# referral for knowledgeable doc in Philadelphia PA area needed



## csam (Sep 7, 2011)

Hello,
I am struggling to find a doctor in the Philadelphia area who is up too date on Hashimoto's and it's treatment. I am also new to Hashimoto's, and in fact, have not even had a final diagnosis that I do have it.

Although I've been complaining about a range of symptoms for years that are apparently related to Hashimoto's, I had never even heard of Hashimoto's until a cousin told me she has it and said that I should have tests done.

I have had basic tests done and here are the results:
TPO: 522 
Antithyroglobulin AB: less than 20 
TSH: 2.22 
T-4 serum: 7.3
Free T-3: 2.8
T-3 serum: 82
Free Thyroxine: 1.39
T3 uptake: 36

The problem I am facing is that only my TPO is high - according to my doc, everything else is normal. But I feel HORRIBLE and still my doctor won't treat. I need to find a doctor who specializes in Hashimoto's to tell me if I do have it and to get me started on meds so i can feel better.

Here are some of my symptoms:
Feeling of tightness/fullness in throat (past 3 months)
hoarse voice (past 3 months)
extreme fatigue
sensitivity to cold
difficult concentration and mental fogginess
elevated cholesterol level
muscle stiffness in shoulder and hip (right side of both)
decreased libido (or, really, nonexistent)
sleeping problems
random feelings of anxiety
weight fluctuation of 10 pounds (I weight around 105, so 10 lbs is a lot)
migraines

Any help in finding a provider who can help me figure out what is wrong and who can get me started to feeling better - would be GREATLY appreciated. Thanks!


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## Andros (Aug 26, 2009)

csam said:


> Hello,
> I am struggling to find a doctor in the Philadelphia area who is up too date on Hashimoto's and it's treatment. I am also new to Hashimoto's, and in fact, have not even had a final diagnosis that I do have it.
> 
> Although I've been complaining about a range of symptoms for years that are apparently related to Hashimoto's, I had never even heard of Hashimoto's until a cousin told me she has it and said that I should have tests done.
> ...


Hi there and welcome!!

I hate to inconvenience you but it is hard to tell much w/o the ranges from your lab. Different labs use different ranges!!

I can tell you this right off the bat; I personally don't like your physical symptoms, especially the throat stuff.

Thyroid cancer symptoms
http://www.cityofhope.org/patient_care/treatments/thyroid-cancer/Pages/symptoms.aspx

I urge you to get a sonogram or best case scenario RAIU (radioactive uptake scan.)

High TPO is not a definitive diagnosis but it is "suggestive" of many things. One of them is Hashi's but another is cancer.

You can read here about that:

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

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

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

And these tests are recommended (only the ones you did not have)

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/

About TSI, Thyroid Stimulating Immunoglobulin

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

Hopefully some of our Philly posters will see your thread and help you out w/ a good doctor. You do need one. You are very symptomatic and it sure sounds like thyroid disease.

When you re-post w/lab results and ranges, it should look like this please;

TSH 2.2 Range 0.3 -3.0 FT3 0.0 Range 0.0 - 00.00 FT4 0.0 Range 0.0 - 00.00 and so on.

Thank you and welcome!


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## csam (Sep 7, 2011)

Hi again,
Sorry I posted my labs without the ranges - I didn't know that different labs use different ranges. Newbie mistake 

here they are again with the ranges:
TPO 522 Range 0-34
Antithyroglobulin AB less than 20 Range 0-40
TSH 2.22 Range 0.450-4.500
T-4 serum 7.3 (no range given)
FT3 2.8 (no range given)
T-3 serum 82 (no range given)
Free Thyroxine 1.39 (no range given)
T3 uptake 36 Range 24-39
C-Reactive Protein 0.4 Range 0.0-4.9
Sedimentation rate-Westergren 1 Range 0-39
Vitamin D 37.1 Range 32.0-100.0

I am sure you all use abbreviations, but I am so new at this that I don't know them and I can only give what my print out says.

Thank you again for your help!


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## Andros (Aug 26, 2009)

csam said:


> Hi again,
> Sorry I posted my labs without the ranges - I didn't know that different labs use different ranges. Newbie mistake
> 
> here they are again with the ranges:
> ...


You did an excellent job and thank you so very much. I don't like abbreviations myself as I like to be exacting and guessing as to what the letters might mean, could cause some serious mistakes. Wouldn't you know that the 2 I personally was most interested in did not give ranges? Dang.

Why would that be? Because I suspect you are hyper, not hypo. And seeing exactly where the FREES are at could be very helpful but don't worry. We will figure it out.

Your T3 uptake is high.

T3 Resin Uptake (hyper if high)
http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm

The actual physical symptoms can and do cross over. Many of us, myself included, gained weight while hyper.

So...............there is one test that would rule it in or out!

About TSI, Thyroid Stimulating Immunoglobulin

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

Do you think you could get that test?


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## csam (Sep 7, 2011)

Andros,
Thank you so much for your warm welcome and your help. You have already given me a lot to go on, which feels wonderful considering how confusing and isolating this all feels at the moment. I really appreciate your suggestions and thoughts. I will ask my family doctor to run the tests you suggested (she will order them, but probably won't know what to make of the results) while I continue to look for a thyroid doc. I'll ask for a RAIU, and for TSI, TBII, ANA - I think I have had the rest, as far as I can tell.

Thanks again!!


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## Andros (Aug 26, 2009)

csam said:


> Andros,
> Thank you so much for your warm welcome and your help. You have already given me a lot to go on, which feels wonderful considering how confusing and isolating this all feels at the moment. I really appreciate your suggestions and thoughts. I will ask my family doctor to run the tests you suggested (she will order them, but probably won't know what to make of the results) while I continue to look for a thyroid doc. I'll ask for a RAIU, and for TSI, TBII, ANA - I think I have had the rest, as far as I can tell.
> 
> Thanks again!!


You are most welcome and all of us here will help you best we can. Got some really wonderful posters here!

We can help w/ the results and really, if your family doc thinks outside the box and is willing to learn along w/you; there is no reason why she cannot treat you more than adequately.

Do what you think is the best thing for you to do.

Let us know when you are going for those tests! Keeping you in my thoughts and prayers!


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