Glad you started your own thread.

Without a doubt, you are dealing with hypothyroidism....and I wonder if your fibro is actually a manifestation of that.

You linked some info along those lines on another thread and it's a valid concern.

The physical issues with your thyroid (including the presence of nodules) indicates that your thyroid is sick.

I suspect your doctor is confused by your "normal" (aka in-range) TSH.

Unfortunately, doctors were taught in medical school that the TSH test is the gold standard for diagnosis and treatment.

Those who have kept up with things know that pituitary hormone TSH is NOT a reliable indicator of thyroid status and only the thyroid hormone levels - FreeT4 and FreeT3 tell the true story.

That said, you can see that your FreeT4 level is at the very bottom of the normal range and your FreeT3 level not far from it.

As documented in thyroid textbooks, healthy people have FreeT4 levels near the high end of the range and FreeT3 levels in the upper third/upper quarter of the range.

Please see as many doctors as necessary to get the treatment you need.

It can be difficult but it's worth every effort.

You could try checking the Top Thyroid Doctor site for one in your area:

http://www.thyroid-info.com/topdrs/index.htm

If that doesn't work, I have some other ideas to share with you.

Best of luck to you moving forward!!

Some of what I've read is thyroid issues may be one of the causes of Fibromyalgia.

Thank you for your time and advice. Now I know to move on to a different doctor if I have to.

I had my doctors appt today. Didn't seem very productive to me. As far as the ultrasound and the nodules, he is gong to call an endocrinologist and ask if it should be biopsied or just leave it and recheck in 6 months.

The Hypothyroidism. A definite maybe. No meds, he wants me back in 3 weeks to redo the labs if I still have the symptoms, of course I will, it's been like over a year. I'll give him the 3 weeks and the labs and if no results after that I'll move on.

One question I have if you don't mind. Does it matter what time of day I go or if I should not take any of my vitamins that morning or fast or anything to have a more accurate reading?

It's always best to get thyroid labs done in the morning when seeking a diagnosis.

Reason being: TSH is highest in the morning

Recent studies have shown that fasting provides more accurate thyroid labs so, if you're so inclined, you might want to do that as well.

I'm glad you're not going to sit around and wait on a clueless doctor.

Best of luck to you moving forward - please keep us posted!

I have read now that you should not take your thyroid med at least 8 hours before the test and you should fast and go early in the am. A lot of people with low levels of thyroid hormone will have pain.Once the levels go higher, the pain will diminish.

That would not be a problem to do.

Yes I will let you know how it goes.

Thanks for the info.

I had my labs redone on Friday. The T4 came back as 0.5, officially in the abnormal range. My PCP gave me two options.
1. do nothing and have them redone in 2 months
2. take 75mg of Levo once a day and have it retested in 2 months

I'm opting for option 2 of course. I called and left a message though to see if I could go on Armour rather than the Levo. I haven't heard back yet.

Sorry to hear that your levels have worsened but, very happy to hear that your PCP finally offered you meds.

I do suggest that you seek the care of another doctor because you should have been started on meds long ago and it's clear to me that your doctor is too focused on numbers falling within the normal range vs. symptoms.

I suspect that, once your FreeT4 level gets back into the normal range, your doctor might call his/her job done and you'll continue to suffer with symptoms.

For whatever it's worth, your labs did not indicate the need for Armour which also contains T3. Yes, Armour was the first-ever thyroid hormone preparation available but that doesn't mean everyone needs it.

Choice of meds should really be based upon the patient's labs.

The FreeT4 test is a measurement of our T4 storage hormone that is available for use by the body to convert to T3, our active hormone.

The FreeT3 test measures the level of T3 that is available for use by the body.

Since your FreeT4 level is proportionately lower in the range than your FreeT3 level, that tells us that you need more T4 storage hormone which is found in levothyroxine.

If your body continues to work as it has been, your FreeT4 level will not only increase after taking levo but, also your FreeT3 level. This is what we want to happen.

Armour is made from porcine thyroid that contains a larger proportion of T3 than T4 compared to human thyroid.

Taking Armour would increase your FreeT3 level much more than your FreeT4 level.....I suspect you would need to have some levo added to your Armour dose if you want to optimize your FreeT4 and FreeT3 levels.

We all need both levels to be optimal if we are to be free from thyroid symptoms.

Please let us know how things go with the doctor - best of luck to you moving forward!!

Just a word of advice, starting on 75mcg of levo is way too much for most people. You should discussing starting out at 25 and gradually increasing.

cd, I asked for the Armour because I have Fibromyalgia (Hypothyroidism is common with this) and read on the blogs that many others with both don't handle the Levo well but when they switch to Armour they do much better. I didn't understand how the T3 and T4 works. But it sounds like he's okay with me having it so I'll hopefully pick it up tomorrow and be able to start it right away. I agree that I was concerned he would start me on a small dose and leave me there if I crawl into low normal again. But 'helerown' comment above says he started me on a high dose. Odd. I wonder what he will give me in the Armour.

cd - why are doctors so against giving RX for this?

They don't like to prescribe Armour because the big pharma companies PUSH the Synthroid type meds which is fine, if they work for you and many do well on it. Some may need an additional med like Cytomel (T-3) thrown in too. I would start on 50 though and go up from there but like CD said, if your numbers go normal,(in the range) this guy sounds like he'll keep you there and not increase.He didn't even want to put you on them when your FT4 was at the bottom.he sounds too strict to me.

I've also heard it said that Armour is much harder to regulate dosage wise simply because each batch can contain different levels of thyroid hormones (simply because it's extracted from pigs and naturally there will be differences). Sensitive people feel the differences much more profoundly than others.....