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Experiencing Symptom, but have "Normal" test results
I am at my wits end. For two and a half years, I have been struggling with cold intolerance, edema, dry skin/nails, hair thinning, fatigue, lack of mental clarity, tinnitus, difficulty maintaining my weight, and higher cholesterol levels. I am 36 and have adhered to to a strict vegetarian diet averaging daily intake of 1,700 calories, over 30 grams of fiber, under 25 grams of fat and run 4 times a week. Yet I still struggle to maintain my weight. Gained 14 lbs in 2007 of which I have only been able to lose 7. I have been to 4 different doctors that all listein intently to my symptoms only to pronounce me the picture of health when the blood work up comes back normal. I have recently developed an intolerance for any shirt collar that comes close to touching my neck, but my thyroid is said to be normal size. I would drop it and learn to deal with my symptoms, but am concerned I may be dismissing something serious. Any suggestions? I recently asked for a thyroid antibodies test to be added to the thyroid panel and was told the value of 13, but not given any reference range other than "normal".
Thanks in advance for any advise you may have.
Thanks in advance for any advise you may have.
Three months of "Something New":
1) Go back to the doctor and make sure you have done the tests for the disorders that I mentioned. Also ask him for a bone density test - very important.
2) Remember that any change in diet MUST be gradual, or it may cause digestive, metabolic, mood, and other issues.
3) Hire a personal trainer certified by an accredited agency. I strongly urge you to find someone with a degree in the field. (If you can find an NSCA CSCS, I personally would strongly urge you to hire them. NSCA is the leading certification organization when it comes to strength training and seems to have the highest standards. The CSCS requires a bachellor's degree.)
Then begin to introduce yourself to a resistance training program that will challenge your bones and increase your bone density, as well as helping to increase your metabolism (in large part because of the exercise itself). A good trainer should be able to design an exercise program for a beginner that lasts 20-30 minutes. (Ex, supersetting lunges with bench press with elbows close to body; super-setting step-ups with seated rows, again elbows close to body; doing a circuit of neutral military presses, plank pose, and neutral grip lat pull-downs). You may begin with lighter weights (say, 12 reps per set) but after a couple months, you'll be able to get heavier (6 rep sets).
Explain to the person working with you that you are concerned about bone density and therefore want to avoid machines in favor of simple, complex free weight exercises. If they know what they are doing, they will understand why (just mumble something about axial loading impulses.) Avoid the ab/adduction and knee extension machines, along with anything other machinery that pushes against the "side" of the bone as opposed to down the length of the bone. Starting with lunges and step ups is great. Eventually, as you get stronger and more coordinated, you can move more load-bearing exercises, like very strict form squats (which are used, with proper form, on successful research in increasing bone density). Avoid, until you know your bone density, avoid any abdominal flexion like crunches; but planks and other "neutral" abdominal exercises are fine. Try to keep your elbows in towards your body on bench presses and rows to protect your shoulders (especially in the first few weeks, when you're working on increasing the strength of your connective tissue).
4) Begin to supplement your diet with Omega-3s. For example, try making salad dressing out of lemon-flavored fish oil. Omega-3s are in cold milled flaxseed and capsule supplements, but can be somewhat difficult to get in food unless you purchase glass-fed beef and (for the most part) wild-caught fish with low mercury content. Omega-3s will help to improve your metabolism quickly. Increasing the fat in your diet will help you stay fuller longer, help to regulate your blood sugar, and stimulate biological pathways essential for weight loss.
5) If you have time in your day, split up your three meals into 5 smaller meals. In fact, at 1700 calories, you could probably just add two small snacks in a day, such as some veggies, nuts, etc.
6) Start ignoring the weight on the scale and using the mirror and your old clothing as a judge of progress. Strength training will technically make you heavier, but you will actually be thinner and be leaner. Some of the women you see on magazine covers weigh 10-20 lbs more than you would guess.
7) Gradually begin to increase your caloric intake, trying to incorporate healthy fats (particularly Omega-3s, nuts, olive oil, etc), protein (in whatever form is agreeable to you, even if it is just a protein shake - the more expensive, the better tasting), and only complex carbohydrates (primarily vegetables, some fruits, only whole grains). If you can afford it, I would suggest consulting a dietician with a Master's degree to help you. Unfortunately, it is difficult for an undergraduate degree to just squeeze in all the basics of nutrition, so many dietitians are not up to date on research into fat and carbohydrates. Remember that not everyone responds positively to higher carbohydrate diets, and in many people lowering their carbohydrate intake increases their insulin sensitivity, improves their lipid profile, produced significant fat loss, and improves both energy and mental clarity. Unfortunately, it is also true that not many doctors keep up to date on the volume of research that's out there on this, and the paucity of research on some of their dietary assumptions.
