How to speak to a doctor (lab results)

[johndoe123]

Hello all,

This is my first post and am happy to have found this community. I hope it's okay to ask for help and I am looking forward to your replies.

I will also try to be as succinct as possible. I am a 31 year old male, and my life quality is terrible. I am struggling with depression, mood swings, fatigue, excess weight, poor sex life, etc. Quick Google search for my symptoms and voila - possible thyroid problems. So far I have seen two doctors and have ordered some tests privately, but the doctors I saw said all is good - but I still feel bad, of course

I had my basic blood work done in March last year, and more recently a thyroid panel this month. I also had a thyroid ultrasound. Here are the results (reference scales in brackets):

anti-tpo in March: 33, now: 29 (0-60)

anti-thyroglobulin abs in March: <15, now: 18 (0-60)

oestradiol: 153 (<170) - pretty high for a male

testosteron: 12.8 (10-30) - pretty low for a male

tsh in March: 2.1, now: 1.4 (0.3-5.5)

free t4 in March: 15.7, now: 14.4 (9-25) 33.75%

free t3 5.4 (3.5-6.5) 63.33%

Additionally:

MCHS level in red: 319 (320-370)

lymphocyte count: 1.55 (1.30-4)

cholesterol level in red: 5.3 (1-5)

LDL level in red: 3.4 (1-3)

cortisol: 256 (130-580)

C-reactive protein in red: 5.2 (<5)

Looking at the blood / thyroid panel, the majority of results seem (with a few exceptions) be within the reference ranges, however the ultrasound revealed that my thyroid is approx. 25-30% smaller than in other man. There is also a liquid filled lesion of 2 mm in diameter on the left lobe. The scan paper also said "suspected hypothyroidism".

Obviously, test results are one thing, but how I feel is another. To spare you reading my entire biography, here are a few bullet points:​

* thin, dry skin, always cracking in cold weather

* thin, dry hair, going gray quickly

* yet I have a quite youthful looking (fat) face

* overall body shape 100% resembling Cushing's:

- thin arms, long fingers

- stretch marks on thighs, buttocks, triceps

- scoliosis

- central obesity, with moon face but thin arms and legs

- buffalo hump

- very poor facial hair

- discoloured nipples

- I used to weigh around 8 stone up to my early 20s (looking too skinny), now I'm over 13 - this changed over the course of 2-3 years and I look like a balloon with thin arms and legs

- telangiectasia in my legs

- varicose veins

- no Adam's apple

* permanent feeling of depression

* I could sleep all day... but I find it difficult to fall asleep

* can't focus on a book or a movie

* ditched all my hobbies

* PE

* constantly feeling cold

* raised high rate

* permanent fatigue

* ever since I remember no physical strength, lifing my finger feels like a chore

* low exercise capacity

* high-pitched voice

* cramps

I quit alcohol and cigarettes for a year, signed up to the gym and ate healthy - I lost about 1 stone, but the overall body shape remained the same. No muscle mass, fat everywhere. Barely noticed the change in weight visually.

Long story short, I feel terrible and I look like a skinny pre-adolescent teenager with enormous belly and graying hair. My life quality is 0.

Previous doctors told me that:

1) I need to work less, ideally change my job (I wake up at 7 am back home around 9 pm)

2) I am lazy

3) I need to go the gym

3) I am just like that

4) when I start exercising, I will feel better

Well, I tried everything and nothing changed. Am I just imagining things and looking for an excuse for my laziness, or is there something else at play here?

Many thanks,

John Doe

[RobinAnn]

First Johndoe123 welcome and I'm so sorry you are going through such hell. You mention cushings- has anyone ruled that out? Did you have acth test done. Or any pituitary stim tests? Cushings is very often misdiagnosed and I think would impact you thyroid. You thyroid tests do seem normal but dropping which makes me wonder about secondary thyroid issues... aka pituitary, just like cushings. Has anyone in your family ever had cushings? I'm not remotely knowledgeable about pituitary issues except I was misdiagnosed for about a year in 2004 with secondary adrenal insufficiency so I read a lot.

[RobinAnn in reply to RobinAnn]

Also what kind of doctors have you been to? GP? Endocrinologist?

[johndoe123 in reply to RobinAnn]

Hi RobinAnn , many thanks for a reply. No, I don't think ACTH has been tested. First doctor ruled out Cushing's based on normal cortisol levels.

You mention that my thyroid tests are dropping - are they not supposed to fluctuate anyway? And what do you think about the size of my thyroid? The ultrasound revealed it's 30% smaller. Given the declining test results and the thyroid size, is it possible that it's shrinking?

EDIT: One was a GP, the other one was an endocrynoligst. He did the ultrasound.

[RobinAnn in reply to johndoe123]

I did a quick Google search. A daytime test of your cortisol does not seem relevant. So I would suggest you research that point and see if you think your endocrinologist did the right test or made the right call. This could/would impact sex hormones... I would think. My comment about fluctuating thyroid levels might be off. That might be normal but maybe someone else can step in who's more intelligent them I am:-). But it is possible to have thyroid disease with normal blood values... thyroid hormone resistance... I think.Maybe try a second opinion. Second endocrinologist or gp. Do you have people close enough in you life who can go with you and help argue your case. Vouch for sudden changes. That you are not lazy, etc... sometimes a tag team works better. My husband had to help me because thyroxin nearly killed me and nobody believed me or would help me and I went through 30 docs and finally left the country to get the help I needed. I know it can be worse then hell. Please keep in mind I'm not qualified regarding cushings but you have to believe in yourself. Never hesitate to fire a doctor or go to another country... if that's an option. Dr. Thirty Hertoghe in Belgium is an option but pricey. I know people here will try to help but don't give up. I almost once did. Have you tried other forums as well?

[greygoose]

A shrinking thyroid would suggest Hashi's. Yet, you have had two antibody tests, and both are very low. It's true that some people with Hashi's never develop high antibodies, but they are picked up with an ultra-sound. Was there any mention of damage to your thyroid? Or a suspicion of autoimmune hypo (Hashi's)?

When your doctor ruled out Cushing's on the basis of 'normal' cortisol levels, what type of test did he do? And early morning blood test?

[SlowDragon Administrator]

Have you had vitamin D tested?

Or B12, folate and ferritin too?

Post results and ranges if you have

You could get saliva cortisol testing done

thyroiduk.org.uk/tuk/testin...

[Angel_of_the_North]

Have you been tested for Cushings? And can you get a referral to an endo for the sex hormones?