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Hyperthyroid and Synthroid?
I just found out recently that I have some kind of thyroid problems by an ultrasound with a 2mm nodule and goiter. My pcp referred me to see an Endo and he order tests for me to do. Blood work, scanning and uptake. Good news, was great, it was not cancerous, BUT when he left a message, he told me to just take my Synthroid 50mcg. With really no diagnosis if this is hyper or hypo, I decided to pull up my records (which you can do at this one hospital facility. But hey, why not, it's my own information) and the radiologist says at the end of his results that I have Hyperthyroid which he suggest Grave Disease. I tried to call my dr and ask lots of questions, but their office was close early. I did a lot of research and with Synthroid, shouldn't the person ONLY takes it if he/she is HYPO? And now from what I read that most doctors don't use Synthroid medication to shrink the nodules. It only works if you have HYPO or Hashimoto Disease. .....And I have not taken the meds yet, because why would I take something with out a diagnosis. NOT all doctors are right.
Best Answer
Starting meds before labs are out of range can help prevent you from becoming hypo. To some extent, once you have antibodies, it's a matter of when, not if, you start to have symptoms. However, Hashi's can move very slowly, and it can take antibodies years, or even decades, to cause enough damage to make us hypo. Of course, they can also do that in a matter of months, and there's no way to predict the timeline. Taking meds will not prevent you from becoming hyper, however, if your hormones are awinging up and down.
Some doctors believe is treating patients with high antibodies early. Many of the hypo symptoms can be avoided that way, and inflammation of the thyroid can be reduced. Other doctors wait for labs to go out of range and/or for symptoms to appear before treating (I believe the majority of doctors are in this last category). My point in saying that was that some doctors would treat you at this point in time, and some wouldn't. So, whether you continue to take the meds or wait until you see the new doctor isn't crucial.
The 12th isn't so far away. I hope your new doctor is more responsive to your questions.
Some doctors believe is treating patients with high antibodies early. Many of the hypo symptoms can be avoided that way, and inflammation of the thyroid can be reduced. Other doctors wait for labs to go out of range and/or for symptoms to appear before treating (I believe the majority of doctors are in this last category). My point in saying that was that some doctors would treat you at this point in time, and some wouldn't. So, whether you continue to take the meds or wait until you see the new doctor isn't crucial.
The 12th isn't so far away. I hope your new doctor is more responsive to your questions.
Yeah...my appt isn't until Dec 12. I was told to just stay on the Synthroid. Do you think since my levels are still pretty good so far, but my antibodies are high, having to already take the Synthroid will MAYBE help stop me from becoming HYPO or HYPER. But yes, I know Synthroid isn't taken when HYPER, so after a couple of weeks I'll find out. Will this medication help me stop to becoming hypo. Because I noticed you said that most doctors won't even treat a patient even if their thyroid panals are normal, but antibodies are high. But if that's the case, if my old Endo dr didn't give me the Synthroid, then I would have turn out to a complete hypo?? Sorry for all the questions. Obviously, that's why I had to find a new doctor to answer all these questions that wasn't answered by my old Endo.
Synthroid doesn't work immediately. When you first start on it, it takes 4-6 weeks to reach its potential in your blood. After a week, you might feel a little better, but you still have several weeks to go before you know how you feel on that dose.
50 mcg is a pretty modest dose. So, to tell you the truth, I don't think it matters a lot whether you continue to take it or wait until you see the new doctor. When is your appointment with him? One advantageof discontinuing: If your new doctor wants to run more tests, it could be advantageous to have results on an unmedicated or "baseline" basis. On the other hand, if you are already feeling a little better and you keep taking it, your dose will have stabilized more (or maybe completely) by the time you see the new doctor, and you might be ready for an adjustment.
From the standpoint of your health, your FT3 and FT4 are still at a reasonable level, so waiting a few weeks to start treatment isn't going to impact it much. Many doctors wouldn't even consider thyroid meds at your levels (not saying I agree with that, just letting you know treatment options aren't clear cut).
