TSH 3.5 and Nodule - New to Synthroid - Have some questions

[goodlordyIjusturned40]

Hi there ~

Well I was recently diagnosed with a hypoechogenic thyroid nodule and referred to an Endocrinologist. She did an ultrasound and said the thyroid itself look fine but we want to watch the nodule and if it grows we will proceed with FNA and biopsy.

Fair enough. Nodule - monitor - Got it!

So while there I took full advantage and told her how I have not felt well for the last 8 months, have gained a lot of weight and cannot lose it despite daily workout and hiring a personal trainer, and that I have asked about hypothyroid but was always told my TSH was "normal"

So she looked at my labs (which I brought) and said with the new lab values of .3 - 3.0 that I actually WAS hypothyroid and started me on a baby dose of Synthroid .25 with repeat labs and follow up in 6 weeks.

My labs: TSH 3.7  T3 119  T4 1.14  (have no idea what the other two mean? Just know on the lab slip they are normal)

GREAT! I'm not crazy - perhaps I really am hypothryroid.

Problem is, she was not a big talker so although I got the validation that the hypothyroid thought was NOT all in my head, she didnt really provide any information about the diagnosis or the medication.

She is called a "Thyroidologist" who specialized in nodules, so she pretty much talked mostly about the nodule, why the hypoechogenics are more cautious and historically more cancerous, and why we may have to do a biopsy, ect.. She basically really liked her nodules and spent most of the time talking about that... which is great

But - I, ME the person (not the nodule) feel like **** and want to know why. So that is where I am asking all of you to help and provide me with some feedback.

How log does it take the Synthroid to start kicking in?

How will I feel.. A slow back to normal, gradual feeling of wellness or will I get a jump start back to my life?

How long does it take with the Synthroid to get the weight off?

Is it normal to still feel tired, achey, run down, flu like, moody, restless, lightheaded, even after the Synthroid?

How long?

I get heart palpitations / PVCs already - can/will Synthroid make it worse. So far I actually dont feel as many so maybe its helping.

Does Synthroid ever cause symptoms? I am a tad anxious about taking any medications, so when I do - everything thing I feel I tend to blame on the  meds.. neurotic I know, but I had an allergic reaction to Sulfa that almost killed me, so I think it is a anxiety fear thing.

As an example, felt a tad spacy this morning and SO tired yesterday I literraly fell asleep during work hours (thank gosh I work from home!) but in 40 years I have never taken a "Nap" - so when I say tired I mean the worst fatigue ever and then today spacey and kind of light headed, so is it the Synthroid or am I coming down with something?

Because I am neurotic about meds, my brain thinks "Synthroid" and then get anxious about taking it... which is why I am writing and asking for feedback : )

I did take it today because I want so badly to get this weight off and to feel better, so I have hope and a light at the end of the tunnell.

I just dont know what are actually Hypothyroid symptoms... No one has ever told me because I have always been told I was normal TSH until my appointmen on Thursday the 3rd when the meds were given - but no info.

Do nodules cause symptoms?

And now I have the meds but NO IDEA what the expect from them. I have been on it for 6 days.

I am hoping you all can help provide some knowledge and experience.

Thank you!!!!

[Barb135]

Do you have the reference ranges for the FT4 and FT3?  Different labs use different reference ranges and/or units of measurement.  Your TSH is definitely high, since the reference range for that is 0.3-3.0.  

Just because your thyroid is "smooth" and your endo can't feel any nodules, doesn't meant there aren't any, nor does it mean that you don't have Hashi's.  They couldn't feel nodules on mine either, but I have them, as shown on the ultra sound, plus I have the antibodies.  

You can't feel the antibodies and once you have them, they will always be there, so even though there may be weeks when you feel better and weeks when you don't, doesn't mean the antibodies go away during the weeks you feel better and come back during the weeks you don't feel well.  

You may need a larger dose of synthroid.  Some doctors start you out with a lower dose and work up, which is actually the best way to do it.  As Tamra said, too, you might be bouncing back and forth between hypER and hypO....

As far as the cytomel, I don't think I'd be too quick to ask for it - give the synthroid time to work and make sure you really need a T3 med.  T3 med is usually taken if you have trouble converting synthroid (T4 med) to T3.  

I can't give any advice/info about the Armour or other natural thyroid meds as I've never used them.  I do know though that there are a lot of people on here that do use them and are having great luck with them, so I'm sure they will help you out there.  

[goodlordyIjusturned40]

Thank you for your reply

Much appreciated. Serioulsy - I love the information and the not feeling alone in all this, so I truly thank you!!

I must say that I feel kinda tired on the Synthroid? But I read that when you first start there can be paradoxical reaction to it?

I dont know. I may skip it tomorrow to see if it is the Synthroid or me. My son had a cough, so perhaps I am fighting something.

I will also ask about the T3 med. It seems many people prefer the Armour which is all the Ts (does that make sense,.... such a rookie)

Here are my labs if you can make sense of them and have any insight, it is SO welcomed.

Thank you again and wishing you well!!

FT4 1.14 ng/dl

FT3 2.6 pg/ml

Total T3 119 ng/dl

TSH 3.68

[goodlordyIjusturned40]

Hi Tamra ~

Thank you so much for your post. I really appreciate it. And you did not ramble (did you see mine...) You were great, so thank you!!

