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hair loss and weight gain with central hypo thyroid
Hello, I have a pituitary ademoma and take dostinex for it. I also take 88 mcg of levothyroxin (levothyroxine) and 1/2 of 25 mcg of liothyronine. My hair is falling out, dry and lifeless. My blood test results are tsh-.006 free t4- .96 and free t3 1.9. I am on the low end of the range and feel much better when I am at the high end but because the tsh is so low, my dr. keeps reducing my cytomel. I used to alternate 50 and 25 mcg. I have gained 10 lbs despite going to a gym 4 days a week and barely eating. Constipation came back as well. Any suggestions for my hair and weight?
I have found that most doctors are sympathetic to inadequate insurance coverage. If I explain to them that I have to pay out-of-pocket for all testing, they will make an effort to keep it to a minimum.
You can try to educate your current doctor, but from what you've said about him, he has a long, long way to go to understand how to treat you with your concommitant pituitary issue. The fact that he uses your TSH at all, with a known pituitary issue, demonstrates his total lack of understading about how to treat you. My PCP had the same problem. Most PCPs don't understand garden variety hypo (the kind where TSH behaves) let alone any kind of hypo that makes TSH irrelevant.
I just think this doctor is going to keep you sick.
You can try to educate your current doctor, but from what you've said about him, he has a long, long way to go to understand how to treat you with your concommitant pituitary issue. The fact that he uses your TSH at all, with a known pituitary issue, demonstrates his total lack of understading about how to treat you. My PCP had the same problem. Most PCPs don't understand garden variety hypo (the kind where TSH behaves) let alone any kind of hypo that makes TSH irrelevant.
I just think this doctor is going to keep you sick.
When I went to endos back when I had insurance, they always wanted a current mri for the adenoma. I can't pay for that now. That is why I stay with my dr. I'll just have to talk to him more. I am always afraid he will feel insulted if I challenge what he is doing.
I understand the cost. My insurance ia "inadequate". However, remember that if you find a good doctor and get on a consistent dose, the time between labs/visits can be extended. I now only see my endo once a year and have labs every six months. Shoveling money at a doctor who obviously doesn't understand your condition at all will cost you much more in the long run.
Good analogy!!!! This whole thing is making me broke with blood tests every three months including prolactin which is more costly. I found a lab with discounted prices but still..... :(
You might want to try splitting your dose...you can probably avoid that 3:00 pm crash that way. Late morning to early afternoon is when most people take the second half dose. If you take it after about 3:00 pm (on a "normal" sleep/wake schedule), it can disturb sleep. However, you can experiment with the best time for you, and the best split (it doesn't necessarily have to be 50/50). Some people can take it right before bedtime with no ill effects. If you regularly crash around 3:00 pm, that's a good indication that you ought to take your second half dose maybe 2-3 hours before that.
Your doctor ought to be totally disregarding TSH. With a pituitary issue, your TSH is completely irrelevant. I'm afraid this is another issue that makes me wonder just how well your doctor knows how to treat thyroid. We know your pituitary is "broken". If you were a car, your gas guage would be stuck on "full". How long would you keep running out of gas before you stopped looking at the guage and found another way to determine how much gas you had in your tank? Your doctor doesn't get that your guage is broken.
I have a pituitary issue as well, but I have the opposite problem. Mine is "stuck" right around 20.0 (on "empty"). I know what you mean about endos (any specialists), but I did find one who is both knowledgable and probably the least obnoxious of any doctor I've met lately.
Your doctor is treating you "by the book", and not only are you not a textbook case, but the book doesn't apply to you at all. If I were you, I think I'd try to find a new doctor. Another option would be to educate this one, but it sounds like he has a loooong way to go.
Your doctor ought to be totally disregarding TSH. With a pituitary issue, your TSH is completely irrelevant. I'm afraid this is another issue that makes me wonder just how well your doctor knows how to treat thyroid. We know your pituitary is "broken". If you were a car, your gas guage would be stuck on "full". How long would you keep running out of gas before you stopped looking at the guage and found another way to determine how much gas you had in your tank? Your doctor doesn't get that your guage is broken.
I have a pituitary issue as well, but I have the opposite problem. Mine is "stuck" right around 20.0 (on "empty"). I know what you mean about endos (any specialists), but I did find one who is both knowledgable and probably the least obnoxious of any doctor I've met lately.
Your doctor is treating you "by the book", and not only are you not a textbook case, but the book doesn't apply to you at all. If I were you, I think I'd try to find a new doctor. Another option would be to educate this one, but it sounds like he has a loooong way to go.
When he reduced me to 12 1/2 mcg a day my level fell to what I stated earlier. When I was on the 50mcg one day and 25 the next, my level was in the upper third. I think he is treats me as tho my thryroid is the issue rather than my pituitary. This might be why my symptoms are back and why I crash by 3pm....Thanks for your explanation. You are very knowledgable!!!
Cytomel (T3) is very fast acting. It peaks about 3 hours after you take it, and it's mostly gone a few hours later. That's why most peole find that they have to split the dose into two half doses, taking one in the morning with their T4 and the second late morning to early afternoon. This helps to level out the peaks and valleys in energy you can get taking T3.
