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Lab Interpretation - possible diffused hair loss linked to hypo-thyroidism
I am Quasar and I hail from Mumbai city, India. I am 28 years of age, my weight is 74kg (163 lbs) and height 5'6''. I have a decent work life and a great set of friends, family.
Experience with Hair Loss
I have had hair-loss for the last 6 years. My hair fall has been diffused. My frontal hairline is still intact with thick hair and therefore frames the face well.
I am thin on the top, have a few scars on sides(no thinning), dense hair at first but sparse towards the end in my donor, but its coarse(no thinning). My donor is stable though. Since I am a diffused, I would say I am a II-III on the Ludwig scale.
Diet and medication
My diet is good, great metabolism too! I am a non-vegetarian, consume meat/fish/eggs. I have a good amount of green vegetables too. About a month back, I have started to take a protein shake. Medication - I have begun with the following regimen for the last 1 month. Applying Minoxidil(Dr. Reddy's) 5% twice a day + Finasteride 1mg/day to arrest/slow down the shedding. There is initial shedding of thin hair(as expected), but will wait upto 5-12 months. I have absolutely no noticeable side-effects as of now. I cycle about 5-6 miles everyday.
A few cosmetic surgeons suggested to me, that hypothyroidism may cause diffused thinning all over. This is what lead me to take the thyroid test. These are the results :
T3 : 0.941 ng/dl Normal values : 0.8 to 2.0
T4 : 6.13 ug/dl Normal values : 5.1 to 14.1
Ultra TSH : 10.24 ulU/ml Normal values : 0.27 to 4.2
I have a number of questions -
1. Are these indicative of mild/sub-clinical or elevated hypo-thyroidism? What additional tests should I get done to zero-in on hypo-thyroidism? Are TSH levels sensitive to other things?
2. Is hypo-thyroidism a contributing factor to diffused thinning?
3. What will be the line-of-treatment? Will I be able to keep/maintain my existing hair the thyroid medication(to keep thyroid levels in the normal range) + the traditional hair-loss drugs(Rogaine and Finasteride)?
4. Can the condition degrade further in years to come? What could have triggered HypoT?
Experience with Hair Loss
I have had hair-loss for the last 6 years. My hair fall has been diffused. My frontal hairline is still intact with thick hair and therefore frames the face well.
I am thin on the top, have a few scars on sides(no thinning), dense hair at first but sparse towards the end in my donor, but its coarse(no thinning). My donor is stable though. Since I am a diffused, I would say I am a II-III on the Ludwig scale.
Diet and medication
My diet is good, great metabolism too! I am a non-vegetarian, consume meat/fish/eggs. I have a good amount of green vegetables too. About a month back, I have started to take a protein shake. Medication - I have begun with the following regimen for the last 1 month. Applying Minoxidil(Dr. Reddy's) 5% twice a day + Finasteride 1mg/day to arrest/slow down the shedding. There is initial shedding of thin hair(as expected), but will wait upto 5-12 months. I have absolutely no noticeable side-effects as of now. I cycle about 5-6 miles everyday.
A few cosmetic surgeons suggested to me, that hypothyroidism may cause diffused thinning all over. This is what lead me to take the thyroid test. These are the results :
T3 : 0.941 ng/dl Normal values : 0.8 to 2.0
T4 : 6.13 ug/dl Normal values : 5.1 to 14.1
Ultra TSH : 10.24 ulU/ml Normal values : 0.27 to 4.2
I have a number of questions -
1. Are these indicative of mild/sub-clinical or elevated hypo-thyroidism? What additional tests should I get done to zero-in on hypo-thyroidism? Are TSH levels sensitive to other things?
2. Is hypo-thyroidism a contributing factor to diffused thinning?
3. What will be the line-of-treatment? Will I be able to keep/maintain my existing hair the thyroid medication(to keep thyroid levels in the normal range) + the traditional hair-loss drugs(Rogaine and Finasteride)?
4. Can the condition degrade further in years to come? What could have triggered HypoT?
Hi Gimel,
Still awaiting my Ferritin results. Will visit an endo only next week. Meanwhile, started with 25mcg low dose of Thyroxine.
