Help preparing for Endo Visit

[ms_sally1974]

Ok, I'm going to a new Endo on Friday and I'm compiling a list of symptoms.  It seems awful long, but I'm feeling every one of these things.  I'm so nervous because I've had a bad experience with an Endo before and took a similar list of symptoms and was told "none of this has to do with your thyroid" and he barely looked at the list.  I took some advice that I received and called the new Endo and asked some questions. I will get a 40 mins consultation at my first visit, they do treat based on symptoms and blood work.

Here's my list:
Mood swings (sad one minute, mad or snappy the next)
Easily irritated (unable to “let things go”)
Joint pain (especially in hips and back)
Muscle weakness (used to be able to lift a good amount of weight, but can’t even attempt it now)
Forgetful/unable to keep focus
Depression (cry for no reason often, often sad)
No motivation for anything
Low to no sex drive
Constipation (often go 2 or 3 days without BM, but then will have diarrhea for a couple of days)
Low Metabolism
Pain/numbness in hands/wrists
Slow nail growth
Fatigue (if I ever stop moving, I can’t stay awake)
Tired upon waking in morning
Have raised white bumps on the insides of my elbows, other white spots on skin
Persistent horse voice/sore throat
Constantly swallowing or clearing my throat
Pain in chest, occasionally, dull ache
Pain in my neck, occasionally
Inability to lose weight*
Elevated Cholesterol despite good diet
Headaches (severe, on and off for 3 to 4 days at a time)
Cold all the time
Hearing loss
Easily winded

So my question is... does this list look excessive?  Have I missed anything?  Could some of these be unrelated and I should remove them or explore other means of diagnosis for?  I'm going to ask for FT4, FT3, TPO, TSI, Reverse T3, Vit D, (I'm leaning toward possible Hashi's diagnosis as I've been symptomatic for 4 years and I've had "normal" blood tests that were within optimal range about two years ago).  My test as of now
T4 12.7 (4.5-12.0)
t3 uptake 20 (24-39)
TSH 1.01 (.45-4.5)
Free Thyroxine Index 2.5 (1.2-4.9)
(I realize some of these are obsolete, so I'm going to ask for the others.)  Sorry for the long post, I appreciate any advice.

[ms_sally1974]

Yes some of the same, of course I have more now. Back then, I had depressed thoughts, fatigue, dry skin, constipation, low sex drive, scrambled thoughts.  I had to fight to get the endo to do Ft3 and Ft4. He told me that the symptoms were in my head and I had depressive disorder and sent me on down the road with no meds.....I could kick myself for not persuing a second opinion at the time. So I've been getting sicker and sicker and just dealing with it because I was scared and frustrated. Not to mention that I took antidepressants for 18 months which raised my BP through the roof and did who knows how much damage, while not helping the symptoms at all.

[gimel]

Looking at those results, your Free T4 and Free T3 by themselves would not be cause for alarm; however, the unusually low TSH would make me wonder about hypothalamus/pituitary dysfunction.  In other words, central hypothyroidism that now seems to be the cause for the symptoms you have. Were you having symptoms back ion 2013?

[ms_sally1974]

So I went back and looked at my 2013 results.  I was possibly misdiagnosed, and I didn't persue it.
  TSH .6 (.45-4.5)
FT4 1.25 (.82-1.77)
FT3 3.8 (2.0-4.4)

[gimel]

Most likely with any type of hypothyroidism it takes a while for the Free T4 and Free T3 levels to diminish enough that you start to notice symptoms; however, be aware that you can have symptoms even though your FT4 and FT3 are within the so-called "normal" ranges.  Due to the erroneous assumptions used to establish the ranges, FT4 and FT3 in the lower half of the ranges should be suspect when the patient has symptoms frequently related to being hypothyroid.   Note the following words from a good thyroid doctor.

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

[ms_sally1974]

Sorry I have one last question (for now), I can't find an answer, with central hypothyroidism can you have symptoms and it not show up in your labs for a while?  Is it something that's comes on gradual?

[gimel]

Those are the tests that I think are most important for you.  

[ms_sally1974]

Thank you for clearing that up.  I'll go and do some more research on that.  So are there any other tests that I should ask for besides the vitamin tests?  I so appreciate it.  There is just so much information out there and I'm trying to be an "informed" patient so I can get some relief from my symptoms. And since I've had one bad experience I'm so scared of having another one.

[gimel]

TSH is high with primary hypothyroidism (Hashi's).  TSH is relatively low with central hypothyroidism, which is due to a dysfunction within the hypothalamus/pituitary system.  In turn the relatively low TSH does not adequately stimulate the thyroid gland to produce thyroid hormone.  

[ms_sally1974]

Definitely feel hypO.  Maybe I'm confused, there's so much information to absorb.  I was under the impression that with central hypothyroidism that TSH would be high, mine has always been somewhere near 1.  I need to go read some more on that.

[gimel]

The reason I questioned the need for those tests is that your TSH does not indicate the likelihood of Hashi's, and your symptoms are consistent with being hypo, not hyper.  

[ms_sally1974]

I wanted to be through :)  I was thinking the Antibody tests because I've been symptomatic for a long time and I have a family history of thyroid disease.  This is the first time since I've been symptomatic that I've had "abnormal" test results.

[gimel]

Your list might be more than necessary to get the doctor's attention, but those are your symptoms that you suffer from, so why not just go with it.  Although I did not look back through your history, I agree with the Free T4, Free T3 and Reverse T3; however, with your test results for TSH and Free T4, along with hypo symptoms, I don't understand the need for the TPO ab and TSI tests.  Your TSH level seems more in line with central hypothyroidism.  Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, I would include those.  Also a good idea to test for cortisol levels with a diurnal saliva cortisol test taken at 4 times during the day; however, with most doctors it is very difficult to get that done.  I'd at least ask about it.