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3113201 tn?1341780938

Is my enlarged thyroid causing these issues? Treatment or diagnosis tips?

I'm a 21 year old female college student, and since I hit puberty when I around 12 years old, I have had trouble losing weight... I'm about 6 foot 1, 250 lbs but I'm very active and I workout 5 days a week, resistance training for an hour and sometimes cardio. I play basketball once a week as well. I found out 5 years ago that I had an enlarged thyroid, which I blame for the massive weight gain and extreme hair loss. However, after going to the doctor numerous times, all my tests came out "normal". I know something's wrong... I still have hair loss, I can't lose any  weight, I'm always fatigued, and I get this weird burning, achy sensation in my throat every once and a while. Sometimes I have heavy periods, have random nausea, and my voice is deep. Nevertheless, I really need to lose weight; I have almost every genetic factor leading to CVD, diabetes, HBP, etc in my family history. Weight loss and energy is essential! Please help! What can I do? What could it be?
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1756321 tn?1547095325
Thyroid labs to request: TSH, free T4, free T3, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb).
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3113201 tn?1341780938
Thanks!
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Avatar universal
Please post all those "normal" test results and their reference ranges shown on the lab report.  
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3113201 tn?1341780938
These are the only test results I could find at home. I'll put the dates for each test as well.

TSH w/ Reflex to T4 = 0.99              March 2014

SED RATE BY MODIFIED WESTERGREN, MANUAL 38


And below is the metabolic panel I took in March 2014. The numbers to the far right represent "normal" values.

GLUCOSE                         93 65-99 mg/dL
UREA NITROGEN (BUN) 13 7-20 mg/dL
CREATININE                 0.94 0.50-1.00 mg/dL
eGFR NON-AFR. AMERICAN 88 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 102 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO N/A 6-22 (calc)
SODIUM                         139 135-146 mmol/L
POTASSIUM                 4.2 3.8-5.1 mmol/L
CHLORIDE                 105 98-110 mmol/L
CARBON DIOXIDE          20 19-30 mmol/L
CALCIUM                          9.5 8.9-10.4 mg/dL
PROTEIN, TOTAL          7.6 6.3-8.2 g/dL
ALBUMIN                          4.1 3.6-5.1 g/dL
GLOBULIN                  3.5 2.0-3.8 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.2 1.0-2.5 (calc)
BILIRUBIN, TOTAL          0.6 0.2-1.1 mg/dL
ALKALINE PHOSPHATASE 51 47-176 U/L
AST                                  20 12-32 U/L
ALT                                  15 5-32 U/L
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3113201 tn?1341780938
If its hard to read, I apologize... But the first double digit numbers were my results, and the following numbers are the normal ranges.
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Avatar universal
I see nothing of concern in that long list of tests.  The only thyroid test you had was the TSH.  Since it was within the so-called "normal' range,  even Free T4 was not tested; however, having a TSH like yours does not assure there is no thyroid issue.  It only means that there is no likelihood of primary hypothyroidism.  There is also central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system, characterized by relatively low in the range TSH, and also low in the range Free T4 and Free T3, which are the biologically active thyroid hormones.  Note that Free T4 and Free T3 are not the same as Total T4 and Total T3.  So you need to be tested for Free T4 and Free T3 every time you go in for tests.  If those test results are in the lower half of their range, then that is a good indication that your symptoms are due to hypothyroidism and that you need to take thyroid medication.  

Also, since hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, I also suggest getting those done.  Then when you have new test results, please post them along with their reference ranges and we will be glad to help interpret and advise further.   Weight issues can be related to a number of things, but you should get all these tests done to find out for sure if thyroid issues are affecting you.  

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3113201 tn?1341780938
Thank you so much! I'm not sure when I'll get the tests done but I will post them for sure. I know one thing that my doctor has said (the one I see while I'm in college) is that my ferritin levels are low. I couldn't find the paper but I think it was in the low twenties last month.


