# New here, would love some insight!



## mrswh (Jan 16, 2011)

Hi all,

I am new to this board and to thyroid issues - I have a lot of questions and would love any insight you all can share.

I just turned 40. I have two small kids (4 and 6) and am usually go, go, go! Over the past few months I have started to feel awful. Not on a daily basis, but it seems to be more and more often. Painfully tired, dizziness (dysequilibrium), "brain fog," ear pressure/ringing. I have noticed that I seem to be losing a lot of hair in the past year or so. Not noticeable on my head but very much so when I rinse my hair in the shower. More and more I am feeling cold when others aren't (though I am not wearing a sweater in the summer or anything) and have cold hands and feet. My resting heart rate has dropped from the mid to upper 60s to the mid to upper 50s. I have *not* had any significant weight gain (other than a sudden unexplained 3% weight jump about 18 months ago). The tired and dizzy feeling is driving me insane. It's very mentally draining and difficult to live this way.

Blood work shows a TSH of 3.48, compared to a 2.01 at last check 2.5 years ago. No other thyroid tests were done. My MD wants me to go on meds - I am not sure exactly which one but she said she'd start me on a 25 mcg dose. She *swears* that at this dose I will have ZERO side effects.

As much as I REALLY want to do something to feel better, I am hesitant to jump into a lifetime of meds without further investigation. Do I need further lab work done? Is TSH sufficient to make a confident diagnosis of hypothyroidism? Should I be looking for underlying causes for this issue, or is just treating the thyroid production sufficient? I did have a complete blood count and an arthritis panel and that all came back fine.

Can a person really feel this crappy with my TSH level - one that labs consider to be within normal range? Is there one med that is better than another? Will I really have no side effects? I have never been on long term meds, and I really hate taking any kind of meds at all. It takes a real killer headache for me to even pop a motrin. I feel like my body is very sensitive to meds (esp. hormones - the pill was a disaster for me - I felt horrible on it).

I am low on calcium and read that you can't take calcium supplements while on thyroid hormone because they inhibit absorption - is that true?

Are dizziness and ear pressure/ringing symptoms of hypothyroidism? Are symptoms of hypothyroidism necessarily continuous or can they be on and off the way they have been for me? I know everyone is different but there must be something that is typical.

I would really love any insight you all can share. All I hear from the medical community is "this is so easy to treat, you just pop a pill with no side effects and everything is great." Sounds good to me, but I am doubtful this is the whole story.

Thanks in advance for any responses!! 

ETA: Should I see an endocrinologist?


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## desrtbloom (May 23, 2010)

Hi and Welcome!

If it was me I would go to a good Endo and get a full thyroid panel before I started any medication. TSH alone is not enough to indicate whether or not you should start a thyroid replacement, so I would go to an Endo and get a full work up.

Don't be afraid to ask the Endo questions. When you get your thyroid panel results, you might want to post them on here because there are a lot of folks that are very good at determining what is going on with the blood levels.

As for your TSH being 3.48, that might be too high for YOU. We all have different systems and some of us do better around a TSH of 2.0 to 2.5 and others do better with a TSH 1.0 or below. If you previously were doing well at around 2.0, then that might be the TSH level that is best for you; however, your Free T4 and Free T3 levels will also determine what is going on as well as your thyroid antibodies.

Good luck!!!

Patti


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## GD Women (Mar 5, 2007)

mrswh said:


> Hi all,
> 
> I am new to this board and to thyroid issues - I have a lot of questions and would love any insight you all can share.
> 
> ...


Hello and Welcome to the Thyroid Boards!

Endocrinologist is not necessary unless thyroid issue is more in depth or you feel your current doctor is not capable enough. I was diagnosed and treated from day one by an Internist.

You can take calcium in any form including food/drink/supplements as long as taken 4 hours or longer, before or after, thyroid medication.

Normally symptoms come with TSH over 10 called overt hypothyroidism.

It is not unusual for TSH levels to change or fluctuate throughout life even in normal thyroid persons, as long as it does not fluctuate outside of the thyroid box.

Personally if it were me and know what I know today, I would not agree on medication unless TSH was way out of the box. However this is an individual decision between doctor and patient. When levels are thyroid acceptable, Some doctors will prescribe thyroid medication for the placebo effect and not the thyroid, in hopes to trick patient or the brain, into feeling better or relieve symptoms.

