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  Symptoms, Testing & Treatment History

Jan 15, 2015 - 0 comments
Tags:

Thyroid

,

Hypothyroidism

,

Hashimoto's



Symptoms: Sudden onset 11/30/12
Inability to take deep breaths
Dull chest pain
Palpitations
Dizziness
Total body weakness
Exhaustion - can't stay awake in the daytime
Excessive sleep - sleep 12 hours & wake up tired
Insomnia - hard time falling asleep at night
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Other (not so sudden) Symptoms:
Tight feeling in throat
Difficulty swallowing
Heat & cold intolerance
Cold hands & feet constantly
Low body temperature consistently
Dry eyes - vision more blurry than usual
Sinus congestion
Headaches
Sore throat
Neck pain - radiates to jaw/ears/shoulders
Ear pain & ringing
Numbness & tingling - left jaw/mouth, upper left arm, feet & hands
Lack of concentration
Forgetfulness
Total body aches
Digestive problems
Menstrual problems
Nausea
Loss of appetite
Weight gain despite eating very little
Dental problems
Hair loss - dry, breakage with normal washing
Outer half of eyebrows missing
Pale dry flaky scaly skin
Brittle breaking peeling nails
Decreased libido - not 'me' at all
Very emotional - crying over the littlest things
No motivation
Facial muscle twitches - mostly around eyes & mouth
Tremors - standing, sitting & lying down
Sharp pain - seem to jump from one body part to another to another
Tenderness from below right ear to collarbone

-------

2 surgeries in 2013:
Gallbladder removal
Uterine polyp removal & D&C with biopsy for endometrial hyperplasia

-------

Testing & Treatment History:

11/30/12 - 6/17/13
In ER & Urgent Care multiple times
Saw several doctors
Chest x-rays, chest CT scan & leg ultrasound revealed nothing
Only concrete diagnosis was Anemia
Began Iron supplementation

6/17/13
Diagnosed with "mild hypothyroidism"
Started generic Synthroid 25mcg
TSH 3.121 (0.358-3.740)
FT4 1.02 (0.76-1.46)
FT3 2.00 (2.30-4.20)
Iron 19 (60-160)
%Sat 4.4 (13.0-59.0)
TIBC 428 (250-350)

9/10/13 generic Synthroid 25mcg
PCP refused to increase dose because "in range".
FT3 2.30 (2.30-4.20) only test done

9/20/13 generic Synthroid 25mcg
Returned to 1st PCP because he ordered tests without
trying to tell me how pointless they are. Also referred me to
yet another new PCP.
TPOab 66 (0-34)
TGab 0.9 (0-0.9)
TSH 3.450 (0.450-4.500)

9/27/13 generic Synthroid 25mcg
Convinced new PCP to run other tests.
Increased generic Synthroid to 50mcg.
Started D3 150,000IU/wk, tapered off to 10,000IU/day
Vit D 11.1 (30.0-100.0)
B12 611 (211-946)
Folate 12.7 (>3.0)
Magnesium 2.0 (1.6-2.6)
Iron 50 (35-155)
% Sat 14 (15-55)
TIBC 350 (250-450)
Ferritin 30 (15-150)

11/21/13 generic Synthroid 50mcg
Convinced PCP to note brand name Synthroid only on Rx
Also got her to prescribe T3 med & order a thyroid ultrasound
Started brand Synthroid 75mcg & Cytomel 5mcg
TSH 3.210 (0.450-4.500)
FT4 1.07 (0.82-1.77)
FT3 2.4 (2.0-4.4)
Vit D 20.8 (30.0-100.0)
Folate 10.2 (>3.0)
Iron 76 (35-155)
% Sat 23 (15-55)
TIBC 335 (250-450)
Ferritin 51 (15-150)

1/10/14 -- Thyroid Ultrasound
R Lobe: 3.6 x 1.6 x 1.6 cm
Isthmus: 1.7 x 0.4 mm
L Lobe: 5.0 x 1.6 x 1.3 cm
Heterogenous appearance to the thyroid gland.
At the mid portion of the right lobe there is a 9.8mm nodule.
Also at the mid portion of the right lobe there are three solid
nodules that measure 0.6, 0.4 and 0.3 cm.
Impression:
1. Heterogenous appearance to the thyroid gland.
Multiple subtle nodules are noted in the right lobe that measure up to 9mm.
Consider comparison with nuclear medicine thyroid scan.
Consider ultrasound-guided fine-needle aspiration biopsy if clinically indicated.

