Misdiagnosed with Hypothyroidism?
The doctor at the clinic I started going to a few months ago for treatment of Rheumatoid Arthritis became concerned about my thyroid and after running some tests, told me I am hypothyroid and put me on Levothyroxine. Last week I went to see a doctor I have been seeing for a number of years, but from whom I can not afford to get blood work done - I brought him the results of my blood work and told him about the diagnosis and he immediately said I was misdiagnosed and to stop taking the Levothyroxine. He explained it to me, and from internet research it seems I was misdiagnosed (and, as I very much trust my long term doc, I stopped taking the medication).
The doctor at the clinic appears to have diagnosed me with hypothyroidism based on low TSH levels, while my T3 and T4 levels fall within normal ranges.
Here are the results of the blood tests he ran:
T3: 73 ng/dl (normal ranges 71-190)
Free T4: 1.06 ng/dl (normal ranges 0.82-1.77)
TSH: 0.331 uIU/ml (normal ranges 0.450-4.500)
I have chronic fatigue, weight gain, joint pain, etc. - but I have RA and am currently on prednisone (20mg/day, started 3 months ago at 60mg/day, reached 20mg/day a couple of weeks ago) and methotrexate, as well as gabapentin for persistent sciatica and other neurological issues, Vitamin D (blood work showed low vitamin D levels), and folic acid - so there are any number of reasons for various symptoms I have.
While I don't have much choice in regards to doctors at the moment, I am quite concerned if this was indeed a misdiagnosis - and need to address it on my next visit (he has also failed to properly manage my prednisone taper.... left me on 60mg/day until I said something about it, then told me to taper to 40/mg, then never said anything about tapering more... I took it upon myself to taper down to 20mg and will continue to taper as much as I can while retaining enough mobility until the methotrexate hopefully starts working - which is another area he seems to have failed to properly treat me with, having started and left me at a dosage of 7.5mg/week for 2 months, when my understanding and advice from friends who work with rheumatologists and RA patients is that he should have been increasing my dosage... I know this doesn't have anything to do with the thyroid issue, just explaining my concerns about this doctor in general!).
I would appreciate any confirmation or at least thoughts regarding the diagnosis/misdiagnosis!
Re: Misdiagnosed with Hypothyroidism?
I'm as distrustful of MDs as anyone can be. It's always a good idea in my book to double-check what they tell me.
I know nothing about the management of RA and next to nothing about how to taper a prednisone dose; but I do know about hypothyroidism, and I can assure you that this doctor does, too. You [b]are[/b] hypothyroid. I have no doubt at least some of your symptoms are due to it, and that replacement of your missing thyroid hormone will benefit you.
Healthy people have TSH around 1 to 1.5 and free T4/3 levels at 50-70% of their ranges. Your TSH is below range, on the hypERthyroid end, while your T4/3 are on the lower ends on the hypOthyroid side. In the textbook world, TSH is supposed to rise once T4/3 become deficient, but in reality it hardly ever works that way. Most of the time, hypoT is caused by auto-antibodies that suppress thyroid hormone production. These antibodies are known to also prevent the rise of TSH, but doctors aren't taught that. It means most people suffer for years in the hypothyroid state before their TSH rises high enough to be diagnosed.
Occasionally, hypoT happens due to pituitary dysfunction. The pituitary produces TSH, a signal hormone that tells the thyroid gland to adjust its output of thyroid hormone. Your below-range TSH coupled with low T hormones suggest that your pituitary might be sluggish. It isn't producing enough TSH to signal your thyroid gland to make more hormone.
A smart thyroid MD would see that your thyroid hormones (T4 and T3) are too low, regardless of your low TSH. Again... In an ideal, textbook world, your TSH would be high with Ts as low as yours. But in the real world, hypothyroidism comes in all shades of gray. Pituitary dysfunction is considered an ususual cause for hypoT, and it's one not commonly recognized. Therefore, an MD who's looking solely for the textbook high TSH/low T4/3 scenario is going to tell you everything is well when it actually isn't. Your trusted MD is mistakenly seeing it this way.
Whatever faults the diagnosing MD may have, he does seem to have better-than-average thyroid diagnosing skills.
Get other opinions if you must. I won't tell you not to trust your first doc, but I will tell you the second is not wrong (about your hypoT, anyway).
Re: Misdiagnosed with Hypothyroidism?
Thank you so much for the detailed explanation. That does make sense to me - and while I trust my long term doc, that doesn't mean he is infallible... or that the clinic doc has got everything wrong... thus my checking around and asking here! Trying to navigate such a myriad of different health issues and medications, most of which have a number of overlapping symptoms and make sure that I'm taking the meds I need but not any meds I don't need... well, confusing isn't a strong enough word for it.
Thanks again.... I will resume with the thyroid medication in the morning.
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