Some of us find it works better, with faster results, to treat our symptoms separate from thyroid anyway. In a lot of cases its not the thyroid that is the cause of symptoms but rather an underlying issue.

I am not stating that any of the above reflect you or your thyroid but rather issues to ponder.

TSH relates to whether a person is hypo or hyper and whether med. does is too high or too low or just right.

TSH comes from the driving force of brain hormones, the pituitary, a little gland in the brain. F/T4 is produced by the thyroid gland in the neck. They are two different things made by two different organs, connected to bring a balance to thyroid metabolism, i.e thyroid levels.
TSH "tells" the thyroid gland to secrete the hormones thyroxin (T4) and triiodothyronine (T3).

Adjusting by brain TSH tells the F/T4 (and F/T3) thyroid gland which direction for levels to go according to thyroid med. adjustment. That is, for thyroid levels to go up or down per med. dose adjustment.

TSH is so sensitive to changes in thyroid hormone levels it is used as the number one test for screening for thyroid disease and adjusting medication.

Going by T4 and T3 is old fashioned and was used before TSH tests were used. But now there is the sensitive TSH which is the gold standard of today.

TSH should be used because the heart could be over stimulated by excess thyroid hormone if one ignores the TSH level and must be watched to keep things safe.

"Guideline 27. Clinical Utility of TSH Assays (Functional Sensitivity < 0.02 mIU/L)" 
"Serum TSH measurement is the most diagnostically sensitive test for detecting mild (subclinical), as well as overt, primary hypo-or hyperthyroidism in ambulatory patients."
"A serum TSH measurement is the therapeutic endpoint for titrating the L-T4 replacement dose for primary hypothyroidism and for monitoring L-T4 suppression therapy for differentiated thyroid carcinoma. 
"A serum TSH measurement is the primary test for detecting amiodarone - induced thyroid dysfunction (see Guideline 5)."
http://www.medscape.com/viewarticle/452667_5

Hope I answered all your concerns.


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## northernlite (Oct 28, 2010)

I am also a newbie, 2 months on thyroid replacement. I could have written your description of how you feel, my symptoms matched yours. For me dizziness and ear pressure were a sign of hypothyroidism and although we are still working on getting me up to my optimal dose, they have gone away on my current dose of medication.

There is tremendous debate on the proper range for TSH but many recommendations have 3.0 as their upper limit which you exceed. I would think they would also want to run at least a free T4 as well as the anti-thyroid antibody panel on you. I was diagnosed with a TSH = 8.44 but my FT4 was in the normal range. Even with my FT4 in the normal range I was very symptomatic. I was positive for antibodies and was diagnosed with Hashi's.

I started on 50mcg which is a low dose so 25 mcg is a very low dose. I have zero side effects at all and positive improvement in all my symptoms. And it is funny, once you start feeling better, you really realize how lousy you felt before. On 50 mcg my TSH dropped into the normal range and was just over 2.0 with a FT4 still in the normal range. But even at TSH=2.1, I don't feel 100% well so I believe you could be quite symptomatic at 3.48 and may benefit from T4 replacement. I would say I feel 80%. Many of my symptoms are gone completely, but still a little lingering fatigue and stamina issues. So I am going up in dose of medication and trying to find my sweet spot where I feel great.

I work with my regular MD and have not had any testing besides blood tests. My #1 goal is to feel good again so I am working on that with my dr and then I will discuss other issues such as ruling out cancer that have been recommended to me on this board since I am positive for the antibodies.

Also, I never had any significant weight gain either.

Personally, I would start the medication and ask for a full thyroid blood panel. You can always stop the medication if you have undesireable side effects but you will never know if it can help you feel better unless you start it.

It took me almost 2 weeks before I felt anything at all from the medication so be patient if you start it.


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## lavender (Jul 13, 2010)

Welcome! I hope we can help you out.

Many of your symptoms sound like hypothyroidism. Not everyone gains weight when Hypothyroid. We are all different.

"Blood work shows a TSH of 3.48, compared to a 2.01 at last check 2.5 years ago. No other thyroid tests were done. My MD wants me to go on meds - I am not sure exactly which one but she said she'd start me on a 25 mcg dose. She *swears* that at this dose I will have ZERO side effects."

25 mcg is a very low dose.

"As much as I REALLY want to do something to feel better, I am hesitant to jump into a lifetime of meds without further investigation. Do I need further lab work done? Is TSH sufficient to make a confident diagnosis of hypothyroidism? Should I be looking for underlying causes for this issue, or is just treating the thyroid production sufficient? I did have a complete blood count and an arthritis panel and that all came back fine."