50 mcg is a pretty modest dose. So, to tell you the truth, I don't think it matters a lot whether you continue to take it or wait until you see the new doctor. When is your appointment with him? One advantageof discontinuing: If your new doctor wants to run more tests, it could be advantageous to have results on an unmedicated or "baseline" basis. On the other hand, if you are already feeling a little better and you keep taking it, your dose will have stabilized more (or maybe completely) by the time you see the new doctor, and you might be ready for an adjustment.
From the standpoint of your health, your FT3 and FT4 are still at a reasonable level, so waiting a few weeks to start treatment isn't going to impact it much. Many doctors wouldn't even consider thyroid meds at your levels (not saying I agree with that, just letting you know treatment options aren't clear cut).
I've been taking the Synthroid and it's been almost a week now and no changes. Well, forget that, I mean I noticed that during the day I seem to feel a little better, not too tired and not feeling that choking sensation around my neck. But at night, I can start to feel that weird feeling again. My throat seems to be so dry and that tightness comes again. Ok, should I just stop my Synthroid until I see this new Endo dr or just continue the medication? What would you do?
"I pretty much figured out what this dr is trying to make me do, which is take my Synthroid, so the nodule shrinks (which it's only 2mm), once that happens (if it happens) then the antibodies stop attacking my thyroid."
That's not quite the way it works. Nodules sometimes shrink when you take Synthroid. As you said, your nodule is very small. So, from what you've posted so far, I really don't understand why your doctor is so intent on shrinking it. Perhaps he has information we don't have.
However, whether or not your nodule shrinks, the antibodies will not stop attacking your thyroid. Once we have antibodies, we have them for life. The antibodies will continue to attack your thyroid. The nodule is caused by the antibodies; the antibodies are not caused by the nodule.
I'm glad to hear you will be gtting a second opinion.
That's not quite the way it works. Nodules sometimes shrink when you take Synthroid. As you said, your nodule is very small. So, from what you've posted so far, I really don't understand why your doctor is so intent on shrinking it. Perhaps he has information we don't have.
However, whether or not your nodule shrinks, the antibodies will not stop attacking your thyroid. Once we have antibodies, we have them for life. The antibodies will continue to attack your thyroid. The nodule is caused by the antibodies; the antibodies are not caused by the nodule.
I'm glad to hear you will be gtting a second opinion.
I agree! I decided to just continue with my Synthroid until I find a new dr that will listen and answer my questions. After all this is my health. I pretty much figured out what this dr is trying to make me do, which is take my Synthroid, so the nodule shrinks (which it's only 2mm), once that happens (if it happens) then the antibodies stop attacking my thyroid. I had to guess and figure that out without talking to that dr. Now that's hilarious! The first time I seen that dr he asked me my symptoms and I told him what I feel, he asked my if anyone in my family has hashimoto? I told him my aunt is hyper. So from there on he ordered tests. I need a new dr that runs test and calls the patient back and answers the questions. Not the other way! Your answers are accurate to me. Thanks again for your help :) Time for a better Dr!
I didn't really finish this thought:
"You seem to have a number of hypo symptoms, and taking the Synthroid should help with those. Your labs do look good, but we all have a personal comfort zone within the "normal" ranges. Some of us have to be higher in the ranges and some of us lower."
We use certain rules of thumb to look at labs and say "they look really good (or bad", but not everyone fits that mold. MOST people might feel really good at your levels, but you might be one of those people who would feel a lot better higher in the ranges, and Synthroid should boost your levels. With experience and a lot of trial and error, most of us eventually find out sweet spot.
I just think you'd feel a lot better with a firm diagnosis and reconciling the contradiction between what the radiologist's report indicated and what your doctor has said. No one's giving you the complete picture.
"You seem to have a number of hypo symptoms, and taking the Synthroid should help with those. Your labs do look good, but we all have a personal comfort zone within the "normal" ranges. Some of us have to be higher in the ranges and some of us lower."
