When do doctors treat hypo?

[stategirl]

I know the new "normal" range for TSH os .3-3.0, but I was wondering when doctors consider treatmentfor subclinical. I recent;y had blood work done and my TSH was 2.65 and my free T-4 was 1.21. Is this considered hypo by strict doctors? Mine told me it was fine. I don;t think a TSH that low could be contributing to my symptoms, such as a mildly irregular menstrual cycle. Any advice? Thanks:)  

[stategirl]

It seems to me that 1.2 is almost right in the middle of .8-1.8. How can this be considered low? If the guidelines are that strict, then basically everyone should be a certain number, not a certain range.

[kitty9309]

The ferritin is the storage protein for iron.

It is the iron your body has stored for future use. When your body needs iron, it takes it from the ferritin molecule. If the ferritin is already low or near the bottom of the range, you can easily become anemic.

Some symptoms of low ferritin are the same as those of anemia.

[alikat709]

in addition to the tsh you also need to look at FREE t4 AND FREE t3, you should request these test for your thyroid. not t3 and t4. Your freet4 looks low if the high range is 1.8,you didn't post your're range so Im going by the usual one.your free t4 and free t3 should be within 60 to 80 % of the range for a woman of childbearing age..

[stategirl]

Okay thanks. What does the ferritin actually tell?
No it's kind of just thinning, not patches. And it doesn't actually come out when I pull on it, it's just more like I can tell it's thinner overall.
I think my doctor meant that once you start taking it, you more than likely have to keep taking it. I've also heard that Synthroid can actually cause more hair loss!

[kitty9309]

Your doctor is not correct when he says that. If your thyroid is healthy and you start meds, it will go right back to normal when you stop them.
Sometimes doctors, mostly endos, will call this a "trial" on thyroid meds to see if you feel better. Your doctor may be using a scare tactic to not put you on the meds.

The upper range at 5 includes people with occult thyroid disease. They have positive antibodies and their thyroid are more than likely beginning to fail.

Here is a great article on the reference range:

http://jcem.endojournals.org/cgi/content/full/90/9/5483

Is your hair loss all over or in patches? I had Alopecia Areata where it falls out in patches. It is also an autoimmune disease.

If the hair loss is the only symptom, I would go with repeat thyroid testing as you mentioned and try seeing a dermatologist. They will also know about the ferritin.

[stategirl]

Thanks! I just don't want to get on anything if I don't have to because my doctor told me that once you suppress the thyroid with meds, there's no going back. Could a TSH of 2.65 be causing dramatic sx such as hair loss? It seems hard to believe when just a few years ago the normal upper limit was 5.

[kitty9309]

It could be a fluke, not likely though.
If it bounces around from test to test, it may signal the start of Hashimoto's- that is antibody positive hypothyroidism. My TSH did that for years, but was never below 3.5.
I would stick with the 8am time. I have mine done consistantly at about the same time in the morning.
The PCP can order the antibody test and I would definately ask for it.
Never mind all the questions- it is what the forum is for.
You are welcome and keep in touch here!

[stategirl]

Is it possible that it may be lower next time, and it wsa just a fluke? Shoudl I get it done at 8am? Also, shoudl I request antibody testing and will Primary Care physicians test this as well?
Sorry for all the questions!! Thanks for the help!

[kitty9309]

Sorry- a typo.

Yes, the TSH is LOWEST in the afternoon.

More testing would be a really good idea.

Good luck.

[stategirl]

So they peak at night and early morning? So do you mean "lowest" in the late afternoon? I do have a great aunt that had thyroid problems. That's all I know of. I guess I should get some repeat testing.

[kitty9309]

Also have your ferritin checked. It is the iron storage protein and is more accurate than a serum iron level. It will be low long before you are anemic.

A TSH in the early morning is the best. Out TSH levels reach a peak late at night through early morning and are at their highest in the late afternoon.

If your antibodies are positive, the thyroid may get progressively worse, or not. It is hard to say. Repeat testing is the only way to be sure.

Do you have a family history of thyroid disorders?

[stategirl]

Hi,
The reason I got it tested was for some minor menstrual irregularities. I am only 29-yrs-old, so is my thyroid going to get progressively worse? Does it ever get better or stay the same?
Also, at only a 2.65 TSH, could it be causing such dramatic effects such as hair loss? Because my hair is really thinning out.
One more question: I had the test done at 8am fasting. I heard that your TSH is the highest early in the morning. Anyone have any insight on this? Thanks!

[Melmo36]

Hi stategirl,

I am wondering the same thing.  My TSH was 6.85 and that's the only thyroid test I got.  I haven't been back to the doc yet (not diagnosed with hypo as of now) but I was told they may just decide to do more tests and not treat me yet, but keep an eye on it.  Are you experiencing any other hypo symptoms?  I think docs will be more inclined to treat if their patients complain of symtoms, eh?  I dont know.  Good luck to you and I hope everything turns out well!

[kitty9309]

Each doctor has his/her own opinion in when to treat.

My endo says any TSH over 2.5 should be treated, especially when the thyroid antibodies are positive.

I would request a thyroid antibody test. You may be just in the beginning stages of hypo and the antibody test, if positive, would indicate a need for periodic retesting.