to treat or not to treat?

[RCinNY]

Hi, everyone.  I posted here a few weeks ago, and I thought this would be a good place to come back to now that I have a little more information.  I'll try to be brief...

29 year-old male, came down with alopecia a few months ago, dermatologist ordered labs, TSH = 3.61 and Free T4 = 1.4.

Derm flagged free t4 incorrectly, but by the grace of God, it caused me to come here to realize that TSH is a bit off.  Rather than go directly to an endocrinologist, which can take months, I went to my primary doctor on my day off to order more tests.

She's on vacation right now so I don't have #'s to post, but she left me a message the day before she left: my thyroid itself is functioning normally (making the right about of hormones, doing the right things with them), but I do have anti-thyroid antibodies (she tested for TPO and Tg, so I don't know if I have one or both).  For function, she tested for the 5 or 6 things that are normally recommended here - Free t4, t3, and she repeated TSH.

She recommended at the very least monitoring thyroid function every 3 months or so.

However, in reading a lot over the last few weeks, I realize that some other symptoms I've had for years could be thyroid-related.  I wouldn't consider them all that debilitating, and very possible that they're from a different problem, but they are: fatigue (I need a lot of sleep to get by day-to-day for as far as I can remember - I noticed it after I had mono at age 6), mildly depressed at times, low sex drive forever (29/male!).  I also am at times anxious (doesn't go w/ hypo) and my blood pressure is somewhat higher than ideal (does go w/ hypo, but also the anxiety).

I don't have a goiter or anything, and with eating the right things and exercising, I've had no trouble dropping 20 pounds since Christmas.  I weight just 5 lb more than my goal.

With all that said, I'd like your input:
(a) Should I just continue to monitor the thyroid, and if so, how often and which tests should I make sure get done?
(b) In light of alopecia, anti-bodies, TSH consistently in the mid/high 3's, and mild forms of some of the symptoms, should I demand treatment?  If so, what should I ask for?  After all, my thyroid, though it needs more stimulation than ideal, is making enough hormone right now.  I'm not sure that taking supplemental hormones would help - esp. since my TSH isn't that awful just yet.  And I'm not sure whether the symptoms are thyroid-related after all.  If they are usually due to a hormone shortage, I don't have one yet.

I have a feeling that right now, I'm a very borderline case, but if taking a small dose of some medicine might get rid of some lifelong annoying symptoms, why not try it?  I also feel that given that I'm such a borderline case, I may need to fight harder than usual for treatment (or at least to get a referral for a thyroid specialist).

OK, that's more than enough for one post!

[ChitChatNine]

Hello .. I do not have any experience with the T3 or T4 being off .. my thyroid had nodules and had partial thyroidectomy in January but my daughter at age 4 had alopecia .. tested normal for thyroid two times and it came and went for a few yrs and now is gone for good it seems (fingers crossed as she is now 16.5yrs old).  Sorry you are going thru this .... she had 2 bald spots that formed a classic alopecia exclamation point and potent topical steroids started regrowth ea. time (whew) .. started with peach fuzz and into full hair.  It was awful. Derma said if the nape of the neck has not fallen out there is a 90% chance that there will be regrowth.

Good luck .. keep us posted on your #'s

Cheryl (Synthroid 100mcgs Thy Ca supression)

[RCinNY]

Glad to hear your daughter responded well.

I've got 2 patches as well, and I've been putting topical steroids on them as well for almost 2 months.  I've had no regrowth yet, but the patches are stable in size.  The next step would be injections, and I'll give that a try if, in a few months, I get no regrowth.  This still has a good chance of resolving on its own, so I'm not bothering with them yet.  Plus, I still have 80-90% of my hair left, and can cover the patches fairly easily.

And now back to my thyroid...

PS - I expect to get copies of the labs when the Dr is back from vacation, but the message she left was pretty thorough in verbal descriptions, if not #s.

[RCinNY]

and as an aside...

