Ok Nonstick Pam and other Thyroid Guru's...

[Lisa Rae]

Results are in...Looks normal right?


Component Your Value Standard Range Flag

TSH 1.31 0.4-4.00 uIU/mL

T4 FREE 1.01 0.70-1.48 ng/dL

T3 81 58-159 ng/dL

Not sure if she ran other tests...as they don't always come in at the same time..and the tech said 48 hours ( I just went in yesterday for the draw) Still...unless I'm really really really bad at math ( had to add the extra "really" as I am bad at math) I did not find out what is causing my symptoms.

The only interesting thing I did see..is that they have done the TSH 3 times in the last 2 years ( first one is about 2 weeks after I quit smoking) and it has continued to decline ( very little..but decline) Have no idea what that means..since it's still within the normal range..but figured I might as well post this as well.


Name 11/1/06 6/14/08 7/12/08
TSH 1.74 1.46 1.31

Back to the drawing board!!!!!

[JuliaL]

I'm certainly not a thyroid guru but I am hypothyroid, and I know that the lower the TSH the better. Pam will tell you that TSH is really not the best way to tell if you're hypo or not, I know, but my endo looks for TSH to be lower on medication. Mine was 3.84 when I started meds and it's 1.80 now.

[Buffy45]

According to one endocrinologist I went to, too low of tsh is not good either and can cause symptoms, it is really a hard balancing act to get it just right and you have to go by symptoms as well as blood tests. That is where is it good to get a dr. who will listen to you and not just go by blood tests, I recently changed drs. b/c of that.

[Magicsmom]

Buffy, that is so true! I have a TSH so low it's scary, but my doctor is cool with it because I feel good at this level. Boo hiss on doctors who go only by TSH and not symptoms.

[CrzyCatLady]

Pam's going to ask where's the FT3? and didn't they run TPO? TPO checks antibodies.

[Lisa Rae]

CrzyCatLady,

This is the list of what Pam said to start with:
TSH (but you dont' go by that, it's usually just looked at).
Free T4
Free T3 (NOT a 'T3 Uptake'...specifically ask for FREE T3 and mention you don't want to pay for a FT1 OR a T3 Uptake..I've made doctors pay for that if they order it before!)
TPO (thyroid peroxidase antibodies)...to see if you have Hashimoto's
progesterone
estradiol

That is the list I requested with my doctor, who gave me the green light. I get notified whenever a test comes back..so more may follow.

This is the one that just came in since my first post:

*PROGESTERONE 0.62 - ng/mL *

There was no normal range given. When I tried to google for a normal range..it was so confussing..and depended on the site I went too!

Probably TMI, but I don't want to hold back on anything important..so..just finished Tom Yesterday

I'll keep posting as I get more results

Thanks!!

[CurlsNCuffs]

Hi Lisa Rae,

I think you will have to contact the lab or your Doc to get the ranges they are all different...don't worry Pam will be in soon to straighten it all out ....she is the expert in this....she has certainly helped me...

[MaddieJ]

Pam is over on the medical board a lot. Maybe post this over there and she will see it faster.

[Lisa Rae]

Thanks!

I could send it to her pm..but so many were nice enough to be apart of this..I wanted to make sure everyone was involved..

Maybe I'll just post over there...the link to this one

[nonstickpam107]

Although the TSH isn't over the top (and mine wasn't either), the FT's are too low. You do, indeed, need a TPO antibodies at this time. Also, be on lookout for an iron and ferritin test to come back. That is NOT a Free T3. It is just a total T3. But it's SO low that the FT3 may be even lower, under range. That's not good. If your doctor had that low of thyroid hormones, he/she's be crawling around, not walking. LOL (sorry, mental image).

Pam

[Lisa Rae]

Thanks Pam!

I just sent her another message asking about the other tests that I had requested. Not sure if she requested them and they have not come back yet..or she didn't bother. The Lab tech did say 48 hours..and that would be today around 10..so I'm thinking she may have no requested all I asked for. I will continue to read and push..and of course keep you all posted.

It's hard having a hospital plan. I have had some great care in the past..but I also know when they run tests..unless the test is flagged as low or high..it is very hard to get more testing or meds.

