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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?
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".
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.
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
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.
I have similar symptoms, and I was on synthroid for 8 weeks before I started synthroid i has a TSH of 3.75, I went on 50mcg synthroid for 8 weeks and i felt like crap. I went to a top endo dr for a second opnion in ny and he said you are not hypo and is now testing me Cortosol and adneral functions. He said that if you were truly hypo your numbers would have dropped more and that I am within the range that 95% of the population is in. Also my free T3 and T4 and antibodies are normal. He said no need to take medication when it is not meant for me and is not helping me. Please seek a second opnion from a dr who is willing to first explore other areas. i am now being test for cortosol, but no free cortosol, it has to be tested by taking a single corotsol pill at night and then going in for a test at 8am.
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