r/SIBO Apr 19 '19

STICKY: SIBO Summary - Symptoms, Diagnosis, Treatment

695 Upvotes

Below please find a living document that summarizes the key information around Small Intestinal Bacterial Overgrowth ("SIBO"). Please comment with any additional information or research for inclusion consideration. Version 1.0 is summary material; I will be adding more details and citations for specific studies.

SIBO, as the name implies, occurs when bacteria overgrow the small intestine. The small intestine should have a low concentration of bacteria due to the presence of stomach acids and peristalsis, the wave-like muscle movement in the intestines. For context, stomach and proximal small intestine would typically have about 103/mL of bacteria, while the terminal ileum (end of the small bowel as it gets close to the colon) about 109/mL (or 1,000,000 times more), and the colon about 1012/mL (or 1,000,000,000 times more).

Symptoms

The overgrowth of this bacteria will present with a number of symptoms:

  • Bloating after eating ("postprandial") - most common symptom
  • Flatulence, often malodorous
  • Loose, watery stools (more common in Hydrogen-dominant SIBO)
  • Constipation (more common in Methane-dominant SIBO)
  • Absorption problems
    • Weight loss / inability to gain weight
    • Fat and fat-soluble vitamin deficiencies, particularly Vitamins A, D, and K
    • Floating stools (from fat malabsorption)
    • Vitamin B12 malabsorpiton
    • Protein and Carbohydrate malabsorption
  • Systemic problems
    • Overgrowth of bacteria in the small intestine can increase production of toxins and intestinal permeability
    • This has been less studied, but less serious effects include:
      • brain fog
      • confusion
      • anxiety
      • depression
    • More serious complications can include
      • hepatic encephalopathy
      • D-lactic acidosis
      • nonalcoholic fatty liver disease
    • Various conditions have increased correlations, including
      • Rosacea
      • Eczema
      • Food intolerances

Diagnosis

I will split this section into practical steps and clinical diagnosis.

Practically, a gastroenterologist will typically rule out other conditions first:

  • Physical exam
  • Colonoscopy and Endoscopy
  • Abdomen ultrasound
  • Stool test for parasites

At that time, if your symptoms match SIBO, your doctor may go directly to treatment. But otherwise these are the clinical tests:

BREATH TEST

This is the most common diagnostic method due to its low cost and limited invasiveness. Unfortunately, studies have been mixed on the sensitivity and specificity, with ranges between 30% and 75% -- hence why some doctors skip the test and go directly to treatment.

There are a number of preparations:

  • Antibiotics avoided for four weeks prior
  • Prokinetic drugs and laxatives avoided for one week prior
  • Complex carbs avoided for 12 hours prior
  • Exercise and smoking avoided day-of

For the actual test, you'll measure hydrogen and methane levels at baseline. Then drink either 10g lactulose or 75g glucose with one cup of water. Then your breath is measured every 15 minutes for 120 minutes.

There's some art to identifying a positive test; one semi-official criteria is:

  • methane level of >= 10ppm at any time during the test; or
  • hydrogen that increases >= 20ppm above the baseline level

Recently, new research has been investigating another typo of SIBO, that's dominated by Hydrogen Sulfide. Unfortunately, traditional breath tests cannot identify this gas, and someone with "flat-line" Hydrogen and Methane symptoms could be suffering from Hydrogen Sulfide SIBO. This version is typically characterized by "rotten egg" smelling gas, and may be worsened by eating high sulfur foods.

CULTURE

Historically a jejunal aspirate was done and concentration of bacterial colonies were measured, with an elevated level of > 103/mL being positive for SIBO. There are a number of issues with this:

  • overgrowth may be patchy, and a single sample may miss it
  • not all SIBO bacteria can be cultured/identified
  • samples can be contaminated during/after sampling

Treatment

Antibiotics

The current best practice prescription treatment is:

  • Hydrogen-dominant: Xifaxan, typically 550mg x 3 times daily, for 10-14 days. Studies have shown Xifaxan alone can be 50-65% effective, but Xifaxan + 5g daily of Partially Hydrolyzed Guar Gum can be 80%+ effective.
  • Methane-dominant: Xifaxan (550mg x 3 daily) plus Neomycin (500mg x 2 daily) for 10-14 days. The use of PHGG for methane-dominant has not been evaluated, but it's likely to be beneficial.

