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Blood tests from primary doc normal, but feel so tired. What is the next step?
First time poster here. Seems like a really neat community, so I hope I can get some advice about the next step.
Medical History:
46 year old female
Diagnosed with thyroid nodule almost 30 years ago in another city (Dr. has since retired). Tested at the time, including nuclear testing, and nodule was found to be benign, and in terms of "hot" or "cold", it was the good one that isn't bad. (can't remember which one that is).
Had 6 kiddos in 8 years. All C-sections. History of seizures after medication was given with baby #4 and then had pneumonia with a chest tube after baby #6 four years ago. All that to say, my body has been through a lot in the last 13 years.
Recently, I have been so tired, like can't get moving tired. Fuzzy thinking, no memory, hearing loss, hair loss, splitting fingernails, increased panic attacks, very overweight. When I work on the weight loss with proper eating and working out, panic attacks increase after a while. I am an emotional eater, so I know that the weight can be an issue all on its own.
It's the fatigue and panic attacks that are so debilitating.
So, went to my primary care doctor to get a thyroid panel done. Here are my results that I just got today. They say they are all normal, and now what do I do with all of these symptoms that are exhausting, confusing, and changing me into someone I don't want to be? It seems like many of these symptoms could also mimic perimenopause, which I haven't officially been tested for yet, but am probably the right age for (46).
T3 Uptake: 26 (range listed on lab sheet is 22-35%)
T4 (Thyroxine), Total: 7.0 (range is 4.5 12.0 mcg/dL)
Free T4 Index (T7) 1.8 (1.4 - 3.8)
TSH 1.77 (mIU/L)
I was planning on going to an endocrinologist anyway, just to follow up on the nodule tests done when I was 18.
Any thoughts from the forum? Tips? Help???
Thank you!!
Medical History:
46 year old female
Diagnosed with thyroid nodule almost 30 years ago in another city (Dr. has since retired). Tested at the time, including nuclear testing, and nodule was found to be benign, and in terms of "hot" or "cold", it was the good one that isn't bad. (can't remember which one that is).
Had 6 kiddos in 8 years. All C-sections. History of seizures after medication was given with baby #4 and then had pneumonia with a chest tube after baby #6 four years ago. All that to say, my body has been through a lot in the last 13 years.
Recently, I have been so tired, like can't get moving tired. Fuzzy thinking, no memory, hearing loss, hair loss, splitting fingernails, increased panic attacks, very overweight. When I work on the weight loss with proper eating and working out, panic attacks increase after a while. I am an emotional eater, so I know that the weight can be an issue all on its own.
It's the fatigue and panic attacks that are so debilitating.
So, went to my primary care doctor to get a thyroid panel done. Here are my results that I just got today. They say they are all normal, and now what do I do with all of these symptoms that are exhausting, confusing, and changing me into someone I don't want to be? It seems like many of these symptoms could also mimic perimenopause, which I haven't officially been tested for yet, but am probably the right age for (46).
T3 Uptake: 26 (range listed on lab sheet is 22-35%)
T4 (Thyroxine), Total: 7.0 (range is 4.5 12.0 mcg/dL)
Free T4 Index (T7) 1.8 (1.4 - 3.8)
TSH 1.77 (mIU/L)
I was planning on going to an endocrinologist anyway, just to follow up on the nodule tests done when I was 18.
Any thoughts from the forum? Tips? Help???
Thank you!!
A personal referral is always best, but you might quiz your neighbor a bit and find out what s/he knows. You could ask your neighbor the same questions you'd ask your doctor.
As you know, many doctors think TSH is the be all and end all in thyroid testing. So, a good question to ask is which tests the doctor customarily orders for his hypo patients. You want to hear TSH, FT3 and FT4. If they say TSH only...run...I don't care who recommended them or how prestigious they're supposed to be. If they say TSH and FT4, I'd ask the further question "Will he run FT3 on patient request?"
Another good question is which meds the doctor uses. Ideally, they should use T4, synthetic T3/T4 combos and desiccated porcine thyroid (has both T3 and T4 in it). Practically speaking, most doctors fall into either the synthetic camp or the desiccated camp. As long as they will prescribe something with T3 in it, they're no all bad.
Another good question is whether the doctor treats strictly "by the numbers" or if he will treat clinically to relieve symptoms.
How much of the doctor's practice is thyroid patients? Many endos specialize in diabetes and really have no desire to treat thyroid, nor do they keep up on it.
Those few questions will weed out the worst of the worst, but you can ask anything else you feel is pertinent. If you get a junk yard dog receptionist, you might have a hard time even getting through to the nurse. If that happens, ask the receptionist those questions. When s/he doesn't know how to answer, you'll get put through.
Do you know what your neighbor takes for meds?
