lab results/hyperthyroidism or not?/what next?

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Hello, 

I am a 49 year old male, 6'1", 152lbs.. About three years ago, I experienced a panic attack shortly after the tragic death of my mother.  I never had any prior history of anxiety issues, but because of the timing, doctors put me on anti-anxiety and anti-depressants without even questioning my thyroid. Since this moment, I've been experiencing severe anxiety, restlessness, insomnia, dizziness, brain fog, fatigue, an unquenchable thirst, frequent urination, frequent bowel movements (diarrhea often), heart palpitations, weight loss (even though I have a good appetite), intolerance to heat and excessive sweating.  I've seen a cardiologist for my heart (no problems), done a colonoscopy for my intestinal issues (no problems), a neurologist for my dizziness (he found nothing). I checked my fasting blood sugar levels (also fine). My ion levels and blood work and blood pressure are good. I've changed my diet (very little sugar and or high-glycemic carbs), cut out caffeine, started excercising regularly, did cognitive therapy, acupuncture, even a few sessions of hypnosis ! I went off of the anti-anxiety and anti-depressants nearly one year ago (since they didn't make me feel any better)...And, now I've never felt happier in my life and YET I still present all of those symptoms above. My girlfriend ran into an article about hyperthyroidism as a cause of anxiety and panic attacks, and it reminded me that the neurologist I saw a couple of years ago had mentioned that he saw nodules on my thyroid. At the time he said it was "surely no big deal". I finally convinced my GP to give me a blood test and this is what I got back:

TSH 1.331 µUI/mL (0.400-4.000)

Free T3 4.52 pg/mL (2.50-3.90)

Free T4 13.3 pmol/L (7.8-14.3)

I haven't seen the GP since my results. I'm not sure what to think since the TSH is "normal". I wanted to ask for opinions about my case as well as what additional tests I could ask from my GP to confirm or deny a thyroid problem. I must admit, I've gotten to the point where a hyperthyroidism diagnosis would feel like an answer to my prayers ! Anything to minimize this ever-present agitation that feels so out of place with everything else in my life.   

Thank you for your advice, 

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8 Replies

  • Posted

    Hi pierre68, your results show that you are hyperthyroid despite the thyroid stimulating hormone being within normal range. Often hyperthyroidism is overlooked and the symptoms are attributed to anxiety. This happens if the symptoms are not severe enough. Also, the likelihood of having a thyroid disease is much higher for women. 

    Typically, the thyroid produces mainly T4 which is converted to the active form T3 outside the thyroid. 

    Thyroid nodules can sometimes become autonomous (they secrete hormone with or without TSH) and they may produce too much T3. 

    You will likely need to have a scan of your thyroid to detect if you have (hot) nodules and to find out what treatment is needed. For further investigation, you should be seen by an endocrinologist. 

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    • Posted

      To clarify, I meant:

      Thyroid nodules can sometimes become autonomous (they secrete thyroid hormone with or without TSH being present) and they may produce too much T3. 

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    • Posted

      Hi danR, thanks for your reply. I saw my GP this morning and she told me that since my TSH was negative and my free T3 wasn't that elevated that she would not refer me to an endocrinologist ! Seriously, that makes me feel hopeless. I mean, what is the point of giving a normal range if getting lab results outside of it don't mean anything?? She still seems convinced that all of this is just "inside my head" and that it relates to anxiety. Do you think it's possible to feel symptoms of hyperthyroidism like I am with barely elevated free T3 levels? She did, however, send me to get an ultrasound of my thyroid and give me a prescription to redo my labs in three months. I can't imagine living with these symptoms for three more months, so I hope the ultrasound will give her enough evidence to justify a visit to the endocrinologist ! 

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    • Posted

      Would it be possible to switch to another GP? I think you are being fobbed off. Personally, I would not have accepted that. If you are in the UK, there is a waiting list for patients that are being referred to the endocrinologist. It would have taken a few weeks anyway so see a specialist. Why delay it any further? 

      Another option would be to take a small dose of anti-thyroid medication (say 5mg Carbimazole per day) to see how you respond to the medication.

      In the worst case, I would make an appointment with a private clinic. Should you do that, remember to take a printout of all your blood test with you.   

      Btw, I found a scientific article describing your condition, namely elevated FT3 level without suppression of TSH. It was named: Isolated FT3 thyrotoxicosis. It will send you a private message with a link to the paper. Maybe this will help clarify things further. 

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    • Posted

      Thanks danR, I decided to make an appointment with the endocrinologist anyways (wasn't sure I could do that, but apparently I can - it just won't be reimbursed by social security...but at this point, I don't care about money - I just want help !) I am actually in France, so things are probably a bit different here. But, thanks for the link to that paper and your responses, it all gives me hope. I'll keep you updated.

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  • Posted

    There is a condition caused by the adrenal glands that causes hyperthyroidism due to elevated cortisol levels.  You might want to get your cortisol level checked.  Thyroid nodules will also cause it as well as autoimmune diseases like Graves or Hashimoto's.  Of all your results, your Free T3 is the most elevated and this is the thyroid hormone that is available for use in the body.  I was on a low dose of T3 hormone replacement for years before I got Graves disease.  My disease was triggered by stress in the workplace.

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    • Posted

      Thanks linda187 for your reply, I had seen posts about cortisol levels before, but I wasn't sure that the symptoms corresponded to mine. I'll look into it, thanks for your insight. May I ask, why were you on a low dose of T3 hormone replacement to begin with ? So, you do believe that an initial stress/shock can trigger thyroid problems? If true, that would make sense about the timing....

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  • Posted

    Absolutely I  believe that stress can cause this, especially autoimmune thyroid diseases.  Certainly true in my case as I had an abusive co-worker.  As for why I was on T3, I had a depressive episode and the only antidepressant that works for me has not nice side effects when taken at a therapeutic dose, i.e. 75 mg or three 25 mg pills of imipramine.  The psychiatrist who gave it to me said that they have found using a low dose of Cytomel (T3) combined with the antidepressant boosted the antidepressant effects without havng the side effects.  It worked well for me for about 10 or 12 years and then that episode and I was off to the races.  Needless to say, I had to stop the T3 then.
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