just diagnosed, confused, need help!

i was just diagnosed with hashimoto's thyroiditis. i am 41, female, have always been very high energy, slender, positive mood, regular periods. there is a family history of thyroid issues in my family. i have had high stress the last year or so--life stuff, nothing too terrible.

. 6 months ago, my dr noticed my neck (thyroid) seemed swollen. i went to an endo, had slightly elevated tsh.  doc said to wait and see. i had gained a couple of pounds at that point, but thought nothing of it. in the last month i have gained about 5-10 pounds. i am more fatigued than i have ever been. my periods became irregular. i went back to endo, who did more bloodwork and reported hashimoto's. my numbers are: t4 1.1; tsh 1.4;  t3 76; tpo 129; t globulin 29. doc said i a not hypothyrodic. i said what about weight gain and fatigue, she said thats not your thyroid. your numbers are fine for thyroid.

seems to me a bit coincidental--the symptoms and the hashimotos diagnoses. is my doc off? anyone else have this situation? any tests to ask for, ultrasounds, etc? i hate taking meds, would prefer a natural approach--but cant keep gaining weight and being tired, either. how do  get a doc that treats hashimotos with symptoms, even if hypo tests are "normal"?

many thanks.

[gimel]

From your test results it appears that you do have Hashi's.  With Hashi's the autoimmune system wrongly identifies the thyroid glands as foreign and produces antibodies that attack the thyroid glands until, over an extended period, the glands are destroyed.  As a result, you will need to take thyroid medication in gradually increasing amounts to offset the loss of natural thyroid production.  There is no known  "natural approach" that is a viable alternative.  

For future testing you should make sure to request Free T3 and Free T4 (not the same as Total T3 and Total T4), along with the TSH they always test for.  If the doctor resists, then insist on it and don't take no for an answer.  Free T3 is the most important thyroid hormone test because FT3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

Since hypo patients frequently have deficiencies in other areas, I would suggest additional testing for Vitamin A, D, B12, iron/ferritin, zinc, selenium, and RBC magnesium.  

With Hashi's there seems to be two approaches used by doctors.  One is to start medication fairly early, to prevent the worst of hypo symptoms.  Others like to wait until hypo symptoms become overt.   You can read about the preventive approach at this link.

http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm

Regardless of the treatment approach, Hashi's does not go away, but the  symptoms can be prevented by taking adequate doses of the proper medication.   It will become very important to find a good thyroid doctor that will treat clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  This is a link to a letter written by a good thyroid doctor.  Note the clinical approach to treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Regarding your doctor's response to your test results and questions, it was not unusual, unfortunately.  Many doctors have the "Immaculate TSH Belief" by which they only pay attention to TSH levels.  This is totally wrong.  Others use "Reference Range Endocrinology" by which they will tell you that a thyroid test result that falls anywhere within the refernce range is adequate.  This is also wrong.  The ranges are far too broad, since they have never been corrected like done for TSH over 8 years ago.  For example many of our members, myself included, report that symptom relief for them required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the midpoint of its range.  

Endos tend to be even more rigid in diagnosing and treating hypo patients, so based on your experience to date, I don't have much hope that you will be able to get needed treatment there.  If you will tell us your location, perhaps a member may be able to suggest a good thyroid doctor based on personal experience.

[stellabloom13]

many thanks. i am currently in washington dc area, but plan to be relocating. if anyone knows a good doctor in dc, or boston area or pacific northwest id love to hear it. what type of dr other than endocrinologist is the right doctor to go and see about this?

i had stage 1 melanoma years ago, and no dr suggested i wait until it hit stage 5 before getting treatment. yet the dr  who identified me as hashi's won't treat me for my hashi/hypo symptoms and  wasn't even that interested in hearing about them b/c of "unimpressive" hypo numbers! crazy! she kept saying "I've seen worse" like it was a competition, and if i don't score high enough on the test, i cant get the prize (medication, etc). i got the symptoms, i got the hash's diagnoses--i think i get the prize.

i welcome all tips, doctor names (wherever you might be located--id travel for good care!) meds to inquire about, tests to take, hoops to jump through, diet, etc.

im glad this forum exists--im learning a lot!

-s

[Barb135]

Please let us know what the reference range is for the T3, and whether or not it's free to total, which as gimel said, are not the same.  The range we sometimes see for FT3 is around 230-420; at 76, yours is very low, IF that's a "free" T3..... IF that's the case, it's not surprising that you have hypo symptoms, and you would need medication.

[gimel]

I do have a member recommended doctor, who happens to be an Endo, in the Pikesville, Md. area.  If this is of interest, I'll send a PM with info.  

For later use, when you get to the Pacific Northwest, I have several for that area.

[Pattyisha]

I'm in the Pacific NW. I called my clinic today to get a copy of my blood tests which I will posh when I get them. Can you tell me the dr's here that you recommend?
Pattyisha

[gimel]

PM sent with info.  

[stellabloom13]

just picked up my labs. from test done back in  5/2011 (range in parentheses) : free t4 .90 (.7-2.0) tsh 1.34 (.4-4.7) anti thyro ab 103.1 (0-9). i was told my labs were fine back in may, but clearly my antibodies are off the charts?

then, different dr, different tests from last week, i have more symptoms than i did back in may: free t4 1.1 (.8-1.8) tsh 1.41 (.4-4.5) t3 total 76 (76-181) thyroid ab 129 (less than 35) thyroglobulin 29 (less than 20).

i just got tests for free t3 today, thanks to you folks. is it insignificant that my t3 total is on lower end--actually, the lowest end of acceptability?

all send pm or open message here  to me regarding anything you like-drs. etc. thanks.

[gimel]

Again, your thyroid antibodies tests both indicate Hashimoto's Thyroiditis.  Your Free T4 is a bit on the low side.  Your Total T3 result is very indicative, and I'm positive that your free T3 will be very low in the range as well, which is very indicative of being hypothyroid.    

So you either need to present enough info and beat on your current doctor until you get agreement to be treated clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, or you will have to find a good thyroid doctor that will do so.  

[stellabloom13]

many thanks. please send along any and all dr info.

[gimel]

Did you receive my PM with doctor in Maryland?

Sending another PM with two doctors in the Pacific Northwest.  

[stellabloom13]

i got only the pacific northwest dr info. thanks.

[gimel]

Just tried again to send PM with info.

[stellabloom13]

got it--thanks!!