Concerned about Hashimoto's Thyroid and Hypothyroidism

[concernedirritable]

Hello,

I just received my blood test results:

T4 Free pmol/L (Referance Value = 8.0-18.0) = 11.7
TSH mIU/L (Referance Value = 0.40-4.40) = 4.49
Anti-TPO IU/mL (Referance Value = 0.00-9.00) = 69.00 H

Should I be concerned and should I go see an Endocrinologist?

Thank you!

[FTB4]

First of all, when your MD observed these levels, like the high Antibody and TSH, he should have ordered a Free T3 and Free T4 thyroid hormone tests, this would tell him (Or since he diid not order them, maybe not) where you stood with your thyroid hormone production. The Antibody test and the Slightly high TSH would indicate Hashimoto's Thyroiditis, this is a disease were your body's immune system does not recognize your thyroid and attacks it, this attack will continue decreasing the thyroids ability to make and produce the T4 Hormone, and you would be taking hormone medication to make up the difference, eventually it would stop your thyroid from producing any hormone at all and would result in taking this hormone replacement medication for the rest of your life. I have Hashimoto's also. Best Wishes FTB4

[concernedirritable]

Well thank you for the answer, just for reference, which medication would you suggest? And also, which blood tests should I redo?

I am also going to see an Endocrinologist soon, is there anything you think I should ask him?

[Barb135]

Your TSH is slightly elevated and your Free T4 is relatively low in the range, so I would imagine you might have some hypo symptoms.  

Agree that you need to have a Free T3 test, since FT3 is the hormone actually used by the cells.  

TSH is simply a messenger from the brain to the thyroid, to produce more hormones.  The fact that it's elevated indicates that your thyroid isn't producing enough hormones.

The elevated antibodies indicate Hashimoto's. Do you know which antibody test that was.  There are 2 antibody tests to diagnose Hashimoto's.  One is TPOab (Thyroid Peroxidase Antibodies); the other is TGab (Thyroglobulin Antibodies).  TPOab can be slightly elevated in other autoimmune diseases, as well as Hashimoto's.

When you see the endo, make sure s/he tests for both Free T3 and Free T4 every time s/he orders labs.

Because your TSH is so slightly elevated and FT4 is actually in range, the doctor may want to wait before prescribing medication.  Some doctors prefer not starting medication until TSH is considerably higher.  If you have symptoms of hypothyroidism, be your own advocate and insist on medication, or find a different doctor.

[concernedirritable]

Hi again people,

So I saw my endo today, and he noticed a very very small bump or lump in my throat, cant remember what he called it. He was a very arrogant doctor but looked and sounded knowledgeable. I had printed all your answer from this board as well as underligned the important stuff along with my symptoms but really did not even bother looking at anything. My Family Doctor had already written on the paper that was given to him that I was suffering from chronic mild depression, chronic anxiety and very irritable, loss of energy, etc.

He said I did have Hasimoto's but explained to me that just means that I am more prone to getting low thyroid. He also said that since my symptoms range from both sides (Meaning that some symptoms are present to people with Hypothyroidism and others with Hyperthyroidism) he concluded that many of my anxiety issues (Which I've had for over 15 years) are to do with emotional issues and not with low thyroid.

I mentioned to him about me doing a T3 Free Test and he just brushed it off. He said I am borderline low thyroid. He also made his receptionist make me an appointment for a throat scan, forgot the right word... to see what that lump is/? and he said if it's something serious than he would put me on medication to fight that and for nothing else.

1) Do I go get another opinion from a more professional place, somewhere where they can actually sit down and look at the stuff you bring them and talk to you about it? I did not even have time to ask him about the .03 to 3 decrease range for low thyroidsm...

2) Should I go see a Psychotherapist since I have all these symptoms (Low Depression, mood swings, very irritable, forgetfulness, low energy, lack of sleep (Sleeping only 5-6 hrs a night), Anxiety due to bills, etc, No energy to do anything but stay at home and read, surf the net, tv...

