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Test values...question
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Test values...question

These are the results of my initial test after a routine exam revealed that my thyroid is enlarged. Ultrasound showed nodules, which will be biopsied in a couple weeks. Meanwhile, I've been doing some research and while these numbers are normal (except the FT3, which is close enough not to matter, according to my PCP), they're all on the low side of the range.

3rd Gen TSH -- 0.587 (0.358-3.74 mclU/ml)
FT3 -- 2.3 (2.4-4.2 pGm/ml)
T4 Free -- 0.92 (0.66-1.38 nGm/dL)

I'm just wondering if anyone who knows more about this than I do thinks there's anything here to look into.

Thank you!
16 Comments Post a Comment
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Avatar_m_tn
Both your levels are low, the Free T4 is only at 36.11% of its range, your Free T3 is the active hormone your body needs to function, so you have an underactive thyroid or Hypoactive, has your MD done antibody tests Tgab and TPOab to diagnose if you have Hashimot's Disease? It is the most common cause today of thyroid disease, it means your auto immune (Tcells) do not recognize your thyroid as a part of the body, and attacks it, this attack decreases the amount of thyroid hormone your thyroid produces. Which means you will have to take thyroid hormone replacement medication to bring your levels to where they should be in order to stay healthy. You can google Hashimoto's Thyroiditis for more info, also check symptoms to see if you have any. If you have any other test results or questions, feel free to post with ranges and members will be happt to help, I could not do a percentage on your Free T3 because it is below range, it does not mean you don't have any, but I just can't do a percentage.  Best Regards FTB4
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649848_tn?1357751184
"Meanwhile, I've been doing some research and while these numbers are normal (except the FT3, which is close enough not to matter, according to my PCP), they're all on the low side of the range."  That may indicate that you will need to find a different doctor, as it appears that he doesn't know how to interpret thyroid tests, or know much about the need for the hormones, themselves.  

Since Free T3 is the hormone that the individual cells actually use, it needs to be adequate, in order for you to feel well.

Are you currently on a thyroid replacement medication? If so, which one, what dosage and for how long?  

What, if any, symptoms do you have?  
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Avatar_f_tn
Wow. No, I'm not on any thyroid medication. Have been tested (not necessarily the correct tests though) over the years and have always been within range, so nobody ever considered my thyroid to be an issue. The symptoms I DO have are the sort that could be explained by any number of other things going on in my life. Although...looking at the various lists of symptoms of hypo made me add a few more to my own list and...while I am not trying to diagnose myself or manufacture problems, the similarities are unnerving:

Confused and a little anxious top the list right now, with all this going on. I just took some time at lunch to compile a list of what I've been feeling. Some things I have been attributing to other reasonable explanations but I guess they could be thyroid-related too:

- almost never wake up feeling refreshed
- tired during day
- brain fog and trouble concentrating
- ringing in ears
- dry hair (feels like straw sometimes when I rinse out shampoo)
- enlarged thyroid with nodules
- feeling like there's a lump in my throat at the base of my neck, slightly above where collar bones meet
- sort of tickly or scratchy feeling in throat sometimes, need to clear throat more than usual
- feel the cold a lot more than I used to, but I've also lost a lot of weight in the last year (planned, not unexpected) and can't say this just isn't my new normal, not having all that fat as insulation
- a more recent development is frequently cold hands and feet
- at the same time, my weight loss has slowed to less than a crawl even though I'm still under-eating my daily calories and still exercising well
- when I get hungry, if I don't eat something I end up feeling nauseated for a while
- mild depression
- some constipation (my high protein, low fat, low carb diet plays into this)
- some diarrhea (recent gall bladder removal surgery plays into this)
- started taking cholesterol medication recently even though I've lost over 70 lbs. and am more physically active now than ever before
- my mother tells me that she thinks HER mother had her thyroid removed; for what, we don't know and can no longer ask
- maybe unrelated but not long before I started noticing some swelling in the area of my thyroid (I thought it was a tendon I never noticed when I weighed more) my shoulder started hurting where the collar bone joins the sternum; that's been an ongoing problem and affects my shoulder, neck, head, strength, and range of motion in my arm...but the source of the worst pain is right next to the thyroid

