hair loss - help!!!!

[mgmon]

I had my thyroid out approx 3 1/2 years ago due to suspicious nodule...........have done well with levothyroxine ever since...really almost no dosing changes......I'm on 88 mcg I believe.........

But for months now it seems I'm shedding hair terribly, and I'm due to go back for annual bloodwork this month, but in the meantime can you help me and see what you think of these lab numbers?

In JAN 2013 I had TSH of .08 [ref .34-5.60]
                               T4 Free 1.27 [ref .58-1.64]

and in July 2012 I had T3 Total 76 [ref 87-178]
                                     T3 Free 2.5 [ref 2.3-4.2]

Is it odd that all of a sudden I'd have a problem with this shedding?  I'm assuming its related to my thyroid meds and levels, I can't think of another reason for it.  Not sure my dr. is going to be sympathetic though, so I want to have some information before I go to see him after I have this blood work done.  

Thanks so much!!

[gimel]

Nest time you go in for tests, I urge you to make sure they test for Free T3, not Total T3.  I'd even make sure the lab people know it is to be Free T3 not Total T3.  

Anyway, if your doctor thinks that your labs are perfect, then he is only paying attention to the TSH and Free T4.  Your Total T3 appears to be well below the reference ranges I see very often.  You need to confirm the ranges and post them, please.

So, you need to tell your doctor that scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.   This is only logical since Free T3 is the thyroid hormone that basically regulates metabolism and many other body functions.  Your Total T3 is so low that I expect that your Free T3 is also very low.  I would attribute your hypo symptoms to low T3 due to inadequate conversion of the T4 med to T3, which is a frequent occurrence when taking T4 meds.  The solution to this is to add some T3 to your meds.  If your doctor won't reconsider, you might give him a copy of this link and ask again if he will at least give you a trial dose of T3 for a few months and see what effect it has on your symptoms.

http://www.hormonerestoration.com/Thyroid.html

If that doesn't work then you will need to find a good thyroid doctor that will treat clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  

[mgmon]

ok...ughhhh....can you see what you think of my newest info?  I just had bloodwork done this week, and no......he did not order free t3.  grrrrr!

Also, I forgot to get the reference ranges, I"m sorry, I will call back for them if I can..........but recall I'm now on 75 dose of levothyroxine since september (lowered from 88 in July, and had been 100 dose since August 2012.  I CAN identify that I've had the most significant hair loss since the fall of 2012......so maybe it was that I never should have been upped from 88 to 100 dose in August 2012.  I also lost about 25 lbs in spring of 2013, so that combined with the higher dose.........could that have caused the really realllllllllllly bad shedding??

Current results:

TSH 0.52  (I've ALWAYS been closer to .04 for years....the highest that reading has been was 0.19 in June 2012

T4 Free  1.5
T3 Total  46

My appt with him was cancelled....twice...ughhh he is now going out of town and can't have an appt with him til jan.  But he did just call me said my labs were perfect and he will not change my meds (ie I had asked again about adding cytomel).  

I'm not sure if its wishful thinking, but maybe, just maybe the shedding has slowed down very recently............could be because of the lower dose??  I seriously will have to look at a hair topper if I lose any more.  my frontal bangs are truly almost gone, if I didn't use a scalp makeup to cover my scalp, I would not be able to go in public.  And the difference in seeing my bangs in a picture from a year ago to now, is just unbelievable.  When will it start growing in noticeably............ :((

[gimel]

Nothing wrong with taking Armour and Levothyroxine, or Armour and Cytomel, or Levo and Cytomel.  By having separate sources for T4 and T3, you can adjust levels of Free T3 and Free T4 as necessary.  It is easier to adjust using Cytomel, but can be done without.  

The important thing is to find out your Free T3 level.  Did you ask for that test?  If not, you should insist on Free T3, along with Free T4 each time you go in for tests.  Following is a link to a scientific study that concluded that hypo symptoms correlated best with Free T3, and that Free T4 and TSH did not correlate at all.

http://informahealthcare.com/doi/abs/10.1080/13590840050043521

There is just no good reason to prescribe so much T4 that it raises your Free T4 above range, trying to get your T3 levels high enough to relieve symptoms.  If he is willing to prescribe Armour, then that should be considered.  Since you are taking 88 mcg of T4, a good replacement dose of Armour would be a gull grain (60mg).  That would give you 39 mcg of T4 and 9 mcg of T3.  Considering that T3 is equivalent to about 4 to 5 times as much T4, the equivalent amount of T4 is about 75 to 84 mcg of T4.  

