In medicine, the key to choosing the best treatment is an accurate diagnosis. If the diagnosis isn’t correct, the treatment will be ineffective – or even cause harm.
Unfortunately misdiagnosis is common in the management of hypothyroidism. If you go to a doctor with hypothyroid symptoms, you’ll simply be given replacement hormones without any further inquiry into the cause of your condition.
Even worse, if you have hypothyroid symptoms but your lab tests are normal, you’ll be told you’re “fine”. If you insist you’re not, you might be sent home with an antidepressant, but no further clue about the cause of your symptoms.
The problem with this approach is that thyroid physiology is complex. The production, conversion and uptake of thyroid hormone in the body involves several steps. A malfunction in any of these steps can cause hypothyroid symptoms, but may not show up on standard lab tests. It’s incorrect and even negligent to assume that all cases of hypothyroidism share the same cause and require the same treatment. Yet that’s exactly what the standard of care for hypothyroidism delivers.
In this article I’ll present five patterns of thyroid dysfunction that won’t show up on standard lab tests. If you have one of these patterns, your thyroid isn’t functioning properly and you will have symptoms. But if you go to your conventional doctor, you’ll be told there’s nothing wrong with your thyroid.
A standard thyroid panel usually includes TSH and T4 only. The ranges for these markers vary from lab to lab, which is one of two main problems with standard lab ranges. The other problem is that lab ranges are not based on research that tells us what a healthy range might be, but on a bell curve of values obtained from people who come to the labs for testing.
Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health? (For more on the problems with standard lab ranges, watch this great presentation by Dr. Bryan Walsh)
The five thyroid patterns
- Hypothyroidism caused by pituitary dysfunction
This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance. These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough thyroid hormone. There may be nothing wrong with the thyroid gland itself. The pituitary isn’t sending it the right messages.
With this pattern, you’ll have hypothyroid symptoms and a TSH below the functional range (1.8 – 3.0) but within the standard range (0.5 – 5.0). The T4 will be low in the functional range (and possibly the lab range too).
- Under-conversion of T4 to T3
T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90% of thyroid hormone produced is T4.
This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. Inflammatory cytokines damage cell membranes and impair the body’s ability to convert T4 to T3. High cortisol also suppresses the conversion of T4 to T3.
With this pattern you’ll have hypothyroid symptoms, but your TSH and T4 will be normal. If you have your T3 tested, which it rarely is in conventional settings, it will be low.
- Hypothyroidism caused by elevated TBG
Thyroid binding globulin (TBG) is the protein that transports thyroid hormone through the blood. When thyroid hormone is bound to TBG, it is inactive and unavailable to the tissues. When TBG levels are high, levels of unbound (free) thyroid hormone will be low, leading to hypothyroid symptoms.
With this pattern, TSH and T4 will be normal. If tested, T3 will be low, and T3 uptake and TBG will be high.
Elevated TBG is caused by high estrogen levels, which are often often associated with birth control pills or estrogen replacement (i.e. Premarin or estrogen creams). To treat this pattern, excess estrogen must be cleared from the body.
- Hypothyroidism caused by decreased TBG
This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid – not hyperthyroid – symptoms.
With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.
Decreased TBG is caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.
- Thyroid resistance
In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms.
Note that all lab test markers will be normal in this pattern, because we don’t have a way to test the function of cellular receptors directly.
Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors.
Conclusion
The five patterns above are only a partial list. Several others also cause hypothyroid symptoms and don’t show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, it’s likely you have one of them.
Not only do these patterns fail to show up on standard lab work, they don’t respond well to conventional thyroid hormone replacement. If your body can’t convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesn’t matter how much T4 you take; you won’t be able to use it.
Unfortunately, if you have one of these patterns and tell your doctor your medication isn’t working, all too often the doctor’s response is to simply increase the dose. When that doesn’t work, the doctor increases it yet again.
As I said at the beginning of this article, the key to a successful treatment is an accurate diagnosis. The reason the conventional approach fails is that it skips this step and gives the same treatment to everyone, regardless of the cause of their problem.
The good news is that, once the correct diagnosis is made, patients respond very well to treatment.
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{ 95 comments… read them below or add one }
“These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough TSH”
I think you need to edit this misleading wording - the thyroid doesn’t release TSH, the pituitary gland releases TSH to stimulate the thyroid to release thyroid hormones (not TSH). I’m pretty sure you know this, but some might not.
Thanks for catching that. I changed it to what it should have been in the first place (“thyroid hormone”, instead of TSH) I think my brain is melting down from too much studying. 4 weeks until the licensing exam, and I’m feeling it.
I need a proofreader.
Just to let you know, I have been studying anatomy and patterns of disease around adrenals and thyroid for about 4 year. You BY FAR are the most knowledgeable, articulate, and thorough source I have come across. Thank God for your brain. I wish all doctors were like you.
My name is pauline long i have had Thyriod resistance disorder problems for 10yrs now, and still feel very tired lerthergick sorry but im also dyslexic so my spelling wont be upto date,i am at present on 125mgs per day of Levothyroxine, and feel worse every day, with no energy what so ever im also depressed and cant think properly, the thyriod problems run through my dad who is no longer with us, not only that but ive found out theres thyriod problems on my mothers side but have never youfound out if she had any cos she was never tested please could you help me sort this medical problem out once and for all so i can get on with the rest of my feeling much better in myself thank .
hi ive been having hypo symptoms for at least 3 yrs now all the tests the dr’s have ran says im in the normal range what kind of dr do you think i should see besides a thyroid dr for much deeper tests . they said i have fibromyalgia after diagnosing me with mixed connective tissue desease and polyarthritis i think it was im frustrated help please
Hi Chris
I read your article and it was very interesting. I have a son with special needs who I am taking him in to be tested. Can you please tell me exactly what tests need to be done. He is 18 years old and has Down Syndrome.
