enlarged thyroid and normal tsh and antibody test

[Tiffany]

my tsh was 1.11 and the antibody she said was 20 and then said well less then 20. I asked to get the t3 and t4 but they refused. they are doing an ultrasound on it. Im 25 and my husband says he can really notice my enlargement. I have all symptoms of hypothyroidism and its really annoying. tonight I was eating and it felt as if my food was stuck in my throat which was painful and my chest hurt as well to the point of throwing up. I calmed down and tried to take a drink and it happened again. I have had this happen in the past but not this bad. what do I need to do to get my doctor to see something is not right ?

[Maria]

An ultrasound, possibly followed by a biopsy, is probably the best way to go, especially if it's causing difficulty swallowing. A thyroid that enlarged with normal TSH and antibody screening (TSH is much more accurate than free t3/t4 in determining thyroid function - I've had normal t3/t4 with elevated TSH, and was symptomatic) would make me worry about thyroid cancer. Difficulty swallowing could also be caused by esophageal dysfunction - do you have acid reflux?

Remember, many of the symptoms of hypothyoroidism are very non-specific, and could have other causes.

[Tiffany]

No I do not have acid reflux but Im getting worried at this point.

[AZQuitter]

Tiffany wrote:

my tsh was 1.11 and the antibody she said was 20 and then said well less then 20. I asked to get the t3 and t4 but they refused. they are doing an ultrasound on it. Im 25 and my husband says he can really notice my enlargement. I have all symptoms of hypothyroidism and its really annoying. tonight I was eating and it felt as if my food was stuck in my throat which was painful and my chest hurt as well to the point of throwing up. I calmed down and tried to take a drink and it happened again. I have had this happen in the past but not this bad. what do I need to do to get my doctor to see something is not right ?

You need to find another doctor. And look for one who does not worship TSH results - that is a pituitary hormone. It may indicate that you need further thyroid tests, but other than that, the number is pretty useless. Free T3 and free T4 testing are vital. Then of course your doctor needs to understand what the tests mean. Good luck, because most do not understand and under-medicate.

[Maria]

I disagree. TSH testing is much more valuable than T4/T3 in determining thyroid function. The only time that TSH does not accurately reflect thyroid function is when the pituitary is not working properly - but in that case, you wouldn't have an enlarged thyroid, since TSH is a thyroid growth factor. You CANNOT go off free T3/T4 results - my T3/T4 returned to normal within a month of starting medication, but I was still symptomatic for a LONG time after that! My medication adjustments were based off TSH, not T3/T4.

Anyone who suggests that TSH number is pretty useless quite frankly does not understand endocrine physiology - which is not surprising, since endocrine is notoriously one of the most difficult topics in medical schools.

[AZQuitter]

Maria wrote:

I disagree. TSH testing is much more valuable than T4/T3 in determining thyroid function. The only time that TSH does not accurately reflect thyroid function is when the pituitary is not working properly - but in that case, you wouldn't have an enlarged thyroid, since TSH is a thyroid growth factor. You CANNOT go off free T3/T4 results - my T3/T4 returned to normal within a month of starting medication, but I was still symptomatic for a LONG time after that! My medication adjustments were based off TSH, not T3/T4.
Anyone who suggests that TSH number is pretty useless quite frankly does not understand endocrine physiology - which is not surprising, since endocrine is notoriously one of the most difficult topics in medical schools.

The problem is that most doctors look ONLY at the TSH. And nothing else.