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Hypothyroid... or Low Cortisol and Adrenal Fatigue
Hi -
Is this a popular area of confusion? I went to my PCP today and presented him with a lot of information. List of symptoms, comparisons of blood work and even this article (http://www.hormonerestoration.com/Thyroid.html) to explain my push for a diagnosis of hypothyroidism.
In review my labs are:
TSH: .68 (.50-5.0)
FT3: 1.0 (.8-1.7)
FT4: 2.7 (range 2.3 – 4.2 )
List of symptoms:
WEIGHT GAIN (20lbs in 2 years - and I'm active)
Very brittle nails
Occasional constipation
Shortness in breath during exercise (noticed Dec 2012, increasing)
Depressed/crying (Began Jan 2012)
Irritability
Decreased libido
Tightness in throat
Lightheaded when I stand up too fast
2 week period of body temp 96.2-97 degrees, with occasional 97.9. – ongoing, see notes
Waking up with thick white coating in mouth
Dry eyes (I do wear contacts, but drier then normal, age?)
Fatigue
Dry skin
Cold hands and feet
Next day effects after a few drinks
AND he believes that these are symptoms of low cortisol and adrenal fatigue rather then Hypo. He also stated he isn't a big fan of the doctor who wrote the article, because he has no evidence to back statements up. So, I have a huge battery of bloodwork to be done tomorrow morning, first thing.
What does the community think here? Any thoughts on how to proceed?
Is this a popular area of confusion? I went to my PCP today and presented him with a lot of information. List of symptoms, comparisons of blood work and even this article (http://www.hormonerestoration.com/Thyroid.html) to explain my push for a diagnosis of hypothyroidism.
In review my labs are:
TSH: .68 (.50-5.0)
FT3: 1.0 (.8-1.7)
FT4: 2.7 (range 2.3 – 4.2 )
List of symptoms:
WEIGHT GAIN (20lbs in 2 years - and I'm active)
Very brittle nails
Occasional constipation
Shortness in breath during exercise (noticed Dec 2012, increasing)
Depressed/crying (Began Jan 2012)
Irritability
Decreased libido
Tightness in throat
Lightheaded when I stand up too fast
2 week period of body temp 96.2-97 degrees, with occasional 97.9. – ongoing, see notes
Waking up with thick white coating in mouth
Dry eyes (I do wear contacts, but drier then normal, age?)
Fatigue
Dry skin
Cold hands and feet
Next day effects after a few drinks
AND he believes that these are symptoms of low cortisol and adrenal fatigue rather then Hypo. He also stated he isn't a big fan of the doctor who wrote the article, because he has no evidence to back statements up. So, I have a huge battery of bloodwork to be done tomorrow morning, first thing.
What does the community think here? Any thoughts on how to proceed?
Wow! Great article. How do we get an appt. with the author Dr. Lindner? Sign me up! It looks like your doctor is testing all the right stuff. Free ranges instead of total and those antibody tests are going to be your biggest indicator of what is going on. After years of battling these symptoms and many many many doctors and specialists, I am still looking for someone willing to treat my symptoms and not my levels. Hang in there and keep searching. Someone on here I think has a list of fellow members' recommendations on endos, so maybe there is one on there that is close to you.
Not handling stress is my number one symptom when i had severe adrenal insufficiency. What you don't think could possibly in a million years be a stress IS when you dont have enough cortisol to help you handle the situation.
An example of this: asking for something and being told it's not available. Normal reaction - that's fine i'll check elsewhere. Severe adrenal insufficiency reaction - major crying jag in front of everyone. :(
http://www.medhelp.org/posts/Adrenal-Insufficiency/adrenal--fatigue-or-thyroid-issues/show/1655386
An example of this: asking for something and being told it's not available. Normal reaction - that's fine i'll check elsewhere. Severe adrenal insufficiency reaction - major crying jag in front of everyone. :(
http://www.medhelp.org/posts/Adrenal-Insufficiency/adrenal--fatigue-or-thyroid-issues/show/1655386
Just because a person is within the so called "normal" range means ABSOLUTELY NOTHING!
The "normal" referred to is a mathematical statistical term, not a medical term. Yes that means that 95% of the population falls within that range. The problem is that they do not remove all of the "hypo" or low thyroid people from the pool they test and simply ASSUME that the bottom 2.5% are the ones who are hypo, and the very top 2.5% are Hyper.
The problem is that a significantly higher percentage of the population is hypo than the bottom 2.5%. Some would even argue it would be near 20% but I don't know if I believe it is that high. I do know from being here that it is FAR about 2.5% of the population.
To give a ludicrous example of how silly this is. Consider that a sample of people from the population are examined for legs. And only the bottom 2.5% of the population who had their left leg missing and the top 2.5% of the population who had their right leg missing were excluded. That would mean that everyone else is "normal" because they fell within the 95% of the population. Yet clearly a person who has a broken leg is not "normal". But they fit within the statistical definition of "normal" so no treatment is necessary according to the Dr who goes solely by the numbers. You are told that you are normal and go home. This is what the current "normal" ranges are doing with regard to Thyroid and God only knows what other conditions.
