Can I get feedback on these two specific questions

[JJWatkins]

Hi all,

First thank you for all the very helpful information and feedback I've already gotten.

I have two questions that I'm very interested in as much feedback as I can get.

1.  Is there a specific hair loss pattern associated with a thyroid problem? (Diffuse, areata, any?...TE, androgenic)

I have googled but most of the info is too technical.  I'd really just like some actual real people.

I lost leg, underarm, arm hair years ago with no known cause.  Started losing head hair 8-9 months ago, or at least when I really noticed.  I've had MANY tests, with no real answers.  Lost eyelashes in patches a couple of times.  Eyebrows are just thin and have been for a quite a while.  Was told I over plucked, but I don't pluck.  

And 2.  Has anyone on here had thyroid results in the normal range (perhaps not optimal) with symptoms and had success getting a treatment trial?  Was there something that you feel persuaded your doctor?  And for those with normal tests, but symptoms who did a trial, did it prove to alleviate symptoms?

I feel terrible, with normal (anecdotally not optimal) tests and a bizillion symptoms, but no doctor willing to do a trial.  I just don't know if I should keep pushing.

Thanks in advance for all your feedback.

[gimel]

Following is a quote from the same source listed above.  "A normal TSH does not "rule out" hypothyroidism. Many, and possibly most people with various degrees of
hypothyroidism have normal TSH levels. Their hypothalamic-pituitary system is dysfunctional and not making sufficient TSH to give
them optimal thyroid levels. The hypothalamic-pituitary secretion of TSH is every bit as fallible as the secretion of any other
pituitary hormone or neurotransmitter. Indeed, the hypothalamus is part of the brain and is affected by its connections to all parts
of the brain. It can be dysfunctional due to genetic alterations, neurotransmitter imbalances, toxins, stress, aging, drugs, etc."

If you want to delve further, you are out of my area, so you can get some insight from this link.

http://medical-dictionary.thefreedictionary.com/Hypothalamic-pituitary+dysfunction

When it comes to ANA testing I have gotten the impression that its predictive accuracy is not very high.  So, I don't expect that a positive ANA, with other normal tests is all that unusual.  But then, I understand even less than I know about this.  LOL

[JJWatkins]

Gimel, you are the best and so patient.

I'm curious, are there any symptoms that are more indicative of central hypothyroidism or a malfunctioning hypothalamus/pituitary (other than hypothyroid) that would also be persuasive to a doctor?

Also, how unusual is it to have a positive ANA, no rheumatological + tests, and "normal" thyroid tests, but with many symptoms, possibly for both?  

[gimel]

To understand the tables in the link, just imagine that if TSH correlated perfectly with Free T4 (or Free T3), that the graph would be a straight line.  For any value of Free T4, then you could predict exactly what TSH would be, or vice versa.   Instead, if you picked a TSH of 1.0 and then followed a horizontal line across the graph, you will see that for patient results with 1.0 TSH, Free T4 results ranged all the way from about .7 to about 1.7.  That is about the full range for Free T4.  So the correlation is so poor that there is almost no useful predictive value from a known TSH result.  

Yes, your Free T4 being at 1.1 and your Free T3 being at 2.6, along with symptoms, is very indicative of being hypothyroid.

We don't post names of doctors on the main Forum.  This is a site where you will find similar info from the same doctor.  

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

There are two basic types of hypothyroidism.  Primary is due to Hashimoto's Thyroiditis, characterized by high and increasing levels of TSH (and lower levels of FT4 and FT3) as the pituitary tries to get the thyroid gland to produce more hormone.  Central hypothyroidism is due to a malfunction in the hypothalamus/pituitary areas, characterized by TSH levels in the lower part of the range, and low Free T3 and Free T4 levels.  

  

[JJWatkins]

Thank you for the feedback.  I was not able to fully comprehend the tables...just not so educated with all of this yet.

I have heard this comment in other threads:  "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."

So, because my FT4 is 1.1, and my FT3 is under 3.4 (2.6), this is indicative of hypothyroidism?

Who is the thyroid doctor who states this?

And can you explain what central hypothyroidism is as opposed to other types?  Not clear what the distinction is.

Thanks!

[gimel]

OOPs, forgot the link.

http://www.clinchem.org/content/55/7/1380/F2.expansion.html

[gimel]

I am sure others will tell you about their experiences.  I would bet that a majority of the members who have posted here have run into doctors who have looked at their lab results and said that they were all within the normal range and that their symptoms were not due to thyroid.  I faced that for so many years I am not sure when I coerced my doctor into a trial of thyroid med.  

As I started on the med and then the dosage was gradually raised, I did feel better.  Unfortunately my doctor was only testing TSH and Free T4.  So for 20 years I continued to have lingering hypo symptoms, while the doctor refused to raise my T4 med beyond 200 mcg.  Only when I fond this Forum and learned about the importance of Free T3, was I able to talk my new doctor into testing for both Free T4 and Free T3.  We found that my Free T4 was at the top of range and Free T3 at bottom of range.  I talked her into switching to Armour Thyroid to raise my Free T3 level and after some tweaking of meds and dosages, I felt better than I could ever remember.  So, in appreciation for the help from this Forum, I joined other knowledgeable and experienced members in trying to help others.  

