Hashimotos and hair loss

[hashihairloss]

Hello fabulous people!

I’m new to this forum, and posting for the first time. I’m a 60 year old female, Hashimotos hypothyroid for more than 20 years. I am taking Tirosint 750 mcg per week at the moment (increased recently from 700 mcg per week due to TSH of 4.56 mUI/l (range 0.30 – 4.30).

My main concern, and the reason why I am writing, is hair loss. It is driving me crazy. The last two years have seen a lot of fluctuation in TSH levels, and simultaneously a lot of hair loss.

I know there can be hundreds of reasons for hair loss. I just want to make sure that at least my thyroid hormone levels are optimized. And also that some of the well known culprits – like ferritin, zinc – are all good.

I am due for a blood test (TSH, fT3, fT4, thyroid antibodies) in June. I’m meeting my GP next week to request that we also test for zinc, vit D, vit B12, folate, ferritin.

Here are my questions:

1. Do I need to test for anything else?

2. How to convince GP to test for vitamins at this point of time? I do get a yearly blood test for everything, but that happens once a year, usually in November. Are there any peer reviewed studies which support the Hashimotos-vitamins connection? Because I’m not going to talk to her about hair loss, just about optimizing thyroid. Because I’m never taken seriously if I talk about hair☹ Even if my hair has thinned down so much that I don’t feel like stepping out of the house anymore ☹ In the past, all I’ve ever gotten from docs when I mention hair, is a prescription for Biotin. For heaven’s sake! Why would they assume there is a problem with Biotin without even testing for it? Biotin did nothing except make my hair and nails grow faster. Why are docs so useless. Sorry for the rant.

[GlowCoach Administrator]

Welcome to the group. If you could complete your profile it helps members understand your thyroid journey so far and be able to advise you better. Click on your image icon to start. Fill out the free text box at the top.

Your TSH of 4.56 being over range shows that you are likely quite a bit under replaced. An increase of 50mcgs a week is probably not going to be enough to bring your levels to optimal. It seems pretty conservative. 25mcgs a day would have made more of a difference.

Did they only test TSH? To understand thyroid health we need to see 3 results: TSH, FT4 & FT3 as TSH alone is not necessarily the best way to make an asssessment although doctors don't always understand this.

Other than low thyroid hormone levels, hair loss is often associated with low ferritin or iron which again are common with being hypo.

You could also ask for a full iron panel.

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

[hashihairloss in reply to GlowCoach]

Hi Jaydee1507, Thanks for your reply. Sorry, didn't post fT4 & fT3 because I thought I'll seek advise on all levels after the more comprehensive blood test in June. Here they are:

fT4 16.7 (9.0 - 19.0 pmol/l)

fT3 2.9 (2.4 - 6.0 pmol/l)

I know the fT3 is very low and something needs to happen on that front. Sigh. One step at a time. Having found this forum, and having read loads, for the first time I'm trying to take matters in my own hands as far as thyroid is concerned. Because no endo cares about anything other than TSH. And I've seen quite a few endos in my time. The current one is supposed to be the BEST one in town. God help me.

[GlowCoach Administrator in reply to hashihairloss]

Free T4 (fT4) 16.7 pmol/L (9 - 19) 77.0%

Free T3 (fT3) 2.9 pmol/L (2.4 - 6) 13.9%

Your TSH is on the high side for the level of FT4 that you have. Are you taking anything with your Levo at the same time or eating drinking either before or just after you take Levo?

Your conversion rate is pretty bad but optimal vitamin levels are required for best conversion so once you get the vitamin tests, post results for members suggestions re supplementing.

You may, in time need to add a smal amount of T3.

[hashihairloss in reply to GlowCoach]

No I'm very careful about that, always first thing in the morning, with water and nothing else, wait for at least 30 mins before breakfast.

[SlowDragon Administrator]

what were your vitamin levels last November?

[hashihairloss in reply to SlowDragon]

here they are, all taken in october november timeframe

blood test results4

[hashihairloss in reply to SlowDragon]

oh no, I had attached 4 images, but only the last one got posted. Do I need to post 4 separate replies?

[GlowCoach Administrator in reply to hashihairloss]

Yes, 1 image per reply.

[hashihairloss in reply to SlowDragon]

Sorry, I'm lost. If I'm allowed only one image per reply, then do I reply to your post 4 times in order to send 4 images? Am I allowed to reply 4 times to one post?

[GlowCoach Administrator in reply to hashihairloss]

Yes I'm afraid thats the only way to get 4 images to post. Reply as many times as you like in order to post each image at a time. No limit.

