Aa
Goitre
I had an ultrasound scan done recently which says I have a goitre. It is causing a lot of trouble swallowing and I keep getting a tickly feeling in my throat. I also take thyroid medication which is 150mcg levothyroxine as I was diagnosed 5 years ago. Could I please have advice about what I need to do please.
TSH 1.66 range 0.2 - 4.0
Free T4 15.1 range 12 - 22
Free T3 3.8 range 3.1 - 6.8
TPO antibody 275.5 range <34
TG antibody 255.3 range <115
TSH 1.66 range 0.2 - 4.0
Free T4 15.1 range 12 - 22
Free T3 3.8 range 3.1 - 6.8
TPO antibody 275.5 range <34
TG antibody 255.3 range <115
Being in the UK, I expect that you will have difficulty getting enough thyroid med. You might benefit from this bit of advice from a fellow UK member. After much difficulty she was finally able to get the testing and treatment she needed. This is how she described what it took to get there.
"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge. You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid. If you fight for what you want, you will eventually find someone that is happy to go along with your wishes. But we all have to take charge of our own health, right?"
You can get the knowledge you need from the link I gave you above, and ask your doctor to also read it. You should insist on a higher dose of T4 and also request T3 med to raise your FT3 level. If the doctor resists and says your dosage is good because your TSH is in range, then you can point out Rec. 10 on page 13 of the link, that there are scientific studies showing that a suppressed TSH occurs most of the time when the dosage is adequate.
Your Vitamin D is adequate, your B12 should be higher in the range, and your ferritin is only a bit low.
Please keep in touch and let us know how it goes with your doctor.
"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge. You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid. If you fight for what you want, you will eventually find someone that is happy to go along with your wishes. But we all have to take charge of our own health, right?"
You can get the knowledge you need from the link I gave you above, and ask your doctor to also read it. You should insist on a higher dose of T4 and also request T3 med to raise your FT3 level. If the doctor resists and says your dosage is good because your TSH is in range, then you can point out Rec. 10 on page 13 of the link, that there are scientific studies showing that a suppressed TSH occurs most of the time when the dosage is adequate.
Your Vitamin D is adequate, your B12 should be higher in the range, and your ferritin is only a bit low.
Please keep in touch and let us know how it goes with your doctor.
The goiter is apparently due to having Hashimoto's Thyroiditis, as shown by your TPO ab and TG ab test results. When did you first start noticing the discomfort? What other symptoms do you have?
With Hashi's, symptoms can be relieved by taking adequate thyroid med. This usually requires FT4 at least mid-range and FT3 in the upper third of its range. Your results are a long way from that. Your FT4 is only at 31% of its range. Worse is that your FT3 is only at 19% of its range, which may also indicate that your body is not adequately converting T4 to T3.
Where are you located? Since some of your test results are in metric units, I assume you are possibly in a country that only prescribes T4 med and only enough to get the TSH back in range. That does not work for many people. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT4 and FT3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. Scientific studies have shown that TSH usually becomes suppressed when taking adequate thyroid med. Such a suppressed TSH does not mean hyperthyroidism, unless there are accompanying hyper symptoms due to excessive levels of FT4 and FT3. You can read about that in the following link. I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
So if you can only get T4 med, then you need an increase to get your FT4 into the upper half of its range, and see if your FT3 increases enough. I doubt that it will and I expect that you are going to need to add some T3 to your med, if that is possible, to bring your FT3 level high enough to relieve symptoms. Adequate medication will also help eliminate the conditions causing the goiter and shrink it.
Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin I highly recommend testing those and then supplementing as needed to optimize. D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100. Note also that low ferritin will adversely affect conversion of T4 to T3.
With Hashi's, symptoms can be relieved by taking adequate thyroid med. This usually requires FT4 at least mid-range and FT3 in the upper third of its range. Your results are a long way from that. Your FT4 is only at 31% of its range. Worse is that your FT3 is only at 19% of its range, which may also indicate that your body is not adequately converting T4 to T3.
Where are you located? Since some of your test results are in metric units, I assume you are possibly in a country that only prescribes T4 med and only enough to get the TSH back in range. That does not work for many people. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT4 and FT3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. Scientific studies have shown that TSH usually becomes suppressed when taking adequate thyroid med. Such a suppressed TSH does not mean hyperthyroidism, unless there are accompanying hyper symptoms due to excessive levels of FT4 and FT3. You can read about that in the following link. I recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
So if you can only get T4 med, then you need an increase to get your FT4 into the upper half of its range, and see if your FT3 increases enough. I doubt that it will and I expect that you are going to need to add some T3 to your med, if that is possible, to bring your FT3 level high enough to relieve symptoms. Adequate medication will also help eliminate the conditions causing the goiter and shrink it.
Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin I highly recommend testing those and then supplementing as needed to optimize. D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100. Note also that low ferritin will adversely affect conversion of T4 to T3.
2 Comments
Thanks for reply, yes I live in the UK. I noticed the discomfort over 4 years ago and it has come and gone in intensity over the years. Sometimes I get pressure in my throat, other times I get the tickly sensation which makes me clear my throat or I end up coughing up lots of mucus. Other symptoms are rabbit pellet stools, heavy periods, hair loss, puffy eyes, weight gain, bloating, sweats, pale skin, looking generally unwell.
I take 3000iu vitamin D and 210mg ferrous fumarate for iron deficiency diagnosed in 2013. My haematologist has asked my doctor to keep prescribing the ferrous fumarate to me because my MCV is still below range. I also take B12 injections. I have been getting more episodes of ulcers on the corners of my mouth.
Ferritin 87 (15 - 150)
MCV 76.3 (80 - 98)
MCHC 374 (310 - 350)
Vitamin B12 445 (180 - 900)
Total 25 OH vitamin D 63.3 (50 - 75 adequate)
I take 3000iu vitamin D and 210mg ferrous fumarate for iron deficiency diagnosed in 2013. My haematologist has asked my doctor to keep prescribing the ferrous fumarate to me because my MCV is still below range. I also take B12 injections. I have been getting more episodes of ulcers on the corners of my mouth.
Ferritin 87 (15 - 150)
MCV 76.3 (80 - 98)
MCHC 374 (310 - 350)
Vitamin B12 445 (180 - 900)
Total 25 OH vitamin D 63.3 (50 - 75 adequate)
Sorry 50 - 75 for vitamin D is suboptimal.
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