Thank you!
Great post thanks Chris! It’s great to know there are reasons thyroid tests come back ‘normal’ when they don’t feel normal at all. Do you know much about using basal body temperature as a means of testing thyroid function?
It’s not a reliable indicator. Too many different factors affect BBT for it to be conclusive.
thank you for the article and best of luck on your test. you’ll be awesome!
Wow, just wow. 55 years of Synthroid, several doctors including endocrinologists, and not one tested me for anything except TSH and free T4 and T3. I went through misery after misery, fought with those doctors, changed doctors. NOT ONE mentioned a possibility of any other problem with my endocrine system. I’m floored.
This is depressing me since I don’t think I can find the kind of doctor I need in my area, At age 80, perhaps I will just have to do the best I can with my present situation. Outside of my hypothyroidism, and skin itching the dermatologists can’t find a reason for, I’m very healthy.
Perhaps when I started Synthroid in 1955, there were no tests? I was just trying to get pregnant, at age 26, and my doctor tried the low dosage of Synthroid. It worked.
Thank you, Chris, for your enlightenment. I’m sure that if I take this article to my endocrinologist, he will just pooh pooh it and tell me to stop reading junk science on the internet.
Go on the functional doctors website to find one near you. Most will be covered by anMD copayment
This article displays lack of understanding of basic thoiroid function. Taking the points above in order:
1. T4 will be low in hypothyroidism secondary to pituitary dysfunction
2. Control of TSH is dependant on feedback from T4 and T3 levels acting on the hypothalamus and pituitary. The action of T4 and T3 on inhibiting TSH production is proportional to peripheral activity (ie T3 has more peripheral activity and more feedback (for a given concentration). Therefore if you are poor at converting T3 to T4 you will secrete excess TSH until the combined action of T4 and T3 is at a physiological level (T4 may be above ‘normal’ and T3 lower but overall activity will be unchanged.
3. Assays which measured total thyroid hormone went out in the 1980′s. All assays used now measure free hormones therefore changes in TBG are irrelevent.
4. Now I’m completely lost. Tempting to say you couldn’t make this stuff up but of course you have. High levels cause thyroid underactivity? Well obvoiusly thats why all those people with thyroid overactivity have symptoms of underactivity. Except they don’t they have symptoms of overactivity (sweats/palpitations/weight loss etc). Can you produce any evidence for this? Thought not.
Also, for your information I expect the testosterone levels seen in female to male transexuals are rather (about 10 times) than the slight increases seen in PCOS.
5. Untrue. Usually Thyroid hormone resistance (which is mainly inherited) affects the receptors in the pituitary and hypothalamus in a similar way to to those in the rest of the body. The end result is elevated TSH levels and T4/T3 but the peron with the condition has no symptoms.
Sadly the symptoms seen with underactive thyroid are very non specific, really common, usually not caused by thyroid problems and often caused by complex factors with no simple cure. In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thryoid hormone over placebo. Unnecessary thyroid hormone treatment carries a risk of side effects including osteoporosis and changes in heart rythm. There are good reasons why UK doctors who prescribe thyroid hormones to people without any evidence of deficiency are struck off and national guidelines are explicit in advising against (http://www.british-thyroid-association.org/news/Docs/hypothyroidism_statement.pdf).
Sorry it has taken me so long to respond to this. As some of you know, I was preparing for the acupuncture licensing exam in early August, and then on vacation until last Sunday night.
1. T4 will be low in hypothyroidism secondary to pituitary dysfunction
That depends what you mean by low. It’s possible in this pattern for T4 to appear within the normal lab range, but below the functional range. Lab ranges are not based on scientific studies, but instead on bell curve analyses of patients who get tested in labs. Who gets tested in labs? Sick people. Therefore standard lab ranges represent what is “normal” for sick people, not what is normal for healthy people.
What’s more, many people who have their TSH & T4 tested are taking supplemental hormones, which further skews the lab ranges.
Finally, as much a we’d like to think that these feedback loops work in a textbook manner, they don’t. For example, I have a patient with confirmed Graves’ disease. According to the textbook, she should have low TSH (she does) and elevated T4 and/or T3 (which she never has). In fact, it’s not at all uncommon to have patients that don’t fit the expected patterns.
2. Control of TSH is dependent on feedback from T4 and T3 levels acting on the hypothalamus and pituitary. The action of T4 and T3 on inhibiting TSH production is proportional to peripheral activity (ie T3 has more peripheral activity and more feedback (for a given concentration). Therefore if you are poor at converting T3 to T4 you will secrete excess TSH until the combined action of T4 and T3 is at a physiological level (T4 may be above ‘normal’ and T3 lower but overall activity will be unchanged.
There is some controversy on this issue. But I can tell you that I’ve seen lab work on patients with normal TSH, normal T4 and low T3. If it were always true that low T3 would increase TSH, then such a result shouldn’t be possible. But as I mentioned above, patients very often don’t present with the textbook pattern.
I’ve also seen and heard of patients improving when treated for T4 to T3 conversion problems even when their TSH is normal.
3. Assays which measured total thyroid hormone went out in the 1980′s. All assays used now measure free hormones therefore changes in TBG are irrelevent.
I don’t know what it’s like in the UK, but here in the US the standard measurement is total thyroid hormone (which includes free and protein bound). Few doctors order free T4 or free T3 routinely. Therefore TBG is not at all irrelevant. This is why T3 uptake is still included on standard thyroid lab panels.
4. Now I’m completely lost. Tempting to say you couldn’t make this stuff up but of course you have. High levels cause thyroid underactivity? Well obviously thats why all those people with thyroid overactivity have symptoms of underactivity. Except they don’t they have symptoms of overactivity (sweats/palpitations/weight loss etc). Can you produce any evidence for this? Thought not.
