Her Hair Loss Help Rotating Header Image

blood tests

Hypothyroidism and Thyroid Hair Loss in Women

Claire, one of our lovely forum members, put together this incredibly informative post on hypothyroidism, TSH levels and doctors…

Just a little background. I was diagnosed with Hypothyroid in June of 2005. After over a year of fighting with doctors I finally reached a TSH level below 3.0 in August of 2006.

I am not a doctor, nor a health professional. I’ve read, experimented, and suffered through this thyroid maze. As I would say if you came to me with someone else information, please take everything I say about my treatment with a grain of salt. What works for me may not work for you, but I feel it’s important to give you an idea of what can be done.

The reason I had so much trouble with doctors is that many of them have been out of med school longer than the newest findings.

As of 2012 the AACE (American Association of Clinical Endocrinologists) published new findings on the correct thyroid levels in most individuals. No longer is the range between .5 and 5.0 but a smaller range of .3 to 3.0

AACE guidelines for correct thyroid levels in women to help find solutions to hair lossThe full AACE Guidelines can be viewed by clicking this link.

What does this mean? That many many doctors are under treating their patients. Even more frightening is that there are doctors who have not been updated on thyroid function for an even longer period of time and think that a TSH level under 10 is appropriate. Luckily those doctors are few and far between. What this teaches us is that educating oneself on ones health matters is most important. We assume that doctors are knowledgable about all health matters. The truth is, scientists and specialists come to new findings every year and general practitioners are the last to know. Doctors are well educated on health matters, unfortunately, they are well educated within the time frame in which they went to medical school. This leaves several years of updated information that they have not had access too. Even more frightening is that many of them dismiss new findings if such information is brought to them by a patient.

Synthroid tablets are a common treatment option for women who suffer from thyroid problems and hair lossIf you are hypothyroid and still suffering with symptoms and your doctor is telling you that your thyroid is functioning normally it is time to start taking control of your situation.

First, obtain a copy of your most recent lab work. Find out what your thyroid levels really are. Second approach your doctor about what issues you are having. If he is unwilling to listen, then you have a couple of options.
A. you can take in a copy of the AACE’s newest research {http://online.liebertpub.com/doi/abs/10.1089/thy.2012.0205?journalCode=thy}, a copy of a checklist of your symptoms {http://thyroid.about.com/cs/hypothyroidism/a/checklist.htm}

If you have any other symptoms that seem abnormal to you, but are not listed, please list them as well. Recently, I’ve discovered that overnight leg cramps is also a symptom of hypothyroid.

B. you can switch doctors.

You may have to do B. anyway, if your doctor is unwilling to work with you. The best thing you can do is request to be sent to an endocrinologist. If your doctor is unwilling to refer you, you are not without hope. Most insurance companies have patient outreach programs. Obtain a copy of your records, including blood tests (you have the RIGHT, by law to get copies of your medical records), a copy of the AACE’s findings, a list of ongoing symptoms and a letter requesting referral to see a specialist. It is possible to go over your doctor’s head in order to do this. You can also switch doctors and request this of your newest doctor. Be warned, even some endocrinologists go by an older TSH scale. If you find this to be so, request a second opinion.

Most important, do not think that the doctor knows more than you. You, and only you truly knows how you feel. Do not worry about offending your doctor. As it is, your doctor doesn’t seem to worry about offending you. You are the boss in this situation. He works for you, if he is unwilling to do his job, then you’ve every right to hire someone else.

Once you find someone willing to work with you ( and if you already have, thank your lucky stars) do not expect your symptoms to alleviate as soon as you start a new dosage. Do not expect your symptoms to alleviate as soon as you reach a healthy TSH level. It’s going to take some time for your body to begin to heal itself. However, you will notice some changes within weeks.

