Is it common to have normal labs with goiter & HYPO symptoms?

[SunshineFLA]

PCP says no worry for Hypo/Hyper because labs are fine. PCP is sending me to an Endo for a FNA. Any questions (or testing) I should ask the endo?

12/2/16 Ultrasound
Goiter & nodule right side.
Nodule: 0.54cm x 0.33cm

Nov/16/2016
T4free: 1.0 (0.8-1.8)
TSH: 1.22 (0.4-4.5)

Dec/9/2016
T4free: 2.4 (1.4-3.8)
TSH: 0.94 (0.4-4.5)
T4: 7.9 (4.5-12.0)
T3: 30% (22%-35%)

My symptoms below have become worse over the past year-and-a-half. High cholesterol.
I feel extremely faint. Decreased appetite, but gained 40lbs. lost 60% of my hair, fingernails brittle, my feet are freezing 24/7, insomnia, painful dry eye, IBS issues. I feel like I'm losing my mind, I can't remember places I went to the day before. I unknowingly ask the same questions 3-5 times in a conversation (I've been told). Sometimes the words I want to say won't come out. I try to talk but I can't form words. Then sometimes I can't remember the correct words to say. last night I tried to ask my husband "what time is it?" But I said "The round thing with numbers, what are the numbers?" That happens often. My goiter is making me feel like I'm choking & have a golf ball in my throat. I feel short of breath, even before I packed on the pounds.

[gimel]

I am glad you are seeing the Endo to find out about the goiter.  However, don't be surprised if you get the same diagnosis of your thyroid status that your doctor gave you based only on lab test results compared to reference ranges.  That is the prevalent approach by most doctors.  

What you want to find out from the Endo is whether he is willing to treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  Also it would be a good idea to ask the Endo if he is willing to prescribe T3 type meds like Armour Thyroid and Cytomel.  If either answer is no, then you will need to find a good thyroid doctor that will do so.  

If you find that you need a good thyroid doctor, then if you will tell us your location, perhaps we can suggest one in your area based on recommendations from other thyroid patients.  

[gimel]

Based on your symptoms and the reference ranges shown for the two different results, I firmly believe the second result is Free T3, not Free T4.  So based on that,  your Free T4 of 1.0 is only at 20% of its range and Free T3 of 2.4 is only at 41% of its range.  Paraphrasing a very good thyroid doctor, with a rather low FT4, the body will convert more T4 to T3 in an effort to maintain thyroid effect as well as is possible.  So if the FT3 is below 1.3 and the FT3 is also below say 60%, then it is likely that hypothyroidism is the cause of the person's symptoms.  

Also, in view of your relatively low TSH, combined with the relatively low FT4 and FT3, that is consistent with central hypothyroidism, which is a dysfunction of the hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.

In diagnosing a possible thyroid patient, a good thyroid doctor will emphasize symptoms first and FT4 and FT3 levels second.  A good thyroid doctor will then treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by TSH levels.   Symptom relief should be all important, not just test results.  You need to be prescribed thyroid med adequate to get your FT4 above mid-range, and your FT3 high enough in the upper half of its range to relieve your symptoms.  You can confirm all that I say by reading at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence of the suggestions on page 2.  If your doctor resists then you could also give him a copy of the paper and ask him to read it and reconsider.  

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

Since hypothyroid patients are so frequently deficient in 3 other important areas, I highly recommend testing for Vitamin D, B12 and ferritin and then supplementing as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.

When you see the Endo, I'm sure they will do an ultrasound of your thyroid gland.  That way you will get a better idea of what is causing the goiter and you can find out the Endo's diagnosis of that and what should be done for it.  

[SunshineFLA]

Thank you so much, great information. I will check the link & read/print the information out.

I've been to multiple PCP's in 2016 alone. Every time I'm checked they say there isn't anything wrong other than I'm fat/high cholesterol. I felt like I was being treated as a hypochondriac. I'm looking forward to my Endocrinologist appointment in January.

Also, I found out my lab report was typed up & printed out by someone in my Doctor's office. It wasn't an actual copy from the lab like I was lead to believe.

Thank you again!

[gimel]

Please check the 12/9 Free T4 result that is so different from the 11/16 result.  Could the 12/9 result be Free T3?

[SunshineFLA]

I thought it was odd myself. But that's what my report is showing. I was wondering if the lab (quest diagnostic) or something else was giving an incorrect number?