For 2+ years I have had abnormal thyroid tests with inability for any doctor to commit to a definitive diagnosis. I am *very symptomatic.
* I will add details on symptoms later (to try to keep this brief), but would greatly appreciate input on to what you believe diagnosis is-
49 yo single female, self-employed (barely able to work at presentdue to weakness) professional with 2 children age 10 & 20-
Pertinent Labs (most recent first, month/year format):
TSH: (My values=Always VERY LOW -since first tested '08)- -(Lab Norm=0.35 to 5.50).
Results 02/10 to 10/10: -- 0.04 (10/10) -- 0.04 (08/10); -- 0.03 - (08/10); -- 0.09 - (04/10); -- less than 0.05 - (03/10); -- less than 0.01 - (02/10). Note: NOT ON ANY THYROID MED 02/10- to present.
TSH - Results 02/08 to 01/09:
-- 0.014 (01/10) -- less than 0.005 (12/09); -- less than 0.005 (10/09); -- 0.11 (06/09); -- 0.299 (02/08)
Note: Intermittently on Armour and Levothyroxine during this time frame from 02/08 to 01/09).
FREE T4: (My values =Low to Low-Norm) (Lab norm= 1.4 to 3.8); = 1.6 - (10/10)
(Lab norm= .89 to 1.76); =1.1 (08/10); -- 1.0 - (02/10); -- 1.85 - (12/09 On Levo); -- 1.28 - (10/09);
T4: (My values =Low to Low-Norm) (Lab norm=4.5 to 12.0).
Results= 6.2 (10/20/10); -- 4.9 (10/04/10); -- 5.3 (08/10); -- 4.2 (04/10); -- 4.6 (03/10); -- 5.7 (02/10);
Note- Some of my doctors refuse to order "free" T4 and only do total T4, some also refuse to do freeT4 and only do TSH, despite my telling them my TSH: fT4 & T4 + T3 do not coincide with "normal" trends.
Thyroid Peroxidase (Mine= VERY HIGH - Lab norm= 0 to 60):
-- 4,425 (02/08) - Yes, result was 4 "thousand", 4 hundred and 25- Lab said this is highest they had ever seen-
T3 Uptake- Mine High to High Norm - (Lab normal values= 23 to 36) E.G. My result =33 on 10/10; 30.8 on 04/10, etc. T7- Mine normal E.G. 1.9 on 10/10, 1.3 on 04/10. (lab norm value range= 1.0 to 4.5)
Other labs- Cortisol 5 to 11.0 runs low to normal- Doc said ACTH stim test last year normal, but would not give me results.;
Metanephrine: Doc said "slightly high" last year, 12/09 but would not give me result, c-peptide 01/10 less than 0.05 (N=0.80 to 3.90);
DHEA Prolactin & FSH normal all WNL. My H&H, albumin and total protein usually low-normal but improving since I've been putting more effort into eating more to gain some weight- My weight is in normal range (130-140), but dropped down to 110 last year before they discontinued the thyroid pills-
I said I would not include symptoms until later (sorry I am very tired and difficult to type and concentrate for so long)- But I feel I must add: I have been very hypertensive & tachcardic in recent years, with wide pulse pressure (high systolic)...B/P range 140 to 220 systolic- 70 to 110 diastolic, depending on meds I'm on, which has been between 1 and 5 different HTN meds during this time- Currently on 4 different B/P meds (Accupril, Norvasc , HCTZ, and Metoprolol (Lopressor)... Current B/P range= 150-180 syst over 76-96. (Doctors well aware)
Pulse on beta blockers 60-80's (currently closer to 90)- Pulse prior to beta-blockers- high 80's to 120.
OTHER TESTS- Summary, since I'm really too tired right now to complete post..
MRI Brain 06/09: 2 cysts "2mm parenchymal lucency PITUITARY", mild frontal atrophy, prominent adenoids,..
