Does anyone have Hypothyroidism with Beta Thalassemia minor?

[Suegrab]

6.5-7.5My TSH is 0.63, T3 total is 85, Free T4 is 0.96.  I also have vitamin d deficiency which I seemed to be managing now @ 66.4k.  I take vitamin B12 injections monthly, 800 micrograms Folic acid daily with additional magnesium and calcium.  

I am a type II Diabetic and have been for a very long time, I acquired it genetically, it is well controlled.

[Barb135]

I don't have Thalassemia but I have hypothyroidism, vitamin D deficiency, I take B-12 injections weekly, along with Folate (vs Folic Acid).  I'm also deficient in magnesium and calcium, both of which I supplement.

I don't have Diabetes (yet), but I do have pre-Diabetes.   Several members of my family have Type I Diabetes and other have Type II.  

All of that said, do you have some questions I might be able to answer?  

[Suegrab]

Yes, I didn't really state my question very well!  

My GP is not willing to treat the thyroid issue, states labs are all normal, even though I have some pretty obvious thyroid symptoms.  How low does the TSH have to be before it is treated?  

[Barb135]

Do you have symptoms of hyper or hypo.

TSH it's counter intuitive... When you're hyper TSH goes low and when you're hypo it goes high.  That's generally speaking as there are instances on which it works differently but those are more rare.

Your labs are all within normal ranges but that doesn't mean they're normal for you.  Yours actually appear quite low indicating hypo. If you'll let  know your symptoms, I can help you better.

[Suegrab]

I have fatigue like I never experienced before, with shoulder, body joint pain, palpitations, bradycardia but with spurts of tachycardia.  Blood pressure has slightly increased, I am taking Atenolol  25mg. daily.  I really don't do well in the heat, I sweat profusely.  

The GP did do testing for C-reactive, Sed Rate, RA Quant., Lyme's, ANA, CK Total and all were normal.

My ferritin level is at 40.5 lab range is 15.0-205.0, this result is quite good for me I usually run in the high teens mid 20 range, and my MCV is 69.   The Thalassemia does complicate things, I did ask my GP if this played  a roll in the Thyroid and I got the feeling I said the wrong thing.

I am trying to find a reliable Endocrinologist.  

[Barb135]

What are the reference ranges for the Free T4 and Total T3?  Ranges vary from lab to lab and have to come from your own reports.

I'm under the impression your doctor might not know a lot about thyroid conditions.  The fact that he ordered Total T3 instead of Free T3 is a big indicator.

Your Ferritin is actually on the low side, even though it's in range.  It should be around 100.  Iron is necessary for the conversion of Free T4 to the usable Free T4.  

What were your latest B-12 results?   Have you ever had magnesium tested?  What dosage do you take every day?  Magnesium is responsible for approximately 300 reactions in our body and a good share of us are deficient.  Most of us don't take adequate amounts when we do supplement.

It's not really necessary to see an endo... Many endos specialize in Diabetes and aren't well versed in thyroid issues.  Too many of them go only by TSH and pay no attention to actual thyroid hormones or symptoms.   Any type of doctor can treat a thyroid condition.. the trick is finding one that will acknowledge a possible thyroid condition with levels in normal ranges.  You might do better with a Naturopath or Functional Medicine doctor is there's one in your area.

Why did you feel you should not have asked your doctor if the Thalassemia plays a roll in thyroid?

[Suegrab]

Thank you so much for taking the time to respond.  

I felt the GP totally discounted the Thalassemia with the thyroid and ferritin connection.

My B-12 was done on 6/04/21  result 708, lab range: 180-914,  I take monthly injections of B-12.
Magnesium 6/4/21 was 2.0  lab range 1.6-2.6.  I take 600 mg. of Magnesium daily, if I don't I get body  cramps,  I also supplement my Calcium.

The Total T3 85 lab range 35-193,
Free T4 0.96  Lab range 0.70-1.80

[Barb135]

Some doctors are so used to treating individual symptoms instead of the entire body, they may not even be aware of how one condition can affect another condition.  Nearly every cell in the body requires thyroid hormones (Free T3), but it seems like doctors, either don't know this or choose to ignore it.

Your B-12 is okay, but I have to keep mine right near the top of its range in order to avoid symptoms of deficiency.  My lab uses a range of 200-1100.   I get horrible body cramps, as well and have been told to supplement with, up to 1000 mg of magnesium.  If your 600 mg helps avoid the cramps it could be enough.

All of that said, your thyroid hormone levels are actually pretty dismal.  Rule of thumb to avoid symptoms of hypothyroidism is to have Free T4 at about mid range... Your Free T4 is only at 26%, which indicates that your body isn't producing adequate amounts.  The other rule of thumb is for Free T3 (the usable hormone) to be in the upper half to upper third of its range.  Your Total T3 is only at 32% of range and a good share of Total T3 is bound by protein and can't be used - that's why we need to test Free T3, not Total.

So I did mention that, typically, when thyroid hormone levels go down, TSH goes up.  Of course, there are always exceptions to the rules.  There's a condition called Central (or Secondary) Hypothyroidism in which there's nothing wrong with the thyroid, but the pituitary doesn't produce enough TSH to stimulate the thyroid to produce adequate hormones.   Central hypothyroidism is missed by many doctors because they assume that with a low or "in range" TSH, everything is fine.  Central hypothyroidism is still hypothyroidism and needs to be treated with replacement hormones just as other types of hypothyroidism.

Have you ever had thyroid antibodies tested to determine whether you have Hashimoto's?  The 2 tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  You need them both because they're both markers for Hashimoto's.   Hashimoto's gradually "kills" the thyroid so it produces less and less hormones, until eventually, it produces none.   This can happen quickly or over a period of years.

If you think your current doctor would be willing to test for the antibodies (if he hasn't already) you can ask for the tests.  You can also mention Central hypothyroidism and see if he's willing to look into that, as well.   It doesn't sound like he's real receptive to patient input but I'd suggest getting those tests if possible.

[Suegrab]

I went online to review my medical chart and it states in there that I have Hypothyroidism, which has me a bit confused,  Because I was told I don't have a problem.  

The GP indicated to me that people abuse Thyroid medication for weight loss, which really threw me because that was never even expressed in my concerns.  I didn't even know that was happening out there.  Is that a real problem or was I being told something false?  

I have not been tested for either of the Antibodies and I doubled checked if I had been tested for Free T3 and I haven't.  I'm not sure if this doctor will be willing to do anymore testing.  I guess I may have to go to someone else, which I don't look forward to because they make you feel like your making up symptoms.

I was reading on Hashimotos or a secondary hyp0thyroidism and that seems realistic also.

[Barb135]

No, it is not a real problem for people to abuse thyroid medications for weight loss.  I'm not saying it never happens - just that it's not common.  Abusing thyroid hormones is purposely causing oneself to become hyper, which is just as, if not more, dangerous as hypothyroidism.

If this doctor isn't willing to do more testing or even treat you when he says you have hypothyroidism, I'd certainly find someone else as he seems to be contradicting himself.   He sounds like one that tends to keep his patients ill.

[Suegrab]

I was to embarrassed to bring it up sooner because one starts questioning your own symptoms.  It's just really sad to be treated like that, there obviously is a disconnect going on.

Thank you for all of your support and knowledgeable information,

[Barb135]

It sounds like the doctor is trying to justify his own unwillingness to treat his patients with respect and compassion.  If my doctor indicated that he thought I abused my medication, I'd find another doctor asap.  

You're very welcome and please be sure to ask any other questions  you might have and keep us posted on your progress.