A bit of research...

I've been doing research for about a week or so on Hypothyroidism. I have been having increasing symptoms that point toward hypothyroidism, but so far my Dr has not felt that my symptoms point toward anything but needing an increase in my Lexapro, and a monthly check-up with him to go over journal entries that I'm to be writing each day about how I feel...

So, the following is cut-and-paste info that I got from a variety of different websites (all cited at the end of this entry). The list of symptoms is included, and the italizied ones are what I have issues with currently...

A Look at Undiagnosed Thyroid Problems

It's a common story. After having a baby, you find it unusually difficult to lose the baby weight, despite serious diet or exercise. Or you think you're getting enough sleep, but find yourself waking after eight or more hours of sleep exhausted and then drag around during the day feeling like a nap is the only thing on your mind. Or, conversely, you may find yourself anxious for no apparent reason, losing weight, up all night with insomnia and heart palpitations, and noticing that you're losing hair.

For many of you, the doctor will suggest that these symptoms point to depression, not enough sleep, a need for exercise, premenstrual syndrome, or simply the effects of stress.

The reality is that symptoms such as fatigue, anxiety, unexplained weight gain or loss, hair loss, depression, and palpitations may indicate that you have an undiagnosed thyroid condition.

A February, 2000 research study found that the estimated number of people with undiagnosed thyroid disease may be 10 percent -- a level that is double current estimates, and may represent as many as 13 million Americans currently undiagnosed. For women, the risk is even higher. A woman faces as high as a one in five chance of developing thyroid problems during her lifetime. That risk increases with age and for those with a family history of thyroid problems.

The thyroid is our body's metabolic engine, controlling use of energy and foods. A small butterfly-shaped gland, the thyroid is located in the neck behind the Adam's apple, and produces key hormones -- triiodothyronine (T3) and thyroxine (T4) -- that fuel metabolism and help our bodies properly use energy and calories.

How do you know if you have hypothyroidism, the most commonly diagnosed thyroid problem? Your symptoms might include depression, forgetfulness, fatigue, weight gain, hoarse voice, high cholesterol levels, constipation, intolerance to cold, coarse hair, hair loss, dry skin, reduced libido, tingling hands and feet, heavy or irregular periods, and infertility or recurrent miscarriage. A careful review of our comprehensive Hypothyroidism Symptoms Checklist can help.

Undiagnosed hypothyroidism is blamed for many conditions and symptoms in women, including:

• infertility and recurrent pregnancy loss
• heart attacks and clogged arteries
• high cholesterol levels
• difficulty losing weight
• exacerbated menopausal symptoms
• fibromyalgia and chronic fatigue syndrome
• carpal tunnel syndrome and tendinitis
• low sex drive
• mitral valve prolapse

If your doctor suspects hypothyroidism, he or she will order a TSH (thyroid stimulating hormone) test. Most American laboratories have a normal range from around .5 to 5.5. TSH level above 5.5 or 6 is usually diagnosed as hypothyroid.

More doctors are also viewing high-normal or normal TSH levels as possible evidence of low-level hypothyroidism. Dr. John Dommisse, in an interview with Mary Shomon, has said that that "The so-called 'normal range' is way too high" Elizabeth Lee Vliet, M.D., is author of Screaming to Be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. She does not tell her patients their thyroids are normal based only on TSH results. According to Vliet, "The normal range is relative. Many women have symptoms -- or are hypothyroid -- when TSH anywhere but the lower end of the range."

This broader interpretation of what constitutes 'normal' in terms of the thyroid is discussed in greater depth in “HELP! My TSH Is "Normal" But I Think I'm Hypothyroid.”

Dr. Vliet also tests for elevated thyroid antibodies, and low Free T3 and Free T4 levels. "Most women with elevated antibodies are in the process of developing autoimmune thyroid disease," says Vliet. "And even with normal TSH levels, I've found that majority of women with elevated antibodies, low Free T3 and low Free T4 require thyroid hormone replacement to feel well."

