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Avatar universal

New and a bit confused and worried

I was diagnosed with hypothyroidism about 13 years ago and was put on Synthroid.  I'm a 53-year-old female.  About five years ago, my current doctor added Liothyronine.  I  have been on 88 mcg Levothyroxine and 25 mcg Liothyronine for a while now  My blood results from a few weeks ago included TSH .07 (.34-4.82), T4 (Thyroxine) Free .59 (.52-1.4), T3 (Triiodothyronine) Total 118 (60-181), and T3 Reverse 11 (8-25).  My doctor tried to explain to me twice how my TSH at .07 was normal, but I still don't understand.  She didn't change any dosages on my thyroid meds.

In the meantime, I've been having a lot of heartburn, constant sore throat (which doesn't look red when looking through my mouth because it's deeper down), a raspy voice, crackling sounds in the back of my throat, wheezing, and generally feeling really run down and tired. I saw an ENT who doubled my Prilosec for a month, put me on a heartburn diet, and has me doing nasal saline rinses twice a day.  A month later, the upper chest burn moved down to my gut (for which I will now see a gastroenterologist), but the throat pain and raspy voice were not any better.  Looking through my nose with a scope, he saw infection deep in my throat, so he put me on an antibiotic.  He also found a nodule on my thyroid, so he sent me for an ultrasound.

The ENT office called me late yesterday afternoon to tell me they had my US results and to make sure I keep my follow-up appointment, which isn't until Sept. 3.  Of course, my thought is that if the results were fine, they would have just told me that, so now I'm a bit apprehensive.  To add to all this, I'm anemic, type 2 diabetic, hypertensive, and have fibromyalgia.  I'm also a 7-year breast cancer survivor.

Does anyone have any thoughts for me about any of this, or do you need any more info?  Thanks for reading.
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Avatar universal
It's crazy that that doctors can have such radically different thoughts about proper diet.  I can understand that a regular person on the street might not grasp the too low/too high stomach acid concept, but you'd think that doctors, whom I'm sincerely hoping have a strong grasp of physiology, can't see the common sense of the facts right in front of them.

I saw my PCP on Tuesday.  She is going to recheck my iron in a few weeks, but I asked her a few times about a full iron panel, and she said it wasn't necessary.  Of course, I really don't understand the full reasoning myself, so it was hard for me to insist.  I will wait to question the thyroid levels until I get more information from the ENT on Wednesday regarding my thyroid ultrasound.  My PCP did call to get the results, but she could basically only tell me that it wasn't a nodule, but rather a suspect area 8 x 9 x 3 mm, and that I should recheck in six months.  That sounds relatively good to me, but the "recheck" part leaves a small nagging question in the back of my mind.  Nevertheless, I'll wait until I hear the official results.

After 10 days of antibiotics for my sore and infected throat (which could only be seen by the microscope through my nose), my throat is not any less sore and my voice is still raspy ... and I still cough up mucous that varies from yellow to green to white/clear. I think he is going to request a CT scan of my sinuses.

Then the following week, I see the new gastroenterologist, who will probably want to scope me.  Such fun...
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1756321 tn?1547095325
Pineapples contain the enzyme bromelain is very efficient at breaking down proteins. Some digestive enzyme supplements use bromelain as the protease (enzymes that digest protein). Peppermint is also used as a digestive aid. Distilled (white) vinegar is usually less acidic than cider vinegar. Organic, unfiltered apple cider vinegar also contains the "mother" of the vinegar which has raw enzymes and gut friendly bacteria that promote healing.

Excerpt from book The Hypothyroid Diet by Kevin Dobrzyski...

"Research has shown that people with hypothyroidism have lower gastrin levels of serum gastrin and other enzymes that are produced by the pancreas. Gastrin is responsible for the production of hydrochloric acid, which aids in the digestion of food in the stomach."

***

Excerpt from The Baseline Of Health Foundation article - Stomach Acid...

