[Aussie Girl]

Dear Andi,

I think you are safe to wait until you see the new endocrinologist. Both hyper and hypothyroidism make you tired/sluggish as well as a zillion other things.

If I got this right, I think you are saying that the problem is low TSH despite normal FT4 and T3. Previously you've have normal tests. The commonest cause of this pattern is subclinical hyperthyroidism, a second common cause is accidental or intentional ingestion of a thyroxine supplement (Yes, this happens more than you'd think because people think it'll pep them up). Non-thyroidal illness, a few drugs including steroids and rarely pituitary disease (secondary hypothyroidism) could cause this pattern. Thyroiditis of any sort can cause fluctuating hyper- and hypothyroidism but usually the antibody tests show what the problem is.

The second issue is the thyroid nodules which seem to be long standing. Rarely a thyroid nodule can independently pump out too much T4. I think this quite unlikely. A radioiodine scan would be needed to exclude this. It may not be necessary, but you need that second opinion in December.

I don't think your original endocrinologist was completely off track, but her communication skills and manners (including those of her staff) appear suboptimal, to say the least.

Thyroid hormone levels adjust slowly (6 weeks) so it would be best not to change your supplements before you see the new doctor. It could confuse things. He/she may need to test you again to see if the low TSH was only a temporary glitch.

It would probably help if you could hand him a written copy of your health summary, your medications and current supplements. And any prior thyroid tests, including antibodies. It can get difficult for doctors when the history is complicated. Supplements taken in the distant past probably aren't an issue.

Most people get sufficient iodine and selenium in their diet but your nutritionist will have checked this.

Good luck with this.

Aussie Girl