"normal" bloodwork but swollen thyroid and lots of HYPO symptoms.

[Texas5738]

I recently had some blood work done, because ive been feeling all together awful and no one can seem to figure out what is wrong. I'm constantly feeling tired, depressed, drained and all I want to do is sleep. I've gained a ton of weight, my thyroid gland is visibly swollen and entire face looks puffy, my muscles and joints are constantly aching, hair is becoming incredibly thin--even losing whole patches in a couple of spots, and my periods have gone from 28 days every month exactly, to anywhere between 27 and 35 days. I'm at a complete loss for what to do, and just looking for any answers I can get. These were the results from the thyroid portion of my recent blood work.

Tsh 1.710 ulU/mL
Thyroxine (T4) 6.5 ug/dL
T3 Uptake 25%
Free Thyroxine index 1.6

Any thoughts, suggestions, or help?

[Morning_Light]

First you need the right labs and diagnostics. The most important thing is to test your thyroid hormones by testing Free T3 and Free T4, and also your two antibodies. With your symptoms and the few and incomplete labs you've had, this looks like it might be Hashimoto's. A swollen thyroid is a goiter. A goiter is not normal. It means thyroid disease. After getting the correct thyroid labs, you'll also need to ultrasound your enlarged thyroid to make sure there is no cancer. Selenium or any other supplement won't fix this. If you are found to have Hashimoto's or you are hypothyroid, you'll be prescribed thyroid hormone replacement to address your symptoms and you'll feel much better.

The other thing is is that thyroid disease is not diagnosed on TSH. Your TSH is ideal, but the correct thyroid hormone labs are missing.  The way that thyroid disease is diagnosed is by complete thyroid labs. When I was diagnosed with Hashimoto's, my TSH was about the same as yours. My FT3 and FT4 were low, and one of the two antibodies was very high. I did not have a detectable goiter, but the doctor felt my thyroid and said it was enlarged. I had got a thyroid ultrasound that showed nodules. I had them biopsied and they are not cancerous.

[AJWS6]

Hi friend, sorry to read of all your thyroid difficulties, I can certainly relate.  I was feeling horrid, as my thyroid swelled with normal labs, unfortunately all test returned normal.  But, my thyroid continued to swell for 5 years, to the size of a softball.  I took my lab results, Xray, ultrasound, paid out of pocket, went out of town to Austin, to get a 2nd opinion, was told my thyroid needs to come out immediately.  

One of the reasons, I was feeling super exhausted, my thyroid was wrapping around my trachea, crushing it, which caused short of breath during sleep, next day I woke up exhausted.  

Low Vit D can cause severe muscle/joint aches, once I began Vit D, symptoms went away.  

But, as all shared have much testing as possible, and if you can, get a 2nd opinion pertaining to thyroid.  If your willing to travel, there are a few decent physicians/endo in central TX area.  Wishing you well.  

[Texas5738]

That's incredibly interesting...I did not even know that was possible.

I've actually had quite a bit of trouble breathing when I sleep, as well and frequently wake up gasping for air quickly and change positions. Also, I have started snoring terribly, and seems to be getting worse literally by the day. (I've never snored in my life other than when I'm extremely congested and sick) Unsure if those things are related, but seems like they could be.

I actually have an appointment today to get some more labs and a second opinion, hoping for the best--weather that be some sort of relief or even just answers at this point.

[jmbirds]

Take selenium supplement use cbc oil at health food store use turmeric n cucumin

[Texas5738]

Oddly enough, those are all things my husband and best friend have been preaching that I need to take. I sort of blew it off as "how would they know", but appears there is validity in their suggestions. ill

[gimel]

I just sent you a PM with info.  To access just click on your name and then from your personal page, click on messages.  

By the way, I agree with Red_Star that it would be good to test for TPO ab and TG ab, along with the others I listed.  Even though your TSH does not stand out as possible Hashi's, the fact that you mentioned a swollen thyroid is good reason for those tests.  Also Vitamin D, B12 and ferritin are very important due to their effect on the body's response to thyroid hormone.    So after testing you should supplement as needed to optimize.   D should be at least 50 ng/mL, B12 in the upper part of its range and ferritin should be at least 100.

[Red_Star]

Two YouTube videos to check out:

Four Ways To Diagnose Hypothyroidism - Dr Hotze's Health and Wellness Solutions

Hypothyroidism Type 2 - Myxedema Symptoms

[Red_Star]

Tests I requested when I suspected Hashimoto's thyroiditis: TSH, free T3, free T4, thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb). Results showed both antibodies high and my TSH had risen into the 2 range (not my normal). In my case TSH took 4 years to rise to 6.  No doctor would treat me until then. Smh.