[hashihairloss in reply to SlowDragon]

I did not succeed in posting all the photos, even by trying to send them one at a time. Simply does not work. So here I send them as text. These are results from October, November. Any insights are much appreciated!

Hémoglobine 142 g/l (120 – 160)

Hématocrite 0.45 I/l (0.37 – 0.45)

Erythrocytes 5.04 T/l (3.90 – 5.30)

MCV 90 fl (82 – 98)

MCH 28.2 pg (26 – 34)

MCHC 313 g/l (320 – 360)

Ferritine 169 µg/l (10 – 400)

Vit B12 255 pmol/l (150 – 650)

B12 active 120 pmol/l (> 35)

Folates 13.4 nmol/l (6.1 – 77.0)

Zinc 18.0 µmol/l (10.7 – 23.0)

CRP ultra-sensible 3.4 mg/l (< 5.0)

25-OH-vitamine-D clinique 94.0 nmol/l (50 – 150)

[SlowDragon Administrator in reply to hashihairloss]

Vit B12 255 pmol/l (150 – 650)

B12 active 120 pmol/l (> 35)

Folates 13.4 nmol/l (6.1 – 77.0)

What B vitamins are you taking

Folate low and serum B12 low

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[hashihairloss in reply to SlowDragon]

Hi SlowDragon,

I'm not taking any vitamin B supplement. The only supplements I take are calcium and zinc. So thanks for the Thorne recommendation, will have a look. One question: do any of the B vitamins have a risk of toxic build-up?

I'm dead sure I ought to be taking omega3, because I don't eat any oily fish, and a test done several years ago showed that I have little to no omega3. For some time I took a liquid supplement - a local (swiss) brand, but gave it up. Bit inconvenient. I prefer a tablet or capsule - that way everything stays in my pill box for the week and it's very convenient. Do you know any good brand for tablet/capsule omega3?

[SlowDragon Administrator in reply to hashihairloss]

Do you know any good brand for tablet/capsule omega3?

Sorry no I don’t….I can’t swallow large pills or capsules, so I use liquid 3. (Nordic naturals)

I can’t swallow Thorne capsules either, so open them up and swallow powder (it’s very yellow and taste is grim)

Now I prefer Igennus, small tablets. I only take one per day But some people find that’s isn’t high enough

[Wua13262348 in reply to hashihairloss]

You look to have a Vitamin b12 and folate problem. Your serum B12 is only 21% through the range. This is active b12 and stored B12. Your active B12 is likely around 56.57% if you assume a range of 35 to 185. You say you do not supplement B12. It looks as if you may be using up your stores of B12 and this might be maintaining active levels around mid-range. As you use up your stored B12, your active levels may drop into deficiency. B12 and folate are to do with methylation, and methylation problems can turn gene mutations on and off. You look as if you may have a genetic mutation resulting in a high FT4 relative to FT3. Your TSH is slightly over range because FT3 is slightly inside the range, but low. The Thyroid Canada site states that TSH is more heavily influenced by the FT3 result, rather than by negative feedback through the HPT axis. It looks as if TSH isn't rising much as FT4 is 77% through the range, but TSH is slightly over range as it recognises FT3 to be too low, I think????? Lots of us on the forum have genetic problems with thyroid signalling and DIO mutations, responsible for converting T4 to T3, and you may have this too. You live in Switzerland, and I do not know if you are able to privately test for this or not. In the UK, Blue Horizon offer a genetic predisposition test. It might be possible to get genetic insights re. thyroid from an Ancestry . Com test. I have no experience of this route. Other forum members may be able to advise.

[hashihairloss in reply to Wua13262348]

Gosh, this is all new info. Thanks for posting! Going to try and read up on the thyroid canada website.

You know, I was reading somewhere that we should not supplement on folate (B9) & B6 needs to be a very limited dose. If this is true (& I don't know if it is) , then instead of getting into a muddle by taking a B complex supplement wouldn't it be better to just take a B12 supplement? Any thoughts?

[Wua13262348 in reply to hashihairloss]

Thyroid canada site absolutely excellent. Thoroughly recommend. No, do not take just a B12 supplement. Follow Slow Dragon's advice on vitamins. All the b vitamins should be taken for balance. I take the Thorne Basic B. You should avoid folic acid and take methylfolate instead, which is within the B complex. The B6 within the B complex is the recommended maximum dose, and is the p5p type which is superior to pyridoxine b6. Folate and b12 work together and b12 needs to be at a decent level before supplementing folate or sub acute degeneration of the spine can occur. It would do no harm to take a high dose liquid sub-lingual methylcobalamin b12 for a short time along with the B complex to raise your B12 to a decent level. Thyroid hormones need good vitamin levels to be able to tolerate and make good use of them, as Slow Dragon has explained.

