Fluctuating TSH / thyroid - normal or weird?

July 4, 2008 2:39 PM

[Thyroid/CFS-Filter] Do TSH and thyroid levels typically fluctuate within a period of weeks? If so, how much fluctuation is normal?

I've looked at previous thyroid questions before but couldn't find any that answered my specific questions... and I know, YANMD. I'll be seeing a doctor next week - but then, I've also seen about 3 doctors this year, with varying results.

I was diagnosed with CFS at the beginning of this year. As a teenager, I went through a period of subclinical hypothyroidism for about a year or so. During the past two years (I'm in my early twenties now), I started experiencing some symptoms of hypothyroidism, the more persistent symptoms being coldness and numbness in extremities, fatigue, dry skin, low blood pressure, hair loss, cold intolerance, constipation, increased sleepiness, inability to concentrate/focus and depression. About 3 months ago, I got my TSH and free T4 tested - which turned out to be 5.082 mIU/L and 14.48 pmol/L respectively. Six and a half weeks after that test, I had another thyroid test done: my TSH was 2.21 mIU/L, free T4 was 18.65 pmol/L and T3 (which hadn't been tested previously) was 1.32 nmol/L.

I had no treatment between the tests (the tests were administered by different doctors), and to my memory, did not make any changes to my diet or the supplements (vitamins and minerals) I was taking. For each test, the doctor administering the test pronounced me healthy and said I had no thyroid problems.

Up until now, I've figured my symptoms were/are just part of the CFS. But I was just looking at the test results again and wondering why my TSH and free T4 seem to fluctuate quite a bit (?) within 6.5 weeks when I didn't really make any changes to my diet or lifestyle, let alone take any hormone supplements. Is this normal? Am I overthinking this?

posted by anonymous to health & fitness (9 comments total)

I question the diagnosis of CFS if you have signs of thyroid disease. However, though you give your test results, the labs' ranges weren't included, and that's important. The different results may lay between different lab ranges.

That said, widely fluctuating TSH is common with Hashimoto's thyroiditis.

In addition. TSH fluctuates throughout the day, every day, and if your thyroid problems are secondary or tertiary (pituitary or hypothalamus), TSH becomes really meaningless. It is widely questioned as being a meaningful measure of thyroid function at all.

Sorry this is abbreviated. You aren't overthinking at all. Question everything, and feel free to MeMail me.
posted by vers at 3:19 PM on July 4, 2008

I don't think you're overthinking this. I think you can ask the doctors for an explanation of your symptoms and the tests. Make an appointment specifically for this.

If things are in fact normal, you might consider that many of those symptoms might be from depression--you have been dealing with a lot. However, don't let them tell you it's depression unless they rule out everything else.
posted by sondrialiac at 3:46 PM on July 4, 2008

I am sure you mean well, sondrialiac, but the OP's stated coldness and numbness in extremities, fatigue, dry skin, low blood pressure, hair loss, cold intolerance and constipation are not consistent with depression, but hypothyroidism. I say this as a patient who was difficult to diagnose and treat, but who has gotten her life back, which no antidepressants could do.

Sometimes, it's not all in our heads, you know?


Anon, you may want to post your test results with lab ranges at in the forums at Real Thyroid Help.
posted by vers at 4:05 PM on July 4, 2008

As vers said, fluctuating TSH is not uncommon in Hashimoto's hypothyroidism (That's the autoimmune form. Do you have any other autoimmune diseases? They often occur together.)

I didn't find any reference to exactly how much fluctuation is normal, though. (Standard disclaimer that IANAD, but I play one on tv... no, no, that's not right... but I do regularly do medical reference searches for doctors.) :-) Oh, and I've been hypothyroid for 24 years. Just FYI.

Your signs and symptoms are almost a textbook description. And also seconding what vers said about depression. Depression is often listed as a *symptom* of hypothyroidism.

There are also a few kind of weird symptoms that, afaik, are very telltale of hypothyroidism: losing the outer edges of your eyebrows and a yellow tint to your palms.

If your doctor doesn't seem to think the test results are significant ask if you can have a referral (if your insurance requires referrals) to an endocrinologist. That's really the type of doctor you need to see if you have or are trying to diagnose hypothyroidism.
posted by INTPLibrarian at 4:34 PM on July 4, 2008

Here's a pretty decent list of recommended lab tests.

And an incomplete yet still smart and sarcastic list of symptoms.

IMHO, endos like diabetes and infertility. They might give you a path, but don't be afraid to try the thyroid boards to find more progressive doctors.
posted by vers at 4:47 PM on July 4, 2008

Yes, this definitely rings Hashimoto's thyroiditis bells to me (my sister has it, and I used to have it -- till they took my thyroid out for cancer on top of the Hashimoto's!). And definitely look for an endocrinologist who specializes in treating thyroid issues. Non-thyroid endos can overlook plenty of the subtle (and even not-so-subtle) signs of thyroid disease, as I found out myself after years of being told by non-thyroid endos that I was "just fine," despite my ping-ponging TSH levels and the lump in my thyroid that got bigger and bigger and the half dozen or so other symptoms that had been plaguing me for years.
posted by scody at 4:59 PM on July 4, 2008

vers, I understand that, which is why I encouraged the poster to rule everything out before turning to depression as a cause, rather than a symptom. Three members of my immediate family suffer from thyroid conditions and I have lupus. I am all too familiar with the "it's all in your head" theory of medicine.

However, CFS, like any chronic illness, can take quite a toll on the mind as well as the body. Perhaps I should have suggested ongoing psychological support and treatment, no matter what is going on with your health.
posted by sondrialiac at 7:42 PM on July 4, 2008

I've had chronic fatigue for over 10 years. My new doctor started me on thyroid supplements, even though my thyroid levels weren't very low. I feel so much better. A trial of thyroid supplement might be helpful.
posted by theora55 at 5:03 AM on July 5, 2008

One more comment about finding an endocrinologist... if you find an endo that specializes in Diabetes TYPE I, aka Juvenile Diabetes, they're very very likely to also be familiar with hypothyroidism, even if they don't list it as a specialty in particular.

Just FYI, in case you're having trouble finding a thyroid specialist.
posted by INTPLibrarian at 12:59 PM on July 8, 2008