Any advice would be greatly appreciated, feeling frustrated

[smilee1]

I am 46 and have not felt "well" for awhile, which is hard because we are a very active family. I have just chalked iup a lot of symptoms to getting older. Over the last few years started gaining weight, really achy muscles, tired,... a few weeks ago I came down with a cold virus along with my son and was really sick for a few days. Did not leave the house after 4 days I felt like I was improving until around a week ago when I felt like somebody had their hands around my neck with their thumb on my adams apple. My eyelids and face were puffy, I was freezing, I could not get warm, completely exhausted and my body hips and joints ached. My throat is constantly dry and always clearing it. My doctor order labs which I got back two days ago, I was hoping someone can give me their thoughts on them as I have never heard of Hashimoto's before and now looking back I have the majority of the symptoms for awhile, but before my provider is going to refer me since the labs are within "normal" he is ordering an ultrasound Friday.

Thyroglobulin ABS   13
Thyroid Peroxidase ABS  4
TSH  .61     .40-4.50
T3, Free       2.7    2.3-4.2
T4, Free      1.0   .8-1.8

From some of the information I am reading the TSH is normally higher with Hashimotos? Again, I am new and the only reason I started researching this was from a co-worker who is a RN who wanted me to look into it.  Any help or advice would be great!

[Barb135]

Sorry I missed these responses...

So your TgAb is 34 and the reference range is <= 1, which makes it elevated.  It's not elevated a lot, but that would, typically, indicate Hashimoto's, though antibodies can be slightly elevated with some other autoimmune conditions, as well.

Looking at your thyroid hormone levels, there's definitely room for improvement.  

Nodules are common with Hashimoto's, as is swelling/inflammation.  Your physician still may not be willing to refer you to an endo, and even if he does an endo may not see fit to treat... it all depends on whether or not the endo is willing to look beyond the TSH.

Your vitamin B12 is good - continue whatever you're doing, but we know that's not what's causing your fatigue and hypothyroidism becomes a bigger possibility.  Be sure to ask for vitamin D and ferritin.  Low iron also causes fatigue.

[smilee1]

I had an ultrasound today and it was mentioned that there are nodules on my thyroid and it is "on the larger size" but the result will not be back to my physician on Tuesday. I am hoping that this will be enough information so that I can be referred to a specialist?

[smilee1]

Thank you so much for the quick response and the information, you have given me a lot of things to consider.
The range for TgAB is < or = 1 IU/mL H and TPO/ab is < 9 IU/ml N, almost a year ago the TgAB was 34 < 1 IU/mL H

He did also test for vitamin B12 which was 1018  200-1100 ( pg/mL),
but not vitamin D and ferritin.

Thank you again for the information!

[Barb135]

What are the reference ranges for the Thyroglobulin ABS (TgAb) and Thyroid Peroxidase ABS (TPOab)?  Ranges vary from lab to lab, so they need to come from your own lab report.

You're right that we'd, typically, expect to TSH higher with hypothyroidism, especially, primary hypothyroidism caused by Hashimoto's.

Your actual hormone levels, Free T3 and Free T4, are much considerably lower than what we'd consider optimal.  Most of us find that FT4 has to be about the middle of the range; yours is only 20%; in addition, most of us find that FT3 needs to be in the upper half to upper third of its range and yours is only at 21% of its range, so they both fall considerably short.  Considering your labs, along with your symptoms, I'd still say you have hypothyroidism, regardless of the low TSH...  

You might talk to your doctor, however, about the possibility of Central or secondary hypothyroidism, which is when the thyroid works fine, but there's a problem with the pituitary/hypothalamus axis, in which there isn't enough TSH to stimulate the thyroid to make adequate hormones.  

Hypothyroidism is hypothyroidism and needs treatment, regardless of its cause. Many doctors will look at results like yours and say they are just fine, because they're "in range", completely overlooking the symptoms, which they find all to easy to blame on something else, such as fibromyalgia, chronic fatigue, etc.  

Because of the fatigue and achy muscles, you might also ask to get tested for vitamin B12, vitamin D and ferritin.  Vitamin B12 deficiency can cause the most horrible fatigue/tiredness imaginable, as can low iron.  Ferritin is the iron storage hormone and will tell how much iron you have in store.  Both iron and vitamin D are necessary for the proper synthesis of thyroid hormones.  Additionally, vitamin D deficiency can cause many hypo-like symptoms.  

An ultrasound is a good idea, because it will determine if you have nodules on your thyroid.  Nodules are quite common and are usually nothing to worry about, but it's good to know if they're there or if there are any unusual characteristics about your thyroid, such as inflammation, swelling, etc.