# Hypothyroidism?



## CMaso (Jul 5, 2013)

Hello all - I found this message board after I googled "goiter choking feeling".

My story's a long one, so summing it up - for a long time I've experienced throat symptoms - difficulty swallowing, hoarseness, and throat tightness/choking feeling, now and then. In addition, I've had certain hypothyroid symptoms - intermittent anxiety/depression, memory loss, difficulty concentrating at times, need to sleep a lot, and low energy (usually in the morning). What strikes me most - all of these things, physical and psychological - started up at the same time.

Recently a doctor felt a node on my thyroid. I've been on meds for depression for a couple years, and the throat symptoms have baffled multiple ENT docs. So now I'm investigating to see if hypothyroidism is the root cause of all of it. Blood tests have come back normal, ultrasound has shown a benign node. But my understanding is that a lot of hypothyroidism gets missed; the blood tests alone don't always reveal it. I'm currently seeing 2 docs here in NYC who are known for catching thyroid problems that other doctors miss.

I'm writing here because I've been researching thyroid problems and I have a few questions. I've heard about a "TRH" test, and that it can detect hypothyroidism even when it's missed by the routine blood tests (TSH, T4, T3). Does anyone know about this? Also, recently an endocrinologist said I might have something called "Hashimoto's", but it's "nothing to worry about". After researching what Hashi's is, and the problems that resulting hypothyroidism can cause, I was stunned that he would be so dismissive. I've read that since endocrinologists deal with very serious conditions like diabetes and thyroid cancer and such, that a lot of them don't want to bother with Hashi's. Has this been anyone else's experience?

Thanks much! Hoping I've finally discovered a root cause of my problems, and that they can be successfully treated.


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## Andros (Aug 26, 2009)

CMaso said:


> Hello all - I found this message board after I googled "goiter choking feeling".
> 
> My story's a long one, so summing it up - for a long time I've experienced throat symptoms - difficulty swallowing, hoarseness, and throat tightness/choking feeling, now and then. In addition, I've had certain hypothyroid symptoms - intermittent anxiety/depression, memory loss, difficulty concentrating at times, need to sleep a lot, and low energy (usually in the morning). What strikes me most - all of these things, physical and psychological - started up at the same time.
> 
> ...


I have heard of this test....http://en.wikipedia.org/wiki/TRH_stimulation_test

But, I believe there are better tests now.


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## Lovlkn (Dec 20, 2009)

> Blood tests have come back normal


Can you please post some of those "normal" labs with ranges please?


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## CMaso (Jul 5, 2013)

Post lab results - Yes, I will, as soon as they get them to me.

I saw one doc here in NYC who known to specialize in thyroid problems - he took a look at my results, and immediately prescribed my liothyronine. (He also felt I had low testosterone and prescribed me testosterone cream, but after researching it, a couple days later I decided the danger of exposure to my wife and pets was too high, so I'm not using it.) Which brings up another question -- do thyroid problems cause low T, or the reverse? Or do neither affect really the other?

In any case, my follow up visit isn't until August 20, and they can't see me any sooner. I don't want to wait that long, so in the meantime I'm seeing another doctor on Thursday July 11th who also specializes in thyroid problems, for a second opinion and for more timely treatment.

This particular doc likes to use the TRH stimulation test - which though old is the most accurate test for detecting thyroid problems, he feels.


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## hrsweet75 (May 1, 2013)

For a couple years I suspected I had thyroid problems as well. My symptoms were what you described as well as; many new allergies including food allergies, constant body pain, joint pain, problems moving around, and more. Not sure what blood test was done but initially my doctor told me I was fine. He tried me on mobic for pain, which did help some, but only with my back pain. I then went to a new doctor who did another blood test, among the tests done, they checked my; TSH, free T3, see rate...all of these were abnormal. My TSH was 41x higher than normal, and my free T3 was 8x lower than normal. I'm scheduled to see a specialist at the Cleveland Clinic at the end of the month. What i have noticed is I seem to do great for about 3 weeks and then level off. Right now I'm back to being fatigued, hurting, in constant pain, and allergies are just oddly spar odic.

Good luck!