It is well-known that receptor site expression and sensitivity are both down-regulated in the presence of excess hormones – whether thyroid, insulin, leptin or other.
It’s true that a large excess of thyroid hormone will produce hyperthyroid symptoms. But it’s a question of scale. To illustrate this, let’s look at a similar pattern that occurs with another hormone: insulin resistance. Chronic elevations of insulin cause insulin resistance. The cells are less sensitive to circulating insulin and hyperglycemia results. However, what happens if you give a hyperglycemic an insulin shot? They become hypoglycemic. Even though their cells are insulin resistant, they still have some receptor site activity, and the flood of insulin from the shot is enough to activate the receptors – whereas the smaller amounts of insulin produced from eating food is not.
Thyroid hormone resistance with decreased TBG is similar to what I described above. The elevations in free thyroid hormone are enough to down-regulate receptor site activity, resulting in decreased proteonomic response. However, in hyperthyroidism, the level of circulating free hormones is more analogous to the levels of insulin after a shot. These much higher levels are still able to activate the receptors and increase proteonomic response.
5. Untrue. Usually Thyroid hormone resistance (which is mainly inherited) affects the receptors in the pituitary and hypothalamus in a similar way to to those in the rest of the body. The end result is elevated TSH levels and T4/T3 but the person with the condition has no symptoms.
Sadly the symptoms seen with under-active thyroid are very non specific, really common, usually not caused by thyroid problems and often caused by complex factors with no simple cure. In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thyroid hormone over placebo.
My answer to #4 above addresses this. Of course there would be no benefit to giving thyroid hormone to people with resistance. Their cells can’t use it. The factors causing resistance in the first place must be addressed for these people to improve.
This is one reason why people on supplemental thyroid hormone continue to need larger and larger doses.
“But I can tell you that I’ve seen lab work on patients with normal TSH, normal T4 and low T3.”
Well, such lab work is the reason I am here. Haven’t been officially diagnosed with anything, but I had my tests last week, saw the results and now I am educating myself.
Thank you, Chris.
I am suffering from almost all of the symptoms of Hashimoto’s Thyroiditis and my THS & T4 levels are normal. I asked to take the TPO & TG tests!
Hi Chris, I have had hyperthyroid a few times in my life. It came after childbirth and a few more times after that. I take medication for a few months till the thyroid becomes hypothyroid and I ween off the medication and I go back to normal. I am 45 and had a partial hysterectomy which now has put me in menopause . What has been happening now is that I have had major heart pounding that went straight through a week long period and now I have palpitations and tremors . My muscles are very fatigued and I have no energy and my blood pressure gets high at times( I never have high blood pressure) . It feel very much like how I felt with hyperthyroidism but the blood work is showing up fine. I have went for 3 tests and there is nothing. They checked the tsh and the free t3 and t4. I feel horrible and I am so frustrated because I am a very healthy active person. Can you let me know what you think. Thank you
FYi, it isn’t always necessary to go through a doc to get the tests you need (though it is great to have a good doc to help with test result interpretation – so I’m not knocking consulting with a good doctor). In many, if not most cases, patients CAN order the tests themselves, without having to hurdle a gate-keeper doctor, pay unnecessarily for an office visit, or share the results (except in NYS where the legislature seems to think the residents are too feeble-minded to mind their own health).
If you are willing to pay out-of-pocket instead of billing your insurance co, have a good PPO plan which will reimburse fees for any accredited lab, or if you already are paying out-of-pocket for lab tests, consider using a service that will allow patients to order their own tests.
There are numerous labs that will take a lab order direct from patients, such as MyMedLab.com (no affiliation other than as a customer). The test fees are often discounted, especially when “bundled” with other tests typically ordered for common conditions, and include the doctor’s order necessary to run the tests (except NYS, where this arrangement is specifically prohibited by law). Test samples are collected at many convenient locations, including the widespread Lab Corp network. Results are usually speedy and communicated directly to the patient, though can be also copied to a physician if desired.
I couldn’t get my endo to run thyroid tests for thyroid antibodies (he said it wouldn’t make any difference in my treatment) so I ordered the test my self from MyMedlab.com and had the blood draw done at LabCorp. I received an email the next day that my results were in (avail via secure log-in at the website). The fee was very reasonable.
I also have ordered my own tests at Enterolab.com to check for gluten sensitivity.
why have you not responded to what Angus wrote?
I don’t have time to answer in the detail I’d like to right now because of my upcoming exam. So I’m going to wait until I do.
Something tells me Angus is from the BTA or the BTF, with his talk of good doctors being struck off. He seems obsessed with the TSH, which is a pituitary hormone for a start!
Sorry it took so long to approve that comment, againstthegrain. It got caught in my spam filter.
I like directlabs.com for ordering labs w/o a prescription.
Hi Chris, I noticed in this article about thyroid testing you didn’t mention Free T4 or Free T3.
My MD has always ordered TSH, FT4, FT3, TPO & TgAb when checking my thyroid, stressing the importance of measuring the Free’s.
T3 uptake gives a rough idea of free thyroid hormone status, is included on most standard lab panels, and is cheaper than running FT3 and FT4. But yes, if I am particularly concerned about the free hormones I’d probably run them too.
Low thyroid hormone supposedly can cause high cholesterol…
Unfortunately, my doctor says all my thyroid numbers (t3, t4, etc) are normal.. so i’m on statins to keep my cholesterol on check (otherwise it shoots up to above 400!!))
There’s a book by David Brownstein, that I’ve heard covers how to step by step diagnose thyroid issues! In the meantime I’m minimizing my pufa intake, and increasing the number of antioxidants!
