Elle,
There are two very important things that a doctor must be willing to do, in order to be a good thyroid doctor.
1. Be willing to order full labs, including Free T3, Free T4, Reverse T3, in addition to TSH and thyroid antibodies if needed, and for diagnosis, be responsive to patient symptom evaluation, not just blood test results, and especially not TSH.
2. Be willing to prescribe treatment such as natural desiccated thyroid, T3-only medication (e.g. liothyronine, compounded T3), AND/OR combination methods of T3+T4 medication, as needed to relieve hypothyroid symptoms.
Good thyroid doctors are hard to find. You can try locally, by using the above and asking if the doctor is willing to do those 2 things. If unsuccessful, you may need to travel a bit to find one, that you need so badly. I am sending you a PM with info on some prospects that are in Corpus Christi. To access, just click on my name and then from your personal page click on messages.
Elle, with all those symptoms that are frequently related to hypothyroidism, plus the limited test data you have, I suggest that you get in to your doctor soon and request to be tested for the actual, biologically active thyroid hormones, Free T4 and Free T3. Don't take no for an answer. You should also request to be tested for cortisol and Reverse T3. You have already tested for B12 and ferritin, so you should also request to be tested for Vitamin D. I expect that you will find out that your Free T4 and Free T3 are in the lower part of their ranges, further indicating hypothyroidism.
A good thyroid doctor (does not need to be an Endo) will diagnose and treat clinically, by testing and adjusting your Free T4 and Free T3 levels as needed to relieve hypo symptoms. A good thyroid doctor is also willing to prescribe T3 type meds such as Armour Thyroid, NatureThroid and Cytomel. You should ask your doctor if he is willing to do both. If the doctor is resistant, then you will need to persuade him to give you a trial of thyroid med adequate to raise your Free T4 and Free T# levels and confirm that symptoms are improved. Otherwise you will need to find another doctor that will do these things for you.
To confirm what I have said and also to have info to give your doctor to persuade him, if necessary, please click on my name and then scroll down to my Journal and read the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
I went in to test for Hashimoto's thyroiditis when I strongly suspected I had this autoimmune diseases from my symptoms. TSH was in the mid 2's so right there was a problem! My TSH had been tested for decades and never was below 1.4 or above 1.6 mU/L. Both antibodies were high confirming the diagnosis. My mother and sister have Hashimoto's thyroiditis as well. I've HLADR/DQ gene testing and my genes for Hashimoto's thyroiditis are HLADR4 and DQB1*0301.
***
Hashimoto's thyroiditis...
"In Asians, HLA class I (A2, B16, B35, B46, B51, B54, C3) and HLA class II (DR2, DR9, DR53, DQ4) genes showed an association with the disease [31, 100, 101, 102, 103, 104, 105].
In Caucasians, HT is associated with HLA class II genes such as DR3, DR4, DR5, DQA1*0301, DQB1*0201 and DQB1*0301 [106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120] but not with the HLA-DP and HLA class I (HLA-A, HLA-B and HLA-C) genes [113, 114, 121]."*
*Immunogenetics of Hashimoto's thyroiditis -
J Autoimmune Dis. 2005; 2: 1.
PMID: 15762980
TSH is affected by so many variables that it is useful as a diagnostic only when at extreme levels. A TSH within range does not preclude hypothyroidism. Contrary to the common belief that hypothyroidism is just "inadequate thyroid hormone", in reality the correct definition is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone". Since there are no direct measures of TISSUE T3 EFFECT that can be used for diagnosis and treatment, indirect measures must be used instead. The best indirect measures start with an evaluation for symptoms that occur more frequently with hypothyroidism, supported by expanded testing. Tests should include Free T4 and Free T3 (not the same as Total T4 and Total T3), Reverse T3 and cortisol (at least at the start of testing), Vitamin D, B12 and ferritin. The need for these additional tests is due to their effect on the body's response to thyroid hormone.
So, before more discussion, please list all the symptoms you have currently.
Hi ElleHolloway,
I can't answer for sure if you are hypothyroid or not, but I was diagnosed with Hashimoto's with a TSH at 3.44 (range 0.45-4.5), with lots of hypothyroidism symptoms even though my TSH was considered "normal".
Even if your test range considers up to 5 normal, you are on the very high end of that range and there is some disagreement among the medical field as to whether to treat hypothyroidism at a TSH at 5 or at a lower number since the 95% of people with normal thyroid function will have a TSH below 2.5.
In order to analyze your free T4, we need to know the test range because ranges vary from lab to lab. If your freeT4 range is similar to my lab's, 0.8 to 1.1 would put you at below 50% of the range. Many people experience hypo symptoms if their freeT4 is below 50% of the range.
The fact that you are experiencing hypo symptoms, and your TSH is on the high end of normal, (and depending on your FT4 range - if you are on the low end that is also an indicator of a thyroid problem), I would say there is a good chance you have a hypothyroidism issue. Your doctor has probably referred you to an endocrinologist because your TSH is at the high end of normal (or above normal depending on your range). Your endocrinologist may want to start you out on a low dose of Synthroid (synthetic T4) and see if that helps with your symptoms and bring your thyroid hormone levels back to a "more normal" level.
Have you ever had the thyroid antibody test for Hashimoto's? Hashimoto's is a major cause of hypothyroidism in the US and other countries with iodized salt. If your endocrinologist does not order this test for you, I would push to have it done..
As for not being cold - I have gone from "subclinical hypothyroidism" to "full blown hypothyroidism" after having thyroid surgery, with my TSH going up to a peak around 16. I have experienced a lot of hypothyroidism symptoms while I was subclinical and onwards from that, but never constipation, and my PCP kept asking me if I had constipation problems since that is a major hypo symptom. I wouldn't worry that you don't have all the symptoms on the list.
Good luck with your appointment, and I hope you get the answers you are looking for and feel better soon.