Aa
Aa
A
A
A
Close
20845900 tn?1533223710

Requesting help to interpret thyroid labs/extreme hair loss

I have found the input and support from folks on this website to be so very helpful, informative and encouraging!  I am hoping someone here can help me interpret my recent self-requested labs and offer some advice on my hair loss issue.  I have Hashimoto's hypothyroidism, diagnosed in 2009.  Current symptoms that may or may not be related are:

Extreme brain fog and forgetfulness (first noticed in 2010; it gradually has worsened)
Hair Loss (have had since mid 2000s but it has worsened)
Difficulty losing weight (started gaining fast in 2013, only recently have lost some)
Intolerance to both heat and cold (used to be only to cold but started noticing intolerance to heat around 2013)
Hirsutism (ongoing, and I have PCOS)
Irregular cycles (started in 2015 after starting a very stressful job)
Oily scalp and acne on scalp (in past two years)
Poor complexion (since 2013)
Acid reflux (since 2009 after taking an antibiotic)
Inability to handle stress and easily startled (ongoing; possible adrenal issues)
Low energy in afternoons (possible adrenal issues)
Joint stiffness and pain (since 1999, no autoimmune connection found)


I need to clarify that I currently am not under a doctor's care and have been self-medicating on NDT.  I admit it's an unwise way to go, but I haven't ever found a doctor who was willing to treat based on symptoms -- every doctor I've seen would treat based on TSH, didn't see a need to order extensive thyroid labs, and thought synthetic T4 was a good fit for everybody.  I've had other conditions throughout my life that have worsened under doctors' care and I have avoided doctors for years.  I realize that it's time to try again to find a good doctor but I dread trying to find one here in San Antonio who treats clinically on symptoms instead of basing treatment on TSH levels and who routinely orders comprehensive thyroid labs and understands their importance.  (The place that diagnosed me with Hashimoto's back in 2009 was a Fibromyalgia clinic located 250 miles away.)  Funds also currently are an issue, as I am out of work.

Here are my labs from July 2018, which reflect taking NDT (but I withheld my morning dose until after the lab draw):
TSH:     0.042  "LOW" (Ref range 0.45 to 4.5)
FT4:      1.35  (Ref range 0.82-1.77)
RT3:     28.6   "HIGH" (Ref range 9.2 to 24.1)
FT3:       3.8  (Ref range 2.0 to 4.4)
ATA:  <1.0  (Ref range 0.0 to 0.9)
TPO Ab:  103  "HIGH"  (Ref range 0 - 34)

Here are my previous labs, done in 2013.  I don't remember whether or not I was taking anything for the thyroid at the time:
TSH:  1.39
FT4:   0.84
RT3:   20.6
FT3:     2.3
ATA:  <20
TPO Ab:  161

Some recent history:  At the end of February, I decided to cut wheat and sugar out of my diet to see if I could improve my hashimoto's, improve my health and lose weight (starting weight was 250lbs, I am female, 50 years old and 5'1").  It led to doing the Keto diet and I currently still am eating low-carb though I don't actually count the carb grams.  I still intentionally don't eat wheat but I think that sometimes it may be in seasonings of some restaurant foods.  The only grain I have is the occasional corn tortilla.  In the past five months, the only sugar or wheat "cheats" I have had was a slice of wedding cake I ate in early July.  I started taking NDT (Thyroid-S from Thailand) in February and worked up to taking 2 grains per day.  I did notice an increase in hair loss after starting it but it was hard to say at the time whether it was the NDT or a possible deficiency from changing my diet.  It was concerning but not extreme.  I sometimes would forget to take the NDT.  In late May, I realized I was running low so I ordered more.  It took much longer to arrive from Thailand than expected and I ended up going a little over 3 weeks without any NDT.  During this time, I started gaining back weight I had lost since February (had lost 24 lbs and was at a point of losing 1/2 to 1 pound a week, very slow weight loss, but now was gaining a pound a week instead).  Also, I started having chills in the evenings and sometimes had trouble falling asleep at night because I was so cold and couldn’t seem to warm up.  When I finally received the NDT about 3 weeks ago, I immediately resumed taking it.  Perhaps unwisely, I upped the dose to 3 grains (wasn't feeling any symptom relief on 2 grains) and within a few days of taking it my hair started falling out at an alarming rate.  Once I realized the hair loss wasn't stopping, I lowered the NDT dose back down to 2 grains (1 grain upon awakening, the other in the early afternoon), but unfortunately the pronounced hair loss has not improved.  In less than a month I have lost 30-40% of my hair with no signs of it stopping.  I find it everywhere, it clogs the drains, it falls in my food, it falls on my clothing throughout the day, and my scalp is visible and is very itchy.  I have no idea if restarting the NDT without gradually working up to the previous dose suddenly suppressed my thyroid, causing temporarily increased hair loss, or if I'm taking too much.  I certainly do not have any hyper symptoms.  I am so distressed over the hair loss.  If it doesn't let up or start growing back, I will have to wear a cap or wig to hide my baldness by the time my birthday rolls around this month.  The only positive I've seen so far since restarting NDT is that my weight has gone back down a couple of pounds.  

