I was diagnosed in 2005 and I made lots of changes to my diet and lifestyle. I think I became a lot healthier, fitter and stronger. I used to get colds, the flu often. But for the most part I seem to have become much more resistant to sickness. I’ve not had a flu or fever sufficient to warrant checking my temperature or seeing a doctor for more than two years. So two weeks ago, when I felt ill with a sore throat on a Sunday as my wife was recovering from strep throat, I thought it might be prudent to see the doctor.
Well, come monday the doctor concluded it was just a virus, but announced that my temperature was 97.X deg F. I though that an odd “fever” and just packed it in the back of my mind. Then, I had a regular quarterly appointment with my doctor this monday, my temperature was 97.4 deg F. Historically, I’ve always run a bit high, my temperature during the day is normally 99-99.5 deg F. So I asked him about it and whether I might have a thyroid problem. You all see where this is going.
So I checked at home with my old thermometer, yup, I’m running in the 97s. So I bought a new thermometer and started what has become known as the “Barnes Basal Temperature Test.” My first oral reading this morning, 95.4 deg F. This is not good. But perhaps being hypothyroid would explain some things. Even I have to admit I am feeling fatigued. I sometimes go to bed at 9pm and I am taking 4-5 days to recover from exercise. Perhaps that is why my cholesterol is high. Perhaps that is why my HbA1c is always higher than my meter suggests (see this)?
So my plan is to continue recording my morning temperatures. My doctor usually calls me with results from my tests and I’m going to inform him of the results and ask him to look into whether I have hypothyroidism.
What do you think I should have him test for? Clearly more than TSH, Free T3 and T4?
What are your experiences getting proper diagnosis and treatment of your thyroid condition?
Do you think my GP who is only a 2nd year resident can steer me through this (he will have staff help)?
And what about Hashimoto’s and Grave’s?
Have you had a TSH test run in, say, the past year?
I know that lots love to jump in the deep end with every test under the sun. But really, you need a TSH run.
Back when I was diagnosed hypothyroid the initial guess that I had it, was done by docs who loved to push and prod all my glands and they noticed my thyroid was obviously enlarged. They said they could even see it without pushing and prodding. Of course they were endos of a very traditional “internal medicine” tradition. No docs seem to do as much push and prodding like they did when I was a kid. Today everything seems to be done with blood tests.
A symptom that I have if I’m not taking synthroid, is hair loss. Of course I’m past middle aged now so I’m not sure that anyone other than me would notice.
And despite the fact that I’ve been Hypothyroid for the past 25 years and taking synthroid, I honestly have no idea why others think it’s so complicated. My docs have never ever used the words Hashimotos or Grave’s disease. I pop a synthroid every day.
I’m not hypothyroid but I know my endo ran an antibody test to rule it out, since it’s autoimmune like diabetes. I would ask for an antibody test along with the tsh, T3 and T4.
Do you think my GP who is only a 2nd year resident can steer me through this (he will have staff help)?
Maybe your GP can help you, but based on my own experience, I would seek an endo who specializes in thyroid issues and who is willing to work with you instead just putting you on Synthroid and leaving things there. My GP correctly diagnosed me with hypothyroidism two years ago based upon my elevated TSH. I had many of the symptoms such as dry skin, thinning eyebrows, memory problems, and worst of all, chronic fatigue. By checking my TSH level on each subsequent doctor visit, my GP gradually raised my Synthroid dosage to 100mcg per day which is the point where my TSH fell within the normal range. My symptoms did not go away.
That was two years ago. TSH testing is a good indicator for diagnosing hypothyroidism, but not necessarily in treating it. I've had my Free T3 and Free T4 levels tested as well, but they also fall within the normal ranges. I still have the hypothyroid symptoms, including chronic fatigue. My GP admitted that treating chronic fatigue successfully, no matter what the cause, is a challenge. I see an endo tomorrow, and I hope he will work with me. If not, my search for a good endo will continue.
Finding a good endo who treats hypothyroidism correctly is very difficult. Hypothyroidism is not something I would leave up to my GP to handle. I honestly hope you're able to rule out hypothyroidism. Good luck in getting to the bottom of the issue.
I have had to deal with thyroid stuff since I was 18 when I had a nodule removed. My endocrinologist at the diabetes center has always measured my TSH, but when I recently found another cyst they ran a T3 and T4 panel to rule out things like Graves and Hashimotos. I know that one of the symptoms of hypothyroidism is being sensitive to cold temperatures. It couldn’t hurt to have the tests. If you have an endocrinologist for your diabetes maybe you could have him/her run the tests and give you their assessment. Good luck. Hope you get well soon.
B,
The temp issue could be anything, or nothing. Since I am prone to Addison’s, that will also mess with the temps. I kept a log for a week, several times a day, and my lowest temp was 94.6*. I’m also prone to running a little high in the late afternoon / early evening (due to Rheumatic Fever x2). Stress can also cause the fluctuations in the temperature. I agree with Tim, if you haven’t had the TSH done, have them do one. There are also other tests that need to be done, along with the TSH. You may also want to bring up the possibility of Addison’s to the doctor. Your lab sodium level plays a factor in Addison’s, as do many other things. Addison’s will make you very ill, along with probably being in the hopsital (I was admitted thru ER). One other thought, hypos and hypers also seem to affect our temperatures.
Trisha
There are several tests that a good GP or endo will run. Yes, TSH, T4, T3, and Free T4 are standard. They should also test your cholesterol, which will be affected if you are hyper/hypo. I would ask for them to test for Thyroid Peroxidase (TPO).
The doctor should also do a physical examination of your neck to feel for nodules. Depending on what he/she feels, they may send you for an ultrasound.
