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Should I get a second opinion?

Hi!  New here and desperate for some help!  I am a 38 year old female.

Here are my Symptoms:
Weight loss of 15 lbs in the past year
Fatigue
Shortness of breath
Heart palpitations
Depression
Always cold
Sleep for 8 hours but feel like I haven’t slept at all
Poor memory/concentration


I went to the doctor.  She tested my TSH and T4 on June 5th.
My Results:
TSH  - Standard Range 0.358- 3.74 ulU/mL  My value .533
T4 FREE - Standard Range 0.76 -1.46 ng/dL  My value .72

Then I went to an endocrinologist, thinking they would do more in depth tests.
Well, they did the same two tests and only two different ones.

My results dated July 20th:
TSH  - Standard Range 0.358- 3.74 ulU/mL  My value .842
T4 FREE - Standard Range 0.76 -1.46 ng/dL  My value .90
Cortisol – Standard range – 3.1 - 22.4 ug/dL  My value 30.7
Adrenocorticotropic Hormone   - Standard range  <=45.9 pg/ml  (I’m guessing this mean less than or equal to 45.9?)
My value 15.2

The doctor tells me all my test results are normal.  Should I accept what she tells me or should I see a different doctor?  Does it seem like there's nothing wrong with my thyroid?  I don't want to waste my time barking up the wrong tree if what's wrong with me has nothing to do with my thyroid.

Thanks in advance for any response!
14 Responses
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Avatar universal
Another thing.  I have always thought I have low blood sugar.  But recently one of the doctors I saw gave me a glucose monitor to check my blood sugar.  Every time I've checked my blood sugar it comes back around 80 - even fasting it comes back around 80.

Somehow I online I came across symptoms about low blood PRESSURE - lightheadedness, espeically when going from lying down to sitting up, fatigue, shortness of breath, heart palpitations, blurred vision.  Check, check, check, I have all these symptoms, the most obivous one is when I get up first thing in the morning I almost pass out.

I started checking my medical history and looking at what my BP has been in the past.  Anything below 120/80 is consider low blood pressure - my scores have been 102/60, 119/67, 98/60, etc. etc.    And then I saw that low blood pressure could be caused by a thyroid problems.  

Does anyone know if issues with their thyroid has caused problems with their blood pressure?
Helpful - 0
Avatar universal
Hi, I'm back again.

I brought my lab results to a different endocrinilogist.  He looked at all my results and said they did not test me for antibodies.  So he ran that test.  He also did a ultrsound of my thyroid.

His assistant called a couple of days later and told me the test for antibodies came back negative which means I do not have thyroiditis, but the doctor wanted me to get a scan done of my thyroid.  The Dr. believed I had a "hot" nodule that was hyperfunctioning.  I had the scan done this past Monday.  

I had the scan done at the same hopsital that has an online system where you can check your results.  So I was able to see the test results as of last night.  This is what it said----

EXAMINATION: Sodium pertechnetate UPTAKE AND SCAN

INDICATION: possible hot nodule in Left Lobe. possible hot nodule in Left Lobe

FINDINGS:  Static images of the thyroid demonstrate homogeneous uptake of radioiodine throughout both lobes of thyroid gland. There is focal radiotracer uptake noted within the right lower lobe. There are no visualized accessory lobes of the thyroid gland.

IMPRESSION:  Increased radiotracer uptake within right lower lobe likely representing a hyperfunctioning adenoma.

-----------------

So I called my doctor, but they have not gotten the results yet.  But I'm guessing this means I'm hyperthyroid?
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Avatar universal
Thank Gimel.  

I found a doctor that takes my insurance that I think will be good.  I just have to get a referral from my primary.  Hopefully I'll be able to report back with good news.

I'll keep your advice in mind.
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Avatar universal
That Free T3 result is way too low in the range.  It should be in the upper third of its range, or as necessary to relieve hypo symptoms.  As you proceed, keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results. If you can get that from any doctor you choose, you will be fine.  Please stay in touch and let us know how it goes.
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Avatar universal
My doctor's office has an online system call "MyChart" where you can view your test results as they come in.

Well, one more test result came in last night.  It was my T3FREE.  Standard range 2.3-4.2 pg/mL.  My value was 2.6.

