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Please Help!
I have felt for a long time as if I've had thyroid issues. The past two years, my symptoms have continued getting worse. I have many more symptoms, including my hair falling out extreme amounts, muscle cramps, unable to lose weight, fatigue, extreme dry skin where it resembles snake scales and trouble sleeping. And now, add pulsatile tinnitus to the list. It's in my right ear, the same side as my thyroid is enlarged on. I also have a nodule on my adrenal gland.
Last year, my endo ordered standard testing and I requested T3 and T4 also. She didn't want to run those tests, but she did because I asked. I'll list all my test results below. I also have an enlarged thyroid {ultrasound results below}, especially on the right side.
Once we entered my appt, all the Dr. wanted to talk about was my weight and kept pushing for gastric bypass. I tried to explain all my thyroid symptoms which corresponded with the labs, and her response was she's the Dr.
I'm feeling at a loss here. Can someone review my labs and ultrasound and tell me I'm not crazy?!
LABS
Free T4 - 1.3 {normal range 0.8 to 2.7}
Free T3 - 205 {normal range 210 to 440}
Triiode Thyronine - 113 {normal range 76 to 181}
TSH - 0.75 {normal range 0.45 - 5.00}
ULTRASOUND
RIGHT LOBE
Ant-Post: 1.33 cm
Volume: 9.9 ml
Transv: 2.79 cm
Sag: 5.10 cm
Echotexture: Homogeneous
LEFT LOBE
Ant-Post: 1.21 cm
Volume: 5.3 ml
Transv: 1.74 cm
Sag: 4.84 cm
Echotexture: Homogeneous
IST AP TH: 0.35 cm
Last year, my endo ordered standard testing and I requested T3 and T4 also. She didn't want to run those tests, but she did because I asked. I'll list all my test results below. I also have an enlarged thyroid {ultrasound results below}, especially on the right side.
Once we entered my appt, all the Dr. wanted to talk about was my weight and kept pushing for gastric bypass. I tried to explain all my thyroid symptoms which corresponded with the labs, and her response was she's the Dr.
I'm feeling at a loss here. Can someone review my labs and ultrasound and tell me I'm not crazy?!
LABS
Free T4 - 1.3 {normal range 0.8 to 2.7}
Free T3 - 205 {normal range 210 to 440}
Triiode Thyronine - 113 {normal range 76 to 181}
TSH - 0.75 {normal range 0.45 - 5.00}
ULTRASOUND
RIGHT LOBE
Ant-Post: 1.33 cm
Volume: 9.9 ml
Transv: 2.79 cm
Sag: 5.10 cm
Echotexture: Homogeneous
LEFT LOBE
Ant-Post: 1.21 cm
Volume: 5.3 ml
Transv: 1.74 cm
Sag: 4.84 cm
Echotexture: Homogeneous
IST AP TH: 0.35 cm
Breaking out is most likely from the Estrogen. You could reduce dose or stick with it for a short time to see if your body acclimates. I think the doctor should test for estradiol, progesterone and testosterone before prescribing hormones like estrogen.
In my opinion, I would get all the tests done mentioned above, and supplement as needed to optimize all of those, and allow some time for you body to respond. Then get re-tested for Free T4, Free T3 and Reverse T3 and see if thyroid med is needed. The alternative would be to prescribe some T3 med now to try and speed up improvement in your symptoms. Forget about TSH. Focus on FT4, FT3, RT3, and the others I mentioned.
In my opinion, I would get all the tests done mentioned above, and supplement as needed to optimize all of those, and allow some time for you body to respond. Then get re-tested for Free T4, Free T3 and Reverse T3 and see if thyroid med is needed. The alternative would be to prescribe some T3 med now to try and speed up improvement in your symptoms. Forget about TSH. Focus on FT4, FT3, RT3, and the others I mentioned.
