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Mystery Diagnosis
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Mystery Diagnosis

Hi, I'm Kelly and I am 27 years old.  Lately, I have been having some health problems that leave me feeling incredibly frustrated because my doctors don't seem to have an answer.  I originally went in because my right eyelid started drooping.  I absolutely hate it and I feel as though it is destroying my self confidence.  My doctor suggested that I see an opthamologist, who after testing me, recommending that I get blood tests to see if I had a thyroid disorder.  I got blood work done, and my TSH levels were normal except that my T3 hormones were slightly low. My doctor suggested that I get some more bloodwork done.   I also had extremely high "good" cholesterol, and this time, she said a severe vitamin D deficiency - while a score of 30 is considered low, mine was 6.  I also feel very fatigued and sluggish.  My doctor wants me to go for a thyroid sonogram next week.  Are my symptoms indicitive of thyroid disease?   What could this possibly be?  I also have anxiety and have been extremely worried about this for the past couple of weeks.
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Yes eyelid/s drooping is one of the symptoms of hypothyroidism. The level of thyroid hormones influences the nervous system control of the eyelid position. Decreased nerve stimulation of the eyelids due to hypothyroidism can lead to eyelid drooping.

The most common cause of hypothyroidism is due to Hashimoto's Thyroiditis (autoimmune hypothyroidism - elevated TPO and/or Tg antibodies).  Vitamin D deficiency is a common deficiency in general but in autoimmune thyroid disease, i've read that 98% are found to be vitamin D deficient due to genetic defects in the vitamin D receptor site. More vitamin D is needed to keep levels up.

As for labwork, TSH can be "normal" with thyroid disease.

"If you suspect low thyroid function, but have had "normal" blood tests, you and your doctor may want to take a second look. A TSH of greater than 2.5 is not normal.

Nine years ago, the American National Academy of Clinical Biochemistry narrowed the reference range for thyroid stimulating hormone (TSH) from 0.5-5.0 to 0.2-2.5mIU/L.  Similar revisions by the American Association of Clinical Endocrinologists (AACE) meant that 13 million people previously considered to be normal, could now become officially diagnosed with under-active thyroid.  (1)

You should also consider the fact that TSH is lower if the blood test is taken later in the day, and if you were not fasting. (2) Your TSH reading may be artificially low if you are deficient in cortisol, an adrenal hormone.

Another very important test for thyroid is the blood test for thyroid antibodies. Thyroid antibodies can cause symptoms even when TSH is normal. In particular, they have been shown to have a role in fertility and miscarriage. (3,4)" excerpt from Sensible Alternative - Thyroid disease.

To add to this, there is a condition called by any number of names: Euthyroid Sick Syndrome (ESS), Non-thyroidal Illness Syndrome (NTIS), or Low T3 Syndrome.

"Serum thyroid hormone levels drop during starvation and illness. In mild illness, this involves only a decrease in serum triiodothyronine (T3) levels. However, as the severity and duration of the illness increase, there is a drop in both serum T3 and thyroxin (T4), without an elevation of TSH.

This decrease of serum thyroid hormone levels is seen in starvation, sepsis, surgery, myocardial infarction, bypass, bone marrow transplantation, and in fact probably any severe illness(1-9). The condition has been called the "euthyroid sick syndrome" (ESS)." Excerpt from the article: Chapter 5b – The Non-Thyroidal Illness Syndrome
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