We use certain rules of thumb to look at labs and say "they look really good (or bad", but not everyone fits that mold. MOST people might feel really good at your levels, but you might be one of those people who would feel a lot better higher in the ranges, and Synthroid should boost your levels. With experience and a lot of trial and error, most of us eventually find out sweet spot.
I just think you'd feel a lot better with a firm diagnosis and reconciling the contradiction between what the radiologist's report indicated and what your doctor has said. No one's giving you the complete picture.
Those all sound like hypo symptoms.
I know how hard it is to get a diagnosis. It takes a lot of patience.
You seem to have a number of hypo symptoms, and taking the Synthroid should help with those. Your labs do look good, but we all have a personal comfort zone within the "normal" ranges. Some of us have to be higher in the ranges and some of us lower.
Yes, that's what I'm saying. In the initial stages of Hashi's, the thyroid often swings from hyper to hypo. The antibodies are killing off thyroid function all the time, so the thyroid sputters, sometimes producing too much hormone, sometimes too little. When enough thyroid function is destroyed, you will be hypO, not hyper. Taking Synthroid can reduce inflammation by allowing the thryoid to "rest" a little and not have to try overly hard to produce hormones.
"Thyroiditis nodule" isn't really a diagnosis. Nodules are often the result of thyroiditis (which is nothing but inflammation of the thyroid), but nodules are not the cause of your thyroid problem, they are the result of the antibodies attacking. Has you doctor said anything about Hashi's?
Brain fog is very typical of hypo.
I think you should pin your doctor down and get some explanations. He should give you a formal diagnosis and explain his treatment plan to you and tell you what he hopes to achieve by it. He's really kind of left you in the dark, and that's not a nice place to be. None of us like taking meds when we don't know the reason or we've gotten contradictory information. I'd make an appointment with him or with a new doctor and sit down for a chat. You should be comfortable with what you're doing and know why you're doing it.
I know how hard it is to get a diagnosis. It takes a lot of patience.
You seem to have a number of hypo symptoms, and taking the Synthroid should help with those. Your labs do look good, but we all have a personal comfort zone within the "normal" ranges. Some of us have to be higher in the ranges and some of us lower.
Yes, that's what I'm saying. In the initial stages of Hashi's, the thyroid often swings from hyper to hypo. The antibodies are killing off thyroid function all the time, so the thyroid sputters, sometimes producing too much hormone, sometimes too little. When enough thyroid function is destroyed, you will be hypO, not hyper. Taking Synthroid can reduce inflammation by allowing the thryoid to "rest" a little and not have to try overly hard to produce hormones.
"Thyroiditis nodule" isn't really a diagnosis. Nodules are often the result of thyroiditis (which is nothing but inflammation of the thyroid), but nodules are not the cause of your thyroid problem, they are the result of the antibodies attacking. Has you doctor said anything about Hashi's?
Brain fog is very typical of hypo.
I think you should pin your doctor down and get some explanations. He should give you a formal diagnosis and explain his treatment plan to you and tell you what he hopes to achieve by it. He's really kind of left you in the dark, and that's not a nice place to be. None of us like taking meds when we don't know the reason or we've gotten contradictory information. I'd make an appointment with him or with a new doctor and sit down for a chat. You should be comfortable with what you're doing and know why you're doing it.
Oh and my blood pressure which I monitor, I'm normally around the high 90's or 100's. But sometimes I end up with 93/56 heatrate 72....around there. I also feel like my mind is hazy, brain fog or slight head rush, but not to where I'm going to faint. Is that part of the thyroid symptoms?
Again thanks for the help.....I'm just so upset and still feel the same. My symptoms are: feeling so tired, body ache/pain, back neck pain, choking feeling or tightness in neck. I seem to forget things at times. My weight seems to be the same. I'm not skinny or big. To be honest I haven't been exercising. At times I do get irritable. I started feeling the fatigue 2 months ago, which I thought I was catching a flu. Before that I used to get this weird tremble inside me, but no to where people can notice. i thought it was just because I was so tired and stress. anyways my dr told me I have thyroditis nodule? whatever that means. He still wants me to take the synthroid, which I don't understand why? I guess on what your saying is that with my thyroid panals shows that it's still working, however it's going to end up either hypo or hyper because of my antibodies attacking my thyroid. I'm just getting upset feeling like this.
