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greenmtn amoeba 07-15-2009 08:32 PM

Newly hypo—need input on labs/treatment
 
Good evening, everyone!

After six years of feeling like I was losing my mind, having doctor after doctor label me depressed, anxious, stressed, exhausted and so on, my labs are back and I have a diagnosis: central hypothyroidism potentially caused by a lazy pituitary gland, which might have started with a missed case of Sheehan's Syndrome after the birth of my second daughter six years ago. (Apparently, one's illness isn't real unless it has an official name. But I digress!) My numbers are not straightforward, which may explain why it has taken me so long to get to this point.

Here's the lowdown on me. Labs are what the endo ordered; they seem very complete to me in some areas and potentially lacking in others. Does this diagnosis and testing approach seem right/thorough to you?

38-year-old female
diagnosed with premature ovarian decline (not failure) at age 32, central hypothyroidism at 38
symptoms since postpartum, age 31.5
cold, depression, irritability, rashes, weight gain (20 lbs. since Jan 2009), exhaustion, etc.
autoimmune illness (rheumatoid arthritis, pernicious anemia, goiter) on both sides of family

current meds:
zenchent (birth control pill, taken without break as estrogen supplement)
synthroid 12.5mg daily (just started)

imaging:
MRI of pituitary normal in size and architecture, no lesions (negative exam)
Nuclear scan of thyroid normal
Thyroid RAIU low at 2.7%, lobes normal, no hot/cold nodes

labs (June 2009):
ACTH 7.6 pg/mL (tested 6/25/09, reference range 10-60 a.m. draw)
ACTH 7.1 pg/mL (tested 6/9/09)

Serum Cortisol (stimulation) base 17.5 ug/dl (reference range 5.0-25.0)
Cortisol 30 min. 32.4 ug/dl
Cortisol 60 min. 40.8 ug/dl

Urine cortisol 35 ug/24 h (reference range 3.5-45) volume 127 ml

Urine volume 24 hrs. 750 ml
Urine creatinine 24 hr 208.0 high (reference range 20.0-125.0)
Urine creatinine cal 1.6 (0.6-2.5)

labs (May 2009):
TSH 0.68 (range .40-4.00) *in April it was .89
T4 Free .80 (range .5-1.50)
T3 total 119 (range 60-181)

Thyroglobulin antibody 59 high (range 0-40)
Thyroperoxidase antibody 12 (range less than 35)

Leukocyte count 3.8 low (range 4.0-10.5)

vitamin D, B, etc. not tested

long-ago labs in 2005/2006 had my TSH around 1.4; lowest was .9 and that's where a hormone specialist flagged me for potential problems (possible Hashimoto's).

While I am pleased to have a diagnosis in my chart, I'm not 100% thrilled with the treatment I am receiving and would love some thoughts from others more experienced with this than me. My endocrinologist is nice enough, but seems a bit half-hearted about treatment and is extremely focused on numbers—when she gave me my lab results, she pushed for me to take an antidepressant until I specifically requested action on my thyroid. That said, when I told her I had taken antidepressants in the past with no response to the medication or alleviation of symptoms—in fact, they make me horribly ill, cause tremors and make me feel like I'm going crazy—she seemed to respect that. But when I asked for nutrition/dietary and lifestyle ideas to help with my symptoms, and mentioned to her that I liked to treat things as naturally as possible, she didn't offer much.

My current treatment is 12.5 mg Synthroid daily; I wasn't given any other options. She says she may bump it up based on lab results (ugh).

Do you have ideas for:

How long it will take before I'm able to tell if this med helps me at all?

Other meds that I might want to ask about/consider?

If lab numbers are a reasonable way to measure progress for treating my condition (I want to know how much medicine to take to make my symptoms better, not to "treat the numbers")?

How to be an educated and assertive patient?

My apologies for the very long post. I appreciate your taking the time to read and comment!

javelina 07-16-2009 12:19 PM

Re: Newly hypo—need input on labs/treatment
 
Interesting post! I'm not that well versed on central hypothyroidism but I can make a few comments on your labs:

Your Free T4 is somewhat low. It should ideally be in the top 1/3 of range. Yours is just around 50%. You really need a Free T3 to effectively diagnose hypothyroidism but I'm guessing with your symptoms you're hypo.
Your ACTH seems to indicate you've got a cortisol problem and I'd look to get a saliva cortisol test to see where you fall with diurnal cortisol levels. If your cortisol is low you need to treat that before any thyroid hormone replacement is going to work. Cortisol is necessary to get the active thyroid hormone, T3 into your cells.
You also have Hashimoto's per your antibody test. Hashi's can cause all kinds of symptoms and alternate from hypo to hyper.
[COLOR="Blue"]* Disallowed website and related information removed by hb-mod, moderator * [/COLOR]
Also get your Vitamin D and B12 as well as ferritin levels. It's very likely you're low there too so you'll need to verify that and treat.
You might have trouble (major understatement here) getting your doctor on board for all this. Endos are pretty notorious for being a tad rigid in their treatment. You might have to search around to get the kind of treatment you want and don't just limit yourself to endocrinologists. [COLOR="Blue"]* Disallowed website and related information removed by hb-mod, moderator * [/COLOR]

I hope this helps!


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