thyroiditis with normal test blood

[semo990]

Hello everyone

I have been struggling for years now with some issues since I was 15 now I’m 26 I will mention below:

1- soft erectile and sometimes ED.
2-minimal facial hair and chest hair.
3-low self steam.
4- brain fog.
5-Gynecomastia(i did a surgery to remove it when it got bigger but still my nipple looks active all day).
6-hair loss.
7-anxiety and waves of depression in any pressure I got.

I noticed when I exercise and lose weight ( my weight now is 90kg most of it around my thighs and I'm 170 cm tall ) so many of these symptoms are getting better, especially the first 3.

Before I didn’t get money or insurance to check on this but now I do so here are the results I got from my endocrinologist doctor who said your test results are normal no need for any treatment he only gave me a VIT D and magnesium.

blood test:
https://imgbox.com/p2NJ0K5Z
https://imgbox.com/oWqnWg5S

ultrasound:
https://imgbox.com/H8k2gabJ
https://imgbox.com/SSmdzM9k


Note: you can ask me for any blood test and I will do it with no issue.

[AnnieBrooke]

I don't click on links people post. Could you mention if either of the blood tests was for Free T3, Free T4 or antibodies that suggest Hashimoto's? You mention thyroiditis, but don't say what test told you it was a possibility.

[semo990]

THYROID ULTRASOUND:

= RIGHT THYROID LOBE:
>>Is mildly enlarged ( 60x 23x 25mm) with no evidence of retro-sternal
extension.
>>Heterogeneous parenchymal echotexture with no solid or cystic lesions.
>>No evidence of thyroid calcification.
>>Moderately increased vascularity by color Doppler US.

= LEFT THYROID LOBE:
>>Normal in size ( 56x 21x 23mm) with no evidence of retro-sternal
extension.
>>Heterogeneous parenchymal echotexture with no solid or cystic lesions.
>>No evidence of thyroid calcification.
>>Moderately increased vascularity by color Doppler US.

= THYROID ISTHMUS:
>>Is mildly thickened ( 5.5mm), heterogenous parenchymal echotexture with
no solid or cystic lesions.
= Preserved surrounding neck structures.
= Normal appearance of the adjacent great vessels at both sides of the neck.
= No abnormal enlarged cervical LNs.


IMPRESSION:
** Mild diffuse thyroid enlargement with heterogeneous texture and increased
vascularity, likely thyroiditis for clinical and laboratory correlation and follow up.

[semo990]

Total Testosterone           586.88 ng/dl​                        167.3 - 810.4
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
  TSH                               3.398 [µIU/ml]​                     0.35 - 4.94
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
VITAMIN D-3                 53.9 nmol/L​       75-250 normal 50-75 insufficient
                                                             250.0 excessive
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
LH (LEUTENIZIN                     3.05 [mIU/mL]​                            1.5 - 9.3
HORMONE)​​
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
​
PROLACTIN​713.43 *H     mIU/L​                          72.7 - 407.4
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ

FREE T4                                14.60 pmol/L​                           9 – 19
ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
FSH                                          0.68 *L​mIU/mL​                0.9 - 11.9

[AnnieBrooke]

So, you're saying that the doctor reading the ultrasound said it is likely to be thyroiditis, but you think you don't have high enough levels of Free T4 and FSH to be anything but "normal"?

[semo990]

My issue is my doctor stopped there and didn’t continue to investigate my symptoms. (Sorry if im bad explaining my self :( )

[AnnieBrooke]

Watch for a post to you from Barb, who is the Community Leader in this Thyroid Disorders community. She knows everything there is to know about thyroid and thyroid tests, and what doctors know and don't know about thyroid. She will give you much better advice than I can. All I can say is that if the ultrasound doc thought it was thyroiditis, because of the physical things he actually saw, it seems like your regular doc should be running every test there is.

[Barb135]

Hello there... I assume this is all the tests you've had up to now?  Does your endocrinologist believe you're "fine" with these test results?  

"Thyroiditis" is inflammation of the thyroid.  The most common cause is Hashimoto's, but that's not the only cause.  

With a Free T4 at 56% of its range, we'd expect your TSH to be lower since TSH is counter-intuitive (when thyroid hormone levels are high TSH should be low and when thyroid hormone levels are low, TSH should be high).  That said, your Free T4 level actually right about where we'd want it to be, though your TSH could/should be lower, even though it's "in range".  These levels would bring your doctor to the conclusion that your thyroid function is "normal", even though it may not be normal for you.  

If you can get another set of thyroid tests, including TSH, Free T4 and Free T3, that would be good.  Free T3 is the actual hormone that our individual cells actually use, whereas Free T4 is considered a storage hormone that much be converted to Free T3 before it can be used.  

Your vitamin D is also too low.  Please note your report indicates that levels between 50-75 are "insufficient".  Your level is 53.9, indicating you should be supplementing.  

Your high prolactin level (713.43) is concerning.  High prolactin can cause a variety of symptoms, including ED.  Men's reproduction isn't my forte', but there's a direct relationship between testosterone and prolactin.

As noted previously, you should try to get another set of thyroid function tests (TSH, Free T4 and Free T3).  I'd also suggest you get thyroid antibody tests - Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) to rule out Hashimoto's.  Depending on your results, you could have a condition called secondary hypothyroidism, which is when the thyroid works fine, but there's an issue in the pituitary gland.  

I'd also recommend Vitamin B12 and Ferritin tests as both are necessary for proper thyroid function.  

