Thyroid health

[nussekok]

Rheumatologist office report test of my daughter's thyroid within normal range.
27 yr old female: Thyroid test ST4 yield  0.79 / Thyroid Stimulation Hormone test yield 2.42.
Considering her symptoms below, could something be missed? She seems well but something is not right and this has been going on for the past year. She initially sought a doctor because of strong headaches Dec 13.

Symptoms experienced are many:
-- Very sudden onset early Jan 14, almost overnight: Sensitive to cold especially in hands, some fingers on both hands get numb. Last winter to the point of almost loosing circulation in one fingers and developing an ulcer at fingertip.
-- Swellings of hands when waking up in the morning. Disappears throughout day.
-- Shortness of breath. Has had lunge functioning test w 8 moth apart. Reduced function on both tests. Lunges checked CT w contrast, northing unusual found.
-- Heart functional test performed. Heart normal.
-- CBC considered normal.
-- Dry red rash on face between nose and mouth and below the eyes, both sides of the face. She has been tested for food and environmental allergies. Will be tested for contact allergies.
-- Pain in joints under/after exertion. Wrists/shins/hips/knee/shoulder. Recieved medicine for a month for tentinitis in wrists this summer.
-- Since October , both eyebrows started thinning on outer halves. During the last two weeks, noticing thinning of arm pit hairs
-- Headaches off and on. Doesn't take meds for it, usually doesnt' interfere with daily life.
-- Some degree of constipation. Not extreme, but occationally a day with some stomach pain, often feels bloated.
-- Dental cavity eroded very quickly and root canal/crown was needed.
-- Brittle nails. Has always had this to some extend
-- Hoarse voice, does not notice this herself.
-- Slight puffy, redness to face
-- Weight gain of 7-8 pounds this year, could be due to reduced exercise
-- A feeling of heavy legs
-- Dry lips
-- Some TMJ
-- Dry lips
-- Gets dizzy easily
-- No fevers, mood ok
-- Has been tested for Scleroderma three times. Positive but doctors do not think she has it.

[Jme1226]

First week of jan I had my first panic attack and it was extreme!  In the past 3 weeks I've had about 8 more, not quite as severe so I went to the er and dr.  I told her It was always bright on by this tight, choking feeling in my throat!  She scheduled an ultra sound which I have a small goiter and looks slightly hyperactive, she said nothing to be concerned about!  Telling that to a person who constantly feels like they are being choked is aggravating.  We are running more blood tests t4 free t3 free rhumitoid.  The symptoms for me seem out of this world!  Hot flashes, night sweats, panic attack, rapid heart beat, high adrenaline feeling, the feeling that my muscles are being ripped off my shoulder blades and upper spine, heavy chest,  headaches, numb lhands and feet, hot/ cold issues, dark what seems like pregnancy mask ( not pregnant) on my cheeks, flushed skin,velvety skin on my belly, clammy hands, pressure in my right temple and ear, tight neck and under chin area.  m sure there is more... Dr says I need antidepressants and I keep telling her that's not the problem!!!!  This is horrible, I'm mid30's and have 4 kids. It's hard to feel normal when ur body doesn't!

[nussekok]

Thank you, gimel, for your careful answer. This will be a help when she next speaks to her doctor. I appreciate you taking the time to take everything into account.

[gimel]

TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms (of which your daughter has many), and also levels of the biologically active thyroid hormones, Free T3 and Free T4.  Her TSH is well within the range but that does not preclude being hypothyroid.  That T4 range is strange looking to me, but assuming that is correct her T4 result is a bit low in the range.  We usually want to see Free T4 at the middle of the range, at least.  Unfortunately there is no test result for Free T3.  Free T3 correlates best with hypo symptoms.

I suggest that you should request the doctor to run both Free T3 and Free T4 tests again, and every time she goes in for tests.  If the Free T3 is also in the lower half of its range that, along with all the symptoms,  is strong evidence that your daughter is hypothyroid and in need of thyroid medication.  The list of symptoms that can be caused by hypothyroidism is very long.  This link lists only 27 of the most typical of them.  You may be able to use this info to convince the doctor to do the tests and consider prescribing thyroid medication.  

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Since hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin, I also recommend testing those as well.  D should be around 55-60.  B12 should be in the very upper part of its range, and ferritin should be around 60 minimum for women.

If you can get those additional tests done, when results are available, please get a copy of the lab report and post results and reference ranges shown on the report and members here will be glad to help interpret and advise further.  

[nussekok]

ST4:      0.79  ( range  0.59-1.17)
TSH:     2.42  ( range 0.34-4.82)

[gimel]

Please post the reference ranges shown on the lab report for those thyroid tests.