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Thyroid and estradiol/estrogen plummeting (28yo)

Hi, I just received some bizarre test results and wondering if someone can help interpret them. I am an expat living in Indonesia where good healthcare is very hard to find, and my thyroid and estrogen both seem to be plummeting. Iron and B12 also very low/deficient. I am a 28yo female.

Symptoms: weight gain, inability to affect fat composition with exercise, hair thinning and loss, hair by hair turning white and crinkly, low body temp (~97.4F), hirsutism (since puberty), acne (especially chin/cheeks), lately hot flashes! Sleep quality has been extremely poor for well over a year now. Wake ups once or twice a night, and if I stay awake past midnight I'll be awake for hours (was always a night owl but these patterns particularly started March 2013). Never feel rested. Last year massive sugar cravings but under control with Metformin. Mother has Hashimoto's.

Medications: 2,000mg/day Metformin XR since August 2013 (a doc in US looked at me when I was seeking help for many of these symptoms and said "PCOS". She only tested TSH at that time, which was 1.040 (0.400-5.500)). Also took roaccutane 10mg/day June/July this year for acne.

Test results:

APRIL 28, 2014

T3: 1.05 ng/mL (0.8-2.0)
T4: 6.31 μg/dL (5.10-14.10)
TSH: 1.88 μIU/mL (0.27-4.20)
FT3: 4.53 pmol/L (3.10-6.80)
FT4: 1.09 ng/dL (0.89-1.76)
Anti Thyroglobulin AB: 18 IU/mL (Negative: = 115)
Thyroglobulin: 38.30 ng/mL (0-55)
Anti TPO: 0.20 (AB Index) (1.1: Positive)

---
Still not feeling well! More tests!
---

AUGUST 5, 2014

Ferritin: Low 15 ng/mL (15 – 150)
Vitamin B-12: Low 123 pg/mL (174 – 878)

FT3: Low 3.00 pmol/L (3.10 – 6.80 (Adult))
FT4: 1.13 ng/dL (0.89 – 1.76 (Adult))

Estradiol : Low 18.8 pg/mL
- Follicular Phase: 39-189
- Mid-Cycle Peak: 94-508
- Luteal Phase: 48-309
- Post-Menopause: 0-41
- Male: 7.6-42.6

Progesterone: 0.19 ng/mL
- Follicular phase: 0.2-1.5
- Ovulation phase: 0.8-3.0
- Luteal phase: 1.7-27
- Post-menopause: 0.1-0.8

(This was 5 days after first day of my period, so follicular phase. At least i'm still menstruating??)

I went to the doctor that day because of a throat infection which ended up a mean bug. I think my low body temp (usually 97.4) is making me more susceptible to bugs. Also, thyroid ultrasound that day revealed nothing.

Actions taken since last year: tried low carb, then not-so-low carb, low GI, on/off gluten free, routinized sleep schedule, exercise (swimming 40 min 4x/week). I eat healthily, mostly food I cook for myself, veggies/chicken/eggs/fruit. I've changed my whole lifestyle and tried everything and this is only getting worse.

Do you have any suggestions for what might be wrong here, and what follow up tests I need? I can request any tests I might need. Already guessing TSH for sure, FSH, then ACTH? cortisol (blood test)? Unfortunately I can't get cortisol saliva test here. Should I test my liver function? Ultrasound of my uterus? Pituitary gland?

Would very much appreciate if you have any insight or advice. Thank you so much!
9 Responses
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Avatar universal
To gimel - I'd like to thank you for your time answering this initially. I've noticed your posts in other places on this site and you seem knowledgeable as well as generous with your time, which is rare and I'm sure very appreciated.