I wish you luck, whether it's a thyroid problem or not! Keep it up, stay motivated, and good luck.
1) Go back to the doctor and make sure you have done the tests for the disorders that I mentioned. Also ask him for a bone density test - very important.
2) Remember that any change in diet MUST be gradual, or it may cause digestive, metabolic, mood, and other issues.
3) Hire a personal trainer certified by an accredited agency. I strongly urge you to find someone with a degree in the field. (If you can find an NSCA CSCS, I personally would strongly urge you to hire them. NSCA is the leading certification organization when it comes to strength training and seems to have the highest standards. The CSCS requires a bachellor's degree.)
Then begin to introduce yourself to a resistance training program that will challenge your bones and increase your bone density, as well as helping to increase your metabolism (in large part because of the exercise itself). A good trainer should be able to design an exercise program for a beginner that lasts 20-30 minutes. (Ex, supersetting lunges with bench press with elbows close to body; super-setting step-ups with seated rows, again elbows close to body; doing a circuit of neutral military presses, plank pose, and neutral grip lat pull-downs). You may begin with lighter weights (say, 12 reps per set) but after a couple months, you'll be able to get heavier (6 rep sets).
Explain to the person working with you that you are concerned about bone density and therefore want to avoid machines in favor of simple, complex free weight exercises. If they know what they are doing, they will understand why (just mumble something about axial loading impulses.) Avoid the ab/adduction and knee extension machines, along with anything other machinery that pushes against the "side" of the bone as opposed to down the length of the bone. Starting with lunges and step ups is great. Eventually, as you get stronger and more coordinated, you can move more load-bearing exercises, like very strict form squats (which are used, with proper form, on successful research in increasing bone density). Avoid, until you know your bone density, avoid any abdominal flexion like crunches; but planks and other "neutral" abdominal exercises are fine. Try to keep your elbows in towards your body on bench presses and rows to protect your shoulders (especially in the first few weeks, when you're working on increasing the strength of your connective tissue).
4) Begin to supplement your diet with Omega-3s. For example, try making salad dressing out of lemon-flavored fish oil. Omega-3s are in cold milled flaxseed and capsule supplements, but can be somewhat difficult to get in food unless you purchase glass-fed beef and (for the most part) wild-caught fish with low mercury content. Omega-3s will help to improve your metabolism quickly. Increasing the fat in your diet will help you stay fuller longer, help to regulate your blood sugar, and stimulate biological pathways essential for weight loss.
5) If you have time in your day, split up your three meals into 5 smaller meals. In fact, at 1700 calories, you could probably just add two small snacks in a day, such as some veggies, nuts, etc.
6) Start ignoring the weight on the scale and using the mirror and your old clothing as a judge of progress. Strength training will technically make you heavier, but you will actually be thinner and be leaner. Some of the women you see on magazine covers weigh 10-20 lbs more than you would guess.
7) Gradually begin to increase your caloric intake, trying to incorporate healthy fats (particularly Omega-3s, nuts, olive oil, etc), protein (in whatever form is agreeable to you, even if it is just a protein shake - the more expensive, the better tasting), and only complex carbohydrates (primarily vegetables, some fruits, only whole grains). If you can afford it, I would suggest consulting a dietician with a Master's degree to help you. Unfortunately, it is difficult for an undergraduate degree to just squeeze in all the basics of nutrition, so many dietitians are not up to date on research into fat and carbohydrates. Remember that not everyone responds positively to higher carbohydrate diets, and in many people lowering their carbohydrate intake increases their insulin sensitivity, improves their lipid profile, produced significant fat loss, and improves both energy and mental clarity. Unfortunately, it is also true that not many doctors keep up to date on the volume of research that's out there on this, and the paucity of research on some of their dietary assumptions.
I wish you luck, whether it's a thyroid problem or not! Keep it up, stay motivated, and good luck.
First, I certainly encourage you to pursue the hypothyroid issues, particularly with the information I put above at your disposal.
It is really wonderful that you are taking the initiative to do what you can for your health. You seem to be trying very hard to work towards health, and are obviously very dedicated. While what you're doing is great, there are still things that you definitely need to check for and pay attention to. One of the issues with disease is that some people do not display classic symptoms. With your fiber intake, constipation may not be an issues for you, for example.
