Expat hoping for thyroid help

[indomie]

Hi there, I am an expat living long-term in Indonesia (female, 28yo) where good health care is extremely rare. I'm having symptoms of hypothyroid (gained 10-15 pounds which won't come off, thinning hair, exhaustion beyond belief, horrific sleep...), also my mother was diagnosed with Hashimoto's several years ago.

I pushed to get tested here and was wondering if any of these numbers stand out to you, from your experience? The doctor here told me everything is normal but I understand after googling that the whole picture is hard to get, so I am hoping to seek some additional thoughts. Thanks so much for your help!

TSH: 1.88 μIU/mL (0.27-4.20)
FT3: 4.53 pmol/L (3.10-6.80)
FT4: 1.09 ng/dL (0.89-1.76)
Anti Thyroglobulin AB: 18 IU/mL (Negative: = 115)
Thyroglobulin: 38.30 ng/mL (0-55)
T3: 1.05 ng/mL (0.8-2.0)
T4: 6.31 μg/dL (5.10-14.10)

Thank you!

[goolarra]

If you can get it, a 24-hour saliva test is best for cortisol.  You basically spit into four different cups at four distinct times of day and get four discrete readings.  This will give you much more information than any test that averages, as cortisol should be higher in the morning, gradually tapering off later in the day.  

In addition, some vitamin and minerals have to be present in sufficient quantity both for the synthesis of thyroid hormones in the thyroid and for the hormones to be used by cells.  These include vitamin D, iron/ferritin and magnesium.  Vitamin B-12 deficiency can cause debilitating fatigue.  As with thyroid tests, just being in the bottom of the range on these tests often isn't sufficient.  You want to be well up in the ranges.

[indomie]

I haven't tested anything adrenal yet… I'm not sure where to start, is it the cortisol test? Are there others that would be diagnostic of any possible problems happening?

[jacrjacr]

did you test first thing in the morning hence that is what I do to get the most accurate TSH.
You need to make sure you are not vitamin D deficient, or b12 deficient because both can make you feel terrible.
it may also be good to get your hormones and cortisol checked.
You may want to try a thyroid support formula with that long g word in it that helps to thyroid and see if it makes you feel better, take a bcomplex supplement and d3 supplement and a multi vitamin but keep listening to your body .

[goolarra]

TSH can vary as much as 70% intraday just depending on the time of day the blood was drawn.  So, the change from 1.04 to 1.88 is within a "normal" circadian variation.

I don't really see a pituitary issue here.  Your FT3 and FT4 are a little low, but some people are quite symptom free with low levels.  

Adrenal and thyroid hormones are interdependent.  While I might ordinarily agree with you that a trial dose of thyroid meds might be in order, if you suspect adrenal involvement, you have to address that first.  Thyroid hormones are usually almost impossible to regulate if adrenals are off.

Have you had any adrenal testing?

[indomie]

Forgot to mention - adult acne and hirsutism too! Hooray.

[indomie]

Hi there, thanks for your response. I did have a google binge after posting my results and realized that my TPOab is missing. I'll go have that done asap.

Last August my TSH was 1.040 (0.40-5.50) (doc diagnosed PCOS). Is its increase to 1.88 now significant, or normal? In the event my TPO gives no information, do you think it's worth pursuing medication for the results I'm showing now? Or do my results suggest something's wrong with my pituitary and I try hunting there instead?

For what it's worth, I also exhibit signs of adrenal fatigue. During its most brutal period last year I was waking up every night at 3am and 6am and the exhaustion was beyond anything I could think possible. I switched my diet to homecooked veggies and protein and started walking everywhere (not easy in Jakarta), and now deliberately get 8-9 hours of sleep every night, but I'm still always sleepy, and usually wake up at either 3am or 6am. Also if I stay awake past midnight, I won't sleep till 2am. Sugar cravings were crazy during the brutal period, which I got under control with apple cider vinegar (wonder drug) plus metformin XR (fasting glucose in August 93 (65-100), 2-hr sugary syrup value 112 (40-140)). Still gaining weight easily though, thinning hair, brain fog… also my temperature is usually at or below 36.6 (97.9 F). I would already feel feverish at 36.9 (98.4 F).

Health care here is a bit DIY so I can push for any tests or drugs within reason, they are happy to take my money, but I'm hitting walls as to what's actually wrong and what will work. I will however get the TPO and see if that is finally the right red flag.

[goolarra]

Your FT4 is at 23% of range, which is often a little on the low side.  Many of us find it has to be closer to 50% before symptoms are relieved.  Your FT3, which is the test that correlates best with symptoms, is at 39% of range, which is also short of the 50+% that's the rule of thumb for FT3.  

Thyroid test ranges are very flawed; the whole bottom part of the range is a very gray area.

TGab is present, though still within range.  However, by far, TPOab (thyroid peroxidase antibodies) is the dominant marker for Hashi's.  Most of us are TPOab positive, some also TGab positive and a very, very small percentage only TGab positive.  So, you have to have TPOab tested to rule out Hashi's.  

While your FT3 and FT4 are both a bit low, your TSH is good, which would indicate that your pituitary thinks your levels are fine.  TSH, however, is a very unreliable test.  

I'd urge you to have TPOab tested.  Depending on the results of TPOab, I'd suggest some vitamin and mineral testing.