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Could this be secondary hypothyroidism?
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Could this be secondary hypothyroidism?

Hi all.
I had chemo 4 years ago due to breast cancer and suffered quite badly with neuropathy and joint aches from the chemo side-effects.  This got better and the past 18months I have started feeling worse again.  Endo did full body CTscan and revealed in her words "nothing to be worried about".  I got a copy of my report that showed I had a multinodular goiter. My pcp tested my tsh in February and it was .98 (.27-4.2).  I feel horrible and have alot of hypo signs. I have suffered with muscle cramps (drink more water is the answer I get), tiredness, muscle aches, joint aches, eye puffiness, watery eyes, light sensitivity, headaches, severe brain fog, etc. Finally got an u/s of my thyroid at a surgeons office and the diagnosis was large cysts on my thyroid.  "I'm sorry to give you the bad news...but you have a very fat thyroid" were his words.  He didn't even listen to me when I asked if I could possibly be hypo, because he responded with "your thyroid is acting normal, you are not hyper".   No one would test further than tsh because it is the "gold standard".  Had to start seeing a chiropractor for pain in shoulder with tingling in arm and fingers.  Neuro thought is was carpal tunnel.  Finally got my chiropractor of all people to order new tsh, ft3 and ft4 tests. July labs:  tsh .8 (.27-4.2), ft4 1.1 (.9-1.7), ft3 2.7 (2.3-4.2).  I did hemorrhage 23 years ago when I had a baby, but had 2 more children after that.  I am wondering about the possibilities of Sheehan syndrome and if the multiple surgeries/chemo stress to by body brought it to a head.  My husband thinks I'm a hypochondriac and that I should be happy all my tests have been normal.  I am beat down, and wondering if anyone has any feedback with these numbers if I should see an endo or internal md.  THANKS!
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Avatar_m_tn
From your symptoms and your test results I'd say that you have secondary hypothyroidism.  Just because your Free T3 and Free T4 are within the ranges does not mean that is adequate for you.  The ranges are far too broad to be functional for many people, due to the erroneous way ranges are established.  Without getting into detail about that, suffice to say that most hypo patients find that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.

Also, hypo patients often find that they are too low in the ranges for Vitamin D, B12 and ferritin.  If you have been tested for those, please post, along with ranges.  If not, then it would be a good idea to do so.  

The most important thing for you right now is to find a good thyroid doctor.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

Understand that good thyroid doctors are few and far between.  Most Endos and many other doctors have the "Immaculate TSH Belief" and use "Reference Range Endocrinology", which preclude effective treatment.  If you will give us your location, perhaps a member can recommend a good thyroid doctor in your area.  

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Avatar_f_tn
Thanks for your help.  I had my vitamin D checked.  Dr. said normal, but didn't mean anything to me:
25-hydroxy D2 <4 --no reference range given
25-hydroxy D3 37 --no reference range given
25-OH D Total 37 --ref 25-80

I am in Maine, and know that I will probably have to drive a couple hours to see a decent Dr.

Thanks!!!
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Avatar_m_tn
Just like with Free T3 and Free T4, having Vitamin D that is in the low end of the range is not optimal either.  Recommended level is around the middle of the range.  Also recommend getting tested for B12 and ferritin.  

The following link is to the Top Thyroid Doctors site, for Maine.  Have a look and see if you find any prospects.  The things I look for in the patient reviews are willingness to treat clinically, and also prescribe T3 type meds.  

http://www.thyroid-info.com/topdrs/maine.htm

If you find one and confirm him as a good thyroid doctor please let me know so I can add the doctor to the list I have been developing for the last 4 years.  
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