I'm seeing an endocrinologist on the 7th for probably a biopsy of the nodules and will bring along my symptoms as well. I also have an appt with an ENT (listed in the thyroid best doctors page) on the 11th because I was trying to get the soonest available appt and ended up with two. I think I'll keep the earlier appointment with the endo and cancel the other. Fits better into my work schedule anyway.

I'm trying not to feel alarmed but this is all a little overwhelming, lol. At 39, my reproductive system rebelled and I had it all removed (so no menstrual symptoms to deal with at least). I turned 40 and needed bifocals. At 45, my knee arthritis got so bad I had arthroscopic surgery on both knees that year. At 46, my gallbladder quit and now possibly my thyroid. I'll be 47 in July and have decided that I'm done with this stuff. Strong and healthy from now on, y'hear me body? :)

Thank you all so much! I'm sure I'll be back with more questions, lol.
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Avatar_f_tn
I have another question. I'll definitely be mentioning it when I see the doc next week: close to the time I started noticing the swelling near my thyroid, I started having pain in my collar bone, right where it connects to the sternum. It's at the sternoclavicular joint and has affected the sternocleidomastoid muscle, the base of my skull, and my flexibility and ability to exercise--reaching over my head, stretching in certain directions, pushups, putting dishes away on higher shelves, hanging up my coat, sleeping on my right side without carefully positioning my shoulder--all things that cause some level of pain. Sometimes it's pretty severe, sometimes not so bad at all. My PCP said to try taking ibuprofin around the clock. The chiropractor and massage therapist have worked on the area (not at the same time, lol). Nothing helps for any length of time. The source of the pain seems to be right next to my thyroid but I didn't think anything of the connection until the NP said my thyroid was enalrged. Then *click* went my brain. Could these be related?  (and if yes, do I REALLY want to know right now? ugh...)

Thank you!
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649848_tn?1357751184
Wow, am I ever glad you got an appointment with an endo...... with all those symptoms, plus your low thyroid levels, I can't imagine your pcp telling you, there's nothing wrong.  

High cholesterol is very often a symptom of hypothyroidism. Reproductive system issues are also symptoms of hypothyroidism. Muscle and joint pain are also symptoms of hypothyroidism, as is anxiety.

Thyroid nodules, swelling and inflammation are indicative of Hashimoto's Thyroiditis, which is the main cause of hypothyroidism in the developed world.

I suspect that your pcp was looking only at TSH, which is a pituitary hormone, not a thyroid hormone and since yours is quite low in the range, he "assumed" that your thyroid levels were adequate.  

That said -- TSH stimulates the thyroid to produce hormones, and since yours is so low, your thyroid doesn't know it's supposed to produce hormones, so you could have a pituitary issues, rather than thyroid.  This would be something to talk with the endo about.
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Avatar_f_tn
Biopsy on my thyroid nodules today. Wasn't pain-free, but not quite as bad as I thought it might be.

Doc didn't think there was anything wrong with my bloodwork or thyroid in general and didn't order any more tests (like for thyroid antibodies...I might ask if I get to talk to him again). The results will take about a week. So now I wait. I'm not good with being patient but since I have no choice, no sense in driving myself crazy while I wait.

I asked about ways to shrink the nodules and he said there really aren't any. Hormones haven't been proven to help. So if the nodules are benign, then I have to decide whether I want them removed anyway--like that constant feeling of having a lump in my throat. Does it bother me enough to choose surgery? He said removing them might not resolve the issue. The surgeon might have something different to say so I could always go for a consult later.

He didn't think the nodules had anything to do with the collar bone/shoulder pain I've been having, so I guess it's back to the primary care doc to see about an x-ray or MRI to see if we can figure out what's going on there. Six months of dealing with this baloney is enough.