I don’t see the connection between thyroid hormones and cholesterol. I have hypothyroidism, have had for 55 years, and normal cholesterol. Ben, I’m really sorry you have to use statins. The only time I would recommend statins is in a case like yours becaue they can have deleterious effects.
There is indeed a connection between hypothyroidism and high cholesterol. Thyroid hormone is needed to activate the LDL receptors. So when thyroid hormone is low, there will be a larger amount of LDL floating around in the bloodstream.
I think a lot or people are looking forward to a response to ANgus’s post.
Can you please state which tests to order for a full thyroid evaluation —name them in order in a way the lab will understand and/or I can take to my doctor.
thanks for the great information.
The problem is not what tests to order, but finding a doctor that knows how to do a proper thyroid evaluation. You can order the right tests, but if your doctor doesn’t know how to interpret them, it’s not much use. The standard tests I order for each patient are TSH, TT4, TT3 and T3 Uptake. If I suspect autoimmune involvement (almost always the case if TSH is elevated), then I’ll order thyroid antibodies as well.
So, even if I order the TSH, TT4, TT3, and T3 Update as well as the Thyroid Antibodies… the doctor may not realize if something is wrong looking at the tests? So far they only order the T3 and TSH (I believe)… But since my cholesterol is high and my Vitamin D is low and I have other symptoms of what could be Thyroid issues (sure, they are symptoms of other things as well)… I’d like to truly rule out the Thyroid. I do also have recurrent Iritis (an autoimmune disease), so I am relatively sure that my other non-eye symptoms are autoimmune in nature… just can’t pin them down.
I am one of those people that is looking forward to your response to Angus’s comment.
“In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thyroid hormone over placebo.”
I´m curios how these trials can possibly work, since you have to raise your thyroid hormone until symptoms are relieved and the sufficient amount is so individual. For me it took 100 mcg of tyroxin to get any real benefits, but even that wasn´t enough. I did feel a little better on 50 mcg than on nothing but I was still sick as a dog. I would have probably been written off as one that didn´t respond better than placebo. How high a dose do test patients get in such studies? And do they raise the dose every 6-8 weeks as a normal thyroid patient would?
Carina,
The point of this article is that there are physiological mechanisms which depress thyroid function that won’t respond to standard thyroid hormone replacement.
For example, if your cells are resistant to thyroid hormone, supplemental thyroid hormone will have a limited effect. If you underconvert T4 to T3, taking Levothyroxine or another T4 replacement won’t help much.
The reason thyroid patients have to continually increase their dose is that these underlying mechanisms aren’t being addressed. It’s not “normal” to have to raise the dose every 6-8 weeks. It might be common, but it’s not normal.
I assume Carina meant that when you first start treatment you increase the dose every 6-8 weeks until optimised. Not that you change the dose every six weeks for the rest of one’s life. This is very common when the above mechanisms are not addressed or a person is on T4 only though.
Chris,
I guess I digressed there from your article, but these questions always pop into my head when I hear of trials like the one mentioned.
I really thought it was normal to raise the dose quite a bit. But even so, if some of the test persons had one of the underlying dysfunctions, then that would skew the results, so I would still say that there are problems with trials trying to determine whether or not patients with “normal” labs would benefit from thyroid meds.
But that’s exactly my point, Carina: that “normal” thyroid labs don’t necessarily equate “normal” thyroid function. This is the argument I’m making in the article.
These 5 mechanisms I listed here can suppress thyroid function, but they won’t necessarily show up on lab tests and they won’t necessarily respond to replacement. The value of those trials is that they confirm that replacement won’t work for patients when their underlying mechanisms haven’t been addressed.
Hi Carina
It is normal to raise the dose quite often when you first add thyroid hormone. You do this until you reach your sweet spot. Then, some need to increase slightly in winter and decrease a bit in summer. Otherwise, if you need to constantly tweak your dosage there is something wrong. Check out all the things Chris mentioned in his series as well as ferritin, B12, electrolyte and adrenals.
Also, T3 or natural thyroid works better for most.
If you need to increase your thyroid medication in winter, you probably want to think of getting some D-vitamin instead….. My underlying issue with hypothyroidism was gluten and dairy intolerances and vitamin and mineral defciencies as well as a gut infection.
2 months after I went paleo I had to get off all thyroid medication (I have been taking Levaxin for more than 15 years!). The thyroid medication never worked for me, all the low thyroid symptoms were there all these years despite the medication. My doctor said “everything is OK” year after year – he trusted the results from the blood work…..
Thank you Chris for all your hard work informing and educating us all!
Lynn,
Yes, I meant raising the dose until optimised.
Chris,
I´m with you. I was just pondering the accuracy of such trials. I guess I should have directed my question to Angus who was the one mentioning it in his comment.
Hey Chris
I am hoping you can help me. I have many of the thyroid symptoms, but all my levels check out:
TSH 1.27, FT4 1.1 and FT3 3.7
Negative or “normal” for antibodies. TSH was tested separately and I was on “the raw milk diet”for both the tests.
Testosterone was 306 on the first test, on the second it was 438. I was not fasting during any of these tests which I now have read could screw up results.
I have been gluten-free, Primal type diet, no cheats with any grains whatsoever, since December. Unless there was gluten in something I ate at a restaraunt, although I was very persistant about being “gluten intolerant.
I have had folliculitis caused by gram negative organisms, usually Enterobacter Aerogenes for 3 years, it waxes and wanes. It’s not “horrible”, but it definitely has ruined my face.
I have been on Tetracycline in 2003 for Acne. Then nothing till 2007, where since I have been Doxycycline twice, Amoxicillion, Erythromiycin, and Clarithyromycn. Never for more than a month at a time.
Obviously my gut flora is screwed. I did the raw milk diet and am now taking Theralac and Ohhiras. The condition has improved and definitely improved when I let go of topical therapy (a huge waste).
