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1350417 tn?1303825410

General questions.

I have Hashimoto's and my right thyroid lobe was greatly enlarged at 6.4cm x 2.1cm x 2.0cm and my left one is 4.6 x 2.2 x 2.  These numbers are from March 2010 and I can tell the thyroid glands are much larger as is the isthomus.  I don't know the normal size an isthomus is supposed to be but mine measured  a little over 2 cm. I intially got the ultrasound performed because I was having all the Hypo symptoms (extreme fatigue, hair falling out, weight gain, etc.) but was also feeling as if my throat was tight and was having that feeling as if food wouldn't go down and stayed in the back of my throat. The ultrasound showed "innumerous nodule foci" in both lobes and some were hypoechoic to isoechoic and some were hyperechoic. I have one nodule that is 1.8cm and another that is some smaller...I can't remember the size. I had the ultrasound in Dec 2010. My Endo. changed my medication back in Nov. because my levels were to high, my medication at the time was name brand Synthroid 150 and he changed it 175mcg. When I returned in Dec. for my ultrasound, my levels were down to .528.
I recently started feeling all the same symptoms as before but I had also gotten choked twice (actually choked like I needed the himlic choking) and was having trouble catching my breath after doing anything such as walking to the mailbox or taking the trash out, I have asthma but it hasn't bothered me in over a year. I returned to see my Endo on April 18th and my levels had gone up in three months from .528 to 1.08.  He told me at the visit in Dec. that he didn't feel I was having my swallowing issues and breathing issues because of my thyroid because it was more enlongated than wide and then THIS time (symptoms much worse) he told me he thought it was due to me starting Welbutrin!?!?!  (I had been on Welbutrin for 7 mo prior to my swallowing symptoms and didn't have these symptoms until a month before my last appt.). He went ahead and upped my medicine to 187.5 mcg and told me if I continued to have issues with swallowing or getting choked that I should have my primary do a swallow test and that he would see me in two months to follow up.
I do not feel as though he is taking me serious and the last time I got choked I was driving (with my kids in the car) and barely got pulled over before I got the food down (a small pc of Airhead candy) and I didn't have anything to drink. It was really scary. I am going to get a second opinion in June but it is with an internal medicine doctor because all the Endo's on my insur. are in current Endo's practice :(  
My question now is, how big does a goiter have to be before it really causes problems with swallowing and breathing for the Endo to take me serious enough?  He claims the x-rays didn't show signs of obstruction but my copy of the x-rays doesn't even show the angle that would tell him this. He thought he could shrink the goiter with Synthroid (which I have been on for a little over 11 yrs) but it just keeps getting bigger. Also, are all goiters considered Hashi's? Can you have one without it being Hashi's?  I really need to get something done about it because if I get choked again while doing something like driving, I might not be so lucky next time. Please let me know any advice you have on this post. I really do appreciate your input! Thank you!
4 Responses
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Avatar universal
Please go see an ENT to make sure everything else is okay...

You really do need the swallow test.
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Avatar universal
Have you been tested for Free T3 or was it Total T3.  Could you please post the result and reference range, for whichever it was?

Lacking some vital information, but wanting to try and help you understand what is going on, let me give you a couple of scenarios that we hear quite frequently from members, and see how that fits your situation.   The patient has had a TT or Hashi's and is suffering with typical hypo symptoms.  If the TSH result is high enough, doctors with the "Immaculate TSH Belief" will prescribe a T4 thyroid med.  Then, when the dosage gets high enough for the TSH to be suppressed to the lower end of the range or below, the doctor says that you have become hyper and must reduce meds.  Meanwhile you still have hypo symptoms, not hyper, and need an increase not a decrease.  

The next scenario is that the doctor relies mostly on TSH, but will also test for FT4 as well.    As long as the TSH and FT4 are within the so-called "normal" ranges the doctor declares that you are doing fine and that those nagging hypo symptoms you still have must be due to something else.  Do either of these sound familiar?

The scenario you really would like to have is that the doctor is a good thyroid doctor that treats a patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resulting TSH levels.  This type of thyroid doctor knows from experience that a suppressed TSH does not mean that you are hyper, unless you have hyper symptoms due to excessive FT3 and FT4 levels.  If your FT3 and FT4 levels are within the almighty reference ranges, how can they be excessive?  They're not, It's just that TSH is frequently suppressed when taking significant doses of thyroid meds.  A good thyroid doctor also knows that the reference ranges are far too broad and that they should be used as guidelines within which to adjust FT3 and FT4 as necessary to relieve symptoms, since symptom relief should be all important, not test results.

You can read more about clinical treatment in this link, written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

So in my opinion, the first thing you need to do is to get testing for FT3 along with FT4 and TSH.  I expect that you will find that your FT3 is way out of balance with the FT4.  By that I mean that your FT3 is lower in the range than your FT4, indicating lack of T4 to T3 conversion.   This is a frequent occurrence when taking heavy doses of T4 meds.  If that is the case, it indicates that you need to change your meds to include a source of T3, either by switching all, or part, of your meds to a T4/T3 combo type, or by adding a T3 med.   The objective is to increase the level of FT3.  FT3 is the most active thyroid hormone.  It largely regulates metabolism and many other body function.  Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH correlated very poorly.  

If your doctor resists testing for FT3, then insist on it and don't take no for an answer.  Remember that you are the customer.  While you're at it  you should also find out if the doctor is going to be willing to treat you clinically, as described above.  If not, then you will need to find a good thyroid doctor that will do so.

When test results are available, please get a copy and post results and reference ranges shown on the lab report and members will be glad to help interpret and advise further.



Helpful - 0
1350417 tn?1303825410
I posted but my post was so long it's easily forgotten.  My TSH level was up from .528 in Dec. 2011 to now being 1.810 and my Free T4 was up from .924 to 1.05 .  They did not check my Free T3 this time around. Thanks :)
Helpful - 0
Avatar universal
As a starting point, please post your thyroid test results and reference ranges shown on the lab report so that members can assess the adequacy of testing and results.
Helpful - 0
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