# Input/Feedback Needed



## AFG034 (Apr 5, 2017)

Hello everyone, I'm new to the forum but wanted to take a moment to see if I could get some feedback on my current situation. I'm not sure if it's related to my thyroid or something else. Let me apologize in advance for the lengthy post.

Here's some brief history on me: I'm a 31 year old male and I've had thyroid disease since 2009. I was diagnosed with Hashimoto's Thyroiditis in 2015 and currently take 75mcg of Levothyroxine. I have Asthma and very small thyroid nodules.

All of these conditions I'm about to explain happened after I had hernia surgery in September 2016.

- Almost constant headache (they are almost gone finally). They were never severe but I saw two neurologists and had an MRI of my brain. Everything's good with my head but one doctor said it was a muscle strain or tension headache originating in my neck.

- Almost constant stiff neck. I've been seeing a physical therapist who has been able to minimize the pain, but I still have it daily.

- Slight muscle spasms in my arms and thighs. This happens completely random and usually when I'm relaxing or not doing anything.

- I've put on a little extra weight. I usually weigh 193lbs to 197lbs but I'm currently 203lbs. I monitor my eating but that doesn't seem to help. Exercise has been difficult since having hernia surgery, headaches and neck aches.

- Weakness feeling in my thighs. Nothing crazy about this, they just feel like they don't have the full strength they normally do.

- I haven't slept through the night since September and I'm always hot when I sleep. I have no problem falling asleep or falling back to sleep, but I make up a few times during the night to turn over or get too hot.

- I have swollen lymph nodes. I've had two sonograms of my neck and they both showed the lymph nodes to be completely normal and haven't changed in size from November to February.

- Slight discomfort in my neck right along the collar bone and below my adams apple. The discomfort isn't pain, it just feels...weird. That's the best way to describe it. It's like a dull throb.

So my dilemma is, is this being caused by my thyroid or something else?

Mind you, when I last saw my thyroid doctor in November of 2016 to discuss the headaches and blood work, they brushed off my concerns as not thyroid related and said everything is fine. I've since asked to have the do more blood work because I want to double check and have faced nothing but problems, which is why I have found a new doctor. The only problem is my appointment isn't until May 8th.

Any ideas?


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## joplin1975 (Jul 21, 2011)

It's possible it could be thyroid related.

When you post your history, it's always helpful to post your lab history. You might also want to post your u/s reports, too. 

Symptoms are helpful, but its really a guessing game without as much clinical feedback as possible.


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## AFG034 (Apr 5, 2017)

I will get those results asap. Right now I only have partial and want to get the full thing.


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## AFG034 (Apr 5, 2017)

Here is partial. For some reason it wouldn't let me upload the document. I will have full report shortly.

TSH = 2.84

FT4 = 1.57


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## joplin1975 (Jul 21, 2011)

Could you please include the reference ranges? Thanks in advance


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## AFG034 (Apr 5, 2017)

As requested:

TSH = 2.84 (0.270 - 4.20)

FT4 = 1.57 (0.80 - 1.70)

My apologies for missing information. I wish I had the full report in front of me, but like I said, my doctor isn't being very cooperative.


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## Lovlkn (Dec 20, 2009)

> TSH = 2.84 (0.270 - 4.20)
> 
> FT4 = 1.57 (0.80 - 1.70)


((1.25 1.475)) is your 1/2-3/4 range so your FT-4 is actually above range - strange considering your 2.84 TSH level.

Normally your TSH would be lower, especially with an above range FT-4, even since you are taking 75mcg Levothyroxine.

When in relation to your lab draw did you take your levothyroxine?



> - I have swollen lymph nodes. I've had two sonograms of my neck and they both showed the lymph nodes to be completely normal and haven't changed in size from November to February.
> 
> - Slight discomfort in my neck right along the collar bone and below my adams apple. The discomfort isn't pain, it just feels...weird. That's the best way to describe it. It's like a dull throb.


Do you mean ultrasounds of your thyroid gland?

I'm wondering if you are experiencing some over medication - side effects with an above range FT-4. If I get to 3/4 range I feel hyper and horrible. Muscle tightness is common for me if/when I become over medicated. Sleep is absent - chiropractic adjustments will not hold and are required more often due to muscle tension.

Knowing your FT-3 level wold be most helpful, although with an above range FT-4 you are likely creating reverse T-3.


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## AFG034 (Apr 5, 2017)

Lovlkn said:


> ((1.25 1.475)) is your 1/2-3/4 range so your FT-4 is actually above range - strange considering your 2.84 TSH level.
> 
> Normally your TSH would be lower, especially with an above range FT-4, even since you are taking 75mcg Levothyroxine.
> 
> ...


