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Old 08-07-2009, 12:38 PM   #1
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Exclamation Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

I guess I'm hoping for thoughts, guidance, support, anything here. I'm 26, and my journey into Thyroid Land began last year, when I brought up my fatigue and thinning hair to my doctor for the second time. She ran my TSH, which came back normal (around 1.7). I'd had it tested the previous year too, also normal.

Well, I ended up doing some of my own research, and the more I read, the more shocked I was by how many symptoms of hypothyroidism I could check off:
  • Chronic depression - many years
  • Thinning hair - several years
  • Cold intolerance (basal temp ~96.9-97.0, hands/feet/buttocks frequently cold)
  • Fatigue
  • Luteal phase of menstrual cycle only 10 days
  • Carpal tunnel problems
  • Fingernails prone to peeling/splitting
  • Inability to eat in the morning

To top it off, I miscarried my first pregnancy at 5 weeks along in June. While it may have been spontaneous, the idea that an undiagnosed thyroid problem could have played a role really terrifies me. My husband and I are currently trying to get pregnant again, and obviously I want to avoid another MC at all costs.

Armed with more information, I went back to a different doctor and requested a more thorough thyroid panel. She agreed to test my TSH, free T3 and free T4, but said she'd only do the antibody tests if the others came back abnormal. I just got the results today:

TSH = 1.93 (ref range 0.3-4.5 mIU/L)
T3 = 2.6 (ref range 2.0-4.4 pg/mL) **converts to 260 pg/dL with a normal range of around 230-420
T4 = 1.1 (ref range 0.9-1.7 ng/dL)

So according to the clinic, everything is hunky-dory "normal," but that T3 sure seems on the low side to me. I'm not sure what to think of the T4. Anyone with more experience interpreting labs have thoughts? Should I go back and insist on having TG/TPO tested? Should I ask to be referred to an endocrinologist? Both? I don't get the feeling my doctors are taking me very seriously...my new one did even bother asking what my symptoms are.

Maybe I'm just overreacting and being a difficult patient for no reason?

Also, although nobody in my family has a thyroid disorder that I know of, my brother has psoriasis (auto-immune). Is that pertinent (ie put me at more risk of Hashimoto's)?

Thank you for ANY thoughts you may have.

 
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Old 08-07-2009, 12:56 PM   #2
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Given your symptoms and your labs you are definitely hypo. Your FT4 is at 25% or range when it should be up over 60%. Your FT3 is also at 25% when it should be at the top of range. Most doctors don't know how to read these values unfortunately.

You really do need the antibody tests to see if you have Hashi's. If your doc still refuses I would keep looking for a doctor who will order them for you. Unfortunately most of us have little luck with endos but if you can find one who prescribes natural thyroid hormones and doesn't go by TSH alone, but rather symptoms and your Free T levels, you should grab him... or any doc who follows that way of thinking.

I'm so sorry for your miscarriage. You need to get your thyroid under control before trying again so you are doing the right thing. Stand up for yourself with the doctors * Disallowed website and related information removed by hb-mod, moderator *

Last edited by hb-mod; 08-23-2009 at 02:04 PM. Reason: Please don't post disallowed websites as per Posting Policy. Thanks.

 
Old 08-10-2009, 10:46 AM   #3
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Thank you so much for your respone. It sounds silly but I almost cried with relief just knowing that someone else sees what I see. I have an appointment with my doctor in an hour, at which I plan on talking to her about my lab results and pressing for antibody tests.

What is the correct way to read the lab values? Do you just mean looking at WHERE they fall in the range as opposed to simply that they are IN the range? FT4 should be in the top third of the range, is that right? Where in the top should FT3 be? The nurse who always gets my lab results just sees that they're within the "normal" reference range and that's that.

I'll post an update after my visit and hopefully have good news.

Last edited by Olympia07; 08-10-2009 at 10:47 AM.

 
Old 08-10-2009, 11:04 AM   #4
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Think of levels as shoe sizes. There is a standard range for women's sizes inside which you have one that's a perfect fit for you. You can maybe tolerate a half-size smaller or larger, but only one is perfectly comfortable. Just try wearing a 6 if you need a 9 and see how far you can walk! Right? You can't have a T4 level just any ol' place in the range and expect it to be right for you. Doctors don't seem to 'get' that and miss many cases of hypothyroidism just because everything is "in range". That's such a stupid way to do business.

