Thyroid Disorders Community
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390388 tn?1279636213

Thyroid or something else?

Hi, I'm not sure where to start.  I don't know if this is thyroid or not; but, I have a lump under my chin above the thyroid area.  I have had a very high pitched cough and rough voice now for 3 months.  I was put on advair (for shortness of breath) and she said she could feel some nodules in which I have always had several small ones.  I'm SOB, tired often, muscle pains, chest pains, hair thinning, itchy skin and scalp and just bla feeling.  My heart cath 1 1/2 years ago turned out ok; but, I do have high BP and HR.  My diabetes is under control with diet; but, I'm thirsty all the time.

My TSH used to be around .84 in which was good for me.  I've been taking levothyroxine for years now.
She tested the TSH and it was 1.82 UIU/ML (0.35 - 5.50)  Could this be a thyroid issue?  Also with the numbers going up...I'm wondering if my meds for hypothyroidism might need increased?

I'm not due for another ultrasound she said until September/October.  
The last one was done July 2013 only showed:
Thyroid U/S New cystic foci in both lobes (5 total) and one nodule.  Most are 3x2x3mm with the largest of 4mm.  
No biggy.  One thing that surprised me though is that your thyroid can shrink.  The dimensions are smaller than prior study by 1cm

Just wondering if the thyroid could be causing these issues or not.  The worst part is the high pitched coughing and pressure around the chest and throat????
9 Responses
649848 tn?1534633700
Is TSH the only thing you're being tested for?  You should also be tested for Free T3 and Free T4, every time you have thyroid labs.  Those are the actual thyroid hormones and are much more important than TSH.  If you have results for FT3 and FT4, please post them, along with reference ranges, which vary lab to lab and have to come from your own report.

Your TSH is "great" and if we go just by that, I'd say your levo dosage is "perfect"; however, I, and most of the people on this forum don't go by TSH, because we see that leaves too  many people sick.

Thyroid can cause any number of strange things to happen.  

Do you know if you have Hashimoto's Thyroiditis?  If you do, your thyroid can shrink as antibodies destroy healthy thyroid tissue.

What thyroid med/dosage are you on and how long have you been on it?
390388 tn?1279636213
I just seen this.   Sorry.  I have not been on Medhelp since I posted.
I just had another ultrasound and it was basically the same.  Nodules only grew ~ 1 mm since last time.  thyroid had increased in size from previous study.  
As I mentioned before she only test the TSH.....numbers are still increasing.   2.38 UIU/ML (0.35 - 5.50) this time.  I only take 25 MCG of Levothyroxine.
I feel like my skin is crawling half the time, itchy dry skin and hair is getting very thin.  Also I keep putting on weight despite a very busy summer.  Seeing shadows often and feel like I have bugs walking on my skin....in which are not there.

She upped my cholestesterol and heart meds and wants me to start medicine for type 2 diabetes.  I refused the diabetic med though because I told her I wanted to check my numbers for a couple weeks and see how the increase in my heart meds were working before I go in for my follow-up visit......
My morning glucose numbers are only at 120 at their highest; but, normally around 105-110.  
My morning BP is still high.  163/107 with a Heart rate of 84.  Later in the day it goes down.  I also have fibromyalgia and COPD.  Might explain my AM BP.  

Anyhow, with the numbers going up on the TSH numbers going up.....does that mean that I'm going more toward hypo or hyper with thyroid?

Symptoms and numbers don't seem to match up?  Wondering if I should ask if my meds should be raised?  Confused.....
649848 tn?1534633700
You need to find a different doctor.  High cholesterol is a symptom of hypothyroidism as can be high blood pressure and all of your other symptoms. Your high morning gluclose numbers can also be related.  

In addition, some doctors believe that fibromyalgia is un or under treated hypothyroidism and find that with sufficient dosages of thyroid hormone medication, its symptoms are completely relieved.  Shortness of breath is also a symptom of hypothyroidism - I was diagnosed with COPD at one point, as well and was prescribed Spireva, which did absolutely nothing for me so I stopped taking it because it was horribly expensive; however, when my thyroid levels were increased adequately, my shortness of breath went away.

