Please Help me Understand...

iVillage Member
Registered: 06-25-2004
Please Help me Understand...
12
Fri, 06-25-2004 - 2:24pm
Last Wednesday GYN noticed an enlarged thryoid and sent me for blood work. TSH is 3.73, free T4 is 0.9, free T3 won't be available until Monday. From this, they are saying levels are "normal"; however due to the enlargement he is having an ultrasound performed next Tuesday. Could the T3 level alone indicate a problem? I was actually hoping for some out-of-whack numbers since I've gained 15 lbs (although I do Pilates or Taebo at least 3 times a week and walk at least 2 miles per day and eat relatively healthy) and some days feel like I've been run over by a truck and been frustated by some brain fog lately. My brother and grandmother are both medicated for Hypo as well. I've also had several bouts of laryngitis, thinning hair and dry skin. Please help me understand what normal #s, yet an enlargement might mean -- and if perhaps the T3 level alone could spell "trouble". Thank you!! p.s. Just started corticosteroids today for poison ivy. Do you think this will affect the ultrasound results 5 days from now?? (On steroids for 6 days)

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iVillage Member
Registered: 11-09-2001
Fri, 06-25-2004 - 5:42pm
Hi and welcome ....... I think you need a new doctor. Even if your gyno comes back and tells you that you're normal, with your history and just the TSH level alone, you are plainly hypothyroid. Here are the normal ranges for T3: 2.3 to 4.2, less than 2.3 indicates hypothyroidism. Normal range for T4 is 0.7 to 2.0, less than 0.7 indicates possible hypothyroidism. Did your doctor do any thyroid antibody tests? These will show the presence of antibodies that indicate Hashimoto's - autoimmune hypothryoidism. The enlarged thryoid is enough, for goodness sake, to show that you aren't "normal"! Normal thyroids are not enlarged. And the new upper range for TSH level - for diagnosis purposes - is 3.0 so on that basis alone you're hypothyroid.

Here's an article that talks about the different tests and how to read the results. Hope this helps! Cathy :)

Thyroid

There are 2 types of thyroid hormones easily measurable in the blood, thyroxine (T4) and triiodothyronine (T3). For technical reasons, it is easier and less expensive to measure the T4 level, so T3 is usually not measured on screening tests.

Please be clear on which test you are looking at. We continue to see a tremendous amount of confusion among doctors, nurses, lab techs, and patients on which test is which. In particular, the "Total T3", "Free T3" and "T3 Uptake tests" are very confusing, and are not the same test.

Thyroxine (T4) . This shows the total amount of the T4. High levels may be due to hyperthyroidism, however technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills or estrogen replacement therapy. A Free T4 (see below) can avoid this interference.

T3 Resin Uptake or Thyroid Uptake. This is a test that confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein! The method of reporting varies from lab to lab. The proper use of the test is to compute the free thyroxine index.

Free Thyroxine Index (FTI or T7) : A mathematical computation allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the blood stream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels.

Free T4 : This test directly measures the free T4 in the blood rather than estimating it like the FTI. It is a more reliable , but a little more expensive test. Some labs now do the Free T4 routinely rather than the Total T4.

Total T3: This is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent and shorter lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3.

Free T3: This test measures only the portion of thyroid hormone T3 that is "free", that is, not bound to carrier proteins.

Thyroid Stimulating Hormone (TSH) : This protein hormone is secreted by the pituitary gland and regulates the thyroid gland. A high level suggests your thyroid is underactive, and a low level suggests your thyroid is overactive.

iVillage Member
Registered: 06-25-2004
Fri, 06-25-2004 - 9:51pm
Cathy - thank you for your reply!! I've read so much my head is spinning and I know already that the Endo Assoc had lowered diagnostic levels for TSH. I've also picked up somewhere that even .9 on the free T4 should be a slight concern. I'm trying to be patient at this point since we don't have the T3 back yet and he still wants to do an ultrasound. I agree that something must be "wrong". Anyway, I will tell you that I already had an appt. scheduled for next Thursday with my GP, so if this all doesn't pan out I have back up in line. I was definitely going to take advantage of the fact that my GYN noticed an enlarged thyroid, though. But I will definitely seek a 2nd opinion if this doesn't "pan out". Thank again for the article reference and reply!! :) Stephanie
iVillage Member
Registered: 11-09-2001
Fri, 06-25-2004 - 11:17pm
You're welcome! I know it's a lot of info!! Let us know how you do on Monday when you get the T3 results back or at least by Thursday when you see your other doctor. Good luck!! Cathy :)
Avatar for cl_calley7
iVillage Member
Registered: 03-20-2003
Sun, 06-27-2004 - 10:50pm

Hi Mommy2livnkari,


I would agree that your symptoms do sound as though there is some problem.

