Thyroid Symptoms but Normal Blood tests

[amberhfreeman]

So for the past 6 months I have not felt like myself.  My weight has increased, I'm operating on no energy or motivation, poor sleep, dry skin...the list goes on and on. I was diagnosed with depression and and given Celexa 20mg and Ambien. I continued with the extreme fatigue for the past fews months as I felt worse and worse but didn't know what else to do. Untill about a month ago I went to a routine gyno visit and she noticed my thyroid was enlarged. So after blood tests and ultrasounds, I had my results sent over to my family practice doctor. He asked me several questions about my health and family history. My mother was diagnosed with hypothyroidsm in her early 20s as well as her older sister. He ran a whole battery of tests on me including blood work and chest scan and ekg. Everything looks fine but I have all the symptoms, did not benefit from anti-depressant or sleep medicine. His suggestion was to simply switch the brand of the anti-depressant I'm taking and take the sleep medication on a more regular basis. I feel like they are just treating me for depression and not listening to what I am going thru. I was a little leary to think it could be my thyroid but after talking with my mom I feel like it should be something that should be followed up on.

My test results are below:
TSH 2.743
T4 10.9
T3 143
Any help please? Should I see a different doc?

[goolarra]

Though we usually associate losing weight with hyper and gaining weight with hypo, there are some people who gain weight whenever their hormones are off, either too high or too low, and some people who lose weight when either is the case.  

There are a couple of conditions in which you can be hypo at a cellular level even with perfectly adequate serum FT3 and FT4 levels.  They're pretty rare, however.  One is RT3 (reverse T3) dominance, and the other ir THR (thyroid hormone resistance).  You might want to do some research on those and see if anything rings a bell.  I have my doubts about whether RT3 dominance even exists in unmedicated people, but THR is a genetic mutation so isn't a reaction to meds.  I stress it is extremely rare.

Totie had a good idea in having D and B12 tested.  Defiecincies in either of those can cause thyroid-like symptoms.  Ferritin and iron can also mimic.

Which adrenal tests was he planning to run?  It can't hurt (maybe you could ask for the vitamin tests at the same time and kill two birds with one stone?).

[amberhfreeman]

No, everything that was on the report is what I listed. He didn't rerun the TSH becuase he said the one from the month before would be sufficient. If it's hyper though I shouldn't be gaining weight right? I'm so confused, I just feel like I'm crazy. Should I get the adrenal test done...?

[Totie]

Did they run Vid D or B12?

[goolarra]

Is free T3 (tiiodithyronine, free) the only thyroid test he ran?  Did he test TSH and free T4?  What about thyroid antibodies...TPOab (thyroid peroxidase antibodies, also sometimes called "microsomal" on lab reports) TGab (thyroglobulin antibodies) and TSI (thyroid stimulating immunoglobulin)?  Any of those on your lab report?

Your FT3 is really quite high in the range...almost into hypER territory.  Your FT4 in your post way up above is 10.9 (4.5-12) also almost into hyper terrirory.  

[amberhfreeman]

May have spoken too soon. Just had my follow up and got my lab results. The doc started out by telling me everything looked fine, and we need to start back at square one. He before even show me the lab results told me the thyroid was not the issue, and maybe I need to make some lifestyle changes like exercising and a food diary, and stop being a couch potato. At this I knew he was not going to be helpful and had just labeled me a lazy person. He finally quickly went over the lab results, and the thryoid scan results.

The thryoid scan showed that the nodules were neither hot nor cold, and we simply just fluid filled cysts.