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## CMaso (Jul 5, 2013)

Lovlkn said:


> Can you please post some of those "normal" labs with ranges please?


Okay, here they are. The range in brackets indicates the "normal" (reference) range:

FSH: 5.8 [1.6-9.7] mIU/mL
LH: 3.1 [1.2-11.00] mIU/mL
Prolactin: 7.5 [5.0-18.0] ng/mL
T3: 0.98 [0.8-1.7] ng/mL
T4: 5.6 [4.8-11.0] mcg/dL
TSH, 3rd generation: 1.19 [0.4-4.0] mIU/L

Thyroid Peroxidase (TPO): Ab H 14.3 [0.0-5.5] IU/mL

Right off the bat, I see the TPO antibodies are out of the normal range. These were the "slightly elevated" levels of antibodies that the endo saw. I'm wondering how strongly this suggests Hashi's. The rest, though apparently in their "normal" ranges, strike me as low, except for the FSH.

The same set of tests included testosterone, which is low (note that I'm 46). I'm not clear on the relationship between testosterone and thyroid; which affects which, or if they both affect each other, or if neither affect each other:

Total T: 406 [300-890] ng/dL
Sex Hormone Binding Globulin: 36 [11-80] nmol/L
Bioavailable T: 196 [131-682] ng/dL
Free T: 73 [47-244] pg/mL
% Free T: 1.8 [1.6-2.9] %

The doc I saw most recently prescribed me T gel, but after 2 days I decided not to use it due to danger of exposure to my wife and pet. If TRT is called for, I'd rather do shots or something with zero risk of exposure to others. Of course, I'd much rather fix whatever the underlying cause is, if any, rather than fix the symptoms alone.


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## CMaso (Jul 5, 2013)

I saw the new doc last Thursday. We're doing some more blood tests (including the TRH stimulation test) to get an idea of what's going on, but he's confident that I have an auto-immune disorder with my thyroid, based on my symptoms. I follow up with him on the 25th.

Assuming I indeed have Hashi's or Grave's, I've started researching to find out if the actual swelling/inflammation of the thyroid can be halted, along with my other throat symptoms (difficulty swallowing, hoarseness, frequent need to clear throat). From what I've read on the forum here, it sounds like that takes a lot of trial and error, see if there are food triggers such as gluten or dairy that need to be eliminated from one's diet, etc. But I would think there are anti-inflammation meds that can prevent thyroid inflammation -- aren't there?

Also, it sounds like a number of folks have or have thought about having their thyroid surgically removed. That's a measure I hadn't even realized was possible, given the thyroid's vital role in the body - I assume this means being on hormone meds for the rest of one's life?


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## joplin1975 (Jul 21, 2011)

Yes, it would mean being on hormones of the rest of your life. Just eye balling your numbers, your t3 is woefully low and your t4 isn't much better (are those free t4 and free t3 or total?). Disregarding the TSH, you look hypo.

That said, you testosterone is dang low too. I'm not well versed int e interaction between the two, but I know there is a connection...I'd investigate further. My husband has been struggling with TRT and just from his reactions/experience, I'd take the gel method, if it works, any day over the other options. There's a a risk, yes, but as long as you are reasonable careful, it's not over the top risky. I mean, it's not like I go touchingly husband's armpits frequently.


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## CMaso (Jul 5, 2013)

joplin1975 said:


> Yes, it would mean being on hormones of the rest of your life. Just eye balling your numbers, your t3 is woefully low and your t4 isn't much better (are those free t4 and free t3 or total?). Disregarding the TSH, you look hypo.
> 
> That said, you testosterone is dang low too. I'm not well versed int e interaction between the two, but I know there is a connection...I'd investigate further. My husband has been struggling with TRT and just from his reactions/experience, I'd take the gel method, if it works, any day over the other options. There's a a risk, yes, but as long as you are reasonable careful, it's not over the top risky. I mean, it's not like I go touchingly husband's armpits frequently.


Hi, thank you for your comments. My concern with the gel is that it can get into my clothes; my wife does the laundry, and my cat will snuggle in on top of the laundry if given a chance.  I've heard some men say they prefer getting shots, and there's even a sub-dermal pellet I've heard about. What makes you say the gel is the most preferable option?