Doctors usually prescribe the synthetic T4 hormone levothyroxine to treat hypothyroidism. Popular brands include Levoxyl and Synthroid. Research reported in the New England Journal of Medicine in February of 1999 found that a majority of patients may feel better on a combination of hormones. On that basis of that study, more doctors are also adding synthetic T3 (liothyronine). Alternative physicians tend to prefer Thyrolar, Armour, or Naturethroid, drugs that include both hormones.

Occasionally, symptoms may accompany suspicious thyroid nodules. Nodules are typically evaluated by ultrasound scan and blood tests, and sometimes by an outpatient biopsy called fine needle aspiration (FNA). The vast majority of nodules are benign, and some are treated with levothyroxine. If cancer can't be ruled out, or your thyroid is obstructing breathing or swallowing, your doctor will likely recommend surgery.


Can You Prevent Thyroid Disease?

There are several things you can do to reduce your chance of thyroid problems.

Be Careful About Too Much Soy

There's evidence that excessive isoflavones -- found in popular soy products and supplements -- may cause hypothyroidism, goiter or nodules. Larrian Gillespie, M.D., author of The Goddess Diet, says "one serving of tofu a day is all you need to enjoy soy's benefits. Going overboard on soy supplements and powders may trigger or worsen thyroid problems." Also, remember that a long-term, steady diet of soy formula may make your baby more vulnerable to developing autoimmune thyroid conditions, due to overexposure to antithyroid isoflavones.

Drink Bottled Water

Fluoride in water, and a rocket fuel manufacturing by-product known as perchlorate, and other toxic chemicals are among the many substances in water that may trigger or worsen the risk of thyroid problems. Consider drinking purified or bottled water.

When It Comes to Iodine -- Think Moderation

Too little iodine, an increasing problem in the United States, increases your risk of hypothyroidism or goiter, but excessive iodine intake -- including kelp or bladderwrack -- can also affect the thyroid.

Stop Smoking

Smoking can damage the thyroid, and actually worsens some existing thyroid conditions . . . yet another reason to quit -- or never start -- smoking.

Reduce Your Stress

Reducing stress using effective techniques such as aerobic exercise, yoga and mind-body techniques can play a part in preventing some autoimmune problems like thyroid disease.


You can use this checklist to bring to your doctor to help aid in getting a proper diagnosis of hypothyroidism, or as background information in your discussions regarding finetuning your dosage so you are at the optimal TSH level for your own level of wellness.

Adults
In adults, hypothyroidism is associated with the following symptoms:

Poor muscle tone (muscle hypotonia)
Fatigue
Cold intolerance, increased sensitivity to cold
Depression
Constipation
Muscle cramps and joint pain
Arthritis
Goiter
Thin, brittle fingernails
Thin, brittle hair
Paleness
Dry, itchy skin
Weight gain
Bradycardia (low HR <60 BPM)

Late symptoms

Slowed speech and a hoarse, breaking voice. Deepening of the voice can also be noticed.
Dry puffy skin, especially on the face
Thinning of the outer third of the eyebrows
Abnormal menstrual cycles
Low basal body temperature

Less common symptoms

Heat intolerance, increased sensitivity to heat
Impaired memory
Impaired cognitive function (brain fog) and inattentiveness
Urticaria (hives)
Migraine headache
A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and decreased contractility.
Reactive (or post-prandial) hypoglycemia
Pericardial effusions may occur.
Sluggish reflexes
Hair loss
Anemia caused by impaired hemoglobin synthesis (decreased EPO levels), impaired intestinal iron and folate absorption or B12 deficiency from pernicious anemia
Anxiety/panic attacks
Difficulty swallowing
Shortness of breath with a shallow and slow respiratory pattern.
Impaired ventilatory responses to hypercapnia and hypoxia.
Increased need for sleep
Osteopenia or Osteoporosis
Irritability and mood instability
Yellowing of the skin due to impaired conversion of beta-carotene to vitamin A
Impaired renal function with decreased GFR.
Thin, fragile or absent cuticles
Elevated serum cholesterol
Acute psychosis (myxedema madness) is a rare presentation of hypothyroidism
Decreased libido
Decreased sense of taste and smell (late, less common symptoms)
Puffy face, hands and feet (late, less common symptoms)
Depression