Can someone help me interpret my labs and offer any advice on where to go from here?  Also, any insight as to the sudden excessive hair loss?  I think that the stress from the hair loss is causing me to lose even more hair!  

I have scheduled more labs for Monday: Female Panel to include hormones; B12 & Folate; Ferritin; Vitamin D, as I know those can affect my thyroid and adrenal functions.  I also I believe I need to get my adrenals tested.  Can anyone recommend which Adrenal test is most useful?  I’m trying not to spend more than I need to as funds are very tight for me.  Thanks so much to everyone who takes the time to read this.
3 Responses
Sort by: Helpful Oldest Newest
1756321 tn?1547095325
I do plenty of home tests for free! In regards to adrenals, try the tests below. When I had terrible adrenal issues the line on my skin turned white and spread over 2 inches. My pupils also fluctuated so rapidly in the light it was less than a second between contractions! Crazy disco eyes! lol. I didn't own a blood pressure machine at the time. I could not handle any stress at all!

***

Adrenal Fatigue Recovery -
Adrenal Function Tests You Can Do at Home...

"ADRENAL FUNCTION TEST #1- Postural Hypotension
Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs upon rising from a horizontal position.  It is commonly expressed as a  feeling of dizziness or lightheadedness, a "head rush", or "standing up too fast".

To do this test, you will need a blood pressure cuff.  Lie down and rest for 5 minutes. Take a blood pressure reading while still horizontal.  Then, stand up and take another reading.  

Normally, your blood pressure should rise 10-20 points. If it drops, particularly by 10 points or more, hypoadrenia is indicated. Generally, the bigger the drop, the greater the adrenal insufficiency.

It should also be mentioned that low blood pressure in general is also an indicator of exhausted adrenals when present in conjunction with the other symptoms of adrenal gland fatigue.

ADRENAL FUNCTION TEST #2-Iris Contraction Test
For this test you will need a weak flashlight or penlight, and a mirror.  In a dark bathroom or closet, wait a minute for your eyes to adjust to the dark. This will allow your pupils to dilate (open) fully. Then, shine the flashlight into your eyes, and watch the reaction of your pupils for at least 30 seconds.

The light should cause your iris to contract, making your pupils (the dark spot in the center of your eye) smaller.  Normally, they should stay that way, but if you have adrenal gland fatigue, the iris will be weak and will not be able to hold the contraction, it will either waver between contracted and relaxed, or will contract initially, but then open up after 10-30 seconds.

As with the postural hypotension test, the degree to which you "fail" this test is an indicator of the degree of adrenal insufficiency you are experiencing

ADRENAL FUNCTION TEST #3-Sergent's Adrenal White Line
With your fingernail or the dull end of a spoon,  draw a line across your belly.  In moderate to severe cases of adrenal fatigue, the line will stay white, and even get wider over the course of time, while a "normal" reaction would be for the line to almost immediately turn red.