1/15/14 brand Synthroid 50mcg & generic Cytomel 5mcg
Convinced PCP to increase Synthroid but she refused
to increase Cytomel because it's "dangerous"
Referred me to an Endocrinologist
TSH 0.072 (0.450-4.500)
FT4 1.64 (0.82-1.77)
FT3 3.0 (2.0-4.4)
Vit D 46.2 (30.0-100.0)
Iron 39 (35-155)
% Sat 10 (15-55)
TIBC 387 (250-450)
Ferritin 68 (15-150)

2/27/14 brand Synthroid 75mcg & generic Cytomel 5mcg
TSH 0.032 (0.450-4.500)
FT4 1.36 (0.82-1.77)
FT3 3.0 (2.0-4.4)

4/2/14 brand Synthroid 75mcg & generic Cytomel 5mcg
1st visit with endo. Doubled Cytomel dose.
TSH 0.643 (0.270-4.200)
FT4 1.10 (0.93-1.70)
FT3 2.56 (2.50-4.30)

5/21/14 brand Synthroid 75mcg & generic Cytomel 10mcg
TSH 0.412 (0.450-4.500)
FT4 1.07 (0.82-1.77)
FT3 3.9 (2.0-4.4)
Vit D 55.0 (30.0-100.0)
Folate 5.7 (>3.0)
Iron 55 (35-155)
% Sat 16 (15-55)
TIBC 339 (250-450)
Ferritin 74 (15-150)

7/2/14 brand Synthroid 75mcg & generic Cytomel 10mcg
Endo said levels were "stable" & switched to Armour 60mg.
TSH 1.64 (0.270-4.200)
FT4 1.00 (0.93-1.70)
FT3 3.4 (2.0-4.4)

10/8/14 Armour 60mg
Endo did 2nd ultrasound in office. No results given to me.
Said: "this is Hashimoto's thyroid, I wouldn't worry about
this, re-check 1 year"
Increased Armour to 75mg
TSH 3.43 (0.270-4.200)
FT4 0.87 (0.93-1.70)
FT3 3.4 (2.0-4.4)

10/13/14 Results of Urine Cortisol 24hr Collection
Cortisol, Urine 13 (3.5-45 mcg/24 h)
Creatinine, Urine 130.1 (29.0-226.0 mg/dL)
Creatinine, 24hr Urine 1.2 (0.7-1.5 g/24 hrs)

11/3/14 Armour 75mg
All symptoms persist.
Decreased Armour back to 60mg because of high resting pulse,
chest pain & higher blood pressure than normal for me
TSH 2.540 (0.450-4.500)
FT4 0.87 (0.82-1.77)
FT3 3.6 (2.0-4.4)

1/7/15
Iron 50 (35-155)
% Sat 14 (15-55)
TIBC 356 (250-450)
Ferritin 91 (15-150)

2/2/15 Armour 60mg
All symptoms continuing to worsen.
1st visit with new Endo
Switched to Synthroid 100mcg & Cytomel 5mcg - also changed iron to 2x/day instead of 1x
TSH 1.6 (0.5-4.7)
FT4 0.77 (0.73-1.95)
FT3 2.6 (2.3-4.2)
Iron, Serum 51 (35-145)
TIBC 370 (250-450)
UIBC 319 (155-300) *Above High Normal
%Sat 14 (20-50) *Below Low Normal
Ferritin 77 (10-220)
Magnesium, Serum 1.9 (1.3-2.3)
Folate 3.4 (>3.0)
Vitamin B-12 428 (250-1100)
Vitamin D, 25 OH 40 (no range given)

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