19 and losing hair... related to hypothyroidism?

[in33dhelp]

Hi All,

First let me first start with my genetic backstory. On my mom's dad, her dad never went bald whereas her oldest brother never lost hair (60 now) and her youngest brother only started losing hair in the mid 50s. On my dad's side, his mom has really strong hair at 87, his brother (60) did not lose hair and my dad himself did not lose hair until mid-40s. None of these men had any hair issues in their 30s whatsoever.

Last month (May 23), when I got my haircut, I did not notice any problems with my hair. However, throughout the month of June I kept feeling as though I was getting balder since bald spots kept appearing in my hair so I cut my hair. Doing this revealed a MASSIVE balding near the spiral. My mom argues that the haircut was cut too close in that area, but I don't think that would affect hair density. My hairline seems normal however.

Because of this, I really believe it may be due to some kind of thyroid issue. I have other symptoms of this as well (severe fatigue (previously diagnosed as ADHD), depression/anxiety, an expressionless face, constantly feeling sleepy and taking day naps, I have been working out for 8 weeks and have not lost a single pound, having gyno from a young age). Also, my mom and members of her family have been diagnosed with hypothyroidism.

I am going to see the doctor this Wednesday but I am really scared. I think my mom is just trying to calm me down as from photos, it looks like I am obviously balding (even though it looked nothing like this in late May). I was wondering what you guys think is causing this and what you would recommend I do to fix this issue.

[gimel]

A single test for cortisol can be misleading.  Why didn't they do the 4 point cortisol test taken over a 24 hour period?

[in33dhelp]

New test results as follows:
Cortisol AM 473 (Normal 170-720)

However,
TSH now shows as 6.77, increased from 4.34 just two weeks ago
I have some (small) gynecomastia—breast tissue
Testosterone is 27.4 (Normal 21-103)
Prolactin 24 (Normal 2-18)

Any clues as to what it may be? I no longer suspect it's hypothyroidism itself.

[gimel]

The pituitary can possibly be a secondary cause of low cortisol.  You'll know a lot more after getting the 4 point saliva cortisol test done.  When is your next doctor appointment?

[in33dhelp]

I am starting to think this may in fact be related to my pituitary gland (hence why the T3/T4 levels are out of balance, but not "bad").

Some things:
1) All of my male (and some female) cousins, on both sides, are taller than me. Most are >6 feet. I'm 5'7 and have been this height since 15. My arm span is 5'8.
2) I have an extremely young face. At 19, I'm regularly confused to be a 14/15 year old.
3) I do not have any signs of wisdom teeth whatsoever.

Are there any specific tests I can do for this?

[gimel]

Nothing further right now other than getting the 4 point saliva cortisol test done, along with Vitamin D.

[in33dhelp]

Thanks for your reply. Beyond cortisol (which I will speak to the doctor about), is there anything else? Today, I feel really bad and just sat in my bed. I have actually done this quite a lot in the past 2-3 years (one school term, I just sat in bed and never went to class).

I have also done some anti-body tests:
Anti-TPO <5 (Normal <35)
Anti-TG <11 (Normal <40)

[gimel]

Sorry, in the third paragraph I meant to say, "Your test results do show a somewhat unusual pattern of Free T4 being lower in the range, while Free T3 is in the high end of the range."

[gimel]

Several things come to mind for you.  First, hair loss is not the only symptom you mentioned that could be related to thyroid level.  So, if we evaluate your thyroid test results, what do we see?  TSH is on the high side, but the main value of TSH testing is to determine if there what type of hypothyroidism may exist.  When you have test results for the biologically active thyroid hormones, Free T3, and Free T4, those are much more important than TSH, for diagnostic purposes.  

Your Free T4 is below the middle of its range, which is a bit lower than optimal, but not low enough to be the cause for your hair loss, in my opinion.  Free T3 is more important, since it correlates best with hypo symptoms, and Free T4 and TSH do not correlate well with symptoms.  However, your Free T3 test result was in the upper part of its range, yet you still report having symptoms.  