Good intuition. TSH can show that something is wrong, but it is not sufficient in and of itself to diagnose what is going on. I would suggest having TSH, Free T3, Free T4, TPO, Thyroglobulin, and TSI tested. The first 3 tests show how your thyroid is working, and the last three are antibody tests which can help determine why your thyroid might be mal-functioning. If you have a goiter (enlarged thyroid) or any nodules, these should be investigated with a Radioactive Iodine Uptake and Scan (RAIU) and depending on the results, possible Fine Needle Aspiration (FNA aka biopsy)

"Can a person really feel this crappy with my TSH level - one that labs consider to be within normal range?"

Yes, some of us are very sensitive to very small changes in TSH. There is some debate among medical professionals (and on this board) about what a "normal" range for TSH ought to be. Even the most conservative studies suggest that a TSH over 3 + symptoms of hypothyroidism are sufficient to diagnose hypothyroidism. I think some posted the AACE (American Association of Clinical Endocrinologists') guidelines not too long ago, and that is basically what it said. I know I can not function at 3.

"Is there one med that is better than another?"

med options generally include levothyroxine, either generic or brand name synthroid, (synthetic T4 supplement); Cytomel (synthetic T3 supplement); and products made from pig thyroid such as Armour or Nature-Thryoid. Doctors tend to prefer synthroid, but it really depends on your body and what helps you feel your best.

"Will I really have no side effects?"

I can not guarantee anything, but I highly doubt you will. Thyroid hormones are something our bodies naturally produce. Basically, what is listed as a side effect for thyroid meds are the same things that are side effects of hyperthyroidism, and they occur when you are over-medicated. Some people have allergic reactions to fillers in the medications.

"I have never been on long term meds, and I really hate taking any kind of meds at all. It takes a real killer headache for me to even pop a motrin. I feel like my body is very sensitive to meds (esp. hormones - the pill was a disaster for me - I felt horrible on it)."

I look at my thyroid meds as a supplement of something my body would make if it could, not as a drug. I am very sensitive to many medications, and have not experienced any side effects. I have found that I feel a lot better on natural products such as Armour than on synthetic thyroid preparations.

"I am low on calcium and read that you can't take calcium supplements while on thyroid hormone because they inhibit absorption - is that true?"

I have to take calcium because I have very low levels as well. My calcium must be taken either 4 hours before or after my thyroid meds to prevent absorption issues. This is not a problem since thyroid meds are usually taken once a day in the morning.

"Are dizziness and ear pressure/ringing symptoms of hypothyroidism?"

I am not sure. thyroid hormones control a lot more than I ever could imagine.

"Are symptoms of hypothyroidism necessarily continuous or can they be on and off the way they have been for me? I know everyone is different but there must be something that is typical."

Symptoms of thyroid disease often wax and wane. Off and on is pretty typical.

"I would really love any insight you all can share. All I hear from the medical community is "this is so easy to treat, you just pop a pill with no side effects and everything is great." Sounds good to me, but I am doubtful this is the whole story."

For some people this is very simple to treat. Others of us struggle for a long time and get very sick. What is important is that your doctor is on the ball and willing to treat you before your entire life has been turned upside down. I would suggest you ask for further investigation with blood work to help you learn the whole story.


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## mrswh (Jan 16, 2011)

Thank you so much for the responses! It is great to hear from people who are actually experiencing these issues, for many reasons but the most important of which is that I feel less like I must be going insane.

I'm not sure my MD is incapable of working this out, but so far she has jumped to the quick conclusion that since my TSH is over 2, I should go on meds, without any further investigation - that's what makes me wonder. I will see if she is willing to delve deeper into this and if not I'll go the endo route.

@GDWomen - you mention treating symptoms separately. I have no idea how I'd do this. I can surely put on extra layers of clothing if I am cold, but how do I fight fatigue, dizziness and brain fog? I can't make any correlation between my diet or activities and when the symptoms strike. I'd love to hear any suggestions on this front. I'm also curious about what you know now that would make you not take meds unless your TSH was way high. I've got symptoms that are making me miserable and I'm not sure what else to investigate. I'm going to see an ENT next week for the dizziness, but the only other thing I can think of is perimenopause? According to my GYN there is no real way to figure out if that's causing symptoms. :confused0003:

How does the replacement hormone work? If my TSH is only slightly high, am I more likely to have hyperthyroid symptoms because there is such a small range that will work for me? (I see people on a 50 mcg dose that go from 14 TSH to 4, for example. Is there a dose small enough that it wouldn't take me down too low when my starting point is 3.48?)

