Hypothyroid or hypochondriac?

March 30, 2007 2:26 PM

Is my thyroid underperforming, or am I just being a hypochondriac? My TSH level is 3.47 and my primary care physician thinks I'm fine. But I don't feel quite right. The endocrinologist is expensive and takes forever to get an appointment with. I just want to know if I'm wasting my time.

I am exhibiting symptoms of being hypothyroid. Here they are. About a year ago I went off hormonal birth control and began charting my fertility patterns. I noticed that my body temperature is consistently below 98.6, usually around 97.1 or less. I also have the hardest time losing weight. Last summer, as part of my scientific approach to my body (chart for fertility, fitday.com for weight loss), I went several months tracking my caloric intake and exercise. I work out 4 days a week, 3 days doing 30 minutes cardio + 30 minutes weight training, plus a vigorous yoga class. I ride my bike around town. I walk places and take stairs. As far as eating, I started out around 1800 calories a day, then slowly took it down till I saw results. I didn't see any weight loss till I got to about 1200-1300 a day. I should add that I'm 5'7" and pushing 170 lbs. So, yeah. That was frustrating. The weight loss I did see was minor, like a pound every 2 weeks. Other signs: dry skin / eczema, not a lot of energy (I need 9-10 hours of sleep a night or I find it hard to concentrate & yawn all day), constipation, and I always feel cold. Oh, and my blood pressure is always low. Like, 110/60. Both my grandmother and mother are diagnosed as hypothyroid and are on medication.

So I went to see my gynecologist as my PCP. I had the blood tests, and here are the results:

TSH: 3.47
Thyroxine – free: 1.1
T3 – total: 116

From my online research, a TSH over 3.03 is now considered hypothyroid. I told this to my doctor, and she said I should see an endocrinologist to pursue it further, because these numbers seemed fine to her. I'm in the Bay Area, and have heard great things about Dr. Nathan Becker. But he's expensive, doesn't take insurance, and it takes forever to get an appointment. I just want to know if there's anything that he could even do for me, or if I'm imagining these problems. I am a little neurotic. But, you know, the thermometer doesn't lie!

posted by apostrophe to health & fitness (13 comments total)

Thyroid disease is hard to diagnose, and all the symptoms you describe are quite nonspecific - that is to say, they happen for a lot of reasons other than thyroid disease.

Your lab numbers that you provided are not meaningful, because you did not provide the normal ranges from the laboratory that measured them. Normal ranges differ from laboratory to laboratory and you must always consider the normal range. You must not compare values from different laboratories, which you try to do in your last paragraph. This practice leads only to sorrow.

I understand the temptation to think, "Am I hypothyroid? In that case, thyroid supplementation would make me lose weight, give me more energy and wakefulness, and all in the context of improving my health!" Unfortunately this is not the case. If it were, I'd be taking thyroid supplementation myself. Thyroid supplementation is unnatural and causes health problems of its own. It's appropriate as a treatment for severe hypothyroidism.

Go get your opinion from the endocrinologist, who is an expert. Value that opinion as you would any expert's, and try to follow his/her advice.
posted by ikkyu2 at 2:50 PM on March 30, 2007 [1 favorite]

I don't know if anyone here can answer your question fully. I do know that TSH is not the whole picture. If you are in fact feeling the symptoms of hypothyroidism then a visit to an endocrinologist is certainly in order.

Anecdotally, I am hypothyroid and have been taking daily pills for the last ten years. I'm not happy about it. On my recent regular test I had a TSH of 4.3 --- that is, my TSH is 4.3 even though I'm already taking a thyroid supplement. My doctor said she'd be willing to up my dose if I was feeling hypothyroid symptoms but that otherwise I was on the upper end of normal. I do know what happens if I dont take my pills (e.g. when I was traveling once and I forgot them) and the symptoms were much more severe than the ones you describe. My results don't apply to you(!) but thats one data point...

on preview: what ikkyu2 said
posted by vacapinta at 2:59 PM on March 30, 2007

My random data point: When I don't take my thyroid medication, my TSH levels will work themselves up to ~20. Yikes.
posted by cgg at 3:21 PM on March 30, 2007