The next few things I am about to say to you may be antithetical to your ideas and you may find yourself very resistant to them. However, I would encourage you to give it a shot. You have already tried one way for almost three years. I would suggest you try the following suggestions for three months. If, at the end of that time, you are unhappy with the results, you can always go right back to where you started.
First, vegetarian diets can be great. There are certainly health benefits in some people. However, especially in conjunction with extremely low calorie diets, they can lead to certain deficiencies. All the symptoms you mentioned are related to one or more of the deficiencies I have related below. You would have to look a little deeper into each. If you have not already taken these tests (or have taken B-12 while supplementing with Folic Acid) these are important tests to have done:
Iron: Fatigue, mental decline, decreased immunity. Ferritin is the best test.
B-12: Fatigue, light headed, feeling sick to your stomach, constipation, mental decline, among others.
Protein: Because of both your low caloric intake and vegetarianism, this may be an issue. Mental decline, brittle hair, weakness, elevated cholesterol.
Folic Acid: Can mask B-12 deficiency. Weakness, mental decline, concentration issues, etc.
You are getting 25 grams of fat a day, or about 225 calories from fat. That means that less that 13 percent of your daily caloric intake is from fat. While that would have been considered beneficially back in the 1980s, that is certainly no longer considered healthy. Given our increased understanding of cardiovascular disease, the mechanisms underlying nutrition, as well as a better understanding of fat in particular, less fat is no longer necessarily considered better. Before our fast food began spreading in the region, the healthiest people on Earth were in the Mediterranean and consuming 30% of their calories from healthy fats each day. Research has shown that healthy fats such as Omega-3 help to increase mental clarity, aid in fat loss, improve blood profiles (including cholesterol), improve depression, and benefit the heart. Raising your percentage of primarily healthy fats up to at least 20% would be very beneficial.
I am assuming that you are an average adult female, in which case a caloric intake of 1700, especially over the course of almost three years, can cause a host of issues. Many would mimic hypothyroidism. Prolonged caloric restriction in combination with the amount of running you are doing can put you at risk for bone loss and fracture, menstrual irregularities, and a decline in your metabolic rate. This all can lead to weight gain and problems losing weight. Yes, low calorie diets can lead to weight gain.
So I'll follow this with a post of some specific steps you can take if you want to try something new.
It is really wonderful that you are taking the initiative to do what you can for your health. You seem to be trying very hard to work towards health, and are obviously very dedicated. While what you're doing is great, there are still things that you definitely need to check for and pay attention to. One of the issues with disease is that some people do not display classic symptoms. With your fiber intake, constipation may not be an issues for you, for example.
The next few things I am about to say to you may be antithetical to your ideas and you may find yourself very resistant to them. However, I would encourage you to give it a shot. You have already tried one way for almost three years. I would suggest you try the following suggestions for three months. If, at the end of that time, you are unhappy with the results, you can always go right back to where you started.
First, vegetarian diets can be great. There are certainly health benefits in some people. However, especially in conjunction with extremely low calorie diets, they can lead to certain deficiencies. All the symptoms you mentioned are related to one or more of the deficiencies I have related below. You would have to look a little deeper into each. If you have not already taken these tests (or have taken B-12 while supplementing with Folic Acid) these are important tests to have done:
Iron: Fatigue, mental decline, decreased immunity. Ferritin is the best test.
B-12: Fatigue, light headed, feeling sick to your stomach, constipation, mental decline, among others.
Protein: Because of both your low caloric intake and vegetarianism, this may be an issue. Mental decline, brittle hair, weakness, elevated cholesterol.
Folic Acid: Can mask B-12 deficiency. Weakness, mental decline, concentration issues, etc.
You are getting 25 grams of fat a day, or about 225 calories from fat. That means that less that 13 percent of your daily caloric intake is from fat. While that would have been considered beneficially back in the 1980s, that is certainly no longer considered healthy. Given our increased understanding of cardiovascular disease, the mechanisms underlying nutrition, as well as a better understanding of fat in particular, less fat is no longer necessarily considered better. Before our fast food began spreading in the region, the healthiest people on Earth were in the Mediterranean and consuming 30% of their calories from healthy fats each day. Research has shown that healthy fats such as Omega-3 help to increase mental clarity, aid in fat loss, improve blood profiles (including cholesterol), improve depression, and benefit the heart. Raising your percentage of primarily healthy fats up to at least 20% would be very beneficial.