The lab results were as follows:

Rheumatoid Arthritis Factor 10 IU/mL  range 0.0-13.9
Actin Antibody 9    range 0-9
ANA with reflex Negative
triiodothyroine free 4.2pg/mL  range 2.0-4.4


WBC: 4.5  RANGE 4.1-10.9
RBC; 4.49  RANGE 4.20-6.30
HGB: 13.1 RANGE 12-18
HCT: 40.2 RANGE 37-51
MCV: 89.5 RANGE 80-97
MCH: 29.2 RANGE 26-32
MCHC: 32.6 RANGE 31-36
RDW: 12%
PLT: 184 RANGE 140-440
MPV: 9.9 RANGE 0-99.8
NEUT# 2.8 RANGE 2.0-7.8
LYMPH# 1.5 RANGE 0.6-4.1
MXD # 0.2 RANGE 0-2.5
NEUT % 60.4 RANGE 37-92
MXD% 5.2 RANGE 0-10
LYMPH % 34.4 RANGE 10-58.5

I dont know what any of it means, so I posted it all. The doc mentioned running adrenal tests, but only after I began crying because he kept suggested things like getting a personal trainer, and starting a food log. I felt like he totally was discounting everything and it really frustrated me. What does everyone think, am I just crazy, should I have the adrenal tests done...?

I just feel lost again...

[goolarra]

I'm glad you connected so well  with the doctor...having a good doctor to work with makes all the difference in the world.  

If you'd like, post your labs when you get them, and we'll help you interpret them.

Now we have to work on your mom!

[amberhfreeman]

Starting on a better path...found a doctor I like and willing to run more comprehensive tests and acutally listen to whats going on with me. I had more blood drawn earlier this week to check my free T3, ana, cdc, and many other things. I get the thyroid scan done this afternoon to see if the nodules that were spotted are hot or cold. This new doctor is older and seems more thorough and and I really hit it off my first visit. He is worried that my symptoms could also be pointing to some type of auto immunine disorder since I have psoriasis and the symptoms and somewhat consistent with the early worry signs. I'm glad once the blood results and thyroid scan are back I will have a much better picture of whats going on with me. The idea of facing an auto-immunine disorder so young in life scares me but at least I know that he is taking the right steps to really find out the cause instead of just giving me anti-depressants. He also has me weaning totally off the Viibyrd and Lunesta. He appologized too for the bad experience I had with the other doctors and said he didn't understand why they only half-way looked for the issue. It may because I'm young that they think I can be passed off easily but I'm not the type of person to ignore what my body is telling me.

[goolarra]

I agree that they are often all too willing to give you a pill (especially anti-depressants and anti-anxiety meds).  I prefer to take as few meds as possible as well, but I was hypo enough before being diagnosed to be convinced that not taking thyroid meds was not an option.Thyroid meds are not really drugs, just an almost identical replacement for a substance that our bodies would make naturally if they could.

Good luck with your search for a doctor, and I hope you can break through your mother's stubbornness to help her out as well.  Keep us posted.  

[amberhfreeman]

My grandmother(moms mom) and her mother as well as all her brothers had MD. My mom has not been tested, but we have enough in the family we know the warning signs. My grandmother also developed MS in her last few years and caused rapid detoriation for her, but as far as I know so far only the MD has been passed from generation to generation. I am familar with auto-immunine conditions due to my grandmothers MS as well as the strong psoriasis gene I was passed. I am working to find a doctor that I like, trust, and will really do all the right tests. I feel like too often now, they are so willing to just give you whatever pills they have as samples and shoo you out the door. Just bc you gave me some pill doesn't mean you listened or fixed me. I am going to pursue finding a doctor for myself and then hopefully I will be able to pursuade her to see the same doc and that should make her more comfortable since super stubborn. I love being natural as possible but I accept if something is not right with our bodies its our responsibility to make sure we do what we can to keep it working its very best. I just never knew this endeavor would be so frustrating...but thanks so much for the suggestions on finding a doc by interviewing before the visit. I'll keep you posted on any new results I get.

[goolarra]

If your mother suffers from constant fatigue, she really should get tested.  I appreciate her dislike of doctors, but if taking one little pill could improve her quality of life...

MD or MS?  MS is also autoimmune and tends to run in families.  Yes, both Hashi's (hypo, except in early stages when swings from hypo to hyper can occur) and Graves' (hyper) are autoimmune.  Hashi's is the predominant cause of hypo in the developed world, and Graves' and hyper are virtually synonymous.  

An endocrinologist is the specialist who treats thyroid.  However, just because a doctor is an endo does not mean he's a good thyroid doctor.  Many endos just want to treat diabetes.  Endos in more rural areas tend to be more "generalist", however, and treat both diabetes and thyroid.