Well, I'm 5'6" and have a general body temperature of about 97 and have to get down to about 1,200 calories to lose weight (1,600 to maintain, 1,800 to maintain when active), I have low blood pressure and always feel cold, and I don't have any thyroid issues. I think these are factors that aren't that unusual for women in general.
posted by croutonsupafreak at 3:24 PM on March 30, 2007

Count me in as exactly the same as croutonsupafreak re. losing weight, low temp, low BP and no thyroid issues. Your symptoms are non-specific and only an endocrinologist can tease out any problem.
posted by gaspode at 4:12 PM on March 30, 2007

Is there no chance of finding another endocrinologist that does in fact take insurance?
posted by Octoparrot at 4:32 PM on March 30, 2007

I must chime in to agree with croutonsupafreak & gaspode. I often run 96-97 degrees (anything above 98 is a mild fever for me), have low blood pressure, often feel cold (especially hands & feet), need a *lot* of sleep, and don't tend to lose weight unless I drop calories to at or below what is supposedly my basal metabolic rate. The first three are not uncommon for women, which is only to say that your symptoms don't *necessarily* point to hypothyroidism. However, given that you have a family history, I can only add my agreement to the chorus of calls for an endocrinologist.
posted by tigerbelly at 5:10 PM on March 30, 2007

You have all the classic symptons.

Actually when Im around 3 something TSH, I know Im going hypothyroid again.

I found out just the other day at the pharmacy my thyroid pills were defective, and replaced with new ones.

Funny thing that because I kept saying to husband, my thyroid pills feel like sugar pills and like they aren't working, and Ive been sleeping a lot more and my hair is starting to fall out again.

My old endo used to keep my TSH around 1 something but with these latest pills it zoomed up to almost 4.

I think at the very least you are borderline and moving towards hypothyroid and considering your family history....

I have to have a fever to even make it a 98 degree body temperature.

I would go see an endocrinologist as soon as possible. Dont let it go to far, hypothyroidism left untreated can do bad things...
posted by Budge at 6:19 PM on March 30, 2007

It sounds like the blood tests were the 'old way' of diagnosing hypo. TSH tracking really isn't effective, since some people can have normal TSH levels, but still be clinically hypo.

Now that I've gone hypo (from hyper), my endo tracks my thyroid hormone by using the Free T4 blood test (T4 being what supplements like Synthroid have - the body converts T4 into T3) rather than TSH, FTI, and Total T3.

From talking with her, it's not uncommon for some people to have TSH levels as low as 2.0 yet still have low thyroid hormone levels, so the 'recognized' 3.03 (and the previous 4.5) TSH cutoff isn't a good indicator.
posted by rmoody at 6:40 PM on March 30, 2007

If it makes you feel any better, I'm another one: 97.1-97.7 body temperature, exercise a lot and don't lose weight (but I do eat a lot), low blood pressure, and I also have the hairloss and fucked-up eyebrow thing going on. TSH 3.521 with reference range 0.380-5.500. The doctor refused to do a full thyroid panel for me, so I don't know the rest of the numbers.
(I'm getting another doctor.)
posted by bink at 8:24 PM on March 30, 2007

get a referral to an endocrinologist that takes your insurance. the "gourmet" doctor might be good, but there are plenty of good doctors out there, and it's not like you are dealing with something all that exotic, especially given your family history. you can drive yourself crazy analyzing the symptoms and comparing them to other people, but only a doctor can put all the pieces together in a meaningful way. you can always go to dr. amazing for a second opinion if the one your insurance covers isn't able to help you.
posted by thinkingwoman at 9:06 PM on March 30, 2007

I really like my SF-based endocrinologist, E. Ann Myers (2250 Hayes). She might help you explore both thyroid-related issues and other related and unrelated endocrine issues as needed.
posted by judith at 9:27 PM on March 30, 2007

Jacob Teitelbaum advocates using thyroid medication on Chronic Fatigue patients whose thyroid levels appear normal. Which is not to say that you have CFS; just that it's possible you could benefit from thyroid treatment. In any case, Teitelbaum's website covers the specifics.
posted by Clay201 at 10:04 PM on March 30, 2007