No, I DO think it's the antibodies making your thyroid swell (goiter) and giving you nodules. However, since your FT3 and FT4 are so good right now, it indicates that your thyroid is still functioning pretty well...the antibodies haven't destroyed too much of its function yet. Lots of times, when antibodies are present, we get thyroid symptoms even when our labs are "normal". Also, in the initial stages of Hashi's, swings from hypo to hyper aren't unusual. So, just because your labs look great today doesn't mean they will tomorrow.
The only reason I'm suggesting the TSI is that it's possible (very rare, but possible) to have both Graves' and Hashi's antibodies. Your radiologist thought you had Graves'. However, a hyper phase of Hashi's can look very much like Graves'. Perhaps your doctor has already ruled out Graves' from some of your other tests that we haven't seen the results of, but if that's the case, he should really communicate that to you (and give you a diagnosis).
Well, understand that I am not a doctor or medical professional of any kind, so this is strictly my opinion as a fellow patient. If I were you, I'd probably want to stop taking the Synthroid until you get some answers. You've only been on it for two days, so there's no problem stopping. You can take it for much longer than that and discontinue it as well...more slowly, perhaps.
Your FT3 and FT4 are excellent, so you don't need Synthroid from that perspective. A 2 mm nodule is very small, and most of us have those, so shrinking it wouldn't be a huge priority.
It sounds like the goiter (swelling, inflammation) is the main problem...am I interpreting correctly? Do you have any of the other classic symptoms of hypo or hyper? Constipation/diarrhea? Fatigue? Insomnia? Elevated or lowered blood pressure or heart rate? Hair loss? Weight gain or loss?
The only reason I'm suggesting the TSI is that it's possible (very rare, but possible) to have both Graves' and Hashi's antibodies. Your radiologist thought you had Graves'. However, a hyper phase of Hashi's can look very much like Graves'. Perhaps your doctor has already ruled out Graves' from some of your other tests that we haven't seen the results of, but if that's the case, he should really communicate that to you (and give you a diagnosis).
Well, understand that I am not a doctor or medical professional of any kind, so this is strictly my opinion as a fellow patient. If I were you, I'd probably want to stop taking the Synthroid until you get some answers. You've only been on it for two days, so there's no problem stopping. You can take it for much longer than that and discontinue it as well...more slowly, perhaps.
Your FT3 and FT4 are excellent, so you don't need Synthroid from that perspective. A 2 mm nodule is very small, and most of us have those, so shrinking it wouldn't be a huge priority.
It sounds like the goiter (swelling, inflammation) is the main problem...am I interpreting correctly? Do you have any of the other classic symptoms of hypo or hyper? Constipation/diarrhea? Fatigue? Insomnia? Elevated or lowered blood pressure or heart rate? Hair loss? Weight gain or loss?
by the way... I just started taking my Synthroid and now my second day. Is it possible to just stop taking it, because I heard if you take it for at year it's not good. I do get that chocking feeling at times but I just learn to relax. So question is, would you just quit the Synthroid until you were to find out if you actually have Hyper?
Thanks for your help....One more thing that seems to be scary is that, you mentioned that if my FT3 and FT4 are pretty good at the moment, you said that with my antibodies so high and it might not be the thyroid causing this, but your saying somthing else can be causing to inflamed my thyroids to go crazy, so what might it be? I've had weird feeling before after I've had my first child and went through panic attack, which never happened to me before. Ever since then I've seen so many doctors and everything is normal. So what your saying could be both hypo/hyper or it can be something not coming from my thyroid? And Im planning on changing my Endo dr because he's no help and he keeps brushing my questions off.