I am anti-TSH person. TSH is a thyroid stimulating hormone that comes from your pituitary gland. It does not tell you how well your thyroid is functioning. As one of the doctors said that I see that actually “gets” thyroid, TSH is what they are taught in med school and a lot of doctors can’t see outside of the box
http://www.stopthethyroidmadness.com/tsh-why-its-useless/
Two years ago when my thyroid took a nose-dive, my TSH was within lab range so the doctor I was seeing told me that there was nothing wrong with my thyroid. I was sitting there with labs on my lap and my Free T4 was so low that the lab did not even register a number for it. My thyroid was not functioning but she looked at TSH and felt it was normal. TSH: .94 – lab range 0.35 – 4.94. Free T4: <0.40 – lab range .7 – 1.48.
I took the same set of labs to another doctor and was told that my numbers were horrible.
TSH can fluctuate during the day and can also fluctuate a lot if someone has Hashimotos.
There are two tests that you need to have done to check for Hashimotos. You want both because you can have normal of one and abnormal of the other. The Anti-Thyroid Peroxidase (TPO) is the first one. The day my labs I gave you above were drawn, mine was 3044 on a scale of 0-9 (and no, the 3,044 was not a typo nor was the lab range), yet nothing was wrong with my thyroid! That number will go up as the disease progresses (meaning it may be normal today but abnormal a year from now). That was the first I ever had mine checked. A year later, it was 1332.7 on the same lab range. The doctor that ran that one also announced nothing else needs done with my thyroid.
http://www.stopthethyroidmadness.com/recommended-labwork/
There are two forms–one set targeting your thyroid peroxidase (an enzyme that is important in the production of your thyroid hormones) and the other targeting your thyroglobulin (a protein carrier for your thyroid hormones). It is not uncommon for one to be in range, and the other to far out of range. The latter fact is why you need BOTH tested.
Given that I am 51, and that I have more hair in my moustache than on the top of my head, I also can’t really point to hair loss as a noticble symptom. My doctor did feel around my throat at my appointment, but did not find anything.
I have had TSH tests over the years, but they never showed anything.
Well, I think the temperature is something, but you are right, it might not be hypothyroid. I’ll have to look to keep the Addison’s and adrenal problems in mind, but from what you say perhaps hypothyroid would be a blessing.
I have not had a cholesterol test for six months, last time it was high (TC > 300). I like the idea of TPO, it probably makes sense to just get the tests done for Hashimotos since I only pay a co-pay for one battery of tests.
Thanks for the thorough response Kelly, this is the sort of thing I was hoping for. I have heard from a number of sources that the TSH is perhaps not a good measure of thyroid health. It seems oriented towards diagnosing a hypopituitary condition, but not a hypothyroid condition.
I am a little confused about the two forms in the last paragraph of your post. Are you talking about the two antibodies for Hashimoto? Anti-TPO checks for antibodies to attack the Thyroid Peroxidase and the TgAb checks for the antibody that attackes the thyroglobulin. So I need to test for both antibodies, is that right?
Based on what I have heard here, if my temperature is low for another day or two, I think I’ll ask for TSH, Free T3, Free T4, Anti-TPO, TgAb and a cholesterol panel.
I have hashimotos thyroid since I was a child. When my thyroid is low my temp runs in the 97s as well. I might add that I had high cholesterol at the young age of 18 come to find out it was caused by my low thyroid. I would def recommend you get a full panel thyroid tests T3, T4, TSH, cortisol levels, and be checked for thyroid antibodies. I was on t4 supplementation for a long time making the mistake of letting my family dr take care of my hypothyroid needs. Once I got in with a endo he watches my thyroid much more closely and I am also now on T3 supplementation-cytomel which is a huuuge part of helping with the hypothyroid symptoms that you suffer with.
BSC, was your cholesterol high compared to what it was before? Mine started going up this last time my thyroid went out of whack but it is back to normal now. I was going thru some old medical records recently and looking at old labs – I almost had a heart attack when I saw those cholesterol numbers. They did my cholesterol a couple weeks after they decided I was hypothyroid. Back in those days, they looked at TSH and mine was 5.29 but considered in range. My total cholesterol at the time was 336, my HDL was 94, LDL was 216 and triglycerides 128. That doctor had only run cholesterol once 2 years before and my triglycerides were flagged low at 33, my total cholesterol was 182, HDL was 70 and LDL was 96.
Thyroid can really mess up your cholesterol!
Yes BSC, you are right about the 2 antibody tests - you want to have both of them done.
The paragraph under the link was actually copied from STTM and I forgot to indent it, sorry! I did not copy everything, just the part we were talking about.
It’s nice that you found an endo who will Rx Cytomel in addition to Synthroid. Finding such an endo seems more the exception than the rule. As you know from personal experience, the Synthoid-only approach doesn’t work for all of us with hypothyroidism, yet it is the standard treatment.
Well during my year with my endo who won’t get out of my life, we spent most of our time arguing about cholesterol (I refuse statins). It was during this time it started to really rise. Before, I had pretty much been TC - 200, HDL - 60, Tri 150, LDL 120. I believe the last test, my LDL had risen to 250, but my HDL and Tris were about hte same.
I have a feeling it is your thyroid. They probably looked at TSH and did not think you will have a problem.
BSC, if it turns out that you do have Hashimoto’s, you might want to consider natural thyroid meds instead of Synthroid. I switched to Armour a couple of years ago, and have much more energy. Armour is dessicated pig thyroid and contains T3 as well as T4.
That is a good point. I have repeatedly seen recommendations to be careful about just treating T4 with Synthroid. It also seems that things are quite complicated with T4 converting to T3 and a number of feedback loops. What is really surprising to me is I also looked up the pricing. Armour is “dirt cheap.” The synthetics are expensive. I am sure that does not affect doctors decisions on which medication to choose.