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4987347 tn?1361974337

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?
34 Responses
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Avatar universal
Pathetic...  Really?  Can't hurt you?  Why not just have an open-ended reference range, then?  Existential medicine?
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4987347 tn?1361974337
When I spoke to him about it, his exact words were "oh, that's just indicative of you living in the US! High Cortisol won't hurt you in any way."

I beg to differ.
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Avatar universal
You're right...it's not in either range.  It's also a one time test, which I'm told tells you virtually nothing.  Definitely ask your doctor about it.

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4987347 tn?1361974337
Yesterday my PCP called to tell me my blood results were normal - and he had no explination for my fatigue or brittle nails. (He didn't know I saw an endo on Monday and already had part of the results)

I went to pick them up today - for my records - and since cortisol was brought up I checked the results. It was a blood cortisol test.

Cortisol, Total, Serum     30.1 mcg/dL
AM range 4.0 - 22.0
PM range 3.0-17.0

First - if doctors are going to stick to "whats in range" then why didn't this come up? It clearly isn't in EITHER range listed. Right? (This will be my first question when he calls me back)

Second - maybe we are on to something with this coritisol theory - while I do feel my thyroid is in the starts of a problem... maybe this is a key indicator of something going on...
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Avatar universal
if you are not on meds than that is a possible area to try. You may have to convince your Dr to give you a small starter dose and come back and re-test and see how you feel in about 6 or 8 weeks.  This may be a tough sell.

Most advice here has been that the 24 hours saliva test is the ONLY one that is worth anything as cortisol varies so dramatically throughout a 24 hour period. So testing every few hours is the only real way to get a handle on what is happening.

Since Cortisol does vary, it really does make one wonder that a burst of cortisol about 8PM is not what is going on.

I did not go back and read the entire thread. But if I did not give you this website you may want to go on it and do some reading.

http://nahypothyroidism.org/

I found the article under abnormal thyroid transport along the left side of the site to be very interesting.  What I got out of it was that a series of situations or conditions seems to result in the body needing significantly higher levels of FT4 and FT3 than in non symptomatic patients.  This completely explains in my mind why so many people here have found that they need their FT4 to be at 50% of the range and the FT3 to be at 67% of the range and not simply just somewhere within the range.  For whatever reason the absorption of the hormone is reduced and thus a higher level of the hormones in the blood is needed to make up for that decreased efficiency to utilize the hormone.

You may be one of those people who have to have their levels a bit higher than a person who has perfect thyroid hormone transport.
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Avatar universal
goolarra--good points---i still seem to retain fluid in my feet and lower legs and knees--and I have very dry skin--but i have seen improvement.
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4987347 tn?1361974337
The doc today said those aren't very effective - so I am doing a blood test where I take a pill at night and blood immediately the next morning.

I'm actually building interest in the iron deficiency theory... I have read where that can cause hypo type symptoms if deficient enough.
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Avatar universal
Feeling like a bus ran over you until 8:00 at night and then suddenly feeling normal sounds a lot more like a cortisol/adrenal problem than thyroid.  

Have you tried getting a 24-hour saliva test?
Helpful - 0
4987347 tn?1361974337
I can't bump meds - considering I'm not on any :)

I'm still feeling like crap. Actually this entire weekend I felt like a bus hit me, until almost 8pm at night when I would suddenly feel normal

This whole ordeal has been a year long battle - feeling progressively worse. Plus with more recent weight gain, I'm really at a loss. I've met with 2 nutritionists who claim "people like me don't need help from them" since I weigh and measure everything and calorie count already. I even wear a bodybugg. The month of Feb alone I put in 6lbs. Making for a total of 22 gained.
Helpful - 0
Avatar universal
your latest test shows:

Your FT4= 1.1 which is 30% of  the range which is still quite a ways away from the target of 50% or more.

Your FT3= 3.1 which is 42% of the range which is quite a ways away from a target closer to 67%.

How are you feeling?  If feeling well then no worry's. If still feeling poorly then a bump in your medication would make sense.

