Q. My thyroids are enlarged and asymmetrical. Should I visit an endocrinologist?

Hello doctor,

I am a 32 year old woman, who in the last six months began to experience thyroid symptoms. I am in the process of looking for a new physician, but I live in a very remote area with a significant shortage of medical professionals, so I am in a lot of ways on my own here. My mother had her thyroid removed at 10, due to a goiter that was large enough to impede breathing and swallowing. My symptoms include extreme fatigue and insomnia. Now I sleep as much as 12 hours at night and still need an afternoon nap to be functional, and have cold intolerance, brain fog, very emotional, and change in my menstrual cycle (get periods every 2 to 3 weeks, with cramps). I also lost about 15 pounds within a month without a change in the diet. The weight loss has slowed since, but I am down around 22 lbs.

At the initial visit, my doctor could determine that my thyroid was enlarged and asymmetric, and ordered an ultrasound and TSH. I never saw the values for the initial TSH test but was told it was within normal limits. The ultrasound showed both lobes to be significantly enlarged, with the left being half as big as the right. Both were full of nodules, but three stood out enough to warrant a biopsy, including one of 4.7 cm that contained a calcification. My biopsy is later this week.

These results were enough to convince my doctor to run more blood tests. I picked up the reports from the lab today and discovered that she did a TSH, T3, T4, and TPO. I will attach the reports. TSH was 1.72 IU/mL, T3 was 118 ng/dL, T4 was 0.87 ng/dL, and TPO was 4 IU/mL. Should I request any other tests? Does being within range mean these values are all normal values? An internet search of ranges for each of these shows a disagreement on good and optimal values. Should I see an endocrinologist for further examination? My doctor had to be convinced by me to run these tests, and she is convinced that I am just depressed. I am on waitlists for every doctor in the county. I even tried a naturopath, who would be amenable to running more bloodwork. The nearest endocrinologist is about a four-hour drive, more when the roads are bad. So I am lost in the woods here, literally and figuratively. Any insight or direction is welcome. I am so tired of feeling awful.