So your Reverse T3 level is on the high end of its range. As previously mentioned, the ratio of Free T3 to Reverse T3 is a useful indicator of tissue thyroid levels, which can be significantly different from serum levels. Tissue thyroid, in combination with other factors at the cellular level, such as cortisol level and Vitamin D, create the metabolism that powers our bodies. Your Free T3 to Reverse T3 ratio would be 340 pg/dL divided by 22 ng/DL, which gives a result of 15.5. One sources suggests that a good level is at least 18 and another source suggests a minimum of 20. So your ratio is low by those measures, and consistent with being hypothyroid.
Since Reverse T3 levels can be adversely affected by "stress, leptin resistance, inflammation, dieting, nutrient deficiencies such as low iron, selenium, zinc, chromium, Vitamin B6 and B12 and iodine, low testosterone, low human growth hormone, and others, the most effective place to start might be to get your ferritin and B12 and B6 levels optimized, and also ask the doctor if there are other of those variables that he suggests testing.
So you definitely need to get your ferritin up to at least 70 and some say 100. Your need to know your Vitamin D level and supplement as needed to get to 50 min. You need to get your B12 into the upper end of its range. You need to get that cortisol test done, since that affects metabolization of thyroid hormone. You might want to talk to your doctor about all that and ask for the Vitamin D and cortisol tests. The doctor may want to get the additional testing done and optimize results before considering thyroid med. If med is considered, I see no reason to try T4 at this point, since your level is adequate, and that might even cause more conversion to Reverse T3. If anything there, I would consider some T3 med to raise your Free T3 level, along with working on further testing and optimizing variables that can affect conversion of T4 to Reverse T3. It will be very interesting to see how your doctor responds.
Since Reverse T3 levels can be adversely affected by "stress, leptin resistance, inflammation, dieting, nutrient deficiencies such as low iron, selenium, zinc, chromium, Vitamin B6 and B12 and iodine, low testosterone, low human growth hormone, and others, the most effective place to start might be to get your ferritin and B12 and B6 levels optimized, and also ask the doctor if there are other of those variables that he suggests testing.
So you definitely need to get your ferritin up to at least 70 and some say 100. Your need to know your Vitamin D level and supplement as needed to get to 50 min. You need to get your B12 into the upper end of its range. You need to get that cortisol test done, since that affects metabolization of thyroid hormone. You might want to talk to your doctor about all that and ask for the Vitamin D and cortisol tests. The doctor may want to get the additional testing done and optimize results before considering thyroid med. If med is considered, I see no reason to try T4 at this point, since your level is adequate, and that might even cause more conversion to Reverse T3. If anything there, I would consider some T3 med to raise your Free T3 level, along with working on further testing and optimizing variables that can affect conversion of T4 to Reverse T3. It will be very interesting to see how your doctor responds.
1 Comments
I've been wondering about this Estrogen cream he put me on, without even knowing if I truly need it. I've been broken out badly since a few days after I started it. My face never breaks out. And they are painful, deep ones. I'm thinking maybe my body doesn't need it, and it's doing more harm than good.
I'm going to take all the GREAT information you gave me above along with me. I'm praying and crossing my fingers he listens to me and my symptoms.
Even though my TSH is on the lower end of the spectrum, you would think I need a T3 medicine? Or in your opinion what does my body need?
I'm going to take all the GREAT information you gave me above along with me. I'm praying and crossing my fingers he listens to me and my symptoms.
Even though my TSH is on the lower end of the spectrum, you would think I need a T3 medicine? Or in your opinion what does my body need?
I expect that the range will be close to 230 - 420 pg/dL. So your Free T4, at 1.1 is at 48.5 % of its range and your Free T3 of 340 would be at 58% of that range. Those values will make it difficult to get a doctor to diagnose hypothyroidism and agree to treat you; however, your symptoms certainly indicate the possibility of hypothyroidism and you should always emphasize those in any discussion with the doctor.
In addition it is very important that you understand that serum Free T4 and Free T3 levels may not accurately reflect thyroid status. First because when T4 is converted in your body, it may be converted to T3 and less frequently to Reverse T3. Reverse T3 is a mirror image molecule of T3, but is biologically inactive. Excess Reverse T3 (RT3 dominance) can counteract the effects of T3, so that is why I suggested testing for Reverse T3 as well.