I'm going to have my PCP keep an eye on the thyroid bloodwork, and ask for antibody tests if none are forthcoming from this endocrinologist. The symptoms I have could all be attributed to other reasonable explanations so maybe that's all they are.

For now, I'm practicing patience. :)
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Avatar_f_tn
I called the endo's office yesterday to see if my results were in, and they were. He called me back later (during the 5 minutes I was away from my phone!) and left a message that the results were "completely reassuring." He sent a letter with the details but I can call with further questions or just wait for the letter.

So...no cancer. Yay! I'm guessing the letter will say he wants me to follow up in 6 months or a year or something like that.

I once had an amazing gyn doctor who found an issue others had missed because she had an open mind and refused to let an issue lie without some kind of closure. I'm thinking I need to find her endocrinology twin if I'm to get any farther with anything at this point. I DO have an appointment with another endo at the end of the month (I was trying to get the soonest available appt and got the end of the month first, so have kept it as a possible second opinion if needed) but am not sure it's worth pursuing at this point.

I've got a message in to an orthopedist about my shoulder/collar bone and hope to have an appt for that in the next few weeks. Since my PCP and the endo seemed convinced it's an ortho issue, I figure I'll start there rather than fight .

I don't know what else to do at this point other than monitor and record symptoms, and ask for thyroid tests with regular bloodwork. Funny--the National Society for Hypothyroidism's website has a self-assessment test concurred with something being off too, and recommended I see an endo.
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Avatar_n_tn
the fact that your TSH was so low along with your FT4 and your FT3 stuck out to me---I have central hypothyroidism and since it is coming from my pituitary, a TSH is fairly worthless on me.

I also had nodules 15 years ago, and my surgeon put me on thyroid suppression therapy to reduce them--it worked, but when I went off thyroid---another doc wanted to see what my thyroid would do on it's own, the nodules must have come back.  they were biopsied and not significant.

I think suppression therapy might be an older treatment.

I would think that if you were to go on a proper dose of thyroid medication, that your thyroid would probably go down in size.  How large were your nodules?   My husband had one very large nodule that you could see poking out the front of his neck, they were not able to rule out cancer--so they had to remove half of his thyroid.   A couple of years later, i discovered I had nodules, but I had several, and they were small, so they didn't do surgery. (my hubby didn't have cancer)

Are you sure it is the nodules causing the feeling of a lump in your throat--it kind of sounds more like the sensation I would get with reflux--the place you say you feel it seems a little low to be caused by thyroid nodules--also the scratchy throat and need to clear your throat sound like reflux symptoms, too.

My reflux is caused by a hiatal hernia, but my doctor believes that low thyroid can also cause it.

I can't believe an endo would not run more tests than yours did--especially not the thyroid antibodies--can't believe he didn't catch the low TSH along with the low FT3 and low FT4---but, I hear it is pretty hard to find a good endo---which haws been my personal experience---they are notorious for not keeping up to date with the most recent information--don't know why.

You might have better luck finding a very open minded DO or internist.
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Avatar_f_tn
Hi Kevieb, thanks for your message!

I got the letter and sure enough, he wants to see me in a year. Nothing else besides the caveat that there's a less than 2% chance of the results being "falsely benign."

The two "significant" nodules are >2cm. Not huge but not as small as the other one (9mm). There is a visible and palpable lump in my neck on one side next to where I feel the lumpy feeling in my throat. I originally thought reflux might be the culprit...guess it's time to mention that to the PCP and see where that might go.

I'm also in surgical menopause and wonder if it's time for HRT again. I did it for the first 10 months after surgery but then stopped and haven't had any noticeable issues. Maybe some of my possible thyroid symptoms would be helped by estrogen.