I take the levothyroxine every morning at 7:30am. I probably had the blood drawn at 9, 9:30am.

I've had an ultrasound of my thyroid gland (which showed no change in nodule size since my last ultrasound but showed swollen lymph nodes) than had a repeat ultrasound in February to recheck the lymph nodes (which also showed no change and look normal).

It's weird you say over medication, as I have been on this dosage for quite some time and most of these symptoms just recently occurred or maybe I just notice them more. If you're telling me it's strange to have a high FT4, why wouldn't my doctor think it's strange? Like I said, I am working on obtaining my blood work.


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## Lovlkn (Dec 20, 2009)

Taking your replacement medication 2 hours prior to lab draw will have an impact on the result - it is impossible to predict what that impact would be but likely an elevated FT-4 result.

Because your TSH is what it is - you actually look under medicated, however, your above range says over medicated.

If you have nodules - that could be the cause of your sudden change in symptoms.

As far as your doctor and their interpretation of your lab results - You are "in range" which is good enough for most doctors. however, when a patient is symptomatic than "in range" needs to be examined a bit closer. I mis spoke in my earlier comment - you are actually above 3/4 range but in range and being at or above 3/4 range occasionally causes hyper symptoms in patients.

The swelling in your lymph glands is concerning. How big are your nodules?


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## AFG034 (Apr 5, 2017)

This is for the lymph nodes:

Right:

Level 2 measuring 2.9 x 1.0 x 1.9 cm
Level 3 measuring 1.3 x 0.6 x 0.8 cm which may correspond with the right neck lymph node
on the prior thyroid ultrasound, not significantly changed

Left:
Level 2 measuring 2.4 x 0.8 x 1.5 cm

Additional lymph nodes are also noted.

Impression:

Scattered morphologically normal-appearing lymph nodes in the neck. Follow-up should be
obtained as clinically warranted.

Here's for the nodules:

The thyroid gland is not enlarged in size. The right thyroid lobe measures 4.6 x 1.6 x

1.6 cms. The left thyroid lobe measures 4.8 x 1.4 x 1.2 cms. The isthmus measure 0.3 cms
in AP dimension.

There is a diffusely heterogeneous appearance to the echotexture of the thyroid gland.
There is evidence of a hypoechoic solid midpole right thyroid nodule now noted measuring
0.6 x 0.3 x 0.4 cm. No discrete dominant left thyroid nodules are noted.

This is the most recent ultrasound of the nodules. The last time I had an ultrasound of the nodules was in 2009. The report says they did not grow in size from 09 to now.


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## AFG034 (Apr 5, 2017)

So I have my full blood work in a PDF format. Any ideas on how I can upload it?


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## Lovlkn (Dec 20, 2009)

Have your nodules been biopsied?

This is info Joplin1975 posted awhile back on nodule interpretation,



> When you look at nodules, red flags are: larger than 1cm, hypoechoic, hypervascular, and calcified.
> 
> When nodules turn completely or nearly completely solid, the chance of cancer increases. Also, if its larger than ~2cms, it usually starts to become problematic


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## AFG034 (Apr 5, 2017)

I have not had them biopsied. My thyroid doctor and regular doctor never saw any reason too.

Is this something I should press with my new doctor?


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## joplin1975 (Jul 21, 2011)

I do think your nodule is a bit concerning. The trouble you may run into is that they don't biopsy nodules (usually) unless they are 1cm or larger. It becomes too hard to "find" the nodule with the needle if its smaller than 1cm.

You should be getting regular, repeated ultrasounds, just to keep an eye on those nodules.

I believe if you click on "my media" and upload your PDF there, then you can share it.


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## AFG034 (Apr 5, 2017)

What makes the nodule a bit concerning, the size or the state it's in? I've had two ultrasounds on the nodules, one in 2009 and the other in 2016, both of which had the same exact result. I am going to another one this year per my request.

When I go to My Media it doesn't even let me search to add a document.


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## joplin1975 (Jul 21, 2011)

The fact that it is solid, hypoechoic (meaning the tissue is damaged and it doesn't reflect u/s waves normally) and singular.

Singular, solid nodules are more likely to be cancer than if you had a thyroid full of nodules. You are male and thyroid cancer tends to be more aggressive in men, so its a good idea to monitor it closely.


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## AFG034 (Apr 5, 2017)

Thank you!


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## AFG034 (Apr 5, 2017)

Just out of curiosity, is there a specific test or test that should be done to confirm Hashimoto's Thyroiditis?


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## joplin1975 (Jul 21, 2011)

There's a little bit of disagreement on that question.

The vast majority of doctors rely on testing TPO. I would say 95% of the time, it's pretty accurate.

But if you consult some thyroid management reference manuals, they said the gold standard is diagnosis by biopsy.


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