With your thyroid more swollen, it sounds like you possibly have a goiter, which would be an indication of Hashimoto's.  You should get tested for thyroid antibodies to confirm.  

Since your doctor is only testing TSH each time she's testing and she's only treating individual symptoms (fibromyalgia, cholesterol, blood pressure, blood sugar) not the root cause - hypothyroidism, she's not doing you a bit of good.  You need to insist on testing the Free T3 and Free T4 every time you test TSH.  As I mentioned, those are the actual thyroid hormones and are much more important than TSH.

If you'll let us know what city you're in/near, we might know of a good thyroid doctor in your area.  

When TSH rises, usually actual thyroid hormone levels are going down, which means you are becoming more hypo.  When one has Hashimoto's, the antibodies are constantly destroying thyroid tissue, and as this happens, the thyroid is not able to produce adequate thyroid hormones. Medication dosages have to be increased to keep up with the decrease in thyroid hormone production.  Apparently your doctor is not aware of this... you definitely need a new doctor as this one will keep you ill for a very long time.
390388 tn?1279636213
Thank you so much for the reply.  Been filling a bit odd today and slightly worried about my BP.  They said not to worry about the 163/107 and set me a appointment for the 24th of this month.  They said if my BP raises  to 180/110 then maybe I should come in; but, since I"m on meds already, that it is safe.
I'm in the 15301 area.  I don't know if I can afford it; but, just in case I get some money it would be nice to know of a good Dr.  :-)

I will bring up to her about maybe raising my thyroid med; but, I have a feeling she won't due to my BP issues.  I ask her about the T3; but, she never wants to check it.  She did though last year.  This was my result July 2013:  Homocysteine  15.1 MC/MOL/L    (Range  0.0 - 15.0)

T3 Free             3.7 pg/ml            (Range  2.0 - 4.4
T3 Total            109.00 ng/dl        (Range 85.00 - 220.00)
T4 Total              7.53pg/dL          (Range 5.10 - 14.10)

I really want to thank you in advance for all of your time and information <3
649848 tn?1534633700
Your Free T3 result was at 71% of its range in July of 2013, which was really good, then, but that's so long ago, we can't figure on it being that high now.  Most of us find that we feel best with FT3 in the upper half to upper third of its range - you don't know where yours is, at this point.

You need to have Free T3 and Free T4 (be sure to specify "Free" for both of them) tested every time you have a TSH.  The tests for Total T3 and Total T4 are obsolete and you might as well as well save your money, as they tell little to nothing about what's going on.  

Actually, she's doing your BP more damage by keeping your thyroid levels too low than she would if she increased your med to a therapeutic dosage, because she's keeping you in constant stress over your condition, which is contributing to your blood pressure elevation.

If you'll tell me what city you're in, I'll see if we have a patient recommended doctor in your area.  If you don't want to post it on the forum, you can send me a private message... you can do that by hovering your cursor over my name, then click on send message to get the message screen.
390388 tn?1279636213
Thank you for your help.  I talked her into doing a thyroid panal by asking her if she was just treating me by the numbers, or actually listening to my symtons. So she ran these test. I haven't taked to her yet; but, got my results back.  They look good; but, I don't know?
Here they are:

T3, Free Triiodothyronine (F T3)  2.8 pg/mL 2.0-4.4
Reverse T3  23.8 ng/dL 9.2-24.1 1
T3, Total Triiodothyronine (T3)  101.70 ng/dL 80.00-200.00
T4, Total (Thyroxine, Total)  5.85 μg/dL 4.60-12.00


TSH, Thyroid Stimulating Hormone  2.38 UIU/ML 0.35-5.50

649848 tn?1534633700
No, your thyroid numbers don't look good at all.  Your Free T3 is only at 33% of its range, when its recommended that FT3 be in the upper half to upper third of its range.  

