# basic thyroid question



## peeptoad (Nov 11, 2011)

First of all, hello, I'm new. 

My initial question is pretty basic: is it normal (even for some people) to actually be able to see your thyroid? I just drank some water while looking in the mirror and I can see the "butterfly shape" of my thyroid in my neck as I swallow. Is this normal?

I have some symptoms of hypothyroid, but I my free T4 and TSH labs are both normal, per my doctor, and I can't tell if my symptoms are really thyroid-related or due to something else (I have a couple of other mild health issues right now that I'm dealing with).

Thanks!


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## Octavia (Aug 1, 2011)

Welcome to the forum!

I never really noticed my thyroid moving up and down when I swallowed, until there was a big nodule there, and it was quite visible, moving when I swallowed. Prior to the nodule, I never had a reason to look in the mirror when I swallowed, so I don't know if it was visible before then. And now that I have no thyroid, I can't give you an answer.

But depending on your other health issues, they may be impacting your thyroid function as well as mimicing symptoms of thyroid dysfunction.

Can you casually look at other people while you're eating dinner tonight so see what happens when they swallow?


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## titian1 (May 12, 2011)

Hi, I could see mine quite clearly fro some time before I had it removed. It was like a tyre around my neck that lifted when I swallowed. All gone now and now I have a lovely swan neck again.


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## webster2 (May 19, 2011)

Nope, don't think you should be able to see it. How about your Free T3?


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## Alicia123 (Oct 7, 2011)

Welcome.

Interesting question. Mine is quite large, so I can see it (nodules too). 
What are your symptoms?


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## peeptoad (Nov 11, 2011)

webster2 said:


> Nope, don't think you should be able to see it. How about your Free T3?


I have never had my fT3 checked. I emailed my doctor a few days ago asking about more comprehensive testing, but have not heard back from her yet.
I guess I could still potentially have thyroid issues even if TSH and fT4 are within the normal range?

Alicia, my symptoms are fatigue, breathlessness (like feeling short of breath), trouble concentrating, dry/brittle hair, and I have a random "fluttering" feeling in my throat exactly where my thyroid is (this is what made me think of my thyroid being the problem). The fluttering makes me cough usually. The past few days my eyes have been sensitive to bright lights also... like the normal, overhead fluorescent lighting in conference rooms/etc at my job. 
I do have an iron deficiency as well that I'm dealing with and a lot of these things could be attributed to that, so I wasn't sure...

Thanks for the responses.


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## Andros (Aug 26, 2009)

peeptoad said:


> First of all, hello, I'm new.
> 
> My initial question is pretty basic: is it normal (even for some people) to actually be able to see your thyroid? I just drank some water while looking in the mirror and I can see the "butterfly shape" of my thyroid in my neck as I swallow. Is this normal?
> 
> ...


Hi and I love your forum name! So cute! Actually, it must be swollen for you to see it that well unless you are incredibly thin.

Could you please post your recent lab results with the ranges? Different labs use different ranges.

Do you think the other health issues are related to thyroid (secondary to thyroid?)


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## peeptoad (Nov 11, 2011)

Andros said:


> Hi and I love your forum name! So cute!


Thanks! 



Andros said:


> Actually, it must be swollen for you to see it that well unless you are incredibly thin.
> 
> Could you please post your recent lab results with the ranges? Different labs use different ranges.
> 
> Do you think the other health issues are related to thyroid (secondary to thyroid?)


I can see my thyroid, but it is not terribly defined. Just appears as a vague, butterfly shape when I swallow. I am thin, but not _that_ thin (really just the proper weight for my height).

Here are the latest labs that I've had done (from a year and a half ago though). All I have is fT4 and TSH. Range is in parentheses:

TSH 0.84 (0.34-5.60)
fT4 0.90 (0.58-1.64)

...so both appear normal, but they are from spring of 2010.

