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Possible Hypothyroidism Despite "Normal" Thyroid Function Tests

THIS IS A LADY, WHO I AM PLEASED TO REPORT, READ THE BLOG AND CONTACTED ME THROUGH THE WEBSITE. SHE LIVES WITHIN DRIVING DISTANCE OF MY OFFICE AND WAS WONDERING IF IT WOULD BE WORTH MAKING AN APPT. HER STORY IS THE SAME OL' ONE--LOTS OF SYMPTOMS SUGGESTIVE OF HYPOTHYROIDISM, BUT HER THYROID FUNCTION TESTS (TFT'S) ARE "NORMAL" AND SHE KEEPS BEING TOLD IT'S NOT HER THYROID:

Good to know somebody out there is reading the blog.

If you have your lab reports available, what is your lab’s normal range for FT4? The values you documented certainly sound low-normal, I was just wondering how close to the lower normal limit they are.

The TSHs are obviously “normal” by any standard, but the question is might you have hypothyroidism due to or in addition to a defect in TSH production from the pituitary.

Any history of head injury, even something minor like knocked unconscious in an auto accident or fall?

Also, let me know all the meds you are on now.

You have enough symptoms that could be due to hypothyroidism, coupled with the lowish FT4’s and family history, that I do think a trial of thyroid replacement would be reasonable. It baffles me why “antidepressants, bcp, adhd medications” and the like are so often considered preferable to thyroid hormone, which is at least a substance that God/Mother Nature intended for us to have in our systems.

Please answer the ?’s I’ve underlined and I’ll get back to you.

***

--the 0.5 lower normal limit for FT4 is a little lower than I’m accustomed to thinking in terms of—meaning that your levels aren’t as low as I was thinking, but they are nevertheless still in the lower half of the relevant reference range. In other words I haven’t changed my mind about the possibility thyroid hormone replacement would help.
--the head injuries increase the possibility that there is a pituitary defect explaining the inappropriately normal TSHs in the face of the hypothyroidism we are postulating.
--I can’t prove this, but my feeling based on seeing a lot of patients with stories similar to yours, is that chronic pain (your headaches), narcotic use for the chronic pain, and various CNS-acting drugs, many different ones of which you are or have been on, contribute to a “soup” that hobbles TSH release—creating a central hypothyroidism-type pathophysiology.
--So, no guarantees as to our success, but I think it would be you coming to see me.

jkr
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