Is having a too-high TSH enough to make you have symptoms, even if your thyroid is making the right amount of hormones?  Or do t4/t3 have to be out of balance as well?

[GravesLady]

Hypothyroid is usually TSH 10 or above so you are well within.

I would have test done on a regular bases and see where it might lead to in the future.

A lot of other health conditions share thyroid symptoms, like your symptoms.  Treatment with meds. is not necessarily a cure-all for symptoms.  You might have to treat each symptom independent from each other and from thyroid.

For a man, a TSH in the mid/high 3' is not bad at all.

[RCinNY]

I've read that the vast majority of people - esp. in my age group are well under 3.  And others here have complained of symptoms at around this level, though I'm not sure if their t4 and t3 levels were as "normal" as mine.  The 3.6 did seem to raise a couple of eyebrows when I posted last month.

Any other opinions or suggestions?

[scarlet37]

Your TSH level of slightly higher than 3 would suggest subclinical hypothyroidism. Not all doctors or endos will treat this, most labs still use the old range of .5- 5.0 . If you honestly belive this is due to thyroid and have ruled out any vitamin defiencies or other causes it may be of benefit to go ahead and make an appt. with an endo.. Thyroid diseases mimic many others- that's why doc's have difficult time determining the cause.

The fact that you have anti bodies with a subclinical TSH is why the doc wants to monitor- and 3mos. is reasonable, in my opinion.  Most people do feel better with a TSH of around 1.




  Good Luck- keep us posted with your progress.

   teresa

[GravesLady]

Per AACE and US Government  guidelines, the TSH of 3 and under issue, is a target range once diagnosed and treated. A diagnose range is different than a treated range.
Data showing that being treated with thyroid hormone at ranges lower than 10 have no benefits with symptoms.

You can not, you must not, go by how others feel at certain levels.  One shoe does not fit all.
People try to stretch the shoe just to fit their own personal issue, plus there is a lot of misinformation.  I guess it is much easier to blame thyroid rather than searching by other test for other possible health conditions.

Have faith and trust in your doctor.  After all, S/He is the one with the years of expensive education, not us on the net.

I hope you find and resolve you health issue soon.

Good luck!

[RCinNY]

I've done my own little bit of researching and found the same conclusions as you - that treating those w/ TSH < 10 is probably of no use.  I didn't see any further breakdowns on patients w/ TSH < 10  - whether they had antibodies or thyroid hormone imbalances or symptoms.

Thanks for explaining the different usage of ranges.  That's something that hadn't occurred to me yet.

I do trust my doctor and testing every few months seems like the prudent thing to do.  But I also have a duty to educate myself and to ask the right questions.

[proudarmywife05]

With all that said, I'd like your input:
(a) Should I just continue to monitor the thyroid, and if so, how often and which tests should I make sure get done?

YES, they told me FOUR times i didnt have cancer and it was. stay on it!
Rachel

[scarlet37]

i guess asking for other opinions and suggestions means nothing-

I never once claimed to be a doctor - and re-reading my post- i do believe i was unbiased- nowhere did I say" RUN FOREST RUN" to the endo.



  

[GravesLady]

Scarlet,

I hope you were not relating to my post.  I was not referring to anyone on this forum.  My concerns are with other forums and (mis)information out there.

You are doing a great job with your knowledge.  All "opinions and suggestions" should be shared and its up to the reader to siphon through them to make their own judgment. The more opinions, the better the knoweledge.

All of us here are doing a great job.  There is room for us all to share our information and "suggestions". We all realize that we are not doctors, I hope. We are just patients sharing experiences and knowledge. We are allowed to have different opinions, information and "suggestions" without butting heads.

I am sorry if you took offense - I seem to unintentionally have that knack.  Why, I don't know!

Peace!

[scarlet37]

  I appologize as well- it seems as if I am taking alot personally lately. You're right in saying there is room for all of us.

  Best Wishes-

     teresa

[thechamp]

this is very confusing, since when is a tsh of ten or above considered hypo, most doctors treat when the tsh is above 5.