Diagnosing hypothyroidism

[sylvia11]

I am a 25 year-old female with lots of health problems since fall 2005. I have hair loss, visual disturbances,loss of colour vision, floaters, weight gain and extreme tiredness, high blood pressure, occasional tremor and muscle twiches. My thyroid levels were tested beginning of January, TSH was 3.8 T4Free was 14. Now at the end of February TSH was 4.33. No other tests were done. My doctor will repeat the tests in 2-3 months. I would like to know what other tests should be done to diagnose hypothyroidism and is this value high enough alone to suggest a thyroid problem. Should I start meds? Are all my symtoms likely to be caused by thyroid problem?
Thank you.

[Mark Lupo, M.D.]

Some of your symptoms are suggestive of thyroid disease but it is tough to say all would approve with thyroid treatment.  I would check thyroid antibodies and consider a TSH of 4.33 borderline hypothyroid and consider a trial of treatment (esp if antibodies positive -- ie, Hashimoto's).

[tabtools]

Just thought it might be worthwhile to recognize the very different perspectives on treating for hypothyroidism.

Dr. Mark belongs to the ATA.  In an online, printable booklet, on p. 16 http://thyroid.org/patients/brochures/Hypothyroidism%20_web_booklet.pdf, as the American Thyroid Association acknowledges the differing veiwpoints doctors have on treating TSH.  


Also, there was an article in the New York Times on the different perspectives on the topic.  http://www.nytimes.com/2005/11/08/health/08hypo.html?ex=1141707600&en=b018bd6a7bde980b&ei=5070.

Actually, being inquisitive, I checked a couple of the articles in the medical journals on the TSH debate and the issue seems to be that all groups agree larger & better studies need to be done so that the evidence is "indisputable" & whether or not clinical experience counts.  There ARE doctors who do not treat unless the TSH is above 10 -- the debate continues.  

The exact meaning of the .3 to 3.0 guidelines are also debatable - they were announced as for treatment and diagnosis -- but, actually, treatment does not begin until the TSH is 5 and over in AACE's guidelines for treatment -- and the .3 to 3.0 "optimal" TSH can be attributed to AACE -- the American Association of Clinical Endocrinologists.

Myself, I had to insist on being treated when I had a goiter, positive TPO-antibodies, as well as a TSH above 5.  My doc at the time thought that a TSH of 5 was not "ill enough" tho he saw me as hyothyroid. Because of advice, I got him to agree to treat.  I'm glad.  ~ Maureen

So, this is one area in which the doc you go to makes a BIG difference to whether or not you are diagnosed, and if diagnosed, treated. ~ Maureen