General Medicine

» SuperSquirrel - subclinical hypothyroidism

In response to subclinical hypothyroidism posted by daisyelaine:

My tsh is 2.69 ani have moderate to bordering on severe symptoms of hypothyroid, i.e low vitals very low heart rate abot 45-50 bpm body temp goes betwwen 96.5-97.5 loss of hair ...-thankfully i have alot of it to begin w/ so at frst it wasnt that noticeable but now its staring to show alittle- .... the classicfatigue ... dzed spacey out of it kind of feeling, loss of concentration, severe and i do meen severe cold intolerance- exaple, i work at a healthfitness center and there is a sauna in the locker room, on my break i will go and sit tin the sauna fully clothed ...a undershirt-wifebeater tank usually a t-shirt, track jacket, and 2 pairs of pants ussually a thinner pair of exercise pants under a big baggy pair of sweatpants, for 30 mins and i will not break a sweat, i actually find it quite comfortable and my co workers joke with me because about 90% of my time is spent behind the trainers kiosk(I'm a personal fitnesss trainer) next to the space heater. and I've have had amenorhea for the 3 years with the occassional spotting if that once a year. all of these things are starting to get worse but i cant make my doc understand the gravity of situation especialy how its affecting my job, how can i motavate explain or show people how to work out if im slurring my speech cant remember what to say or am sleepy and out of it 75% of the time ... please help ... every time i go to the doctor she tells me basically your results ar normal its in your head get more sleep and stop partying so much-I know im 20 but im not the partying typeim the sit home and read a book type.- I can't even do the one thing that i truely enjoy anymore -running- because i just dont have the energy and my joints are so stiff and sore ...not tometion i get really scared when my heart starts to beat irregularly.... and yet with all this i'm told yoour reults re normal ... your fine. again please help.

-- posted by SuperSquirrel

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» Elaine Moore - subclinical hypothyroidism

In response to subclinical hypothyroidism posted by SuperSquirrel:

Hi Super Squirrel,
I'm sorry I missed this post when I returned from vacation, and I apologize for the delay in getting back to you.
A large nutrition study (NHANES Study) showed that most normal adults have TSH levels between 0.3 and 1.0 mu/L. Based on these results and other studies, the TSH level has been lowered several times within the last few years. Now, a TSH higher than 2.5 suggests hypothyroidism. And for the last decade it's been reported that individuals with thyroid antibodies are likely to be hypothyroid with TSH levels higher than 2.0.

Your symptoms sound very much like those of hypothyroidism although amenorrhea is more likely to be seen in hyperthyroidism. This can vary though and considering your occupation you may have a lower body fat that's contributing to the absent or scant menstrual periods.

Doctors who specialize in Wilson's syndrome (not recognized as a condition by some endocrinologists) understand that basal body temperature is more relevant than blood tests. And doctors in the know realize that the TSH range has changed even though most labs are still using the ranges that come with the testing kits and these are rarely updated. The idea here is that endos will keep up with the latest recommendations.

Also important is the fact that TSH results can be misleading. They're falsely decreased in endogenous depression, night shift workers, and people with TSH receptor antibodies. These antibodies can cause hypothyroidism yet the antibodies keep TSH from rising. In a condition known as central hypothyroidism TSH is also low as the normal pituitary/hypothalamic/thyroid feedback mechanism is disturbed. The lack of TSH production causes hypothyroidism. Normally, TSH orders thyroid cells to produce a constant rate of thyroid hormone.

I hope that before your doctor proclaimed your thyroid fine he or she ran tests to measure your actual thyroid hormone levels, optimally your FT4 and FT3 levels and also tests for thyroid antibodies.

You might want to consider seeing another doctor. Through the thyroid board at about.com where I answer questions in The Ask Elaine Moore link, there's a referral page for recommended doctors. After our last move I found my doctor via this referral page. Hope this helps, Elaine

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» hjagasia - Subclnincal Hypothyroid, But No Antibodies. Why?

In response to Subclnincal Hypothyroid, But No Antibodies. Why? posted by RSweeney:

Hi,
I am in the same boat. I was diagnosed with TSH in at 5.2 and then 6.2 after 4 weeks. They did not find any TPO or any antibodies for Lupin, RA etc. I have even had a colonoscopy and upper endoscopy to rule out Chrons and any malabsorption disorder. This is turning into quite the mystery.

Have you found anything new in your case?

Thanks

-- posted by hjagasia

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» Elaine Moore - Subclnincal Hypothyroid, But No Antibodies. Why?

In response to Subclnincal Hypothyroid, But No Antibodies. Why? posted by hjagasia:

Hi,
Make sure they also ran tests for TSH receptor antibodies. Blocking TSH receptor antibodies can also cause hypothyroidism, but often they're not tested for. Best, Elaine

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» jrmdolphin - Possible subclinical hypothyroidism?

I am a 31 year old female who is very active and healthy. I had blood work done recently because I have not been feeling right for about a year now. The three major complaints I have are period that last on average 20 days, extreme intolerance to cold, and fatigue that is getting progressively worse. The blood work came back that I am not anemic, no vitamin b-12 deficiency, ANA (anti-nuclear antibodies) were detected in a very small concentration (1:40) and my TSH was 3.34. I have a great deal of the other symptoms of hypothyroidism also but the lab that did my blood work uses 0.5-5.0 as the reference range so the doctor called me "normal" and that was that.

Well I still feel poorly and I have had enough. Is it possible I am sufering from subclinical hypothyroidism? Something has definitely changed but when my blood work comes back, they just send me home without further investigation.

Any suggestions or advice? I would like to try a trial of thyroid medicine and see if my symptoms improve but I don't know how to find a doctor who treats if your TSH is over 3.0.

Help!

Thank you for your time.