Getting a thyroid diagnosis if your TSH lab tests come back as normal. Many people write to me, asking if they could be hypothyroid, despite having had their TSH tested, and it comes back in the "normal" range. These people often describe a list of standard hypothyroid symptoms and have shown low basal body temperature tests, but standard TSH testing has shown them to be in the "normal range."

Here are some things to pursue in getting a diagnosis. What is your lab's "normal" range, and how does your doctor define "normal?"

Different labs have different values for what is normal. For example, at the lab my doctor uses, the normal range is .5 to 5.5. A TSH of less than .5 is considered hyPERthyroid, and a TSH of more than 5.5 is considered hyPOthyroid. Other labs might use .35 to 5, or .6 to 5.2, etc., but it's important for you to know the values at YOUR lab.

AND, it's important to know that as of March, 2003, the endocrinology community has recognized that the normal range is actually narrower. While labs are not necessarily reflecting this in their testing, the official "normal range" is now .3 to 3.0. For more information, read: Endos Say Normal TSH Range Now .3 to 3: Millions More at Thyroid Risk.

If you're on the higher end of the normal range, you could very well be borderline hypothyroid for YOU, but still in the "normal" range. So, you need to know what TSH level your doctor is targeting for you. This is a very loaded, but VERY important question. Your doctor's answer will tell you her or his philosophy about "normal" TSH. Some doctors believe that being in, or getting you into the very top of the normal range is their sole objective, and then the job is done. So, for example, using the 5.5 outer edge of the TSH level from my lab, that sort of doctor believes that getting me to somewhere around there constitutes full treatment.

Other doctors believe that certain TSH levels within the normal range are more appropriate targets. My endocrinologist, for example, believes that women don't feel well (and can't lose weight or get rid of other hypothyroidism symptoms) unless TSH is down between 1 and 2, far below the higher end of "normal." (There are some suggestions in research that have shown that the average TSH of a women without thyroid disease is 2, so that may be why some women don't feel well at 4 or 5.) My doctor wants me to feel as well as possible within normal range, but finds that on average, women don't feel well at the higher end, so she aims to take it lower.
In my own experience, I feel downright awful at anything above 4, and I feel great between 1 and 2, which is where my endocrinologist keeps my TSH. But some doctors would have no problem keeping me between a TSH of 3 and 4, still in the laboratory "normal" range, despite the fact that I still have the full range of hypothyroid symptoms -- fatigue, weight gain, irregular menstrual periods, dry skin, hair falling out -- at those levels.

The best doctor is one who believes that managing your thyroid is a combination of TSH AND how you feel. These are doctors who treat you like a patient, not a lab value! These doctors might say "well, let's get you into the normal range, see how you feel, and adjust the dosage from there."

Have you been tested for thyroid antibodies?

Some doctors believe that a thyroid that is in the process of autoimmune failure -- as evidenced by elevated antibody levels -- can cause hypothyroid symptoms BEFORE the hypothyroidism shows up as TSH outside the normal range, and should be treated with small doses of thyroid hormone.

One doctor who lays out this information is Elizabeth Lee Vliet, M.D., in her book Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. Dr. Vliet does not believe that TSH tests are the almighty indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone.

Here's a quote from Dr. Vliet:

The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but twoare women, who had a normalTSH and turned out to have significantly elevated thyroid antibodiesthat meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."

Have you had a TRH test?

