High TPO Antibodies but not Hashi?

[kdblack]

I went for my first apt with the Endo today. I was referred due to nodules and enlarged thyroid. My lab results are as follows....
TSH 3.46 range .30-5.60
T3 Free 2.89 range 2.50-3.90
Free T4 .63 range .61 -1.12
Thyroglobulin Antibody 4.4 range 0.0-3.9
Thyroperoxidase Antibody 199.9 range 0.0-9.0
Everything I have read says that this means I have Hashimoto's. The Endo said that having the antibodies meant I had inherited genes and I may or may not develop hypothyroidism. But since my levels were normal right now I didn't need any meds. She is sending me for an ultrasound on the nodules but that is all I got today at my appointment. Do I need to find another doctor or is this the norm?

[kdblack]

I am located in eastern KY and would appreciate any referrals.

[gimel]

Being an Endo does not guarantee a good thyroid doctor.  Many of them specialize in diabetes, not thyroid.  Also, many of them have the "Immaculate TSH Belief" and only pay attention to that.  This is inadequate.  If they test beyond TSH it is usually only Free T4 and then they use "Reference Range Endocrinology" and will tell you that a test result that falls within the so-called "normal' range is adequate.  That is also wrong.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

If you will tell us your location, perhaps we can suggest a doctor that has been recommended by other thyroid patients.  

[kdblack]

Thank you all for your answers and I will be contacting my Primary doctor for another referral to a different Endo. I feel too bad and have too many symptoms to be told "let's wait". I don't want to have to get worse in order to be treated. I really appreciate everyone here and so glad I found this site. Makes it easier having someone to discuss this stuff with that understands what you are going thru.

[Barb135]

Don't be unduly worried about the nodules... Nodules are very common with Hashimoto's.  Many/most of us, here on the forum have thyroid nodules and they aren't anything to worry about.  Thyroid cancer is quite rare (< 5% of nodules turn out to be cancer).  It's always good to have a thyroid ultra sound to make sure the nodules don't have any unusual characteristics or anything, but don't let it get you down.  

I'd like to point out, also, that TSH "does" have a place when it comes to diagnosing thyroid conditions, but it can not be used as the sole basis for making or withholding the diagnosis.  It should only be used in conjunction with other test results and symptoms and that's what too many doctors lose sight of... yours included.  Once the diagnosis has been made and a person is on medication, TSH becomes almost totally unreliable for many of us.

I think it's fine for you to have the ultrasound and get that out of the way, just to ease your mind...  Hashimoto's can also be diagnosed via ultrasound, so perhaps your endo will change her mind about your diagnosis, once she sees the result.  However, I'd still find another doctor, because this one is too focused on TSH and will keep you ill.

[flyingfool]

Your Dr has what we call here: "Immaculate TSH belief".

And we have generally found that any Dr who only will look at TSH is almost a gurantee that they will keep the person feelinig like crap and under medicated and often times on a roller coaster ride of hell up and down with dosages and symptoms.

All because the TSH is a  total joke of a test!  yet  medical schools still teach this as being the "gold standard".    TSH can vary as much as 70% within a single day. So what good is a test that is that variable.  Besides as Barb stated, it is NOT even a thyroid hormone.  

The fact that your Dr has ignored that BOTH, not just one that is necessary, but BOTH of your antibody tests exceed the upper limit and means that you have Hashi's.

AND the fact that as Barb stated BOTH of your FT4 and FT3 are woefully low in the range.

AND that you have symptoms that are consistent with Hypo

AND that your Dr was taking offense to you advocating for yourself and your health.

ALL those things combine to tell me that you shoule RUN, not walk RUN to go find another Dr.  As your current one is almost certainly likely to keep you feeling sick.

Oh, and don't be surprised if you continue to "push" this Dr and the Dr will want to prescribe antidepressants or anti-anxiety medication!  Again if that happens, if you have not already found another Dr,  RUN to find one after that!

Just my opinion.  Others may have different thoughts.

[kdblack]

Thanks so much for your advice. I believe I will have the ultrasound done (scheduled for next week) and then I think I will contact my PCP and ask for a referral to another Endo. I do have a family history of thyroid disease and cancer so I am very concerned about the nodules. I appreciate your help.

[Barb135]

Oh my... your symptoms certainly are those of hypothyroidism and aren't surprising at all.  Neither is it surprising that your doctor acted like she was getting upset that you questioned her - many doctors think they are the "be all, end all" when it comes to thyroid treatment and that TSH says it all, when, in fact, TSH is a pituitary hormone, not a thyroid hormone.  

First off, your lab is using an outrageously wide range; I've rarely even seen the upper level go as high as 5.60... I'm sure a lot of hypo people get left untreated with an upper range like that.  Some years ago, the AACE recommended that the range for TSH be changed to 0.3-3.0, but many labs, therefore, doctors have been extremely slow to follow the guideline. Using the 0.3-3.0 guideline, your TSH is actually over range... but let's just forget about TSH, since it's not a thyroid hormone...

As I noted, both, your Free T3 and Free T4, which ARE thyroid hormones are way too low in the ranges - which, by the way, your lab is also using "odd" ranges for... A doctor's oath is to "do no harm", so it never ceases to boggle my mind how some doctors would prefer to see their patients suffer with symptoms than to prescribe a tiny daily pill that could make them fell so much better.

You're right that she will, probably order an FNA for the nodules, since they are relatively large, however, some doctors wait until they reach 2 cm before they do the FNA... since your doctor refuses treatment for hypothyroidism, she may recommend "watching" the nodules, at this point, as well, because thyroid cancer is rare (less than 5% of all nodules are cancer).

Your choice, at this point, is how long you choose to suffer with the symptoms... it's pretty clear that she's not prepared to treat you until your TSH goes out of range, which could take some time, and your symptoms will only become worse.

I, personally, would kick her to the curb and find another doctor, asap...

[kdblack]

Yes Barb135 I am having symptoms. I have enlarged thyroid, fatigue, brain fog, hair falling out, lump in throat, dry skin, tingling in hands, etc. I even asked her would she not give me meds due to my symptoms and she said not now because my TSH was in normal range. I really felt like she was getting upset because I was questioning her and her reply was lets just wait and see what the ultrasound says. So I have been waiting a month for that apt know I have this and nodules and now I have to wait for them to schedule and ultrasound and I don't see her again for another 3 weeks at which point I am sure she will schedule me for an FNA due to the size of nodules (1.7cm and 1.2cm) without any treatment.

[Barb135]

Unfortunately, we find it to be the norm all too often, but you should still run and find another doctor... It's not just because your doctor says you don't have Hashimoto's; that's probably not that big a deal because some people don't even ever get tested for Hashimoto's.  What "is" a bit deal is that your thyroid hormone levels are so low now, that I'd say you're already hypo and would be surprised if you don't have symptoms of hypothyroidism. I can't believe your doctor didn't start you on medication.

Rule of thumb (where most of us feel best) is for Free T4 to be about mid range... yours is at 4% of its range; that's a long ways from 50%.  Rule of thumb for Free T3 is upper half to upper third of its range and yours is only at 28% if its range.  Again, that's a long way from the target.  

Are you having symptoms of hypothyroidism?