Hypothyroid... or Low Cortisol and Adrenal Fatigue

[amdiegelman]

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?

[amdiegelman]

Holy cow - this really started some interesting info rolling.

I have read that seen a doctor involved in Environmental Medicine could help. One that came up happens to be an Otolaryngology doctor (aka ENT). After further reading, ENT's can specialize in thyroids. Thoughts on this? Any experience?

[goolarra]

"Two symptoms that you will never get rid of with synthetic thyroid medication are dry skin and water retention..."  

After starting T4 therapy, I lost 25 lbs doing absolutely nothing differently than I had been doing.  It came off pretty fast, so it had to be almost all water retention (my feet, ankles and legs had been little blimps while hypo).  I've had dry skin all my life, even when living in very humid climates...it's no worse now than it ever was, and I live in the desert now.  

"I have also read that if you are on a T4 only med, that you will be hypothyroid to some extent because our bodies are not meant to be on T4 only---we have to be able to convert it to T3 which is what our bodies use."

It's true that our bodies can only use T3, but some of us actually do convert T4 to T3 just fine.  Conversion is not a thyroid process.  It happens in sites throughout the body (mostly in the liver) and is a separate metabolic process.  It does not necessarily follow that because we are hypo, we can't convert.  Conversion has almost nothing to do with the thyroid gland.

It's also true that our thyroids, when healthy, produce both T3 and T4.  However, the ratio of T4 to T3 that is produced by the human thyroid is about 20 to 1.  About 95% of ourT3 comes from conversion.  Desiccated contains T4 to T3 in a ratio of about 4.5 to 1.  So, although our bodies are not meant to be on T4 only, they are also not meant to have that much T3 (4.5 times what our thyroids produce) from a source other than conversion.  

It's actually a bit of a complicated, but interesting, question which is more "natural".

"...so it is really a matter of what works for each individual and what your particular symptoms are."  Absolutely.  Some people do well on T4, some on synthetic T3/T4 combos,  some on desiccated.  All have their drawbacks, and all have their positives.  Different people have gotten totally well on each.    

[kevieb]

I have never heard of a test for cortisol where you take one cortisol pill at night and then test your cortisol at 8 am.  cortisol is short acting--so if you take it the night before it isn't going to tell you a whole lot about what your body's cortisol activity is.

i have a condition called central hypothyroidism, which is a rare form of hypothyroidism---my pituitary is not functioning properly, and TSH tests will never be accurate for me.  When treated properly, my TSH levels should be VERY low.

Taking synthroid will only shut down your thyroid completely if you are on suppression therapy---my husband and I have both been on suppression therapy because we both had thyroid nodules---it was supposed to shrink them down.  I went off the medication after 10 years at one doctor's request to see what my thyroid would do on it's own---after about a year, we discovered my endocrine problems--and they were much more extensive than they had been in the past.

My hubby was on suppression much longer than me, plus, he only has half of a thyroid--they had to remove the other half because his nodule was so large and they couldn't rule out cancer with various tests.  He tried to go off of his medication a couple of years ago---but his face started swelling up---guess his 1/2 thyroid didn't want to work after all.

The problem that both of us had, was that the doc who put us on suppression therapy moved, and somehow our other docs got confused and treated us both as hypothyroid instead---which requires a different amount of medication.

I take NP thyroid, which is natural desssicated thyroid and has T4,T3,T2,T1 and calcitonin.  Two symptoms that you will never get rid of with synthetic thyroid medication are dry skin and water retention--however, many people seem to do fine on synthetics---so it is really a matter of what works for each individual and what your particular symptoms are.

I have also read that if you are on a T4 only med, that you will be hypothyroid to some extent because our bodies are not meant to be on T4 only---we have to be able to convert it to T3 which is what our bodies use.

I read parts of that doctor's articles--i have secondary adrenal insufficiency--and when I was tested with an ACTH stimulation test--both my ACTH and my cortisol levels were extremely low--unlike the normal ACTH levels he was saying you would have with secondary adrenal insufficiency.

I question a little some of the things he says--but if it works for you--let us know!!!

[Barb135]

I agree with everything goolarra and flying fool have said, plus I'd like to add:
did it occur to either you or the doctor that your numbers were perfect, BECAUSE you were on the synthroid?  That's what synthroid does; it brings your levels into range and if given enough time, it should alleviate your symptoms.

I was on thyroid replacement medication for over a year, before most of my symptoms were alleviated.

[goolarra]

"...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.  

[sonia781]

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.