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Should I seek a second opinion ?

I went to the doctor and did blood work for my thyroid and I noticed on the results the only thing that was tested was my TSH levels and they were normal (my TSH LEVELS Is 3.620) and my doctor said I didn’t have a thyroid disorder . But I’ve had this swelling/or lump in my neck for years and on top of that I have hyperthyroidism symptoms. I’m not for sure but I thought there were more test than just the TSH test to determine if someone has a thyroid disorder. Im thinking I should get a second opinion?
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Avatar universal
Yes, you definitely need a second or third opinion because this doctor appears to be misdiagnosing you. He doesn't quite understand that a goiter means thyroid disease, which thyroid tests are necessary, and that TSH 3.620 means your thyroid has a problem. What kind of symptoms are you having? Are you sure you don't mean hypo (slow), and not hyper (fast)? TSH at 3.620 is getting to be too high, and is associated with hypo symptoms. Unfortunately, that doctor did not do blood work on your thyroid. He only tested TSH, which is pituitary hormone which communicates with your thyroid. TSH does not mean a whole lot by itself. Thyroid blood work are three tests. TSH, FT3, and FT4. The last two are your thyroid hormones. The first one is the pituitary hormone that tells your thyroid how much hormone to produce. With your level of 3.620, your TSH is probably getting close to the top of the lab range. Knowledgeable doctors know that TSH of 3.620 means that the thyroid is slow and is not able to produce adequate thyroid hormones on it's own. Low or high thyroid hormones cause symptoms. In true hyperthyroidism, TSH is usually very low and FT3 and FT4 are usually very high. In the beginning of hypothyroidism when the thyroid first starts to have problems, sometimes people go between weight loss and hyper-like symptoms, and weight gain and hypo-like symptoms until eventually the thyroid can't make enough thyroid hormones and then the person is permanently hypothyroid.

On top of those standard complete thyroid tests, you also need to test your thyroid antibodies TPO/ab and TG/ab to check to see if you have autoimmune thyroid disease.

The fact that you have a swelling in your neck means that you probably have thyroid disease. A thyroid ultrasound is required to determine if you have thyroid nodules and to make sure that they are not cancerous. It is standard for a doctor to palpate your thyroid to make sure it is not swollen. If it is swollen, a thyroid ultrasound must be ordered to determine the exact condition of your thyroid.
My symptoms are pounding heart beat that happens all day everyday , sensitivity to heat , increased sweating  and that is all.
What are your previous thyroid test results? Your symptoms could be related to your thyroid, or maybe not. Pounding heart, heat sensitivity and increased sweating could also have many other causes. They could also be early stages of either hypothyroid or hyperthyroid. Hyperthyroidism also has many other symptoms and some symptoms cross over to hypothyroidism. No one usually gets all the symptoms, and it's complete thyroid tests that makes the diagnosis. You'll need complete thyroid testing to know if your symptoms are related to your thyroid, or if they are related to some other condition. That doctor didn't test your thyroid hormones (FT3 and FT4), so unfortunately he cannot diagnose you with NOT having thyroid disease. If your FT3 and FT4 results come back high, then you will also need to test for Graves Disease antibodies, TSI/ab and TPO/ab. If your FT3 and FT4 come back under 50% of range, you'll need to test for Hashimoto's antibodies, TG/ab and TPO/ab (this antibody crosses over for both Graves and Hashimoto's. If it's high, then FT3 and FT4 combined with TSH help determine which disease you have.).

Because you have some sort of swelling in your neck, if that swelling is your thyroid, that alone lets you know that you have some sort of thyroid disease. If it's not your thyroid that is swollen, you need to know exactly what is causing that swelling. Your TSH as high as 3.62 means that your thyroid is not functioning perfectly. TSH that high usually mean hypothyroid. TSH in hyperthyroidism is usually suppressed, like under .25. Thyroid hormones in hyperthyroidism will always be increased at either the top of the range, or over the top of the range. In hypothyroidism, thyroid hormones will be low in the range, but it's not unusual to have symptoms even if thyroid hormones are just under 50 % of range. Some people have hypothyroidism even if their TSH is 1.5. It's thyroid hormone levels that matter, FT3 and FT4, in both hypothyroidism and hyperthyroidism. If FT3 and FT4 are too low, then this means hypothyroid. In cases like this, sometimes the cause is elevated thyroid antibodies, meaning that the cause of their hypothyroidism is an autoimmune disease called Hashimoto's.
649848 tn?1534633700
I agree that you need another opinion unless you can get your doctor to test the Free T4 and Free T3, along with the TSH.  

Since you have symptoms of hyperthyroidism, you also should have all three of the antibody tests, even though your TSH is on the higher side.  It's entirely possible to have both Graves Disease and Hashimoto's at the same time.  For Hashimoto's, you need the Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves Disease.

An ultrasound can help diagnose Hashimoto's and determine if characteristics are indicative of cancer, although a biopsy is the only way to diagnose cancer.  It's important to note that less than 5% of all thyroid nodules are cancerous.  

Sometimes, nodules can produce hormones independently of the thyroid.  This could explain hyper symptoms with a higher TSH.  In order to determine if nodules are producing independently of the thyroid, you will need a nuclear medicine scan, otherwise called an uptake scan.

A doctor that's inclined to only test TSH is probably not willing to go out of his way to do other tests necessary to determine whether or not you have a thyroid condition or what is the cause of your symptoms.
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