I am new here. At an ENT appointment for labyrinthitis 3 weeks ago, the consultant noticed a swelling in my neck and subsequently the ultrasound scan showed a multinodular goitre on one side of my thyroid. Having researched online and found that symptoms of palpitations, mood swings, constipation, cold feet and hands, pounding heart beats, and dry coarse hair for the past (at least 5 or 6 yrs, if not more) might be due to my thyroid. Since that scan I have also started having a pulsating ear (mainly at night?), burping after food or drinking, there is a slight hoarseness in my voice, dry throat, my tummy feels funny like gassy and trouble sleeping a couple of nights. I have also purchased an online Thyroid blood test the result of which was normal - TSH 1.08 mu/L, FT4 20.8 pmol/L, FT3 4.3 pmol/L. But I don't feel normal!
I have an appointment with an Endocrinologist tomorrow. I am just wondering if anyone can advise what other tests can be done and what would I expect from that appointment. Everything is such a muddle to me now.
Many thanks!
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sspringer
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For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels tend to lower TSH
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis) usually diagnosed by high thyroid antibodies…..but also can be diagnosed by ultrasound as you have been
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally before 9am
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
Ultrasound scans can’t tell the function of the thyroid, they look at blood test to see if the levels are abnormal.
Most nodules do not function, some function normally and it is possible they autonomously ‘over’ function.
This usually rises FT4 & FT3 & the TSH drops. The TSH is a pituitary hormone which stimulates the thyroid so it drops telling the thyroid to stop producing. But nodules continue to produce.
You haven’t added a range but FT4 looks top of most range & definitely something which need monitoring as lots of your symptoms such as palpitations could suggest hyperthyroid.
Some symptoms are more common with hypothyroidism. Autoimmune thyroiditis can cause damage to the thyroid can cause transient hyper & fluctuations in thyroid levels. So if you haven’t have them test I would suggest you have TPO and TG antibodies as this will show if autoimmune is occurring.
If thyroid levels trend downward having positive antibodies will support beginning treatment before levels reach under range. If levels begin to rise continuously then it may be the nodules causing them or another autoimmune called Graves.
Nodules are common with autoimmune but do occur without. I have a large solitary nodule without autoimmune. Levels rose very gradually & it was missed for many years.
What time was blood sample taken? Early morning will have higher TSH & lower FT4 than later in day.
Do you take supplements?
Do you have a fit bit or tracker as good way to monitor heart rate.
Also important to test:
Folate, ferritin, B12 & vitamin D. If these are deficient it can compound symptoms with thyroid or mimic similar symptoms.
The blood test was done mid morning. The FT4 normal range is 12 - 2w pmol/L and my result was 20.8 pmol/L.
I hope the endo will include TPO and TG antibodies test during our video consultation tomorrow especially after telling him of my 'normal' blood test results. I did take magnesium for a few days but I stopped because I wasn't sure it will affect that blood test I was doing. I'm not sure whether to start taking them again though in case I need to have another blood test on Friday.
Biotin often in multi supplements or B complexes is the only supplement which needs to be avoided a few days before draw. Biotin can skew results.
Magnesium won’t affect a blood test in any way. I take magnesium citrate powder at nighttime. I find it settles muscle twitches near eye that I used to get.
First of all, there's no such thing as 'normal'. When a doctor says 'normal', all he means is somewhere within the range. But, as you can see, that FT4 range is pretty wide, so it can't possibly be 'normal' all the way through. I would avoid that word, if I were you.
Oh, do you have a range for the FT3? It looks low.
And, that's the second thing... If we use the word 'euthyroid', rather than 'normal' - euthyroid means having no thyroid problems whatsoever - a euthyroid FT4 would be around mid-range, and the FT3 just slightly lower. Your FT4 is much too high, and your FT3 doesn't look quite mid-range. So, there's nothing 'normal' about that. Something is more than likely going on - could be Hashi's, which is why you need the antibodies tested - and that might be a better way of approaching the endo.
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