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## joplin1975 (Jul 21, 2011)

He's tried all three.

The gel had no effect on his T levels, so we quickly moved to injections.

The injections worked, but *for him,* the highs and lows of it all was really disconcerting. That is, 48 hours after the injection (roughly), he would be totally energized...almost too much...and couldn't tolerate things like coffee. That would last maybe three or so days and then he'd get maybe four or five days of normality, then he'd crash. Hard. It was up and down, up and down and I think it's fair to say it impacted him mentally, not just physically.

The pellets are an improvement, but man, the surgery is a bit more involved than I think either of us expected. He's reallllllly sore for about a week after implantation. And his poor back side looks like a war zone now. They are very expensive, insurance doesn't like to approve the pellets or the surgery, and they are hard to come by now since that whole compounding pharmacy scandal thing. I guess the FDA instituted some stricter guidelines which means they are scare. So, instead of every four months, he gets them implanted every five or so months. And you get back to the lows again...

If the gel worked for him, we'd be all over it.


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## CMaso (Jul 5, 2013)

Followed up with doc today. Interestingly, the tests didn't show much in the way of antibodies, but without question my thyroid gets inflamed at different times throughout the day. Usually due to certain foods, or from sustained heavy breathing. And a sonogram has shown that I have two small nodules and that my thyroid is slightly enlarged.

As far as treating whatever is causing my throat tightness episodes and phlegm, I read something online by a woman with Hashi's who described the exact same throat symptoms as mine. She says she has been taking a supplement of Pinellia and Magnolia, prescribed by her acupuncturist, and it's worked like a charm - she can eat anything and she never gets thyroid inflammation. High quality, 500mg capsules. I've ordered some and am curious to see how well they work once I get them. It sounds like a number of folks on this board suffer from those Hashi-related choking feelings, and could possibly benefit.

As far as all of my test results -- I got a very in depth explanation of what all the tests showed, which is that I have low testosterone, low magnesium, low adrenal function, and low T3. He tells me I have "MTHFR polymorphism", which has to do with a number of important cycles in the body, including some that create neurotransmitters. So, he's done a few things:
Upped my dosage of liothyronine from 10 mcg/day to 15 mcg/day
Started me on testosterone cream
Has me taking a number of supplements to:
overcome MTHFR polymorphism
balance and restore adrenal function
treat depression, mental energy, and forgetfulness/brain fogginess

I'm on a lot of supplements for the next 3 weeks, but I'm willing to see how it goes. I'm mostly curious about how to end or reduce my throat symptoms, and the long-term fate of my thyroid. If I have Hashi's, does that necessarily mean that one day my thyroid is going to be destroyed by my auto-immune system? That one day I'll probably have to have it surgically removed?

When I get my blood tested again in three weeks, I'm definitely going to take a close look at the thyroid levels and compare to my earlier post, especially the antibodies count.


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## CMaso (Jul 5, 2013)

I've been in bad shape mentally for about a week now.

In short, After being on liothyronine, anastrozole, and testosterone for a couple weeks, I started feeling really crummy. I learned that it's a bad idea to prescribe anastrozole without getting an initial estradiol reading first. Suppressing estrogen too much can cause problems, and I know I was on a strong dose of anastrozole (15 mcg/wk). I'd lost confidence in this doctor, the supplements were expensive and doing nothing for me, so I stopped taking everything last Friday (Aug 9), except for the testosterone cream.

I'm wondering now if my mental state has something to do with quitting liothyronine too quickly. Does anyone have any insight on this?

Here are the results from my 2nd round of blood tests, with reference ranges:

TSH 0.47 (0.5 - 6.0 ulU/ml)
Free T3 2.52 (2.0 - 4.9 pg/ml)
Free T4 1.11 (.075 - 1.54 ng/dl)
TSH Post 3.9 (6 - 11 ulU/ml)

Testosterone 4.23 (348 - 1197 ng/dl)
Cortisol 12.8 (10.4 - 26.4 ug/dl)
Insulin Baseline 2.9 (<17.0 uu/ml)
HgbA1C 5.7 (5.0 - 6.4 %)
PSA 0.23 (0.1 - 4.0 ng/ml)

I don't know what to make of these results. Right away, I see that TSH and TSH Post are below normal. But this panel is different from the first one I had done. The first one has no test for TSH, so I can't compare. Also, on this one, I don't see anything for prolactin or for thyroid antibodies.

