Thyroid ultrasound

[neve022]

So I have been on here before when I was first diagnosed with Hashimotos. I have been hoarse off and on for some time now and Drs keep saying it doesn't have to do with thyroid. Having feeling of lump in throat when swallowing, slight neck pain and my ear bothers me. This has been going on over a year. Went to ent, scope etc and they see nothing with throat. Gastro says its gerd and am now taking omeprazole daily. Been on it for 4 months and still getting hoarse. Along with fatigue, muscle pain and tbh just overall feel lousy. My ultrasound from last year is as follows:
The thyroid gland is diffusely heterogeneous and nodular. Vascularity is within normal limits. The right
lobe measures 4.7 x 1.3 x 1.4 cm, the isthmus measures 0.2 cm, and the left lobe measures 4.6 x 1 x 1.3 cm.
A few benign appearing lymph nodes are seen in the left neck.
They are saying I don't need to follow up with the ultrasound. But all I can come up with is this has to do with thyroid. On Levo and my tsh is back to normal but the t3 and t4 are still out of whack. Though the only thing the endo looks at is the tsh. Please if anyone has feedback, id appreciate it. I'm desperate.
Thanks

[gimel]

With more of an indication of a biopsy being needed I think I would just wait and go over everything with the new doctor.  For any doctor that you see, you want to make sure they are willing to treat clinically as described above, and also are willing to prescribe T3 meds.  

By the way, a while back when Armour Thyroid was not available, my doctor forced me to switch back to T4.   I became hypo and among other symptoms I had terrible acid reflux, even though taking 2 Prilosec daily.  As soon as I got back on Armour, with T3 in it of course,  the acid reflux was gone in about 2-3 days.   I cut back to 1 Prilosec, and then none and had no recurrence of acid reflux; however, a doctor insisted I needed one Prilosec daily to guard against my Barrett's Esophagus becoming a problem.  

[gimel]

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

[neve022]

I have one other question...would you suggest I have a biopsy done on the nodules? There was no mention of size, just multi nodular. I'm concerned as I am so beyond tired, my hoarseness is constant and it feels like i am swallowing past something. Have some throat irritation and ear pain intermittently as well which they treat with antibiotics but doesn't resolve. Ent says gerd. Sorry if I'm repeating myself from above. Thanks again

[gimel]

I expect that your doctor will be a total waste of time.  Apparently the doctor has the "Immaculate TSH Belief" and only pays attention to that, which absolutely doesn't work.  That was also probably why your dosage was reduced from 88 to 25 mcg.  Meanwhile your Free T3 level was actually below range, causing your hypo symptoms.  Which, by the way, includes hoarseness.  I say that because if you look at page 18 in the paper I linked above you will see from a scientific study that hoarseness was one of the symptoms that occur significantly more often in hypothyroid patients than in other patients.  

I think you should try to find a good thyroid doctor, so if you will give us your location, perhaps we can suggest a doctor that has been recommended by other hypothyroid patients in your area.  

[neve022]

I am in Pennsylvania near Philadelphia.

[gimel]

Okay, so it is .250 milligrams, which is equal to 250 micrograms.  That is a significant dose, which is why your Free T4 is near the high end of the range.  But even that has not resulted in adequate conversion to T3, so your Free T3 is far too low.  

Regarding those symptoms you mentioned I know from personal experience that some of those are related to hypothyroidism.  It will be interesting to see just how many symptoms go away when your get all your levels optimized.  

[neve022]

I was at the dr office when I sent the mg, I apologize it is 25 not .25 so it is very little dosage. I asked my dr when I was leaving. I was on 88 and they changed it to 25 in February. I have printed out the study link you gave me and will show it to my dr. They are now testing me for myasynthia graves? I have little knowledge of what that is except from Google. I think they are trying to figure out what is causing the chronic hoarseness. Again, thanks for all your insight. I'm beginning to think the hoarseness is from the thyroid but they said no way as my tsh is fine.

[gimel]

Is that 250 mcg of Levothyroxine, or 25 mcg?  Please confirm.  if 25, that is nothing.  if 250, that is a significant does, but it iw not doing enough for you because you are not converting the T4 to T3.

Do you plan to give a copy of the paper to the doctor and pursue clinical treatment?

[neve022]

.25 not 250, I didn't have a chance to print it out. I will take it to my next specialist appointment

[gimel]

Your Free T4 is more than adequate, but the T4 in your body is not being adequately converted to T3.  As a result, your Free T3 is terribly low.  No wonder you are having all those hypothyroid symptoms.  Free T3 is the most relevant thyroid test.  Free T3 is used by all the cells of the body.  If you read the link I provided above, you will find more than adequate evidence that TSH is inadequate as the sole diagnostic for thyroid status, and that symptoms are the most important indicator.  

So you are going to have to become a vocal advocate for your health and present a copy of the paper linked above to your doctor and tell him that TSH is totally inadequate as the sole diagnostic for thyroid status, and then demand clinical treatment adequate to relieve symptoms, or else you need to find another doctor that will do so.  

In addition, your Vitamin D is terribly low.  Should be twice that level.  So I suggest that you consider supplementing with about 2000 IU daily.   B12 in excess is not toxic so I suggest that you consider taking 500 mcg of B12 daily.  Ferritin is very important and you need to get tested for that.  Ferritin level is one of the important factors for conversion of T4 to T3.  Being female I expect that you are going to need 50-75 mg of a good iron supplement.  I recommend Vitron-C for that.  

Two questions for you.  What is your daily dose of T4 med?  What issues do you have that they think is related to connective tissue disease?

[neve022]

I am on .25 levothyroxine. In terms of the connective tissue, I have a lot of joint pain, rashes from the sun, fevers on and off, raynauds in my toes and feet, headaches, exhaustion, blood in urine. I also have weakness in my legs but they are saying that could be back issues? They are also saying maybe hoarseness is from this but I feel like I'm swallowing past something in the bottom of my neck? It's been a long haul, trying to continue working full time which lately has been just impossible. I appreciate all your help. I'm actually going to dr's now and will ask for the ferritin to be tested.

[neve022]

Most symptoms are immense fatigue, dizziness, anxiety at times, I've had some heart rate issues of it going high. Muscle pain and weakness. I have other things going on as well but they think it's from connective tissue disease which they say I also have.

[gimel]

TSH is a pituitary hormone that is affected by so many things that it is totally inadequate as the sole diagnostic for thyroid status.  TSH is even less useful when already taking thyroid medication.  I say that because there are studies that conclusively show that TSH usually becomes suppressed to the low end of the range, or below when taking an adequate dose of thyroid med.  So thyroid med dosage should never be based on just getting the TSH back within range.  If you will read at least the first two pages of this link you can see why I say this.  If you read through the rest of the paper you can follow the discussion and scientific evidence that supports the suggestions on page 2.  


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

What were the T3 and T4 tests results and reference ranges shown on the lab report?  What other symptoms do you have?

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 constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  In addition, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  If not tested for those you should do so and then supplement as needed to optimize.  D should be 50 min., B12 in the upper end of its range, and ferritin should be 70-100.  If your doctor is unwilling to do all this testing and then treat clinically as described, then you need to find a good thyroid doctor that will do so.  

[neve022]

Last labs on t3 and t4 were done in February 2016 they say my tsh is coming back normal since then so won't redo them. Last tsh in July was 1.82.
Results from february were free t3=2.2 ref range: 2.5-4.3 free t4=1.61 ref range: .9-1.7. My d is 26 and they won't test b-12 because they say it would show in by cbc.