Does this indicate hypothyroidism?!?!?

[always_sick]

Hi all,

I am a recently diagnosed Lupus and Type 2 diabetes patient. On last week, the Nurse Practitioner ran some additional tests due to tachycardia, hand tremors, excessive sweating, hair loss, and weight gain. I received the results on yesterday but was told labs would be rechecked in 3 months. I'm worried that I won't make it that long! Please provide your opinion/suggestion regarding my most recent lab results so that I may proceed in addressing my health issues. Thanking you in advance!

Total T3         0.79 L      ref range ( 0.87-1.78 )
TSH               1.57       ref range ( 0.34-5.60 )
Free T3          2.24 L      ref range ( 2.50-3.90 )
Free T4          0.69        ref range ( 0.61-1.12 )
TPOAb          8             ref range ( 0-34 ) .

[always_sick]

Wow..I guess I never heard of Non thyroidal illness either! I will definitely have a follow-up with the doctor. My rheumy just called and said there's no relation to the low thyroid levels and my lupus activity. BUT...seems to me an appt with an endocrinologist is needed.

Thanx again for your feedback!!

[Red_Star]

Just to add, the non thyroidal illness condition is called by a few names in medical literature but most commonly Euthyroid Sick Syndrome (ESS) although other names can be used such as Non-thyroidal Illness Syndrome (NTIS) and Low T3 Syndrome.

'In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidism (10% subclinical and 10% biochemical), and 10% had hyperthyroidism (5% subclinical and 5% biochemical)." - Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients."

Euthyroid Sick Syndrome can be due to:

Autoimmune hemolytic anaemia
Cardiomyopathy
Diabetes mellitus
Generalised skin disease (eg demodex)
Heart failure (congestive)
Hepatitis (chronic active)
Infections
Intervertebral disc protrusion
Liver failure (eg cirrhosis)
Lymphosarcoma
Malabsorption
Megaoesophagus
Nephrotic syndrome
Polyneuropathy
Protein-losing enteropathy
Renal failure (chronic)
Starvation
Systemic lupus erythematosus (SLE)

[always_sick]

Thank you both for your responses!! I have never heard of Secondary Hypothyroidism...the Nurse practitioner felt it would be better to take a "wait & see" approach and re-run labs in 3mos. However, I felt something more should be done! I will contact my primary doctor and be a lil more aggressive in request for treatment.

[goolarra]

Your FT4 is very low.  It's just above the bottom of the range, and it should be closer to midrange.  FT3 is below range, clearly deficient, especially considering that FT3 target is upper half of range.  TSH is very "normal".  As Red_Star stated, that could indicate secondary hypo, which is actually a pituitary, rather than thyroid, dysfunction.

Your symptoms are mixed.  Tachycardia, hand tremors, and excessive sweating usually indicate hyper, while hair loss and weight gain indicate hypo.  So there's not clear indication from them.

With your FT3 and FT4 so low, I'd ask the doctor to start meds.  With your other issues, that might not be a possibility if you are starting treatment for them as well.

[Red_Star]

Low or normal TSH with low free T3 or low free T4 - common with non-thyroidal illnesses. Highly suspected in your case due to your other medical conditions. A rare condition that may be considered is secondary hypothyroidism (damage to the pituitary gland - tumour, surgery, radiation).

Recommended googling:

Reversing type 2 diabetes
Lupus recovery diet
Low dose natrexone