Anatomy image of the thyroid gland courtesy of UpToDate.com

Anatomy image of the thyroid gland courtesy of UpToDate.com

The Thyroid also changes with time. As you begin to reach a healthier TSH level things may plateau and you may have to adjust your meds as needed. It’s not uncommon to reach a healthy TSH level and a few weeks later begin to feel bad. It’s important that within the first year of reaching a healthy TSH goal to be checked every 3 months. After that it’s important to be tested twice a year. Some doctors say only once a year is enough, this is not true. Thyroid levels change with temperature changes. One of the best ideas is to check your thyroid levels a few weeks into the first cold snap of winter and within the first few weeks of summer heat. Many thyroid patients find they need to adjust their dose with the extreme temperatures of both seasons. Cold weather slows thyroid function, hot weather tends to call for less thyroid supplement.

It is also not uncommon for a short period of time in which you have a few of the sensations associated with HypERthyroid upon starting a new dosage. I’ve found the best way to avoid this is to titer up. My doctor is willing to work with me on this. This consists of me cutting pills and slowly adding till I reach my newest dosage level. Thyroid hormone takes time to build within the system. This is why titering up works in many cases. This is also why you do not retest your thyroid till 6-8 weeks after beginning a new dose. If you decide to titer up, do not retest till the 6-8 week mark after you reach your INTENDED dosage. My pm box is always open if you have additional questions about this. It is important to discuss this with your doctor as well. Do not raise your dosage above what he recommends till you’ve had your TSH checked. Then be sure to inform him of anything you intend to do, so that you may have another test lined up.

There is no magic number. Not when it comes to TSH, not when it comes to dosage. The ideal setting is for you and your doctor to work together by using both blood work and how you feel.

When taking thyroid medications it’s important to understand a couple of things. First, any food or vitamins taken with the thyroid med will change the absorption rate of the hormone. Your best bet is to take the thyroid med first thing in the morning and an hour before and after eating. So, no food for an hour on either side of taking your med. Even more important is delaying the taking of vitamins. Especially iron and calcium. Both of those can have an effect on the way your body absorbs the thyroid hormone. It is best to take your vitamins either in the middle of the day (2-3 hours) after your hormone or at night (6-8 hours) before.

If you are the type that has to eat first thing in the morning then know that you must follow the pattern every day. If you eat less than an hour after taking your thyroid hormone then it is important to follow this habit daily. It is also important to stick to a similar breakfast food. For instance if you drink milk, it will have an effect on how your body absorbs the hormone, so it’s important to have dairy at the same time, every day as to keep the hormone absorption similar.

Hair Loss in Women

Her Hair Loss Help has an outstanding Discussion Forum specifically for women with alopecia and other forms of hair lossWomen experience hair loss because of a number of reasons, such as pregnancy, stress, genetics or an illness. Another cause is Alopecia Areata, an autoimmune disorder which results in hair loss.

Women going through any type of hair loss becomes distraught about their changing appearance. Some are comfortable leading their life as someone without hair, but many seek out hair replacement studios to give them back what they have lost.

Unless you yourself have been through sudden and unexpected hair loss, it is nearly impossible to fully understand the emotions that a person must be experiencing. The process going from someone with hair, to someone losing their hair, to someone seeking hair replacement, is a sensitive and personal journey.

Blood Tests to Have Done First for Diagnosing Hair Loss Causes

These are simple blood tests that you should have done if you think that your hair loss may be caused by a chemical deficiencyIt’s easy to get lost in the maze of tests and blood panels that your doctor should require to diagnose the cause of your hair loss. Here is a complete list of blood tests to talk to your physician or dermatologist about at the beginning of your hair loss journey, along with it’s corresponding recommended normal range/level.

Many dermatologists will recommend Rogaine (minoxidil) immediately without spending time reviewing bloodwork and ordering blood panels. It’s okay to remain assertive with your doctor and request a full series of blood tests to rule out any underlying conditions that could be causing your hair loss. Often times, a simple hormonal imbalance or vitamin deficiency can be discovered early with a blood test and you will be well on your way to restoring your hair.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Vitamin Deficiency:

Simple blood tests to be ordered if you think your hair loss may be caused by a lack of nutrients in your diet.

CBC:
This test will show if you are anemic. Even mild anemia can often cause hair shedding. Look for lower than norm values for Red Cell Count, Hemoglobin.

