High TSH, normal T3 & T4

[tank12335]

After irregular spotting my Dr ran blood tests and discovered my thyroid is not operating correctly.  I am experiencing most of the hypo symptoms... tired, hair loss, weight gain, muscle pain, irregular menstruation, constipation, overwhelmed / depressed, skin changes etc. They have also discovered an ovarian cyst, sized 5cm on my ovary.

Current Dr wants to do nothing and re-test in 6 weeks. I am having trouble with my day to day activities and watching my "normal" self disappear a little more each day.  I have made an appt for a second opinion. I am confused with the lab numbers as my TSH is high and the T3 & T4 are within range... would appreciate any input.

TSH  6.4  (.358-3.800)
Free T3   2.67   (2.18-3.98)
Free T4    .78  (0.40-1.80)

[Kenneth N. Woliner, MD]

Thanks for the compliment. Florida has been tweaking its telemedicine laws and rules to make medicine more national. Pharmacies can already ship out-of-state to other parts of the U.S.  The way Florida physicians interpret telemedicine is that as long as I am not prescribing controlled substances (OxyContin, etc.), I can have virtual visits with patients from other states. I just prefer that the first visit be in-person so I can conduct a physical exam.

[freakingoutinmichigan]

You always give such good advice. I wish I could find a doctor thats half the doctor you are:)

[Kenneth N. Woliner, MD]

Tank,

I'm sorry you have to go through this. I never quite understood how "a patient feels crummy, has abnormal laboratory tests on top of abnormal history and physical exam findings, but the doctor wants to DO NOTHING.". Definitely not the way I approach my patients!

An ovarian cyst is commonly seen with INSULIN RESISTANCE, which might contribute to your other symptoms (in addition to the obvious hypothyroid condition you have with a high TSH. The T4 and T3 levels, while being "in range" are at such a low end, you are now in the "bottom quarter" of the U.S. population.  When 1/3 of America is obese, 2/3 are overweight, 1/3 is on antidepressant drugs, another 1/3 are told to take cholesterol medication ... Why would your doctor not want to raise your thyroid levels to them top third?

Getting a second opinion is a good idea. While you are there, ask them to test for Insulin Resistance with a Fasting Gucose and Insulin to calculate a HOMA-IR score.

There are treatments for both condition. You just need to find a doctor who will actually treat you, instead of just blowing you off.

[freakingoutinmichigan]

It *****..a lot of doctors wont treat a thyroid problem unless your TSH is 5-6 or more but living with hypoactive thyroid the last 10 years I know I have symptoms if my TSH is above 2. I would definitely say get a second opinion. Whats the point of being miserable just because your doctor is stubborn or old school. Get your life back..go to someone else. Good luck:)