Help with blood work...please.
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Help with blood work...please.
| Sat, 11-20-2004 - 2:26pm |
Hello everyone. I am new here with some questions I hope someone can help me with. Yesterday when having a follow up with my gastrointerologist a med student asked me some questions which led him to believe I may have a thyroid disorder. First anytime I walk up the stairs I get very out of breath and my heart starts to race. Also I have had a heat intolerance for a long time, and also cold intolerance. I stay tired even though I am only 23 years old. I have two children ages 18 months and almost 3 years old but I do not work. I go to college full time which isn't causing any stress and I go in the evenings so I don't have to get up too early. When I do wake up it takes me forever to get the energy to get up. He also said in med school he learned if a person can't stick their tongue straight out and hold it still then that may also indicate a problem. Well my tongue kept twitching and I had never heard of this before and neither had the GI. For two years I have had weight loss and many symptoms of hyperthyroidism but he seemed to think I have hypothyroidism. The only tests they ran was the TSH and FT4. Nine months ago my TSH only was checked which was 0.841. He said this was not clinically low but on the low normal range. The hospitals normal levels are 0.465-4.68 and yesterday my level was 0.275 and my FT4 was 0.93 with normal ranging from 0.78-2.19. I have read that birth control pills can increase the FT4 level. At first I thought I may have hyperT but after researching it seems if you have both low TSH and FT4 then it can be secondary hypoT. If this were the case why would I have lost so much weight instead of gaining as with the condition? Also is the TSH level low enough for them to see a problem or no? I am very confused about what could be going on and won't know anything until next week. Any help at all would be greatly appreciated.

That is odd. I am hyper/Graves.
Hi and welcome - According to the book, Living Well with Hypothyroidism, by Mary Shomon, a low TSH with a low T4 could possibly indicate a pituitary problem. Here's a site with info on the pituitary gland: http://www.ecureme.com/emyhealth/data/Pituitary_Disorders.asp
But don't start freaking out when you read about it because it may not be that at all. It's just what she says in her book. Often times, people with symptoms that seem like thyroid conditions have adrenal or pituitary conditions instead. The three glands are linked in the endocrine system.
I looked up secondary hypothyroidism and find that it's also linked to the pituitary gland: (http://www.muhealth.org/~daveg/thyroid/thy_dis.html)
Here's what it says:
Seconday Hypothyroid (Hypopituitarism) Secondary hypothyroidism is defined as the failure of the thyroid gland due to the inadequate production of Thyroid Stimulating Hormone (TSH). This can occur due to primary failure of the pituitary or as the result of hypothalamic dysfunction (tertiary hypothyroidism). Pituitary failure can result from destruction by pituitary and non-pituitary tumors, head trauma, radiation, postpartum infarction (Sheehan’s syndrome) or unknown causes (idiopathic). Generally the symptoms of hypothyroidism are less severe than in primary hypothyroidism and are often complicated by deficiencies of other pituitary hormones, as well as the mass effects of the intracranial tumor. Patients with secondary hypothyroidism must be evaluated for pituitary tumors and other hormone deficiencies.
Here's another article that also indicates there may be a problem with the hypothalmus:
http://www.merck.com/mrkshared/mmanual/section2/chapter8/8e.jsp
Secondary hypothyroidism occurs when there is failure of the hypothalamic-pituitary axis because of deficient TRH secretion from the hypothalamus or lack of TSH secretion from the pituitary.
Symptoms and Signs
The symptoms and signs of primary hypothyroidism are generally in striking contrast to those of hyperthyroidism and may be quite subtle and insidious in onset. The facial expression is dull; the voice is hoarse and speech is slow; facial puffiness and periorbital swelling occur due to infiltration with the mucopolysaccharides hyaluronic acid and chondroitin sulfate; cold intolerance may be prominent; eyelids droop because of decreased adrenergic drive; hair is sparse, coarse, and dry; and the skin is coarse, dry, scaly, and thick. Weight gain is modest and is largely the result of decreased metabolism of food and fluid retention. Patients are forgetful and show other evidence of intellectual impairment, with a gradual change in personality. Some appear depressed. There may be frank psychosis (myxedema madness).
There is often carotenemia, particularly notable on the palms and soles, caused by deposition of carotene in the lipid-rich epidermal layers. Deposition of proteinaceous ground substance in the tongue may produce macroglossia. A decrease in both thyroid hormone and adrenergic stimulation causes bradycardia. The heart may be enlarged, partly because of dilation but chiefly because of the accumulation of a serous effusion of high protein content in the pericardial sac. Pleural or abdominal effusions may be noted. The pericardial and pleural effusions develop slowly, and only rarely result in respiratory or hemodynamic distress. Patients generally note constipation, which may be severe. Paresthesias of the hands and feet are common, often due to carpal-tarsal tunnel syndrome caused by deposition of proteinaceous ground substance in the ligaments around the wrist and ankle, producing nerve compression. The reflexes may be very helpful diagnostically because of the brisk contraction and the slow relaxation time. Women with hypothyroidism often develop menorrhagia, in contrast to the hypomenorrhea of hyperthyroidism. Hypothermia is commonly noted. Anemia is often present, usually normocytic-normochromic and of unknown etiology, but it may be hypochromic owing to menorrhagia, and sometimes macrocytic because of associated pernicious anemia or decreased absorption of folic acid. In general, the anemia is rarely severe (Hb > 9 g/dL). As the hypometabolic state is corrected, the anemia subsides, sometimes requiring 6 to 9 mo.
Myxedema coma is a life-threatening complication of hypothyroidism. Its characteristics include a background of long-standing hypothyroidism, coma with extreme hypothermia (temperatures 24 to 32.2° C ), areflexia, seizures, CO2 retention, and respiratory depression. Severe hypothermia may be missed unless special low-reading thermometers are used. Rapid diagnosis based on clinical judgment, history, and physical examination is imperative because early death is likely. Precipitating factors include exposure to cold, illness, infection, trauma, and drugs that suppress the CNS.
Diagnosis
It is important to differentiate secondary from primary hypothyroidism; while secondary hypothyroidism is uncommon, it often involves other endocrine organs affected by the hypothalamic-pituitary axis. (you can read the rest of this on the site.)
I'm giving you all this info and these links in an effort to help you help your doctors if they should come back and tell you they have no idea what's wrong with you!! That may not happen but if it does, you may be able to direct them to look at some of these issues. I hope this helps!! Cathy :)