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Hyprothroidism: Proper Diagnosis
I am a 73 tear-old female (recently diagnosed with hypothyroidism) whose Metabolic Panel on 2-14-06 showed an elevated fasting TSH of 9.6.52H (0.340-5.600 uIU/mL) and low sodium--so I increased my salt intake. My CBC was fine; my lipids (total cholesterol & LDL)were borderline high, triglycerides and HDL were "desirable." Overall, I am in good health, but have a low basal body temperature.
On 3-6-06, when I went to see him my doc (Internal Medicine) about test results, he gave me a prescription for 50 mcg. of Synthroid based on very little diagnosis/discussion other than my family history of hypothyroidism and my high TSH score. I asked him if he would do further testing, but he did not think that was necessary. Then I told him I would not start taking the Synthroid until I had a T4 test done, so that day he approved my having a T4 test and added another TSH. I had a non-fasting TSH and a T4 test done. No response from him re the second tests other than mailing a copy of the results to me.
The result of my second, non-fasting, TSH was 7.014H (0.340-5.600 uIU/mL), lower because of my increased salt intake, no doubt. My T4 was a normal 6.3, but lower end of normal (6.1-12.2 ug/dL). I began taking Synthroid 50 mcg. on Mar. 9, 2006; however, I sometimes adjust my dose, alternating between 50 mcg. with 25 mcg.
[Prior Tests: Previously, in 1990 at age 57 my T4 was normal, my T4 was 6.9 (3.8-13.6 MCG/DL, my T3U was 32 (25-35%), free thyroxine IND 2.2 (1.0-4.2 Units) and Thyroid Bind Glob 12.5 (12.5 (7.2-21.6 mcg/dL). In 1991 at age 58 my T4 was (6.8 95.0-13-0 ug/DL) and T7 was 2.0 (1.1-4.1 and T3 Uptake was 29.4 (23-32%)].
Question #1: According to www.labtestsonline.org my scores makes me subclinical/borderline hypothyroid. Is this dose (50mcg.) appropriate for a female of age 73 who weighs 165 lbs. and is 5'5" tall with my history? At times I think it is too high. What is your recommendation?
Question #2: I am not scheduled for another office visit until June 9 (3 months later). Should I get a second opinion from an endocrinologist? My opinion is that I should have a TSH, Free T4, and Free T3 in 6 weeks on/about April 20, 2006 and with an endocrinologist. I do not think that I have gotten a thorough evaluation yet. What would you recommend? What tests?
Question #3: What thyroid support vitamins/supplements would you recommend? The amino acid, tyrosine? L-tyrosine? Other?
On 3-6-06, when I went to see him my doc (Internal Medicine) about test results, he gave me a prescription for 50 mcg. of Synthroid based on very little diagnosis/discussion other than my family history of hypothyroidism and my high TSH score. I asked him if he would do further testing, but he did not think that was necessary. Then I told him I would not start taking the Synthroid until I had a T4 test done, so that day he approved my having a T4 test and added another TSH. I had a non-fasting TSH and a T4 test done. No response from him re the second tests other than mailing a copy of the results to me.
The result of my second, non-fasting, TSH was 7.014H (0.340-5.600 uIU/mL), lower because of my increased salt intake, no doubt. My T4 was a normal 6.3, but lower end of normal (6.1-12.2 ug/dL). I began taking Synthroid 50 mcg. on Mar. 9, 2006; however, I sometimes adjust my dose, alternating between 50 mcg. with 25 mcg.
[Prior Tests: Previously, in 1990 at age 57 my T4 was normal, my T4 was 6.9 (3.8-13.6 MCG/DL, my T3U was 32 (25-35%), free thyroxine IND 2.2 (1.0-4.2 Units) and Thyroid Bind Glob 12.5 (12.5 (7.2-21.6 mcg/dL). In 1991 at age 58 my T4 was (6.8 95.0-13-0 ug/DL) and T7 was 2.0 (1.1-4.1 and T3 Uptake was 29.4 (23-32%)].
Question #1: According to www.labtestsonline.org my scores makes me subclinical/borderline hypothyroid. Is this dose (50mcg.) appropriate for a female of age 73 who weighs 165 lbs. and is 5'5" tall with my history? At times I think it is too high. What is your recommendation?
Question #2: I am not scheduled for another office visit until June 9 (3 months later). Should I get a second opinion from an endocrinologist? My opinion is that I should have a TSH, Free T4, and Free T3 in 6 weeks on/about April 20, 2006 and with an endocrinologist. I do not think that I have gotten a thorough evaluation yet. What would you recommend? What tests?
Question #3: What thyroid support vitamins/supplements would you recommend? The amino acid, tyrosine? L-tyrosine? Other?
A related discussion, high TSH score was started.
Dr. Mark, thank you for your comments which were very helpful.
What would cause the variance in my TSH scores? Both tests were taken before I started Synthroid, 50 mcg. now changed to 25 mcg.)
2-14-06 TSH was 9.652H (0.340-5.600) uIU/mL fasting test
3-6-06 TSH was 7.014H (0.340-5.600) uIU/mL non-fasting test
2-14-06 TSH was 9.652H (0.340-5.600) uIU/mL fasting test
3-6-06 TSH was 7.014H (0.340-5.600) uIU/mL non-fasting test
MEDICAL PROFESSIONAL
The low sodium typically means that you are retaining water, not that you need to eat more salt. And eating more salt likely had little to do with the TSH.
You are right about having subclinical hypothyroidism. There is no consensus that all patients in your situation need treatment. I usually treat if there are symptoms, high cholesterol, ?heart disease?, or if the TSH is >10.
Would go with 25mcg at age 75 for the first 6 weeks in the case of subclinical hypo (depending on symptoms, etc) and would certainly see an endocrinologist.
Multivitamins, ?selenium, b-complex, balanced diet and regular physical activity are recommended.
You are right about having subclinical hypothyroidism. There is no consensus that all patients in your situation need treatment. I usually treat if there are symptoms, high cholesterol, ?heart disease?, or if the TSH is >10.
Would go with 25mcg at age 75 for the first 6 weeks in the case of subclinical hypo (depending on symptoms, etc) and would certainly see an endocrinologist.
Multivitamins, ?selenium, b-complex, balanced diet and regular physical activity are recommended.
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