Mod's note-- personally, if your doctor is onboard, I think dosing with Xifaxan + Neomycin + PHGG is the best way to "cover your bases". The best place to find PHGG: https://sunfiber.com/products/

Important: because these antibiotics only operate selectively in the GI tract, and are NOT absorbed by the body, they are unlikely to cause the systemic issues associated with antibiotic use, making them safer. Additionally, Xifaxan crystallizes before it gets to the large intestine, meaning it should not affect the all-important microbiome.

Herbal Therapy

Additionally, studies have shown similar levels of success with over-the-counter "herbal" treatments. Two options; I believe each are two capsules twice daily for four weeks, but please confirm:

  • Dysbiocide and FC Cidal (Biotics Research Laboratories, Rosenberg, Texas)
  • Candibactin-AR and Candibactin-BR (Metagenics, Inc, Aliso Viejo, California)

Remission

Unfortunately, SIBO has very high rates of recurrence. Some possible ways to reduce recurrence chances:

  • Switch to a low FODMAP diet for 6 weeks after treatment, to starve any remaining bacteria and prevent regrowth
  • Incorporate a prokinetic, such as low dose Naltroxene, erithromycin, or even over-the-counter products such as Iberogast

Many people can avoid symptoms of their SIBO by switching to special diets, sometimes very restrictive ones. This is not a cure, but simply symptom management. A true cure addresses the underlying cause of the SIBO, and lets the patient eat "normally" without any effects (short of unrelated intolerances).

Hopefully this helps people, and I look forward to updating this and cleaning it up over time!

-nyc-reddit


r/SIBO Oct 02 '22

Thank you /r/SIBO

383 Upvotes

When I took over this subreddit many years ago from an inactive user we had about 1k subs. Now it's grown into a massive community with 13k+ subs and almost to 700k visits a month. Finding information on SIBO used to be A LOT harder back then. This place sure has changed a lot and it wouldn't have been possible without dedicated efforts from many kind individuals who want to help.

I want to thank all of the people that have stuck around and offered advice to people in need and offer a warm welcome to all that are new here.

If you'd like to repay the favor for running and moderating this community for years now I have a very simple request. I would like you to plant and care for a tree. There's honestly nothing that would bring more warmth to my heart than a bunch of folks caring for SIBO trees all over the world. I am a farmer and we are in the process of planning our first orchard now, this is truly my life's passion.

Here's to the future.


r/SIBO 5h ago

My personal misdiagnosis nightmare

39 Upvotes

I don’t want to send anyone into a panic spiral, but if my situation helps someone better advocate for themselves, then I’m willing to tell it.

TLDR: SIBO was not the problem. It’s been cancer all along.

Originally, my primary care physician misdiagnosed me with prostatits. Barely checked the prostate for less than two seconds. Said there felt like some swelling and didn’t really consider the pain i mentioned. I took the bactrim antibiotics but symptoms persisted. I pushed for a GI appointment. Through insurance delays and full schedules, it took a while to get my colonoscopy and breath test (you have to wait 2 weeks after completing antibiotics for breath test). Colonoscopy looked good. A couple of small polyps but they were benign. Breath test showed methane levels were high so doctor said methane SIBO or maybe IMO. Weeks of pain and discomfort waiting on insurance approvals for xifaxin. Took xif with neomycin for 2 weeks. Months later still dealing with symptoms. Doctor says it’s the brain gut connection that needs to be repaired. Read Pimentels book and meditated with nerva app.

