Endocrine Nightmare?

[Turzy]

I have had issues with my thyroid for two years now. Im 35, four children, history of graves disease and thyroid disorders in family. I was taking .25 of synthroid, then  37.5, and now 50 after my recent testing. While on 37.5 of synthroid my tsh is  7.86 and t4,free is .9. Im also borderline glucose, which I've never had. I had a scan done and they saw 3 nodules, all adjav=cent on same side, that were hypoechic on a heterogeneous thyroid.  My wieght has increased by about 10-15pds in 2 years but seems to be rapidly increasing now. I am scheuled to see an endo but not for 2 mths? Any ideas? Also been suffering terrible headaches lately all in same exact area.

[Barb135]

TSH of 7.86 is high, FT4 of 0.9 is probably way too low in the range, but you didn't post the range so we can't know for sure.  Reference ranges vary from lab to lab, so must come from your own report.  Please post the range for your FT4.  

I agree with the other posters, that you really need to get your doctor to do an FT3, each time TSH and FT4 are done, since FT3 correlates best with symptoms, and yours are typical hypo symptoms.

Do you know if you have Hashimoto's Thyroiditis?  Many of us with Hashi's have nodules and they are usually of no concern; however, they do need to be watched for major changes in size/shape.  I'd be more concerned about getting the proper testing/treatment, than about the nodules.

[gimel]

You are missing the most important thyroid test, which is Free T3.  Doctors like to think that if they test for Free T4, then Free T3 test is not needed because T4 just converts to T3.  Many times that is not the case, due to inadequate conversion of the T4 to T3.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  Since it is so important, you need to test for Free T3 each time you go in for testing, along with the Free T4 and TSH.  

Since hypothyroid patients frequently have deficiencies in other areas, so I suggest that you also test for Vitamin D, B12, ferritin, and a full iron test panel.  Having hypo symptoms, low-in-the-range Free T4 and nodules also suggests that you should be tested for Hashimoto's Thyroiditis.  Those tests are TPO ab and TG ab.

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.  Symptom relief should be all important, not just test results.  You can get some insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.

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

Just because a doctor is an Endo does not mean he is a good thyroid doctor.  Frequently they are proponents of the "Immaculate TSH Belief" and use "Reference range Endocrinology" and the patient does not get adequately tested and treated.  While waiting for the Endo, I suggest that you go ahead and ask your current doctor to get the additional testing done.  If you will do that and post your test results and reference ranges shown on the lab report, then members will be glad to help interpret and advise further.  While at the doctor's, it would be a good time to give him a copy of the above letter and ask if he is willing to treat you clinically as described.  If not, then you will need to find a good thyroid doctor that will do so.

[oldie]

a cardiologist put me on amiodatone for 15 months wthout testing thyroid. Finally a test showed it was TSH 38. This was bourght down by symthoid. Last year, fed up with fiddling I tried every dose from 150  to xero for 6 weeks each bewtween tests. It made no diffewrence what I took. I showed the year's results to an endo and he said off-hand, , take 75, looks like the best....i'm on 50 now. Watch those nodules but don't fret too much about minute dose changes. and test for Free T3 above all.