As you know, many doctors think TSH is the be all and end all in thyroid testing. So, a good question to ask is which tests the doctor customarily orders for his hypo patients. You want to hear TSH, FT3 and FT4. If they say TSH only...run...I don't care who recommended them or how prestigious they're supposed to be. If they say TSH and FT4, I'd ask the further question "Will he run FT3 on patient request?"
Another good question is which meds the doctor uses. Ideally, they should use T4, synthetic T3/T4 combos and desiccated porcine thyroid (has both T3 and T4 in it). Practically speaking, most doctors fall into either the synthetic camp or the desiccated camp. As long as they will prescribe something with T3 in it, they're no all bad.
Another good question is whether the doctor treats strictly "by the numbers" or if he will treat clinically to relieve symptoms.
How much of the doctor's practice is thyroid patients? Many endos specialize in diabetes and really have no desire to treat thyroid, nor do they keep up on it.
Those few questions will weed out the worst of the worst, but you can ask anything else you feel is pertinent. If you get a junk yard dog receptionist, you might have a hard time even getting through to the nurse. If that happens, ask the receptionist those questions. When s/he doesn't know how to answer, you'll get put through.
Do you know what your neighbor takes for meds?
Goolarra,
Thank you! I knew I came to the right place for answers!
I talked to a neighbor last night who has an endocrinologist she really likes, so I think I'll start there.
Like you said, I'm going to get a baseline on the vitamin D issue first.
Do you mind posting a few questions for the doctor so I will have them when I am ready to determine if I will go with him?
Thank you so much. I feel like I am surrounded by a lot of support.
Thank you! I knew I came to the right place for answers!
I talked to a neighbor last night who has an endocrinologist she really likes, so I think I'll start there.
Like you said, I'm going to get a baseline on the vitamin D issue first.
Do you mind posting a few questions for the doctor so I will have them when I am ready to determine if I will go with him?
Thank you so much. I feel like I am surrounded by a lot of support.
You can pre-interview doctors over the phone before making an appointment. You'll probably have to do that through a nurse. If you get beyond the vitamin D issue and want to do that, I'll give you a couple of relevant questions to ask them.
Vitamin d3/k2 supplement may be helpful - you can get this from a health store - don't need the prescription type. But ideally get levels tested first so you know your starting point.
Sounds like I need to go ahead and see a specialist. Wish there were a way to find out who would be the best one without trial and error.
Thank you for your quick reply! I learned so much and feel more informed the next time I meet with a doctor.
Now that you mention it, I have been low in vitamin D before and felt this kind of fatigue. They put me on prescription vitamin D at the time and it helped.
Thank you for your quick reply! I learned so much and feel more informed the next time I meet with a doctor.
Now that you mention it, I have been low in vitamin D before and felt this kind of fatigue. They put me on prescription vitamin D at the time and it helped.
The doctor who ordered your tests demonstrated his total lack of understanding of thyroid issues just by the tests he ordered. T3U, TT4 and FTI are all considered obsolete tests of little value. He should have ordered FREE T3 and FREE T4.
TT4 is really the only one worth discussing. Your TT4 is 33% of range, and based on where many of us had to be for symptom relief, 50% is the guideline. So, you are a little on the low side. We have no idea what your FT3 is doing (T3U, despite its name, is an indirect measure of T4), and it's FT3 that correlates best with symptoms. Your TSH, which is the test most doctors just about fall down and pray to, is well within normal limits. That could make it hard for you to get treatment (if you need it). I'm not trying to discourage you, just forewarn you.
You really should have a new round of labs, including FT3, FT4 and TSH. Also, Hashimoto's thyroiditis, an autoimmune disease, is the most prevalent cause of hypo in the developed world. The two antibody markers for Hashi's are TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies). Testing those would let you know if you're in the early stages of Hashi's.
Have you had B-12 and a complete iron panel tested? Both can cause extreme fatigue.
TT4 is really the only one worth discussing. Your TT4 is 33% of range, and based on where many of us had to be for symptom relief, 50% is the guideline. So, you are a little on the low side. We have no idea what your FT3 is doing (T3U, despite its name, is an indirect measure of T4), and it's FT3 that correlates best with symptoms. Your TSH, which is the test most doctors just about fall down and pray to, is well within normal limits. That could make it hard for you to get treatment (if you need it). I'm not trying to discourage you, just forewarn you.
You really should have a new round of labs, including FT3, FT4 and TSH. Also, Hashimoto's thyroiditis, an autoimmune disease, is the most prevalent cause of hypo in the developed world. The two antibody markers for Hashi's are TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies). Testing those would let you know if you're in the early stages of Hashi's.
Have you had B-12 and a complete iron panel tested? Both can cause extreme fatigue.
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