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[Briony]

Had my estrogen and thyroid measured a few years ago after getting fluid retention, painful shoulder, tingling fingers, fatigue and dizziness; thyroid was normal and estrogen was low (41). FSH was normal.

With the help of BCP/HRT, symptoms gradually disappeared.

Gradually over the last few months, things have changed. I have started to get the tingling and aches I had a few years ago, and have developed constipation, cold intolerance (strikes at random moments), fatigue  (again, can feel fine in the morning and then suddenly cant keep eyes open) and hair loss - despite still taking oestrogen. I have also gone from a life long size 10 to 12-14.

This has made me wonder whether my thyroid is to blame after all? Or are these returning symptoms due to needing more estrogen? (Currently on 100mcg patches). How do your thyroid symptoms differ from low estrogen symptoms? Is there an overlap? Does HRT affect your thyroid at all? Can you have an under-active thyroid but a normal reading (blood test)?

I dont want to bother my GP again until I am sure it's not just my usual strange estrogen issues. Any suggestions? My iron, B vits, vit D all normal.

Any advice much appreciated.


B

[dazned]

I know that hrt and thyroid meds interact and its a very fine balancing as one thing sends the other off kilter. I believe that I've read you can get a normal reading but there be a thyroid problems nonetheless.

[warwick01]

Hi Briony

I too am taking 125 thyroxine along with HRT. The first indication my thyroid is low is always constipation. Things are stable at the moment but its worth getting bloods checked every 6 months.

Wx

[scriv]

Definitely get it checked out again, Briony as the symptoms of hypothyroidism  are sometimes so similar to menopause and often interlinked that it's often hard to diagnose.

It sounds time to have another test done as hypothyroidism creeps up on you.

[Scampi]

You say it's been a few YEARS since your levels were measured?  My GP wanted me to get checked out at least every year after I saw her last year - she said my oestrogen and FSH levels were 'borderline', and thyroid 'on the low side of normal' so wanted to keep an eye on how things progressed, especially as my maternal grandmother and mother both had (have) under-active thryroids.  My bloods will be done more often for a while after the end of this month as I'm having a Mirena fitted and the gynae wants to keep an eye on things for a while.

Go back to the GP and get those levels re-tested.  We change - rapidly!

[Hurdity]

Hi Briony I agree that all those symptoms - weight gain, feeling cold, fatigue, constipation - are all symptoms of hypothyroid and more so than menopause.

As Scampi and scriv said - thyroid function becomes less efficient with age and it seems women are particularly prone to the effects of this.

There are several aspects to hypothyroid conditions - although I know very little about it. Firstly the TSH reading  at which it is considered treatable maybe differetn from that at which a woman experiences symptoms. The cut off point I think is TSH of 4.5 (hopefully someone who knows more will be along!) but say for example, you had a reading of 3.7 and had all the symptoms - then perhaps some treatment would be beneficial. I don't think you would get this on NHS though ( if your reading was below the cut off)??

Also most thyroid function tests ( the initial ones anyway as part of overall bloods) just test TSH but this is the hormone produced by the brain which tells thyroid gland to produce T4 which is then converted into active hormone T3 ( think I'm remembering this - soz haven't got time atm to look it up as working this pm!).  If it's looked into further and you are referred to endocrinologist they then test for T4 and T3 (I think). However some people don't convert T4 to T3 very well so can have normal TSH and T4 but still be hypothyroid due to insuffucient T3 - the active hormone. This is not recognised on NHS as far as I understand from a friend of mine who is treated privately with the dessicated thyroid which contains T3. This whole condition is poorly understood, tested and treated, and has links with fibromyalgia syndrome. This friend of mine was diagnosed with this condition (fibro) but her symptoms are more or less controlled with thyroid hormone - but on NHS she would have been left both with hypothyroid symptoms and the fibromyalgia diagnosis and left untreated. There is a lot of info on this on thyroid UK and there is a forum too. I've just about told you all I know but hope it's helpful!

My onw TSH levels have increased by one whole unit in the last 9 years and each time I have a blood test they are going up - last test a year ago was 2.97. However doc says this would not be treated. I have complained about my morning fatigue, and I feel the cold and have found extreme difficulty in losing weight - so in my case it's probably only having a small effect - but I will keep an eye on it as I get older. The testosterone helped with the muscle pains and fatigue after exercise so the whole endocrine system is very complex.

From what I read oral HRT interacts with thyroid meds so if you start oral HRT and you are taking medication for hypothyroid this may need readjusting once you are settled on HRT - it says this on the leaflets as far as I remember.

In haste - apols for any typos/inaccuracies -gtg!

Hurdity x

[countrybumpkin]

I used to work for a thyroid advice charity.   

A full thyroid function test that is routine in Uk will test your TSH Free T4 and T4.  The ones your Dr is looking at is the TSH and Free T4.  Every lab has different reference ranges but in general 0.1 to 4.5 is considered normal.  As everyone with a thyorid problem knows whats normal for one person might be abnormal for another person.
Without you having the test its impossible to know if your thyroid id causing any symptoms.
We used to advise people that if they were borderline under or over then to have a retest in 6 months. When you ring for results do not accept " your result is in the normal range" ask for specific numbers for TSH and free T4 and the reference range of your particular path lab.  If you are close to either end then see Dr and ask to be retested in a few months.
I am happy to answer any other questions as they arise.