And, big question here . . . if I start on replacement hormones, will my body stop making thyroid hormones?

Thank you, thank you, thank you all so much for your responses and insight! It is great to have help trying to work this out.


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## northernlite (Oct 28, 2010)

I don't have a complete enough understanding of the medical aspects of this disease to answer most of your follow on questions but I do know that Levothyroxine is a scored tablet and is splitable in both Synthroid and the generic form so if 25 mcg proved to be too much it could be reduced to 12.5 mcg.

I believe that hypothyroidism is way under diagnosed and although I am not impressed that your MD treats after running only TSH, I am impressed that she is will to try T4 replacement at 3.48. Symptomatic and a TSH = 3.48 should be treated in my opinion (for what that is worth!!!).


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## lavender (Jul 13, 2010)

mrswh said:


> Thank you so much for the responses! It is great to hear from people who are actually experiencing these issues, for many reasons but the most important of which is that I feel less like I must be going insane.
> 
> I'm not sure my MD is incapable of working this out, but so far she has jumped to the quick conclusion that since my TSH is over 2, I should go on meds, without any further investigation - that's what makes me wonder. I will see if she is willing to delve deeper into this and if not I'll go the endo route.
> 
> ...


Thyroid hormone replacements meds have a very small window of effectiveness. This means that the difference between a dose that is high enough to keep you from having hypo symptoms and the dose that makes you hyper is very small. This is true for everyone who takes it. That is why it is good to start out with a low dose, measure blood work and look at symptoms in 6-8 weeks, and adjust if necessary. If, at any point in the process, you start to feel hyper it is important to call your doctor and have blood work checked.

To the best of my knowledge, as long as you still have a functioning thyroid, your thyroid should continue to make it's own hormones. It is possible to placed on a high enough dose to shut down your natural thyroid production, but 25mcg is not enough to do that.


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## Andros (Aug 26, 2009)

mrswh said:


> Hi all,
> 
> I am new to this board and to thyroid issues - I have a lot of questions and would love any insight you all can share.
> 
> ...


Hi and welcome to the board. A lot of us would tell you that if our TSH was that high, we would be quite ill. Of course it can be in the double and triple digits but "not right is well; just not right!"

The majority feels best with TSH @ 1 or less. With FT3 and FT4 mid-range or higher.

I would advise some antibodies tests "before" you start on meds. If you start on meds (thyroxine replacement), it could skew the tests and you will see listed the FREE T3 and FREE T4 which I hope you doc will run as well.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), 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/unders...s/thyroid.html

I would also recommend a ferritin test. Most of us w/thyroid disease have low ferritin.
Ferritin http://www.thewayup.com/newsletters/081504.htm

You may be better off sticking w/the doc you have provided she is willing to run these lab tests and think outside the box.

For the most part, endos specialize in diabetes. A "lot" of our posters don't see endos as you will come to find out as you hang around and read the posts.

Once again, welcome and I am sorry you are feeling so unwell.

Listen to your "inner" doctor. You are on the right track.


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## GD Women (Mar 5, 2007)

*"@GDWomen - you mention treating symptoms separately. I have no idea how I'd do this. I can surely put on extra layers of clothing if I am cold, but how do I fight fatigue, dizziness and brain fog? *
Some symptoms can't be dealt with unless there is an underlying condition that can be treated. I suffer ear issues and coldness (hands and feet being the coldest). I never associated these with thyroid because I have suffered from then since my early twenties, way before i was diagnosed with thyroid. I just live with it. Others like sleep and/or depression or anxiety I take meds.

*Many conditions are associated with dizziness.* However, the most common subcategories can be broken down as follows: 40% peripheral vestibular dysfunction, 10% central nervous system lesion, 15% psychiatric disorder, 25% presyncope/dysequilibrium, and 10% nonspecific dizziness. The medical conditions that often have dizziness as a symptom include: 
Benign paroxysmal positional vertigo 
Meniere's disease, Vestibular neuronitis, Labyrinthitis, Otitis media, Acoustic neuroma, Chronic motion sickness, Ramsay Hunt syndrome, Migraine, 
Multiple sclerosis, pregnancy, low blood pressure (hypotension), low blood oxygen content (hypoxemia), iron deficiency (anemia), low blood sugar (hypoglycemia), hormonal changes (eg, thyroid disease, menstruation, pregnancy), panic disorder, hyperventilation, anxiety, depression, 
age-diminished visual, balance, and perception of spatial orientation abilities.

