Discussions By Condition: I cannot get a diagnosis.

I think I may have hypothyroid

Posted In: I cannot get a diagnosis. 18 Replies
  • Posted By: rbcountrygirl
  • December 18, 2007
  • 02:44 AM

I read through the symptoms of hypothyroidism and my symptoms match perfectly. When I get my blood checked tho the results keep comming back is within the normal range. What could be causing the very same sypmtoms as having a hypothyroid:(

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  • I've heard that 24hr urine test for thyroid hormones is a good one to have if blood tests are normal. Also, is your thyroid visibly swollen ? (base of neck at front)
    kentishman 19 Replies
    • December 22, 2007
    • 11:26 PM
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  • "Normal" isn't good enough. Most docs don't know what normal is, you need to know the numbers. Preferably at least TSH and Free T4, but Free T3 would be good too, as would antithyroid antibodies (anti-TPO, Tgab)
    Tranquillity 34 Replies
    • December 23, 2007
    • 09:55 AM
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  • the very bottom part of my neck that is against the shoulders seem to be a lil larger than i think it should be.
    rbcountrygirl 3 Replies
    • December 29, 2007
    • 02:12 PM
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  • I am fascinated by the assertion that doctors have no idea what normal ranges are for thyroid function tests. I have seen alot of posts that suggest thyroid disease is a mystery to physicians. FYI- Thyroid d/o are covered extensively in med school and on the boards. As for the normal ranges of TFTs- take a look at your lab results... they are printed on the paper... The symptoms for hypothyroidism are pretty general, but if you are concerned, that is always the indicator that you should be evaluated. The anti thyroid peroxidase and anti thyroglobulin antibodies are tests that will specifically test for Hashimoto's. TSH and free T4 levels are the best screening test for hypothyroidism. In fact T3 is usually not as helpful when hypothyroidism is suspected, because the levels do not change until late in the disease course.
    fewd4thought 126 Replies
    • December 31, 2007
    • 03:06 PM
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  • I am fascinated by the assertion that doctors have no idea what normal ranges are for thyroid function tests. I have seen alot of posts that suggest thyroid disease is a mystery to physicians. FYI- Thyroid d/o are covered extensively in med school and on the boards. As for the normal ranges of TFTs- take a look at your lab results... they are printed on the paper...The symptoms for hypothyroidism are pretty general, but if you are concerned, that is always the indicator that you should be evaluated. The anti thyroid peroxidase and anti thyroglobulin antibodies are tests that will specifically test for Hashimoto's. TSH and free T4 levels are the best screening test for hypothyroidism. In fact T3 is usually not as helpful when hypothyroidism is suspected, because the levels do not change until late in the disease course.I agree, kind of. I've heard MANY stories, most likely all of which are true, of people who had major hypothyroid symptoms, a TSH of 4.5 and Free T4 just at the bottom of the range, being told that they're fine (since the old US range for TSH was 0.5-5.0).Just the fact that SO MANY don't feel good until their Free T4 is mid-range kind of tells you that "normal isn't good enough", and certainly, with a TSH above 3, low-normal free T4 and plenty symptoms, treatment will likely not hurt.However, when people negative for antibodies, and truly *normal* values still have symptoms, well... I obviously agree that the thyroid isn't to blame. I'm not much for these naturopathic ideas, not to mention electromagnetic field sensitivity and "magnet deficiency". :DBTW, regarding T3. I do know that - in most people - the T3 won't drop until very late, due to increased T4->T3 conversion. However, what if the patients has trouble converting? I don't know what the official medical literature says about this, but surely it's been proven many times that selenium deficiency for one can create hypothyroidism symptoms due to bad conversion, since the enzymes that convert T4 to T3 contain selenocysteine (which, in turn, contains selenium, of course). In which case, by the way, adding T4 might not do much good either.
    Tranquillity 34 Replies
    • December 31, 2007
    • 03:25 PM
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  • IMO most MDs have very little knowledge about the hormone glands and their functions, and how they are interrelated. Most only order TSH tests, which are pituitary hormones, not thyroid hormones. And blood levels are often not a good indicator of what may really be going on. Tranquility said: I'm not much for these naturopathic ideas, not to mention electromagnetic field sensitivity Why do you have such an opinion ? A bad experience ?
