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Hypothyroidism runs in my family... could I have it too? I'm only 20

Over the last year my mother has noticed my health decline the way hers did before she was diagnosed with hypothyroidism. I recently had blood work done. It shows my TSH is at 3.3 and T4 is 1.1 and my doctor is telling me these are normal. I just want another opinion. I've gained 30 lbs in the last 8 months, I am constantly exhausted/fatigued, I get migraines 2-3 times a week, I'm freezing cold all the time and my skin is getting drier and paler each day. I am constipated, haven't had a regular period in years, my hair has been shedding more than normal over the last year... I feel like I have every sign of hypothyroidism but just haven't been diagnosed.
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Avatar universal
Of course rules are different among different health insurance companies, but I would think that if you can get your doctor to write the lab order in a way that identifies the possibility of hypothyroidism as the basic reason to do the additional tests, and that each of the variables to be tested can affect a patient's thyroid status, it might work to get coverage.  
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Avatar universal
Good that you don't have to wait longer.  In preparation for the doctor, I suggest taking a copy of the list of symptoms I gave above and marking those that you have and give it to the doctor to help convince him of the need for additional tests.   Also give him a copy of the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective, and ask him to review and consider clinical diagnosis and treatment, rather than just test results for TSH and Free T4.  .  
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Avatar universal
Good question.  Never thought to find out before.  When I looked up the half-life of B12 I found it was about 6 days, which is less than T4.  Since the ATA/AACE Guidelines for Hypothyroidism even state that the morning thyroid med dosage should be deferred until after the blood draw, in order to prevent false high results, I'd say it is a good idea for B12 as well.
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I was able to move my appointment up to 5 days from now. I've stopped taking my B12 and I've written up a few concerns. I believe I'll have to go to a specialist in order for my insurance to cover the testing of Vitamin D among others. Thanks so much for all of your help!!!
Avatar universal
Your B12 is adequate.  You do need Vitamin D and cortisol since they directly affect the cellular response to thyroid hormone.  Also, ferritin is very important since it significantly affects conversion of T4 to T3, and the Tissue T3 Effect is what creates your thyroid status.  You can see these effects shown in Fig. 1 , page 7, of the following link to the full paper I mentioned.  

https://tinyurl.com/y7sfp5r8

Note the different processes involved  and on the left hand side, the variables that affect each.
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I take B12 supplements already, I have since cutting out red meat a few years ago. I'll be sure to ask to test the others specifically next time I go in. This might be a stupid question, but should I not take my B12 prior to my next test?
Avatar universal
It is too bad you have to wait for 2 weeks to see the doctor, but at least you can make good use of the time by learning all you can about your condition and becoming your own best advocate for the diagnosis and treatment needed.  

So most doctors have been taught that hypothyroidism is essentially always primary, due to Hashimoto's Thyroiditis.  The theory is that as the Hashi's progresses, the output of thyroid hormone declines and is correctly sensed by the pituitary which then secretes increasing levels of TSH to provide more stimulation to the thyroid gland to produce hormone.   They erroneously believe that TSH is an extremely accurate measure of a person's thyroid status, in both the untreated as well as treated states.  

This is totally incorrect.  First because extensive data show that TSH has only a weak correlation with the biologically active thyroid hormones, Free T4 and Free T3, and a negligible correlation with symptoms, which are the patients' concerns.   So TSH cannot be used as the primary diagnostic for a person's thyroid status.    

Further, hypothyroidism is not as generally believed, just low thyroid levels.  Instead hypothyroidism is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".    And you weren't even tested for Free T3.   So the Tissue T3 Effect determines a person's thyroid status and whether the patient has symptoms or not.  There is no biochemical test that accurately defines a person's Tissue T3 Effect, so there is no pass/fail test available for diagnosis.  Instead,  an integrated approach is best, including a full medical history, an evaluation for signs/symptoms that occur more frequently with hypothyroidism than otherwise, and extended biochemical testing.    

Looking at your symptoms, I can find all of them in this list of symptoms typical of hypothyroidism.    

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

As for biochemical tests,  as discussed, TSH is totally inadequate as a diagnostic unless at very extreme levels.   Your FT4 is at mid-range, so the doctor would see that as "normal".    So you need to have additional tests done.  Specifically, you need to be tested for Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin.    All are important to adequately evaluate and see what is causing your inadequate T3 Effect with resultant symptoms.  

If you can get those done and then post results and reference ranges shown on the lab report we will be happy to help interpret and advise further.   In preparation for the appointment I also recommend clicking on my name and then scroll down to my Journal, and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   You can also make a copy and give it to your doctor and ask him to review and consider clinical diagnosis and treatment, rather than just test results.   If the doctor resists, you should at least insist on the tests.  If he ultimately refuses to treat clinically then you will need to find a good thyroid doctor that will do so.
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Thanks for all the info! I will ask for more testing to be done when I see him next. My B12 was 926 and the range was 200-1100pg/mL, though I'm not sure what any of that means. And how important is the Vitamin D? My insurance doesn't cover testing that and I don't want to dish out a couple hundred dollars for something that isn't absolutely imperative.
1756321 tn?1547095325
I gained weight from hypothyroidism when TSH was in the mid 3's. I have Hashimoto's thyroiditis as does my mother and sister. Ask for TSH, free T4, free T3, thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).
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Avatar universal
There is much to discuss, but first please give us the reference range shown on the lab report for the T4 test, and confirm that it is Free T4, not Total T4.  Also, what did your doctor have to say about all the symptoms you have?    
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the reference range is 0.8-1.4 and it is Free T4. My doctor didn't want to make any decisions about my symptoms without a blood test and I don't see him again for another 2 weeks.
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