This test has historically been used to indicate severe adrenal fatigue and Addison's Disease. Milder cases of adrenal fatigue may not exhibit this sign."
Helpful - 0
2 Comments
Red_Star, thanks so much for your response! I will give these a try today, the blood pressure one if I can get my monitor to work.  It is old and can give wonky, inconsistent readings.  May I ask how you've addressed your adrenal insufficiency?
I had varying degrees of adrenal fatigue from numerous conditions but the worst from severe vitamin B12 deficiency. Whatever the cause I treated that condition...and just needed time in a no stress environment to heal. With the line test it took 18 months to show up red after treating B12.  
Avatar universal
The selenium will have a slight effect on reducing antibodies.  When you get your thyroid hormone levels optimized that will also reduce the level of antibodies; however, destruction of the thyroid gland won't be stopped.   That loss of natural thyroid hormone output won't really matter if you optimize your thyroid medication and any supplements required.    We'll discuss further when you have new test results available.
Helpful - 0
8 Comments
Thanks, I look forward to further discussion!
Hi, Gimel.  My new labs are in and I must say, there were some concerning levels that reveal I have lots going on in other health areas.  Sigh.  Any advice you can provide based on my new lab results will be greatly appreciated!  Here are the results that I think might effect my thyroid function/numbers:

Iron:  89 ug/dL (ref range 27 to 159)
Ferritin:  209 ng/mL "HIGH" (ref range 15-150)
Vitamin D, 25-Hydroxy:  22.1 ng/mL "LOW" (ref range 30.0 to 100.0)
Vitamin B12:  507 pg/mL (ref range 232 to 1245)
Folate:  5.6 ng/mL (ref range >3.0)
TSH:  0.092 (went up slightly, coincides with lowering my NDT dose when my hair started falling out like crazy)

Clearly I need to up my Vitamin D level, correct?  I am below the low end of the reference range but not sure what is optimal for a hashimoto's patient.  I'm not sure if I'm optimal for B12, Folate and Iron.

The Ferritin result both surprises and concerns me.  Being that my Iron is not high, there must be another cause for the Ferritin to be so elevated.  Unfortunately I cannot find that my Ferritin was ever tested before so I have no idea if this is new or ongoing.  My C-Reactive protein level also was HIGH -- 12.61 mg/L (ref range 0.00 to 3.00) whereas in 2013 it was 3.01.  These two high readings may go hand-in-hand since both can be signs of inflammation in the body.  They definitely warrant further research on my part.

I did not test for selenium, unfortunately.  Many other levels were tested (standard CBC, Chemistry Panel and hormones) but I'm not sure which may be relevant; I'm happy to share any that might be helpful.  
Results look okay except Vitamin D needs to be at least 50 ng/mL.  So about 3000 IU of D3 should take care of that.   Your B12 should be supplemented to raise it into the upper part of the range.    500 mcg of B12 daily should take care of that.

From your other tests, the only ones that would interest me would be the hormones.  

I agree that your ferritin and CRP need further evaluation.   What does the doctor think about those?  
I currently am not under a doctor's care but am on the hunt for a doctor now.  I've avoided doctors for years due to very bad experiences with every one I've  had in the past 20 years.  For now I'm going to modify my diet to exclude inflammatory foods when possible; hopefully that will help bring down the elevated ferritin and CRP levels.

I have started the supplements and am hopeful they can make some real differences in how I feel by getting me to more optimal levels.  Here are the hormone results.  Keep in mind these are blood levels, not saliva.  I estimate they were taken on cycle day 21 (Luteal phase) though I can't be 100% sure of the timing until the next cycle begins.

AGE 50, pre-menopausal
Testosterone, Serum:  30 ng/dL (ref range 8 to 48)
Free Testosterone:  1.9  pg/mL (ref range 0.0 to 4.2)
Progesterone:  5.1 ng/mL (ref range 1.8 to 23.9 in luteal phase)
DHEA-Sulfate:  150.2 ug/dL (ref range 41.2 to 243.7)
Estradiol:  86.8 pg/mL (ref range 43.8 to 211.00 in luteal phase)

I have PCOS and many of the symptoms that come with it, including hirsutism, thinning hair (worse since starting NDT), difficulty losing weight, acne, and irregular cycles.  So I was surprised that my Free Testosterone wasn't thru the roof.  