Thanks!
Still awaiting my Ferritin results. Will visit an endo only next week. Meanwhile, started with 25mcg low dose of Thyroxine.
Thanks!
The TPO ab test being positive, along with your symptoms and other test results are proof of you having the most common cause for hypothyroidism, which is Hashimoto's Thyroiditis. The actual number from the test is not an indicator of the severity of your status. The results from Free T3 and free T4 tell lots more about how hypo you are at the moment.
With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland. Along the way to destruction, natural thyroid hormone production gradually diminishes and has to be replaced with thyroid medication as necessary to relieve symptoms.
What has your doctor said about your test results and plans to treat you with thyroid medication?
With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland. Along the way to destruction, natural thyroid hormone production gradually diminishes and has to be replaced with thyroid medication as necessary to relieve symptoms.
What has your doctor said about your test results and plans to treat you with thyroid medication?
Hi gimel
Just got the results of the antibodies test.
Anti-TPO Antibodies (Positive)155.62 U/ml normal : Negative <5.61
Thyroglobulin antibodies : Negative (0.78). Normal : negative <4.11
What are these results indicative of? Is the ailment mild/moderate/severe?
Awaiting your reply urgently.
Just got the results of the antibodies test.
Anti-TPO Antibodies (Positive)155.62 U/ml normal : Negative <5.61
Thyroglobulin antibodies : Negative (0.78). Normal : negative <4.11
What are these results indicative of? Is the ailment mild/moderate/severe?
Awaiting your reply urgently.
Yes, it would be find to test Monday. Taking the ferrous glutamate won't affect the D and B12 test results.
You don't need to wait until seeing an Endo. We actually find that Endocrinologists are not necessarily good thyroid doctors. That is because many of them specialize in diabetes, not thyroid. Also many of them have the "Immaculate TSH Belief' by which they only want to diagnose and treat based on TSH. That doesn't work. If they test beyond TSH typically it is for only Free T4, and then they will tell you that a test result that falls anywhere within the range is adequate. That is also wrong.
You need a doctor that will treat clinically, by testing and adjusting Free T3 and Free T4 levels as necessary to relieve symptoms, as I previously described. If your doctor does not agree to treat clinically, then you will need to find a doctor that will do so.
I just sent a PM with info you wanted. Just click on your name and go to your personal page. Then click on messages.
You don't need to wait until seeing an Endo. We actually find that Endocrinologists are not necessarily good thyroid doctors. That is because many of them specialize in diabetes, not thyroid. Also many of them have the "Immaculate TSH Belief' by which they only want to diagnose and treat based on TSH. That doesn't work. If they test beyond TSH typically it is for only Free T4, and then they will tell you that a test result that falls anywhere within the range is adequate. That is also wrong.
You need a doctor that will treat clinically, by testing and adjusting Free T3 and Free T4 levels as necessary to relieve symptoms, as I previously described. If your doctor does not agree to treat clinically, then you will need to find a doctor that will do so.
I just sent a PM with info you wanted. Just click on your name and go to your personal page. Then click on messages.
Hi Gimel,
Would it be fine, if I get the test Vitamin D3, B12 (and I actually meant Folate) done on Monday - it would imply a gap of two days between today(I took my Ferritin test)? Also, I took a tablet of Ferrous Glutamate today - I hope that would not affect the D3, B12 levels and produce biased results?
I would love to know about the local source of T3 in Mumbai as well as T4 med. If you could also PM me the source for NDT, that would be amazing. What does Armor cost?
Since I am a definitely a Hypo-T patient, could I actually start with T3/T4 meds right away or defer it till I see an endocrinologist, and see what he prescribes?
Would it be fine, if I get the test Vitamin D3, B12 (and I actually meant Folate) done on Monday - it would imply a gap of two days between today(I took my Ferritin test)? Also, I took a tablet of Ferrous Glutamate today - I hope that would not affect the D3, B12 levels and produce biased results?