 

Calley7

iVillage Member
Registered: 06-25-2004
Tue, 06-29-2004 - 11:22am
Cathy and Calley - thank you both for your replies and information. Just returned from the ultrasound. The tech lingered quite a bit on the right vs. the left. She didn't indicate much and I wouldn't know what to ask. A side-by-side view was left on the screen as I left and the right definitely looked bigger. The results should be in in 3-4 working days. Should it have been a bit painful for her to roll the ultrasound ball over my neck? It was on the right - just uncomfortable, really. I'm still waiting on the T3 results, could be as late as Wednesday. I will keep you posted. Thanks again!!
iVillage Member
Registered: 06-25-2004
Wed, 06-30-2004 - 12:27pm
I have received the results of my ultrasound...somewhat. So much for that 3-4 day wait! There is a "goiter" on the right side, as suspected. Still no word on my T3 levels. However, my GYN is referring me to an ENDO. I have an appt. on July 6th. I'm nervous, yet a little excited that I'll be able to talk to someone who specializes in this sort of thing. Given my symptoms and levels, etc. are there any questions you recommend I pose to the ENDO? I have a few, but want to make sure all of my bases are covered. Thanks again for all your replies and helpfulness in understanding all of this!! :)
iVillage Member
Registered: 06-25-2004
Sun, 07-04-2004 - 9:19am
I've now received the report from the lab on the ultrasound and my T3 results. Free T3 was measured at 288 (normal ranges for this lab are 210-440). T3 by RIA (?) measured at 121 with normal being 65-164. The pathologist report regarding my goiter read "right lobe measured at 4.7 cm, left at 3.8 cm - both within normal range. Thyroid does demonstrate what appeared to be several nodules scattered throughout both lobes, likely representing multinodular goiter. No significant cystic areas are identified. Nuclear medicine study is suggested for correlation." I honestly have no idea what some of this means, but it would sound as if I would need treatment of some sort. I meet with the Endocrinologist on Tuesday.
iVillage Member
Registered: 04-16-2004
Mon, 07-05-2004 - 12:28pm
Hi there. What the report on your ultrasound meant by the nuclear medicine study is they sometimes do what is called an Radioactive Iodine Uptake test (RAI-U). What that is they give you a small dosage of radioactive iodine---usually in a pill, sometimes through an IV and scan (X-ray I think) your thyroid to see how it is utilizing iodine. They will look at the scans to see if you have any hot or cold nodules, hot meaning using more cold meaning using less. From what I know that's pretty normal for people who have nodules in their thyroid because it's a better gauge to check for the possibility of thyroid cancer.

I haven't had that type of scan, a friend of mine has and she said it was no big deal. I do know what its like to have a "goiter". Mine is multinodular diffuse goiter, so my nodules are very small and there is a TON! but, my condition is autoimmune, so the nodules are caused by the attack on my thyroid then the antibodies are settling in there. But I can't be diagnosed with hashimoto's (underactive) of grave's (overactive) because for now my TSH is normal, I'm not on the low end of either range, although in the spring I was closer to the hyper side.

Also the swelling of the thyroid is usually called thyroiditis, and all that means is it's inflamed. itis= swelling. Some research describes it as arthiritis of the thyroid, but its really referring to the inflamation. Its common if your thyroid isn't working correctly to have swelling. I have about the same measurements on the lobes of my thyroid. Sometimes mine is uncomfortable. The pressure kind of feels like I have on a turtleneck sweater, or a choker necklace. And sometimes I pull my shirts and jackets and seatbelts away even though they aren't tight.

If I were you I would ask your doctor about the possibility if your goiter has been caused by an autoimmune thyroid disorder. They will have to check your anti-thyroid antibodies through bloodwork. But from your test results you are hypo and they might want to start you on thyroid hormone supplement, or wait and do more testing.

Your doctor has good advice about the vitamins. A good B-complex will definately help boost your energy level! If you do decide to take a multi, buy a good multi that also includes trace minerals, like copper, selenium, zinc, etc. And don't waste your money at GNC-- too expensive. Also Bee Pollen is great for energy too. Stay away from energy drinks like Red Bull, from what I've been told its worse on your body than taking ephedra. Try reading up on about.com-- there's tons of thyroid information, and good info on diet & exercise & nutrition for thyroid sufferers : http://thyroid.about.com/blthyroid.htm

here's some info on thyroiditis: http://www.mythyroid.com/thyroiditis.htm

more nutritional & supplement info: http://www.wellnessresources.com/protocols/ThyroidMetabolism.htm

I found that my endocrinologist couldn't give me any advice about vitamins or herbal supplements, but it would be a good idea to mention that you want to include some or to tell them what you are taking in case they know of any interractions. And just like Cathy & Calley said, it's important to take your thyroid meds alone so they can function they way they need to.

Good luck, I hope your endocrinologist can help shed some light on the whole situation. You gyno & MD have some knowledge of what's going on and it was very smart of them to run the bloodwork and have you have the ultrasound. You are lucky to have gotten such a quick appointment. I hope this info helps you in some way. --Lisa

iVillage Member
Registered: 06-25-2004
Mon, 07-05-2004 - 3:53pm
Lisa - thank you for the information. I'm looking forward to learning more at my appointment tomorrow. I've also learned this weekend that my paternal grandmother passed away of thyroid cancer 30 years ago - I had thought all this time it was an aneurysm, but with this thyroid goiter of mine, my family has now corrected me.
iVillage Member
Registered: 11-09-2001
Tue, 07-06-2004 - 1:12pm
Thanks for all the great info, Lisa!! Cathy :)

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