I'll keep you all posted. Thanks, as always, for the support!

[Lisa Rae]

Last post...

Component Your Value Standard Range Flag
TPO AB <60 - U/mL

I'm exhausteed..frustrated...depressed..and honestly..DONE!

I appreaciate all the kind posts..was hopeing for a better outcome..

[nonstickpam107]

The TPO with no range?? Is that your value, or the 'range?

Pam

[Lisa Rae]

Originally Posted by nonstickpam107

The TPO with no range?? Is that your value, or the 'range?

Pam

Sorry Pam, forgot to address this when I sent you the info. In all my other labs..you can hit " About this test" and it will give you a range. For some reason..I can't with that one. I will ask my doctor when she is back in town ( thursday)

I also got back my estradiol and is it scary low. 12.3! ( normal range for woman before menapause is 30-60) under 30 is concidered menapause levels..and I've just started pre-menapause!)

I'm going to keep plugging along..and try and decide what to do. The thought of switching doctors is posslble..but scary. I've had this one for 10 years..and she is always very generous with her time and questions. She also will run almost any lab I ask for...just have to decide if another one would be better. Maybe request a seperate gyno? since a lot of this seems to be hormones?

Again..this is me --->

[AllieCat0817]

I dont know if anyone has addressed this yet or not with you... but if you need female hormone supplementation, hopefully your dr will prescribe BHRT (bio-identical hormone replacement therapy) instead of synthetics.... or you can find one that will.

[nonstickpam107]

I know what!! Lisa...call the pharmacies around you. Ask each one if they compound bio identical HRT. If they do, ask to speak to the compounding pharmacist. Many of these places test and treat on site! And even if they don't, they can tell your doctor which hormones to Rx. for and how to do that.

Pam

[AllieCat0817]

I want to be tested for a female hormone panel... I called my local compounding pharmacy (which thank God takes my insurance!) and they gave me the name of a dr who prescribes BHRT!! My appt is July 25.

[Lisa Rae]

thanks Pam and Allie,

Unfortunately my plan does not believe in HR of any kind. The only way you can get a prescription for it is in cases of early menopause like hysterectomy (sp?) I was not even really supposed to be able to get the progesterone and est. blood tests done but my doctor bundled it for me to get it through without me having to pay for it.

I haven't had a chance to go over all the results with her yet. she will be back Thursday, and I will try and get an appointment vs. continuing to do this via e-mail. I appreciate all the help and info..and will continue to read so I sound like I know what I'm saying when I see her (LOL)

P.S.There is a homeopathic apothecary on the street where I work..I will try and swing by and see if anyone there is helpful

Thanks again..you girl have really helped keep me and McDonalds enemies

[Butterflyk]

For Pam, can nodules cause thyroid symptoms? I always have this feeling that something is stuck in my throat, especially when I am eating (feels like food sticks there). Also can never wear anything around my neck always feels like choking feeling. Is it true that the nodules or goiter may also not be noticeable? I have tried looking into a mirror while swallowing but its hard to see. When I feel the front of my throat there is a small bump and the left side seems slightly larger than the right side. And for arguement sake - do women have adams apples like men - only smaller? There seems to be so much contraversial information around this. Thanks.

[Butterflyk]

Hi again, sorry for the extra post. For the past month my weight has gone no where. I usually weigh about 143 and feel good at that weight, I went up to 173 and of course felt terrible - it has come down to 162 but is just stuck there -every other time my weight would go up, it came down when I started to feel better - this time the recovery swing back is much slower and no matter what I do the weight isn't coming back off this time. I don't even have an apetite (have to remind myself to eat or blood sugars get too low and then hypo-g symptoms add to existing problem). I managed to find a natural path/MD dr near my city - but can't get into see him until early September and that took alot of begging and pleading. He is suppose to be very good with hormone balancing the natural way and listens to his patients. Is there anything I can do in the meantime ie: tests, diet etc. I took that Metabolic Typing Test and it came back that I was Parasympathetic Dominant - they gave me a list of foods with do's and don'ts on it. Am trying that for now. Again thanks for any help you can offer.

