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Thyroid Test Results and Symptoms
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Thyroid Test Results and Symptoms

Hi - I am a 42 year old male. For almost 20 years (and possibly even longer) I have had every single symptom of hyperthyroidism except for the thinning hair and weight loss (I actually have steadily gained a little bit of weight since my 30s but stabilized at 180 lbs - I am hardly overweight).

The most debilitating part of my symptoms is significant fatigue, heart palpitations, dramatically foggy mind, significant post exercise fatigue especially in my arms and legs (like dead weight - even in my teens), tremor in hands, depression, memory issues, tingling in hands and feet, almost constant diarrhea, moodiness, lately shortness of breath (I have had a stress EKG - no concerns).  Over the last 20 years I keep going back to my PC physician (switched many different times out of frustration) and explaining that there must be something wrong with me.  Over time I have been tested so many times but everything is "in the normal range" other than an on-and-off B12, D3 and iron deficiency.

Additionally, lately I have been having some dull throbbing in my throat - kind of where the glands are.  But no noticeable swelling.  And this is not on the inside of the throat like a swollen throat - it's like a gland thing. I had a throat scan a few months ago - apparently nothing shows.  I also have been having a sore neck in the back with radiating pain to the back of my head.  

I am wondering if I have had thyroid issues most of my life but "modern" medicine has not been able to recognize it because of the one-size fits all test results interpretation for TSH, T3F and T4F readings.

As I said I have been tested many times and therefore have access to my test results going back to 2008 - and here they are:

TSH (Date, Test Result, Std Range):
12/15/2008 0.91 0.4-4.5
8/5/2009         1.58 0.28-3.89
7/30/2010         0.82 0.28-3.89
3/8/2011         1.55 0.28-4.1
11/15/2011 2.55 0.28-4.1
2/9/2012         1.57 0.28-4.1

THYROID PEROXIDASE AB (Date, Test Result, Std Range):
3/8/2011            <10  <35

T4 Free  (Date, Test Result, Std Range):
3/8/2011            0.72  0.61-1.64

T3 Free  (Date, Test Result, Std Range):
3/8/2011            3.1    2.5-3.9

Given my symptoms and given these tests:
a) Does the up and down TSH indicate anything
b) Does the front and back throat issues (but nothing showing on scan) add any meaning to my issues
c) Do the more realistically interpreted results indicate any possible thyroid issues?
4) When I look at hypo and hyper thyroid symptoms I seem to have a mix.  Is this normal?

Thanks very much...
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649848_tn?1357751184
"I am wondering if I have had thyroid issues most of my life but "modern" medicine has not been able to recognize it because of the one-size fits all test results interpretation for TSH, T3F and T4F readings."  

Very good assessment!!

a) Yes, the up and down TSH can indicate something.

b) While scans are very useful tools, they might not always show EVERYTHING that's going on.

c) MY realistic interpretation of your Free T3 and Free T4 do indicate possible thyroid issues.

4) Yes, it's very possible to have a mix of hyper and hypo symptoms.

My first impression is that you possibly have Hashimoto's Thyroiditis.

Your Thyroid Peroxidase Antibodies (TPOab) was negative, but that's not the only test your doctor should have run.  You should also have had a Thyroglobulin Antibodies (TGab) test.  Either one or both of these antibodies (TPOab or TGab) can be present with Hashimoto's, so just testing for one, is not good enough.  Additionally, since you have some hyper symptoms, you should also get Thyroid Stimulating Immunoglobulin (TSI) tested to rule out Graves Disease.

Quite often in the early stages of Hashi's levels can swing from hypo to hyper, then back again.  TSH is a pituitary hormone, which fluctuates widely, so while it should never be used alone to diagnose or treat thyroid issues, it can be seen as an indicator of potential issues.

