Is it Hashimotos?

[HCC72]

Hello.  I have been doing the "wait and watch" approach for about 1 year.  My labs are typically normal.  I have a family history of thyroid disease.  My mom, grandmom, aunts and brother have all had issues.  For about 2 years I have had some hair loss and heavy, painful periods.  Complaining to the GYN she put me through testing to which she only found small fibroids, but nothing needing surgery.  About 6 months ago she told me to go on birth control to help with the periods.  I am 46 and was nervous to do the combination pill so reluctantly went on the mini pill.  Within 1 month I gained over 20 lbs.  I called and let them know about the weight gain and they said it's either stay on it for lighter bleeding or not..   So I stayed on it 3 months.  My cramps got worse and I stopped taking it.  My brother suggested seeing a Naturopath which I did.  My testing is back:

Diffuse Goiter via sonogram
TSH 1.6 (normal)
T4 .96  (normal)
T3 2.9 pg/ml  (normal)
RT3 25.9 ng/dl (high)
Tpoab 11 (normal)
Tgab 5.6 (high)

I have an appointment in the next week or so to go over the results.  Should I ask for treatment or just keep "watching and waiting"?

[Barb135]

Please post the reference ranges for the results you've posted. Reference ranges vary from lab to lab so have to come from your own report for the best comparisons.

Are hair loss and the menstrual issue the only symptoms you had prior to starting on the birth control?  

[HCC72]

Yes, those were my only complaints..  I am glad you asked for the references as I had a typo on TGab.

Diffuse Goiter via sonogram
TSH 1.6 (normal)              0.450-4.500 uIU/mL
T4 .96  (normal)                0.82-1.77 ng/dL
FT3 2.9 pg/ml  (normal)    2.0-4.4 pg/mL
RT3 25.9 ng/dl (high)        9.2-24.1 ng/dL
Tpoab 11 (normal)            0-34 IU/mL  
Tgab 1.4 (high)                 0.0-0.9 IU/mL
Ferritin 45                         15-150 ng/mL

[Barb135]

Thank you for providing the reference ranges.  Although your TSH looks wonderful and, unfortunately, that's what most doctors are going to look at, your actual thyroid hormones are much lower than is recommended or where most of us feel comfortable. I would certainly consider you to be hypothyroid with levels like that.  

Your TgAb could indicate Hashimoto's, however, we would expect TSH to be higher with such low hormone levels, though.  Your body is converting more Free T4 to rT3 than to Free T3 for some reason.

Since your TSH is as low as it is, you could also have a condition called Secondary or Central hypothyroidism. This is when the thyroid actually works fine, but there's a problem with the hypothalamus/pituitary axis.  

One thing I do see is that your Ferritin is too low.  Ferritin is the iron storage hormone and iron is necessary for the metabolism of thyroid hormones.  

Although iodine is the main component in producing thyroid hormones, it requires iron to be fully utilized.  According to nahypothyroidism.org, research shows that iron  also plays the following roles:

    "Iron (in the heme form) is necessary for thyroid hormone production.
    Iron is necessary to convert T4 to T3; T3 is the active form.
    Iron status (ferritin) inversely correlates with TSH.
    Iron is critical for thyroid peroxidase activity (TPO)."

There are other vitamins/minerals necessary for the production/utilization of thyroid hormones, as well, such as selenium, zinc, vitamin D, etc.

Do you have a copy of the ultrasound report?  Does it have an impression printed at the bottom or recommend any follow-up?  Sometimes, the report will mention that the image is consistent with Hashimoto's...

[HCC72]

In looking at my results it shows:
CONCLUSION:
1. 0.3 cm nodule in the midpole of the left lobe.
2. Diffuse thyromegaly.
3. Normal lymph nodes in the neck with no adenopathy.
INDICATIONS: Prominent thyroid, enlarged

[Barb135]

The ultrasound sounds pretty standard.  It appears as though you only have one nodule and it's pretty small, so it wouldn't require anything to be done.

Thyromegaly means that you have a swollen thyroid, which is also known as a goiter.  This is common with Hashimoto's.  

Things you'll want to discuss with your doctor next week include your low thyroid hormone levels (both Free T4 and Free T3), your high rT3 and your low Ferritin.  

Your doctor should suggest an iron supplement to increase your Ferritin level since iron is so important to the process of thyroid hormone production.

You should also ask your doctor to test your cortisol levels since stress can cause too much Free T4 to be converted to rT3.  The most accurate cortisol test is the 24 hr saliva test.  If your doctor can't order it for you, we can tell you how to it. Other causes for over conversion to rT3 are insulin resistance, depression, obesity, diabetes and others. You'll know if you're obese or have diabetes, however, insulin resistance is a bit more complicated. It's the forerunner to diabetes and many doctors don't bother to look for it.

You should also ask your doctor to test your vitamin D and B-12 levels and ask whether or not you should supplement with selenium since selenium is also necessary for thyroid hormone production.  

These suggestions will get you started for your appointment next week and we'll see how it goes.