Icy cold feeling

[nasireddin]

Need you help and advice on hypothyroidism related Icy cold feelings.

Male, age 76y, suffering from hypothyroidism for last 20 years. He has been taking daily at a single dose Eltroxin 125 mcg.

He has developed some symptoms probably related to this disorder, such as scoliosis, IBS, exhaustion, muscular pain etc.

For some few years he is feeling extreme chill all over body with cold limbs ( winter is tormenting! ). His body temperature is 95 F. – 96  F. Recent TSH reads….

Please advise what he should do to get rid of this problem.

[gimel]

The most important thing he can do is to find a good thyroid doctor.  by that I mean a doctor that will treat him clinically, by testing and adjusting levels of the biologically active thyroid hormones, free T3 and free T4, with medication as necessary to relieve symptoms.  symptom relief should be all important.  Please not that free T3 and free T4 are not the same as total T3 and total T4.  FT3 and FT4 are much more important.  TT3 and TT4 are somewhat out of date and not nearly as useful.  

If the patient has been on 125 Eltroxin and still has hypo symptoms, there are three possible contributors that come to mind.  First is that his current medication is too little.  

Second, and more likely, is that his body is not adequately converting the significant dosage of T4 into T3.  This will result in too low of a level of FT3, which is the thyroid hormone that largely regulates metabolism and many other body functions.   Studies have shown that FT3 correlated best with hypo symptoms, while TSH and FT34 did not correlate very well at all.  Many of our Forum members have reported that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  

Third is a very infrequent occurrence where, for several reasons, the body converts too much T4 into reverse T3, which is biologically inactive.This can be determined by a test for reverse T3, along with tests for free T3 , free T4 , and TSH.  

Many hypo patients also report having low levels of vitamin D and B12, so testing for those is also worthwhile.

Hope this is enough to get things started.  Please keep in touch and members will be very happy to help in any way possible.

[nasireddin]

ICY COLD FEELINGS

Thanks for your comments.

As on 16.01.2011 his TSH is 0.10

He is taking Eltroxin 125 mcg daily.

Please advise.

[gimel]

The TSH test is not nearly enough information to determine if he still has a problem of being hypothyroid.  I suggest that you help him get tested for free T3 and free T4 (note that this is FT3 and FT4, not total T3 and total T4), along with vitamin D and vitamin B12.  

If you find that his FT3 test result is in the lower part of its range, that would be consistent with being hypothyroid.  If the FT4 test shows to be low in the range also, that would indicate a need for more Thyroxin.  If the FT4 is midpoint or above in the range, and FT3 is low in the range, that would indicate he is not adequately converting T4 to T3 and therefore, he may need to add a source of T3 into his meds, such as a dessicated type T4/T3 combo med.    

If you can get this testing done, then I suggest that you get a copy of the lab report and post results and reference ranges shown on the report and let members help interpret and advise further.  

[nasireddin]

February 17, 2011

ICY COLD FEELING

Seeking help and advice
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Patient’s name: Mr. Sabiq Khan,
Age-76 years

He is suffering from hypothyroidism and has bee on Eltroxin for more than 3o years. He feels very cold (icy-coldness) even at room temperature 23 c / 73 f.  In winter his body temperature falls to 95 f. Recent tests reports are a under:

June      23, 2010  TSH 4.19   -  Medicine using Eltroxin 50mcg 2 and half tablets.
January 16, 2011   TSH 0.10  -  Medicine using Eltroxin 50mcg 2 tablets.
January 23, 2011   FT4 1.36   -  Medicine using Eltroxin 50mcg 2 tablets.

Is Nicotinic Acid of any help in this regards?

Kindly advise how he may get rid of this feeling of miserably extreme cold feelings.

Thanking you.  

[gimel]

Please read again all my comments above.  The patient has not been adequately tested.  He needs to be tested for free T3, along with the TSH and free T4.  I am confident that you will find that his free T3 is below range or in the low end of the range.  He also needs more medication, but not just more T4.  He most likely needs a desiccated type natural thyroid medication which contains both T4 and T3, instead of the T4 only type med.  He will need for medication to be increased until his symptoms are gone.

[nasireddin]

Date : April 18, 2011

Patient’s name: Mr. Sabiq Khan,
Age-76 years

He has undergone the FT3 & FT4 test, the result is given below

April 17, 2011    FT3  2.95  Pg/ml  
April 17, 2011    FT4  1.28  Ng/dl  

He is taking Eltroxin 50mcg x 2 tablets evryday.

His body temperature is 96 f.

Now at room temperature i.e. 29 degree centigrade he is feeling almost normal.

Please advise your comments.

Thanking you.

[gimel]

Test results and reference ranges vary from lab to lab.  Please post the reference ranges that were shown on the lab report for those two tests.