Can high TSH levels cause symptoms in a 46-year-old woman?

Question

Hello doctor,

I am 46 years old, and a few years ago I underwent a total thyroidectomy. My family doctor initially sent me for a thyroid scan, and within a few months, I was on the operating table in my early forties. My thyroid was removed due to large nodules and goiters that caused it to wrap around and constrict my airway, pushing my windpipe to the left.

Fast forward to today, and I am in a constant battle. I have taken matters into my own hands, which I feel I should have done much earlier. We are now more than three years post thyroidectomy, and I am still not balanced on thyroid medication. I have consulted two specialists and two family doctors without finding a resolution. Over this time, I have been prescribed Synthroid and Armour Thyroid, and I am currently taking Levothyroxine.

On four separate occasions over the past few years, I have been seen in the emergency room for the same recurring issues. After beginning my own research and reviewing my medical history from before the thyroidectomy, I obtained all my medical records and scrutinized them. Each emergency room visit had one common factor. My TSH levels ranged between approximately 7.3 and 13.0, while my T3 and T4 levels remained normal and well within range.

Throughout the last several years, I have struggled with this rollercoaster, and I have only been fully balanced for a total of about five months combined. Even that is not a solid stretch of time but rather the result of adding together periods where my blood work appeared balanced. I have repeatedly asked for my pituitary gland to be evaluated, but I do not feel heard.

Because of this ongoing imbalance, I have developed additional health conditions that did not exist before this experience. These include episodes of extremely high blood pressure that seem to occur when my TSH levels are elevated, kidney damage, a resting heart rate between 100 and 110 (beats per minute), shortness of breath, and an abnormal EKG that was recently performed. Recent emergency room blood work again showed a TSH level above 7 milliunits per liter, which causes not only physical symptoms but significant emotional and mental health distress as well.

I feel lost, but I am not giving up, and I will not let this defeat me. I may be in a constant battle, but I want my life back, the life I had before my total thyroidectomy.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

It is clear that you have been through an extremely challenging journey since your total thyroidectomy, and your persistence in advocating for your own health is commendable.

From what you describe, despite being on various thyroid medications, including Synthroid (Levothyroxine), Armour Thyroid (desiccated thyroid), and now Levothyroxine 88 mg, your TSH (thyroid-stimulating hormone) levels have remained elevated, ranging from approximately 7.3 to 13.0 (milliunits per liter), while your T3 (triiodothyronine) and T4 (thyroxine) levels have generally stayed within the normal range.

This pattern suggests a condition known as subclinical hypothyroidism (a condition where the thyroid gland is underactive, causing elevated TSH levels but normal thyroid hormone (T4) levels), where the pituitary gland continues signaling for more thyroid hormone even though peripheral hormone levels appear normal.

Persistently elevated TSH levels can contribute to high blood pressure, increased heart rate, kidney strain, shortness of breath, and cardiac changes, all of which you have described. Given your multiple emergency room visits and ongoing symptoms, it is important to consider additional contributing factors such as pituitary or hypothalamic dysfunction, medication absorption issues, or other metabolic causes.

Some patients experience reduced absorption of thyroid medication due to gastrointestinal conditions, interactions with supplements or food, or improper timing of medication intake. Dose optimization and medication formulation are also important, as some individuals respond better to Levothyroxine alone, while others may benefit from combination therapy.

Moving forward, it would be helpful to determine whether you have had pituitary imaging, such as an MRI (magnetic resonance imaging), repeat free T4 and free T3 testing, thyroid antibody testing, and evaluation for medication absorption issues. Involvement of an endocrinologist experienced in post-thyroidectomy management and complex hypothyroidism would be ideal, especially someone who can coordinate your laboratory results, symptoms, and cardiovascular risk factors.

Although this has been an exhausting and difficult journey, your detailed documentation of laboratory values, symptoms, and medication changes is extremely valuable for future specialist consultations.

To guide further evaluation, it would be helpful to know whether you have ever had a pituitary MRI to rule out central causes of elevated TSH. It is also important to clarify whether you are taking supplements such as calcium, iron, or antacids that may interfere with Levothyroxine absorption, and how you time your medication in relation to meals and other medications. Answering these points can help narrow down why your TSH remains elevated despite normal T3 and T4 levels.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

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