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jeansp 03-15-2011 05:20 PM

hypothyroid symptoms for years neg tsh,t3,t4
I have complained of hypothyroid symptoms for years and tsh always neg. Docs always want to diagnose me with anxiety, depression, and etc. Symptoms getting easily fatigued, dizziness with nausea, tight feeling in neck (like squeezing and tight muscles), food gets stuck when trying to swallow, and always feels like swelling in my neck. My sister and grandma are hypothyroid, dad and grandm have rhumatoid arthritis, I also have endometriosis, and mom diabetic. TSH always comes back in normal range. Sent to ENT because PCP think I have inner ear thing. Day before ENT appt. I found nodule on right side of thyroid. Saw ENT on Friday and scheduled me for u/s on Saturday also ordered T3 and T4. Got call today From ENT office and they said he wants to do u/s with FNA and that my labs were normal. They said there is only one nodule less than 1cm. I'm scared to have the biopsy, I hate needles, but I will have it done. Anyone been through this and what can I expect. I have 4 young children and I am scared to death that it is cancer.

cd37 03-16-2011 06:41 AM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Please do not accept "normal" (aka in-range) as an acceptable answer for your thyroid labs.

"Normal" results does not mean they are YOUR normal.....especially if the results are below mid-range.

Most people have FreeT4 and FreeT3 levels in the upper third of the range, if not higher.

You are legally entitled to copies of your lab results - please post them here and we'll help you interpret them.

It sounds like you are hypothyroid.

jeansp 03-16-2011 09:29 AM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Thank you so much for you post. Does it sound like they are going in the right direction with the nodule? I'm scared to death of the FNA. Does it hurt? I was so uncomfortable with just the ultrasound probe on my neck. I will find out my exact # for t3 and t4. My tsh(3rd generation) is 1.2.

cd37 03-16-2011 09:48 AM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Glad I could help :)

Well, the guidelines for FNA is nodule 1.5cm or larger *but* it is wise to investigate a solitary nodule. Most people develop nodules on their thyroids and don't realize it until investigations "in the area" result in the discovery of them. And, please be comforted in knowing that most nodules are benign.

I had a FNA done on a 1.3cm nodule - the ENT applied a numbing agent - the actual procedure wasn't painful per se but it was uncomfortable mostly from a feeling of pressure.

If you want to be adequately treated for your hypothyroidism, you're going to need to work on your fear of needles. The patients with the most successful outcomes get regular labs (I actually go for labs every 4 weeks since I am trying to "nip things in the bud" in, "catch" any changes in my thyroid hormone levels and adjust my meds doses before I develop symptoms.....I do this because it takes so long for symptoms to dissipate after dose adjustments and quality of life is VERY important to me).

Please let us know how things go.

jeansp 03-16-2011 12:55 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
T3 =28, T4=8.6, TSH=1.2

cd37 03-16-2011 12:59 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Unfortunately, lab values are useless unless the reference ranges are also listed (ranges vary from lab to lab and by geographical area - it's important to see "where" your results "fit" within the ranges) Any chance you can post the ranges?

Also, please check to see if those are "free" results....."plain" T4 and T3 levels are obsolete and do not provide accurate information since the results can be falsely elevated due to binding issues.

jeansp 03-16-2011 01:22 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
These are plain T 3 (24-35) T4 (4.5-12.5) TSH 3rd gen 1.12 (.40-4.50). Scheduled for FNA 3-30. Is that too long? So tired of dr and staff saying my symptoms can't be related to my thyroid because the nodule is too sm to cause symptoms and all labs normal. I'M SOOO FRUSTRATED. Is this normal?

jeansp 03-16-2011 01:26 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Also the nurse said I must really be in tune with my body because the nodule isn't big enough to cause problems. I requested antibodies be tested and she said with Hashimoto you have more than 1 nodule or goiter so it couldn't be that. Wonder why we get Dx with depression so much?!

cd37 03-16-2011 01:34 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
People can have Hashi's without having nodules. And, those that do have nodules can suffer from a hyper-functioning nodule which will cause them to be basically hypothyroid but, as the nodule "throws off" thyroid hormone, will also cause them to have hyper symptoms.

At the end of the day, you are dealing with medical professionals that obviously do NOT understand thyroid disease.....they aren't even running the right labs!

Just looking at your "plain" T3 & T4 levels (which are falsely elevated due to binding issues), they are very much below mid-range.

Most people need their FreeT3 and FreeT4 levels well above mid-range if not towards the high end of the range.

You just might want to read "What Your Doctor May Not Tell You About Hypothyroidism" by endo Dr. Ken Blanchard.

He explains how people can be blatantly hypothyroid with "normal" (aka in-range) labs.

I suggest you start doctor-shopping.

You might want to call your pharmacist for contact info for doctors that Rx Armour and/or Cytomel....these are T3-containing thyroid hormone replacement meds that most "with-it" doctors Rx. This is not to say you need a T3 med....many fare well on synthroid/levothyroxine (T4 med)....this is just one way to improve your odds of finding a "with-it" doctor.

cd37 03-16-2011 01:36 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
You just might want to read some of the stories posted on here by other members....your situation is, unfortunately, all-too-common......

midwest1 03-17-2011 09:44 AM

Re: hypothyroid symptoms for years neg tsh,t3,t4
I have Hashi's without goiter or nodules. Your medical "pros" are so wrong, there needs to be another word for wrong.

Find a doctor who knows enough to recognize the disease when he sees it.
Oh... And we get diagnosed with "depression" so much because it's the easy way out. Wham bam ... MD can make that "diagnosis" within the first 5 minutes, no labwork needed, anti-D pills earn huge profits in kickbacks. What's not for an MD to like about a depression diagnosis?

jeansp 03-17-2011 05:22 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
@ midwest1 I know I am sooo frustrated with the whole situation

jeansp 03-17-2011 05:43 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Ok went and got my us report and some past labs. Anyone please give me some feedback.

us report
Finding: The right lobe of the thyroid gland measures 3.7x0.9x1.4cm. It is mildly heterogeneous in echotexture. There is a 9.0x5.0x7.0mm mixed echogenicity nodule associated with the medial inferior pole.
The left lobe measures3.0x0.6x1.3cm. No thyroid nodule is demonstrated. Thyroid isthmus measures 2.0mm in thickness
Impression: Single 9x5x7mm nodule associated with the inferior pole of the right lobe medially. Consider fine needle aspiration biopsy

3-24-05(date) tsh 1.2(.3-4.8)
2-13-07 tsh 1.6(.3-4.8) T4free .88(.58-1.64)
9-18-08 tsh 2.0(.3-4.8)
3-4-10 tsh 1.1
8-9-10 tsh .98
2-10-11 tsh 3rd generation 1.12(.40-4.50)
3-11-11 T3 UP 28(24-35) T4 8.6(4.5-12.5)

I have FNA sched 3-30-11 will be done by radiologist

What do you think...anyone?

cd37 03-17-2011 07:55 PM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Not sure what was going on in between 'cuz you just had TSH done (which often doesn't give a clear picture) *but* you were most definitely hypothyroid in 2007 and are hypo now (even though the right labs weren't run - T4 is often falsely elevated and your level is already low)

Good idea to get a FNA of a solitary nodule even though it's so small - just to play it safe.

jeansp 03-18-2011 10:22 AM

Re: hypothyroid symptoms for years neg tsh,t3,t4
Does my us description sound like Hashimotos? What about the description of the nodule? Are they doing FNA because the nodule looks suspicious or to see if it is Hashimotos? Anyone have any idea?

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