new thyroid problem

[DBraddock]

My TSH was found to be high during a routine screening exam. 24.7 (.45 - 5.0)    My free T4 is 0.77  (0.89-1.76)   Thyroid ultrasound revealed multinodular thyroid with the largest nodule being 1.8 cm. Nodules are predominantly hypoechoic.

My new PCP (never been sick before) said that my TSH was high but my T4 is normal.  He is recommending I see an endocrinologist for poss biopsy.  I tried to tell him that my copy of the lab said that my T4 was low.  He insisted it was normal.  

By the way, the normal ranges for our lab (I work in a hospital) changed as of 9/28/09 for free T4.

I've been doing a lot of internet research.  This looks to me like hypothyroid.  Do you agree?  Is a biopsy really indicated?  I'm scared of needles; I'd rather avoid that.

[goolarra]

I'd definitely see someone who can sort this all out for you.  US interpretation is not something I'm good at so really can't comment.  The antibody tests would rule out or confirm Hashi's.  If your hypo is not due to autoimmune, it would be interesting to find out what they do think the cause is, and if they think it might be temporary.  With your TSH so high, I don't think there's an endo in the world who wouldn't treat you.  I think it's worth pursuing one more step...

[DBraddock]

When I researched the symptoms of hypothyroid, I discovered that I do have many of them.  I had attributed them to getting older.  My hair is thinner, I'm tired all the time, my cholesterol profile has taken a turn for the worse, dry skin has become a year round problem and I have some muscle weakness and achy joints.

My thyroid US indicated that the vascularity was normal with "low suspicion for thyroiditis."

[goolarra]

Your TSH is not only high, but very high.  Currently accepted range for TSH is 0.3-3.0.  Even if your FT4 is within range according to the lab report your doctor has, it is too low.  It looks like hypo to me.  I'd see the endo.  Hypo is a condition that you will be dealing with for the rest of your life, so you want a doctor who has a clue about thyroid conditions.  An endo may or may not want to do a biopsy once he reviews the US report.  We're all scared of needles!  He may also run thyroid antibody tests (TPOab and TGab) to confirm Hashi's.

Do you have hypo symptoms?