I'm visiting the US this month so I went to see a referred endocrinologist at the Cleveland Clinic (near home) prepared with all my history and evidence and the info from the web that FT3/FT4 need not be crazy low for a patient to be sympomatic. In the end she declined treating me for hypothyroid and offered two options forward: get evaluated for Chronic Fatigue Syndrome at rheumatology, or go see an accupuncturist. I was so blindsided and confused, I had pinned so much hope on finally seeing a doctor who could give a birds-eye view of my two years of hell, and I had researched so much and knew everything I wanted to say and talk about, and I made sure to get a really good referral through the one top medical connection I have!, but the only thing she really told me was that there's nothing wrong with my thyroid, that she doesn't like to "chase a single number," and that while she "wouldn't hide from me that there are specialists in the department for PCOS and the pituitary gland," such a specialist is not her so she wouldn't comment. Brick wall. She wouldn't even help me logic out the B12 vs. metformin, or give tips on how to improve any of my deficiencies - she said I would have to see internal medicine. She did agree to retest my thyroid panel and hormones (estradiol/progesterone/ACTH (new!)) so I'll get new results in 2-3 days -- but then she stood by the door and let me go. It was demoralizing.

So I'm going to wait to get my new numbers and see what they say, and if they're still off, I'll try desperately to get in with an endo in the area who was recommended on Mary Shomon's site, though I probably won't have much luck as she schedules for January and I don't have a referral. I only have two more weeks in the US and then I'm back to Indonesia, where I might just ask a doctor to treat me with levothyroxine because I am so desperate to feel better. Is that irresponsible? It seems justifiable to me, or should I keep fighting to unravel the birds-eye cause? Or are they right, and despite everything I think and feel…. I'm really just not that sick??

This just *****. Big hugs to everyone out there working through these same issues and frustrations - you are not alone!
Helpful - 0
Avatar universal
Well my wife was recently tested for the sex hormones.  We were suspecting possibility of estrogen dominance. As my wife is now 44 years old and it is known that progesterone usually wanes resulting in estrogen dominance.

However when the tests came back they showed:

Follicular phase only 3 days afeter start of menstration.

Testosterone:  20 (20-73) ZERO percent of range!
Estrogen: 23 (56-204) Significantly BELOW RANGE
Progesterone: 0.42 (0.25 - 0.54) - 58.6% of range

So this showed just the opposite of the anticipated estrogen dominance and instead showd a pretty significant deficiency in Estrogen.  And very rock bottom testosterone.  Both of which may explain her complete lack of libido not to mention still being Hypo and being undermedicated (but hope the Dr increases her dosage of Armour in the next couple weeks).

Interesting that Red Star listed all those low estrogen sylmptoms and my wife has essentially exactly the opposite symptoms or ones that are not relevant (child birth/breastfeeding)!

My wife is waiting until closer to her next blood labs and office visit to discuss upping her Armour dosage to also talk to the Dr about the low and out of range testosterone and estrogen levels.  Or do you think she should talk about this NOW!
Helpful - 0
1756321 tn?1547095325
Yes I've had it clinically diagnosed and my labs showed hyperinsulinemia. My fasting insulin was 39 mU/L (6 - 22) and 2 hours after drinking glucose it was 184 (15 - 65).  In my case high insulin suppresses my appetite. Increased appetite could also be a symptom though. Metformin is a cause of vitamin B12 deficiency actually come to think of it.  

I had estrogen deficiency but I did have my ovary removed so yeah lol.  It took 4 months for the other ovary to take over. So not a fan of that deficiency state!

I found this online from MD Health on Low Estrogen...

"In younger women, low estrogen can result from several physical or behavioral problems including:

Decreased functioning of the ovaries;
Cysts on and in the ovaries;
Pregnancy problems that lead to miscarriage;
Childbirth and breast-feeding;
Decreased functioning of the pituitary gland;
Eating disorders and dieting resulting in low body fat;
Certain fertility drugs;
Excessive exercise resulting in low body fat.
Helpful - 0
Avatar universal
FYI for the general record, I had more tests done (six days after the first ones):

TSH 2.00 (0.27-4.20)

FSH 8.02 mIU/mL
- Follicular: 3.5-12.5
- Ovulation: 4.7-21.5
- Luteal: 1.7-7.7
- Post-menopause: 25.8-134.8
(I think I'm between follicular and ovulation now)

Crazy low estradiol and normal-looking FSH with low FT3 and FT4. I really want to get a head MRI and try to image the pituitary gland, check for hypopituitarism. Is that going too far?
Helpful - 0
Avatar universal
Interesting! And good to know. I definitely feel like something is up with my blood sugar, but I've never known how to get to the bottom of it or understand it. If I'm not taking metformin, I will feel starving an hour after I eat any well balanced meal. Often that happens even with the met. I just tried to go off metormin after finding out the B12 deficiency, but it was torture, so I'm going to try to dial back to 1,000 mg/day instead. Also going back to apple cider vinegar, I love that stuff.

