do I need surgery? My endo dr thinks I need to see a surgeon.

[Mmaytn]

Vitamin d 31, cortisol 11.3, calcium ioniz 1.2,tsh 2.14 (levothyrocin) free t4 1.11, ferritin 34.1, b12 718, free t3 2.35 and acth plasma 2.6. I have a 3cm thyroid module. Was told I have hypothyroid and Hyperparathyroidism. Several years ago about 10 I had pituitary dwarfism and took shots for it for 6 months. Gfr 87 and ifg 67

[gimel]

The first thing you need to do is locate a good thyroid doctor that will treat you clinically by adjusting your Free T4 and Free T3 levels as needed to relieve hypothyroid symptoms that you have.   To get an idea of how much thyroid medication wo;; be required, the average body produces 100 mcg of T4 and 10 mcg of T3 over an entire day.   Since T3 is 3 times as potent as T4 that daily amount is equivalent to 130 mcg of T4.  

Thyroid medication is not additive to your prior levels.  When you take thyroid med, it reduces your TSH level and thus reduces the output of natural thyroid hormone.  Since serum thyroid levels are the sum of both natural thyroid and thyroid med,  that means that your serum thyroid levels won't start increasing until  TSH is essentially suppressed.  Only after that will additional increases in thyroid med start raising your serum levels of thyroid.  

You mentioned that the 50 mcg dose of T4 med lowered your TSH to .40.  That is not a problem.   Many doctors erroneously think a suppressed TSH when taking thyroid med is an indication of hyperthyroidism.   In reality, when taking thyroid med a suppressed TSH  indicates the possibility of  hyperthyroidism only if having hyper symptoms due to excessive levels of Free T4 and Free T3.   So you need a  good thyroid doctor that will titrate your thyroid med dose as needed to relieve symptoms, without being influenced by resultant TSH levels.   Symptom relief should be all important, not just test results and especially not TSH.  

In addition, hypothyroidism is accurately defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."  So it is not just the supply of thyroid but also the response to it at the cellular level.   There are a number of variables beyond Free T4 and Free T3 that can affect your thyroid status.   Some of the more important ones that you need to get tested are Reverse T3 and a Free T3 from the same blood draw, cortisol, Vitamin D, B12 and ferritin.    Do you think you can get those done?

I realize that there may be other issues, but I think you need to get your thyroid issue taken care of first.  And of course everything I have said here about thyroid  may also apply to your mom.  

Also, if you will tell us your location, perhaps we can suggest a good thyroid doctor in your area, that has been recommended by other thyroid patients.

[Gracevd70]

Just throwing this out here.  You said you just developed psoriasis and you have thyroid issues and a variety of body pains and osteoporosis.  This is just my opinion and I'm not a medical doctor but I'm a life long sufferer of psoriasis and I had a thyroidectomy (cancer) and was just diagnoised with Psoriatic Arthritis that has caused all my maddening pains ... have you been checked by a Rheumotologist ?  

[Mmaytn]

No I have not been to see a rheumatologist. Was told that I have osteoarthritis of the spine and nerve damage in arms. Neurologist did a test on my arms because my elbows and wrist hurt and get in cramps. It was some kind of shock test. I also trip and fall a lot somehow I don’t get my foot high enough. Ankles hurt a lot but foot doctor doesn’t know what is wrong yet. Have seen him 2 times this year for severe ankle strain. And put in a boot to wear. I will definitely see if I can see another specialist.

[Gracevd70]

If I were you I would see a Rheumotologist and do some research on Psoriatic Arthritis you might be surprised by what you read I was told over and over that all my pain body issues was from overuse and my ostepenia is from synthyroid and the list goes on.  Psoriatic Arthritis is not easy to diagnose and bloodwork usually reveals nothing but Psoriatic Arthritis can cause so many issues that doctors often blamed on other disorders, overuse injury the medical field love that word.  Sadly I lived this nightmare of misdiagnosis and I'm paying for it I currently walk with a cane since my feet and knees don't function right ...sigh.

[gimel]

Sorry, that should have been your mom.

[gimel]

Please check and answer my question about the TSH.  Was the result 40 or .40?

Also, I am curious about our mom.  Has she been treated for the Graves"?

[Mmaytn]

Yes it was .40 and my mom has Graves’ disease. They removed some of her parathyroid and she is now on thyroid medicine too. Her calcium is still high.

[Mmaytn]

Also all my blood test done before 9 am

[gimel]

You said you tried Levo and your TSH went to 40.  Did you mean .40?

Also, what time of day was blood drawn for the cortisol test?

[gimel]

Need the reference ranges for those test results, as shown on the lab report.  

[Mmaytn]

I submitted the lab test and symptoms would you tell me what you think. My dr wants to send me to a surgeon. I am considering going to Vanderbilt with all my test. Just not sure what to do. My mother had parathyroid cancer and I don’t want to end up like her. She has Graves’ disease and she can not walk anymore.

[Mmaytn]

About 7 years ago endo says I have pituitary dwarfism I take shots for Six months. This gets corrected. Then over the next few years parathyroid gets high but calcium normal. We do nothing. I develop psorasis and muscle weakness test show low vitamin d took 50000 units for 6 mths weekly.  Now I have hypothyroid and Hyperparathyroidism. Calcium ioniz 1.2,cortisol 11.3, vit d 31.6, tsh 2.14, pth 113, free t3 2.35, free t4 1.11,ferritin 34.1, gfr 87,b12 718,1gf 67 and now acth plasma 2.6. Taking 25 levo. Just seems that maybe the pituitary is acting up. But she wants me to see a surgeon for thyroid. I do have 3 cm nodule. She also wants to increase my levo to 50 but my tsh is 2.41? Not sure

[Mmaytn]

Calcium ionized 1.2 (1.1-1.4)
Cortisol 11.3(4.5-22.7)
Vitamin d 31.6 (30-100)
TSH 2.14 (.30-3.04)
T4-1.11 (.78-2.19)
ferrtin 34.1 (11.1-264)
B12 718 (239-931)
TRansferrrin 280.6 (206-371)
Tibc 359 (265-487)
aCTH 2.6 (7.2-63.3)
Igf 67 (53-190)
Pth 113 (11.5-86)
T3 2.35 (2.77-5.27)
This was my last blood test I still have thyroid and parathyroid intact. Still worried about my pituitary gland. My symptoms are weak muscles, tired, muscle cramping in arms and legs, dizziness, stomach pains, edema in (stomach, esophagus, legs,)dry brittle hair and nails, chapped skin so dry, raynaulds, heart valve problems, racing heart taking medicine to slow beat down. Osteoporosis in neck and lower back osteopenia in hips. Taking calcium and vitamin d supplement, thyroid 25, heart meds. My endocrine dr first treated me for pituitary dwarfism then 2 years later parathyroid started going up now in the 3 year hypothyroid and hyper parathyroid and pituitary started to go down again. I have tried 50 levo thyroxine which took my TSH to 40 they took me off that after 3 mths then to 25 after 3 mths told me to stop taking to see if it would straighten out. Triglycerides triples PTH went 189 and thyroid was 2.0 then they put me back on 25 levo thyroxine and this is the new results. I do have a 3cm thyroid module.

[gimel]

Don't know that I can adequately respond to all the different issues, but In trying to assess a person the most important consideration is an evaluation for symptoms.  so please tell us about any symptoms you have.  Also, test results and associated reference ranges vary from lab to lab, so in order to assess your test results, please post their reference ranges shown on the lab report. ,