Looking above in the post I would think both the Iron and B-12 could be higher heck 50% of the range would be 650 and you are at 450 so there is definitely room to improve.  Several people report that they need to have these well up into the range like towards the very top end.

Selenium can help in conversion of T4 into T3.
Helpful - 0
1756321 tn?1547095325
"Most laboratories use 4 mIU/L as the upper limit of normal for TSH. However, new research has found that if a TSH is above 2mIU/L, the thyroid gland is probably in the early stages of disease." - Your Thyroid Problems Solved [book] - Dr Sandra Cabot

"Dr. Friedman recommends iron treatment for everyone with a ferritin less than 60 mg/dL. The goal of treatment is to raise ferritin levels to a value between 70 and 90 mg/dL and is usually achieved with oral iron treatment. Raising ferritin levels to this range may be needed for patients with hypothyroidism to have an optimal response to thyroid hormone treatment." - Good Hormone Health - Iron Deficiency and Fatigue

"At least six neurological and psychiatric papers, in top medical journals, have shown that the normal range should be regarded as at least 500-1,300 pg/ml (rather than 200-1,100), since the cerebrospinal fluid level can be deficient when the serum level drops below 500, and neuropsychiatric symptoms often occur at serum levels between 200 and 500 pg/ml (VanTiggelen et al, Lindenbaum et al, Mitsuyama/Kogoh, Nijst et al, Ikeda et al, Regland)." - John Dommisse MD - Vitamin B12 deficiency: Symptoms, Signs & Optimal Treatment

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4987347 tn?1361974337
Just left my first Endo appt. Here are the old and new blood test results:

Old:
TSH 0.68 (.49-5.6)
FT4 1.0 (.80-1.80)
FT3 2.7 (2.3-4.2)

New:
TSH 2.09 (0.40-4.50)
FT4 1.1 (0.80-1.8)
FT3 3.1 (2.3-4.2)
Iron 67 (40-175)
Ferritin 17 (10-154)
B12 - 452 (200-1100)

He says there is nothing wrong with my thyroid. He wouldn't treat hypo until the TSH hit 450.

Thoughts?
Helpful - 0
4987347 tn?1361974337
I'm here for a new work up of blood work now. Including TSH, FT3 and FT4 as well as Hashi tests, low cortisol and adrenal.

Good catch on noticing my flip in numbers!!! I've looked at numbers so many times they all blend together now!

Has anyone had experience with calling a new doctor and they saying they won't take a patient without an "on paper diagnosis" from their PCP??
Helpful - 0
2102364 tn?1334181277
Hell yeah!   Beautiful post.
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Avatar universal
I knew that was how you veterans saw it, lol- I thought for the sake of future info seekers, I'd mention it :)
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Avatar universal
You're right.  FT3 and FT4 are obviously flipped.  Autocorrect!  The old mind just flipped them right back!
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Avatar universal
Interesting thread indeed...I am still learning so no great info from me, but for future researching purposes, I have to ask: did you by chance get your FT3 and FT4 results flipped around? Just noticed your numbers and ranges.
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Avatar universal
My neighbor had a TT a number of years ago for thyroid cancer.  After the TT, her ENT continued to manage her meds.  When I was looking for a new thyroid doctor, I contacted her because my neighbor had been so happy with her.  As it turned out, she told me I should see an endo.  She said that when she first started practicing here (rural area), there were no endos, so the ENTs treated thyroid.  However, since we now have several endos, she really felt that I'd be better off with one of them.  OMG, a doctor who recognizes her limitations!

By and large, except in very remote areas, I believe ENTs do the surgery on thyroids then turn the patient over to an endo for continuing care.  However, ANY doctor can be a thyroid specialist if he has the interest in continuing his education on the subject.

I think you posted an interesting question...yes, some good info flying around!
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4987347 tn?1361974337
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?
Helpful - 0
Avatar universal
"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.    


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Avatar universal
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!!!
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
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.
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Avatar universal
"...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.  
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Avatar universal
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.
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