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More blood test results and a possible goitre/nodule

Hi, following on from my last posted question I have received more results and would like some input.

Ferritin - 21 (30-400)
Folate - 4.9 (4.6-18.7)
Vitamin B12 - 362 (180-900)
Magnesium - 0.89 (70-1.00)

So, if my TSH is normal at 0.36 (0.2-4.2), why does the front of my neck feel like it's fizzy/full of bubbles and that there are a few defined lumps? Would the increased FT3 at 6.9 (3.1-6.7) and/or the FT4 at 25.1 (12-22) be responsible for it? Would the antibody test I have booked in for next week show something? I am on 125mcg Levothyroxine. Doctor didn't want to reduce the dose even though she has noted the latest thyroid hormone figures. I can't understand why she did this. Thanks!
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Avatar universal
Don't worry about missing my previous post. I'm glad you replied. :)

No, she didn't say why she increased the medication.

I have the test results here, they came much quicker than expected.

TSH: 0.02 (0.2-4.2)
Free T3: 6 (3.9-6.7)
Free T4: 20.3 (12-22)
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649848 tn?1534633700
COMMUNITY LEADER
Sorry I missed your previous post, somehow.  

OTC (Over The Counter) supplements are those that can be purchased without a prescription. I'm pretty sure you can't get them free with your medical exemption card, since they don't require a script.

Your doctor has increased your medication since we began this thread?  Did she say why?  TSH is the only thing being tested tomorrow?  Can you get the FT3 and FT4 tested, as well?

Be sure to get a copy of the lab report.

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Avatar universal
I have an appointment booked for Friday with a doctor who kind of shrugs off every symptom I have and saying it is not hypothyroid. I am worried, she has increased my thyroid medication from 125mcg to 150mcg but my labs do not suggest I am anywhere near hypo! I have a blood test scheduled for tomorrow morning for TSH. I don't know what to expect.
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Avatar universal
Thank you. :)

With the OTC potassium supplement is that something I don't have to ask the doctor for? I have a medical exemption card so I'm not sure if by having a medical exemption card means I can access prescriptions. I know I can get my prescriptions free but not sure about OTC medication.

Yes, I was tested for coeliac disease and it was normal. When I told my doctor my symptoms when eating dairy/wheat/gluten she didn't suggest retesting me for coeliac and she said my symptoms are not due to an intolerance.

I eliminated gluten first and then dairy. I can't remember exactly how long I stayed off gluten before I eliminated dairy but I believe it was about a week or so. Maybe doing again what you suggested for a longer time period - i.e. eliminate gluten for 2 weeks, say and then eliminate dairy might work.

I'll make a list of all these things and bring them to the next appointment with my doctor - which isn't yet - but I'll look at bringing them to their attention soon.
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649848 tn?1534633700
COMMUNITY LEADER
You shouldn't strain to go to the bathroom; that causes hemorrhoids and other uncomfortable symptoms... since it's rather apparent that you're most likely going to go later in the day, it's best to just wait and let it happen naturally.  Even if you don't go pee very many times/day (I don't either) you should still make sure you drink plenty of water, because that can help make your stools less hard.

My potassium levels are always good on the blood work, too, but when I get the cramps, I find that if take an OTC potassium supplement along with drinking plenty of water (has nothing to do with making you pee, simply keeping you hydrated), I don't have them.  You can mention this to your doctor. You have to be careful, because too much potassium is just as bad/worse than not enough.

Have you ever been tested for celiac disease?  That's another autoimmune disease in which a person truly can not eat gluten at all.  Those people must stay off gluten for life.  If you feel better off it, then I'd advice asking your doctor to test you for celiac.  You might also ask to tested for wheat allergy, which is different from celiac. Some people are gluten intolerant, others are allergic to wheat and others can't tolerate either.  Did you eliminate gluten and dairy at the same time?  If so, you don't really know if you are intolerant of them both.  You should try eliminating them, one at at time;  for instance, try going off gluten and continue with dairy in your diet.  If you feel better, you'll know that gluten is the culprit.  If you don't get any better, add back in the gluten and go off dairy.  If you get better, you'll know that dairy is the offender, but if you still don't get any better, you can figure they both are. Making more than one change, either to diet, supplements, meds, etc is, typically not recommended, because then you don't know what works or what causes problems.

Most people with gluten/dairy intolerance have to stay off them for life, but some people can stay off them for 6 months to a year, then add them back in small quantities and be okay, unless they have celiac, then gluten is out for life.

Since we usually can't "feel" when our blood pressure changes, we can't make assumptions as to whether it's high or low and blood pressure can change in a matter of seconds, depending on whether one is sitting still, relaxed or if one is up moving about.  That's proven by the readings you just posted... look how it went up, simply by going from a sitting position  -to a standing position.  While it did increase, it's by no means hypertensive... I wish my blood pressure looked like that.

Antibodies don't increase/decrease the heart rate; it's the hyper/hypothyroidism caused by the antibodies that cause the symptoms.

It's also normal for the heart rate to increase when you move around, but I think we're safe in saying that your elevated heart rate (though "in range") is most likely due to the over medication.