With your high prolactin level, I think you should talk to your doctor and ask about a pituitary CT or MRI.  High prolactin could indicate prolactinoma, which is a tumor of the pituitary gland that's producing prolactin on its own.  Prolactinoma is, benign (non cancerous) and can often be treated with medication.  

[semo990]

Thank you for the very clear answer.

I went and i did the blood tests  you refer to in the comment and here is the results:

sample took at 12PM
__________________________

COMPLETE BLOOD COUNT
Hb (HAEMOGLOBIN) 15.0 gm/dl 13.00 - 17.00
TLC (Total Leucocyte Count ) 8.98 x10°3/uL 4.0 - 11.0
DIFFERENTIAL COUNT
NEUTROPHIL 53.9 % 40.00 - 70.00
LYMPHOCYTE 34.0 % 20.00 - 40.00
EOSINOPHIL 3.8 % 1.00 - 6.00
MONOCYTE 7.6 % 2.00 - 10.00
BASOPHIL 0.7 % 0.00 - 2.00
RBC (Red Blood Cell Count) 5.06 x10°/L 4.50 - 5.50
PCV (Hematocrit) 44.0 % 40.00 - 50.00
MCV (Mean Corp Volume) 87.0 fL 83.00 - 101.00
MCH (Mean Corp Hb) 29.6 pg 27.00 - 32.00
MCHC (Mean Corp Hb Conc) 34.1 gm/dl 31.50 - 34.50
PLATELET COUNT 295 x10°3/uL 150 - 410
RDW -CV 12.1 % 11.60 - 14.00
RDW -SD 38.5 fL 39.00 - 46.00
PDW 12.5 8.3 - 25
MPV (Mean platelet volume) 10.4 fL 0 - 0

____________________________

FERRITIN 80.4 ng/ml 23.9 - 336.2
SERUM ZINC 88.00 ug/dl 60 - 107
25 - OH VITAMIN D  3 41.87 ng/ml   Deficiency :- 24.8
______________________________________

Thyroid Simulating Hormone TSH 2.936 µU/mL 0.35 - 5.50
FREE T3 3.42 pg/mL 2.5 - 3.9
FREE T4 0.87 ng/dl 0.61 - 1.12

ANTI THYROID PEROXIDASE ANTIBODY (ANTITPO)
133.45 UI/mL                                 < 5.6 Non-Reactive
                                                           = 5.6 Reactive

THYRIOD THYROGLOBULIN        
ABS

163.06 *H UI/mL 0 - 4.11


___________________________________________

and these old tests from 2017.

TSH = 5.5
Free T3 = 3.25 pg/ml (2.77-5.27)
‏Free T4 = 1.28 ng/dl (0.78-2.19)
Anti-TG = 803 IU/ ml ( negative < 115 )
Anti-TPO = 99 IU/ml  ( negative < 34 )

_________________________________________

i wloud love if you help me to dirct the issue or which kind of doctor should i talk to.

Thank you for the help

[Barb135]

Oh my - it looks like you’ve had Hashimoto’s since 2017, since you had positive thyroid antibodies even then.  What prompted those tests?   At that time, it looks like you might have been a bit hypo.  

Although Hashimoto’s is, typically, associated with hypothyroidism (not enough hormones), it can often, start out by alternating between hypo and hyper and/or normal.  Many of us have Hashimoto’s for years before it does enough damage to prevent the thyroid from producing adequate hormones.    I was not tested for it prior to my thyroid “dying”, but knowing what I know now, I believe I  had Hashimoto’s for approximately 15 yrs before my thyroid stopped working.  I went through periods of hypo, hyper and normal during that time.   Of course, my TSH was always “normal” so further testing was never done.  

So we know you have Hashimoto’s but you’ll probably need a doctor’s diagnosis (I’m not a doctor - just know how to read labs).   Your thyroid seems to still be working fine - your Free T4 is 51% of its range, which is right where we’d want it.  Your Free T3 is at 65% of its range, which is also right where we’d want it.  

Although, Hashimoto’s can cause some symptoms, those would mostly be symptoms of hypothyroidism that you don’t have, so I’m going to think the thyroid isn’t your major problem at this point.  

You Vitamin D is too low, so I’ll recommend that you start supplementing.  1000-2000 IU/day should help bring your levels up where they need to be.  Ferritin is the iron storage hormone and your level s pretty good, plus your hemoglobin level is really good, indicating you have plenty of iron.  

I don’t see a Vitamin B12 result.  Did you get that checked?  Vitamin D, iron and B-12 are all necessary for our body to metabolize thyroid hormones properly.  

So - that would take care of the thyroid-related issues.  There’s still that high prolactin result that needs to be dealt with.  I’m thinking that’s your biggest problem right now and needs to be explored further.   If I were you, I’d start out with my primary care physician and let him/her refer me to an endocrinologist.  The problem I have with that, in your case, is that you’ve already seen an endo and they’ve missed that key result (high prolactin).  

If you like the endo you saw, you can go back and point out the prolactin issue (along with the Hashimoto’s) and see if the doctor will work with you.  If not, I’d recommend trying a different doctor.   These are all endocrine hormones and the pituitary gland is part of the endocrine system, so at some point, you’re probably going to need and endo to deal with it.   You need pituitary imaging to rule out (or confirm) a tumor.  

[AnnieBrooke]

Best of luck to you, semo990, I knew Barb would be able to help you. Never hesitate to go to a different doctor if one ignores obvious of results in your lab work. I hope you get clear answers from your  pituitary imaging and are feeling better soon.