Please share opinions on approach

[SharonB68]

I am a 48yo female with UCTD (dx but unconvinced).  I have had symptoms of hypothyroid for years and have had it checked typically with my yearly physicals.  My TSH has been below 2, probably averaging 1.6, with the lowest test at 1.25.  The range is 0.4-4.0.

My FT4 remains constant at 1.0, range is 0.8-1.8 and the few FT3 I have had have been 2X at 2.7 and one 3.2, range is 2.3-4.2.  

I had one RT3 done and it was 17 (when the FT3 was 2.7).

I stumbled into rheumatology after hair loss investigation turned up a slightly elevated ANA (1:80).  So far that is the only abnormal finding, it has only ever been slightly elevated (highest 1:160, but generally around the 1:80) and there is a percent of the population that has an elevated ANA with no autoimmune disorder.

TPOab is negative.

I have gone through menopause at 47, with FSH, LH, Estradiol fluctuating high and low, but the most recent has barely detectable estradiol.  

My symptoms (which overlap rhuematoid perhaps but not definitive enough for an actual diagnosis -- UCTD is sort of a catch all dx when you don't fit one -- RA, sjorgens, SLE, etc.):

hair loss (body for years, head 3+ yrs)
constipation forever
weight gain and can't lose
fatigue with no get up and go at all
diminished smell except with exceptionally strong off putting odors
focus issues
exhausted
cold (although having hot flashes/night sweats)
forgetful (even to the point that I say something and then forget I said it 2 minutes later!)
crabby
aches and pains
dry skin (lots of lotion and baby oil -- cracked heals, corners of mouth, chapped lips, etc)
dry brittle hair -- what's left of it!
disproportional fat -- upper arms, stomach -- not sure this is hypoT, but I have hard time with shirt sleeves

I have completely normal bloodwork (have had low D3 and B12, but have been supplementing) but have done a lot of reading about optimal levels and I can't help but think that even though my thyroid levels are normal, maybe they are not optimal.

What I find interesting is that my FT4 doesn't seem to change even with changes in my TSH.  I thought the TSH got high to call for my FT4/FT3 and then dropped when they rise, but my FT4 never moves.  I did ask my PCP and was told it was normal and the FT4 is a set point and not meant to move.  

Could all of my symptoms be menopausal (peri for the last 10+ years)?

Any insight would be great.  Thank you for "listening".

Shar

[gimel]

I just sent you a PM with info.  To access, just click on your name and then from your personal page, click on messages.

[SharonB68]

Thank you Gimel. I will read through the link you sent.

I'm in Texas right now but my husband is being transferred to Connecticut right after Thanksgiving so probably need to look there. I'm not familiar with the state (it's not that big!) but Waterbury is the closest city.

Any suggestions would be great. Thank you for taking the time to help.

Shar

[gimel]

Your doctor is relying mostly on TSH, which is not best for the patient.  TSH is a pituitary hormone that is erroneously believed to accurately reflect levels of the biologically active thyroid hormones, Free T4 and Free T3.  In reality TSH cannot be shown to correlate well with either of those, much less correlate well with symptoms, which are the patient's main concern.  At best TSH is only an indicator to be considered along with more important indicators such as symptoms and also Free T4 and Free T3.  

When a patient has symptoms like yours that are so often related to hypothyroidism, and the Free T4 and Free T3 are below the middle of their ranges, that is strong evidence of hypothyroidism.   You can get a lot of info about this from reading  at least the first two pages of the following link.  I highly recommend reading further if you want to review the discussion and scientific evidence that supports the suggestions on page 2.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.   So you need to find out if your doctor is going to be willing to treat clinically, as described.  If there is reluctance, then give him a copy of the full paper and references and ask him to read it and see if that convinces him to treat clinically.  If not, then you will need to find a good thyroid doctor that will do so.   Also, if you will tell us your location, perhaps we can suggest a doctor that has been recommended by other hypothyroid patients.