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How To Rule Out Hypothyroidism?

Posted on Tue, 17 Nov 2015

Question: I'm not sure what is wrong with me but I feel auful. I have off and on for the past 20 years. I am 52 years old. my doctor has performed several blood tests. He says I have hypothyroid condition but I'm not convinced. My tsh is normal to boarderline high. My last test was 4.760. Needles to say its been higher in the past but nothing was ever down about it. Have 12 out of 16 symtoms for the parathytroid web site. My calcium level at my last test was 10.1 which is still in normal range. My pth was 21 which is still normal, but my vitamin d is 32 but has dropped from 39 in the last 6 months. I've been on levolthyroxine for about a week, but I feel worst since I've been taking it. My doctor doesn't think I could have a parathyroid problem because of my test results. My symtoms have come and gone for the last 20 years. Some days are better than others. I have had 2 doctors tell me it might be in my head which makes me feel like I'm loosing my mind. Where do I go from here? Can anyone help me, please?

Answered by Dr. Binu Parameswaran Pillai (1 hour later)

Brief Answer:
Not overt hypothyroidism or hyperparathyroidism

Detailed Answer:
Good day,
Noted your concern.
Sorry to hear about it.
I wouldnt consider that you have overt hypothyroidism with a TSH of 4.7. I would also like to see your free T4 ( FT4) results.

Again, with a normal calcium and PTH results, i can say that you do not have hyperparathyroidism. The vitamin D level above 30 ng/ml is normal.

I would also suggest to get an early morning cortisol test.

Depression/Anxiety have so many symptoms like weight gain, heart beat variation, tiredness, muscle cramps and weakness, altered bowel movements etc, which may also be present in hypothyroidism and hyperparathyroidism. So many of these symptoms are non specefic .

If more than one doctor suggest that it may be psychological, it could be true. Stay relaxed and discuss with your primary care physician to arrange a psychiatry consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (13 minutes later)

My T4 is 7.4 and my T3 is 104. I know you didn't ask for that one but I thought it might be important.

Answered by Dr. Binu Parameswaran Pillai (8 minutes later)

Brief Answer:
Units of T4. Total or free??

Detailed Answer:
What units are they ng/dl or pg? Could you attach the reports if possible.?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (18 minutes later)

They are ng/dl.

Answered by Dr. Binu Parameswaran Pillai (14 minutes later)

Brief Answer:
Normal refernce range

Detailed Answer:
In that case, seems to be normal. But the normal reference range may vary from lab to lab based on the test kit used. It would be great if you could provide the reference range of T4 in your lab. this will be printed in the report

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (3 minutes later)

Sorry, normal range is 4.5-12.0.

Answered by Dr. Binu Parameswaran Pillai (3 minutes later)

Brief Answer:
Normal

Detailed Answer:
Thank you. T4 is well in normal limit. Not to worry. It may be prudent to stop Thyroxine and recheck Free T4, TSH and anti TPO after 6 weeks.
Shall decide further based on those reports.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (2 minutes later)

What is anti TPO ?

Answered by Dr. Binu Parameswaran Pillai (3 minutes later)

Brief Answer:
Antibody

Detailed Answer:
anti thyroid peroxidase antibody. if that is positive, there is a future risk of hypothyroidism. when TSH is borderline high, we do have to do this test

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (53 minutes later)

Thank you. I get this taken care of and let you know the results.

Answered by Dr. Binu Parameswaran Pillai (5 hours later)

Brief Answer:
Follow up

Detailed Answer:
okay. wish you good health. please feel free to ask further if you have more questions. if there are no further questions, may I request you to please close the query.
regards XXXXXXX

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar