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Old 09-30-2012, 02:17 AM   #1
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Location: Sonoma, CA, USA
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Subclinical Hypothyroidism

I started on BHRT because of digestion problems, fatigue and fat that suddenly appeared around my waist despite 4+ days a week of bikram yoga. Out of left field the words "subclinical hypothyroidism" were thrown at me. I had heard from friends who had thyroid issues but they all were pretty overweight, constantly dieting and ate poorly. I never in a million years thought this could be my problem. After doubting my hormone specialists diagnosis I looked at old labs from 2 years ago when I felt great. My TSH was 1.54. In July of this year when I felt especially lousy my TSH was 3.0 and then in September after having been on BHRT and adrenal support for a month my TSH was down to 2.11. At this level I felt a lot better but I still didn't feel good or even great. I had lost my appetite because whatever small amount of food I ate caused me to feel like I had eaten a whole side of beef. I was so fatigued and tired after the smallest meal. I was also falling asleep in bikram yoga class and other places, was cold all the time with a body temperature that never registered higher than 97 degrees, had lost my libido which was always very strong, had dry skin and sudden weight gain despite little appetite.

My hormone specialist has put me on Cytomel which I've been on for four days. The Cytomel has made me a little depressed and weepy in the afternoon. Today I had a headache all day. I'm wondering if I should even be on this medication and am also wondering what the potential risks are if I don't really need to be on this medication and am not hypothyroid.

My labs are so confusing. I don't understand how bad they are, if they just show a very mild case of subclinical hypothyroidism or if it's very clear by these labs that there is a problem. I definitely don't feel great and my mother and grandmother had thyroid problems. I've been uber healthy and have always eaten very well, exercised and taken care of myself. The thought of having to take medication for the rest of my life is scary to me. I would love some comments to help me understand my labs, what they actually mean and what optimal levels would look like. Thank you!

TSH - 2.11
T3 Uptake - 28
T4 Free Direct - 1.1
T3 Total - 102
Free T3 2.8
Reverse T3 30

 
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Old 10-01-2012, 12:06 PM   #2
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Re: Subclinical Hypothyroidism

TSH shouldn't be the focus to determine a hypoT diagnosis. The free levels of T4 and T3 are most important. Mainstream medicine doesn't agree with that for the most part, so you're lucky to have a more open-minded MD.

T4 Free Direct - 1.1
Free T3 2.8
Without the lab's range for each of these tests, I can't say for sure... But these levels would be hypothyroid for the majority of the population. The center point of most common US ranges for FT4 would be 1.3; for FT3, 3.25. Yours are well below those. If you have symptoms that can be thyroid-related, you should benefit from optimizing those FT levels.

Most cases of thyroid disease are autoimmune in nature. That's what makes them familial. The AI process is thought to be the result of a genetic flaw; the trigger for the process is yet unknown, but lifestyle practices won't prevent it.

Cytomel is synthetic T3. Since your FT4 is just about as low as your FT3, Cytomel only is probably not the wisest choice of treatment. Almost all hypoT patients need T4, with T3 added later if the T4 proves insufficient to raise the FT3 level.

I would say... If you have a family history and FTs as low as yours are now, it's in your best interest to start treatment now. Your gland is failing, and your levels are not likely to improve on their own. Treating now will prevent a further slide into more severe hypoT that will be harder to recover from than a milder version.

Hope that helps in your decision.
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Old 10-01-2012, 03:32 PM   #3
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Re: Subclinical Hypothyroidism

Midwest 1, thank you so much for taking the time to reply. http://www.healthboards.com/boards/images/smilies/angel.gif I've read about subclinical hypothyroidism for what seems like days now but I still didn't know to post the lab ranges. I just assumed that all the lab ranges were the same for everyone's tests. I don't know if this helps.

TSH - 2.11 (.40-4.50 mIU/L)
T3 Uptake - 28 (22-35%)
T4 Free Direct - 1.1 (0.8-1.8 ng/dL)
T3 Total - 102 (76-181)
Free T3 - 2.8 (I don't have the actual labs just the value but I was told by my NP that they should be 3.6-4.4)
Reverse T3 - 30 (Don't have the actual labs just the value but was told they should be less than 10)
DHEA - 76 (25-220 mcg/dL)
Testosterone Total - 43
Testosterone Free - 1.7
Estradiol - 32 (pg/mL)
Progesterone - 0.9 (ng/mL)

Can you tell me if T3 (Cytomel) can cause depression? I'm emotional and anxious and I think depressed which is completely unlike me. Normally nothing bothers me. Do you think that adding T4 will help with that? Is there any reason why my NP might want to start me just on T3? She's been very concerned about my adrenal status and so is titrating me up very slowly. I've been on 1/2 a 5MCG tab for the past week and will then go to one tab every morning although my NP says that I'll ultimately need to go quite a bit higher.

Thank you for the information that lifestyle usually has nothing to do with thyroid disease. Somehow I get comfort in knowing that there wasn't much I could do to prevent this.

Btw, my general doctor saw my 3.09 & 2.11 TSH and told me my thyroid was fine despite my symptoms and the fact that my mother and grandmother had thryoid disease. I ended up going to a nurse practitioner who has a practice that specializes in hormones. Honestly, I'm not sure why I have medical insurance anymore! Thank you again so much.

 
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