All your current thyroid labs are not only in range, but they actually look pretty good. Both are nicely up in the ranges, so it doesn't look like they ought to be causing hypo symptoms.
However, TPOab is elevated, and elevated TPOab has long been considered sufficient for diagnosis of Hashi's. Elevated TGab is confirmation.
Although it sounds like a contradiction in terms and is very rare, it is possible to have both Graves' and Hashi's. The antibody test for Graves' is TSI (thyroid stimulating immunoglobulin). You might want to request that to rule out Graves'.
Often, in the case of Hashi's, being on thyroid meds does help shrink the nodules. When the thyroid doesn't have to try to work so hard, inflammation is reduced, and nodules and goiter often both shrink.
I agree that misdiagnosis is scary, especially when we're talking about dead "opposite" conditions, Graves'/hyper or Hashi's/hypo. So, ask for the TSI. That's considered definitive for Graves'. If you have Graves', you definitely do not want to be taking Synthroid.
If the nodule and goiter aren't bothering you very much at the moment, starting Synthroid is certainly not pressing. Most of us with Hashi's have both nodules and goiter, and as long as they're small and not suspicious-looking, they're just monitored for changes. Nodules virtually "come with" Hashi's.
I hope you get to have a good talk with your doctor and get a diagnosis.
As I said, your FT3 and FT4 are quite perfect at the moment. With your levels, I wouldn't be expecting thyroid to be causing symptoms. However, with the elevated antibodies, we know that something is developing.
However, TPOab is elevated, and elevated TPOab has long been considered sufficient for diagnosis of Hashi's. Elevated TGab is confirmation.
Although it sounds like a contradiction in terms and is very rare, it is possible to have both Graves' and Hashi's. The antibody test for Graves' is TSI (thyroid stimulating immunoglobulin). You might want to request that to rule out Graves'.
Often, in the case of Hashi's, being on thyroid meds does help shrink the nodules. When the thyroid doesn't have to try to work so hard, inflammation is reduced, and nodules and goiter often both shrink.
I agree that misdiagnosis is scary, especially when we're talking about dead "opposite" conditions, Graves'/hyper or Hashi's/hypo. So, ask for the TSI. That's considered definitive for Graves'. If you have Graves', you definitely do not want to be taking Synthroid.
If the nodule and goiter aren't bothering you very much at the moment, starting Synthroid is certainly not pressing. Most of us with Hashi's have both nodules and goiter, and as long as they're small and not suspicious-looking, they're just monitored for changes. Nodules virtually "come with" Hashi's.
I hope you get to have a good talk with your doctor and get a diagnosis.
As I said, your FT3 and FT4 are quite perfect at the moment. With your levels, I wouldn't be expecting thyroid to be causing symptoms. However, with the elevated antibodies, we know that something is developing.
You seem to know what your talking about...I started to feel so fatigue for a week when this started in September. Thought I was catching a flu. I've always had sore/aches all over my body and sometimes behind my neck. I asked my Endo about the back neck pain and he said it was not related..I wonder, but my pcp thought it might be because of my thyroid. I've actually noticed my neck looked swollen months before, more like a year ago and my old pcp said it was my thyroid, but she said my TSH was normal. Here are the ranges:
Test Results Range
T4 Thyroxine 10.6 (4.8-13.9)
Total T3 100 (60-181)
Free T3 3.3 (2.2-4.0)
Free T4 1.17 (0.76-1.46)
TSH 1.530 (0.358-4.700)
Thyroglobulin Autoantibodies 140 H (0-60)
TPO Thyroid Peroxidase Antibodies 421 H. (0-60)
With the radiologist he suggest Graves? I did the uptake and scanning. I actually ate shrimp (about 8) a couple of days ago, BUT the Nuclear Medicine Tech said that should be fine. anyways, my Endo told me to take Synthroid to shrink the nodule.....Now does that work, taking Synthroid and shrinking the nodule? If you say that the test MIGHT be invalid, what other test can they do to show that I have Hashimoto or Grave, besides doing the scanning? I don't want to be misdiagnosis, which can be scary!
