Other thyroid lab opinions?

[CassiopeiaBurke]

I think I may have a thyroid issue because no matter how hard I try, I cannot lose weight. I eat a very, very clean diet based on whole plant foods (I crave starchy foods/carbs and sugary foods). I work out 4-5 days a week with a combo of heavy weights and cardio, light yoga on my days off.  I'm always tired, no matter how much sleep I get. I have constant headaches and my post-workout muscle pains last for days after lifting. My toes and fingers are normally cold however I'm normally always hot. My mother has also said my breath smells of alcohol and I don't drink. I also feel like my hair is thinning out. I also have certain skin spots that just won't heal or scar properly. I also have very mild hypoglycemia. My labs fall in a normal range but I'm just not convinced. No matter what I do I just feel very blah.


My TSH as of 10/17/15 was 1.13
                                                           Reference Range
F Ferritin: 7                                         8-252 (ng/mL)
F Vitamin D: 27                                  30-100 (ng/mL)
( 25-OH Total, IA)
F T4:  1.09                                          0.93-1.60 (ng/dL)
(Free Direct)
F Iron: 59                                            50-170 (ug/dL)
F TIBC: 421                                        250-450 (ug/dL)
F % Saturation: 14                             16-46 (%)

I was also told I have low iron. Based on my results, is it really THAT low?

[gimel]

Your logic just doesn't follow.  Very seldom would a hypo patient start on a full dose and have excess Free T4 that they couldn't utilize.  Instead they usually start on a dose that is lower than the expected ultimate dose, and increase gradually to optimize their Free T4 and Free T3 as needed to relieve symptoms.  This should usually be done in parallel with optimizing D, B12 and ferritin, rather than sequentially, which slows down the healing process.  Also, studies have shown that hypo patients taking T4 meds find that their Free T3 ends up significantly lower in its range, than Free T4, due to altered deiodinase activity from reduced TSH levels.  

[des900]

the reason why i said so is because if one starts levothyroxine treatment with full dose to bring tsh under normal value or even lower end in normal range then problems can occur. for example due to low ferritin and other defeciency there can be poor t4 to t3 conversion and also high reverse t3 due to excess free t4 which cannot be utilized. this makes hypo symptoms get even worse.

[gimel]

If you will tell us your location, perhaps we can suggest a doctor that has been recommended by other thyroid patients.

[gimel]

I disagree because thyroid hormone deficiency itself is a frequent cause for low Vitamin D and ferritin due to the effect of low stomach acid from the hypothyroidism.   So if one should be deferred, it is the D and ferritin supplementation; however, there is no reason to address these actions sequentially. that only delays getting symptom relief for the patient.  It is better to work on both in parallel, with thyroid med and supplements for D and ferritin.

[des900]

my opinion is need to address the basic things first before trating the secondary ones including thyroid. so need to bring vitamin d level to over 50 and ferritin also to optimal level and then need to recheck thyroid levels and supplement appropriately.

[DeeVenter]

You might need to have your tests done a few times, over a course of a year - sounds crazy - but your other levels definitely need to be "off" for a positive diagnosis.  They could catch this if they keep testing - it happened to me.  For thyroid issues - do you have these other issues

Fatigue
Dry, coarse skin
Feeling cold
Cool extremities
Poor memory and concentration
Myxedema (mucopolysaccharide deposits in the skin)
Constipation,
dyspepsia
Hair loss
Weight gain with poor appetite
Slow pulse rate
Shortness of breath
Swelling of the limbs
Hoarse voice
Delayed relaxation of tendon reflexes
In females, heavy menstrual periods (and later light periods)
Carpal tunnel syndrome
Abnormal sensation
Pleural effusion,
ascites,
pericardial effusion
Poor hearing

[CassiopeiaBurke]

I've had my thyroid looked at a couple times, however I always seem to fall into the normal range. Out of the listed symptoms, I experience fatigue, drier skin, hair loss, weight gain/stagnancy, shortness of breath, heavy periods, carpal tunnel, and cold extremities.

[gimel]

Well, that is pretty obvious and already identified.  So what is your point?  Are you suggesting that she should disregard anything about thyroid issues and only pay attention to Vitamin D and ferritin??

[des900]

ferritin and vitamin d defecincy

[gimel]

You are missing a couple of tests normally run for possible hypothyroid patients:  Free T3 and TSH.  Were those not done?

Just from your listed results, your ferritin is horribly low, along with low iron and % saturation.  Ferritin should be about 70 min.  Also your Vitamin D is about half of optimal, which is 55 min.  Ferritin is also very important for hair growth.  

Your only thyroid test listed is at only 24% of its range, when it should be about 50% min.  In the words of a godo 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."  Note that hypothyroidism can also cause hair loss, among other symptoms.

A good thyroid doctor will  treat a hypothyroid patient clinically by testing and adjusting Free T4 and free T3 as needed to relieve symptoms, without being constrained by resultant TSH results.  Symptom relief should be all important, not just test results.  

So you need to discuss this with your doctor and convince to start you on thyroid meds and gradually increase the dosage in order to relieve symptoms, or you will need to find a good thyroid doctor that will do so.

[CassiopeiaBurke]

Thank you. I appreciate you giving me advice and supporting my issues even though my current doctor seems to disregard my symptoms.