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Help with suspected hypothyroidism
History:
46yo white male
Extreme fatigue, shortness of breath, muscle aches, joint pain, constipation, weight gain, high BP, trouble swallowing, hoarse voice, ongoing with daily fluctuations for 5 months, now.
I have been back and forth from my regular Dr to the ER 6 times, now, full cardiac and blood workups, one ER doc suggested hypothyroidism, but all other Drs have rejected the idea out of hand.
TSH = 3.062
T4 = 1.08
My research suggests that those may be hypothyroid, if present with symptoms, but the last 3 Drs have said that unless TSH is over 10, I'm fine, and they don't even need to worry about T4.
Any help?
46yo white male
Extreme fatigue, shortness of breath, muscle aches, joint pain, constipation, weight gain, high BP, trouble swallowing, hoarse voice, ongoing with daily fluctuations for 5 months, now.
I have been back and forth from my regular Dr to the ER 6 times, now, full cardiac and blood workups, one ER doc suggested hypothyroidism, but all other Drs have rejected the idea out of hand.
TSH = 3.062
T4 = 1.08
My research suggests that those may be hypothyroid, if present with symptoms, but the last 3 Drs have said that unless TSH is over 10, I'm fine, and they don't even need to worry about T4.
Any help?
"What's the reference range for the Free T4? "
The lab listed 0.54-1.8, but I think that was for all age groups, not adults, which I usually see as 0.9-1.8, but I also see recommendations that it should really be >1.3.
"your vitamin D is definitely, too low - did they give you prescription "mega-dose" (usually 50,000 IU/week) or just tell you get an OTC Vitamin Dto take daily?"
They told me to use OTC, which I had tried for a while back in January/February, but I've also been indoors a lot more than usual, since I've been ill, so I've just started spending some time sunbathing, now that spring is here.
I have now been to 7 doctors, only 1 of whom read my chart as hypothyroid, and she was an ER doc who told me to follow up with a primary care physician, none of whom will even consider the idea.
The lab listed 0.54-1.8, but I think that was for all age groups, not adults, which I usually see as 0.9-1.8, but I also see recommendations that it should really be >1.3.
"your vitamin D is definitely, too low - did they give you prescription "mega-dose" (usually 50,000 IU/week) or just tell you get an OTC Vitamin Dto take daily?"
They told me to use OTC, which I had tried for a while back in January/February, but I've also been indoors a lot more than usual, since I've been ill, so I've just started spending some time sunbathing, now that spring is here.
I have now been to 7 doctors, only 1 of whom read my chart as hypothyroid, and she was an ER doc who told me to follow up with a primary care physician, none of whom will even consider the idea.
COMMUNITY LEADER
Your symptoms could very well be those of hypothyroidism. Unfortunately, your doctors are doing a disservice by going only by TSH and since yours is well within the range, they don't want to look further. We see this a lot.
That said, is the T4 a test for Free T4 or Total T4? They aren't the same test. Some of the T4 in your blood is bound by protein and can't be used; some is "free" and is available for use. That which is unbound aka "Free" is what we're concerned with. In addition, reference ranges vary from lab to lab and have to come from your own report, so if you could let us know what the range is for the T4, that would be helpful. Next time you get labs, also ask to test for Free T3. Free T3 is the actual active hormone, whereas Free T4 must be converted to Free T3 in order to be used by the body.
You might try to get your doctor to test for thyroid antibodies to see if you have Hashimoto's. Hashimoto's is the # 1 cause of hypothyroidism in the developed world and many of us have it for a long time before our actual thyroid hormone levels go far enough out of range to be considered hypothyroid. The tests you need for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). Both are indicative of Hashimoto's.
In addition, I'd recommend a thyroid ultrasound, which would detect nodules on your thyroid. Nodules are very common and usually aren't anything to worry about but they could account for the hoarseness and/or other symptoms.
Since your doctor(s) seem to have the idea that TSH is all that matters, you might have to look around for another doctor. Sometimes we find that patients have better luck with a holistic doctor or Naturopath as they seem to be more open to looking at things other than TSH. They also, often don't accept insurance. In addition, so Nurse Practitioners practice on their (depending on your location) and may be open to looking at the whole picture, as well.
That said, is the T4 a test for Free T4 or Total T4? They aren't the same test. Some of the T4 in your blood is bound by protein and can't be used; some is "free" and is available for use. That which is unbound aka "Free" is what we're concerned with. In addition, reference ranges vary from lab to lab and have to come from your own report, so if you could let us know what the range is for the T4, that would be helpful. Next time you get labs, also ask to test for Free T3. Free T3 is the actual active hormone, whereas Free T4 must be converted to Free T3 in order to be used by the body.
You might try to get your doctor to test for thyroid antibodies to see if you have Hashimoto's. Hashimoto's is the # 1 cause of hypothyroidism in the developed world and many of us have it for a long time before our actual thyroid hormone levels go far enough out of range to be considered hypothyroid. The tests you need for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). Both are indicative of Hashimoto's.
In addition, I'd recommend a thyroid ultrasound, which would detect nodules on your thyroid. Nodules are very common and usually aren't anything to worry about but they could account for the hoarseness and/or other symptoms.
Since your doctor(s) seem to have the idea that TSH is all that matters, you might have to look around for another doctor. Sometimes we find that patients have better luck with a holistic doctor or Naturopath as they seem to be more open to looking at things other than TSH. They also, often don't accept insurance. In addition, so Nurse Practitioners practice on their (depending on your location) and may be open to looking at the whole picture, as well.
2 Comments
Thanks for the reply!
That was free T4, and I had another lab test done yesterday in the afternoon (the last one was in the morning):
TSH 2.352 uIU/mL
T4,Free(Direct) 0.87 ng/dL
They are saying that these values are fine, but that my Vitamin D is low:
Vitamin D, 25-Hydroxy 16 ng/mL
That was free T4, and I had another lab test done yesterday in the afternoon (the last one was in the morning):
TSH 2.352 uIU/mL
T4,Free(Direct) 0.87 ng/dL
They are saying that these values are fine, but that my Vitamin D is low:
Vitamin D, 25-Hydroxy 16 ng/mL
What's the reference range for the Free T4? It looks like rock bottom to me, according to most ranges we see. Did you get a chance to ask for the antibody tests or a thyroid ultrasound? Those tests could give a wealth of information.
Yes, your vitamin D is definitely, too low - did they give you prescription "mega-dose" (usually 50,000 IU/week) or just tell you get an OTC Vitamin Dto take daily? Don't forget that we need magnesium in order to absorb Vitamin D and Vitamin D is a fat soluble Vitamin, so should be taken with a meal containing fat.
Yes, your vitamin D is definitely, too low - did they give you prescription "mega-dose" (usually 50,000 IU/week) or just tell you get an OTC Vitamin Dto take daily? Don't forget that we need magnesium in order to absorb Vitamin D and Vitamin D is a fat soluble Vitamin, so should be taken with a meal containing fat.
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