Very High TSH 263.47; T3 - 58.46; T4 - 2.50 levels, need advice

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Hi All, 

I need some advice on my uncle's health condition. My uncle's age is 56 years, he was a Hyper thyroid patient from 2011 onwards till mid 2015. From mid 2015 onwards, suddenly his hyperthyroidism turned to hypothyroidism and his TSH levels are increasing day by day in spite of taking medicines regularly. 

Currently he is taking 150 mcg thyroxine tablets and his thyroid levels are: 

TSH - 263.47 

T3 - 58.46 

T4 - 2.50 

We are really worried about his health. We have taken test reports from multiple diagnostic centers all have indicated similar TSH levels. 

Is such high TSH levels normal? 

Does he need to take more tests to diagnose the exact problem? 

What does he need to do in order to control TSH levels and bring them back to normal levels? 

The doctor's in his city are unable to diagnose his condition. Request you to please advice on how to correct his illness. 

Regards, 

Riya.

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8 Replies

  • Posted

    His results are markedly abnormal!  Could he perhaps be taking the wrong drug?  i.e. he was once hyperthryoid and the pills to treat overfunctioning look similar to thyroid supplement tablets.  Check his prescription.  He can ask his doc to prescribe a T3/T4 type of thryoid hormone replacement which might work better.
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    • Posted

      Hi Linda, Thanks for your reply. He was taking 150 mcg thyroxine tablets of gsk (company) for past 1.5 years. When he was first detected as having hypothyroidism (1.5 years before) his TSH was already 165 and he was adviced to take 150 mcg Thyroid medicine by the doctor (I am not sure if giving him such a high doseage was needed). As he felt anxiety and high acidity after taking this drug, he periodically discontinued it for a day or two (without doctor's advice). In order to get rid of anxiety, he started taking another local medicine. His current symptoms are: Joint Pains, Swelling in Joints, not having sound sleep and anxiety.

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  • Posted

    Hi Riya, would it be possible to also post the normal range alongside the thyroid levels? (Different labs may use different units, that's why the normal range is important to know.) 

    Having said that, the TSH value seems very high no matter what unit was used. T3 also seems unusually high but I can't tell for the reasons mentioned above. 

    Does you uncle show any symptoms? Is the unwell? Has his thyroxine dose been adjusted recently? 

    Depending on the underlying thyroid disorder your uncle may well have been hyperthyroid and then became hypothyroid at a later stage. This outcome can occur with Hashimoto's disease. In this case, the thyroid produces less and less thyroid hormones and the dose of thyroxine has to be adjusted (increased) accordingly.  

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    • Posted

      Hi Dan, Thanks for your reply. TSH the value shown in the lab report is 263.47 mIU/mL the normal range is in between: 0.35 - 5.5.

      Yes, he is unwell and his symptoms are: Joint Pains, Swelling in Joints, not having sound sleep and anxiety. He has been taking 150mcg thyroxine tablets for past 1.5 years (there was no adjustment made recently). His TSH level 1.5 years back was 165 as such he was put on a high dosage of tablets (150mcg).

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    • Posted

      Do you know if his T3 and T4 are within normal range? Not being able to sleep and anxiety are more likely to be associated with elevated T3/T4 levels. 
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    • Posted

      yes Dan, his T3 / T4 levels are also not normal. His T3 is 58.46 ng/dL when the range should be between 60.0 - 181.0 and T4 is: 2.50 mg/dL when it should be between 3.20 - 12.6.
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    • Posted

      Since your uncle's T3 and T4 are below normal range his body is trying to stimulate the thyroid to increase the production of thyroid hormones. It does this by increasing the level of TSH (thyroid stimulating hormone). Basically, his body is craving thyroxine.

      From the details you mention above I gather that his thyroid function is impared and he was prescribed oral thyroxine 150mcg/day.  (The average dosis is 1.6mcg/kg/day.) 

      Patient non-compliance (they forget to take the medicine or they deliberately skip doses) is the main cause of low T3/T4 and high TSH even with adequate oral thyroxine supplementation. 

      Another (very rare) possibility would be mal-absorbtion of oral thyroxine. For more details search this scientific paper on the internet: 

      'A curious case of refractory hypothyroidism due to selective malabsorption of oral thyroxine'.

      My advise would be to urge your uncle to take his medication as prescribed. Maybe he could change when to take the medication. One patient reported it helped her to take Levothyroxine at night:

      http://patient.info/forums/discuss/taking-levothyroxine-at-night-improved-my-life--226315

      If he notices that he is feeling agitated, nervous, or restless he should rather go back to his doctor and have a follow-up blood test and the medication adjusted accordingly. This might have to be done every few months till your uncle's thyroid values are fully adjusted and he feels well. 

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