I have no idea if my symptoms that I posted earlier could be related to thyroid. I have low ferritin, and everything could be due to that (except maybe the neck fluttering?). Two months ago my doctor upped my iron from once a day to three times a day because I was on once daily for two years and my ferritin was not rising. Since then the fluttering has started and my other symptoms have actually gotten a bit worse.
I also have a gluten sensitivity (not diagnosed celiac though).
I've been reading that low ferritin can be related to thyroid issues and gluten problems as well, so that (and the fluttering in my neck) got me thinking about my thryoid.

I'd appreciate any input from knowledgeable people here, since I'm still waiting to hear back from my doctor.


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## Andros (Aug 26, 2009)

peeptoad said:


> Thanks!
> 
> I can see my thyroid, but it is not terribly defined. Just appears as a vague, butterfly shape when I swallow. I am thin, but not _that_ thin (really just the proper weight for my height).
> 
> ...


While this is from the spring, something is up as your FT4 is way below the mid-range (1.11) of the range provided by your lab. Now either at the time your FT3 was very high (which I suspect given where your TSH is at) or very low. Whichever it might have been would indicate 2 different things. To bad the FT3 was not run at that time.

If I were to guess, I would suspect hyper, not hypo. Symptoms can and do cross over.

Antibodies tests would be good and a re-run of the basic panel TSH, FT3 and FT4.

TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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/

Incidentally, low ferritin is quite common in people with thyroid disease so that is another very strong "clue" that something is going on w/ the thyroid.


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## peeptoad (Nov 11, 2011)

Andros said:


> While this is from the spring, something is up as your FT4 is way below the mid-range (1.11) of the range provided by your lab. Now either at the time your FT3 was very high (which I suspect given where your TSH is at) or very low. Whichever it might have been would indicate 2 different things. To bad the FT3 was not run at that time.
> 
> If I were to guess, I would suspect hyper, not hypo. Symptoms can and do cross over.
> 
> ...


Thanks for the information. I guess I'll just need to wait and see after new labs are (hopefully) run. I'm starting to think that the fluttering in my throat may be heart palpitations. Yikes. I think these can be caused by thyroid issues as well as low ferritin, yes? (low iron seems to cause problems everywhere it seems) This morning just the act of changing the sheets on my bed caused my pulse to climb to 132 and I was out of breath. I don't think that's normal, esp. since I'm in good shape (I exercise every day)!


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## Andros (Aug 26, 2009)

peeptoad said:


> Thanks for the information. I guess I'll just need to wait and see after new labs are (hopefully) run. I'm starting to think that the fluttering in my throat may be heart palpitations. Yikes. I think these can be caused by thyroid issues as well as low ferritin, yes? (low iron seems to cause problems everywhere it seems) This morning just the act of changing the sheets on my bed caused my pulse to climb to 132 and I was out of breath. I don't think that's normal, esp. since I'm in good shape (I exercise every day)!


It all depends. If your thyroid is vascular, you could feel your heart beating in your thyroid. While the thyroid is a very vascular gland, a nodule w/vascularity would raise an eyebrow.

Have you had an ultra-sound?


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## peeptoad (Nov 11, 2011)

Andros said:


> It all depends. If your thyroid is vascular, you could feel your heart beating in your thyroid. While the thyroid is a very vascular gland, a nodule w/vascularity would raise an eyebrow.
> 
> Have you had an ultra-sound?


I did have an ultrasound, but it was about six years ago. At that time I was told that my thyroid was not enlarged, but that it was "prominent". 
That's why I said I don't know what's normal for me. I suppose my thyroid could normally be positioned in a way that makes it appear enlarged, but I've lived my whole life with my neck and I don't remember it looking this way before (although I don't normally closely inspect my neck, lol). 
At any rate the fluttering and overall sensitivity in that area is definitely a recent development.

I have a call in to my doctor's office and waiting to hear back from her. I just want to describe my symptoms and see what she recommends. Could be thyroid, could be something else... could be nothing I guess. ??