So that is something to discuss with the doctor.  If you can get agreement to switch, I'd suggest that you make the switch in two increments, starting with 30 mg of Armour and half of your T4 for a couple of weeks and then make the full switch.

Also, looking back on your prior posts, I think you should supplement to get your Vitamin D level increased to around middle of the range.  Also supplement with a bit of iron (ferrous fumarate or ferrous gluconate seem to be best), to get your ferritin level up into the 70-80 range.  
  

[mgmon]

update.........well, haven't switched to armour yet, I'm nervous :(  My primary will not prescribe cytomel - says its gonna be illegal soon, and likened it to speed??  So, with him its either levothyroxine all the way or armour all the way.

In the meantime, my other dr.(who did my thyroid surgery and followup) had my tsh and free T4 (only :( ) tested last week, 2 months after he lowered my dose of levothyroxine from 100 to 88.  My new results are TSH .09, and Free T4 2.0  (I do not have the ref ranges for these, am assuming they are the same as before though........tsh .34 - 5.60  and T4Free .56-1.64.

Upon receiving these new results, his office called to have my dose lowered to 75 (I was on this dose the first couple years and I never noticed hair loss then, unless it was just not on my radar at that point).  I will now have the bloodwork repeated in 2 more months and see him.  Recall he seems to only believe in levothyroxine alone.  So, I was just curious if you think I'm at least heading in the right direction?  Still so scared about the hair shedding :((((   I just pray that it will grow back..................

[dgmootry]

Hey,I'm on Armour and my hair actually look great, its grown and actually has thickened, I was hyper for quite awhile didn't loose my hair but it did thin out abit, since I've been on Armour it looks great. If you do go on armour think about splitting it up like 7am and 3pm depending on how much you get, it really helps. deb

[gimel]

There are some claims, unproven as far as I know,  that NDT (Armour, NatureThroid) have some additional benefits.  The main thing about using a T4 med with Cytomel is that you can adjust the levels individually.  

[mgmon]

I've been taking 2000 IU Vitamin D3 for a few months now.  I'll have to check into the iron supplements.

Is there a difference between adding a T3 med to the levothyroxine, like cytomel vs. going on armour?  

thanks:)

[gimel]

I meant to also mention that your Vitamin D was too low and you should consider a daily supplement of Vitamin D3.  I take 2000 I.U.  Also, your ferritin is a bit low.  If the T3 addition to your med does not fully stop the hair loss, then you might want to also consider supplementing with ferrous fumerate or ferrous gluconate, which are OTC.

[gimel]

Well, in my opinion your primary doctor doesn't know very much about treating hypo patients; however, his offer to prescribe Armour might be worthwhile.  Armour itself does not cause hair loss.  Hair loss would be associated with inadequate levels of Free T3 and free T4.  

There is no need to wait for 4 months to see if the dosage change does anything for you  That change will not help increase your Free T3 level.  I think I would tell the doctor that you want to accept his offer and switch from the 88 mcg of T4 to 60 mg of Armour Thyroid (one grain), and re-test after 3 weeks and see what that did for your Free T3 level.  To monitor your levels, you are going to have to insist on being tested for Free T3, not Total T3, along with Free T4.  

Once you have started on the Armour, which is both T4 and T3, at that poinst it should be easier to get your doctor to add in some Cytomel if needed to increase just your Free T3 level, and relieve hypo symptoms.  

[mgmon]

ok, here'e my update.....my primary dr. called me saturday.  WOW!  I was shocked!!  He started talking about my bloodwork results, and I stopped him to tell him I had gone to my thyroid surgeon about them, and he had lowered my dose, but wasn't really concerned about T3.  This dr. (this is the one who had been so rude to me on the phone recently, and wouldn't order a ferretin test, etc..) said he respectfully disagreed, and thought perhaps based on my current bloodwork I might benefit from Armour...........and he did say the research on that was sketchy though.  I am having my physical with him next week, so said I'd think about it.   When I said he was the one who poo-pood me asking for help about my hair, bloodwork, etc.. he said he was sorry he was curt, he hadn't been on his "a-game", so that was nice to hear.

I really hesitate to make too many changes at once.  I am on the lowered levothyroxine dose now, so I'm thinking maybe I should give that the 4 months before I go back to the surgeon and see what my interim TSH/T4 results are?  Armour kind of scares me, I've read more about it causing hair loss than helping it.  Perhaps in 4 months, I could see if the primary thought adding T3 cytomel to my lowered levothyroxine?

what do you think?  Thanks so much

[gimel]

Personally, I wouldn't waste any more time with that doctor.  He doesn't get it.  Not even willing to test for Free T3, which is the test that correlates best with hypo symptoms, which include hair loss. And then not much being done for four months.   Forget him.  