Free T3 was on the low end of normal, so the doctor upped my Rx of liothyronine (which I'd started a couple weeks prior), from 10 mcg/day to 15 mcg/day.

Any ideas on what could be going on? My understanding is that low TSH indicates an overactive thyroid, not an underactive one. And yet, my T3 was on the low end, despite my being on liothyronine. And from the previous blood panel, I see that my TPO antibodies were above normal, 14.3 with a ref range of (0.0 - 0.5 IU/ml). My understanding is that this could possibly indicate Hashimoto's or some case of my immune system attacking my thyroid.

Also, I missed this from my first blood panel, but the first panel also included a result for Insulin-Like Growth Factor I, which was higher than normal - 245, with a ref range of 121 - 237 ng/ml. There's a comment right below it that reads "IGF-1 values well above the age and gender matched reference interval indicate a possible pituitary tumor secreting growth hormone." The doc never even mentioned that to me.

So I'm confused as to whether I could have hypo- or hyper- thyroidism. The test results seem to be sending mixed messages.


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## Andros (Aug 26, 2009)

CMaso said:


> I've been in bad shape mentally for about a week now.
> 
> In short, After being on liothyronine, anastrozole, and testosterone for a couple weeks, I started feeling really crummy. I learned that it's a bad idea to prescribe anastrozole without getting an initial estradiol reading first. Suppressing estrogen too much can cause problems, and I know I was on a strong dose of anastrozole (15 mcg/wk). I'd lost confidence in this doctor, the supplements were expensive and doing nothing for me, so I stopped taking everything last Friday (Aug 9), except for the testosterone cream.
> 
> ...


Oh, dear..........................TSH, FT3 and FT4 are all in the basement. This could suggest pituitary but I doubt it.

It is my humble opinion that before treating anything else, the focus should be on the thyroid issue because many things happen because of the thyroid not functioning well. Testosterone and Ferritin are two things that come to mind. Low Vitamin D as well.

If you are still not taking the Levothyroxine, it might be a good time to get some more tests.

Specifically and ultra-sound of your thyroid and also these...................

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

It could very well be that you are hyper and it needs to be ruled out or in. There are binding, blocking and stimulating antibodies to the receptor sites which in fact skew the number.

And ultra-sound of the thyroid is very very important.


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## CMaso (Jul 5, 2013)

Andros said:


> Oh, dear..........................TSH, FT3 and FT4 are all in the basement. This could suggest pituitary but I doubt it.
> 
> It is my humble opinion that before treating anything else, the focus should be on the thyroid issue because many things happen because of the thyroid not functioning well. Testosterone and Ferritin are two things that come to mind. Low Vitamin D as well.
> 
> ...


I did get an ultrasound of my thyroid - it concluded I have a multinodular goiter. Both globes of thyroid mildly enlarged, and small nodes on each (5x5 mm and 8x6 mm). The ultrasound concluded that the nodules show no worrisome features, but recommended continued monitoring.

So I do have a goiter, but I've no idea what's causing it. That in combination with the blood tests suggests to me that something is definitely wrong with my thyroid, or with something along the P-T-A cycle. And Maybe I'm not communicating clearly to my docs, but my throat symptoms are just short of crippling. I've come close to choking on my food numerous times; it's to the point that I have to chew nearly everything with a mouthful of water.


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## CMaso (Jul 5, 2013)

Saw an ENT today recommended by my GP. I've actually seen this guy before, and trust his expertise and judgement. He didn't think my goiter was anything to be concerned about, and it's doubtful that it's causing any constriction. I told him about my swallowing problems, and he said he think it's due to some meds I'm on (Wellbutrin and Zoloft). These are known to reduce saliva production, regardless of how hydrated one is. However, he's still going to have me come in later and do some swallowing tests, to see what's going on there. And, he referred me to an endocrinologist he works to see what's going on as far as hormone levels.