If you take too much at once, you are really just "wasting" it. Your body will only use so much in the limited time it is active, and the rest will be neutralized by your body within a few hours. You can alternate periods of high energy with a "crash" when the T3 wears off.
T4 is very slow acting, so you can take it in alternating doses and/or a single dose per day because your body "stores" it.
So, T3 should never be taken in an alternating dose. At 25-50 mcg per day, you definitely want to split it. 25-50 mcg per day is also quite a high dose. T3 is approximately 4 times more potent than T4, so 50 mcg of it is roughly equivalent to 200 mcg of T4. Many doctors do not understand that you don't dose T3 just like you do T4. They think they're interchangeable, and they're anything but.
I certainly think that an internist should be capable of managing a thyroid condition. In fact, no matter the specialty (or not), anyone with an interest can mange it. However, prescribing 25-50 mcg of T3, not telling you to split it and telling you to alternate it makes me wonder just how much your doctor knows about thyroid.
If you take too much at once, you are really just "wasting" it. Your body will only use so much in the limited time it is active, and the rest will be neutralized by your body within a few hours. You can alternate periods of high energy with a "crash" when the T3 wears off.
T4 is very slow acting, so you can take it in alternating doses and/or a single dose per day because your body "stores" it.
So, T3 should never be taken in an alternating dose. At 25-50 mcg per day, you definitely want to split it. 25-50 mcg per day is also quite a high dose. T3 is approximately 4 times more potent than T4, so 50 mcg of it is roughly equivalent to 200 mcg of T4. Many doctors do not understand that you don't dose T3 just like you do T4. They think they're interchangeable, and they're anything but.
I certainly think that an internist should be capable of managing a thyroid condition. In fact, no matter the specialty (or not), anyone with an interest can mange it. However, prescribing 25-50 mcg of T3, not telling you to split it and telling you to alternate it makes me wonder just how much your doctor knows about thyroid.
Thanks for the article....I find endos to be obnoxious. They seem to be so arrogant and steadfast. I may give that article to my present dr cause he seems willing to listen even to he is not an endo. You always wonder if it gets them annoyed for challenging them tho. What info can you give me on cytomel and how it should be taken? You seemed to elude to something about it.
Pretty pathetic picture of your Endos that disregard Free T3 and Free T4 below the range and only pay attention to TSH, which cannot be shown to even correlate well with the biologically active thyroid hormones, much less with symptoms, which are the most important consideration.
I thought you might like to read this article, and perhaps even give a copy to the internist to make him more comfortable treating you clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without paying any attention to TSH.
http://hormonerestoration.com/Thyroid.html
I thought you might like to read this article, and perhaps even give a copy to the internist to make him more comfortable treating you clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without paying any attention to TSH.
http://hormonerestoration.com/Thyroid.html
My dr. is an internist. I have never been able to get an endo to treat me even tho I've had the adenoma since 1997 and my free t 3 and 4 are out of the range low. I am now spiitting 25 mcg and taking half a day. I originally took 50 alternating with 25 mcg and that put me in the mid to higher end of the range but the low tsh scared my dr. so he lowered my dose even tho I felt better. I've talked to him about how tsh should be disregarded but he is uncomfortable. The endo's I've seen have always said that my tsh was good so no treatment. Tsh is normal with no meds.They disregarded my low freee t3 and 4. At least this dr. gives me something! I have no insurance so I cant't afford to try different drs.
Your FT3 and FT4 are very low. They're barely above the floor of the range, and many of us find that FT4 has to be close to midrange and FT3 upper half of range to feel well. You are very undermedicated.
You indicate in your title that you have central hypo. Considering that, why is your doctor paying any attention to TSH at all? Was your TSH already low when you were diagnosed?
Do you split your dose of Cytomel into two half doses? Did your doctor tell you to alternate 25/50 mcg of Cytomel? If so, he obviously has no understanding whatsoever of how Cytomel works.
What kind of a doctor are you seeing? He's not giving me that "good thyroid doctor" feeling! LOL
I doubt the hair loss is from the meds. Hair loss is a symptom of hypo. Your levels have never been right for you, since you still had symptoms (hair loss...any others?).
Right now, you desperately need an increase.
You indicate in your title that you have central hypo. Considering that, why is your doctor paying any attention to TSH at all? Was your TSH already low when you were diagnosed?
Do you split your dose of Cytomel into two half doses? Did your doctor tell you to alternate 25/50 mcg of Cytomel? If so, he obviously has no understanding whatsoever of how Cytomel works.
What kind of a doctor are you seeing? He's not giving me that "good thyroid doctor" feeling! LOL
I doubt the hair loss is from the meds. Hair loss is a symptom of hypo. Your levels have never been right for you, since you still had symptoms (hair loss...any others?).
Right now, you desperately need an increase.
My hair loss happens no matter what my test results are tho and I wonder if it is from the medication...
It sounds to me like you know what you have to do...get your levels back to the high end of the range, where you felt well. In order to do that, you're going to have to find a doctor who won't be influenced by a suppressed TSH (that happens on meds, especially meds with T3 in them), but will adjust meds to achieve FT3 and FT4 levels where your symptoms will go away.
What are the reference ranges on your FT3 and FT4? Ranges vary lab to lab, so you have to post them with results.
What are the reference ranges on your FT3 and FT4? Ranges vary lab to lab, so you have to post them with results.
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