Goiter w/normal labs(?), why the goiter?

[SunshineFLA]

Are my labs really OK?

Almost 3yrs now suffering from what seems like Hypothyroid symptoms & now what seems like Adrenal issues. I'm suffering physically & mentally, no improvement w/diet. My Endo thinks I more than likely do have Hypo, but doesn't believe in treating it until my labs confirm it. Wondering if my adrenals or pituitary gland is causing Goiter & these horrible symptoms?

These are my labs from March. New blood work is being done this month, is there any other test I should ask for? I've added some additional testing that I had done just in case it's useful somehow.

*I have PCOS, vit D deficiency, bad cholesterol etc. Goiter confirmed by ultrasound in December & again in March. Thank you for any info or suggestions.

Tested at 7:54am
ACTH, plasma-6 pg/mL
Range: 6-50 pg/mL

Cortisol, A.M.- 0.5L
Range: 8am (7am-9am)
Specimen: 4.0-22.0

Dexamethasone- 356 ng/dL
Reference ranges:
Baseline: Less than 20ng/dL
1mg Dexmethasone overnight:
180-550ng/dL (8-10am)
--—-------------------------
TSH: 2.08
Range 0.40-4.50

T4Free: 1.1
Range: 0.8-1.8

T3Free: 3.3
Range: 2.3-4.2

Thyroid Peroxidase & Thyroglobulin Antibodies: 1
Range: < or = 1

*Other additional blood work if needed(?)


Estradiol ultrasensitive is - 47pg/mL
Ranges:
39-375 pg/mL follicular phase
48-440 pg/ml Luteal phase
or=46 mg/dL

Triglycerides: 310
Range <150 mg/dL

LDL- cholesterol: 173
Range  or =60

Bun Creatinine: Not acceptable

Sodium: 138
Range 135-146

Potassium: 4.3
Range 3.5-5.3

Chloride: 105
Range 98-110

Carbon dioxide: 23
Range 20-31

Calcium: 9.5
Range 8.6-10.2

Protein, total: 7.1
Range 6.1-8.1

Albumin: 4.2
Range 3.6-5.1

Globulin: 2.9
Range 1.9-3.7

Albumin/Globulin ratio: 1.4
Range 1.0-2.5

Bilirubin: 0.4
Range 0.2-1.2

Alkaline phosphate: 99
Range 33-115

AST: 18
Range 10-30

ALT: 20
Range 6-29

Hemoglobin A1c: 5.3
<5.7% total of Hgb

[gimel]

The symptoms of low cortisol, or hypoadrenalism, include:

    Mental and psychological ailments such as depression
    Faintness and dizziness
    Weakness and fatigue
    Heart palpitations
    Emotional hypersensitivity
    Inability to cope with stress
    Social anxiety
    Muscle weakness
    Headache, scalp ache, or general body ache
    Severe or dull lower back pain
    Extremely sensitive skin
    Nausea, diarrhea, and vomiting
    Abdominal pain and hunger pain despite an empty stomach
    Extreme craving for salty foods
    Anxiety and jitters
    Clumsiness and confusion
    Motion sickness
    Insomnia and dark circles under the eyes
    Low bladder capacity and symptoms of IBS
    Irregular or non-existent menstrual period


So you need to get the tests I mentioned above.  I agree with Rios that you need hormone testing, including estradiol, pregnenelone, testosterone, and progesterone.  Of course the cortisol issue needs to be addressed, even before thyroid.  

You can get some useful info from the following link.  I highly recommend reading at least the first two pages, and more if you want to get into the discussion and scientific evidence for all that is recommended.  Note especially Recommendation no. 16, on page 14, which states, " Central or secondary hypothyroidism is frequently part of a more complex hypothalamic
or pituitary disorder. This requires a complete evaluation and biochemical testing of all pituitary hormones and dependent organs. In case of suspected or proven cortisol deficiency of either central or adrenal origin, it is important to defer any thyroid hormone replacement until prior adequate correction of hypocortisolism."

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

[SunshineFLA]

The symptoms are me!
Well, I actually got an appointment today & i had printed out the symptoms & showed the list of tests I'd like to have done. This is how the visit went:

Me:'I was wondering if I could have a prescription for hydrocortisone tablets?' 'My fatigue & over all health has had no improvement since the last visit'.

Doctor: Why in the world would you need that medication?

Me: with my Cortisol being so low on the previous test I figured the HC meds would give me some improvement

Doctor: No, that's not what that test means. When you take the steroid the night before for the test, you can't go by the cortisol results to prove low cortisol. It's generally used to rule out high cortisol for Cushings diagnosis.

Me: so that's a no?
Doc: correct, No.