You should make a list of all these things and bring them to the attention of your doctor, at the same time, asking for additional testing for celiac.
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Avatar universal
Thanks, yes, the constipation is a tricky one. I only get it at the times stated but the stools come out hard. I do strain sometimes. I only go to the toilet (pee) twice a day, three times if I'm lucky. Increasing how much I drink doesn't seem to make much difference. I'm under investigation with a urologist about that but they now believe it's a neurological issue as the bladder ultrasound was normal.

Yes, I get the cramps even when my partner does not massage them. They're kind of like growing pains. Potassium levels are always good in range I believe. My last reading was 4, normal range 3.50 to 5.30. That seems rather low actually and that was in July.

Yes, I eliminated gluten, wheat and dairy from my diet for 3 weeks. There was some improvement in my symptoms, mainly the fatigue and the constipation. Looks like going gluten-free might be best but seeing as the symptoms I have (that are possibly from eating gluten/wheat) then maybe I would need to be off gluten and wheat for life as opposed to staying off it for the same amount of time as before. Unless just increasing the time off it would be better.

I used to check my blood pressure on a regular basis, that started after I had a hypertensive reading, but when more normal readings kept coming back I stopped.

From that point onwards I then assumed that I've been getting feelings of blacking out from blood pressure problems on the odd occasion and that was what I had always thought.

I've just done a reading to check.

Sitting normally - 112/69 heart rate 81
Standing from sitting - 116/72 heart rate 89

Probably not low blood pressure, but that is only just one reading. Maybe tracking it every day at the same time might help.

My heart rate used to be half that before this antibody reading was done.
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649848 tn?1534633700
COMMUNITY LEADER
I understand the weight loss.  That's definitely a symptom of over medication.

As for the constipation... I don't understand that at all.  Just because you may not be using the bathroom in the morning, doesn't mean you're constipated.  Constipation is when stools are very hard and one is unable to use the bathroom in spite of the feeling of a constant need; often for days at a time.  Since you're using the bathroom at other times of the day, you wouldn't be constipated.

Do you get the cramps in your feet/legs when your partner does not massage them?  If not, I'd suggest that you not have him do the massages.  If you get them all the time, you might monitor your fluid intake or ask your doctor to check your potassium levels.  I get cramps if I don't drink enough water or if my potassium level drops too low.

The slow movement, depression and anxiety can apply to either/both over and under medication.  With your levels what they were, we can still say over medication.  Same goes for the heat intolerance.

Have you tried eliminating gluten/wheat/dairy from your diet?  If these foods are causing such immediate stomach distress, it's probably best to simply not eat them at all.

High blood pressure could be related to over medication, but if it's usually normal, it's probably due to anxiety.  

Feelings of blacking out when changing from sitting to standing??  Usually related to low blood pressure.  Are you checking your blood pressure on a regular basis to determine whether it's actually high, low or normal or just going by how you feel?  Actual changes in blood pressure, typically, can't be felt, except for the light headed feeling when standing quickly, etc.
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Avatar universal
Thanks for responding, I spoke to my doctor about this, she says it's Thyroid Peroxidase Antibodies, so Hashimoto's.

No worries about missing the last post. :)

Yes, I am still on the same dosage of medication, 125mcg.

The answer to your last question is going to be complicated, sorry.

The symptoms I still have:

- Weight loss - now underweight and my bones are showing through my skin, more so at my knees, shoulders, collar bone, ribs and hips. BMI is also in the underweight range, too. This now occurs all the time.

- Constipation - happens after eating something in the morning between 9am to 10.30am. I have no idea why. I get this every day but only in the morning.

- Sensations in thyroid area - more like just pain now but also goes sore. Comes and goes.

- Cramps in legs and feet - most prominent in the evenings when my partner massages my feet in bed. It's either him or I have bad circulation! Only happens at night when in bed.

- Fatigue - still there, occurs all day.

- Tremor in left hand still there, haven't noticed the other one. Occurs all day.

- Migraines - gone.

- Headaches - mostly occur in the backs of my eye and above my eyebrows. Comes and goes.

- Joint pains - in my knees, hips and ankles. Comes and goes, worse just before it rains.

- Slow movements - still there.

- Depression - comes and goes.

- Anxiety - I get very anxious in crowds, public places. It's worse when I am near a shop/shopping mall and if there are lots of people around me I get tense and "phase out".

- Heat intolerance - this is more apparent now, I have been walking around outside in a dress and everyone around me is wearing cardigans and coats yet I still feel warm. Occurs all day, worse when outside/in hot weather.

- Food going right through me - seems to only happen with gluten/wheat/dairy, but this is still happening. Sometimes it happens within 10 minutes, other times it happens within 30. When I eat a biscuit it takes 10 minutes for me to want to go to the toilet, if it's bread it takes 20-40 minutes. Occurs every day but only at the times stated.

- High blood pressure - comes and goes. Most of the time it's normal, sometimes it goes high.

- Feelings of blacking out when standing from sitting - still there.
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649848 tn?1534633700
COMMUNITY LEADER
Which of the thyroid antibody tests did you have done... That looks like it might be Thyroid Peroxidase Antibodies (TPOab), but not sure.  If so, that would be the basis for a diagnosis of Hashimoto's.