In an article by Raphael Kellman, M.D. in Alternative Medicine magazine, Dr. Kellman indicates that some hypothyroidism may not be picked up by the standard thyroid hormone panel, which tests primarily the TSH, (thyroid stimulating hormone). If hypothyroidism symptoms are present, but TSH tests are normal, Dr. Kellman often relies on the TRH -- thyrotropin releasing hormone --stimulation test to assess possible hypothyroidism. According to Dr. Kellman, "the physician measures the patient's TSH level (a simple blood test), gives an injection of TRH, then draws blood 25 minutes later and remeasures the TSH. If the first TSH level is normal and the second TSH level is high--above ten--it tells us the patient's thyroid is underactive. A TSH reading of 15 is suspicious, while 20 strongly points to hypothyroidism." Dr. Kellman states that, "of the patients I've seen with three or more typical symptoms of underactive thyroid but who have tested 'normal' in standard tests, 35-40% actually have underactive thyroids based on the TRH test."

Could You Have an Underlying Additional Problem that Requires More than Just Standard Thyroid Hormone Replacement such as Levothyroxine Sodium/Synthroid?

Synthroid, Levoxyl, Levothyroid, Euthyrox, Eltroxin are all brand names for the thyroid drug levothyroxine sodium, which is a synthetic version of the thyroid hormone T4. These are most often the drugs prescribed for thyroid hormone replacement for most patients.

But if you have hypothyroidism and are taking one of these conventional thyroid replacement drugs, your blood tests show a "normal" TSH and yet you still don't feel well, there may be an need for the addition of T3, the other major thyroid hormone.

For example, the book "Myofascial Pain and Dysfunction: Trigger Point Manual, " describes the condition of "hypometabolism," where inability to adequately convert T4 to the T3 needed by the body leaves someone with a normal TSH level, but hypothyroid symptoms. Serum hormone studies typically show marginally low T3 and T4 levels, usually within the "normal" range, and TSH is rarely elevated out of the "normal range." At the same time, cholesterol is often elevated, and basal temperature is likely to be 97 degrees F or less. Patients with hypometabolism problems often respond well to T3 or T4/T3 treatments.

Fibromylagia can also be an underlying reason. Symptoms of fibromyalgia can be very similar to thyroid disease, and researchers have found higher incidence of thyroid disease among fibromylagia patients. And the researchers are also finding that these patients need the additional thyroid hormone T3 to resolve symptoms. For more information on fibromylagia and its symptoms, diagnosis, and relationship to thyroid disease, see my article "Chronic Fatigue, Fibromyalgia, and Autoimmune Thyroid Disease.

T3 is available on its own, as a brandname drug known as Cytomel, or can be included with T4 in the naturally derived thyroid drug Armour Thyroid, or the synthetic version of Armour, which is known as Thyrolar.

But My Doctor Thinks that TSH Testing is the Only Way to Diagnose Hypothyroidism, Antibody Tests are a Waste of Time, TRH Tests Are Useless, Synthroid is the Only Drug to Prescribe, and There's no Such Thing as Hypometabolism or Conversion Problems or Fibromyalgia, and Armour Thyroid is an Old-Fashioned, Dangerous Drug

Many endocrinologists are known for being "numbers" people. They manage by the numbers, and not by the symptoms, which can often create the "you're in the normal range, so you're fine" response many of us get to complaints that we still don't feel well. So keep in mind that even if you have easily diagnosed hypothyroidism, it may take some serious looking to find an endocrinologist who believes in finding an optimal TSH for you, and not just getting you into the high normal range and declaring you cured.

As for getting a diagnosis and treatment via the less conventional methods -- basal body temperature testing, TRH tests, antibody testing -- or drugs -- Armour, Thyrolar, Cytomel --you're probably going to need to look outside the standard endocrinology community and find a doctor who has a more holistic approach.

Sources:

http://thyroid.about.com/cs/hypothyroidism/a/normaltsh.htm by Mary Shoman.
http://en.wikipedia.org/wiki/Hypothyroidism
http://www.mayoclinic.com/health/hypothyroidism/DS00353
http://thyroid.about.com/
http://thyroid.about.com/od/symptomsrisks/a/symptomsrisks.htm