In the paper I gave you in the PM you can see on p. 9 that from one of the scientific studies referenced, it was concluded that, "reverse T3 is an excellent marker for reduced cellular T4 and T3 levels not detected by TSH or serum T4 and T3 levels." So I hope that the doctor is doing the Reverse T3 test to evaluate that.
A further factor can be that serum T4 and T3 levels may not accurately reflect what is more important, which is tissue thyroid hormone levels. To be utilized, serum thyroid hormone must be transported into cells. This is not simply a matter of diffusion of serum hormone. It is also affected by a number of variables.
And at the cellular level the process that metabolizes thyroid hormone and creates the overall tissue thyroid effect throughout the body is affected by co-factors such as Vitamin D, cortisol and TSH.
So as you can see the end result, tissue thyroid effects, are dependent on a whole lot more than just serum Free T4 and Free T3 levels. My reason for taking you through all this is so you will be better prepared for your next appointment with the doctor, and be better able to advocate for what you need. We will know more if you got the Reverse T3 test. I also expect that you need the cortisol testing done, especially since you mentioned a nodule on your adrenal gland.
So pass on any further test results you get and we will be glad to continue to try and get you fully prepared and effective at getting a therapeutic trial of thyroid med from the doctor. In the interim please make sure you get started on the B12 and iron supplements.
In addition it is very important that you understand that serum Free T4 and Free T3 levels may not accurately reflect thyroid status. First because when T4 is converted in your body, it may be converted to T3 and less frequently to Reverse T3. Reverse T3 is a mirror image molecule of T3, but is biologically inactive. Excess Reverse T3 (RT3 dominance) can counteract the effects of T3, so that is why I suggested testing for Reverse T3 as well.
In the paper I gave you in the PM you can see on p. 9 that from one of the scientific studies referenced, it was concluded that, "reverse T3 is an excellent marker for reduced cellular T4 and T3 levels not detected by TSH or serum T4 and T3 levels." So I hope that the doctor is doing the Reverse T3 test to evaluate that.
A further factor can be that serum T4 and T3 levels may not accurately reflect what is more important, which is tissue thyroid hormone levels. To be utilized, serum thyroid hormone must be transported into cells. This is not simply a matter of diffusion of serum hormone. It is also affected by a number of variables.
And at the cellular level the process that metabolizes thyroid hormone and creates the overall tissue thyroid effect throughout the body is affected by co-factors such as Vitamin D, cortisol and TSH.
So as you can see the end result, tissue thyroid effects, are dependent on a whole lot more than just serum Free T4 and Free T3 levels. My reason for taking you through all this is so you will be better prepared for your next appointment with the doctor, and be better able to advocate for what you need. We will know more if you got the Reverse T3 test. I also expect that you need the cortisol testing done, especially since you mentioned a nodule on your adrenal gland.
So pass on any further test results you get and we will be glad to continue to try and get you fully prepared and effective at getting a therapeutic trial of thyroid med from the doctor. In the interim please make sure you get started on the B12 and iron supplements.
1 Comments
I actually just got my reverse T3 results. My result was 22 with the range being 8-25.
I called the doctors office and requested Free T3 and Reverse T3 this morning. The nurse I spoke with had quite a fit about me requesting those. I'm hoping he'll order those. I can't understand why he wouldn't want to retest my Free T3, when I took my results from last year in with me and he could see it was below normal.
Your Free T4 result is good. Unfortunately your doctor did not order the most relevant thyroid hormone test, which is Free T3. Instead he ordered Total T3. Total T3 is a measure of all the T3 in our body. Most of that is bound to protein and biologically inactive. Only the very small portion not bound to protein, thus called Free, is active. Free T3 has been shown to correlate best with hypo symptoms. Even though your Total T3 was around mid-range, similar to your previous set of test results, your Free T3 at that time was below its range, which is consistent with being hypothyroid. You really need to know your current Free T3 level. In addition you need to know your Reverse T3, cortisol and Vitamin D levels.
