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First Time Here--Could someone take a look at my Thyroid Panel labs?

Hello!

I am a male in my 20s and, upon experiencing noticeable hair loss in areas of the scalp NOT characteristic of male pattern baldness (loss of inner 3rd of eyebrows, back of the scalp at the bottom close to the back of the neck, around the ears above the sideburns), I was advised to get a thyroid panel.
I also experience sleep difficulty and VERY pervasive mood swings. However, as I'm not quite sure what I'm looking for...so I would appreciate an interpreter! The following is exactly as it is projected in the results...

FT4:  0.9
TSH (3rd Gen):  1.10
T3T:  79.1

As you can see, the unit of measurement isn't even provided; thus, these blood-work results haven't been too informative to the eye untrained on thyroid disorders.

I truly would appreciate any help you can provide. Thank you so much!

-D
16 Responses
Avatar universal
Unfortunately, thyroid test reference ranges vary from lab to lab depending, among other things, on the test kits being used.  So, we have to see results with ranges from your own lab report.  If you actually have a printed lab report in hand, and it doesn't give ranges you could call the lab and ask for them.

Both FT4 and TT3 look low in range, but once again, I'm guessing since we don't have ranges.

1756321 tn?1547095325
Inner third or outer third?  The thinning or loss of the outer third of the eyebrows is known as the Hertoghe sign (also known as the Queen Anne sign) and is a sign of hypothyroidism.

Avatar universal
Oh!

I found a section where the test results read, "Reference." If that is what we are looking for, it projects the following:

FT4:  0.8-1.5 ng/dL
TSH (3rd Gen):  0.36-3.74 uIU/mL
T3T:  60-181 ng/dL

Is this what you are talking about, goolarra? Indeed, FT4 and T3T seem to be pretty low; and, given the symptoms, is this something I should bring up to an endocrinologist? What should my next steps be, if any?

Red_Star, it is the inner third. The outer third is not exactly thick, though, either. However, I thought I read somewhere that it was the inner third that still could indicate a thyroid issue.

Given the symptoms I provided (Oh - and add occasional heart palpitations [especially at night] to the list!), what could this be, if not hypothyroidism? The hair loss in abnormal areas is quite distressing.
1756321 tn?1547095325
The free T4 and total T3 is on the lower end which may indicate there isn't enough thyroid hormone in the blood. What is your basal (before you get out of bed) body temperature?

Causes of hair loss:

Pattern baldness (androgenetic alopecia)

Alopecia areata - autoimmune disease

Telogen effluvium - hair loss usually due to a change in the normal hair cycle: emotional distress such as a death in the family or a physiological stress such as a high fever; sudden or excessive weight loss; extreme diets; nutritional deficiencies; surgery; metabolic disturbances

Traction alopecia - excessive hairstyling or hairstyles that pulls the hair too tightly

Poor nutrition - inadequate protein or iron; fad diets; crash diets; eating disorders

Diseases such as diabetes and lupus

Medications such as chemotherapy or radiation therapy

Hormonal changes such as pregnancy; childbirth; discontinuation of birth control pills; the onset of menopause; hypothyroidism; hyperthyroidism

Hair treatments - chemicals used for dying; tinting; bleaching; straightening or permanent waves

Trichotillomania (hair-pulling disorder)
Avatar universal
Yes, exactly what I was looking for...

You can see that your FT4 is just above the bottom of the range.  Many of us find that symptoms persist until FT4 is about mid-range, which would be 1.15 on your range of 0.8-1.5.

TT3 isn't as useful as FT4.  TT3 tells the total amount of T3 in your blood, but much of that is chemically bound by protein and unavailable to cells; FT3 tells what's available.  Your TT3 is at 16% of range, and the target for FT3 is upper half of range (50+%).  Next time, you might request FT3.

Unfortunately in terms of getting treated, your TSH is not only flat out normal but just about what's considered optimal.  TSH is a pituitary hormone and a very indirect measure of thyroid status.  FT3 and FT4 are the direct measures and much more important.  However, most med schools teach that all that's really important is getting TSH "right" (they often don't care about FT4 a lot, FT3 at all and totally disregard symptoms).  So, you would be wise to do some interviewing of doctors before making an appointment to get a feel for how much emphasis they put on TSH and if they're willing to treat clinically to relieve symptoms.  If you want to go that route, I can give you some pointers on how to proceed.

It's usually the outer third of the eyebrow, and hair loss due to thyroid tends to be overall thinning as opposed to patchy thinning.  Body hair will also thin.  You might look into vitamin or mineral deficiencies.

I think you'd feel better on meds (it's definitely worth a try at least), but it's going to take some work to get treated.    
Avatar universal
Indeed, I would like to know what the next steps would be if I was to pursue this. Your help would be greatly appreciated!