Sorry I missed your last post - your symptoms are mixed.. some are those of hypothyroidism, others are those of over medication, as your labs indicated.  Are you still on the same dosage of medication?

Are you still having the same symptoms and do you have them all, all the time or do some of them come and go?
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Avatar universal
Thyroid autoantibodies have been tested and the results are here:

Thyroid Autoantibodies - 141 kIU/L (<34)
Doctor's notes - Elevated level
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Avatar universal
Thanks for reply, I had an ultrasound done in March, that was normal. I don't know how often I should be booking one but my doctor has put me on antidepressants in the past when I have said I have swallowing difficulties.

Vitamin D has been tested back in June, that was 60 (50-75 sub-optimal)

I haven't had either of the antibody tests, no.

Symptoms I have:

- Constipation
- Difficulty swallowing
- Fizzy feeling in neck, in thyroid area, but could be wrong
- Cramps in legs and feet
- Fatigue
- Tremor in left hand only and also feeling of a tremor in spine (sounds weird but I can't describe it any better than that!)
- Migraines
- Headaches
- Joint pains
- Stiff joints
- Slow movements
- Depression (comes and goes)
- Mood swings
- Anxiety
- Weight loss
- Heat intolerance
- Sweating a lot
- Generally not feeling very well
- Food (mostly gluten/wheat/dairy) going right through me within 20 minutes of eating it. I thought it was rapid gastric emptying but that is only applicable to people who have gastric surgery and I haven't had gastric surgery...
- High blood pressure
- Heavy/early/painful/long periods
- Feelings of blacking out when standing from sitting.

I think that's it.
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649848 tn?1534633700
COMMUNITY LEADER
Have you had a thyroid ultra sound done to determine if you have nodules on your thyroid?

It seems to me that your doctor is being very lax when it comes to your actual levels.  One thing people, including doctors mistake is ranges... they tend to think that just because something is "in range" that it's okay or good and that's definitely not the case.  Many vitamin/mineral levels need to be relatively high in the ranges in order to alleviate symptoms.  

Your fatigue could be caused by a number of things, including, but not limited to too high levels of thyroid hormones, too low levels of B-12,  ferritin/iron, folate, magnesium, vitamin D (has that been tested?), etc.  Cramps could be caused from magnesium deficiency or too low potassium levels, as well as other things.  The tremors could be from the over medication, which causes symptoms of hyperthyroidism.

Even though your appointment ran over in time, you are entitled to answers to your questions and you should never be made to feel like you are "wasting" the doctor's time.  The doctor is working for you and it's actually a waste of your time to leave an appointment with an unsatisfactory response from your doctor.  She's leaving you over medicated on thyroid hormones and with too low vitamin/mineral levels that can also cause adverse symptoms - you have a right to know why you aren't getting optimal treatment.

The TPOab test will determine whether or not you have Hashimoto's Thyroiditis.  You should also be getting a Thyroglobulin Antibodies (TgAb) test, if you haven't already had it, which is another marker for Hashimoto's.  You need them both, since some of us have one or the other, some have both.

Can you please list the symptoms you're having, along with the cramps, fatigue and tremor listed above?

Have you had a thyroid ultra sound?  That would determine whether or not you have nodules on your thyroid, which could give that bumpy feeling.  If you haven't, you should ask for one.
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Avatar universal
Thanks, sorry, I didn't mean to start a new thread. It was only because I thought it was for a new topic...

The doctor gave no explanation as to why I couldn't lower my dose. I don't know what else I can do as I already had a ten minute appointment that carried over into twenty minutes and I didn't want to waste her time in questioning her. Maybe I should have?

No, I haven't had a supplementation for iron, nor a dosage.

No, she didn't ask me to supplement folate.

She didn't ask me to supplement B12 either.

Nothing was said about magnesium, I thought my level was pretty good considering I thought I had symptoms of magnesium deficiency! (Cramps, fatigue, tremor)

I am scheduled for Anti-TPO tests, I believe. Doctor just said "thyroid antibody tests".
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649848 tn?1534633700
COMMUNITY LEADER
It's usually easier to keep all your questions and lab results in the same thread.  That way we know what all you've posted and the responses you've received, so we aren't duplicating.

Both your FT3 and FT4 are over range, so I'm having a hard time understanding why your doctor didn't want to lower your levo dosage.  What explanation did she give?  If she didn't give one, you should insist that she explain why she's leaving you over medicated.

That said, your ferritin is low, indicating that you need to supplement iron; has she recommended a dosage for that?  Your folate is also too low; did she recommend supplementing that?  What about B-12?  Even though it's "in range", it's way too low.  Vitamin B-12 should be in the upper portion of the range - the range my lab uses is 200 - 1100 and I have to keep my level at or above the 1100 mark in order to feel well.  Your magnesium is also too low in the range -- magnesium deficiency can also cause multiple symptoms.

If your doctor hasn't recommended supplementation for the above vitamins/minerals, plus she's keeping you over medicated for no apparent reason, you might want to think about finding a different doctor.

What antibody tests are you scheduled for?  
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