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unexplained weight gain, night sweats, and only 27rs old. Plese read.
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unexplained weight gain, night sweats, and only 27rs old. Plese read.

Since December I have had 26pounds of unexplained weight gain.  The only thing that has been different is that I started an antidepressant but am on a very low dose.  During this time I also had the mirena but had it taken out b/c I got such headaches from it.  Today I had a recheck with my normal provider to check my iron and ferritin levels again.  My ferritin was 10 back in feb. with the normal being : 14-350 ng/mL today it cam back at only 18 after being on iron 325mg since feb.  My iron was only 29 in feb. with the normal being 60-140 and today it was 96.  She is still keeping me on the iron to hopefully raise my ferritin. She won't be happy she said until its at least 50.   She rechecked my thyroid and all my electrolytes today and all is normal.  She is sending me for an endocrinology consult.  

Along with the unexplained weight gain I have been having horrible night sweats.  I have always warn many clothes and many blankets to bed until a few months ago when i've only used a single blanket and barely wear clothes if any and I sweat like crazy. I'm just drenched at night!! Not normal for me!!!

My thyroid level was checked yesterday and was normal.

Another tidbit to my story is that when we went to the IVF doc he told me that I am in the early stages of perimenopause and my AMH being only 0.6 (very low) for a 27 year old.

Can anyone give me insight to all of this? What tests should I be asking the endocrinologist for? THoughts? Anything?
21 Comments Post a Comment
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Avatar_m_tn
Just because your thyroid level was within the so-called "normal" range does not mean that all is okay for you.  Please post the thyroid test results and reference ranges so that members can assess the adequacy of your testing and treatment.
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2192208_tn?1346529432
I agree with gimel. My numbers are always in normal range and i have most hypo symptoms.
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1756321_tn?1377771734
Symptoms of perimenopause include weight gain and night sweats.  Night sweats and weight gain are also possible side effects of antidepressants. Hypothyroidism symptoms include weight gain and hyperthyroidism can cause night sweats.
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415867_tn?1323369103
My TSH was 1.63 (range being 0.35-4.50)
My T4 was 0.7 (range being 0.6 -1.2)

Thoughts?
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415867_tn?1323369103
Also my normal provider gave me gabapentin 400mg to help with the night sweats and i'm happy to say i've been 4 nights free of sweat!!! i even went back under the covers!
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Avatar_m_tn
Your Free T4 is very low in the range.  Middle of the range is better.  You are missing the most important thyroid hormone test, which is Free T3.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies ahve shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  For those reasons you should always request to be tested for Free T3 and Free T4 (not the same as Total T3 and 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.  I expect that you will find that your Free T3 is also low in its range, which is frequently associated with hypothyroidism.  

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.  Symptom relief should be all important, not just test results.  Many of our members report that symptom relief for them required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range.  

When you see the Endo, don't be surprised to hear something different from what I have said.  Many of them have the "Immaculate TSH Belief", by which they only want to test and use TSH to diagnose and treat a hypothyroid patient.  That is wrong.  If they go beyond TSH, it is frequently only Free T4, and then they will use "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the range is adequate.  That is also wrong.  If you want to see how a good thyroid doctor treats a hypo patient, have a look at this letter that was written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.


http://hormonerestoration.com/files/ThyroidPMD.pdf

In the letter, please note this statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
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Avatar_f_tn
How long have you been on Gabapentin? Some people gain weight being on that. I gained weight using it for neuropathy pain. I had to be taken off due to water retention.
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415867_tn?1323369103
I've only had my T3 tested in the past
3.0 (10-2009)
3.2 (8-2009)
3.9 (8-2009)

I've only been on gabapentin for a week.

I think I will email my primary care provider tomorrow morning and ask her why she didn't order a T3. and see if she will so the endo has it wednesday morning.  this is all so fustrating to me!
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Avatar_m_tn
Those T3 tests are too old to be of relevance now.  When you go for testing, make sure it is Free T3 and Free T4, not Total T3 and Total T4.  The totals are somewhat outdated and not nearly as revealing as the Free thyroid hormone tests.    I would even go so far as to question the lab people drawing your blood to make sure they know it is to be the Free, not Totals.  That will avoid possibility of a mistake and the wrong tests.  

While you are there, you should also test for Vitamin A, D, B12 and ferritin.
When all these test results are available, please post results and their reference ranges so that members can help interpret and advise further.
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415867_tn?1323369103
my ferritin in feb. 2012 was 10
my ferritin in july 2012 was 18

I saw the endo today and he said there is nothing wrong with my throid.
He is making me do a 24hr urine to look at my cortisol levels.  Most  likely he thinks this is all from my steriod use (really bad sinus infection, went through 4 antibiotics and steroids) and my body doesn't agree with it and is compensating??   or i might have an adrenal issue (cushings or a tumor?)