If your mother doesn't want to see a doctor unless absolutely necessary, she might try having FT3, FT4 and TSH tested by an online lab.  You can order those yourself, without a doctor's order, but insurance will not pay for these (about $85 for all three)  They send you to a local lab for the draw and send the results directly to you.  At least that way, SHE'D know if she had a problem before having to go to the doctor for treatment.  Healthcheckusa is one that some of our members have had good luck with, but there are many other online labs as well.  

[amberhfreeman]

My mom didn't really ignore it, she just couldn't afford to do anything about it since we didn't have health insurance and my parents priority was takin care of me. She has always been so fatigued her whole life and also suffers from the beginning signs of MD which her mother and sister both had. We all also suffer from moderate plaque psoriasis. I didn't realize that thyroid issues could be an auto-immune thing...I have spoke with my mom alot over the past few days about it bc I never knew before, I feel like she would benefit from having hers tested again as well, but she is very anti-doctor since she is a breast cancer survivor and just doesn't want anythin else to be "wrong" with her. I live in a small town and my options for doctors are limited, so I will keep up the search and hopefully find someone who is willing to listen and help. What kind of doctor would be a specialist in thyroid issues?

[goolarra]

There's really not a lot you can do on a "natural" basis to help.  Replacement of hormones is the only answer.

If your mother discontinued treatment and feels well, she probably doesn't have Hashi's.  Hashi's is an autoimmune disease.  Our immune systems attack our thyroids because they see our thyroid as foreign protein.  The disease is progressive, with more and more thyroid function being lost all the time.  So, it's unlikely your mother would be able to ignore her condition if it were Hashi's.  Most, if not all, of us with Hashi's will be on meds for life.

It can be a really good idea to interview doctors over the phone before making an appointment.  You can ask to speak to a nurse and ask which tests the doctor customarily orders for thyroid patients...it should be FT3, FT4 and TSH.  You can ask which meds the doctor is open to...synthetic T4, synthetic T3/T4 combos, desiccated porcine thyroid.  That would give you a better idea of the doctor's philosophy of treating thyroid without having to waste an appointment.

[amberhfreeman]

Thank you so much for the direction and support. I was beginning to think I am nuts. I never felt better on the Celexa except maybe for the first two weeks so I suspect it was the placebo effect. I felt like he was so easy to jump to more anti-depressants. I have another appt in two weeks with another general practice doctor. I don't know anymore about my moms and her sisters(deceased) condition other than my mom was treated for hypothyroidism and her sisters condition was far more progressed and she suffered endometriosis and was hospitalized for that and other related issues. My mom took synthroid for about 10 years and has since basically ignored it. She has not taken anything for it since she she had me. I guess I will continue to look for another doctor. Is there any natural thing I can pursue in the meantime to help with symptoms and overall energy level...?

[flyingfool]

I find it disturbing that the Dr will not issue medication for what he agrees to is consistent with hypo. But has absolutely no problem prescribing you medication for depression which is NOT necessarily consistent with your symptoms.

That combined with your family history of thyroid.

GET A NEW DR ASAP!

Many people find that their depression and anxiety are alleviated or improved once their thryoid is in correct balance.

Understand that "correct balance" means for each individual. And that may mean that the thyroid hormone levels need to be significantly higher than the bottom of the "normal" range.

MANY people have found that to feel well they need to have BOTH of the following.

1) Free T4 (FT4) to be at least MIDDLE of the range if not slightly higher

and (that means in addition to)

2) Free T3 (FT3) to be in the UPPER 1/3 of the range.

Do not let a Dr. tell you that you are fine or normal when you are symptomatic simply because you are "somewhere" within the so called "normal" or reference range.  Nothing can be further from the truth and this forum is LOADED with people who can provide evidence of exactly this truth.

Each individual is different and feels well at a different blood levels of hormone.  But the above mid range and upper 1/3 seems to be a FAR more accurate target to shoot for.