I am also on finasteride, a hairloss medication. I don't believe this lowers testosterone...in fact, if I'm not mistaken, I believe it raises it.

My hair loss is not characterized by "thinning all over." It is in the aforementioned spots (that are non-male-pattern-baldness) AND, in addition, the spots that ARE characterized by MPB...So...I guess it is all over except for at the bridge and the midscalp.
1756321 tn?1547095325
Alopecia areata is sometimes referred to as spot baldness. I have a bald spot  (not on my scalp thankfully) that is permanent from AA. I also have nail pitting as well which is another possible symptom of AA.  
Avatar universal
I'd round up a list of possible doctors or endos in your area based on who is covered by your insurance, etc.  

You can call the office and ask to speak to a nurse to ask a few questions about how the doctor treats hypo.  If you get a particularly aggressive watchdog who answers the phone, you might be refused your request to speak to a nurse.  If you then ask the receptionist if she might answer a few questions, you'll most likely get put through to a nurse when the receptionist is totally incapable of answering your questions.

One good question to ask is which tests the doctor routinely orders for his hypo patients.  You want to hear FT3, FT4 and TSH.  If the nurse says FT4 and TSH, I'd ask if FT3 would be ordered on patient request.  You want to run from any doctor who only orders TSH.

Another good question is which meds the doctor uses.  T4-only meds (Synthroid, Levoxyl, generic levothyroxine, etc.), combos of synthetic T4 and synthetic T3 (Cytomel and generic liothyronine) and desiccated porcine thyroid (Armour, NatureThroid, Erfa, etc.) are the three basic groups, and ideally the doctor will use whichever works best for the patient.  Practically speaking, however, doctors tend to fall into either the synthetic camp or the desiccated camp.  The only doctors to avoid here are the ones who only prescribe T4.

You can also ask if the doctor treats clinically to relieve symptoms or just "by the numbers".  Although there seems to be a "right" answer to that question, you can get some amazingly candid replies.

Those three questions will weed out the worst of the worst, but of course, you can ask any other question you feel applies to you.

When I was looking for an endo, I wrote up a multiple guess questionnaire (to save them time) and faxed it to all the possibilities in my area.  My current endo is the only one who took the time to answer.  He's great; I love him...I got lucky.  If I hadn't found him, I'd have been driving 125 or more to the next medical market.

    
Avatar universal
If I was to go on meds, will my hair loss stop and return to its normal thickness?
Avatar universal
IF (the big IF since there can be so many causes of hair loss) the hair loss is caused by being hypo, then once your are on meds AND (this can take a while) your dose is properly adjusted for you, your hair loss should stop and hair will regrow.  However, keep in mind that hair loss is often one of the last symptoms to go away.  The body tends to heal the critical systems (brain, heart, etc.) before those that are not crucial for survival.  It can take months to find the proper dose, and thyroid meds do not work immediately; they have to build in your system for weeks.  So, it's not immediate relief like taking an antibiotic or an aspirin.  
Avatar universal
Hey guys,

Sorry it's been a while. I hope you've been well.

Goolarra, what would be the medication for hypo that I would use that would respond to my hair loss/mood swings?

-D
Avatar universal
There are basically three choices, brand names aside.

#1 - synthetic T4-only, which includes Synthroid, Levoxyl and generics

#2 - a combination of the above and synthetic T3 (Cytomel and generics)

#3 - desiccated porcine thyroid, which contains both T3 and T4 (Armour, NatureThroid, Erfa, etc.)

All have advantages and disadvantages.  
Avatar universal
I've read, however, that some of those drugs you listed (namely Synthroid and Cytomel) actually have "temporary hair loss" as one of their listed, potential side effects! How do you figure this?

-D
Avatar universal
Hair loss is a symptom of hypo.  By and large, doctors do not treat hypo properly.  They get their patients thyroid hormones back into reference range, even if just barely, and they consider their treatment a success.  Well, we don't all feel well in the bottom of the range, in fact, most of us don't.  Doctors need to keep increasing meds and use the whole width of the reference range until symptoms are gone.  I don't think it's the Cytomel and Synthroid that cause the hair loss.  I think it's the person behind the prescription pad undertreating on a regular basis.

I've heard complaints of hair loss regarding all three choices, and I thin the common denominator is undertreatment.  
Avatar universal
Thanks!  If I was going to boost my thyroid by a natural/homeopathic route, are there any effective treatments you recommend?
Avatar universal
Not really.  There's no replacement for thyroid hormones.  Every cell in your body needs thyroid hormones.  Considering how low your FT4 already is, I'd be reluctant to try any iffy treatments; you could acquire a whole array of symptoms in the process.    

Have you had any thyroid antibody tests?  Do you know if you have Hashi's?

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