[AllieCat0817]

Yes having a goiter / nodule is a thyroid problem and can cause symptoms. I had a goiter with multiple nodules. Mine was diagnosed with a ct scan of my neck, and then a fine needle aspiration (biopsy) of my thyroid and finally removal of most of my thyroid.
Cancer was found in the thyroid. You should call your dr.

[AllieCat0817]

Thyroid Nodules, Lumps, Enlarged Thyroid, Goiter / Thyroid Disease Information Source - Articles/FAQs

If your doctor has diagnosed you as having a thyroid nodule, a thyroid lump or an enlargement of the thyroid known as goiter, you'll want to know more about the diagnosis and treatment process, the relationship between nodules to thyroid cancer, and followup.

What is a Thyroid Nodule?

Thyroid nodules are very common. A nodule is a swelling or lump, which can be a solid or liquid filled cyst or mass. Most are benign, but a small percentage can be cancerous. So you should always have a nodule evaluated by your physician as soon as you notice it.

Symptoms of a nodule can be varied. Some people have hyperthyroidism symptoms -- such as palpitations, insomnia, weight loss, anxiety, and tremors -- and others have hypothyroidism symptoms -- weight gain, fatigue, depression. Some will cycle back and forth between hyperthyroid and hypothyroid symptoms. Some people mainly have difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness. And finally, many people have nodules wiht no obvious symptoms related to thyroid dysfunction at all.

If you have a thyroid nodule, don't be very worried that it is cancerous. Only 5% of nodules are cancerous, and most forms of thyroid cancers are highly treatable and curable.

Thyroid Nodule Statistics

An estimated one in 12 to 15 women and one in 50 men has a thyroid nodule
More than 90 percent of all thyroid nodules are not cancerous



Evaluating a Nodule By Blood Test

Typically, the first step when a nodule is discovered is for the doctor to conduct a blood test to evaluate your thyroid hormone levels. The results are usually normal, because thyroid nodules do not typically produce thyroid hormone.

Occasionally, nodules will produce thyroid hormone, and cause hyperthyroidism. Nodules can also develop in patients who have an existing thyroid condition. This frequently occurs with people who have Hashimoto's Disease, the autoimmune thyroid condition that can cause hypothyroidism.

A rare form of thyroid cancer is medullary cancer, which can sometimes be detected by a blood test to measure calcitonin levels. Medullary thyroid is known to have hereditary factors, so calcitonin tests are recommended for those who have family members with medullary cancer.

Evaluating a Nodule By Thyroid Scans

Commonly, in addition to a blood test, a thyroid scan will also be conducted to evaluate the nodule. In a thyroid scan, you'll receive a small amount of radioactive iodine that is absorbed by your thyroid. An image of the thyroid taken is then taken, and can show a picture of the distribution of the radioactive material in your thyroid gland. Thyroid nodules may some iodine ("warm nodules"), show more activity ("hot" nodules), or take up little iodine and show decreased acitvity ("cold" nodules). Warm and hot nodules are rarely cancerous. Even among cold nodules, only a small percentage are cancerous, but these types of nodules typically require further evaluation.

Evaluating a Nodule By Ultrasound Test

A next step can be an ultrasound of the thyroid. This test can determine the nature of the cold nodule -- solid versus fluid-filled. Ultrasounds are being used less frequently, however, because most doctors evaluating a cold nodule prefer to evaluate both the type of nodule, and test the cells for cancer at the same time, a process than can be accomplished by a test known as "Fine Needle Aspiration," (FNA) or a needle biopsy.

Evaluating a Nodule By Needle Aspiration / Needle Biopsy.

In needle aspiration or needle biopsy a local anesthetic is usually used to help minimize any pain. You'll mainly feel just pressure or a pinching feeling as a needle is inserted into the thyroid in order to withdraw cells for testing. Typically, in what's known as a fine needle aspiration (FNA), several samples will be taken from the nodule in order to make sure various parts are evaluated. The sample taken from the thyroid will be evaluated by a pathologist. Typically, the findings will indicate that your nodule is:

Benign. This means your nodule is not cancerous. Approximately 70% of nodules will come back benign.
Malignant. This means your nodule is cancerous. Approximately 5 % of suspicious nodules will be malignant.
Suspicious. This means diagnosis wasn't conclusive, but there was possible cancer.
Inconclusive. If the sampling wasn't sufficient, a diagnosis might be difficult. In this case, an additional biopsy might be recommended.
For an in-depth discussion of the fine needle aspiration process, see my article, Fine Needle Aspiration Biopsy of the Thyroid -- Questions & Answers.