Test Results Range
T4 Thyroxine 10.6 (4.8-13.9)
Total T3 100 (60-181)
Free T3 3.3 (2.2-4.0)
Free T4 1.17 (0.76-1.46)
TSH 1.530 (0.358-4.700)
Thyroglobulin Autoantibodies 140 H (0-60)
TPO Thyroid Peroxidase Antibodies 421 H. (0-60)
With the radiologist he suggest Graves? I did the uptake and scanning. I actually ate shrimp (about 8) a couple of days ago, BUT the Nuclear Medicine Tech said that should be fine. anyways, my Endo told me to take Synthroid to shrink the nodule.....Now does that work, taking Synthroid and shrinking the nodule? If you say that the test MIGHT be invalid, what other test can they do to show that I have Hashimoto or Grave, besides doing the scanning? I don't want to be misdiagnosis, which can be scary!
Lab ranges vary, so you have to post them with results. Since "in normal ranges" is seldom sufficient for us to feel well, we like to see the ranges. A good way to report them is:
test result (reference range)
For example:
FT4 1.17 (0.8-1.8)
TPOab and TGab are both elevated. These two antibodies are the markers for Hashimoto's thyroiditis. Hashi's is autoimmune hypO and the most prevalent cause of hypo in the developed world.
Preliminary comments since I don't have ranges:
FT4 looks low in the range. FT3 ranges vary pretty substantially, so I won't take a guess at that yet.
Antibodies can be elevated for years, or even decades, before they cause enough damage to make your labs go out of range and cause symptoms (not necessarily at the same time...many people have symptoms with "in range" labs). Some doctors feel that it's best to treat early, thus reducing inflammation and avoiding unpleasant hypo symptoms, other doctors want lab values to go out of range and/or symptoms to appear before treating. There's a lot of reading online that will tell you both sides of this debate.
How do you feel? Do you have hypo symptoms? Why was your thyroid tested?
I don't know what your radiologist saw (which test was he interpreting?), but early stages of Hashi's can be characterized by swings from overactive to underactive as the thyroid sputters and "dies", so he might have jumped to an invalid conclusion. None of your lab work indicates Graves'.
test result (reference range)
For example:
FT4 1.17 (0.8-1.8)
TPOab and TGab are both elevated. These two antibodies are the markers for Hashimoto's thyroiditis. Hashi's is autoimmune hypO and the most prevalent cause of hypo in the developed world.
Preliminary comments since I don't have ranges:
FT4 looks low in the range. FT3 ranges vary pretty substantially, so I won't take a guess at that yet.
Antibodies can be elevated for years, or even decades, before they cause enough damage to make your labs go out of range and cause symptoms (not necessarily at the same time...many people have symptoms with "in range" labs). Some doctors feel that it's best to treat early, thus reducing inflammation and avoiding unpleasant hypo symptoms, other doctors want lab values to go out of range and/or symptoms to appear before treating. There's a lot of reading online that will tell you both sides of this debate.
How do you feel? Do you have hypo symptoms? Why was your thyroid tested?
I don't know what your radiologist saw (which test was he interpreting?), but early stages of Hashi's can be characterized by swings from overactive to underactive as the thyroid sputters and "dies", so he might have jumped to an invalid conclusion. None of your lab work indicates Graves'.
T4 Thyroxine 10.6
Total T3 100
Free T3 3.3
Free T4 1.17
TSH 1.530..............These are all in the normal ranges.
Thyroglobulin Autoantibodies 140 H
TPO Thyroid Peroxidase Antibodies 421 H.............These 2, my dr says
are high.
Total T3 100
Free T3 3.3
Free T4 1.17
TSH 1.530..............These are all in the normal ranges.
Thyroglobulin Autoantibodies 140 H
TPO Thyroid Peroxidase Antibodies 421 H.............These 2, my dr says
are high.
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thanks .