Thyroid Function for a 35 year old fitness-minded female

[bhart226]

My girlfriend is 35 years old and extremely fitness-mineded.  She aspires to get into figure competitions and has been on a strict fitness regime for the past 10 weeks, but has not lost any weight/shown little progress.  She has a customized nutrition program that is highly structured and is 100% clean eating (spinach, vegetables, turkey, fish, etc..).  After not losing any weight for weeks her coach lowered her to a 1,200-1,300 calorie diet.  She performs an intense weight program four days a week and high-intense cardio two more days, but continues to show little progress.  Fearing possible problems with her thyroid, she went to her physician and had bloodworm.  Results are as follows:

TSH:  .9 uIU/ML
FT4:  .8 NG/DL
T4:  5.6 UG/DL
FT3:  2.5 PG/ML

Her physician state she is normal and has been blowing her off.  She has begged to get a referral to an endo, and while they agreed, they stated the endo will do nothing with those numbers.  She is extremely distraught and has been suffering for months with the following symptoms:

-  Irregular menstrual episodes:  more frequent, longer and heavier episodes
-  Constipation:  Has 2-3 bowel movements A WEEK even though she is taking in approximately 35g of fiber a day
-  No current weight loss/Weight gain when not exercising
-  Swelling of hands and water retention
-  Moodiness
-  Low libido
-  Fatigue
-  Sensitivity to cold

The TSH is indicative of someone who has her activity level, but shouldn't her FT3/T4 be higher with the exercise and diet she is on.  Any thoughts/recommendations?

[flyingfool]

Also understand that "extreme" exercise & diet can also contribute to being hypo at the cellular level while the blood labs "appear" normal.

What defines "extreme" well I don't know for sure but things such as marathon runners and tri-athletes etc would meet that definition. Not sure if what your friend is doing would meet that description or not.

Please check out this website.  The articles on the left hand side are excellent. But what I'm referring to is the first article or articles under the heading of "abnormal thyroid transport".

      http://nahypothyroidism.org/

What basically happens is that it takes more energy to force the thyroid into the cells.  Which means that higher than what would be expected to be needed blood levels are needed to make up for that reduced efficiency of thyroid into the cells.  Or at least that is the way I understood the explanation.

As can be seen, many of the conditions that would result in this higher energy transfer are fairly common.  And if you've read much on this site you'll find a common recommended target level of blood labs as mentioned above to be BOTH of the following.

1) Free T4 to be in the MIDDLE of the range (50%) if not a bit higher

AND- that means in addition to

2) Free T3 to be in the UPPER 1/3 (66.7%) of the range.

Many people have found this to be a MUCH better target and seems to fall in line with what the website above would suggest that some people need to be higher in the range than would otherwise be expected. That is that a higher than simply being in range levels are needed for some people to get the proper amount of thyroid at the cellular level and thus reduce or eliminate symptoms.

Keep in mind however that ever person is different and feels well at a different level. So the name of the game is to start with small doses and go slowly.  It takes time.  Frustratingly long time in order to get this done.

Finally some other suggestions.

I never saw and you may want your friend to consider getting a few more blood tests run.  It is common for people to be vitamin deficient which often have the same symptoms of being hypo.

Specifically

Vit D
Vit B12
Iron
Ferritin

You may also want to have Selenium checked as it is known to help with conversion of Thyroid hormone T4 into T3.  It is the free T3 that is used at the cellular level.

[gimel]

Keeping in mind what a good thyroid doctor is, I suggest that she should take the opportunity to ask the doctor is he is going to be willing to treat clinically, by testing and adjusting Free T3 and Free T4, without being constrained by TSH results.  Also ask if the doctor is willing to prescribe meds containing T3.  If either answer is no, then you will need to find a doctor that will do so.

[bhart226]

I appreciate the info!  She has an appointment already set for next week with the endo...  I just want to make sure she receives full attention to detail and not given the run around.

[gimel]

I'd say definitely hypothyroid, based on symptoms, and the low levels of Free T3 and Free T4.  Her TSH being as low as it is, with the relatively low levels of Free T3 and Free T4, may indicate a pituitary issue.  

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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

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

So, I think you need to find her a good thyroid doctor.  If you will give us your location, perhaps a member can recommend such a doctor.