-- posted by jrmdolphin

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» Elaine Moore - Possible subclinical hypothyroidism?

In response to Possible subclinical hypothyroidism? posted by jrmdolphin:

Hi,
The new range recommended by the Amercian Association of Clinical Endocrinologists uses a high end of 2.5 with higher levels suggesting hypothyroidism.
Considering your symptoms, many doctors would have run thyroid hormone levels (FT4 and FT3) and also tests for thyroid antibodies. If your thyroid hormone levels are normal this would suggest subclinical hypothyroidism. If either FT4 or FT3 were elevated, hypothyroidism would be suspected.
In people with thyroid antibodies TSH levels higher than 2.0 suggest hypothyroidism.
You have several options.
You could do a search on Wilson's syndrome and see if there's a doctor treating this disorder in your area. I'm not saying you have Wilson's syndrome, but doctors aware of this are more likely to understand the TSH reference range.
You could check Mary Shomon's top doc list for docs in your area that patients recommend for hypothyroidism.
You could call naturopaths or osteopaths in your area to see if any of them treat thyroid conditions.
You could follow up with an endocrinologist but you'd want to ask around and make sure you see one that's more progressive.
Best to you, Elaine

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» jmhilmore - Should I be concerned?

I am a 40-year-old female who has been complaining to my doctor for several years about feeling tired and achy and sinus problems. Of course my tests always come back ok and my doctor can never find anything wrong. She tested my thyroid and told me that my numbers were high but still in the normal range. I didn't think anything of it until I read an article in a health magazine about subclinical hypothyroidism.
I just requested copies of my medical records from my doctor and was surprised to see that my TSH levels have ranged from 6.7 in 2003 to 3.4 currently. Should I be concerned? I am confused about the numbers going down while I am now feeling my worst. In addition to the fatigue and being achy I am always cold, I go to bed exhausted and wake up exhausted. I am gaining weight and I can't seem to think straight and I have many others issues I am dealing with as well. I have not felt right for too long and I just want answers other than I am depressed or I have ear stones. Any information other than "I don't know" would be greatly appreciated.

-- posted by jmhilmore

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» Elaine Moore - Should I be concerned?

In response to Should I be concerned? posted by jmhilmore:

Hi,
According to current recommendations of the American Association of Clinical Chemistry, a TSH value higher than 2.5 suggests hypothyroidism. And it's likely that you were tested with a different method in 2003, which could account for the change or perhaps your thyroid function has improved somewhat since 2003. Either way, both results indicate hypothyroidism. You'd also want to look at FT4 and FT3 levels (not T4 and T3 since these are often falsely increased).
The problem is that many doctors don't take hypothyroidism seriously. Sometimes you have to shop around to find a doctor that understands how devastating even having slightly less thyroid hormone than is needed for your body's needs can be.
You might want to do some research on Wilson's syndrome or Broda Barnes and look for lists of doctors who follow these guidelines. best, Elaine

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» snowcycle - Your opinion please

I just found this site, because I have been doing a ton of research on my own about thyroid problems. Doctors don't seem to be up to date, I just saw my third. I can relate with everyone that has posted.
I have been feeling not great for a while now. Last year I went and had blood work done because of fatigue and swollen face mainly eyes and he said I was vitamin deficient "take a multi". So I did at that time my TSH was 3.8 and T4 on the lower side of normal. I just went agian (different doc) and TSH was 5.3 and T4 was .83 and I have been B12 anemic this whole time (will someone explain to me how that fits into all this). So we retested 5 weeks later (two weeks ago) and my TSH was 4.5 (I had also been taking a thyroid supplement for abount 2 weeks at that point. OH and she said they tested for antibodies and found none. She said I was in the norm and won't treat me. I feel like crap have tons of symptoms and noone has any anwsers. I am an athlete and this is very frustrating. Please anyone help.

-- posted by snowcycle

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» Elaine Moore - Your opinion please

In response to Your opinion please posted by snowcycle:

Hi Snowcycle,
The American Association of Clinical Chemists recommends using a range of 0.3-2.5 for TSH, with values higher than 2.5 mu/L suggesting hypothyroidism. Unfortunately, while the TSH range has been lowered twice in the last few years, no one tells the manufacturer's of our testing kits. And labs today are able to use the range provided by the manufacturer. So unless labs are paying attention, they use these old reference or normal ranges. Some labs know about the recommendations but would have to test their local population to verify these lower ranges. The lab I work in did lower their range. Other labs sometimes think that the endos should know the new recommendations and follow them rather than the range listed by the lab.
Either way, it's poor medicine, with most doctors not realizing that there are new guidelines. Your doctor is a prime example.
I have some articles here that discuss the new ranges dating back to 2003. You should be able to find them with a search on this site. People with autoimmune thyroid disease also have a higher risk of vitamin B12 deficiency. Here's a link to an article I wrote on this:
http://autoimmunedisease.suite101.com/ar...

Most hypothyroidism is autoimmune although most doctors don't run all the thyroid antibody tests needed to determine this. For example, you probably had tests for Thyroglobulin and TPO antibodies. You should also have had tests for either total TSH receptor antibodies or TBII (thyroid binding inhibiting immunoglobulins). These tests measure both stimulating and blocking TSH receptor antibodies. Blocking TRAb contribute to hypothyroidism but few doctors order this test.

You might do some research on Wilson's syndrome or Broda Barnes to help you find a doctor who understands new ranges and who understands that symptoms can be more important than lab tests. Tests for basal body temperature can be a better indicator than blood hormone levels.

You might also skim through the posts on the Graves' disease thread. Because hypothyroidism often develops in people who start out hyperthyroid we end up discussing TSH ranges and problems with hypothyroidism in that thread too. Best, Elaine

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