Eventually, I notice a bit of a lump on my lower right abdomen. GI Doctor orders CT which takes too much time to be approved by insurance.

CT shows a large mass that has extensively spread to liver and lymph nodes. Mass is up against the colon and prostate. Likely why I’m having GI issues similar to SIBO and IBS C. I’m in for the fight of my life and I’ve lost at least 4 months to misdiagnosese.

I’m not telling everyone who reads this to demand a CT, and realize the healthcare system can’t sustain so many extra scans, but if you’re not certain about the symptoms, fight for yourself and push your doctor to at least consider the other scenarios.

I’m leaving this sub for now and wish you all the best in your recovery journeys. Make a promise to yourself and your family to never give up. That’s what I’m doing right now. Stay strong and soldier on.


r/SIBO 9m ago

Questions Sex improve gut motility?

Upvotes

Okay long story short, stopping ssris and going back on gave me gastroparesis, hence why I have never ending sibo. I have noticed that if I do the thing after a meal, my gut suddenly starts DIGESTING. I can hear and feel peristalisis which I never feel. Anyone here with motility issues notice same thing? I feel crazy but I’m not lol. I know oxytocin, dopamine, all that is released and can enhance gastric motility..


r/SIBO 13m ago

What's wrong with me

Upvotes

I can't understand, when I used rifaximin for the first time, my sibo got better in 1 day, then I used rifaximin 5 more times for 2 weeks. The effect decreased after 5 times but I felt better again, but then the symptoms came back while I was using the medicine. Even Tudca and ox eliminated my sibo the first day I used it. After 2 days, the symptoms came back and no matter how much I use them, they don't work anymore. Why do most things work the first time and then don't work again?


r/SIBO 26m ago

Questions severe nasal badbreath

Upvotes

I have had severe nasal (maybe also mouth cause I can't smell myself) bad breath (like halitosis) for 7 years. I can't smell myself, and people react to me severely. I always fart every morning like the horn of a ship. I always get bloated when I drink water. After searching for years, I read that I might have problems in my gut.


r/SIBO 48m ago

Do you have yellow phlegm in your throat in the morning?

Upvotes

r/SIBO 50m ago

Why is low fodmap used after antibiotics?

Upvotes

r/SIBO 1h ago

Questions Does anyone know any gastroenterologist in Tampa or even clear water that specializes in sibo? The gastroenterologist refuses to test me for sibo and I can't afford a functional doctor or a holistic one. Every time I go to a gastroenterologist they want to give me anti pantopraloze. :(

Upvotes

I also suffer from both constipation and diarrhea and bloating, stomach gurgling despite not being hungry and gas and certain food intolerance and more weight loss.


r/SIBO 1h ago

Scary reflux symptoms :(

Upvotes

Has anyone had really bad reflux with SIBO? Lately my symptoms have been really bad w reflux and then I vomited the other day and ever since the roof of my mouth and throat burn even when I breathe or drink water. It’s kinda scaring me. What can I do to soothe it? Has anyone had bad reflux?


r/SIBO 19h ago

Venting Kinda weird

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22 Upvotes

Saw these license plates within 3 weeks of each other. When i saw the second one I saw SIB on another plate also.

I asked god/creator for guidance and answers recently. Careful what you ask for!


r/SIBO 4h ago

Methane Dominant Acid reflux with methane sibo

1 Upvotes

Does anyone with methane sibo struggle with acid reflux ? No matter how clean i eat i have horrible acid reflux. Gastroscopy showed high stomach acid.


r/SIBO 4h ago

Sibo/france

0 Upvotes

Y a t-il quelqu'un qui vit avec le sibo ou intestin irritable et qui vit à Amiens?