I am assuming that you are an average adult female, in which case a caloric intake of 1700, especially over the course of almost three years, can cause a host of issues. Many would mimic hypothyroidism. Prolonged caloric restriction in combination with the amount of running you are doing can put you at risk for bone loss and fracture, menstrual irregularities, and a decline in your metabolic rate. This all can lead to weight gain and problems losing weight. Yes, low calorie diets can lead to weight gain.
So I'll follow this with a post of some specific steps you can take if you want to try something new.
Unfortunately the issues all of you are dealing with are very common. There are a variety of reasons:
1) Some hypothyroidism is caused not by a problem with the thyroid, but a problem originating at the pituitary gland. This is referred to as "Secondary Hypothyroidism". While rare, this form of hypothyroidism can be detected with test for Prolactin. TSH, in this case, would appear normal or even low. Another issue is tertiary hypothyroidism, which originates at the hypothalamus.
2) Many laboratories contain normal TSH ranges that were developed for iodine-deficient countries, which America is not. NHANES data also found that previous ranges were also skewed by including those with underlying thyroid dysfunction. In iodine-sufficient countries like America, 95% of the healthy population has a TSH between 0.4 and 2.5. In America, according to the American Thyroid Association, a TSH above 2.5 is technically above normal and that patient should be tested for anti-thyroid peroxidase (anti-TPO) antibodies.
As I mentioned elsewhere:
According to the American Thyroid Association, "normal" is classified as a TSH between 0.4 and 2.5; back in 2003 they classified 2.5 to 4.0 as "at risk" and 4.0 to 10.0 as subclinical hypothyroidism, which doctors could treat at their own discretion. Above 10 is classified as overt hypothyroidism.
Elevated TSH and normal T3 and T4 is a sign of a typical subclinical thyroid patient.
Research since 2003 has shown that even very small elevations in TSH - within the 2.5 to 4.0 range - carry significant health issues (cardiovascular, etc) and more recently, evidence has shown that treating those patients helps to lower such risks. 95% of the normal population has a TSH between .4 and 2.5. (Previous ranges were based on data skewed by including those with thyroid disorders).
A joint statement by the ATA and the CDC states that women who want to become pregnant and have a TSH over 2.5 should be treated to prevent miscarriages, premature births, and other significant health issues to the fetus.
3) TSH alone cannot paint an accurate picture of what is going on with a patient. Free T3 and T4 tests, and a TSH taken within two hours of waking, are the best indicators of true thyroid function. If answers are still not derived from these tests, prolactin (pituitary function), ferritin (for anemia), and cortisol may be taken.
4) Some people with the antibodies for hypothyroidism remain asymptomatic until a sudden event (ex, pregnancy) causes the person to rapidly progress towards hypothyroidism.
I will answer the first poster's question separately.
1) Some hypothyroidism is caused not by a problem with the thyroid, but a problem originating at the pituitary gland. This is referred to as "Secondary Hypothyroidism". While rare, this form of hypothyroidism can be detected with test for Prolactin. TSH, in this case, would appear normal or even low. Another issue is tertiary hypothyroidism, which originates at the hypothalamus.
2) Many laboratories contain normal TSH ranges that were developed for iodine-deficient countries, which America is not. NHANES data also found that previous ranges were also skewed by including those with underlying thyroid dysfunction. In iodine-sufficient countries like America, 95% of the healthy population has a TSH between 0.4 and 2.5. In America, according to the American Thyroid Association, a TSH above 2.5 is technically above normal and that patient should be tested for anti-thyroid peroxidase (anti-TPO) antibodies.
As I mentioned elsewhere:
According to the American Thyroid Association, "normal" is classified as a TSH between 0.4 and 2.5; back in 2003 they classified 2.5 to 4.0 as "at risk" and 4.0 to 10.0 as subclinical hypothyroidism, which doctors could treat at their own discretion. Above 10 is classified as overt hypothyroidism.
Elevated TSH and normal T3 and T4 is a sign of a typical subclinical thyroid patient.
Research since 2003 has shown that even very small elevations in TSH - within the 2.5 to 4.0 range - carry significant health issues (cardiovascular, etc) and more recently, evidence has shown that treating those patients helps to lower such risks. 95% of the normal population has a TSH between .4 and 2.5. (Previous ranges were based on data skewed by including those with thyroid disorders).
A joint statement by the ATA and the CDC states that women who want to become pregnant and have a TSH over 2.5 should be treated to prevent miscarriages, premature births, and other significant health issues to the fetus.