Warning:  Finding a Dr who will test both Free hormones and treat you clinically is unfortunately very difficult for most people.  Unfortunately the medical schools seem to teach only use of TSH and that is all.  And even if you find a Dr who will test.  Convincing them that you need medication if you are anywhere within the range is extremely challenging.   So don't be surprised if you need to Dr hop until you find one who will listen, test and treat you properly.  I can tell you from experience that this can be a frustrating process!!!

[goolarra]

Unfortunately, your doctor has ordered total T3 and total T4.  They tell the total amount of T3 and T4 in your blood, but much of that is chemically bound by protein and thus unavailable to cells.  Free T3 and free T4 tell what's available.

Has your doctor done antibody testing to see if you have Hashi's?  Most of us with Hashi's have nodules, which are usually nothing to worry about and are just monitored.  Your nodules could be an indication that you have Hashi's.  The two blood tests for antibodies are thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (TGab).  Both should be tested as some of us are TPOab positive, some TGab positive and some both.  Also, Hashi's tends to run in families, and you have a strong family history of hypo.  Do your mother and aunt know if they have Hashi's?

Paradoxically, anti-depressants can make you feel worse if your problem is really thyroid.  Mild depressants (alcohol, opiates, e.g.) can actually make you feel better because they flood the brain with T3, elevating mood.

I agree with gimel that you may need to find a different doctor.  Since this doctor has already agreed that your symptoms match hypo and has refused to treat, we have to assume that he's not into treating clinically and doesn't really care a lot about symptoms.  In addition, he's ordered antiquated tests.  You can try to educate him, but my guess ids that would be a pretty tough road to follow.

Are your mother and/or your aunt satisfied with their treatment?  Perhaps you could see one of their thyroid doctors?      

[amberhfreeman]

Also I have other symptoms, like being cold all the time(I have to have a space heater and blanket in my office at all times), I have begun to have exhaustion issues when trying to run, my hair is shedding like crazy, I can't sleep well at night, my throat feels hoarse from time to time, and I've gained 10 lbs in the last 3 weeks even though my diet and exercise have become a bigger importance to me.

I feel weird bc after decribing all this to my doctor and the fact that my mother dealt with the same issues he agreed that the symptoms matched hypo but since my blood work wasn't out of range he didn't feel comfortable treating it with medication if even for a trial basis. He just pushed more anti-depressants on me which have not helped at all in the past 6 months as I continue to feel worse.

[amberhfreeman]

Okay, the test results were as follows:

T4 Total:   10.9       Range 4.5-12.0
Free T4:   DNR(X)   Range 1.4-3.8

T3 Total:  143         Range 76-181

TSH: 2.743            Range 0.358-3.740

Sorry I am new to all of this, that's why I'm trying to educate myself as much as possible. Also several nodules were found on my thyroid during the ultrasound, but I was told not to worry about them

[gimel]

Overlooked your question about a different doctor.  It all depends on whether your doctor will work with you to do the tests recommended and then if he is willing to treat you clinically.  I'll give you this info that I post so often.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms.  symptom relief should be all important, not just test results.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP  of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

In the letter take note of the statement. "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

[goolarra]

What are the reference ranges on your T3 and T4?  They vary lab to lab so have to come from your own lab report.  Also, are the T3 and T4 total T3 and total T4 or FREE T3 and FREE T4?  If they don't specifically say free T3 (or FT3) and free T4 (FT4), they are total.

[gimel]

Your available test results don't scream hypothyroidism; however, you are missing some very important tests and you have some typical hypo symptoms.  You should request to be tested for Free T3 (not the same as Total T3 previously done).  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.I also suggest testing for Reverse T3, just to know that level.  

If your doctor resists these tests, then you should insist on them and don't take no for an answer.   It is that important.

Since hypo patients are frequently low in other areas as well, I suggest that you should also test for Vitamin D, B12, ferritin, and a full iron test panel.  Since Hashimoto's is the most commonly diagnosed cause for hypothyroidism, you should also test for the thyroid antibodies.  Those tests are TPO ab and TG ab.  When test results are available, please post results and their reference ranges shown on the lab report and members will be glad to help interpret and advise further.