    Anonymous 42789 Replies
    • December 31, 2007
    • 04:41 PM
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  • Why do you have such an opinion ? A bad experience ?Well, it *completely* depends on what topic we're talking about. I'm (defititely) not saying naturopathy is stupid. I am however very science-oriented, and as such I recognize that a lot of things within alternative medicine is downright lies; but naturopathy is generally *not* in this category. However, anyone treating people using magnets or pure water (i.e. (some?) homeopaths) are quacks in my book though. ;)
    Tranquillity 34 Replies
    • December 31, 2007
    • 04:50 PM
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  • OK, some reservations. Does the body ultimately run on electricity ? I would say electricity and hormones. What about the EDS ?Will be back in a while - going out doing errands now.
    Anonymous 42789 Replies
    • December 31, 2007
    • 05:40 PM
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  • Just to follow up on the posting by Tranquillity... Selenium deficiency is really rather rare in the US, but because I don't care for the OP, I am in no position to rule anything out. As a screening test, I still think that free T4 and TSH would be appropriate at an inappropriately high T4 would suggest an defect in conversion. If the screening tests were abnormal, I would follow up with additional testing and imaging to determine more specifically the abnormality. When developing a differential for this patient, I would also consider a number of other conditions, and selenium deficiency would not be on the list. BTW, neither would EMF radiation...
    fewd4thought 126 Replies
    • January 1, 2008
    • 00:18 AM
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  • what is the low range of the t4 and t3. I'm going for more blood work on the 8th and gonna be getting the t4 and t3 tested. What should I tell the doc. if he says that they are within normal range but are at the veryyyyyyyyyyyy bottom of this sole called normal range. Would it be worth my while to get him perscribe me med that will increase my t4 a lil higher. And what bad side affects does this med have.
    rbcountrygirl 3 Replies
    • January 1, 2008
    • 03:55 AM
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  • Just to follow up on the posting by Tranquillity... Selenium deficiency is really rather rare in the US, but because I don't care for the OP, I am in no position to rule anything out. As a screening test, I still think that free T4 and TSH would be appropriate at an inappropriately high T4 would suggest an defect in conversion. If the screening tests were abnormal, I would follow up with additional testing and imaging to determine more specifically the abnormality. When developing a differential for this patient, I would also consider a number of other conditions, and selenium deficiency would not be on the list. BTW, neither would EMF radiation...Interesting. In fact, my T4 level is (or at least) *was* inappropriately high (just 2.4% above normal, but still; along with a TSH of 3.77) and yet I suspected (and kind of still do) hypothyroidism. Any ideas what to check next, then? :) I'm not in the US btw, it seems selenium deficiency is a bit more common over here; I haven't noticed much of a difference with supplementation yet, though.
    Tranquillity 34 Replies
    • January 1, 2008
    • 00:07 PM
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  • How about, instead of chasing for "perfect" numbers, using supplements that have been specifically designed to help the thyroid regain its optimal function ? Most treatment, whether conventional or alternative, pushes a low functioning thyroid up and a high functioning one down. How does one know when the gland is in balance and how can one keep it there with the upper and downers ? I know of, and have used quite often with patients, supplements from 2 companies that are designed to be used when the thyroid is either high or low. And generally used them to excellent effect. Other considerations besides number chasing is to find out why the thyroid is currently malfunctioning. Could be due to hypothalamus, pituitary, adrenal, liver malfunctions or more. Or combinations of those. The problem will always be there if the heart of the matter is not found and addressed. I first got very interested in endocrine work when many patients would have complaints and literally have to harass their MDs (I am a DC in OH where the law allows us to address most problems naturally) into having tests ordered. Very often the tests would come back "normal" and the patients were rudely dismissed with "it's all in your head", even when all the classic symptoms were there.
    Anonymous 42789 Replies
    • January 1, 2008
    • 03:14 PM
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  • great advice ralph.
    fewd4thought 126 Replies
    • January 1, 2008
    • 07:59 PM
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  • I thought I was hypothyroid too. I mean, I had lost my appetite, my skin was dry, I lost about half my hair, I had a lot of comression neuropathies, my blood pressure and body temperature were always low, my voice grew hoarse, my cholesterol and triglycerides were always elevated, I felt tired, weak, slow, constipated, etc etc...Over the course of about 8 years, my thyroid hormone levels were checked at least 6 times, and because they were always normal, I was told my thyroid gland was okay. I was reassured of this numerous times in that tone of voice that implies you're a hypochondriac, coo coo for cocoa puffs, or nuttier than a jar of skippy.At the same time, I began to develop strange neuro symptoms, which prompted a work-up for MS...My 8th- yes 8th neurologist finally decided to check my thyroid antibodies- they were sky high and she diagnsoed me with Hashimoto's Encephalopathy. A subsequent thyroid ultrasound revealed that my gland was full of tiny nodules, clinching the diagnosis of Hashimoto's Autoimmune Thyroiditis.I was so angry! For years my doctors told me my gland was okay, but it wasn't. Did it really have to take eight years and eight neurologists to find out my thyroid gland was sick??? (???????????????????????????)While you may not have the encephalopathy (which is a rare complication of the thyroiditis), please do not let your doctors tell you your gland is okay until they have shown you that your antibodies are negative. Your body may be autoejecting your thyroid and because doctors are not trained to check antibodies until the hormones are abnormal or unless you have a goiter, they will miss some cases of thyroiditis.When you're the patient, that's a pretty big "oops".To this day my doctors deny that all my thyroid symptoms had anything to do with my autoimmune thyroiditis. Of course, I can not agree with them.
