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Old 05-12-2005, 12:55 PM   #1 (permalink)
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Default Is it possible to have BOTH a high TSH and a high FT4?

All this time and since my last thyroid workout in March I thought I had Hashimoto's as I had a TSH of 3,2 and an anti-TPO value of over 100 (normal maximum 40). Both my FT3 and FT4 were somewhere in the middle of the range, more or less. I have many hypothyroid symptoms, including fatigue, hairloss and feeling constantly cold. Today I did the tests once more in a different lab and I was surprised to see that both my TSH and my FT4 have moved towards the high-end of the range.
TSH:4 mlu/L (0,27-4.20)
FT4: 18 pmol/L (12-22, I'm in Europe and the range is different)

Does anyone know if this is normal? I thought that in hypothyroidism the TSH is high and the FT4 low while in hyperthyroidism it's supposed to be the other way around. Could this be a Hashimotos' induced fluctuation? Or could I be slowly becoming hyper?

Please answer me if you know anything at all about this.
Katerina
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Old 05-13-2005, 08:42 PM   #2 (permalink)
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Hi Katerina,

I'm assuming that you are not on any thyroid medication and haven't been (if you are, though, the free T4 and free T3 are the only reliable tests). It is not unusual for the TSH to rise before there is a decrease in T4 or T3. So it may be just a matter of time before the Free T4 drops. Your TSH number is somewhat high, indicating that your pituitary gland is working overtime to stimulate your thyroid to produce hormone.

Some other possibilities:

Did you get a Free T3 test? If that is low, is may indicate that you are one of the "poor converters", meaning the T4 that your thyroid produces isn't converting to T3 sufficiently (most of the T3 in our bodies is made from T4). If that is the case, your thyroid may be upping its production of T4 a bit to try to keep up, and your pituitary is getting signals from the low T3 that you need more thyroid hormone.

You may have thyroid hormone resistance (this is sort of like insulin resistance), in which your thyroid is producing sufficient hormone but your cells aren't responding to the hormone effectively. Do a google search for thyroid hormone resistance for more info about this.

Here is another possibility (a blurb from a site I'll paste the link to):

Thyroid Binding Globulin. Most of the thyroid hormones in the blood are attached to a protein called thyroid binding globulin (TBG). If there is an excess or deficiency of this protein it alters the T4 or T3 measurement but does not affect the action of the hormone. If a patient appears to have normal thyroid function, but an unexplained high or low T4, or T3, it may be due to an increase or decrease of TBG. Direct measurement of TBG can be done and will explain the abnormal value. Excess TBG or low levels of TBG are found in some families as an hereditary trait. It causes no problem except falsely elevating or lowering the T4 level. These people are frequently misdiagnosed as being hyperthyroid or hypothyroid, but they have no thyroid problem and need no treatment.

http://64.233.167.104/search?q=cache:H-NZ_m3w2HsJ:www.endocrineweb.com/tests.html+normal+or+high+t4,+high+tsh,+low+t3&hl= en&start=7

HTH,
Linda
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Old 05-14-2005, 08:01 AM   #3 (permalink)
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Thank you so much for your response Linda!

Wow, I slowly begin to realize that when it comes to the thyroid, things are not as simple as I thought! One is not necessarily either hypo or hyper, receives treatment for that and lives happily ever after. If only!

I'm not currently on any meds and they didn't test my FT3. They only wanted to test the TSH and FT4 and I actually had to tell them to run the antibodies test too (still awaiting results on that one to see if they got even higher). I'm meeting an endo in June and I hope we'll find the answer to my thyroid riddle.

If only my hairloss could stop...

I appreciate your help Linda, hope you are feeling well and taking care of yourself.
Katerina
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