I would love to know about the local source of T3 in Mumbai as well as T4 med. If you could also PM me the source for NDT, that would be amazing. What does Armor cost?
Since I am a definitely a Hypo-T patient, could I actually start with T3/T4 meds right away or defer it till I see an endocrinologist, and see what he prescribes?
If the ferritin is low in the range, as I expect then there is no need to take the other tests. If the ferritin should show as high or over range, then the other tests would be necessary to try and find out the cause.
The tests for D. B12 and ferritin are very important for a hypothyroid patient. Did you mean ferritin rather than folate?
In the interest of minimizing cost of testing, Reverse T3 is not usually done unless there are continuing hypo symptoms that are not explained by other deficiencies.
I do know of a source in Canada that will ship NDT med to India. You will need to have a prescription from your doctor. I just recently was told from a member in Mumbai that she was able to find a local source for T3. If you could find a local source for T3, you could take both T4 and T3 and achieve comparable result as with NDT, plus that way you could adjust the levels individually as desired. If you still want to know the source for NDT, I'll send it by PM.
The tests for D. B12 and ferritin are very important for a hypothyroid patient. Did you mean ferritin rather than folate?
In the interest of minimizing cost of testing, Reverse T3 is not usually done unless there are continuing hypo symptoms that are not explained by other deficiencies.
I do know of a source in Canada that will ship NDT med to India. You will need to have a prescription from your doctor. I just recently was told from a member in Mumbai that she was able to find a local source for T3. If you could find a local source for T3, you could take both T4 and T3 and achieve comparable result as with NDT, plus that way you could adjust the levels individually as desired. If you still want to know the source for NDT, I'll send it by PM.
Thanks Gimel, I was able to get Ferrous Glumarate from Merck. I also took the TPO Ab, TGB Ab, and Ferritin tests today. I had a few follow-on questions, would be glad if you could answer them -
1. There are four iron labs: Ferritin, % Saturation, TIBC and serum iron (sometimes the latter will just say Iron, or total iron). Do I need to test for all of these?
2. How essential are the tests for Vitamin D3, B12 and Foliate?
3. Should I also get tested for Reverse-T3?
4. If my endocrinologist recommends taking meds for Hypo-T, I read on the Internet that Natural Dessicated Thyroid - NDT (Armour) which contains all thyroid hormones T1, T2, T3 and T4 is preferred to synthetic thyroid(Synthoid) that contains only Synthoid. I also found out that NDT Armor is not available in India. Do you know, how I can order it over the Internet, or is there a distributor who sells it in India?
1. There are four iron labs: Ferritin, % Saturation, TIBC and serum iron (sometimes the latter will just say Iron, or total iron). Do I need to test for all of these?
2. How essential are the tests for Vitamin D3, B12 and Foliate?
3. Should I also get tested for Reverse-T3?
4. If my endocrinologist recommends taking meds for Hypo-T, I read on the Internet that Natural Dessicated Thyroid - NDT (Armour) which contains all thyroid hormones T1, T2, T3 and T4 is preferred to synthetic thyroid(Synthoid) that contains only Synthoid. I also found out that NDT Armor is not available in India. Do you know, how I can order it over the Internet, or is there a distributor who sells it in India?
Each of the four is a different form of iron. The ferrous ascorbate is yet another form of iron and it should be okay for you.
Another thing - I was not able to get any of the above preparations at a nearby drug store. Instead, I got Ferrous Ascorbate and Folic Acid Tablet. Would they serve the same purpose as Ferrous Fumarate/Ferrous Glutamate?
Are these two separate preparations?
1) Ferrous Fumarate or Ferrous Glutamate
2) Ferrous Sulfate or Ferrous Bisglycinate
Thanks!
1) Ferrous Fumarate or Ferrous Glutamate
2) Ferrous Sulfate or Ferrous Bisglycinate
Thanks!
Just ferritin for now. As you correct deficiencies the shedding should respond. Then it may take a while for the hair to start growing back. You could start on an iron supplement after the blood draw for tests. I'd suggest starting with about 25 mg of ferrous fumarate, or ferrous glutamate, ferrous sulfate, or ferrous bisglycinate. Then after a week or so, you'll want to increase, dependent on your test result.
