Please - any feedback greatly appreciated!

[knowledge08]

Hello Dr. Lupo/ Thyroid support community:  

I am a 27 year old, healthy female. As a registered nurse, I believed that the "more than usual" fatigue I was experiencing approx 7 months ago coupled with insomnia and an approx weight gain of 8 pounds was related to the physical toll a night-shift schedule demands.

(1). However, in late April I noticed an enlarged submandibular lymph node and was sent for an neck ultrasound and bloodwork in Ocotober '08. All lab values were within normal range (including the Free T4) except for TSH which was at 8.53 on October 17/2008.
(2). Another Thyroid lab level taken on October 22/08 revealed normal Free T4 but a TSH level decrease to 4.61. An neck ultrasound done at this same time revelealed multiple lymph nodes (largest measured at 2.2 x 1.5 x 0.5cm) which is entirely non-specific. Another physician ordered a Chest xray which found everything within normal limits and no acute process was identified.
(3). The last labs drawn Oct 31/08 found normal lab values (including Free T4) except the TSH now increased to 6.85 (from 4.61). I am now to do a thyroid antibodies and prolactin levels ( due to greenish-gray nipple discharge on one breast which occurs only on manipulation, not spontaneously).  The GP suspects this is hypothyroidism but will not look at treatment till the lab values come back.

I would greatly appreciate your clinical insight into the above mentioned. At this time, a family gp is following this but should this be dealt with by an endocrinologist? Are my fluctuating TSH levels indicative of Hashimotos? As well, once on thyroid medication, is there weight gain attributed to the thyroid medications? Which thyroid medication, if any, do you judge to be most beneficial in my scenario?

Thank you for the valued feedback.

[amela321]

I'm guessing you meant to post this to Dr. Lupo's forum which is at http://www.medhelp.org/posts/show/forums/120 ; Sometimes if the question limit is reached there, it will offer you other forums and I think that's how you got here.  I am not a doctor, but your TSH level suggests hypothyroidism.  I'm guessing your doctor is wanting to see if this is being caused by Hashimoto's.  Again, I am not a doctor, so take this for what it's worth.

I do think it would be worth it to get a referral to an endocrinologist.  They definitely are more specialized and perhaps could move things along for you so you can start treatment.  

Taking the thyroid medication itself does not cause weight gain as far as I know.  Normally, being hypothyroid can cause weight gain, though in some (myself included) they gain weight when hyper and lose when hypo.

Good luck to you and take care!

Amy
Papillary thyroid cancer
First diagnosed 1985
Recurrence 2008

[gimel]

With three different lab tests showing TSH levels above the current range of .3- 3.0, I don't know why the doc is still waiting for more lab tests.  The most important thyroid test for you would be free T3, which is the active component that most regulates your metabolism.  If I were you I would check body temperature for several times a day for several days and compare the average to the optimal of 98.6, and use this info plus symptoms and blood test results to push your doctor to prescribe med.   The most likely med. that will be prescribed will be a T4 type.  Assuming adequate dosage levels, and depending on your body's ability to convert T4 to the active component T3, this might be adequate to get your T3 into the upper part of its range and alleviate symptoms.  If not, you might require a T4/T3 regimen, such as Armour thyroid.  Whichever approach is taken should increase your metabolism and cause a weight loss, not a gain.  

[knowledge08]

Thanks Amy and Gimel your appreciated feedback!
Do either or both of you have hypothyroidism?

I will most definitely get a referral to an endocrinologist which will provide more direction towards my treatment. I need to have a free T3 level done, as well. Dealing with this has been frustrating at times but I have been educating myself on thyroid disorders and treatment options. I have read on several forums that after starting on thyroid meds, people gain weight - with your experience, do you believe that this weight gain is related to the medication solely or a lack of physical activity/poor diet. What has your experience been with thyroid medication?  


Thanks again for your responses...I appreciate it. Have a great day! :-)

[gimel]

I have been hypo t for many years, following Hashi's.  My doctor finally decided to try me on thyroid meds., after I told him about my low body temperature and many other symptoms.   I was always fatigued, couldn't get enough sleep, gained weight, etc.   After I was ramped up to a full daily replacement level of thyroid, my symptoms went away, i lost weight back to my normal level and I felt great.  Since thyroid is so vital to metabolism, I'm not sure how a proper dosage of thyroid med. that would get your free T3 into the upper end of its range, could ever cause weight gain.  Perhaps anyone who has had a different experience was not getting the right prescription and dosage, or as you mentioned, other factors were involved.

[Thypatient]

Hope if you did submit a question to the dr it gets answered.

Here is a link with info that might help you:

http://www.thyroid.org/patients/brochures/Thyroid_and_Weight.pdf

In fact, the whole site is helpful too.

I know it can be frustrating but hopefully an endo will help you.

Good luck.

[kitty9309]

I also had insomnia at a TSH of 6. Anxiety as well. All the doctors told me that being hypo doesn't cause this. Not true.
Your levels are certainly high enough to be treated.