RBC (Red Blood Count): normal levels: 4.2 to 5.4 mil cell/mcL
WBC (White Blood Count): normal levels: 4500 to 10000 cells/mcL
Hematocrit: normal levels: 36.1 to 44.3%
Hemoglobin: normal levels: 12.1 to 15.1 gm/dl
MCV: normal levels: 80 to 95 femtoliter
MCH: normal levels: 27 to 31 pg/cell
MCHC: normal levels: 32 to 36 gm/dL

Vitamin B12 and B6:
The lack of these vitamins can cause hairloss.
B6: optimum level: 2 to 26 ng/ml
B12: optimum level: 200 to 900 pg/ml

Zinc:
The lack of zinc is a known cause of hairloss. Be careful though, too much of zinc could cause hairloss as well. 😕

Iron:
Serum Iron: optimum level: 60 to 170 mcg/dl
Serum Ferritin: optimum level: 12 to 150 ng/ml
TIBC (Total Iron Binding Capacity): optimum level: 240 to 450 mcg/dl

A lot of hairloss specialists believe that one needs a level of ferritin higher than 40 in order to maintain hair and ferritin above 70 to regrow lost hair. There’s also a lot of opposing points of view, however in general it’s probably a good idea to get your ferritin stores at a proper level. One thing to notice is that TIBC above the norm (above 400) means the lack of iron in the iron stores. TIBC above 400 often corresponds to lower serum ferritin numbers. As ferritin increases, TIBC should drop.

ESR:
ESR: optimum level: >20mm/hr
There’s an article stating that if your ESR is less than 10 you need to considerably increase your serum ferritin level to stop/reverse hairloss.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Electrolyte Panel:

Blood tests that you should have done prior to and during the administration of anti-androgenic medications such as spirolactone. These tests can also aid in diagnosing adrenal problems.

Sodium: normal levels: 15 to 250 mEq/L/day
Chloride: normal levels: 20 to 25 mEq/day
Potassium: normal levels: 25 to 120 mEq/L/day
CO2: normal levels: 20 to 29 mEq/L

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Thyroid Panel:

Rapid hair loss can be the worst symptom of a thyroid problem

Your thyroid gland is one of the largest endocrine glands in your body. [Image courtesy of SutterHealth.org]

Blood tests that are recommended to diagnose hyperthyroid, hypothyroid and other thyroid related problems.
TSH and T3/T4:
Thyroid conditions often cause hairloss as well. The best TSH value is between 1 and 2. Values above 3 are still considered normal by many labs (the upper level of normal is 5) however it usually indicates an overactive thyroid and should prompt for future evaluation.

TSH (Thyroid Stimulating Hormone): optimum level: .3 to 3.0 mlU/L
** if you are on thyroid medication already, your optimum level SHOULD be between .5 and 2.0 mlU/L
Total T3: optimum level: 100 to 200 ng/dL
Free T3: optimum level: 2.3 to 4.2
Total T4 (Total Thyroxin): optimum level: 4.5 to 12.5 mcg/dL
Free T4 (Free Thyroxin): optimum level: .7 to 2.0

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Auto Immune Testing:

These tests can also aid your physician in giving you a definitive answer as to what is causing your hair loss. They show the possibility of lupus, hashimoto’s, sjoren’s, alopecia areata and other autoimmune disorders.

ANA and Anti-DNA

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Adrenal Function Panel:

These are tests you should have done to rule out adrenal deficiencies which can cause hair loss as well as fatigue, joint and scalp pain.

Cortisol AM:
Cortisol is a stress hormone. Even though there’s no direct link to hairloss, a high cortisol value means the body is under a lot of stress and the adrenal gland is working overtime. This situation shows the ‘fight or flight’ reaction of the body as a result of which a lot of hormonal functions are interrupted. Stress significantly decreases the benefits of ALL the hormones. Moreover, high cortisol values can indicate a possibility of
adrenal tumor.

Cortisol: normal 8am levels: 6 to 23 mcg/dl

Serotonin:
Serotonin: normal levels: 101 to 283 ng/ml

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hormone Panel:

Visit our online discussion forum to read more topics on hormone imbalances and how it affects hair loss in womenThese are ESSENTIAL blood tests to have done if you believe that you may be experiencing hair loss due to hormonal imbalances.