Just want to comment on McA's opinion of T3 needing to be at the top of its range. I'm one who feels terrible with T3 that high. It gives me all the unpleasant hyper effects. Obviously, not everyone needs their levels in the same places. It's safer to target the upper halves of the ranges at the beginning of treatment, then evaluate how symptoms are and tweak from there. I feel fine with my FT4 at 40% and FT3 around 70%. But I am not of childbearing age. I would want my FT4 well into the upper third if I were, because that's where it is proven to be optimal for both mother and baby. FT4 is more important to the pregnancy; FT3 is more important to the way you feel.

To determine what percentage of the range your FT4 result is, do the following calculation using your result of 1.1 and a range of .9 - 1.7:

1. Subtract the bottom of the range from the top (1.7 - .9 = .8)
2. Subtract the bottom of the range from your value (1.1 - .9 = .2)
3. Divide #2 by #1 (.2 ÷ .8 = 0.25) and turn the 0.25 into a percentage = 25%

Last edited by midwest1; 08-10-2009 at 11:05 AM.

 
Old 08-10-2009, 12:32 PM   #5
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Well, I've just returned from the worst experience I've had with a doctor in my life. Never has a healthcare professional treated me so rudely or made me feel so stupid.

In a nutshell, she feels strongly that since my lab values all fall within normal reference ranges, I have a "healthy, functioning thyroid." When I expressed my concerns and told her I'd still like to test my TPO & TG antibodies, a dark frown immediately covered her face and she said, ".....But....there's nothing wrong!"

I tried explaining my history, showed her my list of symptoms (which she has never ONCE even asked about), the studies I've been reading, and she said in a snarky tone, "Say we do test and you come back with antibodies. What do you expect to DO? You can't get rid of antibodies." It's like I'm asking her to pay for these tests with her frigging allowance money or something!

It just kept going downhill. In the end, there was a very long, sullen silence during which she clacked away on her keyboard.

The good: I ultimately got her to order the tests. (She clearly did so to get me to stop bothering her, because I'm a completely inept patient trying to play doctor.)

The bad: I am now in the market for a new doctor. Again.

 
Old 08-10-2009, 12:48 PM   #6
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Arrrrgh! I hate hearing stories like this they just royally **** me off. At least she didn't tell you to stop looking on the internet like several docs have said to me (one had the gall to tell me I'd "only frighten myself", ARRRGH!)

Well you certainly aren't alone and I'm afraid most of us have been through this same experience. You're going to have to drag yourself out to find another doc who hopefully knows something about thyroid disease.

About what Midwest was saying, I think a big culprit is that the ranges are not correct for any of these tests. They need to lop off the bottom half of the FT3 and FT4 and call us "in range" only if we fall in the upper half-- and even then it's an individual thing and everyone needs to be treated by symptom relief. The TSH needs to flag anyone above 1.5 and if symptomatic further FT testing should follow as a matter of course. Doctors are trained to follow lab ranges like the holy grail and unless something is flagged "high" or "low" it's ignored. It just pisses me off that they won't listen to the patient and realize that the symptoms are the key to treatment.

And your doc's response about the antibody test was laughable. * Disallowed website and related information removed by hb-mod, moderator * , many doctors think that a patient with Hashimoto's should just be watched, not treated. But this is about the same as watching your leg get chewed off. I give your (former) doctor a big fat F for her performance.

Keep looking, post on some forums for a good doc in your area. You'll get this straightened out!

Last edited by hb-mod; 08-23-2009 at 01:53 PM. Reason: Please don't post disallowed websites as per Posting Policy. Thanks.

 
Old 08-10-2009, 02:17 PM   #7
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Re: Overwhelmed, not sure where to go from here...miscarriage, undiagnosed hypo?

Mcaimless and midwest -- your support and info is truly helpful, thank you. What you're both saying about the lab ranges makes complete sense to me. I really don't understand why these doctors see them so absolute, so black and white. A great tool, definitely. But it seems common sense to me that everyone is different, and what's normal for one -- or even normal for most -- isn't necessarily normal for all. And you know, I even understand putting a lot of weight on labs over symptoms, because symptoms (and the people reporting them) can be unreliable, vague, inaccurate, whatever. But come on, there has to be at least a smidge of credence given to them! For my doctor to basically say, I don't care if you have 100 severe symptoms and sky high antibodies, tough luck, is just....ugh.

Ok, rant over for the day. Thank you again, really.

 
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