Significant Increase in TSH Levels with Goiter Presentation
Summary: Initial TSH recorded on 11/19 was 0.997, followed by an 8.161 measurement on 12/5 accompanied by an enlarged thyroid. Currently taking levothyroxine. What could be the underlying cause? I am a 27-year-old woman with a medical history notable for hypothyroidism stemming from Hashimoto's thyroiditis. Additional health concerns include hypermobile Ehlers-Danlos syndrome, idiopathic epilepsy, anxiety, depression, postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia, as well as chronic migraines and insomnia. My levothyroxine medication has been part of my treatment for as long as I can recall. During my childhood, I was under the care of a pediatric endocrinologist until I turned 22, after which my primary care physician (PCP) took over my management. Until recently, I had maintained a steady dose for nearly ten years. However, following an episode of COVID in August 2023, my health significantly deteriorated and necessitated adjustments to all my medications, as nothing was effectively managed. Since that time, we have been modifying my levothyroxine dosage and closely monitoring my TSH levels. Remarkably, by the summer, I was able to revert to my original dosage. During a follow-up appointment on November 19, my TSH was recorded at 0.997. But at a routine gynecological visit on December 5, my gynecologist noted swelling in my thyroid, prompting her to request an ultrasound and additional blood tests. Although the ultrasound is still pending, I just received a call stating my TSH has now surged to 8.161. She has forwarded these results to my PCP, and I've requested a referral to return to endocrinology for further evaluation. This spike in TSH is unprecedented for me; I'd appreciate any insights on potential reasons for this sudden increase. Thank you for your help!
Answers (1)
12/9/2025, 10:30:47 PM
OpenHealth AI
It sounds like you are experiencing significant changes in your thyroid function, which can be quite concerning. A sudden increase in TSH levels, especially from 0.997 to 8.161, alongside the appearance of a goiter (enlarged thyroid), warrants careful evaluation, especially given your history of Hashimoto's thyroiditis and recent health changes.
Explanation
TSH (Thyroid Stimulating Hormone) is produced by the pituitary gland to stimulate the thyroid to produce thyroid hormones (T3 and T4). In your case, the significant spike in TSH suggests that your thyroid is not producing enough hormones (hypothyroidism), which could be due to several reasons:
- Medication Under-dosing: With changes in medication post-COVID, it's possible that your current dose of levothyroxine is not sufficient.
- Disease Progression: Hashimoto's thyroiditis can cause fluctuations in thyroid function, and new thyroid dysfunctions can emerge.
- Thyroiditis: Inflammation of the thyroid can potentially lead to hypothyroidism and consequent elevated TSH levels.
- Structural Changes: The goiter could indicate an enlargement of thyroid tissue or nodules, possibly affecting hormone production.
Next Steps
- Monitor Symptoms: Keep note of any symptoms you may experience, such as fatigue, weight gain, hair loss, or depression, as these can indicate worsening hypothyroidism.
- Ultrasound Results: Await the ultrasound results as they will provide crucial information about the structure and any nodules of the thyroid.
- Endocrinology Referral: It's a good step requesting a return to endocrinology for a more specialized evaluation. Prepare a list of questions and symptoms to discuss during your appointment.
- Medication Review: Speak with your primary care physician about adjusting your levothyroxine dosage based on your current TSH levels and overall health changes.
- Follow-up Blood Tests: Regular monitoring of TSH and thyroid hormone levels will be important to determine the efficacy of any treatment adjustments.
It's understandable to feel anxious about this situation, but you are taking the right steps by seeking help and clarifying your health concerns. Always feel free to reach out with any more questions or updates about your condition.
