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I had yet ANOTHER ultrasound

I originally went to my primary care doctor 2017 due to feeling this "lump" when I swallowed and like someone was squeezing my neck. She ordered lab work to check TSH (2.57-- ref range 0.34-5.0mU/L) and free t4 (0.79-- reference range 0.58-1.64ng/dL). She then sent me to an ENT to have ultrasound of neck. I have had approximately 6 ultrasounds and CT scan now. Just had another ultrasound this week: right lobe measures 5.05x1.66x1.40cm. Nodule mid 0.17x0.35x0.28cm. Nodule mid 0.18x0.28x0.22cm. Nodule inferior 0.25x0.23x0.29cm. Isthmus measures 0.30cm. Left thyroid lobe measures 4.76x1.15x1.43cm. Nodule mid 0.16x0.23x0.25cm. Nodule inferior 0.44x0.46x0.55cm. Right cervical node 2.4x0.31x0.9cm and left cervical node 2.7x0.42x0.74cm..... Each ultrasound shows slightly larger than the last. My ENT just tells me that we will repeat in few months. I am physically drained to point that I struggle to stay awake. Holding my eyes open is nearly impossible most days. I have constant urge to clear my throat or cough (I do have history of asthma and acid reflux, but neither have made me feel this way). I feel like I'm falling apart and can't stand to feel this way.
1 Responses
649848 tn?1534633700
COMMUNITY LEADER
It's no wonder you're feeling bad; your Free T4 is way too low in its range, indicating that your thyroid isn't working as well as it should be.  Yes, I know it's "in range", so you doctors think it's good, but they don't understand that levels this low can still cause symptoms.

Most of us feel best with Free T4 at about the mid-range point and yours is only at 20% of its range.  

Unfortunately, your doctor didn't order Free T3, which is the hormone used by almost every cell in your body.  On the other hand, Free T4 is a pro-hormone, otherwise known as a storage hormone that isn't used directly but has to be converted to Free T3 prior to use.

Since your doctor was nice enough to send you for thyroid ultrasounds, I'd wonder if s/he was also nice enough to have you tested for thyroid antibodies.  Hashimoto's is the most common cause of hypothyroidism in the developed world and it's common for those of us with Hashimoto's to have thyroid nodules.  

If you haven't been tested for thyroid antibodies you should ask your doctor to order them.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Those are both markers for Hashimoto's so you need them both in order to avoid misdiagnosis.

What happens when we have Hashimoto's is that the antibodies attack and gradually destroy the thyroid so it can't produce enough of the hormones we need to maintain adequate body functions.  It's not unusual for symptoms to begin months or years before the labs actually go out of range so doctors are willing to treat the resulting hypothyroidism.

In addition, many times when we have Hashimoto's/hypothyroidism, we end up being deficient in Vitamin B-12, vitamin D, and ferritin as well.  These nutrients are essential for the proper metabolism of thyroid hormones, as well as energy production to help keep us going.  If you haven't been tested for these, you should also ask your doctor to order them, along with the antibody tests.  If s/he refuses either the antibody tests or the vitamin/mineral tests, you should think about finding a different doctor.  

In addition, your doctor should order Free T3 to be tested every time you have a Free T4 and TSH test.  Testing TSH and Free T4 without Free T3 is like shooting targets with a blindfold on; you have no idea what you're doing.  Again, if s/he refuses, it's time to think about a different doctor.
3 Comments
Thank you so much for your response! I will certainly be requesting those labs or find new doctor.
Let us know how you turn out... We'll be waiting to hear
I went to the doctor last week and they called me today. My TSH is 2.53 and Free T4 is 0.73... She decided to start me on Levothyroxine for subclinical hypothyroidism.
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