Let's see if we can help you find a better doctor in the Buffalo area.

[mgmon]

p.s. so he is lowering my dose to 88 (levothyroxine

[mgmon]

hmmmm well, my dr. did not seem to support needing any T3 in addition to my levothyroxine.  He feels that my dose is too high, and that may be causing the hair loss.  (I am down 20+ pounds from 2 years ago, and have probably lost another 15 in the last year)..........so I guess it could be conceivable that with my weight loss, my body didn't need that dose of levothyroxine?  He is redoing my bloodwork (though only the Free T4 and TSH) in two months, and in 4 months, then I go see him after the 4 month bloodwork.  Think that might be all I need?????

[ahmee]

I had no success in reducing my hairloss while on a T4-only med. After I switched to a combo T4/T3 med (Naturethroid in my case), my hair loss decreased dramatically in about a month's time. Perhaps I was lucky, but my hairloss was severe and had been occurring for ten years at that point. I have not had much success with regrowth yet, but I am still raising ferritin, which along with adequate thyroid levels, seems to be essential for healthy hair.

Your numbers indicate that you may not be converting the T4 to T3 adequately. I highly recommend you look into adding T3 into the mix, as gimel suggested.

[gimel]

It is unfortunate that your doctor would not test for Free T3, since it has been shown to correlate best with hypo symptoms.  From your test results, your Free T4 is unnecessarily high, and your Total T3 is below the range.  This indicates that your body is not adequately converting the T4 med to T3.  I'm sure that if your Free T3 had been tested it also would have been very low.  

So, I'd say that your hair loss and any other hypo symptoms are due to inadequate T3 level.  I'd suggest that you ask your doctor to reduce your T4 med by at least 25 mcg and add some T3.  You might want to start with only 5 mcg for a couple of weeks and then increase up to 10 mcg for a couple of weeks and then return for followup tests.  Of course all this needs to be discussed and agreed upon with the doctor.  And don't forget that since T3 acts so much faster than T4 you should split your dose and take half in the morning and the other half in the early afternoon.  

  

[mgmon]

hi,

I just got my results back....oh and p.s. I live in buffalo NY if anyone knows a dr. that would be good.

TSH            .02 [ref .34-5.60]   This is down from .08 in jan 2013
T4 Free      2.74 [ ref .58-1.64]  This is up from 1.27 in Jan 2013
T3 Total     64 [ref 76-181]  This is down from 76 in june 2012
He did not test my T3 Free :((
Thyroid AB (ATA, TPO) thyroglob antibody  <20      [ref <20]
                                thyroid peroxidase antibody < 10 [ref <35]
Thryoglobulin AB <20  [ref <20]

Do these results to you indicate why my hair would be excessively shedding?  Why do you think my T4 Free is fluctuating so...and why would it jump so high??   Looking back, my T4 Free has been tested every 6 months, and has gone from 2.20 to 1.18 to 1.27 to 2.74

ughhh Is there a fix to my hair??  Will it grow back if my levels are brought to where they should be?

thank you so much!!

[gimel]

Well, if the doctor actually tested you for Free T3 this time, I expect it will continue to be in the low end of the reference range, indicative of being hypothyroid, including hair loss,  and needing to add a source of T3 to your meds.   From your doctor's reaction, I don't have much hope that he will do what is necessary.  

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

If you will tell us where you are located, perhaps a member could recommend a good thyroid doctor for you.  

[mgmon]

hi,

I just had the 'basic' thyroid bloodwork done and will post results soon.  In the meantime, I spoke to my primary to ask that he include ferritin, in the thyroid bloodwork.  I can't tell you how rude he was.  I merely called the office to request this, and why, and they said to call back later.  When I did, they had obviously been told to put him on the phone.  "what can I do for you?"  I told him about my shedding hair (and I do have genetic female hair loss, that started about 15 years ago, but that is NOT the same as this clear shedding that has been happening for the last many many months) So, he asks if I'm bleeding.  huh?  No I"m not.  He then tells me my ferritin level from last year is normal, and he can't request another one for me, and that my hair is 'age-related'.   I am dumbfounded.  He has always been so courteous and relatively helpful since I've been going to him for about 3 years.  Though I have to say when I first brought up my hair problem with him a year ago or so, he was very quick to point out a wig is an option!!  So...........maybe I shouldn't be surprised.  So, I did make an appt with the surgeon who took my thyroid out.  He followed up with my thyroid levels for a year, and then my primary took over.  I'm praying that he will be able to help me.  Oh, by the way, my levothyroxine dose is 100, not 88..........I was mistaken.  I've been on 100 for a year now.  So, we'll see what my surgeon/dr. says.  I've been taking vit D supplements for a few months now, I just wonder if he'll do something to help me.  Doing NOTHING  has not stopped the loss, so something must change - right????  :((((((((((((