[FallingInReverse]

Without reading the replies above carefully, just weighing in with my experience. Hair loss was one of the earliest low thyroid symptoms 8 years before I was diagnosed. Showed up as a halo of short hairs on top of my head as hair was falling out but growing back. Then by diagnosis my pony tail was so thin and straggly!

I then discovered I was iron anemic with ferritin in single digits.

So for the past 18 months Ive been optimizing my Free Ts and trying to bring my ferritin up.

My Free Ts are optimizing faster… my ferritin is still in the teens.

And just these past couple weeks my daughter noticed how thick my pony tail is.

I thought I’d have to wait until my ferritin got better, but increasing my Free Ts has gone a long way to fixing the hair loss.

Ferritin

[hashihairloss in reply to FallingInReverse]

Thanks FallingInReverse. In my case, I'm not doing too badly on ferritin as you'll see in my recent reply to SlowDragon. Of course the results are from 6 months ago, so .... But then again, hair loss was crazy even 6 months ago. Your point about fTs could well be my issue which needs fixing. No idea how. fT3 is certainly low.

[FallingInReverse in reply to hashihairloss]

Yeah - as you say lots of reasons, but I know how much people talk about iron and ferritin being a big culprit, which I’m sure it is obviously.

Which is why I am happily surprised that my hair loss has reversed, which correlates to my T3 going up.

I can’t see if you put your iron result in- do you have an actual iron blood test result?

[hashihairloss in reply to FallingInReverse]

Um, the result I just posted in reply to SlowDragon's post? It's got ferritin & haemoglobin. Were you looking for some other markers?

[FallingInReverse in reply to hashihairloss]

: )

Yes, there is actually just “iron” - iron and ferritin are the measures of iron that we have. Iron is the ready-to-use form in our blood. Ferritin is the body’s storage cabinets. Our bodies don’t make iron, we have to eat it.

Everything else on the other hand is a derivative really - measuring the things in the body that iron helps make or that iron relies on to work.

Hemoglobin is the part of our red blood cells in our blood that carries oxygen around. Most of of body’s iron is IN that hemoglobin, as it’s needed to help bind the oxygen so it can get carried where it needs to go. When iron is low, it will impact how much hemoglobin we have.

So when looking at your hemoglobin - you are middle of the range - combined with you sufficient fallback store of iron ( your ferritin), I would guess your iron is likely ok as well. But who knows.

I am not a doctor and am always still learning! Just sharing my opinion based on my experience.

I would prioritize your thyroid hormone optimization - the root cause of so many problems.

I would also get an iron panel if it’s easy to. But from the very little in this post, and my own experience, your iron doesn’t look dire. But don’t take my word for.

Here’s the standard things we usually recco for a full iron panel:

Iron

Total iron-binding capacity (TIBC)

Transferrin saturation

Ferritin

High Sensitivity CRP (CRP-hs)

[Jgoodwin977 in reply to FallingInReverse]

what’s the numbers at the side mean, the supplement amount you need? I thought if your blood work for ferritin was above 70 then that’s enough for your hair to not fall out? And ideally 80-90 for it to grow well? Thanks

[FallingInReverse in reply to Jgoodwin977]

Number on left of graphic is blood test result.

So the graphic is broadly saying exactly what you articulated.

That being said - everyone is different , not everyone experiences all of these, and as I shared, the majority of my hair loss has improved with my free Ts.

Is that what your question was?

[Jgoodwin977 in reply to FallingInReverse]

Thanks for clarifying. It says you can still have hair loss up to 100 which is worrying, as I can never get it that high. My ferritin is 75 and stopped falling out, but can never get it much higher to grow back and they say not to take iron supplements, plus it can feed cancer. So I keep losing it just shy of any balding and then it stops. Glad your improved tsh/T3/t4 numbers have helped, how did you get them back in range? Many thanks

[FallingInReverse in reply to Jgoodwin977]

I wouldn’t get hung up in the details like that. Our bodies are so unique so it’s possible you could get to 100 and still have issues since there is so much at play. Or you stay at 75 and something else resolves it.

My ferritin has been in single digits/low teens since I first tested a year or so ago. So for me, my free Ts seem to have gone a long way helping.