[Lulu407]

Yes, i would find another doctor.  I am relatively new to this but I've dealt with my fair share of arrogant doctors and think you should shop around .

[FTB4]

If your MD just brushed off the Free T3 Thyroid Hormone Test, then by all means, get rid of him fast, this type of MD, is on an ego trip and deems no one can tell him his business or ask him questions, and he just brushed off the most important test for thyroid, other than the tests Barb mentioned to diagnose autoimmune Hashimoto's (TPOab and Tgab) This MD will just keep you sick and symptomatic. I would also google Hypothyroid Symptoms, and make a list of all the ones you have, this will not make you less symptomatic, although it will stop you from thinking you need a Psychotherapist, because the symptoms you have are very common with hypothyroid disease (All the ones you mentioned above) Mental and Physical, we all have been through them. You can also start a new post, to members here "Does Anyone know of a Good Thyroid MD in Voorhees, NJ" A few members here (Barb included) have some names of good thyroid MD's she may be able to give you one in your area. Or try and message her and ask.  Best Wishes FTB4

[FTB4]

Sorry I picked up your location incorrectly, disregard NJ and add current location.  FTB4

[Barb135]

I do agree that since your doctor brushed off the most important of the thyroid tests (FT3) and refused to start you on medication, even while admitting that you are borderline hypo, that you should start looking for another asap. Any good thyroid doctor would start you on medication in an effort to alleviate symptoms.  It also appears that you are in Canada and we do find that some members in Canada have a difficult time getting adequate testing/treatment, due to their health care system.

The good thing is that the endo is sending you for an ultra sound (is that what he called it?) to see what the lump is.  Most likely, it's a nodule, which  are very common with Hashimoto's.

It's unfortunate that the doctor doesn't seem to know that some symptoms, particularly, depression and anxiety can apply to either hyper or hypo.  

Also be aware that, while mental symptoms can be symptoms of thyroid, there are also many other things that can cause them, so don't pin all your hopes on thyroid.  Do your best to get the proper thyroid tests/treatment, but keep open to other options.

[concernedirritable]

Thanks guys, I agree with all of you. First of all, my brother is sending me to his private doctor that's in a new style type of clinic where you go and spend a whole day and they run every single test on you, you pay a bit but it's very worth it, not like these old school doctors who are stuck on stupid and arrogance.

But after I get my ultra sound tests do you suggest I take them to him, unless he gets them mailed to him automatically, or would you try and take them to the new doctor, how should I make the switch easier?

[Barb135]

It's easy to make a switch from one doctor to another, if you have copies of all blood work and other testing/diagnostic procedures.  It's best to get a copy every time you go to the doctor, so you'll have them for your records; then you simply take them to your new doctor.

If you don't have copies, the new doctor might want to get them from the old doctor, but not always.  You can start from scratch -- I've done that lots of times.

[concernedirritable]

Hi again!

So I went to my appointment today and did a throat X-Ray to check for the nodule my endo sent me for and when I asked the doctor if he saw anything, he was like: Heck YEA! He said "You have many little nodules all over, not just the one you're endo sent you here for!"

I'm glad to say that I have found an amazing doctor based on ratings at http://www.ratemds.com and from word of mouth that also accepts new patients, and that the copies of the xray will be going to him too and to my endo (Soon to be Ex-Endo) that way I will see what both have to say.

I found this interesting as I was researching nodules: Some symptoms of thyroid nodules include palpitations, insomnia, weight loss, anxiety, and tremors, common in hyperthyroidism. Common hypothyroidism symptoms might include weight gain, fatigue, depression. Some people will cycle back and forth between hyperthyroid and hypothyroid symptoms. Others may have difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness. And finally, many people have nodules with no obvious symptoms related to thyroid dysfunction at all.