But now my thyroid symptoms are really showing up, and I can’t tell if my folliculitis is flaring from the very dry skin from thyroid, or if the Enterobacter is still going strong. I wanna say it’s both.
I was VERY underweight for about a whole year (all of 2007, some of 2008)due to being an overzealous cross country athelete who could not recognize when my overly competitive attitude was doing me wrong. I restored my weight with a junk food-binge type diet quickly by 2008.
Found Primal in 2009. Many health problems left. But now things are much much worse. Did Zero carb for a bit, Very low carb for a few months.
Never had thyroid symptoms till now, but clearly I had them coming.
I am guessing my pituatary, adrenals, and thyroid are just fed up with me.
I have been overfeeding, at least 2500-3500 calories a day for about two months now. There have been days when I feel and look great. But then days where I feel horrible, my eyes get puffy and baggy, skin flaring.
Really don’t know where to go. I really just want that fecal therapy done to correct my gut flora, and then address the rest of the issues. I am afraid to go on antibiotics again unless I can get fecal therapy right after. Folliculitis get’s worse after each antibiotic and I really don;t need any other immune issues.
I am ruling out Hashimoto’s for now. Just because for years I ate gluten and never had any thyroid symptoms. I gained and lost weight like a normal person, slept alright, didn’t really display any food intolerance symptoms besides acne and ADD, some anxiety sometimes about sleep.
Too long of a comment, I am sorry. Hopefully I can get some advice. I have a doctor at Whitaker Wellness.. but so far that is going no where.
Bill,
I wish there was an easy answer I could offer you. As you have no doubt gathered, thyroid physiology is complex and multi-factorial. From reading your story, I suspect (as you do) that it’s your HPA axis that’s driving your symptoms. This isn’t uncommon – I have several patients with normal thyroid labs, but still have weak thyroid function secondary to pituitary or adrenal dysfunction.
There’s really no way to know more without doing a full work-up. If you’re interested in that, please visit my professional site to learn more about how I work with people and schedule a free, 15-minute phone consultation.
Chris
What are the ranges for the FT4 and FT3 Chris? TSH is not a useful test really.
I meant to address that to Bill.
Lynn: I disagree that TSH isn’t useful. I think it’s very useful. It tells us what hormone levels are feeding back on the pituitary, and whether the pituitary is functioning properly.
Bill’s FT3 and FT4 levels are within both the functional and lab ranges.
I should have phrased that more clearly. I meant that that the FT4 and FT3 are more important than the TSH, and that just because his TSH is low does not mean he is euthyroid.
Without ranges, it is hard to tell where Bill’s numbers are though. Ranges differ from lab to lab and they don’t all use the same units.
Ranges don’t differ that greatly, in my experience, for FT3 & FT4. He’s at the high end for FT3, though he is towards the low end for FT4. It’s more likely he has thyroid receptor site resistance secondary to dysregulated cortisol rhythms. It’s perfectly possible for people to have normal thyroid labs and still have symptoms.
Well some labs use the range 2.0 – 4.4 for FT3 and other labs use the range 4.0-6.8 for example. People who are doing well (absence of thyroid symptoms) on their thyroid meds tend to have their FT3 at the very top or slightly over the range. This observation comes from years of interaction at patient groups. Apparently the ranges used to be higher, which explains this.
But he’s not on thyroid meds, unless I missed something?
Nope, he isn’t, but the point of thyroid replacement is to mimic normal phsyiology. So, if thyroid patients do best at the top of the FT3 range; I would venture that healthy people should be there too.
I also FIRMLY believe in fixing underlying causes low thyroid such as low adrenals, low iron/ferritin, low B12, gluten intolerance etc.
I forgot to add that at the moment (as of yesturday) I have started to supplement Betaine HCL, as I also have some symptoms of low stomach acid. Not sure if I will get any results from that.
I have scheduled a phone consultation. Thank you Chris.
What about when labs indicate Hashimoto’s but I felt healthy with no hypo symptoms to report (I had a TSH of 10, FT4 of 1.0, and FT3 of 297, TPO >1000, ATA 1268)? I went off gluten for 5 months and now my TSH is 2.08 and all of a sudden I feel terrible — brain fog, fatigue, mild depression (FT4 of 1.2, TPO 447, and ATA 260). I started a dose of Armour Thryroid a week ago and am hoping this will help alleviate these unpleasant symptoms!
You’re missing a pattern… excessive reverse T3 due to a high conversion of T4 -> rT3.
How to interpret the FT3 rT3 labs is here: http://faqhelp.webs.com/rt3ratiot3meds.htm
And a whole site about how to treat rT3 is here: http://www.thyroid-rt3.com/
did you pass your exam? where are you practicing?
Once again, no high cholesterol, but I am hypothyroid. I’m getting far too much thyroid medication according to my primary doctor, but my endocrinologist lets me stay on the present dose because I don’t have high cholesterol, or heart probems, and bone density is fine. And no diarrhea.
I’ve got another one for you. A friend of mine was recently diagnosed hypothyroid do to a medication side effect (carbamezapine). This manifests as normal TSH, low T4, and low T3 – but in the early stages, T4 (and possibly T3) are depressed but not out of range. This develops over time. It’s unclear if this is acting through the pituitary or something else entirely. Troublesome for anyone on continuous treatment with these sorts of drugs, as the TSH remains normal, and many doctors test only that. In our case, we discovered the change due to a sudden and rapid increase in cholesterol.
Hi,
I came across this forum trying to figure out what my doctors apparently are not able to. While I do not expect you to provide a proper diagnosis simply based on what I write here, I was hoping you could possible point me in the right direction. I have been suffering from insomnia for the past (at least) 3 years. About the same time I started having difficulty sleeping, I had an abdominal surgery (2009) (I have Crohn’s disease, which currently appears to be in remission as of my last colonoscopy a month ago) and put on 30 pounds following the surgery for no apparent reason. I did not change my eating habits at all, I did not change my exercise routine at all and my stress level really did not change either.
