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I think I have hypothyroidism?
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I think I have hypothyroidism?

Hi everyone, I'm new here, thanks in advance for your help! I'm trying to find a new doctor who will listen to me (my current one dismissed my swallowing irregularities as heart burn).  I'm almost positive I have hypothyroidism. My questions are: 1) Who do I need to see? I hear endocrinologists are reluctant to diagnose hypo if the test comes back on the low side of normal, should I just find another general doc? 2) What tests should I ask for? I here the more detailed thyroid test is expensive, how much more?
Here's my history/symptoms: My grandpa, grandma, and mom all had hypo. I have been tested before, and was not diagnosed because although low, I was still in the normal range (this was a few years ago). My symptoms have since gotten worse. I have cold hands and feet, and I feel cold all the time. I take my basal body temp for birth control reasons and my average is way below normal - around 96.8. I have a history of mild depression. I have bad cramps and heavy periods. I feel tired a lot and if I could get 10 or more hours of sleep a day, I would. I feel mentally sluggish - I used to have a very high IQ, and lately I've been feeling like I'm stuck in first gear. I've occasionally get a  strange sensation in my neck - the only way I can describe it is it feels like my esophagus gets stuck over my trachea and then it hurts to swallow until it pops back, and then it feels fine. I get heart palpitations about once every couple months.  I also have a history of sinus infections and frequent UTIs. I am not overweight, and I don't have hair loss or any other symptoms I recognize.
I would normally just live with this but my husband and I are ready to get pregnant. I'm so scared that I will miscarry or have birth defects because of this. Any comments/suggestions at all would be appreciated. Thanks!    
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649848_tn?1357751184
If you haven't been tested for several years, you should do so before getting pregnant.  If your doctor is unwilling to test you, by all means, find another.  

I'm going through that situation with a 91 yr old aunt right now; her TSH is in the lab's normal range, but the lab is using an outdated range; in addition, her FT4 is "in range", but just barely, so the doctor is refusing treatment and my aunt is refusing to go to another dr. I'm caught in the middle; knowing she needs treatment, not getting it, so will remain sick, no matter what other meds they give her.

Yes, a lot of doctors (not just endocrinologists) refuse to treat if results are "borderline", which makes it very hard for some people to get well. You can get tested by any type of doctor who is willing to give you a lab order.  Since you are trying to get pregnant, maybe you could get your ob/gyn to give you a lab order. There are also some labs that will do blood work without a doctor's order, so that might be an option.

The tests you need to get are: TSH (thyroid stimulating hormone); Free T4, Free T3 (don't let them test you for Total T4 and Total T3, because those tests are obsolete and tell you nothing helpful).  You should also get tested for antibodies: TPOab (thyroid peroxidase antibodies, also sometimes called microsomal antibodies) and TGab (thyroglobulin antibodies).  These antibody tests will tell you if have Hashimoto's thyroiditis, which is the # 1 cause of hypothyroidism in the US.  A thyroid ultra sound would most certainly be in order, especially, since you have the swallowing difficulties and will also help confirm/rule out Hashimoto's.

I was in a position some time back where I felt like someone had a thumb pressed against my throat all the time, but my pcp refused to send me for an ultra sound; my ENT got concerned though and HE sent me for one.  I found out that I have a multinodular goiter (swollen thyroid with nodules).  My pcp had also refused to send me for the antibody tests, as well, so the ENT got those done, too.  It was ultimately, the ENT who referred me to my endo, because once again, my pcp was keeping me sick.  

When looking for a doctor to treat thyroid issues, you should first confirm that they are willing to treat symptoms over lab results AND that they are willing to test for and adjust the free T3 and free T4 in order to alleviate symptoms. Many doctors go only by TSH - if yours does, RUN as fast as you can.

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649848_tn?1357751184
If you haven't been tested for several years, you should do so before getting pregnant.  If your doctor is unwilling to test you, by all means, find another.  

