# New here with question about what to do next?



## melissafitz (May 5, 2013)

Hello everyone,

A few years ago, my doctor found that my thyroid was slightly enlarged and sent me for a biopsy. I was found to have benign thyroid nodules. A couple years later, biopsy again, nodules were larger, but still benign.

Last week, I went for another biopsy. The nodules are larger again, but still found to be benign. However, during the ultrasound for the biopsy, the comment was made that my thyroid looks like Hashimoto's. Of course, I go home and look it up, and many of the symptoms sound familiar . . . but the symptoms I have had are not consistent, and they could be other things. I've been attributing bouts of fatigue to "just being tired," being burned out with work; I've thought that panicky/anxious feelings have been stress; and I've attributed changes in my period to perimenopause. But, of course, now that the subject of Hashimoto's was raised, I feel I should get it checked out. When I spoke with my primary care physician, she was pretty dismissive. However, she did say she would check my thyroid hormones if I came in.

The thing is, I have been thinking of changing doctors for a while, and now I am thinking if I am going to have this checked out, I want a better doctor to do it. I basically have two directions I can go in, and am not sure which would be better. I have gotten a referral to someone who is supposed to be an excellent internist, who would do a very thorough physical. He does not take insurance, but I can see what my insurance would reimburse me. OR, since I have PPO insurance, I could just go straight to an endocrinologist. I am not sure what to do . . . . I am leaning toward the endocrinologist . . . does this sound like a good choice?

Thank you in advance for your help. This is all very new to me!


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## Andros (Aug 26, 2009)

melissafitz said:


> Hello everyone,
> 
> A few years ago, my doctor found that my thyroid was slightly enlarged and sent me for a biopsy. I was found to have benign thyroid nodules. A couple years later, biopsy again, nodules were larger, but still benign.
> 
> ...












Since you have PPO, perhaps you might go to the endo first. If pleased, that would be a good thing. If not, see the Internist.

Here are some suggested tests if you like................

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248

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

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

You can read about them and decide which ones you think apply to you.

Let us know.


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## CA-Lynn (Apr 29, 2010)

Go straight to the endocrinologist. ALL endocrinologists are internists, but few internists are board certified in endocrinology.


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## Octavia (Aug 1, 2011)

I'd be a little hesitant to go to the internist who doesn't take insurance. If you have insurance and he doesn't take it...well, I suspect you wouldn't see him over the long term, anyway.


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## jsgarden1 (Aug 29, 2009)

I'd vote on the endo bench


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## Lovlkn (Dec 20, 2009)

melissafitz said:


> Hello everyone,
> 
> A few years ago, my doctor found that my thyroid was slightly enlarged and sent me for a biopsy. I was found to have benign thyroid nodules. A couple years later, biopsy again, nodules were larger, but still benign.
> 
> ...


While you are being tested ask for B-12, Vit D and Ferritin testing which also all can contribute to fatigue


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## hashimotocoaster (Mar 22, 2013)

All the tests Andros listed would be good to have. Be especially sure to get your TPO antibodies tested--that'll tell pretty much beyond a doubt whether or not you have Hashimoto's. Good luck.


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## surge (Aug 15, 2012)

It's good to go to the endo when you're first diagnosed or when you have symptoms/suspicions of Hashis. The endo will probably order a comprehensive set of thyroid tests (all the ones Andros mentioned). Antibody testing is particularly important, and some of the ab tests are expensive, so it's nice to have it through insurance.

You still might want to switch docs if you're unhappy with your primary, just because you'll want allies along the way, and in my endo experience, they can be resistent to see symptoms as 'thyroid related'...you might still need a good primary doc who knows your system, and can help you troubleshoot/rule out other issues. But that choice can be separated out from the how-to-manage-thyroid issue for the moment, since you can go straight to an endo.


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## melissafitz (May 5, 2013)

Thanks, everyone, for your help. I have an appointment scheduled for an endocrinologist in a couple of weeks.


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