When I do test, should I test for anything else other than Free T3 and Free T4?
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Avatar universal
Make sure they test for Free T3 and Free T4, not Total T3 and Total T4.  Also test for Vitamin D, B12 and ferritin.  Since you recall being low on ferritin in the past, I would also request a test for Reverse T3.  That might be difficult to get them to do the Reverse T3 test, but worth a try.  
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3113201 tn?1341780938
Ferritin = 25
TSH = 1.86
T3 Uptake = 32
T4 Total = 6.0
Free T4 = 1.9

They said my Ferritin was kind of low, but other than that, they said everything is normal. They didn't give me the Free T3 or the Reverse T3 test.
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Avatar universal
I expect that your doctor is as outdated as some of those tests.  The T3 uptake and Total T4 are no longer recommended.  Free T4 and Free T3 should be done every time you go for tests.  If they resist, you should insist and don't take no for an answer.  

Before commenting further, what was the reference ranges for those tests, as shown on the lab report?  Test results and associated reference ranges vary from lab to lab so results must always be compared to ranges from the same lab.  
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3113201 tn?1341780938
Sorry! Forgot to post the reference ranges.

T3 Uptake is 22-35%
T4 Total is 4.5-12 mcg/dL
Free T4 is 1.4-3.8
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Avatar universal
I have never seen a Free T4 range that broad.  Is that shown on the lab report, or did someone tell you by phone?
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3113201 tn?1341780938
They called me and said my results are normal. But those were the exact results and numbers the lab report on my health database my university allows me to access at any time.
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Avatar universal
That Free T4 result and reference range actually looks more like it would be for Free T3 instead of Free T4; however, whatever it is the result is far too low in the range.  Even though your TSH is within range, that does not preclude you being hypothyroid, since with central hypothyroidism there is a dysfunction in the hypothalamus/pituitary system that causes relatively low TSH, and thus Free T4 and Free T3 that are too low in the range.  

In addition your ferritin is way too low.  That can cause symptoms, as well as adversely affect metabolism of thyroid hormone.   What did the doctor say you should do about the low ferritin?

So in summary I think you need to go back and have a heart to heart talk with the doctor and explain the many symptoms you have and insist on the need to be tested for both Free T4 and Free T3, along with Vitamin D and B12.  Then you need to request a therapeutic trial of thyroid med as needed to raise your Free T4 to the middle of its range, and your Free T3 into the upper half of its range, or as needed to relieve symptoms.  Scientific studies have shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate.  If the Univ. doctor(s) won't agree then can you get your doctor at home to do so.  

As you proceed, keep this info in mind.  In the words of a good thyroid doctor, In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
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3113201 tn?1341780938
Wow.... Why would they tell me that's normal then? They didn't say anything about what to do with my low ferritin amount.... Do you have any suggestions on that?

I'll most likely wait until school break to go to a doctor at home because I don't know if they will listen to me and give me the free T3 test. I insisted on only getting those two tests and they said we will do the thyroid panel.

I think I had my Vitamin D and B12 tested before and those were above average.... But I don't remember.
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Avatar universal
The problem with the typical protocol for testing and evaluating potential hypothyroid patients to first test TSH, is because of the mistaken belief that TSH is the most sensitive test for thyroid status.  The range for TSH was established based on the NHANES study, which included thousands of people.  After excluding people with identified thyroid problems, they established a statistical distribution of the remaining TSH results and decided to set the upper and lower range limits at plus or minus 2 standard deviations from the average.   There are several errors in doing this that I won't bother you with.  Prior to 2008 the range was .5 - 5.0.  Then in 2008, in response to so much evidence that hypothyroid patients just within the upper limit were not being treated and were suffering unnecessarily with hypo symptoms, the new guidelines issued by the AACE and ATA in 2012 changed the upper limit to 3.0, which was a huge change that exposed many millions of people to the diagnosis of being subclinically hypothyroid.

Then in 2012, apparently because of complaints from doctors about the lower limit, the range was again revised to 4.3.  In reality it is impossible to set a limit and say that a patient that is .01 over the limit is not okay, and a patient that is .01 below the limit is okay.  Currently the range limit is set at a point to avoid false positive diagnoses.  As a result, there are many hypo patients who are ignored.  The problems have been passed on to hypo patients to have to learn about hypothyroidism and be able to argue with most doctors to get adequate testing and treatment.  