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## Andros (Aug 26, 2009)

peeptoad said:


> I did have an ultrasound, but it was about six years ago. At that time I was told that my thyroid was not enlarged, but that it was "prominent".
> That's why I said I don't know what's normal for me. I suppose my thyroid could normally be positioned in a way that makes it appear enlarged, but I've lived my whole life with my neck and I don't remember it looking this way before (although I don't normally closely inspect my neck, lol).
> At any rate the fluttering and overall sensitivity in that area is definitely a recent development.
> 
> I have a call in to my doctor's office and waiting to hear back from her. I just want to describe my symptoms and see what she recommends. Could be thyroid, could be something else... could be nothing I guess. ??


I sure would request an ultra-sound and at the very least TSH, FREE T3 and FREE T4 and see where that leads. For starters!


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## peeptoad (Nov 11, 2011)

I went to my doctor's office this morning. Saw the nurse practitioner because my doctor is booked and the shortness of breath and fatigue was becoming too much. 
She palpated my neck and told me my thyroid felt a little enlarged, but "thyroids are like that sometimes and just don't wear a turtleneck". Gimme a break. 
I asked her (this is the np, remember) if she could run more extensive labs on my thyroid (my doctor actually called me last night and requested this be done as well). I mentioned T3 specifically and she told me "T3 is overrated" to which I responded, "in my opinion it's not overrated". Then I asked about antibodies and she rolled her eyes at me (argh!). I said that I 'd like to know if I have Graves' or not and I got no response to that one... and of course the antibody test was not on my lab paperwork.
So, I got total T3 tested (at least I got that one on the order), a metabolic panel, EGFR (kidneys), and a chest X-ray.

Beyond that, they hooked me up to a pulse oximeter and I walked down the hallway in my doctor's office: my pulse shot up from 81 to 114 just doing that... definitely not normal. Then I had to breathe forcefully into a measuring device (forget what it's called) and I was way below what is normal for my age/height/etc... so that accounts for my feeling out of breath constantly.

The nurse practitioner seemed to think I may have a respiratory issue of some kind... pneumonia, asthma, environmental reaction... they can't tell until the test come back. We'll see.


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## Andros (Aug 26, 2009)

peeptoad said:


> I went to my doctor's office this morning. Saw the nurse practitioner because my doctor is booked and the shortness of breath and fatigue was becoming too much.
> She palpated my neck and told me my thyroid felt a little enlarged, but "thyroids are like that sometimes and just don't wear a turtleneck". Gimme a break.
> I asked her (this is the np, remember) if she could run more extensive labs on my thyroid (my doctor actually called me last night and requested this be done as well). I mentioned T3 specifically and she told me "T3 is overrated" to which I responded, "in my opinion it's not overrated". Then I asked about antibodies and she rolled her eyes at me (argh!). I said that I 'd like to know if I have Graves' or not and I got no response to that one... and of course the antibody test was not on my lab paperwork.
> So, I got total T3 tested (at least I got that one on the order), a metabolic panel, EGFR (kidneys), and a chest X-ray.
> ...


Wow!!! Rolling eyes??? Can you find another health care facility?

Anyway, it's too bad they would not run the FREES. It is unlikely that the Total 3 will tell us much if anything.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=3

And you do need that TSI.

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://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

And yes, you are having respiratory problems for the muscles supporting the lungs are suffering from myopathy. They work like a bellows.

This is most likely a result of my personal speculation that you are hyper.

Myopathy from hyper.
http://www.medicalonly.com/2007/07/27/thyrotoxicmyopathy_hyperthyroidism


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Without proper treatment, functions such as breathing, speaking
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Advanced hyper.
http://www.ucsfhealth.org/conditions/hyperthyroidism/signs_and_symptoms.html

Not all symptoms hold true; for example, many of us have gained weight w/hyper. So read all w/an open mind.