Beyond that your B12 is not optimal. Should be in the upper end of the range. Ferritin is too low. Should be 70 - 100. So you need to supplement for those to optimize. Some of the best iron supplements for the ferritin are ferrous bisglycinate, ferrous fumarate, and ferrous sulfate. It is also good to take some Vitamin C with those to prevent stomach issues. There is a supplement called Vitron C that has both.
Do you think there is any possibility to get the doctor to do the additional tests?
Beyond that your B12 is not optimal. Should be in the upper end of the range. Ferritin is too low. Should be 70 - 100. So you need to supplement for those to optimize. Some of the best iron supplements for the ferritin are ferrous bisglycinate, ferrous fumarate, and ferrous sulfate. It is also good to take some Vitamin C with those to prevent stomach issues. There is a supplement called Vitron C that has both.
Do you think there is any possibility to get the doctor to do the additional tests?
1 Comments
I got my results of my Free T3 test, but it oddly didn't give me a reference range.
Free T3 - 340 pg/dL (reference range - units converted. See lab report for original value)
I called the lab I had it done in, and they gave me a totally different reference range and wouldn't give me any info
Free T3 - 340 pg/dL (reference range - units converted. See lab report for original value)
I called the lab I had it done in, and they gave me a totally different reference range and wouldn't give me any info
I have some of my new labs in and was hoping for input.
Free T4 - 1.1 {normal range 0.76-1.46}
T3 - 146 {normal range 76-181}
TSH - 1.01 {normal range 0.36-3.74}
B12 - 464 {normal range 200-1100}
Ferratin - 49 {normal range 10-232}
Magnesium - 2.1 {normal range 1.8-2.4}
Also, my WBC is below normal.
Free T4 - 1.1 {normal range 0.76-1.46}
T3 - 146 {normal range 76-181}
TSH - 1.01 {normal range 0.36-3.74}
B12 - 464 {normal range 200-1100}
Ferratin - 49 {normal range 10-232}
Magnesium - 2.1 {normal range 1.8-2.4}
Also, my WBC is below normal.
Free T3, Reverse T3, Vitamin D, ferritin and cortisol were not ordered. I would push to get those done as well. Also, if he is putting you on progesterone, I would ask to be tested for progesterone, estradiol and free testosterone, so that you know their baseline levels before starting on progesterone.
Please double check the anti TSO test. I expect that it is anti TPO.
Please double check the anti TSO test. I expect that it is anti TPO.
I do know what tests he ordered as he gave me the lab paperwork to take in with me. They aren't ALL ordered (and I've considered penciling them in).
B12
Lyme IgG
Magnesium
T3
T4
TSH
Free T4
CBC/Diff/Platelet
Anti TSI
Anti TSO
Anti Thyroglobluin
Once the results are in, they'll post them online in MyChart. So I'll definitely be able to get a copy of them and post them here.
I agree, if my labs once again show what they did last time and that I am indeed hypo then I'm going to push for thyroid meds, not an herbal supplement.
I'm not exactly sure about the reason for progesterone. He asked me some sexual questions (not inappropriately though) and concluded from that that my estrogen levels were probably low as well. I'm thinking those sexual symptoms can be chalked up to hypo as well.
B12
Lyme IgG
Magnesium
T3
T4
TSH
Free T4
CBC/Diff/Platelet
Anti TSI
Anti TSO
Anti Thyroglobluin
Once the results are in, they'll post them online in MyChart. So I'll definitely be able to get a copy of them and post them here.
I agree, if my labs once again show what they did last time and that I am indeed hypo then I'm going to push for thyroid meds, not an herbal supplement.
I'm not exactly sure about the reason for progesterone. He asked me some sexual questions (not inappropriately though) and concluded from that that my estrogen levels were probably low as well. I'm thinking those sexual symptoms can be chalked up to hypo as well.
Your doctor today sure sounds better than prior one.
I hope that the doctor really ordered all the tests. I suggest that when you go in for blood draw for those tests, ask the lab person what tests are being done and verify that all are included. If not, then say the doctor committed to all of the ones you want, and get it straightened out right then. Otherwise you will end up short of what you need.
Fish oil and D3 will be beneficial. Why did he prescribe progesterone?
