Help!!

[jozamom]

Hello
So I have been battling fatigue, weight gain, increased anxiety/panic attacks, and brain fog and just not feeling right,plust choking while eating, not able to lie on certain side.
Went to dr 6 months ago she took blood test they came back normal. Still feeling awful and actually worse I went to a different doc. This time he ordered a sonogram along with blood tests. The blood tests came back normal but sonogram showed numerous nodules and and cysts, plus enlarged thyroid.I thought finally physical proof there is something wrong.
I went in for follow up today and he said your blood tests are normal so you are fine. HE barely even looked at the sonogram. I have all these symptoms plus physical proof there is soemthing going on and he discounted it.

I am at a loss of what to do. Should I at least have an endocronologist look at my sonogram. It is especially difficult because I live on a boat with four kids and am travelling. I am ready to throw in the towel.

If anybody has any advice I would really appreciate it!!!!
Thanks so much

[898_1]

If your doctor will  tell you scare things please ask about lymph nodes and Doppler flow image results for nodule in isthmus (no blood flow -- no possibility for cancer, period).
It is hard to diagnose even for ductor over the internet:) but IMHO looks like you arfe dealing with inflammatory process due to infection, perhaps.

[jozamom]

Thank you so much!
So it is not something I should worry too much about?  
Now if I can get my symptoms taken care of, it will be so much better.
I really appreciate all of the help I have received.

[898_1]

Ultrasound review:
R. Lobe 43x14x16 mm volume 4.7 cu cm (average 3.8)
L. Lobe  51x16x16 mm volume: 6.4 (average 3.5) larger than average
Isthmus 3mm normal
Both thyroid lobes are heterogenous (tissue is not uniform and has inclusions) "gravel compared to sand"
numerous and diffuse cysts 5 to 8 mm---fluid (probably colloid) filled blisters uniformly distributed throughout entire gland (think about "raisin muffin")
their size is considered small (less than 1cm)
Nodular mass of isthmus 9 mm (no information if it is solid or cystic)
NO statement about condition of lymph nodes
The ultrasound picture suggests MILD diffuse inflammatory process involving entire gland with damage of follicles (the cysts most likely formed as result of this)
Combined with ESR 23 (should be below 20) it can be sign of subacute thyroid inflammation especially if TOPOs AB's will be within normal limits and patient have had upper respiratory infection recently.
(I am very creative today after enjoying root planing and curettage without anesthesia:) this is what I am using my vacation for:))

[jozamom]

This8 is what the sonogram report says:
Right lobe measures 43x14x16 mm
left lobe measures 51x16x16 mm
isthmus 3mm

Both thyroid lobes are heterogenous
In both lobes numerous and diffuse cysts 5 to 8 mm average diameter
Nodular mass of isthmus 9 mm

Conclusion
Multicystic and multinodular throid

Also here in St Martin the radiologist did the test not a tech. He said he was sorry for what he found and was concerned. NOt sure if that has any bearing.
Thanks again!!

[gimel]

I'd try B12 pills first and see if that works for you.  

Regarding the nodules and cysts, please post the actual report from the ultrasound and there are members who can better provide info on that.  

[jozamom]

Wow!
Thank you so much for the information. You have been extremely helpful!!

It is nice to know I am not completely bonkers for questioning the doctor.  

do you think I could get the Vitamin B-12 by pill or should I get a shot to jump start things. I am not sure if he will do it if I ask.

My other question is do I need to be concerned about the nodules and cysts that showed up on the utlrasound. Both sides were filled and the radiologist just put numerous because there were too many to count.

Thank you, THank you, Thank you for all the helpful information!!!!

[gimel]

I have to really disagree with your doctor.  In view of your symptoms and your test results, your blood tests are certainly not normal.  Even if they fell within the so-called "normal" ranges that doesn't mean that is adequate for you.  The ranges are far too broad to  be functional across the entire range.  Also, each patient has different levels at which they feel best.  

Specifically, your Free T4 is around the middle of the range, which is adequate.  Your Free T3 is much too low.  Scientific studies have shown that Free T3 correlates best with hypo symptoms, such as most of those you mention, while Free T4 and TSH did not correlate at all.  Many of our members, myself included, say that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.  You can also get a good picture of how your levels stack up by reading this quote 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."

Looking again at your Free T3 and Free T4, along with TSH, it appears that your body is not adequately converting the available T4 to T3.  One of the things that can contribute to that is low ferritin, which is clearly a problem for you.  For women ferritin should be around 80 minimum.  For that you can supplement with iron.  Ferrous fumarate and ferrous glycinate are two good forms of iron to consider.  I suggest that you could start on about 25 mg of iron, along with some Vitamin C, and increase as necessary.  In addition, Vitamin D and B12 are very important for someone with hypo symptoms.  D needs to be around 55-60 and B12 needs to be in the upper part of its range.  

IN view of where you live and your travel, you might consider trying to get your ferritin and D and B12 up to par and monitor the results with followup tests.  If that doesn't adequately relieve symptoms, and your Free T3 continues to be too low in the range you should 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

In view of all the above, I doubt that your tests for Hashi's will show positive.  While there, it would be a good opportunity to get tested for Vitamin D and B12.  

[jozamom]

Ok thanks so much for taking the time to respond.

My RBC is 4.79 normal range 4.0-5.5
HGB 12.8 normal range 11.5-16
HCT 40.1 norma rangel 40-50
Ferritn 11 normal range 20-300 very low
MCH 26.8 normal range 27-32
MCHC 32.0 normal range 32.0 -35.0
MCV 83.7 normal range 80.0-100
ESR 23 Didn't give range just marked with a star as abnormal
TSH 1.360 normal range 0.4-4.4
FT3 4.65 normal range 4.70- 7.2
FT4 14.97 normal range 9.0-20.0

My symptoms are trouble lying down because it feel like my throat is closing up, choking on food sometimes, brain fog, exhaustion, my anxiety has been through the roof. I am on prozac and take a xanax as needed. I can not lose weight even while being gluten, sugar, grain, lactose free plus exercising. Very moody one minute crying and than just feel like I have a lot less patience, pain in jaw and ear, swollen lymphs around jaw and ear.

I go in tomorrow to get the blood test for Hashimotos.

Just wondering if my anxiety can cause all of these conditions. I truly feel like there is something wrong with me!

Thanks so much for taking the time to listen.

[gimel]

Just because thyroid test results fall somewhere within the so-called "normal' ranges does not mean they are adequate for you.  The ranges are far too broad for that to be the case.  If you will please post your thyroid related test results and reference ranges shown on the lab report, members will be better able to assess your status.  Also, please tell us more about your symptoms.