I know they're just going to say since it's inside the values that it's "normal" like the other test results.  *eye roll*

Gimel, I checked the list of doctors you gave me, but it looks like only one of them (Dr. Laird) takes health insurance.  A friend of mine gave me the name of the doctor she's been seeing for her thyroid issues.  I guess I'll try either her doctor or Dr. Laird.  Wish me luck.
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Avatar universal
Thanks again Gimel.
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Avatar universal
There are various recommended lists of thyroid tests, but in your place I would get Free T4, Free T3, TSH that they always run, and ferritin.  Unless you have supplemented your D and B12, then you already know those levels.  If possible you could try to get the doctor to also run Reverse T3.  Those should give a good picture of your status.  

By the way, D should be about 55-60 and B12 should be in the very upper end of its range.  So I suggest that you supplement with D3 and B12 to optimize those levels.
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Avatar universal
Thank you again Gimel!  I really appreciate you taking the time to explain all this!  It means a lot.

My B12 was 545 - standard range 211-911
but my vitamin D was 30 - standard range of 30-100

I also just got my sedimentation rate, automated test result back this morning.  My value was 15 with a standard range of 0-20, not sure if that means anything.

Is there a checklist of all the tests that should be done for my thyroid?  Thanks again.
Helpful - 0
Avatar universal
I would not rule out hypothyroidism on the basis of one month's use of 5 mcg of T3 med.  We don't know your Free T3 level, but considering your Free T4 level, that amount of T3 med is unlikely to be enough to make any difference.  I would not rule out thyroid issues without a full set of tests, including Free T4, Free T3, Vitamin D, B12 and ferritin.  Deficiency in either of the latter three can cause symptoms that mimic some of those that are hypothyroid.  Also, low D or ferritin can adversely affect the metabolism of thyroid hormone.  Even your high cortisol can adversely affect the effect of thyroid hormone.  

So, since tiredness, and even anxiety/depression can be related to thyroid, I really think you need to get those tests done and see if that is a cause for your symptoms.  
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Avatar universal
One more question.  I have been seeing a psychiatrist for PTSD.  She prescribed me effexor for anxiety/depression.  It worked great for my anxiety and depression, but one of the side effects was it made me tired.  I'm already tired all the time, and this medication made it even worse.

I did not want to stop the effexor because other than the side effect of tiredness, my mood was better, it helped with my OCD, and I felt less anxious.  The psychiatrist said since I have always suffered from fatigue, maybe my thyroid was low.  She prescribed me cytomel - 5mg.  I took it for about a month but did not notice any difference.  So I went back to her and told her it didn't seem to be working.  She said by a month it should be working so we stopped the cytomel and she put me on adderall.  The adderall is awesome.  I've always suspected I'm ADHD anyway, both of my daughters are ADHD.  The adderall gives me energy, I can focus and concentrate and get things done at work.  

I'm wondering since I took the cytomel for a month and it didn't have any effect, what does that mean in regards to my thyroid?
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Avatar universal
Got it, thanks!
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Avatar universal
I just sent you a PM with info.  To access, just click on your name and from your personal page, click on messages.  
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Avatar universal
"Well then what are your symptoms supposed to be caused by?"  I know, right!

I don't understand how they can consider my results normal when my cortisol  level is 30 and the normal range is 3-22?

Yes, I would definitely like the names of doctors you could recommend.  Thanks!
Helpful - 0
Avatar universal
Same old story that we hear so often.  Doctor tells patient that their thyroid test results are "normal" and that any symptoms are not due to thyroid.  Well then what are your symptoms supposed to be caused by?  Or do they not believe you when you tell them about symptoms?  Neither doctor even bothered to test you for the thyroid hormone that correlates best with hypo symptoms, which is Free T3.  Pathetic.  

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."

Your Free T4 results were way too low in the range.  Free T3 was not even tested.  They probably looked mostly at your relatively low TSH and decided you did not have a thyroid problem.  Maybe they never considered central hypothyroidism.  Central hypothyroidism is a dysfunction in the hypothalamus/pituitary system characterized by relatively low TSH along with Free T4 and free T3 that are relatively low in their ranges.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Based on your experience to date, I think you need to see a good thyroid doctor.  If you are interested I have names of a couple in your area that have been recommended by thyroid patients.  

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