The following summer, we went to take our first annual bike ride (we are avid riders and would ride 15-20 miles every weekend with the kids) and by the time I got to the corner of our street, I was literally crying because my legs burned and hurt so badly, I ended up walking my bike back because I could not pedal it home. I went to my doctor, again complained of being exhausted by this point, still from lack of sleep and the burning in my legs. He ran a bunch of tests, of which I cannot recall, I was told all levels were normal except my triglycerides, which were over 500 or something crazy high like that. None of my other cholesterol levels were above normal, just my triglycerides. I did not want to start statins because my legs were already hurting, so I modified my already relatively healthy diet to exclude the small amount of occasional fried foods. Of note, prior to the surgery, my weight fluctuated between 125 and 130 and I am 5’2″ tall.
Fast forward to a bunch of normal tests and I end up at a rheumatologists office who tells me I have fibromyalgia and prescribes Lyrica, which is in addition to the Ambien my doctor has prescribed for sleep (or lack thereof), neither of which did much of anything for either of my issues (sleep or leg burning).
About 5 months ago or so, the insomnia was getting worse and started to affect my cognitive function….. forgetfulness……so badly, I actually forgot to go to work on two separate occasions (who does that right?), inability to follow along in simple conversations, excessive daytime sleepiness to the point that I would lie down and take a nap for 3-4 hours every afternoon or I could not get through school.
I went back to my doctor because one afternoon last week, it took me 7 hours to answer 15 simple questions in my psychopharmacology class, which happens to be a subject I excel in…..my GPA is 3.98 on a 4 point scale and I have never in my life ever struggled with school and rarely have to study. So, for me, this is a new symptom or I should say worsening symptom. I am also working on my supervised hours for addiction counselor and “forgot” a very important court date I had to appear at for one of my clients.
My doctor has now added a low dose of Adderall (10 mg) as a “temporary fix” until they can figure out what is going on with me and it has greatly improved my energy level and clarity. I easily recall things I need to, do not have a need to take a nap, and for the first time in 3 years feel “normal”.
I had a sleep study performed a few weeks ago (prior to the addition of Adderall)….This showed no evidence of sleep apnea. With taking 3 mg of Lunesta (changed from Ambien because of no improvement) prior to retiring for the night, I only entered REM sleep for 7% of my total sleep time and woke up or cycled back to stage I sleep 29 times. I feel asleep in 11 minutes, the study lasted for 371 minutes and it took me 271 minutes to get to REM sleep, where I spent approximately 26 minutes. Of most clinical significance, it was noted that my O2 saturation dropped to 84% and it was suggested I have an overnight O2 saturation study. I had that study performed immediately after and in a 6 hour period, my O2 saturation dropped 31 times to between 80.4% and 80.8% and staying that low for between 21 seconds to 5 minutes. Restless leg symptoms were not noted, nor was there any evidence of snoring.
In addition, TSH was normal (using that term loosely), CRP was normal, B12 was low (I was given a B12 injection), WBC normal, CBC normal, triglycerides still elevated, but decreased to 282, all pulmonary function studies were normal and I have no evidence of asthma nor do I have any shortness of breath while awake or during exercise.
My doctor sent me to an ENT thinking my tonsils may have something to do with my O2 sat dropping. ENT thought I was crazy and asked if I was depressed…..went to a second ENT (since I thought it was impossible for a proper diagnosis from the first one when he did not even take the time to look at my tonsils or examine me in any way) who informed me I had tonsiloliths, but not significant enough to cause O2 desaturation and this one also asked if I am depressed. By this time, I am frustrated, exhausted and don’t really care if they call it the chicken pox, I just want it to stop so I can get some quality sleep. I calmly told him that since my profession is to recognize signs of depression and provide counseling services to my clients, I am pretty sure I could recognize if I myself was experiencing depression. I went on to tell him I had a very happy childhood, was never sexually abused, have a pretty good relationship with my mother, am involved very happily in a relationship and we are planning on getting married when I graduate in the spring, I absolutely love my job and while I occasionally get a day when I feel like life is treating me like its own personal toilet bowl, for the most part, I am very happy and not very dysfunctional. I also wondered out loud, in an inquisitive tone, when depression started to cause ones O2 saturation to decrease as I have been taught that it can cause difficulties sleeping or excessive tiredness, but have never heard that oxygen desaturation can be caused by depression. I suspected, again out loud, that if my oxygen saturation issue was solved, that likely my sleep issue would also be solved.
So, now that I have taken up a great deal of your time, my question is this……how possible is it that my issue with O2 sats dropping as low as they are is caused by either my thyroid or my adrenal gland? The ENT wants to perform yet another sleep study, which I think is a tremendous waste of my time since I have already had one done only a few weeks ago. Should I be seeking an opinion from an endocrinologist to explore a thyroid or adrenal issue? I feel like I am going out of my mind because even simple tasks like remembering to take something out for dinner is incredibly cumbersome. I struggle to do even basic activities throughout my day and my legs are still burning so bad I cannot even go grocery shopping because of the walking involved. I should also mention that I did have ABI testing performed to rule out any clots or arterial/venous issues and I have had a complete cardiac work up, also normal.
I would appreciate any direction you might be able to lend.
Thank you
Kimm
Kimm
People with Chron’s Disease tend to have low selenium, low zinc levels and high copper levels.
http://www.ncbi.nlm.nih.gov/pubmed/8362213
The high copper can affect women with Chron’s especially as most women already have higher copper levels due to such things as copper IUD’s and birth control pills. Copper also rises as estrogen levels rise. and it needs very good adrenals and liver function to eliminate excess copper. which sress will deplete.