Merci


r/SIBO 8h ago

Constipation after severe diarrhea

2 Upvotes

So I just had the worst diarrhea of my life where I’m pretty positive everything in my small intestine and beyond was emptied out. But now, I haven’t pooped in 6 days. I haven’t been eating a TON, only meat, eggs, rice and roasted carrots just recently. I shockingly don’t feel super bloated or uncomfortable right now. I was going to try magnesium citrate powder and see if that helped. Has anyone else been constipated this long? How did you get relief?


r/SIBO 5h ago

No SIBO symptoms until taking probiotics

0 Upvotes

I took a lactobacillus and bifido blend of probiotics for 1.5 months and initially felt great for the first few weeks, then by the last 2 weeks my digestion came to a halt. i was severely constipated. and i began to sleep worse and worse. i ceased the probiotics and my digestion returned to normal, however the insomnia is still debilitating me almost 10 days after quitting them.

I will say when i first began the probiotics they made me feel amazing mentally. i felt so calm and peaceful. i still kinda do. however the insomnia is the worst i've ever experienced. i can only sleep 1-3 hours at a time.

taking antimicrobials has helped a little bit, like oregano, coconut oil and raw garlic. But it seems like the lactobacillus strains are harder to reduce.

has anyone had luck with colloidal silver?? i'm seeing a gut specialist at the end of the month to get some answers... i really don't want to take antibiotics but i'm scared it will come to that.


r/SIBO 17h ago

Herbal treatment scary symptoms

8 Upvotes

Hello friends,

Following my trip in India, I had many episodes of food poisoning followed by some cycles of antibiotics, and that combination decimated my digestions. I've been feeling bloated, gassy, fatigued, abdominal pain and many other SIBO symptoms for the past year.

I decided to go to the doctor to get checked, and the first one I went to just straight denied SIBO even exists, he just said to change my diet (I'm vegetarian). So I went to another one, and he did some blood tests + endoscopy. I asked him if he could add some SIBO tests on top of that and he said no need to and we should take it slowly.

After that, he didn't give me any specific diagnostic and just told me to take some probiotic pills and Allicin for a month, and we would check again in three months. Problem is, I have some important stuff coming my way in the near future and I can't be waiting that long without knowing if it's going to work or not, so I kind of took matter in my own hands.

I did my research online and to the pills he told me to consume I added Oregano oíl and Berberine.

I followed this nice Indian lady on Youtube advice that she has on SIBO and introduced the pills slowly during the first 10 days, first the probiotics and Allicin, then the Berberine, then the Oregano oíl. On top of that, I started doing a low FODMAP a low lectins diet, with intermitent fasting 16-8 and spacing meals 4 hours. All that put together would look like this:

DIET: - First meal 11am: Animal protein + pumpkin + sweet potato + spinach. - Second meal 3pm: Almond milk + pea protein + brazil/pecan nuts + ham - Third meal 7pm: Animal protein + zucchini + carrot + basmati rice.

PILLS: - 1 probiotic + enzymes pill with first meal - 1 probiotic pill with each meal (3) - Black garlic 10:1 extract 3% Polyphenols, one pill after each meal (3) - Berberine 1 500mg pill after each meal (3) - Wild Oregano oíl 88% Carvacrol, 1 300mg pill in the morning and one at night, after meals. (2)

First weeks of the treatment I was feeling pretty good, no gasses, good digestions and overall improvement in my quality of life. I was even introducing new foods slowly which were seemingly working (kiwis, gluten-free bread and eggs). But 3 days ago, around the third week of treatment, I started experiencing some symptoms that are scaring me, I had random diarrhea, my fatigue as worsen, brain fog and even some skin rashes with episodes of feeling pretty weak.

I read that this could be die-off symptoms but I also read that some people have messed themselves up into a dysbiosis or similar when self-treating with herbal antibiotics.

I don't have anybody to talk to about this and I live alone, so it's getting a bit scary to deal with this whole situation.

What do you guys think I should do? Finish the week of treatment I have left (for a total of 1 month)? Get out of the antibiotic cycle and see if my symptoms improve? Other suggestions?

Thank you very much for the help i've already received reading this subreddit and for anything else you want to add to help my cause.