MANY people who are symptomatic need in order to feel well need to be well up into the range. In fact the target to shoot for is BOTH of the following:
1) Free T4 in the MIDDLE of the "normal" range (50%).
AND-that means in addition to
2) Free T3 in the UPPER 1/3 of the "normal" range (66.7%).
Each person feels well at a little different level. Starting out on a low dose and working up in small dose increases SLOWLY with each change if T4 medication not really any sooner than every 6 weeks with labs. FT4 takes 6 weeks to stabilize in the blood. Go slow and when a person starts to have symptoms disappear then go even slower to get to optimization.
Like I said each person is an individual but many, MANY, MANY people here have found the above target to be WAY more accurate than simply being "within the normal range".
I've recently read an article that states that blindness caused by maccular degeneration is now being suspected may be due to undiagnosed Hypothyroidism or under medicated hypothyroidism.
Also it is interesting to note that prior to all this sophisticated blood testing, the patient was medicated using only symptoms and increased the dosage until the patient felt better. What is interesting is now that all this testing is being done, there are FAR fewer people who get medication at all and also the people that do are on average taking about 1/2 of the dosage of the amount of thyroid that it "used to take" back in the old days.
Coincidental to this is the advent of strange new diseases known as Chronic fatigue syndrome and firbromlygia. Both of which are basically simply "unexplained" symptoms. They are now finding out that with the addition of Thyroid medication these symptoms are relieved. Interesting that the symptoms of both happen to be exactly the same symptoms of low thyroid. But because these people test "within the normal range" they now become "unexplained" because they unwittingly rule out low thyroid as being the cause.
This all suggests to me that the so called "advances" in testing have been incorrectly utilized. Leaving patient to suffer from symptoms and feeling like crap just because a persons labs fall within an arbitrary or ill defined so called "normal" range.
Put simply. If they changed the range to eliminate about 50% of the bottom part of the range, All of this might be avoided, and people would start getting the treatment and dosages they need.
As it is now, the patient is required to be their own advocate and go from Dr. to Dr. until they can find one who listens to them and treats them clinically using blood labs as additional information rather than the be all, end all.
The "normal" referred to is a mathematical statistical term, not a medical term. Yes that means that 95% of the population falls within that range. The problem is that they do not remove all of the "hypo" or low thyroid people from the pool they test and simply ASSUME that the bottom 2.5% are the ones who are hypo, and the very top 2.5% are Hyper.
The problem is that a significantly higher percentage of the population is hypo than the bottom 2.5%. Some would even argue it would be near 20% but I don't know if I believe it is that high. I do know from being here that it is FAR about 2.5% of the population.
To give a ludicrous example of how silly this is. Consider that a sample of people from the population are examined for legs. And only the bottom 2.5% of the population who had their left leg missing and the top 2.5% of the population who had their right leg missing were excluded. That would mean that everyone else is "normal" because they fell within the 95% of the population. Yet clearly a person who has a broken leg is not "normal". But they fit within the statistical definition of "normal" so no treatment is necessary according to the Dr who goes solely by the numbers. You are told that you are normal and go home. This is what the current "normal" ranges are doing with regard to Thyroid and God only knows what other conditions.
MANY people who are symptomatic need in order to feel well need to be well up into the range. In fact the target to shoot for is BOTH of the following:
1) Free T4 in the MIDDLE of the "normal" range (50%).
AND-that means in addition to
2) Free T3 in the UPPER 1/3 of the "normal" range (66.7%).
Each person feels well at a little different level. Starting out on a low dose and working up in small dose increases SLOWLY with each change if T4 medication not really any sooner than every 6 weeks with labs. FT4 takes 6 weeks to stabilize in the blood. Go slow and when a person starts to have symptoms disappear then go even slower to get to optimization.
Like I said each person is an individual but many, MANY, MANY people here have found the above target to be WAY more accurate than simply being "within the normal range".
I've recently read an article that states that blindness caused by maccular degeneration is now being suspected may be due to undiagnosed Hypothyroidism or under medicated hypothyroidism.
Also it is interesting to note that prior to all this sophisticated blood testing, the patient was medicated using only symptoms and increased the dosage until the patient felt better. What is interesting is now that all this testing is being done, there are FAR fewer people who get medication at all and also the people that do are on average taking about 1/2 of the dosage of the amount of thyroid that it "used to take" back in the old days.
Coincidental to this is the advent of strange new diseases known as Chronic fatigue syndrome and firbromlygia. Both of which are basically simply "unexplained" symptoms. They are now finding out that with the addition of Thyroid medication these symptoms are relieved. Interesting that the symptoms of both happen to be exactly the same symptoms of low thyroid. But because these people test "within the normal range" they now become "unexplained" because they unwittingly rule out low thyroid as being the cause.
This all suggests to me that the so called "advances" in testing have been incorrectly utilized. Leaving patient to suffer from symptoms and feeling like crap just because a persons labs fall within an arbitrary or ill defined so called "normal" range.