High copper can cause a lot of your stated symptoms including insomnia and muscle problems. The low selenium and zinc could also cause
thyroid problems. To reduce your triglycerides google” fish oil reduces triglcerides”
I have found this site to be helpful for those with excess copper problems and she will answer any questions.
http://www.tvernonlac.com/copper-toxicity.html
your story sounds like mine. i have burning legs. what are u doing for treatment?
Chris,
In 2010 i went for my phy due to being tired (excessively) and weight fluctuation. I was had maintained 120 lbs w/ no weight fluctation. I was and am highly active workout daily and was eating semi healthy. My prim dr discovered a nodule on my right side of my thyroid. Long story short the TSH came back saying i was hyper. But none of that made sense as i was exhaused and gaining weight. I tried for almost 2 years to manage my healthy w/o pills but in Feb of 2012 after putting myself on a high protein diet, prenatal pills and using every nail growth nail polish when my nails split putting on a necklas (and w/ my weight then and now at 130-133 desiptie my working out and caloire watching and prioir they were long and strong!!) i went and was tested and put on 50 mg of lthyrxine 6 weeks later up to 100 then 3 months later back to 75). It seemed to help some of my symptoms (better sleeping no excessive sweating on my armpits) but now 8 months later my nails are not growing (i have never bitten my nails and they look like i chew on them) I am training for NPC competition and eating the same clean diet no soda no junk and my body isn’t responding ( i am 135 lbs @ 28%fat). I was tested for the anit bodies and that was positive and yet my TSH levels reflect i am hyper but my T4 and T3 are normal. I am at the point of going crazy. I am at a loss what to do!! i am at the point of having the nodule removed as since it came to be is when all this has changed and impacted me. I am looking for direction on what i should ask my dr and i feel like my body isn’t converting things correclty in my body based of my nails (hair dry skin …low engery) and weight etc. ? can you recomend anything to me?
Crystal, I had many of your health issues and was dx with Graves. I told my Endo I felt like I had Hashimotos. He insisted it was Graves and quickly scheduled me for RAI, which I declined and went on 3 surgery consults instead. After my total thyroidectomy June 2011, the biopsy showed I did indeed have Hashimotos… My suggestion to you is to get ALL the antibody tests to see if you are like me and have BOTH Graves AND Hashis. The tests I had done were: TG-AB, TPO and TSIG. My antibodies were high for all of them. Have you had your ANA labs done, with the ANA Pattern? I did, and my ANA was positive, with a speckled pattern, with a positive SSA antibody, so I also have Sjogrens. My point is, if we have one autoimmune disorder diagnosed, often times, we will also have a second autoimmune (or even 3rd, like me). Over half the battle is getting an accurate dx. Good luck to you.
Hey thanks for the heads up! I guess my results in Feb were suppressed tsh and t3 &t4.. thus the l thyroine but w no weight loss and now my tsh ar. 01 i went off (& i am training for npc comp..so clean eating 2 a days and no fat loss). Went on hypo meds and i gained 5lbs in a week!! Now am seeing a sports metabolic dr specialist.. she thinks there is something bigger going on so testing all ny # hormones tsh etc ) hoping they can find out what i will let u know and willask about alk that
So after labs and all have been done .. am being treated for insulin..and leptin resistance…will see how this pans out but fingers crossed
Chris,
I need your help!!!! I had my thyroid removed a year and 1/2 ago and was put on levo 100 mcg after surgery. I have had many of the hypo symptoms since even though all labs were normal. The worst symptom light headed very low heart rate (40′s) and blood pressure sent me to the ER. Had tons of tests in ER for heart and lung and all came back normal. After having every test under the sun and all came back normal I decided to take it upon myself to increase my levo to 125 mcg with my internal med doc’s approval. Gradually my symptoms subsided.
I had been feeling good for 5 months and woke up one day with breast pain and went to doc for exam and he found breast discharge. Had mamo and ultrasound and they said ducts were a little off but normal. I had my doc test for prolactin levels and they came back very high 107. My doc ordered a pituatary MRI and found a 7mm tumor.
I’m now on cabergoline to stop prolactin and shrink tumor.
After all of this my endo doc also decreased my levo to 88 mcg because he said my TSH levels were hyperthyroid (even though I had no symptoms).
I expressed my concerns in changing the dose because of the hypo symptoms i might experience again but he would not listen and said I had to lower it because of the pituatary problem.
It has been 7 weeks since he lowered my dosage and I have the hypo symptoms back (low heart rate, feeling faint, cold hands, chest pains etc)
HELP!!!
Hi Chris,
I was wondering if you could help address my questions. I am 35 and suffering from painful, heavy periods due to a large uterine fibroid. I went to a “natural approach” doctor who checked my Thyroid (TSH, antibodies, T4/T3, etc). My TSH was 2.8 and she said my T3 was 2.4. She also noted that I had some antibodies (she said the range is 0-60 and mine was 45). She prescribed Armour Thyroid (30 once a day) and Prometrium (to get my progesterone up to help fibroid issue) and Iodoral iodine. I have been too nervous to take the Armour meds or the Iodoral for fear that it will do damage rather than help? According to another Dr., my thyroid is in the “normal” range, but to her I need Armour (she seems to think it will help with the bleeding, but my ultrasounds show that it’s the large fibroid causing it). My only “hypo” symptoms are hair loss, fatigue, and constipation (but then again those could be from being on iron supplements due to losing so much blood each month?). What would you advise? Take the Armour and Iodoral or will it do more harm? I’m 5’7 and 120lbs so weight loss is not an issue for me. Thank you:)!