Me: can we run some additional thyroid test? Free t4/T3 and do a reverse T3. Also, Vitamin D, ferritin, b12 and maybe cortisol again? How about ANA?

Doc: No, that makes no sense! (She started to hysterically laugh) The reverse t3 & the t4/t3 isn't needed for you. You've gained weight not lost, and those test aren't needed for someone like you. I'm thinking if you're anything, you sound like hyperthyroid & not Hypo or Hashi that you have in your head. And anything to do with Lupus I can't help you, you have to go to that specialist for the testing.

Me: I know something is not right in my body. Look at my thyroid, it's growing again & it's hurting.

Doc: Where are you coming up with these questions & test? Are you searching online?

Me: that's all I can do, I try to find any and all info about possible things that can happen with thyroids/goiters. I thought if I found useful information from help sites & asked you, you'd give me your opinions.

Doc: No, you need to stay offline. Delete any accounts & stay away from them. You can't search about Thyroid disease and symptoms because- for people like you this could be in your head. Thyroid mimics many other illnesses/disorders, mostly mental illnesses. You very well could have no thyroid problem at all. All your problems & symptoms could very well be from daily life & stress.

I'm taking this as I'm fat, crazy & a hypochondriac. Great

The only tests Endo is willing to do:
TSH.
Cortisol AM w/out the overnight steroid.
Thyroid peroxidase & Thyroglobulin antibodies.
Vitamin D, 25-hydroxy, total, immunoassay

I have to go to a separate lab (quest diagnostics) to have the blood work done. I was thinking I should go ahead & just do these tests. So I have some current labs to have on hand for a new doctor. I know if these new test come back in range or not, I'll probably still not be helped by this current Endo. Not to diss new/young doctors, but I just found out the Endo has only been a Doc for a year. Maybe this is the issue?

[gimel]

Might as well get the tests done, for added information.  Any doctor that feels threatened by a patient reading information on line and asking questions, is not very confident about his own knowledge and practices.  You should move on and make an appointment with a doctor that is going to help you.  

[Red_Star]

Have you had an antinuclear antibody (ANA) blood test yet?

[SunshineFLA]

I've never heard of that, probably not. The results I had posted are literally the only testing I'm ever given. With the exception of the cortisol, 1st time.

I'm writing this test name down on my list. I will leave no test/leaf unturned this time. I don't care if I have to be wheeled out of the lab from so much testing, any test suggestions I'm taking!
Thank you!!

[SunshineFLA]

asked the doctor for this test & the doc laughed. I was told I need a rheumatologist, this Endo said he can't read those test. Ahhhh! Now I'll find one of those doctors. I want to rule this out now.

[Rios8234]

You mentioned you also suffer from PCOS.  Many of your symptoms can also be improved with some progesterone treatment such as a cream or  bioidentical oral progesterone.  Of course, getting your adrenal issues under control, then your thyroid ailment treated will hopefully control most of your symptoms.  Btw, IMHO, your doctor is in the wrong...a goiter is a CLEAR indicator that your thyroid is not functioning properly...get a new doctor before you get worse!!

[SunshineFLA]

I'm to the point where I'd like to yank my goiter out & throw it on the Doctors table so they can see it's acting crazy & it's not just in my head.

I'm definitely buying some of the progesterone, I can't believe a doctor never suggested this all these years. Would you happen to know if it helps with heavy bleeding? I'm trying to get off this horrible BC pill (I didn't want to be on) & the bleeding is way too extreme every time I try to come off of it. I hate being on it & I of course have fertility issues so don't need it. I knew better about the BC, but I thought it might've been different 10yrs later. Nope!

Before this whole thyroid mess/weight I had my pcos pretty well under control. Took me years...Now everything internally is going insane.

Thank you for the information, I'm buying some today!

[SunshineFLA]

I had an unplanned appointment today. I asked my Endo about which would be better for me, pill or cream. I was told I can't take this because of my testosterone. But I did some reading on this last night & it looks to me like this would be wonderful for me! I'm still going to give it a try :)

[gimel]

Regarding your thyroid test results, here is a quote from an excellent thyroid doctor.  "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

For your doctor to say that you are likely hypothyroid, and ignore all those symptoms that relate to hypothyroidism, and then refuse to treat you until your labs were out of range, is just ridiculous.  A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  

In view of your doctor's statement, why did he not address the cortisol test result that was out of range?  Even though you need thyroid med your severe cortisol deficiency needs to be addressed first.  