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## peeptoad (Nov 11, 2011)

I specifically asked my doctor (via email) for free T3 and antibodies, in addition to rerunning the TSH and free T4. The nurse practitioner would not put them on the work order. The np actually said that she was "overriding" what my doctor had entered into the computer system for me. 
I believe my doctor is out of the office right now. I'll either email her or see if I can get in touch with her by phone to see if I can get the additional tests done. I'm not sure if I should wait until I get any results back from the current tests.
Is there no value at all to total T3? Why would they even bother to run it?
Maybe I should ask to be referred to an endocrinologist...


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## Andros (Aug 26, 2009)

peeptoad said:


> I specifically asked my doctor (via email) for free T3 and antibodies, in addition to rerunning the TSH and free T4. The nurse practitioner would not put them on the work order. The np actually said that she was "overriding" what my doctor had entered into the computer system for me.
> I believe my doctor is out of the office right now. I'll either email her or see if I can get in touch with her by phone to see if I can get the additional tests done. I'm not sure if I should wait until I get any results back from the current tests.
> Is there no value at all to total T3? Why would they even bother to run it?
> Maybe I should ask to be referred to an endocrinologist...


There "is" some value if the test results are extreme either really high or extremely low. That would raise an eyebrow. But, Totals are what the word implies. Total 4 is bound and unbound hormone. Unbound is what is available for cellular uptake. Total 3 is bound, unbound and rT3 (reverse) hormone. So, in essence we are not getting down to the nitty gritty. The unbound is the active hormone in both.


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## peeptoad (Nov 11, 2011)

I see. Thanks for the explanation. I think I'll wait until this round of tests comes back. It should only take a day or two, and I see no sense in freaking out before then. If all shows up as "normal" then I'll ask my doctor again (not the np!) about further testing.


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## Andros (Aug 26, 2009)

peeptoad said:


> I see. Thanks for the explanation. I think I'll wait until this round of tests comes back. It should only take a day or two, and I see no sense in freaking out before then. If all shows up as "normal" then I'll ask my doctor again (not the np!) about further testing.


Good deal! You never know who is in collusion these days. So the doc will look like the good guy, he might say, yeah.................I will Rx the FREE T3 but has an agreement with the NP to be the fall guy and over ride the order. Insurance does not want to pay for FREE T3.


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## peeptoad (Nov 11, 2011)

I just got my lab results this morning. The only thing I'm waiting on is the chest radiograph. If nothing else, my doctor is quick at getting results back.

Anyway, everything that was tested came back in the normal range. They actually did more than I thought in terms of thyroid testing. Not everything was listed on the printout they gave me I guess, and of course no one actually told me what was to be tested.

Free T4: 0.90 (0.58 - 1.64)
Thyroid Peroxidase AB: 15 (<35)
Total T3: 1.34 (0.87 - 1.78)

In addition the CBC, metabolic panel and EGFR were all normal. The only test they didn't run (and it was the one I specifically asked for) was the Free T3.
Not really sure where I go from here. It's entirely possible that my thyroid is not the issue, but I feel terrible (severely fatigued, rapid pulse, lightheaded, and short of breath).


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## Andros (Aug 26, 2009)

peeptoad said:


> I just got my lab results this morning. The only thing I'm waiting on is the chest radiograph. If nothing else, my doctor is quick at getting results back.
> 
> Anyway, everything that was tested came back in the normal range. They actually did more than I thought in terms of thyroid testing. Not everything was listed on the printout they gave me I guess, and of course no one actually told me what was to be tested.
> 
> ...


Okay; FREE T4 is very low and while in normal range, not suitable for the majority of us. Mid-range of the range given by your lab is 1.11. FREE T4 and FREE T3 (which was not run) should both be above the mid-range of the range given by your lab.

You have antibodies indigenous to autoimmune thyroid. You should not have any TPO antibodies.

Everyone has a small amount of TPO; this is normal but they should not have antibodies to that TPO.

Here is info.

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

(The normal thyroid has TPO but should not have antibodies to TPO)

Total 3 is bound, unbound and rT3 (reverse) hormone. The mid-range for that is 1.32. Considering the result of 1.34 is a compilation of all three listed above, that should also raise an eyebrow.

