endocrinology question!

[sara185]

Hmm so not sure where to post this - but I thought that maybe some of you future endocrinologists might be able to help my roommate out and also put all your learning to use! (Sorry if I'm breaking some sort of rule - I always read sdn and thought I could use it to help a friend).

She has Hashimoto's hypothyroidism and has been taking levoxyl for years now and everything is fine. She is going to start taking birth control and we read in the package insert for her thyroid medicine that the estrogen can affect the tests, but overall the levels are fine (at least that is what we took away from it - but I am not yet a medical student so this is where you guys come in!).

The issue is that she is from a very conservative family and does not want her mother to know she is taking birth control. Also, her mom is her endocrinologist - so basically will see her test results. She is really worried that it might be possible for her mom to guess that she is taking birth control from her test results - or at least know that something has changed? Is this true?

Thanks guys!

Sara

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[BlackNDecker]

DISCLAIMER: This is not a medical consultation...this is simply an explanation of basic science.

Exogenous Estrogen (i.e. consumed in birth control pills) acts on the liver (and other organs to a lesser extent) to increase protein synthesis. > 95% of Thyroid hormone (T4, T3) is transported in the circulation bound to carrier proteins. <The main carrier proteins are thyroxine-binding globulin (TBG), transthyretin (TTR, or prealbumin), and albumin>. Very simply, increasing the carrier protein results in increased TOTAL thyroid hormone levels with a transient reduction in Free T4 (the free T4 is taken up by the newly synthesized carrier proteins). The liver responds much more rapidly than other organs, e.g. thyroid. Once the thyroid catches up, the free T4 will normalize. The persistent laboratory clue in this scenario would be an elevated Total T4.

If this were a multiple choice question, I would suggest practicing monogamy, or at the very least, safe sex.

 

[RTrain]

Your roommate should get an endocrinologist outside the family. Her mom might be the most brilliant endo doc in the western hemisphere but it's virtually impossible to be completely objective when treating a family member. And it's not really safe to take medications, prescriptions or otherwise, and not disclose them to your doctors. Plus, it will only get more stressful for your roommate as she gets older and there are more and more health related issues that she would want to discuss with her doctor but not her mom.

 

[adam6]

Ditto on having a non-fam endocrinologist. I assume this is already the case? And the prescribing MD really should know of any med changes (but, again, I assume the MD is Rx'ing the birth control?)

However...as to your question: OCPs may change TBG and TT4 and consequently could transiently decrease free T4 and increase TSH, but should not affect TSH or free T4 longterm once the body reequilibrates. However, the PMD or endocrinologist would typically recheck thyroid function tests 6-12 weeks after a medication change (eg: starting OCPs) just to make sure the levothyroxine dose is correct. They shouldn't even be checking TBG and TT4 - so that won't be an issue. But sounds like daughter may want to open lines of communication with mother - but that's none of my business

 

[yaah]

SDN is not the place for medical advice. You need to consult a licensed physician. Closing this thread.