Put simply. If they changed the range to eliminate about 50% of the bottom part of the range, All of this might be avoided, and people would start getting the treatment and dosages they need.
As it is now, the patient is required to be their own advocate and go from Dr. to Dr. until they can find one who listens to them and treats them clinically using blood labs as additional information rather than the be all, end all.
Also the adrenals could be fatigued because they are trying to make up for the lack of Thyroid in the blood. The body is trying to do everything it can to make up for that loss. And the adrenals are not necessarily made to deal with a chronic long term issue and by over working them they "give up".
This suspected the reason why some people feel worse when they first start taking Thyroid medication. The body is not used to having the thryoid and the adrenals etc who were cranked up to make up for the loss, now have to recognize and adjust to the re-introduction of thyroid.
just another reason why starting out slow and making small adjustments over time is the best policy. Although it is AMAZINGLY frustrating when you just want to feel better and want to "cut to the chase".
This suspected the reason why some people feel worse when they first start taking Thyroid medication. The body is not used to having the thryoid and the adrenals etc who were cranked up to make up for the loss, now have to recognize and adjust to the re-introduction of thyroid.
just another reason why starting out slow and making small adjustments over time is the best policy. Although it is AMAZINGLY frustrating when you just want to feel better and want to "cut to the chase".
omg, those who severely disagree with me, do you think its normal for people to take a "pill" everyday for the rest of there lives, do you know that when you are on synthorid it shuts off your thyroid, and your body relies soley on this synthetic thing to function. For those who are on the edge of wether or not to take it and their T3, T4 and antiobodies are perfectly normal and there TSH is under 4.0 , I say seek one additional opnion. Also ask you primary or any doctors that has your blood work from the past, go back to a time when you were feeling good, see what your TSH was then, if it is the same as it now. If your still at same TSH then think seriously whether you want to start synthroid. I dont think anything I have said anything here that is so crazy. Get a second opinion, look at the whole picture. I use to read posts like this and get all sacred and started taking it, there are not enough people like me, who want to inform those of us who are on the cusp of taking synthroid.
"...do you know that when you are on synthorid it shuts off your thyroid, and your body relies soley on this synthetic thing to function"? No, this is not true. If your thyroid is still capable of producing hormone, the synthetic hormones you take will work in combination with your body's own hormones.
"Perfectly normal" has to be defined. Many people with (legitimate) thyroid symptoms have in range labs. For a number of reasons, thyroid lab ranges are severely flawed. Many doctors also practice "reference range" endocrinology...the belief that all of us should feel well anywhere in the ranges. Some people have low thyroid levels naturally (I'm comfortable at relatively low levels), and some have naturally high thyroid levels, and each has to be treated as an individual.
Since TSH is seldom included as part of routine screening tests, very few people have the luxury of comparing current results to previous results when they felt good.
I think if you do much reading on this forum, you will notice that very few of us have a whole lot of respect for the TSH test. I don't know how often I've told people that diagnosing and treating by TSH alone is a recipe for disaster. Tests, in order of importance, are FT3, FT4 and TSH. If TSH isn't supported by FT3 and FT4, then TSH has to be ignored. Since your T3, T4 and antibodies were "perfect", I think very few people here would tell you to start meds based on a TSH under 4.0.
Too many doctors think that FT3 and FT4 barely in the bottom of the range is sufficient and leave their patients with a myriad of hypo symptoms.
While you may have a legitimate complaint that you were put on Synthroid unnecessarily, do realize that the vast majority of people have a very hard time getting treated for thyroid problems. Many doctors order the wrong tests, and many won't increase meds until all symptoms are relieved.
Whether or not you were put on meds inappropriately remains to be seen. You have yet to get an alternative diagnosis.
"Perfectly normal" has to be defined. Many people with (legitimate) thyroid symptoms have in range labs. For a number of reasons, thyroid lab ranges are severely flawed. Many doctors also practice "reference range" endocrinology...the belief that all of us should feel well anywhere in the ranges. Some people have low thyroid levels naturally (I'm comfortable at relatively low levels), and some have naturally high thyroid levels, and each has to be treated as an individual.
Since TSH is seldom included as part of routine screening tests, very few people have the luxury of comparing current results to previous results when they felt good.
I think if you do much reading on this forum, you will notice that very few of us have a whole lot of respect for the TSH test. I don't know how often I've told people that diagnosing and treating by TSH alone is a recipe for disaster. Tests, in order of importance, are FT3, FT4 and TSH. If TSH isn't supported by FT3 and FT4, then TSH has to be ignored. Since your T3, T4 and antibodies were "perfect", I think very few people here would tell you to start meds based on a TSH under 4.0.
Too many doctors think that FT3 and FT4 barely in the bottom of the range is sufficient and leave their patients with a myriad of hypo symptoms.
While you may have a legitimate complaint that you were put on Synthroid unnecessarily, do realize that the vast majority of people have a very hard time getting treated for thyroid problems. Many doctors order the wrong tests, and many won't increase meds until all symptoms are relieved.
Whether or not you were put on meds inappropriately remains to be seen. You have yet to get an alternative diagnosis.
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