    Anonymous 42789 Replies
    • January 2, 2008
    • 08:33 AM
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  • Missing Hashimoto's is an incredibly big Oops, because it is one of the most common causes of autoimmune thyroiditis, and your doctors are trained to check for it. I am really sorry that you went through an easily avoidable series of complications as a result of missing a simple diagnosis.
    fewd4thought 126 Replies
    • January 3, 2008
    • 10:39 PM
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  • Very long article about the reference ranges.Right now, a battle is waging in the endocrinology community regarding the so-called "reference range" for the Thyroid Stimulating Hormone (TSH) test. The importance of this controversy cannot be underestimated. The majority of practitioners -- including endocrinologists, the physicians who specialize in thyroid disease -- rely solely on the TSH test as the primary test, the supposed "gold standard" in fact, for diagnosing and managing most thyroid conditions. There is ongoing controversy about whether reliance on the TSH test -- to the exclusion of clinical symptoms and other tests such as Free T4, Free T3, and antibodies tests -- is medically sound. zSB(3,3)That is a controversy that is unlikely to be decided for years. The situation today, however, is that the majority of physicians do rely almost exclusively on the TSH test to detect thyroid disease, and monitor the effectiveness of treatment. Surprisingly, however, while the medical community does rely on the TSH test, there is complete disagreement within the community as to what constitutes the "normal range." What is a Reference Range? Reference range is a critical component, and the validity of the entire TSH test as diagnostic tool depends on it. A TSH reference range is obtained by taking a large group of people in the population, measuring their TSH levels, and calculating a mean value. Supposedly, these people should be free of thyroid disease, so that the level represents the mean TSH of a typical thyroid disease-free person in the population. The reference range is what determines whether or not thyroid disease is even diagnosed at all, much less treated, and when it is diagnosed, how it is treated. Currently, at most laboratories in the U.S., the reference range for TSH tests is approximately 0.5 to 5.0. Depending on the lab, you may seem some variations, i.e., 0.4 to 5.5, or 0.6 to 5.7, etc., but generally, 0.5 to 5.0 is considered typical of many labs. Typically, doctors interpret levels below 0.5 as indicative of hyperthyroidism (an overactive thyroid), and levels above 5.0 as indicative of hypothyroidism (an underactive thyroid.) Changing the Reference Range After noticing that patients who had TSH levels in the higher end of the normal range tended to go on to develop hypothyroidism more often than those in the lower end of the spectrum, researchers delved more fully into understanding the validity of the reference ranges in use. They found that the upper TSH normal range has traditionally included people who have mild thyroid disease, and their higher TSH levels skewed the standard curve, potentially making the reference range wider than it should be, and excluding some people who legitimately had a thyroid condition. These findings led to the recommendation in January 2003 by the American Association of Clinical Endocrinologists (AACE) that doctors "consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now." In a statement from the AACE, Hossein Gharib, MD, FACE, and president of AACE at the time, said, "The prevalence of undiagnosed thyroid disease in the United States is shockingly high...The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression." AACE cited as evidence the guidelines issued by the National Academy of Clinical Biochemistry, part of the Academy of the American Association for Clinical Chemistry (AACC), and presented in their Laboratory Medicine Practice Guidelines for the Diagnosis and Monitoring of Thyroid Disease. Late in 2002, the group concluded that "it is likely that the current upper limit of the population reference range is skewed by the inclusion of persons with occult thyroid dysfunction." In their guidelines, the National Academy of Clinical Biochemistry reported that: "In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L." They also stated that "a serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism.At the time of the announcement, almost three years ago, AACE estimated that the new guidelines would double the number of people who have abnormal thyroid function, bringing the total to as many as 27 million, up from 13 million thought to have the condition under the old guidelines. These new estimates would make thyroid disease the most common endocrine disorder in North America, far outpacing diabetes. The announcement from AACE was seen by many as a long-overdue and much-needed improvement in the level of awareness of endocrinologists. After decades of denying that patients within the normal range of TSH could in fact have a thyroid condition, they were acknowledging what patients and advocates had been saying quite vocally for years: that the high and low end of the TSH normal range were not, in fact, normal for most people. "...using a TSH upper normal range of 