hormones gone crazy,help?

[loren79]

hello, Can someone help....I previousely from childhood had hyperthyroidism which went into remission, I am now 33 yrs old and have been feeling exhausted,more depressed, and have gained 35 pounds in 6 months. my lab results say my tsh is 6.7 but free t4 is on the low end of normal. My cortisol and prolactin levels are slightly high, my estrogen is very low. The dr.s dont seem to know how to help me or what is wrong?

[gimel]

Some time ago I ran across the following link::


http://jcem.endojournals.org/cgi/content/full/90/1/581?ijkey=9cefd7e1f8b571ef7b5ea3ff13bb5faf63ba783a&keytype2=tf_ipsecsha

This is the subject of the link.

"Subclinical Thyroid Dysfunction: A Joint Statement on Management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society"



To me, the most valuable bit of info in the article was this.  "The critical issue, therefore, is that data-based treatment guidelines in areas where those data are insufficient should not be stated in a way that might be considered restrictive, but should, instead, allow providers the flexibility to use the sound clinical judgment that they, having knowledge of each patient’s individual circumstances, are the most qualified to render."

As I interpret this,  physician judgment and treating a patient clinically is paramount and should over-ride data-based treatment guidelines.  Somehow I think this got left out of the doctors' training manual.  LOL  I always thought maybe the reluctance to treat any patient whose test results fell within the so-called "normal" ranges, was due to a fear of going outside the guidelines and being subject to peer review and censure.  Or being fearful of malpractice lawsuits.  Or being beholden to big pharmaceutical companies, who spread a lot of money throughout the system.  To me, the above quote may be a way for patients to try to persuade their doctors that clinical treatment for symptoms has been recognized and endorsed by the AACE, ATA and ES.

[gimel]

You might have some effect on the doctor if you discuss with him the following info.   First thing is that scientific studies have shown that the test that correlates best with hypothyroidism is Free T3.  Free T4 and TSH did not correlate at all.  This is logical since Free T3 largely regulates metabolism and many other body functions.  Since symptom relief is the usual objective of medical treatment, it is essential to know Free T3 level and to adjust as necessary to relieve symptoms.  I could provide a link to one of the studies if necessary to convince the doctor.  

Second, just being in the low end of the range for Free T3 and Free T4 is  not adequate.  The ranges are far too broad since they were erroneously established many years ago.  These ranges, along with TSH were originally established based on a data base of test results from patients.  All patient data was included.  Over 10 years ago the AACE recognized the error and purged from the data base suspect hypothyroid patient data.  They then recalculated the range for TSH.  The range changed from .5- -5.0 down to .3 - 3.0, which was a huge change.  Unfortunately, the ranges for Free T3 and Free T4 have not been changed.  If the data bases for Free T3 and Free T4 were similarly purged of suspect data and the ranges recalculated, the revised ranges would look more like the upper half of the current ranges.  That is why we hear from so  many members with Free T3 and Free T4 in the lower end of the reference ranges, yet they still have hypo symptoms.  The ranges really wouldn't be such a concern if doctors used them as guidelines within which to adjust Free T3 and Free T4 as necessary to relieve symptoms.  Unfortunately again, the ranges are used as pass/fail, and like yourself, the patients suffer from that.  

I have one further comment, but I need to locate some info first.  

[loren79]

I will also follow your suggestions and request those other labs. Thanks again, Happy Thanksgiving!

[loren79]

Thank You for responding and taking the time to break it down. I also agree with you, I feel I should be treated now not later due to the high tsh and my symptoms. This doctor I am seeing said some physicians would treat me just based on tsh but that he will not because i am still in normal range of free t4, low end. Its very odd to me because I dont understand why my estrogen is low and prolactin and cortisol are mildly above normal range. All I know is the ob gyn doctor told me stop the birth control pills and come back in a month. Then I was retested 2 weeks later which was 3 days ago and prolactin dropped to 15 previousely was 30 and tsh dropped from 6.7 to 4.5. None of it makes sense. All I know is Im very very tired and the weight gain is increasing every week and my diet is the same. Sorry for the lengthy post and thank you for answering.....;)

[gimel]

I also wanted to add that you should request to be tested for Free T3 and Free T4 each time you go in for tests.  If the doctor resists, then you should insist on it and don't take no for an answer.  

Since the primary cause of diagnosed hypothyroidism is Hashimoto;s Thyroiditis, you should also request to be tested for the related thyroid antibodies.  Those tests are TPO ab and TG ab.  

Finally, since hypo patients are frequently low in other important areas, you should be tested for Vitamin D, B12 and ferritin.   If you will get all these tests done, when the lab report is available, please get a copy and post test results and reference ranges, and members will be glad to help interpret and advise further.