Hi Gimel -
I will get tested for TP Ab, TG Ab, Vitamins D, B12 and Ferritin tomorrow. Shall I take both Ferritin & Serum Iron - or only Ferritin(iron store) should suffice? By the way, the results for the tests will be out only by Wednesday.
My hair is falling like crazy - and its the thick hair in the frontal areas! And a lot of my scalp has become visible over the last 2 months. Can I start taking some kind of iron supplements in the meanwhile(after taking the tests)? What are the chances of these shed hair growing back?
I'd like to thank you for guiding me, educating me upto this point!
Thanks a tonne!
I will get tested for TP Ab, TG Ab, Vitamins D, B12 and Ferritin tomorrow. Shall I take both Ferritin & Serum Iron - or only Ferritin(iron store) should suffice? By the way, the results for the tests will be out only by Wednesday.
My hair is falling like crazy - and its the thick hair in the frontal areas! And a lot of my scalp has become visible over the last 2 months. Can I start taking some kind of iron supplements in the meanwhile(after taking the tests)? What are the chances of these shed hair growing back?
I'd like to thank you for guiding me, educating me upto this point!
Thanks a tonne!
Hi Gimel,
Got my free T3 and free T4 tests done as well. To my surprise, my FT3 and FT4 levels look normal.
FT3 : 3.00 pg/ml. Range : 2.02-4.43
FT4 : 1.19 ng/DL. Euthyroid Range : 0.93-1.7
Do you think this is still indicative of mild Hypo-T? Are there any precautions to be taken before doing these tests(fasting in the morning etc.)
Got my free T3 and free T4 tests done as well. To my surprise, my FT3 and FT4 levels look normal.
FT3 : 3.00 pg/ml. Range : 2.02-4.43
FT4 : 1.19 ng/DL. Euthyroid Range : 0.93-1.7
Do you think this is still indicative of mild Hypo-T? Are there any precautions to be taken before doing these tests(fasting in the morning etc.)
Hi Gimel,
Got my free T3 and free T4 tests done as well. To my surprise, my FT3 and FT4 levels look normal.
FT3 : 3.00 pg/ml. Range : 2.02-4.43
FT4 : 1.19 ng/DL. Euthyroid Range : 0.93-1.7
Do you think this is still indicative of mild Hypo-T? Are there any precautions to be taken before doing these tests(fasting in the morning etc.)
Got my free T3 and free T4 tests done as well. To my surprise, my FT3 and FT4 levels look normal.
FT3 : 3.00 pg/ml. Range : 2.02-4.43
FT4 : 1.19 ng/DL. Euthyroid Range : 0.93-1.7
Do you think this is still indicative of mild Hypo-T? Are there any precautions to be taken before doing these tests(fasting in the morning etc.)
Hi -
I will get the Free T3, Free T4, vitamins and TPO ab and TG ab tests done today. I am a non-vegetarian, so I consume meat, fish and eggs.
Finasteride is a DHT blocker. But, I'd like to know, if Finasteride in any way can induce Hypo-T?
I will get the Free T3, Free T4, vitamins and TPO ab and TG ab tests done today. I am a non-vegetarian, so I consume meat, fish and eggs.
Finasteride is a DHT blocker. But, I'd like to know, if Finasteride in any way can induce Hypo-T?
Yes, your test results are indicative of hypothyroidism, even though the tests were for Total T3 and Total T4, which are somewhat outdated and not nearly as useful as tests for the biologically active thyroid hormones, Free T3 and Free T4. The difference between Total and Free is that the Total tests measure essentially all serum T3 or T4, most of which is bound to protein mileculses, which renders it biologically inactive. Only the small portion that is not bound to protein, thus free, is biologically active.
So you should always insist on being tested for Free T3 and Free T4. Since your TSH was also high, you should request to be tested for the most common cause for hypothyroidism, which is Hashimoto's Thyroiditis. With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland. Along the way to destruction, T4 and T3 output from the gland is diminished and TSH levels rise accordingly. The tests for Hashi's are Thyroid Peroxidase antibodies and Thyroglobulin antibodies, often listed as TPO ab and TG ab. Both need to be done.