5.0, approximately 5% of the population is hypothyroid. zSB(3,3)However, if the upper portion of the normal range was lowered to 3.0, approximately 20% of the population would be hypothyroid..."More recently, researchers have looked at an important question: If the normal TSH range were narrowed, as has been recommended by AACE and the National Academy of Clinical Biochemistry, what are the implications? One 2005 study found that using a TSH upper normal range of 5.0, approximately 5% of the population is hypothyroid. However, if the upper portion of the normal range was lowered to 3.0, approximately 20% of the population would be hypothyroid! According to another study, an additional 12.8 to 16 million people would be diagnosed with hypothyroidism if the TSH upper limit was 3.0, and an additional 5.4% to 6.3% of the population --- 10.8 to 12.6 million -- would be diagnosed as hypothyroid if the upper range for TSH was 2.5. Clearly, these narrower ranges have huge implications for millions of people who are not being diagnosed or treated, because their test results are being evaluated according to the old reference range. Untreated thyroid disease can severely compromise quality of life, and in some cases even be fatal. Untreated thyroid disease can cause or contribute to numerous debilitating symptoms and conditions, including, among others: weight problems and obesityexhaustion and fatiguedepression and anxiety disordersheart diseasestrokeinfertilitymiscarriagebirth defectsSome Experts Adopt the New Range Interestingly, however, in the past three years, most laboratories in the U.S., despite what are clear communications from both AACE and the Laboratory Medicine Practice Guidelines, have not revised their TSH reference range, and remain with the 0.5 to 5.0 range as their "normal range." Some practitioners have adopted the new range for diagnostic and treatment purposes. Some physicians, who are aware of the new guidelines, have, however, chosen not to follow them, and remain with the older reference range. Some of them have made this decision because they do not agree with the new range, medically. Others are attempting to "play it safe" and protect themselves because the laboratories have not yet gone with the change, and these doctors are reluctant to diagnose a thyroid condition unless the printed lab report flags a TSH test result as "high" or "low." There are also many doctors, general practitioners and even endocrinologists who are still routinely diagnosing and treating patients according to the old reference range simply because they aren't even aware of the new reference range guidelines. Interestingly, some patients who have asked for physicians to diagnose and treat them by the new reference range have been turned down, told off, or even fired by their physicians. This has led to even greater controversy in the medical community, as doctors are taking sides in the debate over the old and new reference ranges. From About.com thyroid
    rad-skw 1605 Replies
    • January 4, 2008
    • 00:02 PM
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  • I thought I was hypothyroid too. I mean, I had lost my appetite, my skin was dry, I lost about half my hair, I had a lot of comression neuropathies, my blood pressure and body temperature were always low, my voice grew hoarse, my cholesterol and triglycerides were always elevated, I felt tired, weak, slow, constipated, etc etc...Over the course of about 8 years, my thyroid hormone levels were checked at least 6 times, and because they were always normal, I was told my thyroid gland was okay. I was reassured of this numerous times in that tone of voice that implies you're a hypochondriac, coo coo for cocoa puffs, or nuttier than a jar of skippy.At the same time, I began to develop strange neuro symptoms, which prompted a work-up for MS... My 8th- yes 8th neurologist finally decided to check my thyroid antibodies- they were sky high and she diagnsoed me with Hashimoto's Encephalopathy. A subsequent thyroid ultrasound revealed that my gland was full of tiny nodules, clinching the diagnosis of Hashimoto's Autoimmune Thyroiditis. I was so angry! For years my doctors told me my gland was okay, but it wasn't. Did it really have to take eight years and eight neurologists to find out my thyroid gland was sick??? (???????????????????????????) While you may not have the encephalopathy (which is a rare complication of the thyroiditis), please do not let your doctors tell you your gland is okay until they have shown you that your antibodies are negative. Your body may be autoejecting your thyroid and because doctors are not trained to check antibodies until the hormones are abnormal or unless you have a goiter, they will miss some cases of thyroiditis. When you're the patient, that's a pretty big "oops". To this day my doctors deny that all my thyroid symptoms had anything to do with my autoimmune thyroiditis. Of course, I can not agree with them.Elke, what were you nuro symptoms?
    Bristol 6 Replies
    • January 7, 2008
    • 04:39 PM
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  • the only thing that i have not had yet is a high colestoral count but I am the type that watches what I eat.
    rbcountrygirl 3 Replies
    • January 7, 2008
    • 10:46 PM
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