Is my enlarged thyroid causing these issues? Treatment or diagnosis tips?

[Victoria3719]

I'm a 21 year old female college student, and since I hit puberty when I around 12 years old, I have had trouble losing weight... I'm about 6 foot 1, 250 lbs but I'm very active and I workout 5 days a week, resistance training for an hour and sometimes cardio. I play basketball once a week as well. I found out 5 years ago that I had an enlarged thyroid, which I blame for the massive weight gain and extreme hair loss. However, after going to the doctor numerous times, all my tests came out "normal". I know something's wrong... I still have hair loss, I can't lose any  weight, I'm always fatigued, and I get this weird burning, achy sensation in my throat every once and a while. Sometimes I have heavy periods, have random nausea, and my voice is deep. Nevertheless, I really need to lose weight; I have almost every genetic factor leading to CVD, diabetes, HBP, etc in my family history. Weight loss and energy is essential! Please help! What can I do? What could it be?

[gimel]

The problem with the typical protocol for testing and evaluating potential hypothyroid patients to first test TSH, is because of the mistaken belief that TSH is the most sensitive test for thyroid status.  The range for TSH was established based on the NHANES study, which included thousands of people.  After excluding people with identified thyroid problems, they established a statistical distribution of the remaining TSH results and decided to set the upper and lower range limits at plus or minus 2 standard deviations from the average.   There are several errors in doing this that I won't bother you with.  Prior to 2008 the range was .5 - 5.0.  Then in 2008, in response to so much evidence that hypothyroid patients just within the upper limit were not being treated and were suffering unnecessarily with hypo symptoms, the new guidelines issued by the AACE and ATA in 2012 changed the upper limit to 3.0, which was a huge change that exposed many millions of people to the diagnosis of being subclinically hypothyroid.

Then in 2012, apparently because of complaints from doctors about the lower limit, the range was again revised to 4.3.  In reality it is impossible to set a limit and say that a patient that is .01 over the limit is not okay, and a patient that is .01 below the limit is okay.  Currently the range limit is set at a point to avoid false positive diagnoses.  As a result, there are many hypo patients who are ignored.  The problems have been passed on to hypo patients to have to learn about hypothyroidism and be able to argue with most doctors to get adequate testing and treatment.  

Now, understand that overt hypothyroidism is defined as having a TSH above 10, which then gets you some treatment.  A TSH between 4.3 and 10 only gets you another test, for Free T4.  Then the doctor will use "Reference Range Endocrinology" and if the Free T4 is within its range, treatment is frequently denied, in spite of symptoms.  Patients are frequently told, "Your test results are within the normal range, so it cannot be your thyroid that is causing symptoms."  This is ridiculous because of the way the ranges are established for Free T4 and Free T3.  Those ranges are based on lab results for all patients getting thyroid tests, with TSH less than 5.  By this they erroneously think they have excluded hypothyroid patients.  In reality there are included a lot of sick patients, hypo patients and hypothyroid patients being treated with thyroid med.  If a extensive test was done on healthy adults with no known thyroid pathology, the ranges for Free T4 and Free T3 would look more like the upper half of the current ranges.  This is the basis for the quote I gave you above from a good thyroid doctor.

Yet most doctors don't understand this because they were taught that TSH is the best measure of thyroid status and that any test that falls within the so-called "normal" range is adequate.  You can also get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

You can supplement for low ferritin on your own.  I would start with 25 mg of ferrous fumarate, or ferrous sulfate, or ferrous bisglycinate, and after a few weeks, increase to 50 mg.  Then test again.  

Getting the Univ. clinic to listen and do the testing needed is only a small step.  It is very doubtful that you could get treatment since your TSH and Free T4 are within the ranges.  Unless you go to a good thyroid doctor that understands all this and is willing to do the testing and treatment required, you will be disappointed.  So, instead of that possibility if you will tell us where your home is located perhaps we can suggest a doctor that has been recommended by other thyroid patients, and you can start now to try and set up an appointment for when you go home.  

As for Vitamin  D and B12 I would be surprised if they are optimal.  D should be about 55-60 and B12 in the very upper end of its range.  

[Victoria3719]

Wow.... Why would they tell me that's normal then? They didn't say anything about what to do with my low ferritin amount.... Do you have any suggestions on that?

I'll most likely wait until school break to go to a doctor at home because I don't know if they will listen to me and give me the free T3 test. I insisted on only getting those two tests and they said we will do the thyroid panel.

I think I had my Vitamin D and B12 tested before and those were above average.... But I don't remember.

[gimel]

That Free T4 result and reference range actually looks more like it would be for Free T3 instead of Free T4; however, whatever it is the result is far too low in the range.  Even though your TSH is within range, that does not preclude you being hypothyroid, since with central hypothyroidism there is a dysfunction in the hypothalamus/pituitary system that causes relatively low TSH, and thus Free T4 and Free T3 that are too low in the range.  

In addition your ferritin is way too low.  That can cause symptoms, as well as adversely affect metabolism of thyroid hormone.   What did the doctor say you should do about the low ferritin?

So in summary I think you need to go back and have a heart to heart talk with the doctor and explain the many symptoms you have and insist on the need to be tested for both Free T4 and Free T3, along with Vitamin D and B12.  Then you need to request a therapeutic trial of thyroid med as needed to raise your Free T4 to the middle of its range, and your Free T3 into the upper half of its range, or as needed to relieve symptoms.  Scientific studies have shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate.  If the Univ. doctor(s) won't agree then can you get your doctor at home to do so.  

As you proceed, keep this info in mind.  In the words of a good thyroid doctor, In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

[Victoria3719]

They called me and said my results are normal. But those were the exact results and numbers the lab report on my health database my university allows me to access at any time.

[gimel]

I have never seen a Free T4 range that broad.  Is that shown on the lab report, or did someone tell you by phone?

[Victoria3719]

Sorry! Forgot to post the reference ranges.

T3 Uptake is 22-35%
T4 Total is 4.5-12 mcg/dL
Free T4 is 1.4-3.8