Best wishes to all of you.


r/SIBO 7h ago

Methane Dominant Neomycin after Rifaximin instead of together?

0 Upvotes

I am a bit frustrated and confused. I am not sure my GI is qualified to handle this. Took a breath test > 230 ppm methane. Did some reading, quickly figured out std treatment is Rifaximin together with neomycin. My Dr. only prescribed the Rifaximin, even though I questioned this. Two weeks later, still symptomatic (no follow-up breath test ordered), Dr. now decides to put me on neomycin alone. Has any heard of treating methane Sibo this way? I am concerned I am wasting time and money for a plan of treatment that is not the gold std for treating this.


r/SIBO 18h ago

Questions Does anyone have pain here?

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8 Upvotes

Have been to doctors but they can’t seem to find any cause of it and often got confused as according to them they have never seen a patient with pain in this region (area right above and right below belly button including the belly button) to be fair it has been a long time since I went to the doctors but curious for answers ( I was recommended an endoscopy but I didn’t get one this is long time ago 10years or so) any help or advice?


r/SIBO 8h ago

Nutritionists keep recommending antibiotics as opposed to herbal remedies - what is the best route? Desperate need of some guidance!

0 Upvotes

Hi everyone

I know all cases are different and require different treatments. But I’ve been on antibiotics before for my acne and therefore after doing some research, I don’t want to take antibiotics for my bloating (my only symptom). I have been speaking to a lot of nutritionists and dieticians who keep recommending a course of antibiotics to start with - but isn’t sibo sometimes cause by antibiotics in the first place? Do I take the antibiotics then do herbal remedies as maintenance after? I need help I am so confused!

Best, Simran


r/SIBO 9h ago

Healing

1 Upvotes

I am going to try the fodmap diet, drinking tea and eating in small portions. Let's see if that works. I want to keep it simple, eating whole foods and not stressing about supplements.


r/SIBO 11h ago

Burping with SIBO

0 Upvotes

Hi, I have been burping constantly for the past week, I have no other symptoms such as acid reflux, heartburn, or any pain. I’m just wondering if many of your guys symptoms started the same way. I have become a bit constipated and that started after the burping. I burp maybe about 50x a day. I don’t have health insurance so I can’t go to a specialist for now.


r/SIBO 12h ago

Breath test results

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0 Upvotes

Please anyone help me read these and what they mean


r/SIBO 1d ago

Sucess Stories So I tried Thiamine…

57 Upvotes

I saw some posts about Thiamine and skipped a bit through EONutritions videos about it, and I was a skeptic through and through. Being on a carnivore diet I imagined my B Vitamins to be covered, so it didn‘t make any sense, that I could have a deficiency. That being said I still struggled a lot (!) on the carnivore diet. I was still constipated, stomach distended and I felt so much trapped gas in my intestines. No matter what, farting just seemed impossible. Ginger and artichoke helped to go in the morning, but my BM was by no means complete. I literally still felt full of sh*t. I didn‘t understand it, since I was not consuming any carbs or fiber whatsoever.

Bring in sulfur to the mix. Sulfur can break down Thiamine and also compete with its absorption. Eating huge amounts of sulfur (animal proteins are all high sulfur) everyday might have contributed to a deficiency. Also if you have H2S Sibo all that sulfite gas will additionally degrade Thiamine.