You might wonder if the information given here is only anecdotal.  I assure you it is not.  Everything we tell members is supported by scientific studies, along with all our experiences.  I will be listing some for your reference.  I can provide more than you would want to read.  LOL  As a start to evaluating your own test results, here is a quote from a very well recognized 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."

Notice that everything mentioned is within the so-called "normal' ranges.  The basic problem is that the ranges are established based on erroneous assumptions, and have been taught ad infinitum in med schools and recommended in publications of the professional thyroid associations.  So the concepts are blindly accepted and practiced by, I'd say, the vast majority of doctors, and especially Endocrinologists.  It is a lot easier and a lot less time consuming to just run a couple of tests and if within the ranges, tell the patient there is no thyroid problem.  If that is all that is necessary, then why not just use a computer and cut out the middle man and all the related cost?

The problem under everything regarding diagnosis and treatment of hypothyroidism is the false assumption that  TSH is a totally reliable indicator of thyroid status.  In fact, in the 2012 guidelines published by the AACE and the ATA, they state, "Serum thyrotroprin (TSH) is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations, but it is not sufficient for assessing hospitalized patients when central hypothyroidism is either present or suspected"  In another area they go on to say, TSH secretion is exquisitely sensitive to both minor increases and decreases in serum free T4, and abnormal TSH levels occur during developing hypothyroidism and hyperthyroidism before free T4 abnormalities ate detectible."  

So there are several glaring problems with all this.  One is that there is no scientific evidence that TSH correlates well with free T4 (or Free T3 or symptoms).  In fact following is a link to data that show clearly that TSH doesn't correlate well with either Free T4 or Free T3.  Second is that doctors don't seem to even consider the possibility of central hypothyroidism.  If your TSH is within the erroneous ranges, "your symptoms must be something else (Would you like a prescription for depression, or cholesterol, etc., no problem.  Thyroid med---no way.)"

Before the unfortunate discovery of the TSH test, doctors treated potential hypo patients clinically for symptoms.  Interesting also, is that it is reported that the average dose of thyroid med was about double what it is today.  Now everything is based on the assumption of TSH results being infallible.  That assumption has also contaminated the reference ranges for Free T3 and Free T4.

In establishing those ranges, the assumption was made that test results from any patient with a TSH within the very broad range of .5 - 5.0, or thereabouts, was normal and their Free T3 and free T4 test data are included in the data base.  Then they statistically evaluate the data and establish 2 standard deviations from the average as the range limits.  Obviously this data is terribly skewed by their initial assumption of where to draw the range for TSH, and even worse by not excluding any patients with central hypothyroidism, characterized by low TSH.  There are limited studies showing that the range for carefully screened adults with no known thyroid pathology are roughly the upper half of the current ranges for Free T4 and Free T3.  

And the answer to your last question is yes, absolutely you should keep on pushing.  The easiest path is to find a good thyroid doctor and avoid having to fight to get what you need.  I gave you a suggestion on that previously.  If you have to fight and convince your doctor, then you need to start with all the symptoms you have that are known to be related to hypothyroidism.  Then you need to give the doctor copies of scientific studies that contradict his beliefs and practices.  Then you have to push to get what you need.  Sometimes you have to become very aggressive to the point of losing the doctor, but so what if that happens?

[JJWatkins]

Okay, thanks.  I do appreciate the link -- I just didn't want to give too much that people wouldn't want to read.  But thanks!

As for the hair loss:

    Hair loss - y
    Dry hair - y
    Frizzy hair - y
    Brittle hair - y
    Coarse hair - n
    Finer hair - y
    Premature baldness - y ( approx. 8 mths, top and diffuse on sides)
    Premature gray hair - n
    Change in hair texture - y
    Body hair loss - y (approx. 8-10 yrs.  no real need to shave)
    Eyelash loss - y (few times, came back with topical steroid prescrip)
    Facial hair in women - n
    Thinning or loss of outside third of eyebrows - y, but diffuse throughout now

Other symptoms: fatigue, unrefreshed sleep, wake up and can't get back to sleep, weight gain/changes, dry skin, cracked, thick heals, fat arms (myxedema -- can't pinch), bbt averaging approx 97.3, but sometimes in 96s, hands tingling, occasional  frantic appearance despite not being esp. frantic, hair loss.

I'm sure I'm forgetting some.

But I was hoping the type/pattern of head hair loss, esp. In a woman, might be indicative of thyroid or autoimmune.

Again, thanks.

[gimel]

I mentioned the above just because other members would quickly want to know other info, that already exists on the other thread.  

Of course there are other things that can affect hair loss; however, from an extremely long list of symptoms that can be related to hypothyroidism,  following is the section on hair related symptoms.

Hair:

    Hair loss
    Dry hair
    Frizzy hair
    Brittle hair
    Coarse hair
    Finer hair
    Premature baldness
    Premature gray hair
    Change in hair texture
    Body hair loss
    Eyelash loss
    Facial hair in women
    Thinning or loss of outside third of eyebrows

[JJWatkins]

Thank you.

Just thought maybe the hair loss pattern might point.

And clearly would like to hear symptomatic peoples stories with "normal" tests that were able to get a trial based on symptoms -- and then how they fared.

Thanks again!

[gimel]

For background to help in answering, note that the member has more detailed information on a prior thread.

http://www.medhelp.org/posts/Thyroid-Disorders/Help-with-which-direction-to-go/show/2427624