oh, I forgot to mention, there's a really good section called "Abnormal Thyroid Hormone Transport" at [url]http://thyroidmanager.org[/url] if you really want to delve deeply into it. Anything you ever wanted to know about thyroids is there. It's pretty technical but you can often pick up a lot of good information there.

Normal TSH. But Slightly Elevated T3 and T4

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