How fast can TSH drop?

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Hi

I just got finished with my diagnosis of hot nodule.  My 30 yr old daughter went for a surgery clearance and her TSH was 0.09.  He redid the test including free T3 and T4.  

free t4: 0.71 - 1.85 range   she is 1.78

free t3  2.3 - 4.2  range      she is 3.5 

TSH 0.4 - 4.70                    she was 0.09 on Monday at 3 pm appt.

                   

Retest:  1:30 on Wednesday ( 1 day between tests)  she was 0.015 

Is it possible to drop that much in a day? It took me 3 months to raise my TSH from 0.005 to 0.015  so I really don't get this. 

Her antibody test hasn't come in yet. She's cleared for surgery based on T's.  Getting an answer from this pcp office is like pulling teeth.  Of course, the dr won't call us. 

So my first question is:  is this much of a drop possible in one day or could it be a bad test?

Second: Without a diagnosis, is it safe for her to start L-Carnitine to raise TSH even with normal T's? 

It will take a couple to a few months to get to see an endo. 

I asked why the doctor was hesitant to clear her without the T's and they said thyroid storm.  What?  Normal surgery clearance doesn't even include thyroid tests. He only tested hers because of mine. 

I thought you get thyroid storm from very high levels of thyroxine or if they do thyroid surgery?

Help!!  This has been a hellish week.

Thank you all and Happy St. Patrick's Day :-)

Jaye

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14 Replies

  • Posted

    PS  She feels absolutely fine. No symptoms whatsoever. Our entire family has thyroid issues, usually hypothyroid.  This TSH of hers took us by surprise. 

    Can she get thyroid storm with normal T's?  Now I'm worried, even though he cleared her.

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    • Posted

      She can take Regular L-Carnitine with no ill effect on her Frees.  She should also be checked for vitamin D and magnesium levels.  Vitamin D is extremely important to thyroid patients and a lot of us are deficient in it.  I don't know that it will raise her thyroid levels if she is not on Carbimazole or Methimazole.  But as far as I know, it should not hurt her and might help her.

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    • Posted

      Thank you, Linda. I'm going to ask for the vitamin D and mag levels to be tested and I want her to have an ultrasound as we have a tendency for nodules in the family. My sister has them seen on ultrasound but not palpation. I'm wondering if my daughter has them and might be like me with the hot nodules. She's never been over 1. TSH for as far as I recall. Her T's have never been tested other than this week so there's nothing to compare that with. I wish he'd done that during her regular annual bloods. 

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  • Posted

    Hi Jay, did the doctor say why he fears a thyroid storm? Those values seems ok to me, low TSH with FTs in the high range indicates that something might start but between starting to be hyperthyroid and a thyroid storm there are millions of hyperthyroidism shades! Actually those kind of values are the ones that I feel best with myself and suffer no symptoms at all, so I understand why she would feel OK.

    Btw the drop in TSH You report in those numbers is not so big at all and I would not be concerned about it.

    I agree with Linda to get vitD tested, I am severely deficient myself and on supplements.

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    • Posted

      Her pcp never tested her T's so I guess when her TSH was low, he wanted to make sure her T's weren't high. We didn't know he was thinking thyroid storm and couldn't figure out why he wouldn't clear her. After her T's came back he cleared her immediately.  But he put the fear in us for sure talking about thyroid storm!!  I also thought your levels had to be way off to have it.  

      Is your TSH still low on med?  She's always had low TSH but never this low. 1 has been her highest. But she also has low everything! Blood pressure, cholesterol which she wanted to try to increase the good level. I think it did come up a bit this year. She fluctuates often. Our problems all started during her dad's illness and passing. It's odd that both of us have the same TSH level now. 

      Thank you for the info and support Rita and Linda :-)  Hope things are going well with you both. 

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    • Posted

      I just want to make sure you are aware that a low TSH reading means HYPERthyroidism and a high TSH level means just the opposite HYPOthyroidism.  For the FT3 and FT4 levels, it is just the opposite - high level means HYPER and low level means HYPO.  I haven't heard of levels like your daughter's inpeople who are not on medication treatment for hyper.  Mine were like that for a month before they transitioned into pure hyperthyroidism.  Also it is not unusual for hyperthyroid patients just starting on medication treatment to normalize their FT3 and FT4 but have no change in TSH whatsoever.  That happened to me for 2 years and only changed when I added supplements to my treatment.

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    • Posted

      Hi Linda. I'm having that problem now. I've been on Methimazole since early January and my T's are normal but TSH is .015.  

      It's so hard to lift the TSH. I take 4000 L Carnitine now, 2000 mg D - magnesium along with other supplements but it doesn't want to budge. I'm hoping my TSH will be a bit higher next test. My problem now is that I've been getting so many colds / viruses that just when I feel good I come down with something. I told my pcp I want my white blood cells and liver tested next test. I'll have to wait a few weeks as I just finished augmenten yesterday for a bad sinus infection. 

      Our pcp wants her to see an endo to see why her TSH is so low. Last test was .83 a year ago. Then .09 this year. He cleared her surgery based on her T's, which are normal. I'm hoping it's a nodule or something dropping her TSH, like mine. 

      What's the next number after .09 if her TSH raises?  Would it be .1 ? I know the highs and lows of each but not sure how to guage the rise of TSH. Which is lower, .09 or .015?   

       

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    • Posted

      also - do you take your Methimazole on an empty stomach?  Is that better? If so, and I take it upon arising, how long to wait before breakfast?

      thanks :-) 

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    • Posted

      .015 is lower than 0.09.  When I read it before I thought I saw 0.15 which would be a step in the right direction. If you want your TSH to rise, I would lower the Regular L-Carnitine to 3,000 mg and take 500 mg of Acetyl-L-Carnitine.  You do need to be careful though and get your lab tests done at least in 4 weeks and as your TSH rises and your Frees lower, you will have to adjust any meds and even your supplements dose to stay in balance.  It is interesting to hear from someone with nodules as I haven't seen many postings with that.  Were you and your daughter also tested for antibodies?

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    • Posted

      I only took my Methimazole dose once a day and didn't pay any attention to taking it on an empty stomach.  I took all my meds at one time and felt lucky if I remembered to take them once a day.

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    • Posted

      I would like to try the acetyl-l-carnitine. I test every 4 weeks now so that should work. I'd be thrilled to see my TSH rise and be able to lower the med as I may have to stay on it lon term as hot nodules don't go into remission. I don't believe they burn out, either, unfortunately.

      I was tested for antibodies. My daughter was tested this week but the results haven't come back yet.

      I'm anxious for her ultrasound. I wouldn't be shocked if she had nodules as they run in my family.  I also read low TSH can be linked to low blood sugar, which she has, so we'll have to speak to the endo about that too. 

       

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    • Posted

      I take them in the morning too. Sometimes I forget if I took my BP meds and panic lol. When you include supplements, wow, so many pills. I use liquid L-Carnitine which is a blessing. :-) 
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    • Posted

      I used the liquid L-carnitine as well because I would have had to take a lot of capsules otherwise to make up 3,000 mg.  Besides, the liquid was covered under my extra health insurance plan.
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