Recent -Prolactin and FSH= Normal.
CBC w/diff, chemistries, lipid profile, etc. all basically WNL-
CT Head: (Done a few times due to intermittent severe headaches (none at present), frequent (constant) dizziness, blurred vision, etc. Normal last year, this year microvascular changes, mild frontal atrophy...
CT Neck: DONE 09/30/10 (summary): Multiple hyperdense masses in thyroid largest 2.6 cm. + multiple smaller nodules, degenerative changes C5-7, Abnormal lymph node- "thyroid carcinoma is a consideration- Thyroid US and biopsy recommended"...
Thyroid SONOS done on 10/08, 02/10 and 10/10- Summary= Bilateral thyroid nodules, MNG... will add details later).
Thyroid Uptake scan- done 10/10 will add details later) -Increased uptake left- 18%- (low end of range). No mention of "hot or cold" + radiologist both said to me and in report "Biopsy not indicated at this time"- Disagrees with 2.7cm nodule on sono- said largest = 1.7 cm.
Please note- ENT MD I saw on 9/9/10, who reviewed CT neck said I should have biopsies done ASAP-
--------------------Extra Info- Don't spend time reading, if you are busy---
Eye Exam- winter/2010- Mild cataracts, no Diab retinopathy, wrote script (1st time) for reading/distance glasses- don't help- made me dizzier, I use OTC 2.75 reading glasses instead, with much difficulty seeing (blurry) - Photophobic too.
My tolerance for any stress both physical and mental is currently very, very low---
Some more clinical info + some more "ranting" (sorry) about my inability to obtain knowledgeable and helpful physicians...
Primary MD seems clueless (or dis-interested) about almost everything-
Although I've been at their office about 8 times in past 2 mos. they forget the most basic (important) things I tell them- E.G. I think I've told them at almost every appt. that I am a IDDM since age 12, but they always act like it's the 1st time I informed them...
At moment he said he wants me to possibly go to another endo, so far I've been unable to find only one since my (decent University Center-based) endo docs stopped taking my ins. last April-
The endo I saw on 10/07/10 also did not review reports until I repeadedly called office over 2 weeks (like ENT doc)- I reached him this week and he said "I don't do biopsies, you'll have to call your insurance company to find someone"- I explained I could not get done anywhere until a doctor wrote a "script"- he hung up on me- Next, I spent 1+ hr. on phone with ins. company yesterday but of course they were uable to help me to "find and schedule" a doctor to do "biopsies" -
I think it's the responsibility of all (my primary, endo, and ENT) I saw, but they don't seem to think so -
It's been a frustrating battle getting appropriate medical care here in Suffolk County, Eastern Long Island NY- Possibly due to having a very crummy insurance plan (Family Health Plus- Americhoice United),which is "state-sponsored and decent doctors I know here won't take it. (I worked in medical field for years)
Prior to 2008,I was always "very healthy and active", despite - IDDM since age 12 (in case you didn't notice that's why I included the C-peptide results above)- but I've always tried my best to keep blood sugars stable, testing BS 10-12 times, day, carb counting, insulin pump for years ...etc. BTW the only time my BS's are totally out-of-control was during 2 pregnancies (1990+2000) and past year- (hormonal causes)
Thank you for your review and input!
Please excuse any typos poor grammar- I actually am (used to be) a very smart, educated person, but due to my "brain fog", stress, frustration and complete physical exhaustion, I simply don't have the energy or desire to re-read and proof this very long post right now- Thanks for your understanding:)
P.S. I am very "natural health" oriented, particularly with nutrition- Try to avoid almost all chemicals, preservatives etc. (esp. since I've become very hypersensitive)- Note the Dx of "Fibromyalgia and CFS (Chronic Fatigue Syndrome)" have been mentioned recently, esp. since + EBV- but regardless my long-term thyroid/pituitary abnormalities need to be addressed, diagnosed and hopefully corrected....