Related Questions
16-Year-Old Dealing with Scoliosis and Breathing Issues: Seeking Advice
As a 16-year-old male, I’m currently coping with gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS), while also having been diagnosed with an S-shaped type of scoliosis. During my latest spinal evaluation in 2023, the findings revealed: - Thoracic curve: 25°, bending towards the right - Lumbar curve: 45°, bending towards the left For many years—long before my scoliosis diagnosis—I have been experiencing sporadic shortness of breath, approximately once a month or even less frequently. In June, I visited a clinic because I was suffering from a persistent cough following a viral infection. The attending physician conducted an X-ray and subsequently referred me to the emergency room after she suspected I might have a pleural effusion. Upon arriving at the ER, a CT scan was performed, revealing that the curvature of my spine was exerting pressure on my left lung. Initially, my oxygen saturation level was recorded at 88%. However, due to my shaky hands, the physician questioned the accuracy of this reading. Upon retaking the measurement, my oxygen saturation stabilized between 94% and 99%, and arterial blood gases indicated normal levels. Later on, I consulted a senior pulmonologist who recommended that I prioritize appointments with spine specialists rather than pulmonary care providers, and proceeded to order a spirometry assessment. I chose to delay this test due to frequent panic attacks, fearing these might negatively impact the results. However, I am now set to undergo the spirometry test in three weeks and would like to know if anyone else has experienced a comparable situation. I’m also feeling anxious about the potential for pulmonary hypertension. To provide further context, in April, I underwent two echocardiograms: - The first one, carried out by a junior doctor, indicated an estimated pulmonary artery pressure (EPASP) of 48 mmHg. - The second one, just two days later, was performed by a more experienced cardiologist and showed an EPASP of 30 mmHg alongside a tricuspid regurgitant velocity (TRV) of 2.64 m/s. Additionally, I have concerns about possibly having a pectus deformity, or conditions like Swyer-James-MacLeod syndrome, even though these have not been formally diagnosed. Given all of this, how concerning do my lung conditions appear? Can scoliosis by itself account for these symptoms? Moreover, does this situation escalate potential concerns regarding pectus deformity or Swyer-James-MacLeod syndrome?
Considering Trazodone with 2nd Degree AV Block Mobitz Type I: A Personal Inquiry
Recently, I consulted with a psychiatrist on the recommendation of my therapist. During that visit, I was prescribed sertraline, starting at 25 mg for the first week before increasing to 50 mg, alongside trazodone at a similar dosage, to help with my sleeplessness. After undergoing an EKG, which revealed a first-degree AV block, further testing with a Holter monitor indicated a second-degree AV block. Two cardiologists advised me against using trazodone, leading me to solely take sertraline, which I have been on for 12 days without any adverse effects so far. Just two days prior, I had a follow-up appointment with my psychiatrist. To my surprise, she informed me that a lower dose of trazodone, specifically 25 mg, could be an option. I've been contemplating trying it given that the AV block isn't causing me any issues – I wouldn’t have known about it had it not been for the EKG – and also because melatonin isn’t consistently effective for me. I'm reaching out for advice since I haven't come across much information online about the safety of trazodone in conjunction with this type of AV block; most findings seem to focus on trazodone overdose. Thank you for your insights! (Please excuse any language errors; English is not my native tongue.)
Seeking Relief: Ongoing Ear and Facial Discomfort After Two Weeks of Respiratory Illness
I am currently experiencing day 14 of a lingering respiratory illness, the origins of which remain unclear. It initially presented with relentless sneezing and a persistent runny nose, accompanied by a low-grade fever ranging from 99 to 100 degrees. Additionally, I have suffered from facial and sinus pain, conjunctivitis, intense headaches, fatigue, and general body aches. After visiting urgent care, I underwent tests for COVID-19, influenza types A and B, and RSV, all returning negative results. The doctor provided me with azelastine; however, he indicated that no further interventions were necessary at that time. While the sneezing and excessive nasal discharge subsided within a few days, I continue to endure headaches, congestion, generalized aches, and overwhelming fatigue at this two-week mark. Moreover, I've recently started experiencing pain in my left ear, with persistent sinus discomfort on that same side. Occasionally, I find myself running a fever of around 99 degrees. Unfortunately, I am unable to make an appointment with my primary care physician for another couple of weeks. I am contemplating whether another visit to urgent care would be worthwhile. Is there any potential relief available for my ear pain? Due to my allergy to aspirin and NSAIDs, I can only use Tylenol, which hasn't alleviated the discomfort. I suspect that I may simply need to ride out this troublesome illness, but could the symptoms indicate a bacterial infection that warrants an antibiotic treatment? Additional Information: - Age: 60 - Gender: Female - Height: 5'2" - Weight: 120 lbs - Ethnicity: White/Asian - Duration of symptoms: 14 days - Pain location: Left ear and left side of the face - Relevant medical history: MCAS, POTS, hEDS, one adrenal gland - Current medications: loratadine, famotidine, fluticasone, prescription potassium, metoprolol, montelukast, azelastine
