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What is the cause and treatment for subclinical hyperthyroidism?

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Practicing since : 2001
Answered : 1663 Questions
I have a history of graves disease, had a combination treatment with carbimazole/levothyroxine back in 2004/2005, and have regular annual thyroid tests. Although after treatment I initially felt fine, I then began to have symptoms of under-active thyroid and put on a lot of weight, the doc said I was still just within the normal parameters although at the very bottom of the grid. Recently I have managed to lose
weight, 28lbs so far, but my latest test results show TSH 0.09, Free T4 15.9 and Free T3 5.4 which I believe means I am now grade II subclinical hyperthyroid but my Doc says it's okay for me. This could explain my sudden ability to lose weight, my insomnia, heat sensitivity, and I also am having eye problems which I now realise could be connected. Should I be worried and insist on a review, see my optician or what? I already had an irregular heartbeat, have lost muscletone and am worried for the longterm.
Posted Fri, 22 Aug 2014 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 1 hour later
Brief Answer:

Detailed Answer:
I understand you are not on any thyroid medication right now, neither levothyroxine nor carbimazole.

Yes you are correct you do have subclinical hyperthyroidism, provided your free t3 and free t4 are within normal limits. Each lab tends to have different ranges and units for free t3 and free t4, so it would be helpful if you shared the normal ranges on your lab report with me.

To explicate the matter further, I would like you to know that the term subclinical in this instance is a kind of a misnomer. The medical jargon has perisisted over decades and should be reserved for individuals who have lab numbers similar to yours but with no symptoms. The fact that you have symptoms that can very well be due to the over active thyroid makes the term 'sub - clinical' inapplicable to you.

The next question is whether you were under any major stress/illness at the time of the thyroid blood tests, because that can lower the TSH too. Similarly, steroids and opioid pain killers have a similar impact on the thyroid function tests. But I see these are not listed in your medications.

So after eliminating confounders like the ones alluded to above, the next step I perform when I see an individual like you in my clinic, is to order a Radio active Iodine 123 Thyroid uptake and Scan test. This helps decipher whether your Graves is back or if it is a different cause this time, such as a temporary condition called 'Thyroiditis' which tends to get better by itself without any treatment.

I also prefer to have the following labs on file for people who come to me with this problem:
Complete blood count

And if your menstrual cycles have stopped, then the following tests are also helpful in ruling out a rare condition called Secondary hypothyroidism
Above answer was peer-reviewed by
Follow-up: What is the cause and treatment for subclinical hyperthyroidism? 19 hours later
It would be helpful if the Doc had given more info to me but I had to request these results and wasn't actually given the lab report as such, so I do not know their parameters. I no longer have periods, now been 16 months since last one. I do not recall being ill at the time of tests although I was possibly under stress.

So should I be going back to my GP to request a review and investigations?

Also, I am worried about my eyes, I have been diagnosed with blepharitis but I get pain behind my left eye and headaches behind that eye and it is also blurry like a fog over it. Do I go to optician first or GP.

Whenever I go to the GP they are dismissive and treat me like a menopausal hypochondriac, this is why I am seeking this advice.
Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer:
Follow up

Detailed Answer:
I have noted your comments above.
Your best bet is an Endocrinologist.
Above answer was peer-reviewed by
Follow-up: What is the cause and treatment for subclinical hyperthyroidism? 8 hours later
Thank-you for your advice, I am stuck with the NHS system, as I do not have private insurance and do not think I can afford to pay privately so, I need to persuade my GP to refer me to an NHS endocrinologist or maybe change my GP.
Thanks again, you have given me the courage to try again, I was beginning to think they were right and I was being a pain.

regards XXXXXXX
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