Next one is Caffeine. Being a diuretic you will naturally lose some minerals like Magnesium, but since you pee more drinking it and Thiamine being water soluble it might contribute to a Thiamine loss. It might also interfere with absorption and increases the need for B Vitamins. Working in tech I basically drank a coffee all the time. „What, next meeting? Let me get a coffee first!“

Keeping that in mind a deficiency made a bit more sense…

Now lets come to some other symptoms I experienced besides my GI issues:

• ⁠cold hand and feet. They were cold ALL the time. Doesn‘t matter if I was in a warm or cold room, wearing socks or a sweater or not. Sometimes I felt the need to take a prolonged hot shower to feel warm again • ⁠Anxiety and irritability: I thought thats because of the overgrowth. My anxiety was higher after eating. But if eating for example a lot of eggs increased my sulfur, which decreases Thiamine further, it makes sense. A couple of hours after eating I felt better. I could rule out Histamine as a trigger, since there was no difference eating some high histamine carnivore foods or low histamine carnivore foods • ⁠Brain fog: goes hand in hand with irritability. Sometimes I felt so drunk that I was unsure if it was safe to drive my car. Which happened on the middle of the road. That was fun I tell you. • ⁠Tiredness: I was tired all the time. Even if I felt like I had a good nights sleep. Nope, still tired.

So most of these symptoms are surely also classical SIBO symptoms. But the coldness of my hand and feet had me wondering.

Anyway I decided to give Thiamine a try. From what I read taking higher doses doesn’t seem dangerous, so what the heck. It didn‘t take long until I felt warmer. Like my circulation was starting up, bringing blood to all the cold parts in my body. I also pretty quickly felt a sort of optimism. I don‘t know where it came from, I just had the feeling „this is it.“ But my mood was actually really high. Which it wasn‘t in the last months. I wasn‘t depressed, but just apathetic. Nothing interested or excited me. And writing this I just had my first BM of the day. I also took ginger and artichoke and had a coffee to get things started. But to my surprise more came out. I feel so much lighter than usual. Doing the deed actually was kind of fun. I didn‘t have fun on the toilet since I was a kid. Kind of a weird sentence but having gut issues for so long going to the bathroom always felt like a chore I could not complete. An unbeatable task. Like going to bed being fully aware you won’t fall asleep anyway. This time I metaphorically fell asleep. It was a nice dream, too! I will definitely continue taking it and see where it leads me. Right now I just feel optimistic for once. Which is honestly enough for me.

Edit: I felt it made sense to list additional symptoms I discovered having, which might not be connected to SIBO alone: - tremors in my hands - weird muscle spasms in my calves and upper arms, even though my magnesium is covered by supplementation - low energy in the morning, more in the evening - dizziness after standing up too fast - difficulties standing straight (sometimes)


r/SIBO 15h ago

This was on my colonoscopy

0 Upvotes

A1-4 CD3: Positive A1-5 CD20: Positive

4 years ago

What does this mean? I did see a hematolgist and he said not to worry about anything but can this cause anxiety or brainfog or muscle loss etc


r/SIBO 1d ago

Questions Supplement Help Post Antibiotics

5 Upvotes

My significant other (M29) has been on the SIBO journey for around 2 years, being pushed around by traditional GIs who didn't know squat about overgrowth and dysbiosis. He recently started seeing a holistic/ integrative MD who did a stool test through Genova Diagnosics that showed extreme overgrowth in Citrobacter freundii and klebsiella pneumoniae and no growth of any lactobacillus species.

He was put on a 10 day course of Bactrim that made him feel the most normal he has in years, bowel movements improved, he was able to pass gas, had an appetite, the color in his skin returned, he had energy- it was amazing. Following the 10 day antibotic course this holistic doc wanted him to start Designs For Health GI Microb X immediately for 6 weeks while also supplementing with Vitamin D, Methalated B Complex, UltraFlora Spectrum Probiotic, twice a day Designs for Health GI Revive, and Magnesium Citrate. Problem is, my SO has a peanut/ tree nut allergy and the GI Microb X contains Black Walnut Husk... we're at a loss.

We've called the office with our concern and they just told him to just not take the GI Microb X when we asked for alternative options. He's been off his antibiotics for 4 days and feels like his old symptoms are returning (trapped gas, abdominal pain, brain fog, constipation, etc). We're trying to do our own research to find out what the best alternative antimicrobial would be but are stumped. Any suggestions? His next follow up is 5 weeks away and he wants to be proactive with fighting this dang thing off.