"The bottom line here is that most people are very confused about the role stomach acid plays in health. Most people:

Think they have too much, when in fact they have too little.
Treat the symptom and suppress stomach acid production, ultimately leading to long-term health problems.
Ultimately lose the capacity to produce sufficient stomach acid as a result of dietary abuse and continual use of medications to suppress the body's ability to produce it.

Don't get into that trap.

Use digestive enzymes with all your meals.
Drink aloe vera juice.
Use probiotic supplements with confidence.
Use proteolytic enzyme supplements with confidence.
And, if needed, use apple cider vinegar or betaine hydrochloride supplements to make up for stomach acid insufficiency."
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649848 tn?1534633700
COMMUNITY LEADER
One thing I learned a long time ago is not to "assume" anything when it comes to what the doctor will or won't do, because about the time I think I have their patterns down pat, they change one me... lol    

The hemoglobin A1c is only for the diabetes and has nothing to do with iron, but of course, it makes sense to retest the iron at the same blood draw, though I'm not sure how much your iron stores would increase in such a short time.

It's very possible that your doctor isn't ordering a full iron panel, because she doesn't know how to interpret it anyway; some don't.

Your vitamin D is good at 78, but since you're already supplementing, that's probably why.  Your vitamin B12, at 506 is suspect, because the range is so broad.  Many countries actually have 500 as the lower end of their range.  My lab puts a notation on the lab report that anything less than 500 can result in symptoms of deficiency, so your result of 506 is barely sufficient.  I have to keep my level at the very top of the range (range my lab uses is 200-1100) or above in order to keep deficiency symptoms at bay.

I understand the challenge of maintaining a healthy diet when we don't feel our best.  Like you, I'd love to resort to the mac and cheese, potatoes, creamy soups, gravy and all my favorite comfort foods, but when I started considering everything that was going wrong with my body, I knew I had to rethink my diet, as well as everything else.  Sometimes all the medication in the world isn't going to help us, if we work against it.  

I started out really slow, incorporating just one veggie with each meal, still holding onto some of my comfort foods, but putting some distance between them.  I started experimenting with new veggies that I hadn't previously liked to eat, tapping my friends for ideas/recipes to cook them, etc.  Now, I can't remember the last time I had mac & cheese, or a cream based soup.  I've managed to get my fasting blood sugar levels back under control by maintaining a low glycemic diet, though I'm still struggling with the hypo weight gain.

The one citrus fruit juice that I can't drink is orange, but I can eat a whole orange (better than juice anyway) - probably because of the added fiber.  I couldn't eat/drink most of the foods you have listed, along with others, for quite some time, and even when I added apple cider vinegar, I'd get heart burn, at first, but it didn't take long for it subside.  As the acid in my stomach and my thyroid hormones built, I had less and less heartburn.  
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Avatar universal
Regarding the low iron, I forgot to mention that I'm pre-menopausal (will it ever end??), and I generally have 1-2 very heavy days of bleeding each month.  My doctor seems to think this may be the cause of my low iron.  I've had this problem (low iron) on and off for a while, which makes me wonder why she hasn't asked for a full iron panel.  Could it perhaps be because she isn't proficient in interpreting it?  In that case, what good would it do to have her order it?  It seems this could be the case for many blood test that aren't normally requested.  Are we stuck between a rock and a hard place?!
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Avatar universal
I just reviewed my labs and I have 48 different results, but the only one that seems to be related to iron is the "Iron Level" one.  I only increased the iron about two weeks ago.  I assume she'll check it again when they redo my hemoglobin A1c in about three weeks.

They did test my Vitamin D 25-Hydroxy Level, and it was 78 ng/mL (normal: >30).  I do take supplemental Vitamin D3.  Also my vitamin B12 Level is 506 Picogram/ml ( normal: >180).  I do not currently take any B supplements. So, it appears to me that those are both okay, if not high.

