Conflicting medical advice for hypothyroidism

[JimBe]

Dear MedHelp community,

This is my first post -- sorry it's so long. I probably need to ask a specialist about this, but haven't yet been able to get high enough in the queue to post my question there.

My wife’s 74-year-old mother lives in a provincial city in China, and she recently (a month ago) had a stroke, after many years of thyroid problems and erratic blood pressure (sometimes alarmingly low; sometimes too high). She has now recovered reasonably well from the stroke, but is still having to deal with extremely unstable blood pressure.

When she was young (around 30) she had an operation for over-active thyroid. Ten years later she started to have heart problems which, according to her doctor, could have been caused by her thyroid disorder - it turned out that after the thyroid operation she had developed an under-active thyroid. She was then put on medication to regulate her thyroid level, and until her stroke was on the same medication (not sure of the name). For the last ten years or so, she has also been having frequent low blood pressure and dizzy spells.

When she had the stroke, the doctor ordered T3 and T4 blood tests. Some of the same tests were repeated in another hospital a couple of weeks later. Although the results from the two tests were similar, the doctors had wildly different interpretations and hence opposite advice re her medication. She has recently shifted from the Chinese-made medicine she was on for many years to a German drug called Euthyrox (50 mg per tablet).

The first hospital had a look at the T3/T4 test results and said that she should increase the dosage of Euthyrox (from one to 1 and half, and then to two tablets per day), and the other hospital suggested that she reduce the  dosage.

As for the connection between her blood pressure and her T3/T4, the first hospital says her blood pressure abnormality is likely to be caused by her thyroid disorder, whereas the second hospital says there’s no connection. Very confusing.

I'm hoping that someone here might have had a similar experience with conflicting diagnoses, or at least some experience with Euthyrox, and can give me some advice about these four things:

1. according to the latest research, is there likely to be a connection between blood pressure instability and under-active thyroid? Can my mother-in-law expect to stabilise her blood pressure through the use of Euthyrox, or should she treat her blood pressure problem as a separate issue?

2. if her blood pressure is not related to her under-active thyriod, what other factors could contribute to her sometimes high, sometimes low blood pressure?

3. given the test readings (see below), and based on her history of first hyperthyroidism (prior to surgery) and then hypothyroidism, does anyone here have any relevant experience that suggests which medical opinion she should be acting on (i.e., increasing or decreasing the dose of Euthyrox)?

4. Are there any other treatment options you have experience of that she should ask her doctor about - either instead of or as well as Euthyrox - if such treatments turn out to be available in a small provincial Chinese city?

I'll keep trying to get my question into the expert forum, but in the meantime, many thanks for reading this far, and and for any guidance you might be able to offer. (NB: see the test results below; I hope the layout is clear.)

cheers from Australia!
Jim

Test results (NB: second test only tested TT3, TT4 and TSH):

TEST    Test 1             Normal Range Test 1   Test 2           Normal Range Test 2

TT3     1. 22 nmol/L     1.34 - 2.73                   0.87 ng/ml   0.87 - 1.78

FT3     2. 66 pmol/L     3.8 - 6

TT4     63. 45 nmol/L     78.4 - 157.4                   65. 00 ng/ml    60.9 - 122.3

FT4     9. 23 pmol/L     7.9 - 14.4

TSH     0. 11 mIU/L     0.34 - 5.6                   0. 09 uIU/L    0.34 - 5.6

Tg     8. 72 ug/L     1.15 - 130.77

TgAb     0.6 IU/ml     0 - 4.9

Thanks again!

[JimBe]

Thanks everyone for your replies -- they're all really helpful! My wife has also just had a conversation with an old friend from her childhood in China -- a doctor who has been doing medical research in the US for many years -- and he echoed quite a few of the things you've said here. He also recommended that we arrange for her to visit Shanghai (the nearest big city) to see a specialist, and for her to stay there long enough for a full work-up of her condition to be done. We won't be going back to China until next year, but he (the medical researcher) will be visiting his home town (which is also where my mother-in-law lives) within the next few months, so he said he'd visit her then. I'll keep you posted of any news, and many thanks again for being so willing to jump in with your supportive advice and opinions! Jim

[Barb135]

I agree with everything gimel said and would like to add that I don't see a TPOab (Thyroid Peroxidase antibodies) test.  This is one of the tests, along with TGab, used to diagnose Hashimoto's.  

[gimel]

Just from looking at those lab test results, I expect that she probably has more hypo symptoms than just the low blood pressure.  The most revealing result to me is the FT3.  It is way below the so-called normal range.  The range is so broad that we hear from many members with FT3 in the low end  of the range and they still had hypo symptoms.  Since symptom relief should be all important, these members reported that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.   So you can see that she has a lot of room for an increase as part of trying to relieve symptoms.  By the way, the emphasis on FT3 is because it is the most active thyroid hormone, and it largely regulates metabolism and many other body functions.  Studies have shown that FT3 correlates best with hypo symptoms, while FT4 and TSH did not correlate.

The first hospital was definitely on the right track in suggesting an increase in meds.  The second hospital was off track, most likely because they were looking at the TSH result and decided that it was too low, so decrease meds.  This happens far too often and it is wrong.  Many members report that while on thyroid meds, their TSH is suppressed.  This does not mean that they have become hyper.  You are really hyper only if having hyper symptoms, due to excess levels of the active thyroid hormones, FT3 and FT4.  

If your mother-in-law were here, I would suggest that she needs to supplement her T4 meds with a source of T3, since her FT3 is so out of balance with the FT4.  Just increasing the amount of T4 may move both results up somewhat, but it may not raise the FT3 enough to relieve symptoms.   If the desiccated type of thyroid meds (T4/T3 combo) are available, that would be a good alternative for her to discuss with a doctor that could prescribe such.

Good luck to all with your efforts.  Please let us know how things progress.

[redheadaussie]

Hi from another Aussie!

Part of the problem would be it seems is the stroke. Levels of FT3 and FT4 can increase in a patient with stroke, and indeed after major surgeries. I think that is probably why the other hospital is saying to lower her dose.

If you look at the two tests results for TT4 (which really is not a needed test in the first place) You will see one has a range higher than the other. So the first test makes it look under, where the 2nd shows over. Hence the confusion I believe as well.

Blood pressure is regulated in the pituitary gland and this can also be part of her problem as well. I believe it would be treated as a separate issue, as it may have contributed to her stroke. Which many people have issues with who are non-thyroid patients.

Hope that helps!