3) TSH alone cannot paint an accurate picture of what is going on with a patient. Free T3 and T4 tests, and a TSH taken within two hours of waking, are the best indicators of true thyroid function. If answers are still not derived from these tests, prolactin (pituitary function), ferritin (for anemia), and cortisol may be taken.
4) Some people with the antibodies for hypothyroidism remain asymptomatic until a sudden event (ex, pregnancy) causes the person to rapidly progress towards hypothyroidism.
I will answer the first poster's question separately.
A related discussion, Can ANYONE HELP??????? NEED ANSWERES!!!! was started.
I was wondering I have read your comments and have many of the same symptoms. I have heard you should request an antibodies test, do you have any thoughts on this. I continue to increase fatigue, sleep 9-10hrs and get up exhausted - if I sleep through the night at all. Continue to loose my hair and hands and feet are always cold. My levels come back "normal" but I still feel like I can't function.
Hello. I am apologize, I just reread your post and saw that you had a question. I think there are three different types of antibodies tests. There is a site called labtestsonline that explains the different ones. After posting here, I took the suggestion of lazydog and got a copy of my lab results. I see that a thyroglobulin test was run but I don't think that is an antibodies test. My TSH was 2.36 and my Free T4 was .8. They did not run a T3 and I don't think the antibodies test. My calcium, protein and potassium were all normal which I am happy about, but my high LDL is concerning me out a bit.
Wanted to thank you for the very informative and detailed responses to my post. I will take your suggestions and will definitely look into the deficiencies I likely have in my diet. I recently did start some supplements, in particular a B complex and Vitamin C. I am sure that I am lacking in several areas and will seek consulatation for assistance. I have been a vegaterian since I was 13, but the low fat diet happened about 5 years ago when I developed gall bladder problems, fatty foods were a trigger for attacks. After I had my gall bladder removed, I continued to have attacks that felt exactly the same as the gall bladder attacks I had been having. It took about 18 months for my doctor to diagnose sphincter of oddi dysfuction. By the time I had the ERCP to correct the problem, I had been avoiding fat for so long that eating this way is normal to me.
I am slightly over 6' tall and so I am also thinking I may be not consuming enough calories, especially because I did add strength training to my regimine about six months ago. Nothing major, some core work and push ups mainly. Thanks for the different perspecitive. I really appreciate your suggestions and will seek assistance and see how it goes.
I am slightly over 6' tall and so I am also thinking I may be not consuming enough calories, especially because I did add strength training to my regimine about six months ago. Nothing major, some core work and push ups mainly. Thanks for the different perspecitive. I really appreciate your suggestions and will seek assistance and see how it goes.
MEDICAL PROFESSIONAL
If they are normal (even borderline), then the weight is not likely thyroid related - but would need to see the numbers to be certain.
You know I wonder if it should even be as high as 2.5 I am new to all this, but mine is 1.9 and I can’t remember the numbers that follow that. I have the feeling of sand in my eyes in the morning, achy all over, when I am in the cold, I have cold chills go all over my body, my feet fall asleep more often than they did before, I am really fatigued in the mornings, and I have noticed dryer skin on my face and legs, oh also I have ringing in my ears from time to time. I just had a baby 9 weeks ago, and not sure if this is related, but my results came back "in the range" to, but I know that I don’t feel right. They sent me to get an ultrasound and I have 3 complex nodules on my thyroid, but I guess since there is no vascularity they are saying I just need to follow up in 6-12 months which I am not sure about either. I have no insurance as of now, and am hoping I am not denied for the HMO I applied for because of my complex cyst. If I am not, I am definitely going to press the issue of the way I am feeling to my doctor and if I was you Funfeit I would do the same. I don’t think my doctor checked me for T3, T4 or the antibodies, I just saw the TSH test on my report. What would the antibody test be called, does anyone know? I know now I am making an effort to walk every day, trying to eat better, and taking my prenatle vitamin again. I really think I let myself get to run down, at least I hope thats all it is and not the 'C' word.
As doctor for a copy of your blood test results!! Check them out for yourself!! I was told "normal" for years. I should have been diagnosed in 1999 but wasn't until 2005 when I was barely able to function!!!! Lab ranges are still not using world standards of 0.3 to 3.0 TSH. Anything over 2.5 should be treated IMO. They may be using old ranges up to 5 or 6!!! You certainly sound like you are hypothyroid to me! Get your results asap - they have to give you a copy, it's your right.
...Julia
...Julia
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