So I recommend that you call the doctor and ask about a prescription for hydrocortisone, adequate to get your cortisol level to optimal.  Once on adequate hydrocortisone your cortisol will change fairly quickly.  By that time you will be going back for followup tests.  Along with Free T4, Free T3, you should request to be tested for Reverse T3, Vitamin D, B12, ferritin, and cortisol.  You should also give the doctor the complete list of symptoms you provided above.  We can give you lots of info to try and persuade the doctor to also start you on thyroid med at that time; however, based on experience to date, I am not very optimistic about that doctor.  As an alternative, if you will tell us your location, perhaps we can give you the name of a doctor that has been recommended by other thyroid patients.    

[SunshineFLA]

The Cortisol test- she said was fine. I was only given that test because she thought I could have Cushings, she said I was negative for that. That was the end of the cortisol discussion.

I had actually said something about Addisons, but because I gained instead of lost weight she dismissed that idea. Not to sound like a hypochondriac, but w/my symptoms & being told I'm fine in the thyroid department, I wanted to rule out things like Addisons, Lupus, EBV etc. I know most Doctors hate it, but I've been searching (& asking) non-stop online trying to figure out what could possibly be wrong with me & bring the info to the Doctor.


I will definitely ask her in person for the hydrocortisone at my Husband visit this week, he's a patient too. Oddly enough my Husband was given the same cortisol test & his came back low too at 0.6L. Same response for him too, "negative for Cushings/test is fine". Depending on her response tomorrow, I may or may not have a doctor afterwards.

I've changed Endos (who all specialize in Thyroid) & Primary's so many times it's ridiculous. I have an appointment with a Homeopathic MD, but can't get in until October. that is so incredibly expensive, but don't know where else to go. I live in Tampa, FL 33619 if by chance there's a local Doctor I missed, that'd be great! Thanks so very much

[gimel]

I just sent you a PM with info.  To access, just click on your name and then from your personal page, click on messages.  

[SunshineFLA]

Great! After my appointment today, I now know this Endo may just refuse to listen to me. It looks like it's time to move on from that office. Thank you for the info in the message.

[gimel]

There is much to discuss, but first please tell us about the symptoms you mentioned.  

[SunshineFLA]

Thank you for the reply! It's a long list

Light headed when standing
always dizzy
can't get enough air in my lungs
hot stabbing pain above both kidneys CT was fine
My hips & knees lock up & ache
My legs either constantly tingle or fall asleep
Racing heart
Heart palpitations(?) my heart feels like it's skips a beat & it makes me gasp for air-weekly
Dry eyes
extremely dry skin
Heels of feet crack/dry
Finger/toe nails brittle
Odd rash on back of hands across knuckles. When my anxiety kicks in the rash turns red & itches.
I itch all over, I've tried everything to stop it.
Gained 50lbs only in mid section & face
I have no muscle mass
can't open a water bottle my hands are too weak
My hair is 60% fallen out
Scalp tender
Sometimes lips turn blue
My mouth taste like spoiled dairy milk no matter what I do. I don't drink milk (I'm lactose intolerant)
My tongue looks scalloped on the sides
Changes in vision, only in right eye, glasses now
Brain fog
Memory loss
A lot of headaches
My head feels like it's 80lbs
Sometimes I stutter, no history of this
I can't speak/type properly often
I can see the word I want to say, but I can't say it
I have to reread things
I repeat myself often
Have suddenly aged, what hair I have is white & feels similar to hay. Even my eyebrows are turning white
Wrinkles
My right eye & right corner of my mouth have an odd droop.

I look like I have two black eyes
Eyes don't bulge out but are puffy.
My eyes have odd rings on the irises.
The whites of my eyes look like they have light blue-ish/gray tint. There's a dark blue-ish ring around the outside of my irises. This is new within the last 4months- I have Brown eyes

Extremely dry patches of skin on each side of face. I use vegan/organic oils/lotions nothing helps
I either live off 3hrs of sleep or can't get enough.
my hands & feet feel like they're in ice buckets
But my neck down to my ankles is burning hot
I instantly start getting over heated when I'm too active or step outside.
I over stress the dumbest little things
I'm an emotional mess
I developed allergies, never had any before. It's everyday, all day, all year long. Outdoors, indoors, any animals, perfumes & anything w/perfumes in them.

If I somehow get too hot, I start to blackout can't walk/talk I struggle to breathe. my legs tighten up & hurt. My feet tingle & curl. I hear my heartbeat loud like a drum, my face looks sunburnt, my skin head to toe feels like it's burning internally, but is cool to the touch. As long as I don't over do it on physical activity this part doesn't happen.

I have no family history of Goiter/thyroid, adrenal, diabetes etc issues.
I don't drink, smoke or abuse any drugs.
I was in great physical & mental health prior to these symptoms. I drink tons of water, rarely I'll have unsweetened green tea or almond milk. no soda, no coffee, no juice, no milk. I really don't eat junk, so odd on the cholesterol?!

Thank you for taking the time to read this, I probably make no sense & everything is so scattered.