One thing I've found is that it appears that the NDT is causing my blood sugar to rise.  My A1C is at the lower end of "prediabetes" at 5.7%.  I started checking my blood sugars when I began keto and never found them to be  high, even post-prandial, but now when I check them, they are higher despite my still eating a low-carb diet.  Do you know if taking NDT (or any thyroid hormone medication) is known to raise blood sugar?

Thanks again for all your assistance!

The correct way to state it is that hypothyroidism tends to lower blood sugar.    I also know that untreated hypothyroidism increases the likelihood of pre-diabetes.  

If you are interested I have the name of a doctor near San Antonio who has been recommended by another thyroid patient.  
Thanks for the info, Gimel.  Yes, I am interested in the doctor's name who is near San Antonio and has been recommended by another patient.
I just sent you a PM.  To access, just click on your name and then from your personal page click on messages.  
Thank you.
Avatar universal
You have a lot of symptoms normally associated with being hypothyroid.  First thing to note is that hypothyroidism is properly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."

So it is not only the supply, but the response.  So for that reason it is a good idea that you are going to test for  Vitamin D, B12 and folate, and ferritin.   Ferritin affects conversion of T4 to T3 or RT3 and is also important for good hair growth.  In addition it would be good to test for cortisol as your adrenal related test since it can also affect thyroid.  

Looking at your recent test results your Free T4 and Free T3 are at good levels.  The problem I see is that your Reverse T3 is high in both sets of tests relative to your Free T3 levels.  The recommended ratio of Free T3 to Reverse T3 is at least 1.8 and some sources recommend 2.0.  Your latest ratio calculates as 1.4, which is much too low.  the effect is that it binds to membrane receptors and excessive RT3 causes hypometabolic effects.  

Some of the postulated causes for excess RT3 are leptin resistance, dieting, nutrient deficiencies such as low iron, selenium, zinc, chromium, vitamin B6 and b12, vitamin D  and iodine, low testosterone, and a number of others.   You will know more about what needs to be done after getting the additional tests done.   Another approach may be to reduce your NDT dose to reduce your FT4 level, and add some T3.  Reduced T4 reduces conversion to RT3.  

When you have the additional tests done, please post them here along with reference ranges and we will be glad to help interpret and advise further.   If you want to do some reading about all this, click on my name and then scroll down to my Journal and read at least the overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  
Helpful - 0
1 Comments
Gimmel, thank you so, so much for taking the time to read and respond to my post.  I appreciate it so much!

I was thinking the same thing... my FT4 and FT3 aren't bad but RT3 is high and the ratio of FT3 to RT3 is too low.  I suspected that I might have to decrease NDT and introduce T3 so that I'll have less T4 (from NDT) to convert to RT3.  I suspected that the NDT would make my RT3 go up because of the additional T4 and it appears it did.  I will need to start hunting for a good doctor and I'm excited to be able to provide your co-authored paper when warranted.  I'm impressed by the extensive research done to complete this paper and feel very blessed that we patients have someone like you on our side to help in our quest to feel better!  I hope that some day I'll be able to help someone from my own experiences.

I'm hopeful that the additional labs I'm having done on Monday will show some deficiencies that can be treated to improve my hypothyroid and PCOS symptoms and reduce my RT3.  I hope to have the results by next Friday and will post them.  In the meantime, I have started supplementing with selenium, zinc, and vitamin D.  I want to start supplementing with iron but wonder if I should hold off until I know my ferritin levels.  I've tried supplementing with biotin to help my hair grow; however, after two days I had to stop because it caused me to have extreme hunger, something I'm not used to anymore since going low-carb.  It's a side effect I'm not willing to live with.  Being obese, I am 100% sure I am leptin resistant and will do further research to see how I might improve it.

A question:  do you know how the Hashimoto's factors into my symptoms?  Should one ignore elevated TPOs if/when their FT4/FT3/RT3 levels are good?  I worry about the damage that's being done to my thyroid gland by these antibodies, especially considering I've had Hashimoto's for at least 9 years.
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
FL
Avatar universal
MI
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.