*Brain fog may be the result of: *
Adrenal fatigue syndrome - The adrenal glands fail to produce key hormones that effectively regulate the body's stress response. As a result, adrenal fatigue syndrome can cause brain fog symptoms due to the body's inability to handle stress effectively. 
Insomnia / sleep deprivation - Sleep is crucial for optimal brain function. Lack of adequate sleep can affect mood, cause depression, anxiety, and clouded thinking. 
Chronic fatigue syndrome (CFS) - Chronic fatigue syndrome is known for its overwhelming fatigue. CFS affects concentration, short-term memory and disrupts healthy sleep patterns. 
Depression. Almost 10 percent of Americans suffer from depression, which can cause difficulty concentrating, remembering, and making decisions. 
Stress. Chronic stress overstimulates the brain. Turning down the figurative volume helps repair damage done to brain and nerve cells. 
Nutritional deficiencies - Nutritional deficiencies can affect brain function, due to a lack of nutrients necessary for optimal brain function. Deficiencies of magnesium, vitamin B-12, and amino acids can cause significant brain impairment such as lack of concentration, short-term memory loss, attention deficit, and spaciness (or lack of focus). 
Candidiasis - Systemic yeast overgrowth can cause depression, anxiety, sudden mood swings, lack of concentration, headaches, drowsiness, and/or fatigue. 
Disorders such as fibromyalgia or multiple sclerosis (MS) - Fibromyalgia and MS are both nervous system disorders that affect brain function, leading to, in many cases, overwhelming fatigue, pain, depression, and anxiety. 
Chronic viral infections such as Epstein-Barr, Lyme disease, hepatitis, cytomegalovirus - Viral infections can reach the brain and can significantly disrupt thinking and mood. 
Parasitic organisms found in the brain - Parasitic infections such as tapeworm can invade the brain and cause symptoms of acute mental illness such as depression and psychosis in more than 65% of cases. Parasitic infections outside of the brain that can produce psychiatric symptoms include giardia, ascaris psychosis, trichinosis, and Lyme Disease, among many others. 
Heavy metal toxicity - The most common heavy metals that humans are exposed to are aluminum, arsenic, cadmium, lead, and mercury. These often accumulate in brain tissue and are difficult to excrete in many cases. Some people-especially those who suffer from chronic conditions-cannot excrete neurotoxic heavy metals efficiently and a build-up occurs, causing brain fog symptoms. 
Reduced blood flow to the brain due to circulatory problems - Lack of blood flow to the brain disrupts brain function. Thick blood can also slow down blood flow to the brain, causing brain dysfunction. 
Blood sugar issues such as hypoglycemia or diabetes - Uncontrolled blood sugar levels can cause significant symptoms such as depression, anxiety, fatigue, and clouded thinking. 
Overuse of artificial sweeteners and MSG - Artificial sweeteners such as Aspartame and flavor enhancers are considered excitotoxins, meaning that they are toxic to the brain, and can disrupt brain function. 
Allergies and food intolerances such as to gluten and lactose - Many patients who are lactose and/or gluten intolerant find that their brain function often suffers as a result of allergies to these substances. 
Leaky gut syndrome - When the gut becomes more permeable, larger particles escape into the bloodstream and may pass the blood brain barrier, causing a wide variety of mental symptoms such as mood disturbance, depression, anxiety, fatigue, lack of concentration and focus, and short-term memory loss. 
Side effects of prescription and over-the-counter medications - It's always important to double check with your pharmacist for medication side effects that can disrupt brain function. Many medications have side effects that disrupt mental health and may cause symptoms ranging from depression, anxiety and agitation, to severe conditions such as psychosis and suicidal ideation. 
Constipation - Brain fog may be caused by bowel toxicity due to inefficient digestive system that is not able to effectively eliminate toxins from the body. 
Menopause - Many women experience brain fog due to fluctuating hormone levels during perimenopause and menopause. Lowered estrogen levels may cause mood fluctuations and unclear thinking, depression, and anxiety. 
Sick building syndrome (fumes from new carpets, paints, insulation, chipboard, wood treatments, pesticides, carbon monoxide, poor ventilation) - Chemicals used during construction and for building fumigation may cause significant brain impairment in individuals sensitive or allergic to these chemicals. 
*
"I seem to be losing a lot of hair"* 
hair loss can be the result of a lot of conditions that occurs in your body. Reliable medical studies have concluded that the causes of hair loss are due to hormonal imbalance, genetic disorders, psychological, physical strain on hair system, traumatic, infectious diseases and those of unknown causes.