As for my diet, I've been a bit challenged over the past few weeks because of the increased heartburn and gut discomfort.  Ideally, I wish I could live on Mac and cheese, grilled cheese, soup, muffins, potatoes, creamy things ... because those are all comfort foods for my belly.  But I do try to do better than just that!  However most of the healthy things like veggies and other bulky foods, even meat, don't really appeal to me right now.  But I am working on that.  Also because I'm run down, I don't feel much like preparing food, so I often grab and go.  I know very well that diet is a HUGE part of good health, but as I said at the beginning of this paragraph, it's challenging right now.

I have heard about the low/high acid concept, and I'm curious about that. The ENT has me off spicy foods, caffeine, alcohol, chocolate, mint, citrus, vinegar, tomato, pineapple, and fatty/greasy foods for the past six weeks.  In that time, I have very little desire for coffee or citrus because they make my gut hurt just by thinking about them.  I had a small bit of lemonade by mistake and felt horrible the rest of the day.  On the other hand, I had a couple pieces of pepperoni pizza one day (because it was the only choice) and I felt fine afterwards.  But I have read in particular about apple cider vinegar helping with reflux/heartburn and have wondered if it has a different chemical makeup than white vinegar.  And I have read that mint is both good and bad.  Same with pineapple.  I don't know what to believe!
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649848 tn?1534633700
COMMUNITY LEADER
It's too bad your pcp wouldn't take kindly to suggestions you received online, as it sounds like she's one who goes only by reference ranges ("if it's in range, it's good") and that's too bad, because those doctors often leave their patients very ill for lack of adequate medication. It's too easy for them to diagnose something like fibro and prescribe other medications to deal with the remaining symptoms.  

Yes, try splitting the T3, but it's possible/probable that you simply aren't on a high enough dosage...  You most likely need a higher dose of the levo to start with and go from there.  

That looks like a ferritin level and range, rather than iron. Ferritin is the iron storage hormone.  Did you have a full iron panel?  Have you had ferritin retested since you've been taking the iron pills? If your iron was low, then you have iron deficiency anemia, as opposed to vitamin B-12 deficiency or Pernicious Anemia.   Iron is necessary for the synthesis of thyroid hormones, though, so you want to make sure you get that up.  Low iron levels also cause fatigue and other symptoms.

The metformin should get the diabetes under control, so long as you maintain a low glycemic diet... you are doing that, aren't you?

I know the nodule is concerning you and I don't want to concern you further, but we'll go there.  Less 5% of all thyroid nodules are anything to worry about.  Maybe it's because you've already had cancer, that your ENT's office called and wants to be sure you come for the appointment.  That may put you at greater risk.  Thyroid cancer is one of the easiest to cure, as it's done by removal of the thyroid.  That leaves one with hypothyroidism, which you already have and your thyroid will eventually "burn out" and completely stop working, if it hasn't already, anyway.  But of course, while this is a possibility, we never buy trouble.

All of your symptoms are those of hypothyroidism and we should hope that your ENT is having you come in so they can give you a referral to an endo.  It's hard to say whether you're getting a good endo or not, until you actually get there.  The first clue will be in which blood tests they order.  If they order Free T3 and Free T4, along with TSH, that's a good sign.  If they order only TSH or look only at the TSH result, run away quickly.  Also run quickly, if they tell you that your results are "in range, so you're fine"... that's not true, as you can plainly see, by your current results.

In the meantime, since your ferritin was so low, I might suggest that you ask your doctor to test vitamin D and B-12 levels, as well.   Vitamin D deficiency can cause quite a few hypo-like symptoms.  B-12 deficiency can cause horrible fatigue and that run down, tired feeling you mentioned.  If left untreated, it can cause easy bruising, numbness and tingling in the hands, feet, legs.