I'm getting the feeling that I should get to a lab every week or two for a couple months and get blood tests done, just to get a spread of my thyroid and adrenal levels over time. That would probably paint a clearer picture.


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## RH789 (Jul 30, 2012)

CMaso said:


> Saw an ENT today recommended by my GP. I've actually seen this guy before, and trust his expertise and judgement. He didn't think my goiter was anything to be concerned about, and it's doubtful that it's causing any constriction. I told him about my swallowing problems, and he said he think it's due to some meds I'm on (Wellbutrin and Zoloft). These are known to reduce saliva production, regardless of how hydrated one is. However, he's still going to have me come in later and do some swallowing tests, to see what's going on there. And, he referred me to an endocrinologist he works to see what's going on as far as hormone levels.
> 
> I'm getting the feeling that I should get to a lab every week or two for a couple months and get blood tests done, just to get a spread of my thyroid and adrenal levels over time. That would probably paint a clearer picture.


I am in NYC and have been to many doctors. I'm curious if there are any you are fond of? If you are not comfortable sharing it publicly, please feel free to private message me. Also, I have some that I can recommend if you are in need. I have been at this for three years. I am currently off my medication, but feeling terrible. Never felt too great on medication either, but we'll see. I will likely go back on meds this week. My biggest complaint personally is muscle weakness. It's crippling.

I do not have antibodies, never have in the past three years. I had a subacute thyroiditis that mimics a Hashi attack. I have "scant chronic lymphocytic thyroiditis" on my FNA report. I am scheduled to see a very open-minded endo in September who is really good. No hocus pocus, but still liberal enough to believe our symptoms when the bloodwork doesn't show too severe of a situation.


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## CMaso (Jul 5, 2013)

RH789 said:


> I am in NYC and have been to many doctors. I'm curious if there are any you are fond of? If you are not comfortable sharing it publicly, please feel free to private message me. Also, I have some that I can recommend if you are in need. I have been at this for three years. I am currently off my medication, but feeling terrible. Never felt too great on medication either, but we'll see. I will likely go back on meds this week. My biggest complaint personally is muscle weakness. It's crippling.
> 
> I do not have antibodies, never have in the past three years. I had a subacute thyroiditis that mimics a Hashi attack. I have "scant chronic lymphocytic thyroiditis" on my FNA report. I am scheduled to see a very open-minded endo in September who is really good. No hocus pocus, but still liberal enough to believe our symptoms when the bloodwork doesn't show too severe of a situation.


I'm very comfortable sharing my experiences with docs publicly -- doctors are no different from any other professional service providers, as far as I'm concerned. So far, is the one I trust most. He doesn't rely on TSH only to determine thyroid health, and in lab results for T4, T3 etc., he understands that "normal" doesn't necessarily mean "optimal". His testing is thorough, and he's okay with prescribing armour or other dessicated thyroid. And, he takes insurance and will not try to sell you a bag of expensive supplements (at least, not me, so far). He responds to emails quickly. My only complaint is that once you see him, he's not available again for 3 months, so many patients does he have. I'd like to be monitoring my thyroid levels and tweaking dosage if needed more frequently than once every 3 months.

Also, he prescribed me testosterone compound cream, which was good of him, but for TRT I don't think he's the way to go. He never discussed with me the precautions that need to be taken so as not to expose others to it, nor did he discuss other delivery options, nor undesirable effects (such as the testes shrivelling, which can be prevented with HCG), nor all the special things that need to be monitored when doing TRT. If I do anything that has to do with T replacement, it's going to be with , who was referred to me by an acquaintance and my GP knows by reputation.

Which docs would you recommend?


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## jenny v (May 6, 2012)

Hi all,

We would like to ask your co-operation and NOT name specific doctors or names of specific practices on these boards. Your doctor and his or her treatment is subject to strict privacy laws and should be kept private. No doctor names. No doctor addresses. No names of specific practices please.

If you would like to share your experience with a particular doctor with another user you can privately PM (Private Message) that user.


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## CMaso (Jul 5, 2013)

My apologies -- what specific laws are being cited, if you don't mind my asking?


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