Having symptoms of hypothyroidism. Done tests for Vit D, Testosterone and soluble transferrin receptor. What can be done?

Posted on Fri, 26 Jul 2013 in General Health
Question: I don't know where to turn to now. I have had numerous tests over the last couple of years, but only Vit D, Testosterone and soluble transferrin receptor have been abnormal. Vit D and Testosterone have been addresses/corrected, but it didn't help me feel much better. My symptoms seem to exactly fit Hyprothyroidism, but lab work is normal.

What's next at this point? My drs really seemed to be stumped (internist, endo, gastro, rheumatologist. Perhaps it will take someone thinking outside the box a little. I realize that's controversial in the med community, but the symptoms persist with no answers. Should I ask my endo to try a trail treatment for hypothyroid? Perhaps, he would be willing to treat me based on my symptoms instead of the lab work.

Known Issues
•     Low Vitamin D, but elevated Calcitriol
•     Glucose slightly elevated
•     Hypertension
•     High Cholesterol
•     Occasionally slightly high Serum Calcium (with appropriately low PTH)
•     Osteopenia left hip (probably due to hyperparathyroidism – 2009, and low T)
•     Low T (due to low LH, FSH)
•     Iron deficiency in the form of elevated transferrin receptors

•     Fatigue!!!
•     Arthritis – feels like tendon soreness at the insertion points
•     IBS symptoms (nausea, bloating, alternating diarrhea/constipation)
•     RLS!!!!!!!
•     Numbness in hands (Raynauds and sleeping numbness)
•     Weight gain 6’1 – 230lbs
•     Body hair loss – legs, arms – basically thin and brittle – not really falling out
•     Sweating excessively during exercise – drenched!
•     New symptom (2 months) – Lymph node near parotid gland on right side is swollen, painless, and seems to be growing. It’s very small, maybe centimeter wide. Dr doesn’t seem to be concerned as of yet.

Tests Performed
•     Extensive blood work (All thyroid hormones, most Pituitary and various other tests) – only Vit D and Testosterone is low, although soluble transferring receptor was very high, while the iron was low-normal)
•     CT Scan (chest and pelvis)
•     MRI – head - neg
•     Endoscopy/Colonoscopy - neg
•     Capsule endoscopy - neg
•     Sleep study - neg
•     Octreotide Scan - neg
•     HLA-B27 Negative

•     Single Parathyroidectomy XXXXXXX 2009
•     Gall Bladder removed XXXXXXX 2010

•     Sister has Lupus and hypothyroidism (I’m neg on Sed rate, etc)
•     1st cousin, male, same age is hypothyroid
•     Mom has crohn’s (I’m evidently neg)

Answered by Dr. Rajiv K Khandelwal 10 hours later

Thank you for your query.

I can understand your concern. Let us think out of the box as you suggested. However I would like to have the following details:
1. Your haemoglobin level.
2. Your blood glucose levels.
3. What are the blood pressure readings and any medications for it?

I would like to address your issues on the following:
1. Enlarged lymph nodes near the right parotid gland.
2. Your weight, hypertension and high cholesterol.
It will be appropriate for you to request your doctor to get a fine needle aspiration cytology (FNAC) done of the enlarged lymph node to know the cause.

Your issue of tiredness and weight gain is not necessarily due to thyroid as you presume. Though you are exercising you need to sit down with a dietician and discuss your diet. You should note down your food intake for the next two days and see where it can be modified or reduced to take care of your calorie intake and quality of fats. Then you need to discuss with your health care provider and increase your exercises to burn your calories. This shall help you, though slowly, in your various symptoms.

I hope I have answered your query to your satisfaction. Please feel free to revert back in case you need any clarifications or would like to share more facts.

Wishing you all the best.


Rajiv K Khandelwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rajiv K Khandelwal 51 minutes later
Hi, thank you so much for the detailed response.

haemoglobin level -
4/16/2013 - 16.2 (12.6 - 17.7) g/dL
5/9/2013 - 15.3 (12.6 - 17.7) g/dL
6/26/2013 - 17.0 (12 - 18) g/dL

Not sure if this is needed, but just in case...
hematocrit -
4/16/2013 - 48.9 (37 - 51) %
5/9/2013 - 45.8 (37 - 51) %
6/26/2013 - 50.6 (37 - 51) %

Just realized this while I was reviewing the CBCs. The MPV has been slightly elevated over the last several months. I'm not sure if this is significant, but I thought I should include it as well.

11/28/2012 - 9.9 (7.3 - 9.7) fL
6/26/2012 - 9.8 fL - range not shown, so it may not be out of range

2. blood glucose levels - 4/24/2013 - 103 mg/dL (65-99) - They are usually around 90 - 105

3. blood pressure - seems to hover around 120/80 to 135/90. It was 160/100 at a dr appt a couple of months ago, but I think it was "white coat hypertension". I've been checking it regularly since that time, and it hasn't been higher than 135/90. I've taken meds in the past - lisinopril 5mg/day. Each time I do, I almost pass out every time I bend over and straighten back up, or stand up from a seated position.

I have a dr appt scheduled with the Internist on July 31. Should I request an earlier appointment in case it's something ominous. I don't seem to have any other nodes that a swollen at this time. It was confirmed to be a lymph node a couple of weeks ago (ultrasound), but the PA didn't seem to be too concerned. That was the second appt in reference to lump, and it has been two months since I first noticed it.

Thanks again and please let me know if you need any other lab info. I can access most of them online through patient portals.

Answered by Dr. Rajiv K Khandelwal 1 hour later

Thanks for providing the information.

The haemoglobin and your blood pressure are fine and I shall not worry on that count. However you have not mentioned whether the blood glucose is fasting, random or post prandial. In case it is only one reading then you ought to get a fasting and a post prandial blood sugar/glucose to be done.

If the lymph node is not increasing in size then you need not worry about it. However if it is increasing then a FNAC should be done.

I hope you have appreciated my earlier noting concerning your weight and diet and you shall pay attention to it under proper guidance. This should reduce your weight and you should feel better.

You need not worry and should see your doctor later this month.

I hope I have satisfactorily responded to your queries. Please do not hesitate to revert back for any clarifications.

Wishing you all the best.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Rajiv K Khandelwal


Practicing since :1976

Answered : 1872 Questions


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