# How do you guys ever sort all this out????



## twinkie (Jun 1, 2010)

I'm new to this forum and don't understand a bit of all these test results, but I have the feeling I'm getting ready to learn.

About 18 months ago, my PC doctor discovered 2 nodules on my thyroid. I had an ultrasound which showed a 1.2 x 1.0 x 1.00 cm solid nodule and a 6 x 3 x 5 mm solid nodule. My PC doctor ordered a RAI which showed mildly decreased thyroid uptake. After 6 months, she ordered another ultrasound which showed the nodules still there. At that time, my PC decided to send me to an endocrinologist in Tulsa as we don't have one where I live. First off, she did blood tests. These are the results:

Free T4 1.0 (.7-1.9)
Free T3 2.43 (1.71-3.71)
TSH 3.23 (.35-5.0)
B12 555.3 (200-1100)
Anti-TPO .5 (.0-5.6) 
25-OH Vit D 23 (30-80)

Everything seemed okay execept the Vitamin D and she started me on Vitamin D supplements. One month later, I go back for a FNA which came back negative for malignant cells. Six months later (last week) she ordered another ultrasound which showed no change in the nodules. They were dxed as nontoxic uninodular goiter. I also had repeat bloodwork as follows:

Free T4 .9 (.7-1.9) 
Free T3 2.72 (1.71-3.72)
TSH 3.31 (.35-5.0)

At that time. she started me on 50 mcg of Synthroid. I have a strong family history of thyroid problems. (both grandmothers, Mom, Dad, sister, aunts, uncles and cousins). All were hypo except my dad who had a hurthle cell tumor/cyst that was benign 12 years ago, but we recently found has grown back. That was discovered during treatment for liver cancer. He has an appt. with docs at MD Anderson Cancer Center in Houston for that in a couple of weeks. Sorry for TMI. My point being, we have a strong history of thyroid disorders in our family.

I guess my question is why did my doctor start me on meds? I've not had a chance to ask her because the bloodwork was done after my last appt. with her and I got a letter with a prescription in the mail telling me to "take these". I don't see that my bloodwork shows anything out of whack...so why the meds??? She continues to question me about fatigue and that type of thing. I am fatigued, but compared to what? I'm 52 years old and I'm tired; nothing new. I have to take a nap after work before I can make dinner because I do good to make it in the door. I think I'm more fatigued than I want to admit. If you're over 50 you know what I mean.

So, I'd just like to know what some of you more knowledgable folks think of this situation. I've not had any time at all to research and appreciate any and all comments.

Blessings, 
Pam


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## chopper (Mar 4, 2007)

Hi Pam. Welcome!

Your doc did the right thing in my opinion. It's almost odd to find a doctor that in-tune with thyroid trouble.

Your T4, although in the normal range, is a bit low. Most people find they feel best around 1.2 - 1.5 - somewhere around there. Your Free T3 can also come up a hair and your TSH was bit high. I happen to agree with the doc's 50 mcg dose to start. That dose will probably be dead on but if you start to feel hyper, call him and let him know.

Hyper symptoms would include anxiety, heart palpitations, shakiness, hot feeling. One of the first symptoms of turning hyper are usually diarrhea and anxiety....so it's something to watch for but I think you'll feel even better once the meds kick in - lots of energy. If the 50's are too much initially, you can ask the doc to titrate up from .25 mcg then to .375 then to .50 so your body gets used to the meds over time but 50 is a good starting dose for a lot of folks. See how your numbers do when you retest in 4 to 6 weeks.


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## twinkie (Jun 1, 2010)

Is it unusual to go from hypo to hyper? I do have a repeat appointment in 8 weeks. In the past 10 years, my TSH has been all over the place and I remember at one point a doctor along the way said I would probably deal with thyroid disorder at some point. I never DREAMED thyroid disorders were so complicated!


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## Andros (Aug 26, 2009)

twinkie said:


> I'm new to this forum and don't understand a bit of all these test results, but I have the feeling I'm getting ready to learn.
> 
> About 18 months ago, my PC doctor discovered 2 nodules on my thyroid. I had an ultrasound which showed a 1.2 x 1.0 x 1.00 cm solid nodule and a 6 x 3 x 5 mm solid nodule. My PC doctor ordered a RAI which showed mildly decreased thyroid uptake. After 6 months, she ordered another ultrasound which showed the nodules still there. At that time, my PC decided to send me to an endocrinologist in Tulsa as we don't have one where I live. First off, she did blood tests. These are the results:
> 
> ...


Hey Pam and welcome. AACE recommends the range for TSH to be 0.3 - 3.0 and there is chatter here and internationally that the top of the range should be even less. Most of us feel best with TSH @ 1 or less. This is not true for everyone.

That said, she is probably going to give it a test run to see if you feel better. You do have a "smattering" of TPO (antimicrosomal antibodies) which is "suggestive" of autoimmune activity not necessarily thyroid.

Here are some tests that are helpful just for you to keep for reference and a link to look "stuff" up.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies),TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/understanding/conditions/thyroid.html

At the age of 52, you should be feeling tip top. It's not always about thyroid although your TSH "does" make me suspicious.

Getting a ferritin test would be good; that is the protein that stores your iron. You can look that up on the link.

Estrogen protects us females from a lot of things and as it starts to diminish in later life, we "do" find that what has been lying dormant (familial history?) rears it's ugly head.

I do believe you are in good hands w/this doctor.

Welcome to the board and please keep us informed. You are lucky she Rx'd Synthroid; most would not.

AACE guidlines.......... http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf


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