Now, understand that overt hypothyroidism is defined as having a TSH above 10, which then gets you some treatment.  A TSH between 4.3 and 10 only gets you another test, for Free T4.  Then the doctor will use "Reference Range Endocrinology" and if the Free T4 is within its range, treatment is frequently denied, in spite of symptoms.  Patients are frequently told, "Your test results are within the normal range, so it cannot be your thyroid that is causing symptoms."  This is ridiculous because of the way the ranges are established for Free T4 and Free T3.  Those ranges are based on lab results for all patients getting thyroid tests, with TSH less than 5.  By this they erroneously think they have excluded hypothyroid patients.  In reality there are included a lot of sick patients, hypo patients and hypothyroid patients being treated with thyroid med.  If a extensive test was done on healthy adults with no known thyroid pathology, the ranges for Free T4 and Free T3 would look more like the upper half of the current ranges.  This is the basis for the quote I gave you above from a good thyroid doctor.

Yet most doctors don't understand this because they were taught that TSH is the best measure of thyroid status and that any test that falls within the so-called "normal" range is adequate.  You can also get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

You can supplement for low ferritin on your own.  I would start with 25 mg of ferrous fumarate, or ferrous sulfate, or ferrous bisglycinate, and after a few weeks, increase to 50 mg.  Then test again.  

Getting the Univ. clinic to listen and do the testing needed is only a small step.  It is very doubtful that you could get treatment since your TSH and Free T4 are within the ranges.  Unless you go to a good thyroid doctor that understands all this and is willing to do the testing and treatment required, you will be disappointed.  So, instead of that possibility if you will tell us where your home is located perhaps we can suggest a doctor that has been recommended by other thyroid patients, and you can start now to try and set up an appointment for when you go home.  

As for Vitamin  D and B12 I would be surprised if they are optimal.  D should be about 55-60 and B12 in the very upper end of its range.  


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3113201 tn?1341780938
Amazing. Thank you for all the details! It definitely helps me understand thyroid testing and the changes over the years.

I will look in to supplementation with ferrous fumarate.... Any other supplements you suggest that may help? I know it's not good to depend on supplements, but honestly, until I get a hold of a good doctor, I might have try some things like that on my own.

I'll double check on the Vitamin D and B12 tests. If I haven't taken them, I'll try to get them done soon.

Thanks for all your help!
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Avatar universal
We would be happy to help locate a good thyroid doctor if you will tell us your home area.  
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3113201 tn?1341780938
My hometown is in Pompano Beach, Florida
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Avatar universal
I sent you a PM with info.  To access, just click on your name and then from your personal page, click on messages.  
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3113201 tn?1341780938
Got it! Any other suggestions regarding tests, diet, supplements, or anything else that may help?
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3113201 tn?1341780938
I just got the Free T3 test taken after arguing with them on the phone. However, they didn't let me do the Vitamin D or B12 test because they said they didn't think it was necessary. I'm going to start taking that supplement you suggested this week and see if that help. I'll post my results as soon as I get them!
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3113201 tn?1341780938
The results for the Free T3 were considered normal.

Free T3 = 2.8

Reference Range = 2.3 - 4.2 pg/ml
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Avatar universal
Like your Free T4, your Free T3 is way too low in the so-called "normal' range.  The range is far too broad to be functional for many people, due to the erroneous assumption used to establish ranges, namely that any FT4 or FT3 test result from a patient with TSH less than 5 is included in the data base used to calculate the range.  As a result patients with central hypothyroidism (relatively low TSH along with low Free T4 and Free T3) are in the data base, along with hypo patients taking thyroid med are all included in the data base used to calculate ranges.  As a result the range is skewed to the low end, so patients with test results in the lower half of the ranges should be suspect as being hypothyroid.  

It may be difficult for you to get the current doctor to recognize central hypothyroidism and be willing to treat you with thyroid med, but you certainly should try to get them to recognize the problem.  With the expectation of no success you should go ahead and try to get an appointment with the doctor near your home.  I would also recommend supplementing with an iron supplement, Vitamin D and B12.  Ferritin should be about 70 minimum, Vitamin D about 55-60, and B12 in the upper end of its range.  That might give you some help while you are waiting to see the other doctor.  
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