I have an appt with another endo at the end of the month (when I was calling for appts I got this one first, then the sooner one, which I kept; I haven't cancelled this one yet) and could go as a 2nd opinion. But if she's a "normal TSH = you're fine" type, it would just be a waste of my time. Not sure what to do at this point other than wait, have a long chat with my PCP at my annual in April, and do more research.
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Avatar_n_tn
Ideally, a TSH is supposed to be opposite (high or low) from your FT3 and FT4.   If they are high or low together, that is an abnormal result and it points to a possible pituitary problem.

Make sure you point out to the next endo that you know the results should be opposite each other----even if all of them fall "within range"
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649848_tn?1357751184
Now that you know your FT3 and FT4 are way too low, you can point this out to the endo you see at the end of the month, rather than waiting for to bring it up.  We don't have to sit back and blindly accept something, just because a doctor says it's so.  

Also, ASK for the antibody tests; doctors often won't offer tests, if you don't ask for them.  You need TPOab and TGab to test for Hashimoto's.  

You have all those symptoms and your FT3 and FT4 support them as being thyroid related; therefore, there's no reason they shouldn't be checking into it further.  

In my opinion, you also need pituitary testing...... again, ask for it rather than wait for the doctor to offer it.

We have to be our own health care advocates, because too many doctors look only at blood tests and nothing else.  Don't give up.

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Avatar_f_tn
I spoke with my insurance company yesterday (and sent out a huge mental thank you to the company for which I work for having such great benefits) because I still have an appt with another endo this coming week. I hadn't decided whether or not to cancel and wanted to find out if insurance would cover a repeat endo visit if I went. They do--including any tests she wants to run. So I'm going to go. I'll bring all my test results, including the letter about the nodules, and will talk with her about my test values and ask about antibody testing. Hopefully there won't be another biopsy and I do hope she'll look at the low numbers more seriously.

If not, I can always try that functional medicine doctor I found (he runs every hormone test known to man, it seems, lol), and I have an appt with my PCP in April (yearly checkup). So there are still options.

Maybe it's NOT my thyroid. But if it is, there could be help on the horizon. I woke this morning to the doorbell ringing after 8.5 hours of sleep and felt like a zombie for a good 45 minutes. I still feel like I could go back to bed and nap after almost 2 cups of coffee. Pathetic, lol. But I have to get up and run some errands before the snow comes tonight. :)

Thank you all!
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Avatar_m_tn
>Maybe it's NOT my thyroid. But if it is, there could be help on the horizon.

Once thing, do make sure that they check other endocrine things, adrenals, growth hormones, etc. Make sure that nothing sticks out and that they don't assume that having proven your thyroid is okay that therefor they've proved nothing wrong.
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Avatar_n_tn
I don't know how they could NOT think there was a thyroid problem---also, with hashimoto's, you can swing from hyper to hypo and be normal in between--if they test you when you are normal, and haven't tested antibodies that you might have---they could be totally missing the whole picture--and you could end up pretty miserable.
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649848_tn?1357751184
Stay on them, and if you can't get any satisfaction, find a different doctor.  Sounds like you need one anyway, because any doctor who interprets your test results as "okay" doesn't know much about thyroid.
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Avatar_f_tn
So frustrated. Just got a call from B&W saying they noted that I'd recently had a biopsy at MGH and wanted to know if I wanted to keep my appt. tomorrow as a 2nd opinion or cancel. The appt. at B&W was apparently just for an ultrasound and then biopsy if needed. Nothing to discuss my issues in general--THAT would be a "new patient appointment." Apparently they wrote me in for a "nodule" appointment. Doc at B&W doesn't have any "new pt appts" until May or June. That's what I thought I was getting, both at MGH (which explains why he didn't want to hear about any of my other issues) and at B&W. I told her to cancel tomorrow.

Maybe I'll wait and revisit with my PCP in April. Or go to the endos he wanted me to go to in the first place (I chose Boston because it's convenient to work...but NONE of this has turned out convenient at all so what's one more hassle at this point). Bleah.
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