# help what blood tests do i need?



## shorty85 (Aug 25, 2012)

i went up monday and told the lady i needed my thyroid checked i was due it and i got got results and the only one they done was my tsh which was

tsh level: 3.37 normal is (0.27- 4.2)

i feel crap and dont know if its cause of castlemans or hashimotos is my tsh normal


----------



## bigfoot (May 13, 2011)

* TSH, Free T3, Free T4 as a minimum, both to help for diagnosis and for continued monitoring.

* TPO Antibodies and Thyroglobulin Antibodies to check for Hashimoto's.

* Thyroid Stimulating Immunoglobulins to test for Graves' (aka "TSI", *not* the same test as TSH).

* Thyroid ultrasound to get a baseline, check for nodules, swelling, goiter, etc.

A TSH level of 3.37 is actually outside the range recommended by the AACE, which is presently 0.3 - 3.0. So right now with a TSH of 3.37 you are likely hypothyroid, and most certainly not "normal". The real question becomes why? Have you been sick lately (that can ruin TSH numbers), do you have an autoimmune component to this, or are you just plain old hypothyroid? One lab test doesn't tell the whole picture, it's just a snapshot in time. You really need the rest of the above data.

I don't know anything about Castleman's, other than a cursory search on Wikipedia tells me it has to do with lymph nodes and possible tumors. With that in mind, I'd make sure your doctor is an active listener and is turning over a lot of rocks in your quest for better health. And getting an ultrasound of your thyroid would be a priority, too.

hugs6


----------



## shorty85 (Aug 25, 2012)

sorry i have already been diagnosed with hashimotos, i had surgery not to long ago for removal of a 7cm x 7cm lymph node in my neck it confirmed castlemans on top of that i have, annulare granuloma and raynards.

i feel like crap and have for a while now when i was first diagnosed with hashimotos my endo said i needed to have 150mg of levo but my gp refused to give the script as he said my levels were normal while taking 75. i fell really depressed probably more due to the fact i have had nothing but bother with my health since i found my melanoma in 2011. sometimes i get really bad i have went to the gp before complaing about being tired etc and i had low blood pressure and the said thyroid was normal. then other times i am roasting have energy to burn that has come from nowhere and have heart palpatations it doesnt last long though.

only as a rountine check did i get them done in monday and asked for a copy to see what my levels actually are. my hair is crap still falling out, i am tired even if i have had a good nights sleep, my joints hurt i am cold and i am going nowhere with weight even though at the start i was losing it fine :sad0049:

thanks for your reply


----------



## bigfoot (May 13, 2011)

The hair falling out, poor sleep, aching joints, fatigue, heart palps, and overheating sensation all sound familiar to me as a fellow Hashi's sufferer. You could be hypothyroid right now (your TSH sure seems to indicate that), or be swinging between hypo and hyperthyroid with the Hashi's. Either way, the goal should be to optimize your levels (getting TSH suppressed to 1.0 or less, and Free T3 & Free T4 to 50-75% of their ranges is a good starting goal). This will not only help replace the hormone your body is having trouble creating, but also suppress and quiet the antibodies somewhat. If the docs are just treating your thyroid based on TSH levels, it's nearly impossible to know where you *really* stand. The Free T3 and Free T4 are absolutely crucial because they tell you what amount of thyroid hormone is active right this very second. The TSH test is actually looking at a pituitary hormone, not a thyroid hormone, so its use isn't nearly as good in monitoring and treating thyroid problems. Once you start giving someone external thyroid hormone you are altering that HPG axis and feedback loop, and TSH becomes much less relevant.

If your endo is saying you need 150 mcg of T4 and your GP is refusing and saying that no, you don't -- well, you will probably need to advocate for yourself and ultimately choose which doc you want treating your thyroid problem.

The word "normal" is misleading. Normal as compared to what? When they created the TSH test ranges back in the 1970s, they didn't screen out people with existing thyroid problems. So the TSH test is already skewed from the get-go. With thyroid problems doctors should be actively listening to your symptoms (fatigue, poor sleep, joint pain, hot or cold feeling, etc.), examining you for signs (hair loss, dry cracking skin, poor reflexes, etc.), and doing thorough lab work. Simply falling within an arbitrary range on a piece of paper does not necessarily translate into you, or any other patient, feeling well. The keyword here is OPTIMIZED, not just "normal".


----------



## shorty85 (Aug 25, 2012)

My endo discharged me I got the impression he did not like the gps refusing the increasing in meds when he knew what he was talking about


----------



## bigfoot (May 13, 2011)

Hmm... I can definitely see an endo being upset about that. That's their speciality and area of expertise. When people find a good endo who understands all the details of thyroid stuff, they can wind up with really good treatment. And conversely, when people wind up with an endo (or any doc really) who does just the bare minimum, that can lead to poor treatment and feeling unwell.


----------



## shorty85 (Aug 25, 2012)

went to my gp today as needed to get my scar checked and asked about my thyroid levels he said they are normal to which i said but then why do i feel so crap? told him all my symptoms and he said yes sounds like your under again i told him to check i had been up twice not to long ago for the same symptoms so he checked. he checked my weight (increased) and bp which was normal. i asked him why in 2011 did they tell me i was not allowed to have my levo increased to the 150mg my endo said it needed to be he checked and said he didnt authorise it another member of staff did and agreed that he should not have done that as the endo was qualified enough to say how much i needed.

i told him my endo discharged me and i got the impression it was because the gps did not allow my meds to be increased and said he told me my levels were to be at the lower range which he did. he then went on to say yes i can see why that would have frustrated him and told me that as mine is autoimmune related i am different to the normal underactive patient. he decided to do bloods to make sure that nothing else was causing my tiredness then agreed to see me next week when they will be back and told me i will probably be sent to an endo who specalises in hashis and this time i will not be refused any meds i needed he said i looked drained and exhausted. called me his rare bird as i have sooo many autoimmune issues. fingers crossed he is going to try to keep this one under control.


----------



## shorty85 (Aug 25, 2012)

oh he also said my pathology said they need to do more tests to confirm i have castlemans as even though the features suggest it, there are also other thing that could make me have the same things in my lymph node. haematologist on friday.


----------



## bigfoot (May 13, 2011)

"Rare bird", huh? That's rich. 

Glad your doc at least listened to your concerns, addressed past issues, and is willing to work with you on improving your health. Sometimes all it takes is a friendly nudge.

Let us know what happens...


----------



## shorty85 (Aug 25, 2012)

lol yea he is the doctor that has dealt with me since i found the melanoma in 2011 so he remembers everything. thank you for replying to this post had you not i may have thought i was overeacting for nothing and i most probably would have accepted its how i am meant to feel and i was 'normal' so thanks to you he is listening to me now :anim_32:


----------



## bigfoot (May 13, 2011)

You're more than welcome, glad to help! 

While none of us can promise getting back to 110% of where we used to be, and sometimes that means adjusting to things, you certainly shouldn't be dragging yourself around and feeling poorly.


----------

