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Forum Name: Endocrinology Topics

Question: unexplained symptoms, possible hypothyroidism vs vit def.


 stephlenna - Thu Aug 05, 2010 7:12 pm

I have suffered for over a year with many symptoms and my doctor and staff will only tell me I am depressed, and chalk my symptoms up to a past case of mono. I am chronically fatigued, sleeping up to 20 hrs a day when not working(x1yr+). I have a constant mental fog/difficulty concentrating, recurring headaches/migraines, constipation unrelieved by laxatives, stool softners, etc. Severe abdominal bloating after meals looking as if I am 7 months pregnant. I have halitosis, dry scalp, dry skin, dry brittle hair. I have gained 10lbs in the past year with no change in dietary or exercise regimens. Decreased libido. Increased incidence of colds, infection. Cold hands and feet. Difficulty staying warm even in heat. Muscular pain hands and shoulders.

Labs:
White Blood Cell Count 3.3 4.0-11.0 K/uL L
Red Blood Cell Count 4.18 3.9-5.4 M/uL
Hemoglobin 13.5 12.0-15.5 g/dL
Hematocrit 39.7 35.0-47.0 %
MCV 95 80.0-100.0 fL
MCH 32.3 27.0-33.0 pg
MCHC 34.0 31.0-36.0 g/dL
RDW 13.4 <16.4- %
Platelet Count 178 150-400 K/uL
Differential Type Automated
Neutrophil % 48 49.0-74.0 % L
Lymphocyte % 35 26.0-46.0 %
Monocyte % 8 2.0-12.0 %
Eosinophil % 8 0.0-5.0 % H
Basophil % 1 0.0-2.0 %
Abs. Neutrophil 1.6 2.0-8.0 K/uL L
Abs. Lymphocyte 1.1 1.0-5.1 K/uL
Abs. Monocyte 0.3 0.0-0.8 K/uL
Abs. Eosinophil 0.3 0.0-0.5 K/uL
Abs. Basophil 0.0


TSH 0.52 0.34-4.82 uIU/mL
Free T4 0.72 0.6-1.61 ng/dL

Homocysteine 9.9 3.7-13.9 umol/L

IGE, TOTAL 216.00 <114- kU/L H

B12 347

My younger sister was just diagnosed with hypothyroidism, my aunt 2 cousins and maternal grandmother also hold this dx. My sister has mthfr genetic defect homozygous varient and protein s deficiency. both parents are healthy, no outstanding medical problems or hx. older sister being tested for hypothyroidism/ genetic defect.

please help.
 Dr.M.Aroon kamath - Wed Aug 11, 2010 12:34 pm

User avatar Hi,
Hypothyroidism may be
- primary (due to a throid disorder),
- secondary (due to a pitutary disorder), or
- tertiary (due to an hypothalamic disorder).

The secondary and tertiary types together are known as central hypothyroidism.

Your FT4 is closer to the lower limit of the normal range and the TSH (thyroid stimulating hormone), although within range, appears to be inappropriately low for the level of the FT4.This kind of a thyroid profile is seen in secondary or tertiary hypothyroidism.

To differentiate primary from tertiary hypothyroidism, a TRH(thyrotropin releasing hormone) stimulation test may at times help.In this test, the TSH response is studied following an injection of TRH. If there is absolutely no increase in TSH, it indicates secondary hypothyroidism. It there is a delayed and attenuated response (at at 60-180 minutes), this indicates a tertiary hypothyroidism. In primary hypothyroidism and normal controls, TSH rises in about 20-30 minutes.But this test is not a good discriminator in distinguishing between these conditions.

Measuring basal serum prolactin level may be more discriminatory (low or normal in secondary hypothyroidism and increased in tertiary hypothyroidism).However, there is one exception, and that is, if the pitutary destruction is due to a prolactinoma.

One simpler test, often overlooked, is to look for the nocturnal surge of TSH which is seen in normal persons(highest TSH values occur just before a person falls asleep at night).This surge will be absent in both secondary and tertiary hypothyroidism.This may be an easier way to identify central causes of hypothyroidism.

As many of your symptoms could be caused by a hypothyroid state, you need to be investigated promptly to search for possible causes of secondary or tertialry hypothyroidism.however, i suggest that it may not be a bad idea to have your thyroid profile repeated and if shows a similar pattern, then further investigations may be initiated.
Good luck!

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