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Are severe fatigue, weight gain and chronic constipation suggestive of hypothyroidism?

Answered by
Dr. Ajish TP


Practicing since :2002

Answered : 819 Questions

Posted on Fri, 16 Oct 2015 in Thyroid Problem and Hormonal Problems
Question: I suspect I have hypothyroidism. My PCP doesn't much think so (he is VERY resistant to any time a patient makes a suggestion or self-diagnosis), and says my blood test is normal (although he would only order the most basic test which I understand does not always indicate hypothyroidism).

I have about 50 symptoms of hypothyroidism (with no other explanation), the most noticeable being severe fatigue, weight gain (despite eating less and exercising more), chronic constipation, and as I said BUNCHES of other things that can be attributed to low thyroid function.

Several physician friends said they would suspect hypothyroidism. My gastroenterologist TOLD me I was hypothyroidal, and had a blood test to back it up (I'm unsure what the test was or what the numbers were, this was a couple of years ago).

My PCP refuses to believe that though, he basically said "Thyroid symptoms do not come and go," as SOME of mine do, but I've been dealing with this for 20 years. He offers no other help or suggestions though.

I would like to independently have thyroid tests done by an outside lab, which is readily available.

I do not, however, know which test(s) to order, as they have 11 different ones to choose from....

I will list the available tests and their descriptions below if that is helpful.

Thank you.

Thyroid Function Test Level I

(The combination of the Thyroid Profile (T3 uptake, T4, T7) and the TSH test evaluates thyroid function and/or symptoms of an overactive thyroid (hyperthyroidism) or an under active thyroid gland (hypothyroidism).

Thyroid Function Test Level II

A Thyroid Stimulating Hormone (TSH) blood test is combined with the Free T3 and Free T4 tests to provide the most accurate overview of thyroid function. Test also includes T3 Uptake, T4 and T7

Thyroid Profile (T3 uptake, T4 and T7)

The Thyroid Profile is an important test for evaluating thyroid function. The profile is a three part measurement of triiodothyronine (T3 Uptake) and thyroxine (T4) which is frequently ordered with TSH.

TSH (Thyroid-Stimulating Hormone)

The thyroid-stimulating hormone (TSH) blood test is used to check for thyroid gland problems, frequently ordered with the Thyroid Profile to measure levels and ratio of of T3 and T4.

Free T3

Measurements of free triiodothyronine (Free T3) levels are not be affected by certain protein levels, remaining more constant, and therefore correlating more reliably with the true concentration of T3 levels in the blood.

Free T4

The free thyroxine (T4) blood test is not affected by protein levels and is therefore a more reliable measurement of T4 levels in the blood.

Triiodothyronine (T3)

The T3 blood test assesses both free and bound T3 to help determine what may be causing an abnormal thyroid-stimulating hormone (TSH) test.

Reverse T3, Serum

Diminished serum T3 levels (the most biologically-active thyroid hormone) are thought to reflect altered thyroid homeostasis as a mechanism of adapting to severe illness.

Thyroid Peroxidase (TPO) Antibodies

The thyroid peroxidase (TPO) blood test measures the level of an antibody that is directed against the enzyme thyroid peroxidase.

Parathyroid Hormone (PTH), Intact

Diagnosis of parathyroid disease and other diseases of calcium homeostasis; monitoring patients undergoing renal dialysis.

Thyroid Stimulating Immunoglobulin (TSI)

Thyroid stimulating immunoglobulins (TSI) are autoantibodies that are produced by the immune system and associated with Graves' disease.
Answered by Dr. Ajish TP 3 hours later
Brief Answer:
You can do TSH, free T3, Free T4 and if possible antiTPO antibody

Detailed Answer:

welcome to HCM. I have gone through your question and understand your concerns.

The tests needed to assess thyroid function are TSH, free T3 and Free T4. A thyroid test called anti TPO antibody can also be done if you are suspecting hypothyroidism.

If TSH, free T3 and Free T4 are within normal limits, you don't have hypothyroidism and no treatment is needed. The hypothyroid symptoms are non specific. So even if you have all symptoms of hypothyroidism, if your thyroid function test is normal , there won't be any use in treating you for hypothyroidism.

Hope this will clear your doubts. Please upload your thyroid function reports when available.

Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Ajish TP 2 hours later
Thank you for your response. I already have the blood test results.

My gastroenterologist feels that I have hypothyroidism and says his blood tests confirm that. My primary care physician does not seem at all interested in considering that, though (although offers no other explanation or concern for my many symptoms), and virtually refuses to even order any additional tests other than the initial pituitary test he did. This is why I was seeking an additional opinion and further testing.

There does not appear to be any way to upload or attach a file in a follow-up question (unfortunately), so I am sending you a link to the actual lab results which I have placed on my company's server, and also write the results below...

Here is the link to a PDF of the actual report:

And here are the written results:

Thyroid Panel with TSH
TSH 1.250 uIU/mL
Thyroxine (T4) 7.0 ug/dL
T3 Uptake 27 %
Free Thyroxine Index 1.9

Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab 6 IU/mL
Thyroglobulin, Antibody <1.0 IU/mL

Thyroxine (T4) Free, Direct, S
T4, Free (Direct) 1.07 ng/dL

Reverse T3, Serum 15.0 ng/dL

Triiodothyronine, Free, Serum 3.6 pg/mL

I appreciate your review of these results and look forward to hearing your opinion.

Thank you very much, XXXXXXX XXXXXXX

Answered by Dr. Ajish TP 23 hours later
Brief Answer:
Your reports are normal

Detailed Answer:

Welcome back.

I have seen your reports through the link provided.

Your thyroid function tests are absolutely normal. Your thyroid is functioning normally and no treatment is needed. Your symptoms are unrelated to thyroid and won't be benefitted by thyroid hormone treatment.

Please consult a physician and re evaluate for your symptoms. Liver, kidney function tests, complete blood count, vitamin D, calcium profile, blood electrolytes etc may be useful.

Wishing you good health

Dr Ajish TP
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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