Did you have any tests to confirm in the end, or it just stayed a clinical diagnosis? Is "hyperinsulinemia" what you have?
Helpful - 0
1756321 tn?1547095325
I've had insulin resistance for decades.  My endo diagnosed my insulin resistance clinically due to my symptoms.  I already knew I had the condition at that point.  

My fasting glucose has always been normal.  The first OGTT was normal (no insulin tested however).  The second OGTT showed fasting glucose normal and 2 hours later in pre-diabetic range.  Fasting insulin and 2 hours post glucose insulin were both high.

***

Excerpt from Pre Diabetes - FAQs About Insulin Resistance – Normal Blood Sugars...

"Can you be insulin resistant and still have normal blood sugars?

Yes! A person who is insulin resistance can, and often does, have normal fasting blood glucose levels and normal blood sugar after meals. People with insulin resistance can even “pass” an oral glucose tolerance test (OGTT).

But in order to maintain normal glucose levels during an oral glucose tolerance test, a person with insulin resistance will overproduce insulin. Elevated insulin levels is called “hyperinsulinemia.”"  

"Who should be tested for insulin resistance?

If you are 45 years or older, you be screened for pre-diabetes and insulin resistance regardless of your weight.

If you are diagnosed with Hashimoto’s thyroiditis or another thyroid disease, cushing’s syndrome (disease), or polycystic ovarian syndrome you have an increased risk of insulin resistance, pre-diabetes, and type 2 diabetes."
Helpful - 0
Avatar universal
Hi there, thank you so much for your responses. I didn't know about any links between stomach acid efficacy and being hypothyroid - really interesting! I will also make a note to get Vitamin D tested, and looks like magnesium too.

I am worried how thyroid and estrogen are both low simultaneously -- I am only 28 but my estradiol is menopausal. Will ask for FSH tested to rule out  ovarian failure. But do you think there might be a link here to hypothalamus/pituitary, given that multiple hormones are off balance? Should I get a head scan?

Also, I had asked for the 2-hr glucose test last year since I was concerned about insulin resistence, results were:
Glucose (Fasting): 93 mg/dL (65 - 100)
Glucose (2-hr): 112 mg/dL (40 - 140)

--> Doc said this was "an excellent result," but does anything look off to you?

Many thanks!
Helpful - 0
1756321 tn?1547095325
My severe sugar cravings were due to magnesium loss due to insulin resistance. Insulin resistance was one of my reasons why I couldn't lose weight. I also gained weight with Hashimoto's thyroiditis.

The symptoms of vitamin B12 deficiency are long but include the symptoms you mention fatigue, hair loss, insomnia, premature grey hair. Low body temp is also a symptom of anaemia which you may or may not have.  Since your mother has Hashimoto's thyroiditis, you might have autoimmune pernicious anaemia (genetics for both conditions - HLA-DR5- I know as I have both autoimmune diseases lol) with those vitamin B12 lab results. Antibodies for autoimmune pernicious anaemia are intrinsic factor antibodies and parietal cell antibodies.

Helpful - 0
Avatar universal
From your symptoms, low level of Free T3, relatively low Free T4, and normal TSH, I'd say that you have what is called central hypothyrodism.  That type of hypothyroidism is characterized by normal TSH, but insufficient levels of thyroid hormone, due to a problem in the hypothalamus/pituitary area.   This type of hypothyroisism is frequently overlooked by doctors, who mostly pay attention to TSH, until the patient becomes severely symptomatic due to the low levels of thyroid hormone.  

Hypo patients frequently do not produce adequate stomach acid to properly absorb nutrients/vitamins, so they end up with low Vitamin D, B12 and ferritin.  Those low levels also can cause symptoms as well as prevent adequate thyroid hormone from being metabolized.


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 find a good thyroid doctor that will treat clinically, as described.  You also need to be tested for Vitamin D.  You want i tot be around the middle of its range.  You also need to start supplementing B12 and ferritin.  B12 should be in the upper part of its range, and ferritin should be 70-80, for women.

Helpful - 0
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