Thyroid Nodule Treatments

Typically, for a benign nodule, the treatment is to prescribe thyroid hormone, which can usually shrink the nodule, or prevent it from growing. If the nodule continues to grow, your doctor may biopsy it again, or recommend surgical removal.

Most doctors will recommend surgical removal of a malignant nodule. While in surgery, the thyroid cells can be evaluated, and a decision to remove the lobe of the thyroid -- or the entire gland -- can be made based on the results. Based on the diagnosis, thyroid cancer treatment can then be pursued.

In the case of an inconclusive nodule, if a repeat biopsy is not possible, or if the doctor is suspicious of the nodule, some doctors will recommend surgical removal and evaluation. The majority of these nodules are also benign.

Goiters

What is a Goiter?

A goiter is an enlargement of the thyroid, and is sometimes used as a term to refer to an enlarged thyroid. The thyroid becomes large enough so that it can be seen as enlarged on ultrasounds or x- rays, and may be enlarged enough to enlarge the neck area visibly.

What are the Symptoms of a Goiter?

Some goiters can be tender to the touch. An enlarged thyroid can also press on your windpipe or your esophagus, which may make you cough, have a hoarse voice, feel shortness of breath, feel like you don't want to wear turtlenecks or neckties, feel fullness in your neck, experience choking or shortness of breath at night, or feel like food is getting stuck in your throat.

Causes of Goiter

In areas outside the U.S., particularly parts of Asia and Africa, iodine deficiency is a key cause of goiter. But in the U.S. and many other industrialized nations, the use of iodized salt and processed foods has eliminated that problem for all but about 10-20% of the population.

In the U.S., goiter is more commonly caused by autoimmune thyroid problems that cause an inflammatory reaction in the thyroid.

Doctors will typically treat a smaller goiter with thyroid hormone replacement drugs. This can slow down or stop the growth of the goiter, but doesn't typically shrink the goiter.

If the goiter continues to grow while on thyroid hormone, or symptoms continue, or the goiter is cosmetically unsightly, most doctors will recommend surgery. If the goiter contains any suspicious nodules, that may also be reason for surgery.

[Butterflyk]

Hi Alleycat, thanks so much for all the information - the doctor did do the thyroid hormone tests they came back as follows:

TSH 0.6 range 0.5 - 3.0
fT4 1.3 range 0.7 - 2.5
fT3 2.6 range 2.5 - 6.5 (said fT3 was not within optimal range?)
TPO 43 range 0 - 150 (boarderline 70 to 150)?

Given what you wrote above, it would appear as though my tests are within the normal range, except for the fT3 which I still don't understand. So nodules are possible as is perhaps the start of a goiter.

Again many thanks. Anything extra you could tell me would be great.

Not sure about the needle test or the radioactive test - they sound terrible - are they?

[AllieCat0817]

It is my understanding that you want your Free T3 in the upper range of normal (Pam always says 3/4 of the upper range. Free T4 should be mid-range.

Have you spoken to your dr about the results? That would definitely be the next step. My dr first felt my neck and said yes my thyroid seemed enlarged. Then he did a ct scan on my thyroid to see what was what, that is how he knew they it was a multinodular goiter. AFter he did the ct scan, he then ordered the fine needle aspiration biopsy. While it wasn't fun, it wasn't the most horrible thing either.

Even though the biopsy came back normal (because they only biopsy one small spot-- no way to catch all of it), because of the size of my goiter he removed 3/4 of my thyroid. During the surgery they sent what they removed to pathology and pathology inspected it while I was still opened up and knocked out. They determined no cancer, so they left 1/4 of the thyroid in there and closed me up.

After the surgery, they further dissected the entire thyroid that they removed and it wasn't until then that cancer was detected.

