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Old 01-19-2002, 04:20 PM   #1
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help! need PROFESSIONAL advice regarding labwork, hormone levels

I recently underwent a full battery of tests. I have some complicated health issues and need advice from a professional. We have been trying to get to the bottom of my health problems for a long time and just cannot get there.

I've been feeling unwell for quite some time, and have been gaining weight for no reason since I am not an overeater, have a good diet, drink lots of water, and I excercise daily. NOTHING will make the weight drop off, instead I am doing a slow gain. My doctor says that dieting harder will compromise my health. On a normal day I am usually less than 1100 calories. My appetite is pretty much gone, and I know some days I get fewer than 1000 calories. I am losing my hair. I get very sick on warm days, cannot take high temperatures at all.

I have been diagnosed with bipolar disorder (and have been in total remission now for nearly nine years). I did have a tubal ligation nine years ago....although I've always been moody and depressed, shortly thereafter I developed the symptoms of bipolar. My doctor suspects PCOS, however my pelvic ultrasound came back normal. I have been having some problems with edema in my lower extremities, and headaches. Worst of all, I have been having awful episodes of low blood sugar and I am having high blood pressure readings. I am desperate to get some weight off and nothing is helping. I'm feeling quite discouraged.

It appears from my tests that I have some significant hormonal issues.

HORMONE LEVELS:

FSH: I tested out: 8.1 (5.0-20.8) ALTHOUGH WITHIN RANGE, THIS IS QUITE LOW.

LH: 4.4 (18.1-90.2) THIS IS ALSO IN THE NORMAL RANGE, BUT AT THE VERY LOW END.

PROGESTERONE 0.1 THIS IS LOW, WAY DOWN INTO POSTMENOPAUSAL LEVELS, but I am still having my monthly cycles, very heavy ones.

TESTOSTERONE 15 (10-80) LOW END OF THE NORMAL RANGE

FREE THYROXINE INDEX: I test out at 2.6 (2.0-4.3) FAIR, BUT AT THE L0W END OF NORMAL RANGE.

TSH: I TEST OUT AT 1.51 (0.35-4.94) LOW END OF THE NORMAL RANGE

T3 UPTAKE: 32 (32-42) THIS ALSO TESTS OUT AT THE VERY LOW END OF THE NORMAL RANGE.

T-4. TOTAL 8.2 (4.8-12.2)tests out MIDRANGE.

DHEA 907 (130-800) TESTS OUT VERY HIGH

ESTERONE (estrogen): I test out at 32 LOW!

In my blood chemistry, my LDLs are high (137) and my HDL's are high (235). Total cholesteral is slightly high (235). Liver and pancreatic assessment shows a high ALP (114) possibly the result of gallbladder removal. I do take Tegretol, which can elevate ALP levels.

Hematological tests are showing no abnormalities, however I have very low basophils (0.1) and eosinophils (0.7).

My doctor has ordered a 3hr fasting glucose and things that glucophage may be helpful. I take effexor and tegretol for my bipolar.

If anyone can give me some insight about these lab results, I'd be EXTREMELY greatful! If I can't get some improvement in my health, I don't know what I will do. I am the mother of three, and my eldest is disabled with tourettes and possibly bipolar...I need to be in good health so I can help him.

 
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Old 01-20-2002, 01:27 PM   #2
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

Let me first state clearly that I am not a doctor, nor do I play one on TV. I will be studying to be a PA at some time in the future, but I have not even started school, yet. I HAVE studied a great deal about thyroid and adrenal imbalances--more than most doctors, literally several hundred hours--but this is just my interpretation and should be discussed with your doctor or another doctor for other educated opinions.

The first thing I would ask you about is your diet. You say that you eat healthy and drink plenty of water. That's a great start. On the other hand, 1000-1100 calories a day is NOT NEARLY enough to keep your thyroid healthy and keep your metabolism going (I'll get to your thyroid levels in a minute.). 1500 calories a day would be a better target. You might start gaining, initially, but would have more energy and would be more likely to be able to get results from your exercise and have more energy to function.

If you are trying to lower calories and eat plenty of protein, please do NOT eat products that contain Soy. Soy interferes with the function of your thyroid gland so it puts out less thyroid hormone, and it also interferes with how your tissues metabolize thyroid hormones. Thyroid tests might come out low normal, but you still have all the symptoms of hypothyroidism, including weight gain and inability to lose weight, fatigue, hair loss, etc. Your Low T3 Uptake (this test has nothing to do with T3, despite the name) indicates that more than the normal amount of thyroid hormone is being bound in your blood. This could mean that you have too much estrogen, are pregnant, or this is common in people who consume too much Soy. Since you have ruled out the first two, soy is the only remaining COMMON factor left. There may be others, but not likely.

The binding is why your FTI (Free Thyroxine or Free T4 calculated by multiplying your T4 by the T3 Uptake) is low normal, though your T4 is mid range. You have thyroid hormones, but your body can't immediately use the ones that are bound.

Are you taking any thyroid meds? If you are what are you taking? You are likely undermedicated due to the binding effect. Though your TSH is "normal" It may not be an accurate indicator of where you actual thyroid hormones are in your blood. Most people feel best with a TSH of less than 1 but still above the bottom of the range. Ther have been studies done that have clearly indicate that within "normal" levels, TSH has no correlation with symptoms. Further, according to the online thyroid text at <A HREF="http://www.Thyroidmanager.org" TARGET=_blank>www.Thyroidmanager.org</A> , studies have shown that TSH can vary as much as threefold in a single day. TSH can also be suppressed by high cortisol levels, which may be suspected (see below). I would recommend getting direct Free T4 and Free T3 tests done to be able to determine where your levels of thyroid hormone are, just to be sure.