Getting my thyroid hormones to improve has just been the long, low and slow process of increasing Levo and T3 (Liothyronine) at the advice of this forum. I am not where I need to be, and expect a few more 6-8 week titration periods to hopefully resolve some stubborn symptoms.

[csj113]

Plummetting oestrogen is also often a culprit for female hair loss peri-menopause and menopause. You don't mention if you re taking HRT (I might have missed it). It's another major consideration, although HRT does not unfortunately always reverse it.

You could consider seeing a trichologist - they can prescribe things like Minoxidil if necessary.

[hashihairloss in reply to csj113]

Hi csj113,

Thanks for writing. I too wonder from time to time if this is all about the post menopause hormone imbalance, but I'm not taking HRT. Too scared of the side effects.

I did consult a dermatologist once, and she did suggest minoxidil, but I found it to be so very impractical. Makes the hair look greasy. Which would be ok if I had a full head of hair. Which I don't. So then I apply minoxidil and I don't want to step out of the house. Or I apply it at night and then wash my hair every morning. And weep when I see the floor carpeted with my hair. I gave up.

Praying with all my might that optimizing the thyroid hormones will sort out the hair problem.

[flower365]

Hi, In my experience my hair continued to fall out when my TSH was in the accepted range. I had no eyebrows and blocked the plug hole in the shower weekly!!! Despite my protestations of the above, poor nails and feeling lacking in energy I was repeatedly told it could not be my thyroid, probably my age (71). When my TSH finally crawled over the upper range limit they upped my dose by 25mcgs, to the dizzy heights of 75mcgs and I now have a full head of hair and Eyebrows and energy Hurrah!! They are not going to under medicate me again. Luckily found this group and armed with the knowledge and educated counselling from it I monitor privately my tests and will self treat if I think it's necessary. Hope the hair issue responds to the rise in levothyroxine but your T3 does look low.

[hashihairloss in reply to flower365]

Thank you flower365.

For some strange reason, the TSH has been jumping all over the place for the past couple of years. Above range, below range, all sorts. The endo was never very motivated to change the dosage, but I always pushed her to adjust it. I was quite satisfied with the TSH in last october's test, so no dose change. But then the TSH jumped up again. Look at this:

feb 2022: TSH 8.33, ft4 13.8. Changed from euthyrox to tirosint. Increased dosage from 750 to 826.

april 2022: TSH 2.44, ft4 16.3, ft3 3.8

august 2022: TSH 0.03, ft4 20.8, ft3 5.1. Decreased dosage to 784.

december 2022: TSH 2.95, ft4 16.8

august 2023: TSH 0.13, ft4 20.4. Decreased dosage to 700.

october 2023: TSH 1.46. Changed endo!

march 2024: TSH 4.56, ft4 16.7, fT3 2.9. Increased dosage to 750.

Hmmm. Just noticed that in august 2022, the ft3 was good. 5.1. So should I be striving for a low TSH of 0.03-ish.

I'm so confused.

[flower365]

Defo I feel better with a TSH below 1 and so do my eyebrows. But everyone is different. There are much more knowledgeable people on here than me but it looks to me that you are a poor converter of T4 to T3. That could be because you just are and you need T3 or it could be all the other things, vitamins folates are out of kilter. Take it slowly. Make sure everything is where it should by by your test in June and make sure they test T3.From what I gather it needs to be about three quarters through the range, and yours is nowhere near. Best wishes you get it sorted and get some stability, it's horrible feeling so drained.

[Starseed56]

hello thought I’d just quickly add to the above with my own experience. I started taking Erfa last September after 20+ years on Levo and in latter years clearly my numbers weren’t right. I do have one faulty gene result regarding conversion so it made sense. Anyway I’d noticed my hair also thinning specially when in a ponytail and also noticed the new hairs always sticking up a bit! However I have noticed in the last month maybe after nearly 8 months of combined T 3/4 and now good test results, my hair is looking better yippee. My ferritin is still pretty low (28 last test) so I can only claim that theT3 has probably helped 💜

[hashihairloss in reply to Starseed56]

hey, happy to know you got a good result with combined therapy. It helps to know others' experiences. Let's see where my journey takes me. I never ever gave a thought to adding on t3 to my medication, but now I'm beginning to wonder.

[Dahli]

I've had a lot of success with biotin capsules. My hairdresser knows & understands how horrid this condition is. I have a cut every 6 weeks & she always shows me my new hair growth & thinning. She is positive about my find with biotin & has told several other follically challenged clients. Good luck it's so tough. Gill