Thyroid Blood Test Results and Questions

[msdanicat]

Hi Group,
Sorry for the long post. I've struggled with fatigue, joint pain, etc, almost my whole life and have sort of just chalked it up to depression and laziness.I spent many many weekends laying in bed as if I'm in a coma and then I feel guilty because I have accomplished nothing.  My life is a mess, house messy, can't concentrate (I can't multitask at work and was starting to suspect ADHD).  

I have had my thyroid tested before, about 10 years ago, at the request of my doctor after I complained of neck pain which no amount of physical therapy could alleviate. The blood results are long gone, but the ultrasound showed two 4-5mm hypoechoic nodules on the thyroid isthmus and recommended regular follow-up which I never did due to loss of health insurance.  My doctor at the time never said anything about hypothyroid, though looking back I am certain the symptoms were there.

Recently, the fatique feels worse and my hair is thinning, which freaks me out. My quality of life is in the toilet and I can barely drag myself out of bed for work. New doctor requested bloodwork, results below, and an ultrasound (results not back yet).

I go back this week to discuss the blood work and ultrasound, I feel like I don't know enough to ask the right questions or request the right treatment (if any). I would appreciate your thoughts.  It sounds awful to say, but I am hoping something is wrong so I can finally be well. And I am also angry at myself and my doctors because I suspect I've had thryoid issues for most of my adult life.

TSH: 1.41    Range 0.40-4.50 mIU/L
T4, Free: 1.0    Range 0.8-1.8 ng/dL
Thyroid Peroxidase Antibodies:  27     Range <9/IU/mL
Vitamin D, 25-OH Total: 9   Range 30-100 ng/mL

I dont know how Vitamin D fits in...

Thanks in advance for your help.

[msdanicat]

Forgot to mention this, the endo ordered 50,000 IU of D2 which I have to take on a weekly basis for 90 days.  Started this past Sunday.    

Hi Guppy,
Endo put me on 50,000IU of D2 taken once weekly. My question is why D2?  She questioned my food intake (dairy, fish) which makes me think I should be on D3, not D2. Thoughts?

Results were:
25OH D3 =  9 (no reference range estalished)
25OH D2 = <4 (no reference range established)

They were rolled up into a total of 9 and both doctors deemed it deficient.

Thanks for your feedback.  

[msdanicat]

Hi Everyone,

Just wanted to give an update.  I am feeling very good about my new PCP. I was quite nervous when I walked in so I forgot half the reason I was there (another reason to write things down!) but she was very intuitive and thorough and ordered quite a few tests to rule out other issues given an extensive family medical history of auto-immune disorders.

I didn't get the feeling she agreed with my endo based on my bloodwork results and symptoms, however, I really appreciated the way she handled everything -- putting me at ease without bad mouthing or second guessing anyone.  

I have an appoointment to have blood drawn on the 17th for the following:

Endo Ordered:
TSH
FT4
FT3
Cortisol
ACTH

PCP Ordered:
Complete Blood Count w/Platelet
Comprehensive Metabolic Panel
C-Reactive Protein
ESR/Sed Rate
HgbA1c
B12
Ferritin
Iron and TIBC
Lipid Panel with LDL
Rheumatoid Factor (my grandmother had a very severe case of RA that left her an invalid at 40ish).

I feel very validated, it's like someone finally believes me and I'm not just lazy or depressed. I sure hope we can find out what is wrong. I still suspect thyroid issues, but my mother and maternal cousin both have Lupus so the doctor wants to rule it out.

Thanks for all your input. I'll update you when my blood test results come back and again when I have my followup appointments with both doctors.

[Red_Star]

Although she wasn't offered medication which was why she was so upset. The doctors more than happy to give out anti depressants etc. but thyroid medication. *gasp*

[Red_Star]

The same thing happened to my mother just today. And yes she was upset as well. The pain from the fluid in her legs (hypo symptom!) are so bad she'll be in a wheelchair soon!  And she had her labs done in the afternoon which is why her TSH was lower in the "normal" range.  She ordered more labs and will fast overnight and do them between 7 and 9 am. Quite ridiculous frankly that a number means more than a patient's symptoms.

[gimel]

You really need a good thyroid doctor that will treat clinically, by testing and adjusting free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Since you are meeting with a PCP tomorrow, I'd suggest that you plan on relating all about your symptoms, and that they are often related to being hypothyroid, and that you haven't yet been tested for Free T3, but your Free T4 was much too low in the range, and that you would like to have a therapeutic trial of thyroid meds to evaluate the effect on your symptoms.    Giving the doctor a copy of this link might also help.

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

If the PCP wants to run tests also, your symptoms also suggest that it would be a good idea to test for Vitamin B12 and ferritin, along with the D that you previously confirmed as way low.  I would also inquire if the PCP will be willing to treat clinically as described.  If not, then you will need to find a good thyroid doctor that will do so.  We may be able to help with that if you want.

[msdanicat]

Update: Just back from the doctor.  I have been crying. I feel upset, because she was insistent that I did not need Thryoid meds based on those numbers. I asked why my hair is falling out, why I sit in a coma all weeked, why why why...and she had no answers. She said we could try a low dose of meds but strongly, strongly suggested against it and made me feel like a freaking doctor shopper.  It's not like I was asking for narcotics for goodness sake.

And since I feel the need to defend myself, I haven't seen a doctor in nearly 10 years except for two walk-in clinic visits for bronchitis and an eye infection...

Anyway, she prescibed a prescription dose of Vitamin D.  More blood tests:

Free T3 (only because I asked)
TSH
Free T4
Cortisol



I have my first appointment with a PCP tomorrow for a physical and will be asking for a CBC, I assume I should also discuss this with her?  

Not a lot changed on the ultrasound, nodules have grown slightly not they didnt seem alarmed. They are still subcentimeter. Thyroid measured slightly smaller than the one from 10 years ago which she attributed to different machines.  

Thoughts?