Estradiol:
For premenopausal woman the lowest estradiol value should be shown on the test taken on the 3rd day of her cycle (the week of her period). Values between 80-90 are preferable, values below 50 show estrogen deficiency. For the rest of the cycle the optimal range is 100-200 (closer to 200 the better). Younger women can produce significantly higher levels of this hormone.

Estradiol: normal levels:
**** Premenopause: 20 to 400 pg/ml
**** Postmenopause: 5 to 25 pg/ml

Total Testosterone:
If the value is above 50, it could potentially cause the situation of adrogen sensitivity, but the more important number is the one for free testosterone.

Total Testosterone: normal levels: 20 to 80 ng/dl

SHBG (Sex Hormone Binding Globulin):
Values around 90 are desirable. Values above 100 are considered too high. High values of SHBG decrease the availability of all the hormones in the body. Higher levels of estradiol are needed to raise SHBG.

Luteinizing Hormone (LH):
Luteininzing Hormone: normal levels: 5 to 20 IU/L

Prolactin:
Prolactin: normal levels: 0 to 20 ng/ml

Free Testosterone:
Values above 1-1.5 are considered on the higher end of normal range. Values closer to 0.5-0.6 are more desirable. Free Testosterone is the result of Total Testosterone divided by SHBG.

Progesterone:
Value above 5 means that woman is ovulating.

Progesterone: normal levels:
**** Pre-ovulation: >1 ng/ml
**** Midcycle: 5 to 20 ng/ml
**** Postmenopausal: >1 ng/ml

Follicle Stimulating Hormone (FSH):
Hormone that regulates production of female hormones. Levels above 15 indicate menopause. Levels of 3 and below usually indicate BCP use. Higher levels of FSH indicate decrease of estradiol production, while lower
levels indicate higher level of estradiol production.

FSH: normal levels:
**** Follicular: 3.5 to 12.5 IU/L
**** Midcycle: 4.7 to 21.5 IU/L
**** Postmenopausal: 25.8 to 134.8 IU/L

DHEA and DHEAS: Some doctors report finding that a high percentage of patients with autoimmune disorders are also deficient in DHEA, and should be tested.

DHEA: normal level for women by age:
18 to 29 years: 62 to 615 ug/dL
30 to 39 years: 52 to 400 ug/dL
40 to 49 years: 44 to 352 ug/dL
50 to 59 years: 39 to 183 ug/dL
60+ years: 11 to 150 ug/dL

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Illustration of glucose molecular structure

Diabetes is a common cause of hair loss due to the build-up of blood sugar in the body when it is not controlled.

Fasting Blood Glucose (also known as a Fasting Blood Sugar): Blood test done after fasting for 8 to 10 hours
Normal glucose tolerance: From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)
Impaired fasting glucose (pre-diabetes): From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
Diabetes: 126 mg/dL (7.0 mmol/L) and above on more than one testing occasion

Glucose Tolerance Test (OGTT or GTT): Blood test done two hours after a 75-gram glucose drink
[levels below are NOT for gestational diabetes GTT testing]
Normal glucose tolerance: Less than 140 mg/dL (7.8 mmol/L)
Impaired glucose tolerance (pre-diabetes): From 140 to 200 mg/dL (7.8 to 11.1 mmol/L)
Diabetes: Over 200 mg/dL (11.1 mmol/L) on more than one testing occasion

Fasting Insulin: normal levels: 5 to 20 mcU/mL

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


Tests that your Dermatologist should do:

** Pull Test
** Scalp Biopsy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

PCOS ~ What blood tests to have done

What blood tests should be done to diagnose Polycystic Ovarian Syndrome (PCOS)?


Many doctors will require the following blood tests be done to successfully diagnose Polycystic Ovary Syndrome in a patient:

  • Fasting comprehensive biochemical and lipid panel;
  • 2-hour GTT with insulin levels (also called IGTT);
  • LH:FSH ratio;
  • Total testosterone;
  • DHEAS;
  • SHBG;
  • Androstenedione;
  • Prolactin and
  • TSH