Can't say I agree that 90% of women are hypo or that it is because of what they eat. Yes, people are often hypo even when labs show their levels are within range, because the ranges are far too broad due to the erroneous assumptions used to establish ranges. He has concluded that you are hypo, and if your labs come back low in the range again, you should push for thyroid med, not any natural herbs or supplements for that.
Low Free T3 (and Free T4) can occur together when there is central hypothyroidism caused by a dysfunction in the hypothalamus/pituitary system. Along with that TSH will be relatively low in the range. I could make a case for that, given your lab results, instead of Euthyroid Sick Syndrome. Note the info in the following link.
http://emedicine.medscape.com/article/118651-overview
So when lab results are available, if you can get a copy in advance of any followup appointment with the doctor, then post results and reference ranges and we will get you prepared for what to ask the doctor.
I hope that the doctor really ordered all the tests. I suggest that when you go in for blood draw for those tests, ask the lab person what tests are being done and verify that all are included. If not, then say the doctor committed to all of the ones you want, and get it straightened out right then. Otherwise you will end up short of what you need.
Fish oil and D3 will be beneficial. Why did he prescribe progesterone?
Can't say I agree that 90% of women are hypo or that it is because of what they eat. Yes, people are often hypo even when labs show their levels are within range, because the ranges are far too broad due to the erroneous assumptions used to establish ranges. He has concluded that you are hypo, and if your labs come back low in the range again, you should push for thyroid med, not any natural herbs or supplements for that.
Low Free T3 (and Free T4) can occur together when there is central hypothyroidism caused by a dysfunction in the hypothalamus/pituitary system. Along with that TSH will be relatively low in the range. I could make a case for that, given your lab results, instead of Euthyroid Sick Syndrome. Note the info in the following link.
http://emedicine.medscape.com/article/118651-overview
So when lab results are available, if you can get a copy in advance of any followup appointment with the doctor, then post results and reference ranges and we will get you prepared for what to ask the doctor.
I had my doctors appt today with my new doctor. And while I absolutely loved him, loved how he genuinely listened to me, and I agreed with much of what he said, I'm not sure of his treatment plan so I wanted to run it by you experienced and knowledgeable folks.
First, he said I'm without a doubt hypo based on my symptoms and labs.
Secondly, he ordered all the blood-work you mentioned along with an ultrasound of my thyroid.
Third, he put me on progesterone, fish oil and D3.
Fourth, he put me on a strict diet of basically fresh fruit, fresh vegetables, nuts, seeds and distilled water.
Lastly, he said 90% of women are hypo and it's because of what they eat. He said many women present with hypo symptoms, even when their labs show their levels are fine. He feels it's our diet and environment causing all our hypo symptoms. Which makes me feel he's more of a holistic doctor. I'm afraid that even if my labs come back low again, he's not going to want to prescribe anything but natural herbs.
He also said low T3 and low TSH don't go hand-in-hand and that it doesn't really make sense. If I recall, I read an article on low T3 syndrome (also called Euthyroid Sick Syndrome).
First, he said I'm without a doubt hypo based on my symptoms and labs.
Secondly, he ordered all the blood-work you mentioned along with an ultrasound of my thyroid.
Third, he put me on progesterone, fish oil and D3.
Fourth, he put me on a strict diet of basically fresh fruit, fresh vegetables, nuts, seeds and distilled water.
Lastly, he said 90% of women are hypo and it's because of what they eat. He said many women present with hypo symptoms, even when their labs show their levels are fine. He feels it's our diet and environment causing all our hypo symptoms. Which makes me feel he's more of a holistic doctor. I'm afraid that even if my labs come back low again, he's not going to want to prescribe anything but natural herbs.
He also said low T3 and low TSH don't go hand-in-hand and that it doesn't really make sense. If I recall, I read an article on low T3 syndrome (also called Euthyroid Sick Syndrome).
TSH is affected by so any things that fluctuation is normal. Studies have shown it to fluctuate up to 70% during a 24 hour period. The only real value to a TSH test is to distinguish overt hypothyroidism (TSH > 10) from central hypothyroidism (TSH within range, along with relatively low Free T4 and Free T3). Symptoms are most important in diagnosis of hypothyroidism, followed by Free T4 and Free T3 levels. There are also other factors that can affect tissue thyroid effects (which determine symptoms). You can find those in Fig. 1 in the link I gave you above.