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## GD Women (Mar 5, 2007)

"@GDWomen - Con't

*"According to my GYN there is no real way to figure out if that's causing symptoms. "*
At least not by pulling them out of the sky. Finding out what could be the cause of symptoms could be a long, extensive and expensive process. As you see, symptoms are not as easy as taking a little thyroid pill and wallah symptoms are gone, just like that.
*
"How does the replacement hormone work? If my TSH is only slightly high, am I more likely to have hyperthyroid symptoms because there is such a small range that will work for me? (I see people on a 50 mcg dose that go from 14 TSH to 4, for example. Is there a dose small enough that it wouldn't take me down too low when my starting point is 3.48?)"*
That is what concerns me, when TSH is not all that significantly high taking meds. could put one into hyperthyroid state and that's not fun either, and could be dangerous. There is no way to tell how meds. will effect ones level. Its a hit and miss process and if not done correctly it could become a like a ping pong game bouncing back and forth with thyroid levels. I am in that situation now, can't find the correct dose and I have been doing this going on fourteen years. 
Starting on the lowest does and working up slowly as needed is the way to go for any thyroid issue needing medication.

*"And, big question here . . . if I start on replacement hormones, will my body stop making thyroid hormones?"*
Certainly not! Until one reaches approx. 200 to 250 med. dose there will still be a functioning thyroid. In hypothyroid the thyroid will eventually burn its self out, however this can take years for total completion and until then one will have a functioning or partial functioning thyroid as well as med. dose changes and in some cases remaining symptoms. So medication is not a 100% cure all for our ales. For some that is all it takes or at least a first, for others it takes more than just that little thyroid pill. Plus not everything is thyroid. However, we are not all alike either.

Comment:
TSH relates to whether a person is hypo or hyper thyroid. It does not relate to the cause of hypo or hyper thyroid or if there is anything else that might be the cause of an abnormal TSH level

TSI mimics the effect of TSH, thereby causing the thyroid to secrete excess thyroid hormone. This will reflect in TSH levels.

Thyroid antibodies may remain positive for years, and do not provide an indication of whether the person has normal or abnormal thyroid function.
http://www.mythyroid.com/bloodtests.html

I believe there are injections if you absolutely can not take thyroid pills, but the down fall is you would have to go into doctors every day for the injections, just as you would have to take the meds every day.

What I am trying to relate is that symptoms can not be relied on and can be foolers as to what is actually going on and the cause. Nor does it mean that one is hypo or hyper. Nor can one expect being on thyroid medication is going to heal all that ales us, for some it does and for some it doesn't.

US Government panel guidelines set forth by U.S. Preventive Services Task Force (USPSTF) Jan 14, 2004 as follows: "Subclinical Hypothyroidism With Serum TSH of 4.5 to 10 mIU/L early levothyroxine therapy does not alter the natural history of the disease. "Physicians and patients must understand that there is insufficient evidence to expect therapeutic benefit in patients in this group. The available data do not confirm clear-cut benefits for early therapy compared with treatment when symptoms or overt hypothyroidism develop. Therefore, the panel does not recommend routine levothyroxine treatment for patients with TSH levels between 4.5 and 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Levothyroxine therapy is reasonable for patients with subclinical hypothyroidism and serum TSH higher than 10 mIU/L."

"AACE feels that the physician who has performed a comprehensive history and physical examination should decide on treatment of each individual patient." 
I would add, that a patient has the right to participate in the decision of their treatment plan.

