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1193998 tn?1265117597

Am I barking up the wrong tree? :)

Hi, I'm had RA for 46 years (since age 5) and am wondering if it's possible to develop Hashimoto's after all this time? Or for menopause to "unmask" the underlying disease?

Since Jan. 2010 I've suddenly gained 16 lbs and can't lose it no matter what I do. (I'm fairly petite and have never had a weight problem until now - I have two hip implants and CANNOT AFFORD to gain ANY weight!)  I also have nearly every symptom for Hashimoto's listed on the mayoclinic.com web site: falling hair, extremely dry skin, fatigue/lethargy/poor memory, chronic constipation, depression, puffyness, aches in hip flexors and shoulders, heavy menstrual bleeding (alleviated with an ablation in late '09).

Admittedly, many of my symptoms can be attributed to RA but most of what I'm noting are new symptoms and my RA is well controlled with methotrexate and Enbrel. My rheumatologist had TSH and T4 tests run and they fall within normal range, and she's reluctant to test further. However I'm reading a lot recently about the connection between RA and thyroid problems, and overexposure to x-rays and hypothyroid (god knows I've had a zillion xrays in my lifetime).

Should I insist on further testing, or am I barking up the wrong tree? I'd appreciate your thoughts. Thank you!
Best Answer
Avatar universal
With those symptoms, I think you should definitely request further testing.  Specifically I would suggest testing for the most important thyroid hormone, which is Free T3.  FT3 largely regulates metabolism and many other body functions.  If the doctor resists, then you should insist and don't take no for an answer.  Remember that you are the customer.

Studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate very well at all.  If the doctor resists, don't accept the excuses, just insist on it and don't take no for an answer.  While you are at it, I would also ask to be tested for the thyroid antibodies, TPO ab and TG ab.  This will identify if Hashimoto's Thyroiditis is involved.  Hashi's is rhe most common cause of hypothyroidism.  

Another test that might be advisable for you would be Reverse T3. Under some conditions your body sometimes will convert excessive T4 to RT3, instead of T3.  RT3 is the mirror image molecule of T3, but is biologically inactive.  If excessive RT3 exists and gets into receptor cells and blocks FT3 from getting to those cells, then hypo conditions will occur.  

Frequently patients who are hypo will also have deficient levels of Vitamin A, D, B12, iron/ferritin, RBC magnesium, zinc, and selenium.  It would also be good to have these checked as well.

When you have test results, please post along with reference ranges shown on the lab report and members will be happy to help interpret and advise further.  doctors are required t provide a copy of your lab report upon your request.

Getting testing done is the first step.  Getting properly diagnosed and treated is the next hurdle for hypo patients.  More about that later.  











9 Responses
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1193998 tn?1265117597
Sorry, I forgot to add that my most recent test results, done in the a.m., non-fasting, were 1.46 tsh, 1.16 t4
Helpful - 0
1193998 tn?1265117597
Thank you so much!  I'm very good at being my own best health advocate (read: pain in the @ss), so I fully intend to not move my butt from the exam room until I get what I need. I appreciate the backup. ;)  I'll let you know how it goes.

Another question, if you don't mind - does it matter what time of day I get the tests? Should I fast? And should I return to my rheumie or start with my PCP and go to an endocrinologist? Er, sorry, that was more than one question...
Helpful - 0
1193998 tn?1265117597
I also had my D level checked within the last six months and it was normal. Also recently started taking a B12 supplement to see if it would help my energy level - so far no difference.
Helpful - 0
Avatar universal
With most reference ranges there is "normal' and then there is adequate.  For Vitamin D, you want to be higher than the lower end of the range.  

Regarding testing, if the doctor is one with the "Immaculate TSH Belief" I would have suggested the afternoon.  Only because TSH has a Circadian Rhythm and is lowest around 9 a.m.  Since your  a.m. TSH test was 1.16, it is not likely to matter much.  Fasting is required for only selenium,  that I recall.  

I think I would start with your PCP, unless you can find a good thyroid doctor.  That does no imply an Endo.  Frequently they are the most rigid when it comes to using TSH as the sole diagnostic, or using the very broad reference ranges for FT3 and FT4 as pass/fail, rather than as guidelines within which to adjust levels as necessary to relieve symptoms.  A good thyroid doctor will treat you clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test results.  Test results are valuable mainly as indicators during diagnosis, and then afterward to track FT3 and FT4 levels as meds are increased toward symptom relief.  

I think you can get some good insight into clinical treatment by reading this link.  The link is to a form letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

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

If you will tell us where you are located, members might be able to recommend a good thyroid doctor in your area.
Helpful - 0
1193998 tn?1265117597
Thanks again!!  I'm in the Toledo, Ohio area. We *might* be moving to Florence, SC in a few months, though, if my husband is offered a job down there.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
gimel has given you excellent advice.  I'm curious if that T4 is "free" or "total".  If it doesn't say free on the lab report, it would be considered total, which is of little value.

I'd also suggest that you stop the B12 supplements for a while, then request to have your B12 levels tested.  Since you already have RA and your symptoms strongly suggest Hashimoto's/hypothyroidism, you could also have pernicious anemia, which, along with Hashimoto's and RA is an autoimmune disease, which prevents vitamin B12 from being absorbed through the stomach.  I have both Hashi's and pernicious anemia, and do weekly injections of B12 to help control my levels and prevent the never ending fatigue.  

You could also try a sublingual B12, which would be absorbed without having to go through the stomach; but it would be best to be tested first, in order to find out what your levels really are.

Helpful - 0
Avatar universal
When there is no doctor recommendation based on personal experience,  I've had some success with finding doctors on the Top Thyroid Doctors listing.there are two listed for the Toledo area.  Do you have any info on either of those?

http://www.thyroid-info.com/topdrs/ohio.htm

If you do move, I'm not sure about the travel time for you, but I do have a member recommended thyroid Doctor in Greenville, Sc.  Just let me know if you want the name.
Helpful - 0
1193998 tn?1265117597
Thanks again! You've given me tons of invaluable info with which to prepare for dealing with getting diagnosed.

I'm not familiar with the doctors listed for Toledo, but hopefully my PCP will know. Greenville is a bit of a haul from Florence, but I have family in that area (actually all over North Carolina) so it wouldn't be hard to coordinate an appointment with a visit to my cousins, aunts, uncles, sister or mother. :)
Helpful - 0
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