Doc and I are both puzzled...HELP!

[sleepylaura]

Hello, both my doctor and I are extremely puzzled...my thyroid was found to have multiple nodules on the right side, I went in and had I-131 over a year ago...the nodules shrunk while also causing my thyroid to be completely nonfunctioning (per uptake and scan) also to find four nodules on the left side now.  FNA determined 3 benign and one inconclusive.  My latest labs (7-11-07) show T-4 free 0.9 (reference range is 0.8-1.8 ng/dl) TSH 0.17.  Which indicates hyperthyroidism due to functioning nodule(s). But my physical symptoms include excessive weight gain, fatigue, weakness, muscle aches, constipation, hot and cold intolerance, memory loss, malaise, pitting edema, very heavy menses, vision disturbances, itchy dry skin, palpitations, and very depressed to name a few.  I have been checked for Cushings, all tests determined normal. There is some question as to whether it could have to do with my pituitary or adrenal glands but all labs are within range.  Can you PLEASE help me....any suggestions my doc and I could look into would be so very much appreciated.  thank you so much.

[Mark Lupo, M.D.]

I presume you are not on thyroid meds.

Check a free T3 -- if low, and TSH still low, while Free T4 lowish -- then look into pituitary problems.  It's not likely adrenal under-activity with the weight gain and Cushing's has been tested -- so not much more adrenal issues to look into (this is not likely a pheochromocytoma or aldosterone over-production).

The Free T3 is likely to be normal or slightly high.  LIkely this is mild hyperactive thyroid from functioning nodules.  It's likely all benign but the "inconclusive" needs a further look -- if this is clearly an active (hot) nodule on I-123 scan, then not much concern for cancer.

The symptoms suggest hypothyroid but thyroid symptoms are not specific or diagnostic for a thyroid problem.  Would track the thyroid levels and if TSH continues to drop, then the choices are surgery or more I-131.