Subclinical hypothyroidism

[HouGal4714]

I recently had an ultrasound of my thyroid and have a 5mm left interior pole thyroid cyst. This was done because my sister just finished a year of dealing with thyroid cancer and I was feeling exhausted all the time so my GP ordered it for me. I went to an endo who did blood work that came back with a low Free T3 1.18 with the range being 1.45-3.48. The Free T4 was close to the lower level but not out of the range. I have elevated triglycerides, low ferritin (out of range) and now abnormal vaginal bleeding that has been going on for over a month. My TSH has been around 3.460 and sometimes a bit lower. My pap was fine and breast exam was great. My GP requested I get a colonoscopy to check for internal bleeding and while I have evidence of ileitis I don't have any problems that I can tell at the moment.

My endo says there's nothing wrong with me except very low Vitamin D but when I read the symptoms of hypothyroidism I feel like it's all the problems that I have.

I read about subclinical hypothyroidism and wonder if maybe that's my problem. Before my sister was diagnosed with thyroid cancer she was diagnosed with Hashimoto's and told she was an "out of bounder".

I am not looking for medication but I don't feel good. I never eat red meat or fried foods so my elevated triglycerides
seems very suspicious.

Do you think that in light of my sister's thyroid cancer I should push for a fine needle biopsy of my cyst?

My GP gave me Synthroid because she felt my TSH was out of range and that I seemed to be in bad shape compared to the last 3 years that she's known me but the endo said not to take it.

I just want to feel better.

Any thoughts?

[gimel]

As a start, and to rest my weary fingers, I thought I'd post an email that I sent to the Amer. Thyroid Assn. several times over the past 6 months.  Not surprisingly I never received any kind of response.  LOL  I think this will give you some useful info that will help explain how you could be hypo, with your test results.  I'm sure you will have more questions and we have many experienced members who are glad to help.







After having gone through years of not being treated for hypothyroidism, because my TSH was 4.97 and thus "normal", I was very pleased to note that the AACE had finally recognized that the range was incorrectly determined.  After removing some suspect hypo patients' data, and recalculating the range, they recommended  it be lowered and narrowed to .3-3.0.  Six years after this recommendation, why is it that most labs and doctors still do not recognize the change and still use the old range?  Since doctors also over-rely on TSH as the gold standard for thyroid testing, multitudes of hypo patients are still being told they are "normal" and do not get treated.  Is the ATA doing anything to encourage the medical community to change this practice?   If so, why is it taking so long?

My second concern is that doctors predominantly rely on TSH in determining a patient's thyroid status.  Why is this, since TSH is a pituitary hormone that is affected by so many variables, including even the time of day when tested?  Why not promote more widespread use of the actual thyroid hormones that are biologically active (FT3 and FT4) and that largely regulate metabolism and many other body functions?  From studies I have seen and much personal experience, TSH does not even correlate very well at all  with  hypo symptoms.  The test that has been shown to correlate best with hypo symptoms is free T3.  Yet there are very few doctors that order a FT3 test as a matter of course, and some that refuse to order one at all.

When FT3 and FT4 are tested,  the ranges are so broad that patients with overt hypo symptoms will usually still fall in the lower end of the current range.   As a result they are also told they are "normal" and receive no treatment.  Why haven"t the reference ranges for FT3 and FT4 been corrected like TSH, to exclude suspect hypo patients?  If this were done, these ranges would likewise be raised and narrowed,  comparable to the new range for TSH.  I'm sure that some would say that these ranges are just for reference, that as you approach the lower end of the ranges, that the probability of being hypo goes up and that in those cases, doctors look further to determine if medication is advisable.  I agree that this should be the case but I assure you it isn't. Labs and doctors interpret results anywhere within the reference range as "normal" and don't want to go any further.   As a result of all this above  misunderstanding and misapplication, millions of patients go untreated and remain miserable with their hypo symptoms.

Is the ATA doing anything to raise the awareness  of these problems among the medical community so that we hypo patients can look forward to some positive changes?  If you are not, then I cannot imagine any other organization that could do the work necessary to coordinate changing the awful mess that exists in the area of diagnosis and treatment of thyroid patients. Your response will be greatly appreciated.