Seeking Help for Severe Duodenal Reflux Gastritis
Hello, f30. I'm reaching out for guidance on how to effectively communicate my condition to a gastroenterologist. I’m experiencing significant duodenal reflux, resulting in bile and fluid accumulating in my stomach. After only a few bites of food, my stomach fills with liquid rather than emptying properly, leading to prolonged retention that causes irritation. Over time, my digestive function has steadily declined. I’ve lost 13 kilograms and now find it challenging to consume even a single glass of water or two meals a day. While I don't experience nausea, I'm plagued by continuous liquid retention and a persistent dull burning sensation that is worsening, accompanied by a swallowing reflex that feels like water pooling in my throat. Previous symptoms, such as sporadic but intense feelings of hunger that were alleviated by eating, as well as brief periods of gnawing discomfort, were ignored during earlier consultations. I later realized these could indicate a mild form of erosive gastritis. Regrettably, the delay in proper diagnosis and the misleading advice from alternative healthcare providers have exacerbated my situation, something that is quite difficult to accept given that I may have been treatable at that time. In contrast, I’ve observed online communities where people suffering from gastritis report more severe experiences than I initially had, leading me to unknowingly consume foods that exacerbated my condition. Many healthcare professionals attribute my issues to anxiety or stress. Although I acknowledge that worrying about my health has not contributed positively to my situation, I have not seen a direct correlation between stress and physical symptoms. Moreover, I have no history of mental health disorders. I would have been open to a diagnosis of gastritis along with a stress-related component, but the biological factors have never been thoroughly explored. I felt as though I was on a path to recovery but, lacking essential knowledge, I inadvertently consumed inappropriate foods and drinks. My primary challenge lies in articulating the severity and progressive nature of my condition without coming off as self-diagnosing or exaggerating my symptoms. I wish to convey the abnormal and uncontrollable accumulation of liquid and its damaging effects, yet I am continually dismissed because I still consume food and my digestion appears normal. I seek an assessment of whether the fluids I'm retaining are from my stomach or the pancreas. A year ago, an endoscopy indicated a healthy stomach (only a month following an injury), yet my health has deteriorated since, a point that was previously dismissed. I now recognize this decline to be linked to more severe bile reflux, triggered by my injury, which has led to a gradual loss of stomach function. I am exploring the possibility of the DeMeester duodenal switch surgery, but it’s not feasible in my country. I hope to attain the necessary diagnosis to discuss this possibility. How can I express to a doctor that my issues are no longer merely psychological? I am unable to eat or drink the necessary amount for survival, and relying solely on a once-daily meal is not sustainable. How should I approach asking for further investigation or an open dialogue regarding future treatments, including the potential for surgery, when prior referrals have been declined without a full understanding of my situation? I appreciate any advice you might have regarding my language or strategy when addressing this. A candid discussion concerning the risks and benefits of surgery in my circumstance is crucial. Additionally, has my stomach lost neural function? Are the fluids I’m experiencing pancreatic, or are they unusual protective secretions from the stomach? It is vital for me to gain a realistic perspective on my future. I realize that whenever I suspect bile, the subsequent day becomes noticeably more challenging. Can surgery potentially reverse this damage, or is that a futile hope? Those are the types of questions I want to explore with a medical professional.
Breathing Difficulties
Hello everyone. I’m a 25-year-old male, standing at 1.80 meters and weighing 110 kilograms. I take 75 mg of Sertraline daily and have never been a smoker. Recently, I’ve experienced some unusual symptoms and seek your advice. Approximately a week and a half ago, I noticed what felt like a weakness or fatigue on the right side of my face. I didn’t think much of it at first. However, the following day, I began to sense a change in my breathing. Although I could still manage to take deeper breaths, I felt a peculiar pressure in my chest, particularly after eating. This made me more mindful of my breathing patterns. While this pressure subsided somewhat on its own, this morning I experienced something concerning. After using the restroom, I instinctively tried to take a deep breath, but my body seemed to cancel it, only allowing a small intake of air. When I forced myself to take a deeper breath, I was able to, but the volume of air I could inhale felt reduced compared to before. The difference is slight but noticeable. Additionally, after attempting several deep breaths in quick succession, I've developed a persistent urge to breathe deeply every few seconds, and this sensation has not abated for the last 20 to 30 minutes.