I pulled my labs to check about the free and total (I am such a rookie.. I have no idea what any of these mean)

So that you can see and perhaps you can give me some additional guidance.

Here they go:

FT4 1.14 ng/dl

FT3 2.6 pg/ml

Total T3 119 ng/dl

TSH 3.68

No antibodies, but I am going to ask her to run them due to the Hashi's, because you made such a great point because there are weeks when I have them and weeks when I dont - there are also weeks when I feel better and weeks when I am so not feeling well.

My sister does swing back and forth. I guess she was so hypo once that she was sleeping 14 hours a day. So sad!!

The endo said my thyroid looked smooth, so no Hashi's - but I am going to insist on the labs to be sure. With a family history and the palps I think it is prudent.

With the new lab values I guess I do look hypo (although normal using the old standards). It is so confusing. I just know I dont feel well and I used to, so I want "my old life back" so to speak.

I am to see her in 6 weeks, so while there are there any additional questions I should ask?

Should I ask about a T3 med? How about this Armour medication every seems to say is better? What are your thoughts?

Thank you again so much!

I look forward to hearing from you.

[Barb135]

There is a whole "laundry list" of hypothyroid symptoms - some get all of them, some get some of them, some even get ones that aren't on the list -------- I don't mean to give you a run around, but that's pretty much the way it works.  

My MAIN symptoms included extreme fatigue, weight gain (30 lbs in 3 months on a 5' tall frame....ugh), constipation, muscle aches/pains, soreness in the neck area accompanied by a choking feeling, hair loss, swelling/edema, puffiness under my eyes, trouble sleeping in spite of the fatigue. The list goes on, but those were the very worst ones I had.  You can do a search for "symptoms of hypothyroidism" to come up with quite a few lists.  Wording the search in different ways will give more lists........Also, feel free to check out posts here on MH - there are a lot of them that list symptoms.  

6 days is not nearly long enough as it takes several weeks (5-6) for it to build up enough for you to get the full effect.  It IS possible though for you to start feeling some better sooner.  I noticed within the first week or so, that I wasn't quite so tired, the puffiness under my eyes was gone and my hair wasn't falling out so badly - the rest of the symptoms took longer - in fact, I've been on thyroid med for about 18 months and still have some minor symptoms (mainly fatigue, constipation and inability to lose weight), though I'm ever so much better than I was.  

As far as side effects of synthroid -- some people do report side effects, but I was started out on synthroid and didn't have any adverse effects, but it didn't seem right for me. When I was referred to the endo, he felt that generic levothyroxin was just as good so I've been on that since the end of Jan and have done quite well on it.  I also take 5 mcg cytomel/day and I think that's what tipped the scale in my favor.  Cytomel is a T3 only med and the body can use it immediately, whereas synthroid and generic levo are T4 meds and must be converted to T3 in order to be used by the body.  Some of us have a bit of a problem with that conversion.  

Do you know if the T4 and T3 were "free" or "total"?  If they were total, they don't really tell a lot.  If you have a copy of the lab report, it should say Free T4/Free T3 or FT4/FT3 - if it doesn't, then they were most likely totals.......whenever you get labs done, ask for FT4 and FT3 along with the TSH.  The FT3 and FT4 are the actual hormones available for use, with the FT3 being the main one, since it's "ready to use" whereas the body has to convert FT4 to FT3 in order to use it.  

One last thing - because I don't want you to be TOTALLY disappointed - Synthroid is not what's going to take the weight off.  Until your levels get to where YOU need them to be, you might have difficulty losing weight, even with strenuous exercise and strict diet --- I did.......I was told right off the bat by both doctors and members of this forum, that when my levels get right, I would be able to lose weight.  I didn't want to believe that I was going to have to actually WAIT even longer, but that's the way it worked.....my levels are finally getting right and I have actually lost about 6 pounds over the past couple months, and I know that if I'd get off my duff when I get home from work and start working out again, I would be able to lose - right now, I'm awfully tired because I have to get up at 3:30 am and my job is pretty physical.  AND I know that I didn't really NEED those chicken wings I had for lunch today OR those tootsie rolls I ate, either..............lol

I'm sure other members will be able to offer more info.........hang in there - it will get better.......

[TamraW]

Good lordy, I hope your doctor gave you a TGAB and an ANTI- TPO blood test to see if Hashi isn't causing this. The heart palpatations made me think Hashi, because that is not commonly a hypo symptom, but a hyper symptom. Hashi is a form of hypothryoidism, but we swing back and forth from hypo to hyper during the first few years.

Hashi causes nodules.

Hashi causes those 'normal' levels because we swing. Got it?

Your FT4 does look low normal. With your TSH levels, IMHO, high, you will need more than a baby dose of .25 mg synthroid. I'm not sure of your T3 levels. Post the ranges. You might be needing some T3 meds down the road. Synthroid is just T4; however, the body converts a lot of that T4 to T3. Sometimes, not enough.

Every two months or so, the doc will raise your Synthroid dose, which means...You may not be feeling great again for months, a year, more??? It depends on the person.

You can't start out with too much Synthroid, or your body will go into shock. BTW - If you do end up  having Hashi, the treatment is the same, so you are on the right track.

Also, are you willing to follow a good hypo diet? Avoid soy? Uncooked broccoli and cabbage? Possibly gluten? Take the correct vitamins, especially D and B12?

I'm sorry if I've rambled too long.

Any more questions, and you can send me a message.

:) Tamra