Your FT4 is very low in its range, indicating that your thyroid is not producing much in the line of hormones.  Most/many of us find that we need FT4 to be at least mid range and FT3 to be in the upper 1/3 of its range. Your thyroid produces mostly T4 hormone, which is then converted to the active/usable T3.  As your thyroid produces less T4, there will be less to convert, so it stands to reason that your FT3 level will continue to drop as well.  The "free" for the T3 and T4 hormones, indicates how much is actually available for use or conversion; so always make sure that's what you specify when getting tests - Free T3 and Free T4.  

Vitamin B12, D and iron deficiencies can also cause the most horrible fatigue, so don't take those lightly.
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649848_tn?1357751184
"I am wondering if I have had thyroid issues most of my life but "modern" medicine has not been able to recognize it because of the one-size fits all test results interpretation for TSH, T3F and T4F readings."  

Very good assessment!!

a) Yes, the up and down TSH can indicate something.

b) While scans are very useful tools, they might not always show EVERYTHING that's going on.

c) MY realistic interpretation of your Free T3 and Free T4 do indicate possible thyroid issues.

4) Yes, it's very possible to have a mix of hyper and hypo symptoms.

My first impression is that you possibly have Hashimoto's Thyroiditis.

Your Thyroid Peroxidase Antibodies (TPOab) was negative, but that's not the only test your doctor should have run.  You should also have had a Thyroglobulin Antibodies (TGab) test.  Either one or both of these antibodies (TPOab or TGab) can be present with Hashimoto's, so just testing for one, is not good enough.  Additionally, since you have some hyper symptoms, you should also get Thyroid Stimulating Immunoglobulin (TSI) tested to rule out Graves Disease.

Quite often in the early stages of Hashi's levels can swing from hypo to hyper, then back again.  TSH is a pituitary hormone, which fluctuates widely, so while it should never be used alone to diagnose or treat thyroid issues, it can be seen as an indicator of potential issues.

Your FT4 is very low in its range, indicating that your thyroid is not producing much in the line of hormones.  Most/many of us find that we need FT4 to be at least mid range and FT3 to be in the upper 1/3 of its range. Your thyroid produces mostly T4 hormone, which is then converted to the active/usable T3.  As your thyroid produces less T4, there will be less to convert, so it stands to reason that your FT3 level will continue to drop as well.  The "free" for the T3 and T4 hormones, indicates how much is actually available for use or conversion; so always make sure that's what you specify when getting tests - Free T3 and Free T4.  

Vitamin B12, D and iron deficiencies can also cause the most horrible fatigue, so don't take those lightly.
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Avatar_m_tn
Thanks for your detailed response.

My D3, B12 and iron blood results will be coming back in a few days.  I suspect I am low on D3 because it has happened before.  I have a tendency to have a deficit of D3 and need supplements - I had stopped taking them because I had significantly passed the upper range for a while due to the large quantity I was taking.  But I think I didn't time the resuming properly...

Is there a known relationship between Vit D and Thyroid (in any direction or even cyclical)?

The earliest I can remember having symptoms strangely correlates to after my tonsillectomy around the age of 12, which turned in to a major operation because they were difficult to extract apparently.  I just recently read that there may be a correlation between a faulty tonsillectomy and thyroid damage.  Or putting it another way - supposedly sometimes tonsillectomies can go bad and damage your thyroid (like a nick or something)???

Have you ever heard of anything like this or is this just something I shouldn't even waste time on as a theory?  Anyway, even if it were to be true, it doesn't really help me, but just possibly helps explain how my thyroid got damaged...

I also have a gluten theory.  Before I started focusing on thyroid, I always felt like I had a gluten or wheat issue, because of the almost constant diarrhea.

Could I possibly be hypo, but have diarrhea instead of constipation because of a gluten instigated thyroid problem (and the gluten issue is independently causing the diarrhea)?  The other flip flop symptom is that normally I feel hot and sweaty, but lately my hands have been feeling cold and I have been getting some faint chills.

It's almost like I am mildly fluctuating between hyper and hypo.  Does that make any sense?  Can this flip flop over days/weeks?