TSH is a pituitary hormone that is affected by other things and is only an indicator, to be considered along with much better indicators such as symptoms and also levels of Free T3 and Free T4. Be aware that after starting on thyroid med, TSH often becomes suppressed below range and is basically a useless test. Never allow a doctor to adjust your meds based only on TSH levels.
Thinning hair is one of the recognized symptoms of hypothyroidism. You will find it in this link that lists a lot of the typical symptoms of hypothyroidism.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
The usual treatment for hypothyroidism is thyroid medication. Patients are frequently started on T4 meds because they are easier to administer, taken once daily. T3 meds act faster and need to be split and taken twice daily to even out the effect. T4 meds work fine as long as the patient's body adequately converts the T4 to T3. If not, then a T3 med has to be added to daily dosage. 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. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
So you need to get your doctor to start you on thyroid medication and re-test and increase your meds as necessary to relieve hypo symptoms. Since hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, you should make sure to get those tested as well. D needs to be midrange, B12 needs to be in the upper end of its range, and ferritin for men needs to be around 80-90 minimum. Note that low ferritin has also been associated with hair loss. Since you are vegetarian, I would not be surprised that you would be low in ferritin.
If you get your hypo symptoms adequately treated clinically, as described above, then you should have no associated hair loss. Of course there is always male pattern baldness which also affects us with aging.
With regard to Hashi's, there are theories, but no scientific proof about what causes it.
If your hair loss is only due to hypothyroidism, then I don't see any benefit from using Rogaine. I have no idea how Finasteride would help prevent hair loss, since it is a drug for enlarged prostate problems.
So you should always insist on being tested for Free T3 and Free T4. Since your TSH was also high, you should request to be tested for the most common cause for hypothyroidism, which is Hashimoto's Thyroiditis. With Hashi's the autoimmune system erroneously sees the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland. Along the way to destruction, T4 and T3 output from the gland is diminished and TSH levels rise accordingly. The tests for Hashi's are Thyroid Peroxidase antibodies and Thyroglobulin antibodies, often listed as TPO ab and TG ab. Both need to be done.
TSH is a pituitary hormone that is affected by other things and is only an indicator, to be considered along with much better indicators such as symptoms and also levels of Free T3 and Free T4. Be aware that after starting on thyroid med, TSH often becomes suppressed below range and is basically a useless test. Never allow a doctor to adjust your meds based only on TSH levels.
Thinning hair is one of the recognized symptoms of hypothyroidism. You will find it in this link that lists a lot of the typical symptoms of hypothyroidism.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
The usual treatment for hypothyroidism is thyroid medication. Patients are frequently started on T4 meds because they are easier to administer, taken once daily. T3 meds act faster and need to be split and taken twice daily to even out the effect. T4 meds work fine as long as the patient's body adequately converts the T4 to T3. If not, then a T3 med has to be added to daily dosage. 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. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
So you need to get your doctor to start you on thyroid medication and re-test and increase your meds as necessary to relieve hypo symptoms. Since hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, you should make sure to get those tested as well. D needs to be midrange, B12 needs to be in the upper end of its range, and ferritin for men needs to be around 80-90 minimum. Note that low ferritin has also been associated with hair loss. Since you are vegetarian, I would not be surprised that you would be low in ferritin.
If you get your hypo symptoms adequately treated clinically, as described above, then you should have no associated hair loss. Of course there is always male pattern baldness which also affects us with aging.
With regard to Hashi's, there are theories, but no scientific proof about what causes it.
If your hair loss is only due to hypothyroidism, then I don't see any benefit from using Rogaine. I have no idea how Finasteride would help prevent hair loss, since it is a drug for enlarged prostate problems.
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Did you consider testing for TPO ab and TG ab, along with Vitamin D, B12 and ferritin? The antibodies test will confirm if you have Hashimoto's Thyroiditis. With your main concern being hair loss, you really need to know your ferritin level.