[babyjane]

I have to disagree with Hurdity about the T3 not being recognised on the NHS.  I have been on T4/T3 combination therapy for many years and I see an NHS consultant endocrinologist and my T3 is prescribed on repeat according to his instructions.  My levels are checked every 6 months, TSH, T4 and T3.  A GP requesting a thyroid function test will only result in the TSH test, a consultant can request all 3.  That's in my area anyway.  Perhaps it is different in other areas but it shouldn't be.

[countrybumpkin]

Most Gp's order standard thyroid function that tests tsh and free t 4 and they should always test the two to be able to read the results better, I haven't come across a GP that only orders tsh but that may just be my area.  GP's can ask for T3 to be tested as well but often the lab will ignore the request at the first attempt and the Gp  has to re request it ( this has been personal experience as well). Again this is in my health authority.
Only a consultant endocrinologist can initially prescribe T3 supplementation in my health authority as GP's are just not experienced enough. Everyone I know on T3 supplementation is overseen by a consultant endocrinologist. T3 supplementation can be dangerous if it is not closely monitered but it is also a lifeline for people who do not convert thyroxine to T3 or who are allergic to thyroxine medication.

[babyjane]

The only problem I have with T3 is that it is only prescribed in 20mcg tablets and I take 5mcg twice a day with 100mcg thyroxine, meaning I have to cut the tiny tablets into quarters. More often than not they crumble up, I get a lot of waste doing this. 5mcg tablets are available on special prescription but they are prohibitively expensive for the NHS, I resisted them although my GP offered them, as my conscience would not allow me to accept them.

[Briony]

Wow - thanks all of you for such useful advice and information. It's really appreciated.

Apart from anything else, you've given me the kick up the bum I needed to contact my GP. Past experience with a previous GP has meant I am very reticent to see my doctor for fear of seeming like a time-waster/hypochondriac. Having read your posts, I called my GP (was unable to get an appointment out of working hours) and she has booked me in for blood tests next week. Her gut feeling was that my symptoms are due to estrogen issues (I'm one of the strange ones who gets the chills rather than flushes), but she is happy to test my thyroid too.

I am not sure which tests she has requested exactly, but I do know that my previous GP only tested TSH. I now recall at the time reading online that this can be misleading, but concluded it was simply more evidence that my GP just thought I was wasting his time (I had to take photos of my ankles to show that I had water retention before he'd take me seriously!).

One thing I am now a little concerned about is will the HRT I take affect the thyroid test results? I have been taking 100mcg patches and 100 mg of Utrogestan for 25 days for the past two months. I do not have a raised FSH, but have intermittently very low estrogen (40 pmol). I dont really understand the interplay between the two?

Thank you, once again, for all your replies. I've read them all thoroughly and really appreciate the fact you've taken time to respond.

B x


PS Hurdity, interesting what you say about your friend as I too was initially told it was Fibromyalgia and CFS, as have a number of my friends my age. It wasnt until we really pushed that we had any tests - she was so low on vitamin B12 that it did not even register and has had to have emergency treatment.

[babyjane]

I can't answer your question Briony as I have never taken HRT but good luck with the tests and I am sure someone else will reply to you soon.

[Briony]

I can't answer your question Briony as I have never taken HRT but good luck with the tests and I am sure someone else will reply to you soon.

Thanks x 

[Lizab]

Don't worry about your hrt. You need to see how your thyroid levels are with the hrt. Now, if you do get treated for thyroid and later go off hrt, then you'll definitely want to look at those thyroid levels again without the hrt and make adjustments as necessary. Since they will be treating "hrt Briony" that's the labs they need to use, not "hrt-free Briony". Make sense? Also, you mentioned you have normal FSH and low estrogen. I'm not sure if that indicates anything, but do be sure and remind your doctor of that when you go to discuss your thyroid labs. The FSH is a pituitary hormone as is the TSH. I'm not saying it's a problem, don't worry, but your doctor should take note of that when evaluating your labs to rule out a pituitary problem. I honestly can't remember at the moment how those hormones play together, but your doctor should know.

[countrybumpkin]

As said you need to know your levels as you are now. If you stop or start any new drugs especially hormonal ones then you should have a retest after 2-3 months.  If you are put on thyroxine then you must insist on being tested every 6 mnths and not the 1 -2 years that some GP's do, things can change massively even in 6 months.

I have never forgiven my mothers Gp who only tested her levels once every 2 years and she was on high dose thyroxine.  She had terminal cancer which I now know means that her levels needed close monitering and she developed severe thyroid eye disease that he blamed on her cancer and it was only when she was admitted to the hospice that they knew exactly what was happening and she was severely over active due to massive overdosing on thyroxine.  This was before I trained as an advisor for thyroid support. If only I had known then what I knew later.