Thanks again
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Avatar_m_tn
It's almost like I am mildly fluctuating between hyper and hypo.  Does that make any sense?  Can this flip flop over days/weeks?


Simple answer to your question:  YES.  Absolutely.

Hashi's can attack your thyroid at different levels and rates over time.  Thus your Thyroid may produce hormone for a while to make up for the deficiency and then stop.  Thus the fluctuating from Hyper to Hypo.

Another thing that can do this is Thyroid nodules.  Sometimes these nodules "leak" hormone out from time to time.  So you may be  Hypo for a long time then the nodule "leaks" some Hormone out and you then go Hyper.

Barb is right you need also to be tested for TGab to rule out Hasih's.  Also since you are having some Hyper symptoms as Barb states a TSI is also recommended.

It is common that people with Hypo also have Vit D and B-12 deficiency.  I'm not 100% sure they are related or just that they are discovered more as people who complain of being fatigued would be more apt to get tested for these.

I too have my FT4 in the bottom but within range. And I have been unable to get treatment.  I too have a fairly long list of symptoms.  But with TSH in the middle of the range and the FT4 "within" range.  They do not want to do anything about it.  I'm switching Dr's and have to get my plan of attack ready and all my research and lay it on the Dr on the initial visit.  Want to get all my ducks in a row so to speak.  I too have had most of these symptoms for my entire life from my teen years to present.

As a 45 year old man they just don't want to check or believe that a man can have low Thyroid as it is just more common in women.

I truly believe that I could get rid of my Cholesterol medication if I could get my Thyroid levels up a bit.  My job is to try to prove that to the new Dr.
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649848_tn?1357751184
I can't say whether or not a tonsillectomy would cause thyroid issues or not; they always say "anything's possible".

Vitamin D is critical for good thyroid function.  If you google "link between hypothyroidism and Vitamin D", you'll come up will a lot articles.

Pernicious Anemia (B12 deficiency) is another autoimmune condition; once a person has one autoimmune, the chance of getting one or more others, becomes greater.

If you think you have a gluten issue, you can get tested for celiac, which is another autoimmune disease.  Gluten doesn't "instigate" a thyroid problem, but,yes, it's possible to be hypo and have diarrhea rather than constipation.

Yes, your "flip flop" makes sense.  It's very possible to swing from hyper to hypo.
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Avatar_m_tn
flyingfool,

I totally share your frustration.  Listen to this one - I just got my vitamin d results back.  It's 30 (and the range as you probably know is 30-100).  Now - the doctor knows I am naturally deficient because unless I take supplements I go under 30.  For example I was 15 on 3/8/11 and 25 on 5/31/11 (these values are on my record and the tests were performed at the same office).  So what do I get in the mail: a standard "you are in the range and you're just fine" letter.

My true thoughts about that letter would need to be censored if I were to express them... I am taking 4,000 units of vitamin D a day to bounce my number back up again...  This time I am going to try to time reduction of my dose well so I don't shoot over 100 significantly.

BTW - For my thyroid I just got an appointment with an MA thyroid doctor who is known to think out of box and doesn't necessarily adhere to "the range".  I just hope that there is a magic pill I have been waiting for all my life - but I am probably going to have a let down as my understanding is that taking T4 and finding the right dosage is quite tricky...?
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649848_tn?1357751184
There are no "magic pills" you can take and yes, adjusting meds can be quite tricky, however, if you have a really good doctor, who truly is willing to think outside the box, 1/2 your battle will be won.  

Also, keep in mind that there are different meds that can be tried, if one doesn't work for you.  There are several brand names of T4 med, plus generics, there's cytomel (T3) and the generic, as well as several brands of desiccated hormone.  There are a lot of combinations for dosing; you just have to find "your" combination.  The key is patience, because it does take time, which is what most people don't want to hear.  Whatever medication(s) you try, you have to make sure you give them plenty of time to do their thing.  

I'm happy to hear that you are supplementing the vitamin D, even if your doctor says you are "fine"........ we know better.

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