As an example, My TSH has to be very low (less than .01) for my thyroid levels to be even near the middle of the range and alleviate my thyroid-related symptoms. Most doctors would take me off the thyroid meds. This is due to the fact that my hypothalamus does not accurately read the amount of thyroid hormones in my blood. That would be food for another discussion, though.

If your Free T3 and or Free T4 are even low-normal, most people would have symptoms in those ranges. Many forward-thinking doctors go by Free T3 and Free T4 and have better resolution of symptoms with their patients than doctors who use the conventional approach of following TSH. The target woud be to keep the level slightly above the middle of the range. In fact the prescriptoi insert for Synthroid (and I am assuming other thyroid meds as well) states that in cases where TSH does not correlate with T4 levels, to dose it by following T4 levels instead.

On the note of hair loss, have you had your Ferritin (Iron Store) level checked? Especially if you are menstruating heavily (also possibly caused by low thyroid levels), this could be low. Even Low-normal levels (below 50 thought the scale goes down to 20) are known to cause hair loss and this is common in hypothyroidism patients. Others may have more info on other causes, but for some reason this one sticks out in my mind for you.

I am a little confused that you are having LOW blood sugar spells and yet your doctor thinks Glucophage would help. If your blood sugar is already low, glucophage will make it lower. The Glucose Tolerance test will tell you whether you need it ir not. Perhaps he thinks that you are diabetic rather than hypoglycemic? On the other hand if you are truly hypoglycemic, then the glucose tolerance can be an uncomfortable experience, and I don't like it for that reason.

First, I would also suggest an AM Cortisol test and ACTH Stim Test to test your adrenals. Since your DHEA is high and this is made by your adrenal glands, it is also possible that your Cortisol is high, too. This could cause some symptoms, too, including weight gain. This often happens in people with low thyroid function as the adrenals try to boost cortisol and adrenaline to keep energy up becasue the thyroid is slowing the metabolism. Higher cortisol levels raise blood sugar for energy. Eventually The adrenals become fatigued and the cortisol levels go low, then you tend to have LOW blood sugar correspondingly. The book From Fatigued to Fantastic has great information on how to interpret these tests and optimize your health with your doctor's help.

If you have adrenal problems, this MUST be resolved before or concurrently with thyroid problems, according to the manufacturers of ALL thyroid meds. Otherwise, a worsening of symptoms will be the result, confusing you and your doctor and setting you back in your treatment.

Now for the sex hormones. Your FSH, LH, Estrogen, and testosterone ALL are low in the normal ranges and this is fairly common in people with low thyroid function. This is because there are a large number of thyroid hormone receptors on the ovaries and without adequate thyropid hormones, the ovaries cannot manufacture your hormones properly. This is probably an adaptation so that in times of famine (or low cal dieting) you wouldn't be wasting energy on reproduction, but just surviving. These often resolve themselves when you get enough calories proper nutrition, adn get thyroid levels more normal, so it is prudent to get the metabolic problems solved first (nutrition and adrenal, then thyroid in that order).

Again, I am not a doctor, and this is only my interpretations based on many hundreds of hours of studying. This still warrants discussion with a professional. Please don't expect medical advice over the internet.<p>[This message has been edited by Meep (edited 01-20-2002).]

 
Old 01-20-2002, 01:41 PM   #3
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

I missed the fact that you are taking Effexor.
Depression is a symptom of untreated or undertreated hypothyroidism. The book The Thyroid Solution has a good discussion of this and how thyroid hormones being low can affect your moods. It mentions bipolar as well as clinical depression.

SSRI antidepressants (Paxil, Prozac, Zoloft, etc) also affect thyroid levels, so if your depression is indeed thyroid Effexor's insert doesn't mention this, but it is still possible. Effexor's Insert DOES mention sexual problems, but doesn't mention HOW it causes sexual problems. I suspect that possible suppression of testosterone levels may play a part, here.

Just a thought I had to share...

 
Old 01-20-2002, 04:17 PM   #4
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

Meep, THANK YOU for taking the time to give me such a thorough opinion. Sheesh, this is complicated stuff....

I don't eat a lot of soy. It's something I avoid like the plague....I read all my labels and avoid soy products whenever I can. And I am NOT pregnant <IMG SRC="http://www.healthboards.com/ubb/wink.gif">.

I do have very heavy, irregular monthly cycles, however my blood chemistry shows that I am NOT anemic.

My internist strongly suspects PCOS and the glucophage has a secondary use in resolving insulin resistance, which is a problem in PCOS patients...she thinks my pancreas are loading my system with insulin and my body isn't absorbing it. I'm having the three hour glucose tolerance done Monday (yech!).

I'm thinking I need to get to an endocrinologist for some additional evaluations for the hormonal issues. I think maybe this is out of my internist's league.

 
Old 01-20-2002, 09:29 PM   #5
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

Well there is one other thing that comes to mind, too. PCOS and hypothyroidism are often seen together as well.

 
Old 01-21-2002, 07:26 AM   #6
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

hypopituitary??

 
Old 01-21-2002, 07:31 AM   #7
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

did you check out hypopituitarism? when you say you cannot tolerate warm temps.....maybe sould be checked for hypoadrenalism...primary and secondary. do a search on <A HREF="http://www.***********" TARGET=_blank>www.***********</A> for hypopituitary.

 
Old 01-22-2002, 03:25 PM   #8
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Re: help! need PROFESSIONAL advice regarding labwork, hormone levels

BTW,
there is no professional advice on this website.
We meet as peers here.
Just so you know, we are experienced and well-read/studied, that is all.

 
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