I'm going through that situation with a 91 yr old aunt right now; her TSH is in the lab's normal range, but the lab is using an outdated range; in addition, her FT4 is "in range", but just barely, so the doctor is refusing treatment and my aunt is refusing to go to another dr. I'm caught in the middle; knowing she needs treatment, not getting it, so will remain sick, no matter what other meds they give her.

Yes, a lot of doctors (not just endocrinologists) refuse to treat if results are "borderline", which makes it very hard for some people to get well. You can get tested by any type of doctor who is willing to give you a lab order.  Since you are trying to get pregnant, maybe you could get your ob/gyn to give you a lab order. There are also some labs that will do blood work without a doctor's order, so that might be an option.

The tests you need to get are: TSH (thyroid stimulating hormone); Free T4, Free T3 (don't let them test you for Total T4 and Total T3, because those tests are obsolete and tell you nothing helpful).  You should also get tested for antibodies: TPOab (thyroid peroxidase antibodies, also sometimes called microsomal antibodies) and TGab (thyroglobulin antibodies).  These antibody tests will tell you if have Hashimoto's thyroiditis, which is the # 1 cause of hypothyroidism in the US.  A thyroid ultra sound would most certainly be in order, especially, since you have the swallowing difficulties and will also help confirm/rule out Hashimoto's.

I was in a position some time back where I felt like someone had a thumb pressed against my throat all the time, but my pcp refused to send me for an ultra sound; my ENT got concerned though and HE sent me for one.  I found out that I have a multinodular goiter (swollen thyroid with nodules).  My pcp had also refused to send me for the antibody tests, as well, so the ENT got those done, too.  It was ultimately, the ENT who referred me to my endo, because once again, my pcp was keeping me sick.  

When looking for a doctor to treat thyroid issues, you should first confirm that they are willing to treat symptoms over lab results AND that they are willing to test for and adjust the free T3 and free T4 in order to alleviate symptoms. Many doctors go only by TSH - if yours does, RUN as fast as you can.

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Thanks Barb, that really helps! I like the idea of asking my ob/gyn, since I have to go anyway I'll give that a shot first. Sorry about your aunt, if this is a pain in the butt for me at 25, it's gotta be a nightmare when you are older. I wish more doctors would educate themselves on this. I've heard of the ultrasound before, I really wonder if that would show something.  The funny thing is my swallowing problems seem to come and go. I'll have a bunch of "episodes" one month, and then go for months without one. So if I do get an ultrasound I almost feel like I should wait for the symptoms. I hope I can get this taken care of, I feel like I've been living with symptoms for so long I can't even imagine what it would be like to be normal.
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649848_tn?1357751184
The feeling I get in my throat, also comes and goes, sometimes I think it is stress related; other times, it seems to coincide with what I call a "Hashi attack", which seems to be when there's inflammation, with or without stress.  Stress is very detrimental to thyroid issues.  

Well, yes, I must admit it's a real pain the butt................lol.  It's horrible no matter how old one is.  I'm luckier than most, because my TSH came back with a really high number, which left no doubt regarding a diagnosis; before that, one doctor had "blown off" all my symptoms as hypochondria; another insisted it was depression, when in reality it was pernicious anemia, hypothyroidism/Hashmoto's, even when my lab's came back "normal".  Vitamin B12 shots and thyroid med made a world of difference.  My aunt is the one I feel sorry for as she doesn't understand how important thyroid hormones are; she thinks she feels this way simply because she is old and although that has a lot to do with it, I don't believe it's the only issue; so she's not helping me, help her.

In your case, an ultra sound will show whether or not you have nodules on your thyroid; it's always possible that there could be something pressing against your esophagus that the doctor can't necessarily feel by palpitation.  My ultra sound showed nodules that the doctors couldn't feel.

Your ob/gyn can order all the tests, then decide if you need treatment or a referral to an endo.  When you do get the tests, make sure you ask for a hard copy of the lab report; you should always get copies for your own records. Once you have the tests done and a copy of the report, post the results, along with the reference ranges here, since these are lab specific so must come from your own report. That will allow us to give a more educated response.
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