We don't know your actual Vitamin D level, and D is very important for optimal thyroid effect.  Your test results do show a somewhat unusual pattern of Free T3 being lower in the range, while Free T3 is in the high end of the range.  By the way, T4 is converted to T3, not vice versa.  The only thing I have seen that might correspond to your test results and symptoms would be T3 pooling in the blood. .

"Low cortisol/adrenal disfunction. AD often accompanies hypo and gives low T4 with much higher t3: Free t3 is pooling in the blood unable to reach cells due to low cortisol. A saliva (or urine) four-point cortisol test can confirm this."   So if Free T3 is still high, that is something else to ask the doctor about, a four point saliva, or urine, cortisol test.  

[in33dhelp]

I tested for iron and vitamins (although not Vitamin D; I do take Vitamin D pills though). Anemia was also ruled out due to the blood test.

Perhaps it is sleep apnea, since those symptoms also do crossover here.

[23chris]

I wish I had an easy answer but there are many many possible causes of fatigue including diet, iron or vitamin deficiency (testing for D3 was a good suggestion by another poster), viral infections, anemia, sleep apnea, and clinical depression among a whole host of other things. Is your MD specifically treating you for fatigue complaints? If so, what sort of work up have you undergone already?  

Again, I see no massive baldness in your most recent pic and again have to agree with your mom. In fact it looks a lot like my hubby when his hair is cut short and he has a full head of hair otherwise. DEven if he didn't, I'd love him either way :)  My best advice is not to dwell on it. What's on your head doesn't make what you are inside.

Best wishes in finding the cause of your Sx.

[in33dhelp]

I took this photo of my hair yesterday. http://i.imgur.com/nZ5pGXY.jpg

Although it isn't balding, my hair has thinned considerably (it was super thick before). Any idea on why that happened?

And if this is not hypo/hyper, what is causing my extreme mental and physical fatigue? I actually sit in bed all day since I'm too tired to do anything.

[23chris]

Thanks for the clarification. That's what I thought but wanted to check first. I was worried you were treated with risperidol long term which can cause many of the symptoms you mention including male breast enlargement.

Not sure what's going on with you. Your thyroid hormones are within normal limits. Again I would not worry about the difference in TSH between testing. Fluctuations of as much as 50% are common for many reasons including the ones I mentioned and the most recent test is barely outside the range.

Treating for hypo where none exists has it's risks and no benefits. Thyroid meds are not helpful to treat depression or weight gain if there is no underlying thyroid problem. Hypothyroidism should never be dx'd by symptoms alone  because most symptoms can be common to many conditions or may not signify much of anything. There is also a large overlap of the same complaints among hypo- and euthyroid patients. Are you working out excessively thus more tired? Are you eating more than usual because of the workouts thus not losing weight because of increased caloric intake?

Wish I could be more helpful but at this point IMHO I think you need to look elsewhere than a thyroid problem to explain your Sx.

FWIW- I don't think the bald patches in your pics are massive :) I'm more inclined to agree with your mom. The one area to the side top almost looks like it may be due to scarring, perhaps a long forgotten injury? Anyhoo, I think you're a long ways off from a combover:)

Wishing you all the best.

[in33dhelp]

Well I had fat in my chest area, but it's decreased a lot since. My doctor doesn't believe it's breast tissue now but are doing an ultrasound to rule it out completely. The weird thing is that even when I was really light at age 16 (BMI 19), I still had them.

For ADHD, I was treated with Adderall but it did not work at all and made me feel anxious and produced palpitations so I was taken off it after 2 weeks.

I've been tested for diabetes and my sugar is completely normal. So I wonder what's making me feel extremely exhausted mentally and physically, and significantly suppressing my appetite.

[23chris]

Please clarify what you mean by "having gyno from a young age". Are you on any meds now? Were you ever treated for your ADHD? If so, with what and for how long?