On top of that, she didn't even test Free T4; she tested total T4, which shows both the bound and unbound T4.  Of the total T4 in your blood about 90-95% of if is bound by protein and is unavailable for use,  The unbound (Free) portion is what's available to be converted to the active Free T3 hormone.  That said, your Total T4 is only at 17% of its range, meaning that you have very little T4 in your blood to even be converted to T3.  With your TT4 at only 17%, it can be expected that your FT4 would be equally low.  

With that little T4 in your blood, eventually, your FT3 will drop even further and your symptoms will continue to get worse and worse.

Recommended level for FT4 is approximately mid range, so you can see that both your FT3 and FT4 fall far below anything that would be therapeutic.

Apparently, she thought another TSH would be a waste?  Too bad, because your Sept TSH was approaching the upper limit of the recommended 0.3-3.0 reference range (your lab, like many, is using an old range).
390388 tn?1279636213
Thank you for your reply.

I always get very confused with how the Thyroid numbers run.   The doctors office in our town is old school.  I had to guilt her into doing these test by asking her if treating me just by my chart #s or actually listening to what I was telling her on the symptoms.  
I have had a lot of heart and Blood pressure issues over the years and she seems leary of me having arrythmeas and more heart issues, if she ups my dose.
So anyhow, back to my question.....these #s DO actually show that I'm dropping as far as HYPOthyroidism?

When I went in my BP was on the higher end after she upped 2 of 3 of my heart meds.  I told her about all the symptoms I had and she asked me if I still drank.  I always answer honest.....BAD ME for drinking maybe; but, I told her yes.
I have 2 beers and two shots before bed.  She blamed ALL my symptoms on drinking and asked me if I would consider going into a rehab for Alcohalism becuase anything over 1 a night is alcohalism.  Tell you the truth.....it ticked me off that in my medical chart she has me listed as having Alcohal Abuse.  I told her that it's the way me and my husband calm down sometimes at night.  We both have pain issues.  I have Fibromyalgia and other joint issues an he has his own issues too in which is painful.

The only good thing about the appt was the fact that after 3 years of complaining about not being able to use my thumb for anything due to the pain, she finally ordered a x-ray.  Also ordered a x-ray on my foot because I complained about burning stabbing pains; but, this time had to tell her over 1/2 my foot is numb now.  Same thing happend on my upper back.  I'm guessing it has something to do with my nerves before they die out?  I don't care about the numbness as much; but, the pains sometimes are great.

Anyhow, I used to come onto Medhelp all the time for help.  I thank you Sweets for trying to explain.......So my HYPO thyroidism is getting worse?   They have a way up town of making me always feel as if my health issues are just always my fault due to whatever suits at the time it seems.  Too active - slow down, not active enough.....you get the idea.  I'm just so frustrated with Drs anymore.  I can't afford a ton of test and then when they do test... it seems like if something is wrong it's always my fault.  I eat healthy and feel as if I've been VERY active this year compaired to other years, yet still gained over 30 pounds in the last 6 months.   I'm just frustred I guess.......Sorry for the vent and sorry this was so long.

649848 tn?1534633700
Sorry I was off line most of the day yesterday - dental issues... A couple things catch my eye in this last post catch my eye.  First off is the fibromyalgia issue.  Some doctors think fibromyalgia un or under treated hypothyroidism and if given adequate doses of thyroid medication, symptoms will go away.

The other is the numbness in your feet.  Have you had vitamin B-12 tested?  Long term B-12 deficiency can cause nerve damage and permanent neuropathy in the extremities.  I have Pernicious Anemia that went undiagnosed for many years and had the neuropathy, for which I take pain med daily.  

Your weight gain also sounds thyroid related.

I, too, have a couple drinks in the evening and have been accused of being an alcoholic... but even when I stopped drinking, completely, for 3 months, symptoms didn't go away.

Any chance of getting a different doctor?  That's really what you need.
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