[Jenn1302]

4 years? You're "lucky". My thyroid problems started 7+ years ago and my doctors are still refusing to treat me.

[Texas5738]

2014 was the first time I started suspecting a thyroid issue. And ive gotten absolutely nowhere with it since then.

[gimel]

Jenn, where are you located?  Perhaps we can suggest a good thyroid doctor for you.

[Jenn1302]

Thank you Gimel. I wish I could afford to see a good thyroid doctor. My insurance provides very limited options for PCPs and specialists. My doctors seem to be ignoring the fact that I have Hashimoto's and I can't even get a referral for an endocrinologist because my thyroid hormones are "normal" or in range. My only way to see a good endo is to pay out of pocket and I can't afford to do that :(. I'm open to doing a Skype/Face Time/Google Hangout consultation with an affordable doctor anywhere in the US or Canada if such a doctor exists and is able to put me on thyroid medication or convince my doctors to do that (Synthroid/Armour Thyroid/I'm willing to try anything at this point).  

[gimel]

Well, who knows you could get lucky and find a good thyroid doctor that does accept your insurance.   So where are you located?

[Jenn1302]

I can't even get a referral at this point so even if they took my insurance my insurance wouldn't pay for it.

[Texas5738]

I have an another appointment tomorrow, and have specifically requested what all of you have suggested as well as what ever other tests she deems may be necessary or helpful. I appreciate everyone's input, hopefully I will come back with some "good news" and/or answers -- fingers crossed.

[gimel]

You really need to start over and get the right tests done.  If your doctor is like most he will ignore symptoms and just look at TSH and say that it is in the so-called "normal" range and that you don't have a thyroid problem.  You need a good thyroid doctor.  By that I don't necessarily mean an Endo, just  a doctor that will evaluate mostly for symptoms of hypothyroidism and then run blood tests for Free T4 and Free T3 and the others, to confirm hypo symptoms.  With all your symptoms, I expect that you will find that your FT4 and FT3 levels are consistent with the following info from an excellent 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."

If you are interested I know of a good doctor in the Houston area that has been recommended by two other Forum members.  

[Texas5738]

Every nurse and doctor I've spoken with tells me they do believe I have a thyroid issue, yet seems no one is willing to do the right tests to properly diagnose and treat it. The first doctor I went to only tested for TSH no other thyroid hormones--said they TSH was normal but D was extremely low (recommended I take 10,000 IU's daily--not sure if that means anything to you or not), and B12 was also low but I cant think of the dosage that was recommended off the top of my head. The second gave me the aforementioned results. I would absolutely be interested in finding a good Doctor in the Houston area, at this point I feel I've exhausted my go-to resources, wasted time and money, and just need answers.

[gimel]

In trying to assess a person for the possibility of hypothyroidism most important  should always be an evaluation for symptoms that occur more frequently with hypothyroidism.   You have a number that are frequently related to hypothyroidism.  Next is evaluation of blood test results compared to reference ranges shown on the lab report.  Unfortunately in your case you don't really have any test results that are useful.   TSH is affected by so many things that it is useful as an indicator only when at extreme levels.   Your T4 test is for Total T4.  Most of the total T4 is bound to protein and thus rendered inactive.  Only the very small portion not bound is biologically active.  That small portion is called Free T4.  The same goes for T3.  For that reason you should always make sure they test for both Free T4 and Free T3 every time you go in for tests.  T3 Uptake and FT Index are outdated and not very revealing.    If your doctor ordered those tests then I suspect that the doctor is not up to date on thyroid diagnosis.  

If possible I suggest that you go back and get tested for Free T4, Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin.  All are very important to help diagnose a possible hypothyroids patient.  Do you think you can get those done?  If you want to confirm what I have suggested, click on my name and then scroll down to my Journal and read at least the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

[Texas5738]

That is kind of what I was expecting to hear, and slightly my fault. Unfortunately, my commute to work is pretty long and don't have many opportunities to leave early. By the time I can get to my Doctor they are closed, so I just went in to a clinic. I was hoping it would be an easy diagnosis and could just take those results to my regular doctor, but now it just seems like wasted money and time. Do you think there would even be a point in showing these results to my doctor? Or should I just start from square one?