When a TSH is abnormal, either above 4.5 or below 0.45 mIU/L it is recommended that a free T4 test be performed. A free T3 would then be performed if the free T4 is normal and the TSH is less than 0.45. If the thyroid hormone levels are normal and the TSH is abnormal, the diagnosis is subclinical thyroid disease. For TSH levels between 0.1 and 0.45, and between 4.5 and 10, treatment is not recommended. Repeat testing should be performed at 6 Â-12 month intervals to monitor improvement or worsening in TSH concentrations. Levothyroxine (T4) therapy is recommended for patients with TSH levels higher than 10 mIU/L. Patients with TSH lower than 0.1 mIU/L and no signs or symptoms of hyperthyroidism should be retested within 4 weeks of the initial testing. These guidelines can be found at JAMA 291:228, 2004. These guidelines are controversial as others recommend treatment based on clinical judgement.
http://www.aacc.org/events/expert_access/2005/thyroid/Pages/qanda.aspx

AACE thyroid guidelines. Endocr Pract. 2002;8:457-469.
ENDOCRINE PRACTICE Vol 8 No. 6 November/December 2002 457
TSH 0.3-3.0 is just a suggested target level for already diagnosed and treated patients
"We believe that treatment is indicated in patients with TSH levels >10 uIU/mL. or in patients with TSH levels between 5 and 10 uIU/mL in conjunction with goiter or positive antti-thyroid peroxidase antibodies. 
"The target level should be between 0.3 and 3.0 uIU/mL."
http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf

I'm long winded today


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## lainey (Aug 26, 2010)

>>I'm not sure my MD is incapable of working this out, but so far she has jumped to the quick conclusion that since my TSH is over 2, I should go on meds, without any further investigation - that's what makes me wonder. I will see if she is willing to delve deeper into this and if not I'll go the endo route.<<

Lucky you to have a pro-active MD. You don't need an endo to treat you, just a doctor that is smart about managing thyroid disease.

People can have symptoms at all levels---read a little on the threads of this board and any others to find people begging to have a doctor acknowledge that their symptoms could be thyroid related at that THS level--and even lower. Years of struggling, doctor shopping.....

Not that you should jump the gun and take treatment without further investigation, (and you shouldn't start meds before you've had the further blood work, sonogram and perhaps RAIU to see how your thyroid is functioning). Your doctor should be willing to do the rest of the investigation to confirm the "diagnosis".

If you haven't had your iron tested, vitamin D and B also, you should. There are quite a few deficiencies can be a source of a lot of symptoms.

In the interim, all most people want is to be able to function well in their lives. If it takes a little pill (and it is little, about 4 mm) to make that possible, so be it.


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## mrswh (Jan 16, 2011)

Thanks, everyone! Lots of great info and insight here. I have an appointment with my MD next week to follow up and hopefully investigate further before deciding on a course of action. Now I know which labs to ask for, which is a great start. Will post follow up with labs shortly, as I am sure to get lots of great info here. You guys are great!


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## Andros (Aug 26, 2009)

mrswh said:


> Thanks, everyone! Lots of great info and insight here. I have an appointment with my MD next week to follow up and hopefully investigate further before deciding on a course of action. Now I know which labs to ask for, which is a great start. Will post follow up with labs shortly, as I am sure to get lots of great info here. You guys are great!


We will be interested in your follow-up and whether or not the doc agrees to run those antibody tests.

When you get your labs, please include the ranges as different labs use different ranges.


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## prettynikki5 (Dec 9, 2009)

mrswh said:


> Hi all,
> 
> I am new to this board and to thyroid issues - I have a lot of questions and would love any insight you all can share.
> 
> ...


Oh I feel for you! and Welcome!
You really are tugging at my heart strings right now because those are the exact same symptoms I had when I was diagnosed with Hashi's last fall.
Yes, you need more tests run. Andros, I'm sure, will chime in with all that info for you, she is so good at that stuff 
Yes, there may be more to it than just 'hypothyroism'. And no, TSH level is not sufficient to diagnose the actual problem. My TSH was always normal. As were my T3 & T4 levels. I had symptoms of both hyper/hypo, it would alternate as I also had Hashitoxicosis. My symptoms came more from the serious autoimmune war going on with my thyroid. 
Calcium can be taken, it has to be at least 4 hours after you take your thyroid meds. I take my thyroid meds @ 630am every morning and take my Calcium supplement around lunchtime.
I definitely had the dizziness and ear ringing, hair loss, cold feet and hands, all of what you have. My brain was super foggy, it couldn't even add numbers in my head or remember simple things. 
I would say find you a very good Endo, one that will run the necessary tests, listen to you , because that is very important. If you do have a thyroid disorder of some kind, chances are you will be looking at a lifetime relationship with that doctor and your health very much depends on that. 
We are all here for you, these boards and everyone here have helped me immensely, so much support and great advice and a most wonderful group of folks here


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