Dr. Shaikh Sadaf
Endocrinology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My tests results for thyroid stimulating hormone levels are as follows - seven years back TSH levels were - 0.9 mIU/mL. T4 levels were 1.03 ng/dL. And then two years back TSH levels were 0.7 mIU/mL. Last year TSH levels were 0.7 mIU/L and T4 0.83 ng/dL. This year TSH levels are 1 mIU/mL. T4 1.2 ng/dL. Thyroid peroxidase test (TPO) 45 mIU/ml. Are these test results indicative of a developing thyroid issue and could they be contributing to infertility? Currently I am under investigation for infertility, heavy periods, fatigue, brain fog, paresthesia, dry skin, thinning hair (front only), joint pain (migratory and asymmetrical), and muscle pain. All of these symptoms are are present since last five years and improved with iron supplements but did not resolve. Also I have a weight gain of 22 lbs in last two years since I quit smoking.
Hello,
Welcome to icliniq.com.
I have read your query and your reports. I appreciate your concern about getting pregnant and the issues that you are facing, unfortunately. Your thyroid test results are normal and are not the cause of your symptoms. Stopping smoking leads to weight gain. Weight gain can put undue stress on the knees and cause subsequent knee pain. I think a rheumatologist consultant can help you with your migratory joint pains. You must also check rheumatoid factor, X-ray knee joints, and vitamin D levels.
Thank you.
Patient's Query
Hello doctor,
Thank you for the suggestion. I also have low estrogen levels that will fall into the low normal range around ovulation but very low outside of that. FSH, LH prolactin, and progesterone levels are normal. Could this be contributing to or causing the symptoms? I will discuss a rheumatology referral with my general practitioner.
Hello,
Welcome back to icliniq.com.
I appreciate your concern. You have slightly low estradiol levels, but your LH (luteinizing hormone) and FSH (follicle stimulating hormone) are normal, so this is not a major issue here. These hormones are well synchronized in harmony with each other, and if one falls apart, the others follow the same haywire pattern, which does not seem to be the case here. However, for example, if you get a bone DEXA (dual-energy X-ray absorptiometry) scan of the hips and lumbar spine and if you are diagnosed with osteoporosis, then we would be considering this due to low estrogen-induced, and that happens in premature menopause. But yet again, FSH and LH still do not match premature menopause levels, so this low estrogen is insignificant. That is normal. If you undergo fertility treatment, they will solve this little problem as well, but that should not stop you from getting pregnant. You must consult with a rheumatologist for your musculoskeletal issues, and many of your symptoms will have an answer.
Thank you.
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Endocrinology
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