As far as some of your symptoms - the heartburn, acid reflux, etc... some of us have found that to be caused, not by too much acid, but by too little.  When I was severely hypo and first came to the forum, someone suggested that I try drinking dill pickle juice or water with apple cider vinegar and a little sugar.  I thought they were nuts, but I tried it one night and it actually worked - for ages, my dill pickles never had much juice in the jar... lol.  Another thing that worked for me was peppermint oil pills and peppermint tea as well as ginger tea.  Yeah, I was so desperate, I'd try anything... lol  They didn't all work every time, but sometimes one thing would work, when others wouldn't.
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Avatar universal
I appreciate all the time you took to thoroughly explain all of this to me, Barb.  I am awed by the depth of answers people on this forum provide, so thank you!

I see my PCP again on Tuesday. She's the one who ordered the blood tests and prescribes my thyroid meds.  However, it was the ENT who ordered the thyroid ultrasound and has my mystery results. So I'm kind of stuck in the middle right now.  I know that my PCP would not be receptive to advice I got on the internet. I'm kind of hoping that the ENT sends me to an endocrinologist, but how will I know if it's a good one??  

As you mentioned, I believe that getting my thyroid meds in a good place will alleviate a lot of my fibro issues - at least that is my hope.  I'm getting tired of symptoms getting blown off because it's just "a fibro thing."

I will try splitting my T3 med in two doses and see if that makes a difference.  I did not take the thyroid hormones the day of my blood draw, so the results should be accurate.

I don't know what type of anemia I have, but my iron level was 23 (range: 50-170). I am now taking two iron pills a day.  I have been diabetic for over five years, but since my A1c stayed in the "6" range, I was controlling it with diet.  But with these last labs, the A1c jumped to 7.8, so I just started taking Metformin (500 mg 2x day) a few weeks ago, without incident.

I'm only concerned about the nodule because the doctors office called and said they had the results and that I had to come in - and I assume that if everything was fine, they'd just tell me on the phone.  It may sound crazy, and y'all may educate me differently, but I'm almost hoping it is something (treatable, of course) that can be taken care of so I can finally start feeling better.
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649848 tn?1534633700
COMMUNITY LEADER
TSH is a pituitary hormone that stimulates the thyroid to produce more thyroid hormones.  It's often suppressed when one is on thyroid replacement hormones, particularly, one with a T3 component, such as the Liothyronine.  TSH is mostly irrelevant, so in this your doctor is correct.

Your Free T4 level of only 0.59 indicates that you are still quite hypo as your level is only at 8% of the range.  Rule of thumb is for FT4 to be approximately 50% of it's range - that seems to be where most of us feel best.

Unfortunately, Total T3 is considered to be obsolete; however, even at that, your level is quite low in the range, at only 47% of the range.  FREE T3 is the best test, as that's the hormone that's actually used by individual cells.  Rule of thumb (where most of us seem to feel best) is for FT3 to be in the upper half to upper third of its range.  With your TT3 as low as it is, it's safe to say that your FT3 would be low, as well.

Additionally, your symptoms of heart burn, the raspy voice, etc are all those of hypothyroidism.  The symptoms of fibromyalgia are also those of hypothyroidism and most often are alleviated when adequate doses of thyroid hormones are given.

Do you take your T3 medication (liothyronine) all at once in one dose or do you split it into 2 doses?  Because T3 is fast acting and only stays in your blood for a few hours, most of us on T3 med find that splitting it into 2 doses throughout the day keeps our level more stable and helps alleviate symptoms better.  For instance, I'm on 10 mcg/day and I take 5 mcg in the morning with my Levoxyl and 5 mcg around lunch time.  Also, had you taken your thyroid hormones prior to the blood draw that day? Again, because T3 is fast acting, if you had taken it prior to the blood draw, your T3 result would be falsely high.

Thyroid nodules are very common and, typically, are nothing to worry about, unless they have unusual characteristics.  Most of us on the forum have nodules.  I, personally, have several of them.

What type of anemia do you have?  Are you on medication for your Type II diabetes or do you control it with diet?  
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