I can't get my hypothyroidism under control.
November 23, 2010 | 40,00 EUR | answered by Dr. med. Christoph Schmülling
Hello,
I am a 22-year-old female living in Tenerife, and I was diagnosed with hypothyroidism in February 2010.
The medications I regularly take are:
- L-Thyroxine 75 mcg
- Colestyramine
Unfortunately, I still have not been able to control the hypothyroidism. Additionally, I do not feel well overall. Typical symptoms such as fatigue, exhaustion, feeling cold quickly, and hair loss continue to bother me. My levels have also not stabilized.
Here are my results since the beginning of the hypothyroidism:
05.02.2010 TSH: 7.21 µlU/ml (0.40 - 4.00)
- Started taking 25 mcg L-Thyroxine
19.02.2010 Antibodies
MAK: 9.0 kU/l (increased to 50 mcg L-Thyroxine
Moved from Germany to Tenerife
05.07.2010 TSH: 2.15 mcUl/ml (0.34 - 5.60)
- Increased to 62.5 mcg L-Thyroxine on my own responsibility, two weeks later to 75 mcg
20.08.2010 Comprehensive blood test
TSH: 0.77 mU/l (0.35 - 4.94 mU/l)
fT4: 18.22 pmol/l (9.03 - 19.08 pmol/l)
fT3: 3.0 pg/mL (1.8 - 4.2 pg/mL)
Iron: 33.0 mcg/dl (37 - 145 mcg/dl)
Ferritin: 27.1 ng/ml (10 - 160 ng/ml)
- Diagnosis: Iron deficiency and prescription of Tardyferon 80mg
18.11.2010 TSH: 1.9 (no reference value, as no lab report)
fT3: 5.57 pmol/l (4.0 - 8.3 pmol/l)
- Diagnosis: Iron, ferritin levels are normal and therefore Tardyferon discontinued, TSH normal according to doctor, no increase in L-Thyroxine needed
I still feel unwell and believe that the fT3 level should be improved. I admit that I have done a lot of research and do not see my levels in the optimal range. Unfortunately, I cannot accurately assess how I felt with a TSH of 0.77, as I still had iron deficiency.
Symptoms: Fatigue (daily), lack of drive (daily), exhaustion (daily), frequent headaches, dry nose and thick mucus (daily), hands and legs fall asleep quickly (for no reason, in normal positions, even at night), feeling cold quickly, hair loss, cracks in nails
Should I take an additional
Dear Seeker,
Your question is very complex and unfortunately can only be partially answered at this time.
First of all, you are very focused on the thyroid. This is justified as the thyroid is a small but very powerful organ that can be directly or indirectly responsible for all the symptoms you mention. However, it is important to note that many of the symptoms you describe are so nonspecific that other causes could also be considered.
The information you have provided so far is limited to laboratory analysis, which is being attempted to be "harmonized" with the realities of subjective experience. This may sound theoretical, but it is a common practical issue. People tend to interpret things in a way that fits into a larger picture. While this approach is often successful and effective, sometimes it can lead in the wrong direction.
A concrete finding is the elevated TSH level you mentioned. This could indicate an underactive thyroid. The determination of peripheral thyroid hormones FT3 and FT4 should have been done as well. Additionally, the TSH level is sensitive to external influences and shows a circadian rhythm – TSH levels fluctuate throughout the day. Many medications can affect TSH levels, and the accuracy of blood collection and transportation must be ensured.
Assuming a valid determination, an ultrasound examination and possibly antibody testing (anti-TPO and TRAK), as well as a thyroid scan, should have followed.
The low iron level you mentioned may not have a significant impact on your well-being, but it could play a supportive role.
To provide more specific guidance, further blood analysis, especially of the blood count, electrolytes, liver and kidney function, and endocrinological status, is needed. Other important questions to consider include changes in body weight, blood pressure (including at night), resting heart rate, sleep quality, presence of nocturnal breathing pauses (which can be easily tested), etc.
Apart from the medical diagnostic results, how are you feeling? Symptoms like "fatigue (daily), lack of drive (daily), exhaustion (daily), frequent headaches..." could also indicate an overload syndrome – both physically and mentally. This is not uncommon, especially among self-employed individuals who are used to pushing themselves to the limit and ignoring their mental well-being. In such cases, a TSH level of 9 might just be a piece of the puzzle that fits formally but does not truly reflect the current situation.
Currently, there are still many questions and few answers for you, which I understand is very frustrating. However, remain optimistic! Start fresh by consulting a good specialist in internal medicine or general practitioners step by step.
Have the above-mentioned blood analysis and thyroid diagnostics done thoroughly to reach a proper diagnosis.
Avoid reading too much into lab results and trust how you feel, especially regarding thyroid hormone levels. If you feel comfortable below a certain TSH level, don't let anyone convince you to fine-tune it if it doesn't align with current medical opinions.
I am confident that the cause of your symptoms will be found, and you will soon feel better.
Best wishes and kind regards from Cologne,
Dr. med. Christoph Schmülling
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