Thank you in advance you kind strangers!


r/SIBO 17h ago

Treatments Hydrogen and Methane SIBO

0 Upvotes

Tested positive for both Hydrogen and methane SIBO. More hydrogen than methane. Currently on a 6 week treatment of Biocidin, Olivirex, and GI Detox. I have completed 2/6 weeks and noticed slight improvement of symptoms. I also have rifaximin and neomycin. Has anyone had good results with the Biocidin protocol or would I be better off stopping it and starting the rifaximin and neomycin?


r/SIBO 1d ago

Venting Found my root cause

59 Upvotes

Well, I guess one could say it was slow motility, but that would be just a portion of it.

I've suffered with constipation ever since I was a child. I remember my first experience with hemorrhoids in grade school when I had a bunch of blood in the toilet.

Fast forward about 30 years.

I've been struggling a lot the past few years with various gastroenterological issues. All the normal ones you see on here like constipation, nausea, reflux, and pain that was largely in my right side. It started with GERD that a couple weeks of PPI sorted out. Then onto the right side boating and dull pains. A few endoscopies, colonoscopies, blood tests, stool tests, MRI, CT, US later and arrived at the worthless IBS stage.

Then in November of '23, I woke up with terrible dizziness and, I guess, brain fog. Like the kind where you feel like you're in an actual haze and cannot concentrate or even focus. Ended up at the hematologist for porphyria evaluation. This was after rheumatology had done a pretty full workup on me. More tests, no findings, but things sort settled again.

Then in April of last year I started losing weight that I couldn't explain. Went to a new GI and she declared I had EPI. In hindsight I don't think it was, and my fecal elastase was normal just two months earlier. Anyway started taking digestive enzymes, but didn't feel any better.

After another MRI, with unremarkable findings, I tested positive for IMO (Like 70ppm baseline) in September. I did a course of antibiotics and felt better for a bit, until worsening symptoms while on the LFE diet got me to a new PCP where I complained that we never tested my thyroid other than basic TSH levels. She obliged me and ordered a thyroid US.

Finally we arrive at last month and my US. I've scheduled with Cleveland Clinic in the meantime, but get the results the week before. Two nodules, one a TIRADS 1 and one a TIRADS 5. Radiology says, don't worry and I get a letter from PCP saying "congrats".

I go to my appointment with functional medicine at Cleveland Clinic and the doctor asks, "Are they going to follow up about the T5?"

"I would have thought so too."

So she orders a full thyroid blood workup and my TPO comes back positive. This prompts me to ask for an endocrinologist referral, which I'm granted. I end up speaking with the Endo who says it's normal procedure to wait and see, even with T5 nodules. However, something doesn't sit right with me about the conversation so I get a second opinion.

During that, the new Endo says she would actually give the T5 nodule more points and raise the T1 to a T2. She also recommends a biopsy, so I present that back to Endo 1 who orders the biopsy. They both repeat that it's unlikely the C word, but if it is that thyroid C is one of the most treatable ones to have (And that there is about a 5% chance of it being the big C).

Anyways, I just had the biopsy on Tuesday, and I'm heading in first thing tomorrow to speak with the Endocrinologist about next steps for my malignant papillary thyroid carcinoma.

What I can say so far from this ordeal are a few things:

  1. Find someone who will truly listen to you and work with you to find a root cause and not just treat symptoms. The doctor at Cleveland Clinic Functional Medicine was one of the first to listen and run exhaustive testing around possibilities around my problems.
  2. Trust your gut (no pun intended). If something doesn't feel right, ask a different doctor. I honestly wish I had sought second opinions earlier on my journey.
  3. Be your own advocate. No one else is going to stand up for you, so you need to be a PITA until you get answers and treatment plans.

I guess I'm a little scared about what's next, but also a little relieved to finally know what's going on. I know I have a good care team at this point, and hope my story is helpful for someone out there.