Some Questions about Toxic Nodular goiter.

[crosswind]

I am little confused about my condition. I am a little overweight, and I also really always thought that even though the labs came back hyper I was really "hypo" -- considering my symptoms. I tire easily, can't concentrate, I'm *always* cold except now for hot flashes. My nails are destroyed and shreddable. My skin is smooth and oily and I'm just always sort of puffy all over.

I know very little about this, but my lab tests say that my TSH is .226; T3 and T4 are "normal" but at the bottom of the range.

The toxic goiter is one hot nodule among three other cold ones. I never really feel awake or alive, so it would seem to me that logically what I should be shooting for is an increase in t3 just to feel better. I do not have any unmanageable hyper symptoms and that little toxic goiter doesn't seem to be doing the job it should be doing in releasing t4.

Is it ever suggested that a person with my condition supplement t3 and ignore TSH entirely?

[Barb135]

"typically doctors wave off the other markers for Pernicious Anemia because they think it's connected to my iron levels."  Does that mean you haven't officially, been diagnosed with PA?  If you really have PA, oral supplements are very unlikely to help; you should be on injectable B12.

If you aren't on any thyroid medication, it's true that with less TSH, FT4 should be higher, but we don't know what your FT3 is, either. FT3 is active hormone and it may plenty high enough to keep your TSH down.

Have you ever had any pituitary tests done?  

[crosswind]

Yes, I have both Pernicious Anemia and Iron Deficiency Anemia. I am trying to get those levels up with supplemental b12 and iron. The iron deficiency anemia has to do with losing lots and lots of blood every month and typically doctors wave off the other markers for Pernicious Anemia because they think it's connected to my iron levels.

I guess what I'm wondering about is the fact that the numbers I'm getting don't match each other. With less tsh there should be more t4 and that is not the case. I can't even hazard a guess as to why.

[Barb135]

Your TSI rules out Graves Disease, and I'm sure your doctor thinks that your TPOab rules out Hashimoto's; however, I have to argue on that one.

There are 2 antibodies that can confirm/rule out Hashimoto's - that's TPOab and TgAB (Thyroglobulin Antibodies). Some people have only TPOab, others have only Tgab and still others have both.  Apparently, your doctor only did the TPOab... You need to ask for the TgAB.

While Hashimoto's is most often associated with hypothyroidism, it can also be characterized by periods of hyper.  Some symptoms can cross over and apply to both hyper and hypo.. fatigue is one.

Total T3 tells only the total T3 that's in your blood; it doesn't tell how much is bound to protein and unusable, and how much is "free" to be used.  TT3 is considered to be obsolete and of little value.  It's really pretty much a waste of money.

Your FT4 is quite low in the range, but we don't know if those with a working thyroid actually need their levels as high as those of us whose thyroid does not work.

I don't remember if I've asked you this in your other thread - have you been tested for vitamin B12, iron/ferritin?  Pernicious Anemia is another autoimmune and it's characterized by low levels of vitamin B12...... that could be another explanation for your positive ANA.  Ferritin is the iron storage hormone; if ferritin levels are low, iron levels may also be low and could cause iron deficiency anemia.

I have PA and I've had iron deficiency anemia - both can cause horrendous fatigue......

[crosswind]

Hi Again :

Thanks again very much for your helpful comments. You know how hard it is to get much information from an endocrinologist and what's online is really confusing to me, so I very much appreciate your response.

TSH .226

T4 FREE 0.61 - 1.81 NG/DL 0.99

T3 TOTAL 0.87 - 1.78 NG/ML 1.00

So they didn't do free T3 because they were testing for Graves disease.

What's confusing me is that T4 really isn't that high. It's in the "normal" range but barely. T3 seems somewhat evenly matched at the bottom of the normal range. I took the tests for both Hashimoto's and Graves:

THYR STIMULATING IMMUNOGLOB <1.0

Reference Range:
<=1.3

ANTI-TPO IGG <1.0

Anti-TPO IgG Reference Range:
=9.0 IU/mL Positive

Also, the largest nodule was aspirated and found to be noncancerous. I am not on any medication for this and I never was, since the lower TSH has always been considered "subclinical"

From the numbers I am looking at, given what little I understand about this it really seems like T4 and/or T3 could come up from where they are. But how does one do that if one has subclinical hyper TSH? Also, what does total T3 really say? If it is total and no free, does that mean the number for free T3 is even lower than that?

Thanks in advance!

[Barb135]

What, exactly, are the results of those "normal" T3 and T4, and are they Free T3 and Free T4, or total?  They aren't the same and testing for total T levels is considered obsolete and of little value.

Please post the results, and include reference ranges, which vary lab to lab and have to come from your own report.

Have you been tested to thyroid antibodies?  Is so, please post those results, as well.

I know you've had an ultrasound, because I just finished commenting on your other thread.

Some symptoms, like the tiredness and brain fog can "crossover" and apply to either hyper or hypo.  

Are you currently on a thyroid replacement hormone?  If so, which one, what dose and for how long have you been on it?