[gimel]

The TSH becomes suppressed quite frequently when taking significant doses of thyroid meds.  That does not mean that you are hyperthyroid, unless you do have hyper symptoms, due to excessive levels of Free T3 and free T4, which you do not have.  So the point with this is don't let your doctor tell you that your low TSH means you are hyper and need to reduce meds.  There are lots of scientific studies that show that TSH is almost useless as a diagnostic when already taking thyroid med.  

Since you had a thyroidectomy, and have no thyroid gland, your 88 mcg dose is somewhat low considering that it is intended to be a full replacement dosage.  That is why your thyroid test levels are on the low end of the range, which as I said is frequently associated with having hypo symptoms.

In addition, your ferritin is on the low side.  For women it should be more like 70-80.  Your B12 is also lower than optimal for many hypo patients.  For example, in Japan and Europe the low limit of the range is now 500.  Your Vitamin D should be more like 60-65.  So you need to supplement all three to bring them up to optimal levels.  That will also help in propeer metabolism of thyroid hormone.

One thing I haven't mentioned is the hair shedding.  It may be that your Free T3 is too low in the range still.  Or it can also be associated with low ferritin.  You can read about that in this link to an old Forum thread.  

http://www.medhelp.org/posts/Thyroid-Disorders/hair-issues-better-with-T3-/show/1832700#post_8461273

So you have lots to discuss with your doctor, in trying to reach an understanding about how you need to be treated.  As I mentioned, if the doctor is averse to clinical treatment as described, and intends to medicate you based on TSH, or by using "Reference Range Endocrinology" then you will need to look for a good thyroid doctor that will treat clinically.

When you have new test results for Free T3 and Free T4, please post results and reference ranges shown on the lab report and members will be glad to help interpret and advise further.  Also, if your discussion with the doctor shows that you need to find a good thyroid doctor, we will also be glad to try and help with that.  

[mgmon]

thanks, thats great information. Its a bit technical and confusing though....so since I have quite low TSH and my Free T4 and Free T3 are kind of in the low area of the ref ranges..........what would be recommended.....adding a different med along with my levothyroxine, or changing from levothyroxine to something else? Or how do you "adjust Free T3 and Free T4"?  I will def request that all those tests are repeated this month.

Actually last summer I did have a few other tests....ferritin was 57 (ref range 11-307).  Vit B12 was 543 (ref range 180-914), and Vit D 30 (ref range 30-100).  What do you make of those?

I appreciate you taking the time to help me :))

[gimel]

Just because Free T3 and Free T4 results are within the so-called "normal' range does not mean that is adequate for you.  the ranges are far too broad to be functional, due to the erroneous assumptions on which the ranges are based.  Suffice to say that patients with Free T3 and Free T4 in the lower half of the range frequently have hypo symptoms.  Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.You can get some insight from this link, written by a good thyroid doctor.

http://hormonerestoration.com/Thyroid.html

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. In the words of the doctor that wrote the above link, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

So, you need to insist on being tested for Free T3 and Free T4.  I would also recommend tests for Vitamin D, B12 and ferritin.  Frequently hypo patients find they are too low in the ranges for those as well.  Beyond that you need to find out if your doctor is agreeable to treating clinically as described.  If not, then you will need to find a good thyroid doctor that will do so.

[mgmon]

thanks for responding :)  I'm not sure why the testing in jan was limited?  Last june I also had these results:
I did have these tests also last june:  (they seem to be in the 'normal' range - ?)

THYROGLOBULIN ANTIBODY     < 20     [standard range <20 IU/ML]
THYROID PEROXIDASE ANTIBODY<10 [standard range  <35 IU/ML]

I thought my Free T3 was ok, as it was in the reference range....why do you think it was way too low?  If my next testing this month has my Free T3 at the low end of the range again.........what suggestions would you make to me, that I might suggest to the dr?

thanks so much :))

[gimel]

Were you ever tested for the possibility of having Hashimoto's Thyroiditis, which is the most common cause for hypothyroidism, and frequently a cause for nodules on the thyroid gland?  Those tests are TPO ab and TG ab.  Also, do you have symptoms other than hair loss?

Why were you not re-tested for both free T4 and Free T3 in January?  Free t3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  Your Free T3 was way too low in the range back in July, so I expect that it remains too low in the range, which is frequently associated with having hypo symptoms, such as hair loss.