I was then put on Synthroid (a synthetic T4 med) (cant remember starting dose) but I was retested frequently. At that time I didn't understand anything about thyroid hormones so I went with my dr's word. I kept getting Synthroid increases. AT that time I was around 213. 7 months after my surgery I started Atkins and was able to lose all my weight fairly easily on my Synthroid dosage.

Last summer I had the PROPER tests after deciding to educate myself. It was found that my FreeT numbers were lower than I wanted so I requested the addition of Cytomel, a synthetic T3 hormone. I have been doing ok but not great.

After doing more research on thyroid hormone replacement, within the past few weeks I requested to be switched from synthetic thyroid hormones to natural dessicated pig thyroid (known as Armour or Westhroid). I take Westhroid now. Some people do way better on the natural hormone therapy and I wanted to try it.

I now know that since I had thyroid cancer, I want my TSH # suppressed very low, my Free T4 mid-range and my Free T3 upper-range.

[Butterflyk]

Hello again. The dr said that while my fT3 was not within the optimal range that it was still within the normal range with all the other tests so he saw no need to prescribe anything. He is an MD. I asked about seeing an endo dr and he said it wasn't necessary at this time to make such a referral.

All I know is that I haven't felt well in a long time and my weight goes like a yo-yo - I either lose alot quickly or gain alot quickly and yet I eat all the same foods in the same amounts.

The dr said the thyroid probably has nothing to do with my up and down weight and more do with how much activity I am doing. Truth is, either way I am sitting behind a computer all day - so the exercise level is the same (except when I am really unwell and have zero energy).

There is certainly alot to be learned here. I truly can't believe all you have been through, but your story has certainly inspired me to be even more insistent upon getting more tests done. Thank you so much. Will let you know how it goes.

[AllieCat0817]

Originally Posted by Butterflyk

Hello again. The dr said that while my fT3 was not within the optimal range that it was still within the normal range with all the other tests so he saw no need to prescribe anything.

Yeah other than the fact that you WANT it in optimal range, not just normal. And on top of that its on the LOW end of normal. AND on top of that, YOU DON'T FEEL WELL. No way.

He is an MD. I asked about seeing an endo dr and he said it wasn't necessary at this time to make such a referral.

All I know is that I haven't felt well in a long time and my weight goes like a yo-yo - I either lose alot quickly or gain alot quickly and yet I eat all the same foods in the same amounts.

The dr said the thyroid probably has nothing to do with my up and down weight and more do with how much activity I am doing. Truth is, either way I am sitting behind a computer all day - so the exercise level is the same (except when I am really unwell and have zero energy).

His response is typical of apparently what most doctors think. You may want to send a PM to nonstickpam107 and ask her about possible dr's in your area that know how to treat thyroid properly....but like she would say, be willing to drive a coupla hours one way out of your way to go to one. IMO it is worth it, especially since you don't feel well.

[Butterflyk]

Hi Alleycat, thanks again for the encouragement, because you are so very right, most MD's don't care and the fact is that my fT3 is not within optimal range and neither am I so I am not going to settle for this opinion. It just gets so discouraging at times, but I am sure I don't have to tell you that. Can you tell me how to PM? I am very new to all this. I am going to persist in finding the right dr - can you tell me what is the best kind to look for - should it be an endo? Again many thanks.

[AllieCat0817]

Hi Butterfly,
I think you have to be a member for a while before you can PM (sorry I forgot about that).

But read these links..
Canada Top Doctors -- Best Thyroid Doctors in the World as Nominated by Patients, from Mary Shomon

Find The Top Thyroid Doctors, Learning From and Dealing With Doctors for Your Thyroid Treatment

Perhaps there is a Yahoo Thyroid group for Canada..where you can join to find out more about Canadian thyroid drs..

[Butterflyk]

Hello again, and many more thanks. I will definitely check out the links you suggested, had no idea that there was even such a thing. Have a great day and many blessings to you for all your kindness.

[AllieCat0817]

Just trying to pay it forward! Because many here, including Pam and Inatic, have helped me ALOT and pointed me in the direction of where to find the info.