Help with Thyroid Results and Symptoms

[grovesjej]

Hi All.  I am 41 years old and have been having fatigue, depression, constipation, irritability, fogginess, abnormal weight gain, anxiety, and moodiness for a couple years now.  I was initially diagnosed with depression/anxiety and put on an antidepressant.  It did improve my mood and irritability somewhat; however, I was still experiencing lethargy, fatigue, and mood swings.  Thyroid problems are in my family background (my mother is hypo, my grandmother had a large goiter removed, and some of my aunts/cousins have issues as well), so my doctor tested my TSH .801 (.350 - 5.50 range) and Free T4 .76 (.70 - 1.70 range). He did not indicate to me that he thought there were any issues at that time.  
I have recently begun to have increased symptoms.  My fatigue is extreme on some days and I am now having irregular menstrual cycles with heaving bleeding and blood clotting.  My GP did more bloodwork with my TSH .974 (.350 - 5.50 range) and Free T4 .76(.70 - 1.70).  I also had an ultrasound done with no negative results other than the thickened endometrial lining.  My GYN wants to do an ablation or insert an IUD to help with the irregular menstrual issues and told me that I am going through perimenopause.  
I am wondering if I should get a second opinion or pursue the thyroid issue more with my symptoms?

Any thoughts or similar stories would be appreciated to help me feel that I am not going crazy or a hypochondriac!!

[patrinarobey]

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[old_before_my_time]

As gimel mentioned, endocrinologists usually treat solely by TSH. Hopefully, his doctor suggestion(s) will work out for you.

Did your doctor address the low iron and iron saturation levels? It seems you would want to supplement with iron with those lab results. Also, hypothyroidism is associated with low iron. For one, the thyroid needs adequate iron as well as some other minerals to function properly. But there may also be a link to hypothyroidism and the inability to maintain iron stores. I have read that B12 tends to be lower in hypothyroids too. And a lot of people have insufficient vitamin D levels so that may be something to check with future labs.

I wanted to comment on your gynecologist wanting to do an ablation or insert an IUD. Since thyroid abnormalities can affect the menstrual cycle, treating the thyroid may address your irregular cycles. But also you may be entering perimenopause when cycles can go "haywire." If you end up being treated for thyroid and your cycles are still irregular (with or without heavy bleeding), birth control pills can be very effective for regulating the cycle. Although an IUD can be more convenient, there is a pricey insertion and removal fee which may or may not be covered by insurance (I have heard of women whose insertion was covered but then their insurance changed and removal was not covered). And not all women do well with an IUD plus there are some risks such as migration of the device.

Ablation also has its risks. Since the lining is scarred by the procedure and the ovaries continue telling the lining to build, blood can get trapped behind the scarring (hematometra) and back up into the tubes (hematosalpinx) causing chronic pelvic pain that may lead to a hysterectomy. The cervix can also be scarred shut, another way blood can get trapped in the uterus. There is at least one medical study about ablation increasing the risk for hysterectomy in women under age 45. One woman said she was told by a doctor that ablation should not be done on women under age 50.

Sorry for the novel but when I saw your post I had to weigh in. I hope you get the treatment you need.

[gimel]

I just sent you a PM with doctor info.  To access, just click on your name and from your personal page, click on messages.  

[gimel]

As expected, your Free T3 and Free T4 are way too low.  Iron as well.  Hypothyroidism affects glucose levels.  Not familiar with anion gap.

Free T4 needs to be around the middle of its range at least, and Free T4 needs to be in the upper end of its range, or as necessary to relieve symptoms.  

I know you have made an appt. with an Endo for July.  Be aware that Endos frequently specialize in diabetes, not thyroid.  Also,  many of them have the "Immaculate TSH Belief" and use Reference rAnge Endocrinology".  End result is that they are usually unwilling to treat a hypo patient clinically as I described previously.  So, I will look and see if I can find a doctor for you to consider.  

[grovesjej]

An update.  After seeing my PCP again and complaining of severe fatigue, my doctor ordered blood work again and I asked him to also check my FT3. My results:

TSH 1.151 (0.350-5.500)
Free T3 2.90 (2.30-4.20)
Free T4 LOW 0.63 (0.70-1.70)
Iron 42 (40-150)
Iron Serum % Saturation LOW 13% (15-55)
Fasting Glucose HIGH 101 (70-99)
Anion Gap LOW for my last 3 blood tests at 5 (7-16)
(Not sure if there is any significance with the last two results)

Even with my lower FT4 from my two previous tests and my low FT4 on this one, plus the low iron levels, my PCP still wanted to retest my FT4 convinced that there was a lab error based on my FT3 and TSH!

I decided to bypass him and told him that I was going to see an Endocrinologist.  I asked the office to fax over my results and thankfully the Endocrinologist's office accepted that as a referral without my PCP actually having to specifically refer me.  My appt is July 2nd, but I am on a waitlist so I pray I get in sooner.  Pittsburgh and Cleveland are about the same distance from my area and they are both a little over an hour to get to.  It would be fine for one appt, but I wouldn't want to be treated on a regular basis and have to travel that far every time.  

[gimel]

Just in case we may be able to recommend a doctor, what is the nearest town of reasonable size that you would be willing to travel to?

[grovesjej]

Thanks for the info and opinion.  My mom convinced me of the same things.

I called the Endocrinologist that my mother used to see and they are only accepting new patients with referrals from their doctor and are booked until July.  I live in a small town in Western PA, and unfortunately, there aren't many around here that accept my insurance.  I am looking into other doctors in the area and I have an appt scheduled with my PCP to try to get him to provide a referral.  

Not only am I tired of feeling this way, but my family is suffering as well with my moods and fatigue.  I just want to feel sane and rested for once!

[gimel]

Your doctor obviously has the "Immaculate TSH Belief" and uses "Reference Range Endocrinology".  With those as core beliefs your doctor interprets your TSH and Free T4 as adequate because they are within the so-called "normal" limits.  Unfortunately, with your symptoms and test results it is most likely that you have central hypothyroidism, which is characterized by low TSH accompanied by low Free T4 and low Free T3.  Even though your Free T4 is also within the range, that doesn't mean it is adequate, because the ranges are far too broad to be functional across their entire breadth for many people.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

So you need to find a good thyroid doctor that will treat clinically as described.  You should make sure they always test for both Free T4 and Free T3 each time you go in for tests.  Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, you should make sure to get those tested also.  Whenever you have new test results, please post them and we will be glad to help interpret and advise further.  You can also get some good insight from this link written by a good thyroid doctor.

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

If you would like suggestions please tell us your location, perhaps we can recommend a doctor based on patient experience.