The part where some people can cycle between hyper and hypo would apply to me 100%! I'm glad I am switching to a semi private clinic where you pay a bit but they take their time and listen to you and not act like overconfident bafoons... Thx guys!

[Barb135]

"I found this interesting as I was researching nodules: Some symptoms of thyroid nodules include palpitations, insomnia, weight loss, anxiety, and tremors, common in hyperthyroidism. Common hypothyroidism symptoms might include weight gain, fatigue, depression. Some people will cycle back and forth between hyperthyroid and hypothyroid symptoms. Others may have difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness. And finally, many people have nodules with no obvious symptoms related to thyroid dysfunction at all."

Those are all symptoms of Hashimoto's Thyroiditis and since you have high antibodies, and multiple nodules, I'm guessing that will ultimately, be your diagnosis.  

Hashimoto's often starts off with periods of hyper, then cycling to hypo or even normal, before eventually settling on permanently hypo.

Also, some symptoms, such as palpitations, insomnia, anxiety, etc can actually "cross over" i.e - be symptoms of either hyper or hypo.

Wishing you luck.  

[concernedirritable]

Hi again,

So the results of my ultra sound came:

[B]"Ultrasound of the Thyroid With Duplex Doppler:

The left lobe of the thyroid showed multiple nodules. The largest was more proximal in location measuring 8.5 x 9.5 x 12 mm and showed a very thick hyperechoic margin with isoechoic center. Two additional similar nodules were seen in the anterior part of the left lobe measuring 8.5 and 4.5 mm respectively. In addition, the left lobe shows an abnormal texture. It appears quite hypoechoic and has micronodular pattern in it. These types of findings are quite suggestive of Hashimoto's disease.

The isthmus appeared normal.

The right side showed a somewhat different appearing nodule in the lower pole, which showed an echogenic texture and relatively thin hypoechoic border. It measured 7.2 x 9.5 x 13.4 mm.

An additional smaller nodule was seen in the medial aspect of the right lobe, which showed the appearance similar to the lesions on the left side with thick border measuring 6 mm in diameter.

Duplex Doppler study was obtained, which showed surprisingly extensive vascularity involving the thyroid lobes but especially the nodules with very vascular borders but also in the texture.

Diagnosis:

The complex findings suggested underlying texture of possible Hashimoto's disease. In addition, three nodules were seen on the left side and two on the right side in addition to a few micronodules and microcysts. The nodules were unusual in appearance as described and the largest on the left side may warrant a needle biopsy."[/B]

I started reading on the internet on some website that some of these nodules could be malignant, so I hurried up and went to a private clinic and had a biopsy done on the 2 largest ones, one on the left and one on the right as well as a Laryngoscopy Diagnostic because my throat is starting to feel inflated a bit and the fact that I have been splitting some phlegm (Clear and sometimes brownish) in the morning for years now... I thought it was the smoking but not sure now since I've stopped smoking 4 months ago.

Also, my heart started getting some stabbing feeling last week and some pressure on it, this lasted 5 days....

I'm feeling very anxious and Very irritable... I will meet with the doctor who did the biopsy for a follow up March 26th... Not sure if I need medication for thyroid or for anxiety anymore...

I also got some T3 tests done and will get those results on April 3rd than I will go see the Endo as well...

I feel like a mess right now but at least all this is getting done...

Any advice or Comments appreciated...

[Barb135]

"I have been splitting some phlegm (Clear and sometimes brownish) in the morning for years now... I thought it was the smoking but not sure now since I've stopped smoking 4 months ago."

I'm not sure how long you smoked, but if it was very long, 4 months would not be long enough get all the brownish phlegm out.  I quit 6 years ago and had yellowish or brownish phlegm for a couple years after.

I'm guessing that a lot of your anxiety and irritability are due to stress of all that's going on.  It is possible that the nodules could be malignant, however, less than 5% of them actually are.

What T3 test did you get done?  Hopefully, it was Free T3, as that's the only one that will tell you anything helpful.