I'm so confused!
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Avatar_m_tn
What was the basis for his saying that nothing was wrong with your thyroid?  What lab tests did he consider?  Did you ask to be tested for Free T3, Free T4, Vitamin A, D, and B12?  What are you doing to try to increase your ferritin levels?

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415867_tn?1323369103
I'm only taking iron 325mg that i was told would increase my iron and ferritin but it has only really raised my iron.... is there supplements for ferritin? could this by why i'm so tired?

They only did the free T4 and the scale of 0.6-1.2 mine was a 0.7 so the endo told me it was fine....?
I have not had the others tested....
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415867_tn?1323369103
oh! i did email my primary and asked about the free T3 test and she said that is usually ordered for possible hyperthyroidism...?
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Avatar_m_tn
First, let's look at what ferritin is.  

"Ferritin is a ubiquitous intracellular protein that stores iron and releases it in a controlled fashion. The amount of ferritin stored reflects the amount of iron stored. The protein is produced by almost all living organisms, including algae, bacteria, higher plants, and animals. In humans, it acts as a buffer against iron deficiency and iron overload.[3"

As I understand it ferritin is kind of like an early warning system for iron levels in your body.  Iron levels tend to show up first in the ferritin test.  And low iron can cause symptoms which mimic hypothyroid–depression, achiness,  fatigue, weakness, faster heartrate, palpitations, loss of sex drive, hair loss and/or foggy thinking, etc,  Even having a ferritin level at the low end of its reference range, doesn't seem to be adequate.  This is some info I found.


"I  frequent another board where the role of iron in the metabolism of thyroid hormone is discussed. Along with selenium, iodine, L-tyrosine, zinc and other vitamins/minerals/amino acids, iron plays an important role in the conversion of the less inactive T4 form of thyroid hormone to the more bio-active T3 form.

I've seen iron discussed a bit on this board but not so much about ferritin . I thought you might be interested in what I found. Ferritin levels often begin dropping before serum iron levels become critically low or before full-blown anemia becomes apparent.

Many hypothyroid patients find that having good ferritin levels improves their use of thyroid hormone (their own body's or supplemented). The range of 70-90 is quoted as optimal for hypothyroid patients. Someone on another board asked me if I knew of any research she could show her doctor to support this. He wanted her to stop supplementing iron when she raised her ferritin from 17 to 44.

Here's some of the research I found that suggests a minimal ferritin
range of 50-70 and an optimal range for hypothyroid treatment of 70-90. I have read that in Dr. Gillespie's book, "You're Not Crazy, It's Your Hormones", she advises a ferritin level of around 100. I haven't read her book, so I can't confirm the research basis for her recommendation, but the experience of many hypothyroid patient certainly bear her out.

Improving ferritin levels can be beneficial for both reducing or eliminating hair loss & unexplained fatigue. Both of those are also frequently associated with hypothyroidism."  


So, I need to impress on you it is vital that you become knowledgeable about thyroid problems so that you can become your own best advocate for your health.  You can't just assume that most doctors understand this and will always do the right things for you.  You need to be tested for Free T3, Free T4, Vitamin A, D, B12, and ferritin each time you go in until your meds/supplements have raised those levels adequately to relieve your symptoms.  If the doctor resists doing this testing, then you will need to insist on it and don't take no for an answer, or find a good thyroid doctor that will do them and treat you clinically as I previously described.  

There seems to be some hope that your regular provider could be persuaded to provide the testing and treatment you need.   We can help by providing some links to scientific studies that can help the doctor understand better and give you the testing and treatment you need.  If you want some of those links for backup and discussion with the doctor, just let us know.
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415867_tn?1323369103
So what else can i do to raise my ferritin levels?  or just stay on the iron which is going to take me forever since it only went up to 18 (from 10) since feb.  

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Avatar_m_tn
Sending PM with link to info.
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415867_tn?1323369103
just wanted to update.  i found out today I have CREST Syndrome an autoimmune disorder. I don't know much about it yet but I'm glad i have an answer :)
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Avatar_m_tn
What tests were done to diagnose the Crest Syndrome?
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415867_tn?1323369103
I had a positive ANA and then they tested it further to pin point what type of autoimmune disease it was.... i don't have my lab work in front of me so i can't say what the levels were though.....

i'm not familiar with it but any info would be great!
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Avatar_m_tn
If you read this link and a few others on diagnosis and symptoms, you'll know more than I do about Crest Syndrome.  I do know that with your symptoms and the limited test results showing some issues with thyroid and iron, you should get a second opinion.  
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Avatar_m_tn
Forgot the link.

http://www.mayoclinic.com/health/crest-syndrome/ds00580/dsection=tests-and-diagnosis
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