I was just getting all my paperwork and lab results in order for my Dr appt tomorrow, and noticed my TSH level from the previous year. In 2014 it was 1.64 and in 2015 it was 0.75. The normal range is 0.45 - 5.00. Is it normal for TSH to fluctuate like that, or is that another indicator of being hypo?
I think that in addition to writing it down and taking it to your appointment, I would also take him a copy of the second link, shown again below, so that you are giving the doctor scientific evidence for what you would like to have done for you. If he is the right kind of doctor he won't be insulted by being given information that could be helpful.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Also, I just sent you a PM with info on a doctor in your area. To access the PM, just click on your name and then from your personal page, click on messages.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
Also, I just sent you a PM with info on a doctor in your area. To access the PM, just click on your name and then from your personal page, click on messages.
And thank you so SO MUCH for all that info. Writing it down right now to take along to my Dr. appt.
You are very welcome for any info we can provide.
When you see the mew doctor be sure to insist on being tested for Free T4, Free T3, TSH, Reverse T3, Vitamin D, B12 ferritin and cortisol. Also find out if the doctor is willing to treat clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms. Also ask if the doctor is willing to prescribe T3 type meds, such as Cytomel and Armour Thyroid. If either answer is no, then you will need to find a good thyroid doctor.
If you will tell us your location, perhaps we can provide names of doctors that have been recommended by other thyroid patients in your area.
When you see the mew doctor be sure to insist on being tested for Free T4, Free T3, TSH, Reverse T3, Vitamin D, B12 ferritin and cortisol. Also find out if the doctor is willing to treat clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms. Also ask if the doctor is willing to prescribe T3 type meds, such as Cytomel and Armour Thyroid. If either answer is no, then you will need to find a good thyroid doctor.
If you will tell us your location, perhaps we can provide names of doctors that have been recommended by other thyroid patients in your area.
Thank you so, so much!!! Hearing that I'm not having these symptoms from being crazy, lazy or overweight mean so much.
I've decided to not go back to that endo. To say that was the worst doctors appt of my life is an understatement. She told me "You're much too pretty to live life in a body like that". And tried to bully me into gastric bypass, rather than address the test results.
Thank you for the info in the PM. I'll definitely read it. I want to know all the info I can before my appt with my new dr.
I've decided to not go back to that endo. To say that was the worst doctors appt of my life is an understatement. She told me "You're much too pretty to live life in a body like that". And tried to bully me into gastric bypass, rather than address the test results.
Thank you for the info in the PM. I'll definitely read it. I want to know all the info I can before my appt with my new dr.
Clearly your doctor doesn't understand how to test and diagnose hypothyroidism. Your symptoms strongly indicate being hypo. Your Free T4 is below mid-range. Most people find it better at mid-range or above. Your Total T3 is too low and your Free T3 is actually below range, which is totally unacceptable. Free T3 has been shown to correlate best with hypo symptoms, since it is used by all the cells in the body.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and free T3 levels as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
I am sending you a PM with some info. I urge you to read at least the first two pages of the paper linked within. That will give you the basic information you need to understand. Then you have two choices: give your current doctor a copy of the paper and try to work with him to get properly diagnosed and treated. Or find a good thyroid doctor that will treat clinically, as described. Note: Based on what you have said, I don't have much confidence that you will succeed with your current doctor.
To access the PM, just click on your name and then from your personal page, click on messages.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and free T3 levels as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
I am sending you a PM with some info. I urge you to read at least the first two pages of the paper linked within. That will give you the basic information you need to understand. Then you have two choices: give your current doctor a copy of the paper and try to work with him to get properly diagnosed and treated. Or find a good thyroid doctor that will treat clinically, as described. Note: Based on what you have said, I don't have much confidence that you will succeed with your current doctor.
To access the PM, just click on your name and then from your personal page, click on messages.
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