The difference in TSH results could be related to differences in the time of day the labs were drawn, diet, and/or other factors.

[in33dhelp]

Vitamin D wasn't tested.

Free T4
Result: 14
Normal Range: 9-23

Free T3
Result: 6.1
Normal Range: 3.5-6.5

So it appears that the conversion from T3 to T4 has some problem, and my body upped the TSH from 3.4 to 4.34 to counteract it. But it is not helping.

[gimel]

We need to know the  reference ranges for the Free T3 and Free T4.  

Was Vitamin D tested?

[in33dhelp]

Vitamin B12 502
Ferritin 118

[in33dhelp]

Also I should note that at this exact point last year, my TSH was 3.4. It has gone up ~1 in that time.

[in33dhelp]

I have got my results back:

Thyrotropin 4.34
Free Thyroxine 14
Free Triiodothyronine 6.1

[gimel]

I think I would go back to that doctor and get all the recommended testing done.  That would save you some time having to find another doctor and then getting tested.    While there you could initiate a discussion about the possibility of having thyroid problems, but to be honest, I don't expect that doctor is going to be what you need, based on her track record so far.  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 is all that matters, not just test results, and especially not TSH results.    

Finding a good thyroid doctor is the biggest obstacle we all face.  If you will give us your location, perhaps a member can recommend a good thyroid doctor for you.

[in33dhelp]

Hi Gimel, I've been seeing a doctor on-going for the past year for fatigue related issues, and she had diagnosed me with ADHD. I was wondering if I should go see the same doctor (she had previously done TSH/Diabetes tests for heart palpitation problems before). Thanks again.

[gimel]

Hair loss is well known symptom of hypothyroidism.  You can verify that here.  Just find the section on hair.

http://hypothyroidmom.com/300-hypothyroidism-symptoms-yes-really/

The thyroid gland produces mostly T4 and some T3.  Most of that hormone becomes bound up with protein and thus biologically inactive in that state.  Only the small portion that is free of protein is biologically active.  Thus they are called Free T3 and Free T4.  Even though the thyroid gland produces some T3, most serum T3 comes from conversion of T4.  So T4 is important, but mostly as a source for conversion to T3.  Free T3 largely regulates metabolism and many other body functions.   Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.


'So that is why it is so important to test for Free T3 and Free T4 levels.  Doctors mainly are in love with TSH testing and will tell you that TSH tells them all they need to know, since it reflects levels of thyroid hormone..  However, they cannot show you scientific evidence that TSH correlates well with either Free T3 or Free T4, much less correlate well with symptoms, which should be the main concern, not just lab results.

So, please get those tests done and post results.

[in33dhelp]

Hi Gimel thanks for your answer. Since I do not currently have a receding hairline and this "baldness" is on the vertex and the sides of my head (so it does not exactly follow MPB), would it be possible for this to be linked to a thyroid issue (which would explain all over health related issues as well)? Also what does Free T3 and Free T4 mean specifically for thyroid issues.

[gimel]

With those symptoms, I'd certainly request to be tested for the possibility of a thyroid problem  Don't let the doctor determine which tests.  Most often they don't know to test for the biologically active thyroid hormones, Free T3 and Free T4, which are not the same as Total T3 and Total T4.  They always want to test for TSH, under the mistaken belief that it tells them all they need to know about thyroid status.  Unfortunately, TSH cannot be shown to correlate well with either Free T3 or Free T4, much less correlate well with symptoms, which should be  the main concern for you, not just test results.  While there it would also be a good idea to request tests for Vitamin D, B12 and ferritin.  If the doctor resists, just insist on them and don't take no for an answer.  

I would even go so far as to ask the lab person which tests are going to be done, just to make sure they comply with what you want, instead of operating on auto pilot and doing the usual.  

I think you would be well served to read the info in this link, in preparation for your doctor visit.  

http://www.hormonerestoration.com/Thyroid.html

When you have the lab report, post results and their reference ranges shown on the report, and members will be glad to help interpret and advise further.