Hypothyroidism and Hyperthyroidism

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Newbie type question

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cabwj
cabwj Posts: 843 Member
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I have not been diagnosed as hypo, hyper, or anything thyroid related. I take levothyroxine because my endocrinologist hopes it will shrink the multiple nodules I have in my thyroid. I've had the nodules biopsied twice now, six months apart, and have an ultrasound every three months. Biopsies come back fine and the endo has explained to me that with the nodules I could opt to have the thyroid removed, or that since they are benign, we can take the monitor and wait route.

I have only ever had TSH level checked when they order blood work. I am seeing my primary care physician in two weeks and the endo in another six weeks. What other labs should I be asking for? I've seen people talking about T3, T4, free something or other? I've been kind of reactive so far and just gone along with what the doctor orders but I'd like to take charge and really understand what's going on but don't even know the questions to be asking.

Any guidance would be appreciated.

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  • toadqueen
    toadqueen Posts: 592 Member
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    I would recommend:
    TSH
    Free T4
    Free T3
    Reverse T3
    Thyroid Peroxidase Antibodies
    Thyroglobulin Antibodies
    Vitamin D
    Ferritin
    B12

    Good luck!
  • cabwj
    cabwj Posts: 843 Member
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    I did have D and maybe B12 done. D was low and I now take an over the counter supplement. I don't think B12 was specifically low but I take a B complex as well.

    Thanks so much for the list.
  • gaelicstorm26
    gaelicstorm26 Posts: 589 Member
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    toadqueen has a really comprehensive list there.

    I also have a multi-nodular goiter. Lovely, aren't they? ;)

    Anyhow, I would really *insist* upon the T3, free T4, and both antibody tests, as in, refuse to leave the office until they cave in!
  • CSARdiver
    CSARdiver Posts: 6,252 Member
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    You need Total T4 and T3 as well to review Free T4 and T3 to put them into perspective.
  • cabwj
    cabwj Posts: 843 Member
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    Thank you all
  • slieber
    slieber Posts: 765 Member
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    Are you experiencing any hypo or hyper symptoms? If you feel okay, perhaps it's best not to rock the boat, so to speak.
  • lindsey1979
    lindsey1979 Posts: 2,395 Member
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    I don't think you need any total T4/T3. You just need the free T3 and Free T3 in addition to the antibodies (TPO and Tg). I personally wouldn't push for Reverse T3 at this point. It may become necessary down the line depending on what your other tests and symptoms reveal, but I don't think it's a necessary first step test.

    I'd also suggest magnesium, cortisol and DHEA in addition to the other tests. Cortisol and DHEA have to do with adrenal health and should be checked before thyroid treatment starts, but many docs don't do or know this. The problem is that long treated thyroid problems often go hand-in-hand with adrenal insufficiency issues which can show up in both the adrenal hormones and sugar regulation (AC1 or fasting glucose). If you have any level of adrenal insufficiency such as low DHEA, thyroid treatment can actually make you feel worse initially.

    If you have any common symptoms of insulin resistance such as strong cravings for sweets/carbs, big energy crashes after high carb meals/snacks, difficulty losing or maintaining weight, it may behoove you to have insulin resistance checked as well (A1C test is probably the best). My thyroid doc always checks for it since he has noticed that a lof of his Hashi's patients that went untreated for a long time tend to have it (he thinks it's one of the ways the body compensates for an inactive thyroid -- just as the adrenals do and then get exhausted and you end up with adrenal insufficiency). Over 40% of adults in the US have insulin resistance at prediabetic or diabetic levels and the vast majority are unaware of it -- so it's a significant possibility.

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