No TSH??? (thyroid stimulating hormone?)

I believe your thyroid seriously is the issue and can only urge you to seek out another much better doctor.

Here are suggested tests to get to the bottom of it.

TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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/


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## peeptoad (Nov 11, 2011)

Well, my doctor called me last night. They are going to do an ultrasound of my thyroid and she is referring me to a pulmonologist to rule out any respiratory disorders/disease.
In addition to that I'm getting a very, very low dose of lorazepam because I think anxiety (over my symptoms) is complicating matters. I had to leave work early yesterday because I could not breathe and felt faint, and my pulse was jacked. Of course I then started thinking "What if?" and my symptoms escalated from there...

...the saga continues. :confused0024:


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## Andros (Aug 26, 2009)

peeptoad said:


> Well, my doctor called me last night. They are going to do an ultrasound of my thyroid and she is referring me to a pulmonologist to rule out any respiratory disorders/disease.
> In addition to that I'm getting a very, very low dose of lorazepam because I think anxiety (over my symptoms) is complicating matters. I had to leave work early yesterday because I could not breathe and felt faint, and my pulse was jacked. Of course I then started thinking "What if?" and my symptoms escalated from there...
> 
> ...the saga continues. :confused0024:


Please let us know about the ultra-sound. You are right about the saga; sadly!

They "are" raking in the money though at the patient's suffering and expense. Big time!


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## peeptoad (Nov 11, 2011)

Andros said:


> Please let us know about the ultra-sound. You are right about the saga; sadly!
> 
> They "are" raking in the money though at the patient's suffering and expense. Big time!


You aren't kidding, either. I _still_ haven't had a thyroid ultrasound, although I've had an echocardiogram, and am now wearing an cardiac event monitor, so I can report the palpitations/tachycardia to my doctor.
Shortness of breath seems to have resolved at least for the time being. I also had a pulmonary function test which was off-the-charts good (apparently I have the lung capacity of a marathon runner), and I tested negative for all basic respiratory allergens.
The echo was normal as well, although I have slight atrial and ventricle regurgitation and "prominent A-wave" (not sure what that means). 
All this extensive testing and the conventional doctors refuse to do further tests on my thryoid (I've asked 3 times now). It really baffles... I'm giving them one last go with this current issue and then headed off the the naturopath (if nothing comes from the event recorder).


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## Andros (Aug 26, 2009)

peeptoad said:


> You aren't kidding, either. I _still_ haven't had a thyroid ultrasound, although I've had an echocardiogram, and am now wearing an cardiac event monitor, so I can report the palpitations/tachycardia to my doctor.
> Shortness of breath seems to have resolved at least for the time being. I also had a pulmonary function test which was off-the-charts good (apparently I have the lung capacity of a marathon runner), and I tested negative for all basic respiratory allergens.
> The echo was normal as well, although I have slight atrial and ventricle regurgitation and "prominent A-wave" (not sure what that means).
> All this extensive testing and the conventional doctors refuse to do further tests on my thryoid (I've asked 3 times now). It really baffles... I'm giving them one last go with this current issue and then headed off the the naturopath (if nothing comes from the event recorder).


Good grief! You've not had the thyroid tended to yet? I am so sorry for this! What is your next step?


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## peeptoad (Nov 11, 2011)

Andros said:


> Good grief! You've not had the thyroid tended to yet? I am so sorry for this! What is your next step?


My symptoms seem to have died down somewhat, with the exception of the heart palpitations, which have gotten worse. I'm wearing an event recorder for the next ten days. If I get a definitive diagnosis from that, then I'll see where that takes me in terms of dealing with the issue.
If no diagnosis and my symptoms persist, then I'm probably going to go to a naturopath and ask about my thyroid. My regular doctor seems resistant to thyroid testing yet she has had me undergo tests for seemingly everything else under the sun. 
I can't understand it.


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