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Thyroid Problems/Fluactuation of Thyroid Profile

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QUESTION: Hi Dr,

I did ask some questions with regards to my low tsh sometimes ago. To recap, below are my history:

21 Sept 2013
TSH: 0.010
FT4 & FT3 (not done)
HGB: 10.90 (11.5 - 16.5)

25 Sept 2013
TSH: 0.013 (0.270 - 4.200)
FT4: 19.7 (12.0 - 22.0)
FT3: 5.1 (3.1 - 6.8)

April 2014
HGB: 9.9 (11.5 - 16.5)

21 July 2014
HGB: 10.9 (11.5 - 16.5)
TSH: 1.620 (0.27 - 4.20)
FT4: 12.1 (12.0 - 22.0)

My Dr mentioned that my thyroid test fluatuate quite alot compare wuth the previous result & need to be monitor although the TSH is normal now. He will only retest in 6 months. Is there anything I need to take note or worry. Please advice.

As for my anemia, i am still taking iron supplement since 2011. My Dr jyst change my iron to prenatal multivit type (iberet folic 500 with 105mg elemental iron) once daily since last month. I did have upoer scope in 2011 & everything is fine. So my Dr said could be due to my menstrual. Why is my hgb dont seems to go up higher?

By the way, I'm 42, female, height 145cm, weight 35kg. Always feeling tired, breathlessness, exercise intolerance, feeling giddy on & off.

Your advide is highly appreciated & thank you so much!

Regards,
Lee

ANSWER: Hello Lee,
Warm welcome to you!
Sorry for the late reply. Was busy in clinical work.
The gross fluctuation in TSH could mean Hashimoto's thyroiditis or Euthyroid sick syndrome. Please check your antithyroid antibody levels soon. Also its better to check ACTH, FSH hormone levels to rule out pitutary hypofunction.
Please answer some of my queries:
How is your appetite?
Is your menstrual cycle and blood flow normal?
Do you have children? When was your last pregnancy?
Are you on any medication other than iron supplement?

The symptoms like fatigue, breathlessness, exercise intolerance could be due to your low hemoglobin. But for me your Hb doesnt seem concerning for a woman. Anyway Have you checked your serum ferritin? If not please check that also along with above tests.

And as your doctor has said its very important to monitor your TSH, FT3, FT4 regularly.

Thanking you!

---------- FOLLOW-UP ----------

QUESTION: Hi Dr,

Thank you so much for your respond.

My appetite is good & am eating 5 meals most of the time. I eat very little meat.
My menstrual sometimes normal, sometimes heavy & last 6-8 days with average 22 days cycle.
The only out of balance was in April (3 April last five days followed by next cycle on 25 April which
last till 17 May with a mixture of light & heavy in between). Now it's back to normal.
I am still single & have no children or sex before.

I'm not on any medication beside taking the iron supplement. My Dr only check my ferritin
Once in 2011. It was at 4. With all the follow up my Dr only check my hb & iron.

Thanks

Answer
Lee,
Your serum ferritin is very low. It shows you have been chronically iron deficient. So it will take some time to increase Hb level. But also its better for your doctor to find out the reason for such low iron level in your body. There could be many reasons like aplastic anemia, pernicious anemia, parasitic infection, GIT ulcers etc. Also eat foods rich in Vit C/supplements. Its required to absorb iron properly.

And as I told earlier we need to further monitor Thyroid hormone values. Some times people who have chronic anemia can show such variation in TSH due to stress on the body. Other than that some times infections causing thyroiditis can cause TSH variation. If you continue to show variation we need to test you for antithyroid antibodies and also pitutary hypofunction. I hope I have clearea your doubt.

Thanking you!

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