Hi Chris, Don’t know exactly where to start but will try to put everything together quickly. In 1983 I ended up with Thyroid Cancer and had a thyroidectomy and also lost my parathyroid glands. So I currently take Levothyroxine and Vit D replacement. Slowly but surely I have been losing my battle with weight gain, fatigue, depression, insomnia…you name it. My labs show hypothyroidism most of the time, and in the last 5 years I have developed high blood pressure and extreme fatigue and was diagnosed with fibhromyalsia. I have elevated TBG and show signs of anemia, all tests for sugar levels have been normal. I have started taking B-12 and increasing my Calcium intake. It really sounds like the iodine and selenium could also be involved in this picture. I have always questioned the normal levels on the bloodwork especially since I am
struggling with everything like I am and it is getting worse. What is the best way to talk to my doctor about checking things out further as well as trying the iodine and selenium. Oh I also should say that I am a strick Vegetarian (I do not eat fish or eggs but I do eat dairy such as milk or cheeses w/no rennet). Any suggestions you could give would be greatly appreciated. I am only 55 and I feel like I am 75! Thanks Ann
Great post Chris. However I believe your response to Angus #5 was somewhat weak. The only studies I’ve seen suggest that thyroid hormone resistance does not affect the pituitary. This is why synthetic T4 replacement can “normalize” blood tests without relieve symptoms.
Also while low BBT is not definitive, it is a good indicator because it is a symptom that can be measured non-invasively at home.
For those considering Armour, you now have to chew them for full effect.
At 28yrs I was dx as having an underactive thyroid.
rx: .75mcg? Synthroid.
went up to .150mcg Synthroid within 2yrs.
I go up and down but can’t figure what the pattern is.
Dr: tests tsh only most of the time. I am 40 now with same dr. She has only tested antibodies once and it came back with a speckled reading. I don’t understand these tests very well. She sent me to get tested for lupus and it came back negative.
For almost a yr now I have been on taking two 60mg of Armour plus half of another pill. On top of that was put on Adderall since I was having trouble focusing and keeping things organized at home and work. Adderall has worked well but Armour is not. I am still losing hair and extremely fatigued. I have to drink coffee or frapps at work to help me continue to have energy but by the time I am home I am ready to drop and I can’t because I have a family to care for. What tests should I ask my dr to request?
I am 40 and weigh 185lbs (5’7″) this is what depresses me.
How does ReverseT3 come into play and how do you feel about the Wilson’s temp therapy with the sustained release T3?
I am currently experiencing hyperthyroidism, and they are trying to rule out Grave’s disease. I don’t have the antibodies, the eye or skin problems, and no family history of thyroid issues. I’m 35, 6 month post partum, have TSH that is almost non existent. And high T4 (70)
You seem to be very knowledgeable with regards to hypothyroidism….do you know of any other reasons besides Graves that I would be hyper? I also forgot to mention, my thyroid ultrasound showed one small colloid nodule that they figured was in the process of degeneration…..they don’t want to biopsy, just look at it in another 6 months. It was hypervascular though, and inflamed.
Thanks so much for any info!
I am on Armour thyroid, 125 mg per day, because I had an incorrect dosage of thyroid (Synthroid I think) many years ago (when i was just trying to see if thryoid drugs would help even if my tests didn’t show problem except for weight gain), – too high of dose seems to have destroyed or seriously damaged my thyroid function. It took a long time to catch – long story so won’t explain here.
So… Hashi’s is not the cause of my thyroid problem. My doctor recently bumped up my Armour from 90 mg to 125mg so I think I may be one of those that Armour doesn’t work on after it changed.
I seem to have a serious lack of “get up and go” much worse than ever. I am 66 so maybe some of this is expected but I want to “try” something else. I don’t mind leading my doctor in some direction (which I hope she will go in) but I’m not sure which direction. Your 5 reasons didn’t seem to address someone who has thyroid problems because of damage due to incorrect treatment, do them? (maybe except for the comment from someone whose husband you thought should be tested for Grave’s disease?)
What “direction” should I go in since my doctor may not want to try a lot of things? If you were to pick 2 or 3 directions (or maybe only 1 if there is one main obvious one) – which would it be? or which article of yours applies mostly to my situation?
Hi Chris,
Great article!
Can I please get your thoughts on what’s happening with me as my results are a bit odd? Symptoms are fatigue, anxiety, quicker heart rate, insomnia, clammy hands and feet, weight loss and symptoms are usually worse in the morning than in the evening. My naturopath did a thyroid reflex test and said I was hypothyroid, yet my symptoms seem to be hyperthyroid. I did try 30mg of dessicated thyroid for 2 days and I didn’t like how my appetite ramped up, so I discontinued it. About a week after, my endocrinologist finally ordered the T4 and T3 bloodwork (my TSH has historically been in the normal range) and my TSH is 0.5 (normal range is 0.38-5.5mU/L), T4 free is 21.3 (normal range is 10.5-20 pmol/L) and the T3 free is 4 (normal range is 3.5-6.5 pmol/L). Do you think I’m hyperthyroid as opposed to hypothyroid? Could my T4 free be elevated from taking the 30mg of dessicated thyroid for 2 days?
If you are able to reply to this, thank you very much!
What concerns me about the two schools of thought on tsh is that unless medical community can reach consensus. We as patients cost ourselves and medicine a lot of money and continue to suffer poor quality of life. I know that I have low cortisol tested by 24 hr urine and its probably why my original tsh antibody was over a thousand when diagnosed with hashimotos 6 years ago. However because I can’t get a physiologic dose with dhea I continue to suffer even though labs say I’m optimised. The future will be tablets for low bp. Maybe tabs for depression a ppi for gastritis it will go on until someone can totally identify why inflammation starts and how it can be treated rather than the resulting disease and that’s going to take a huge study. In all other forms of medicine disease prevention seems to get a hearing. Talk about cortisol and doctors will hear hydrocortisone and rebound. Putting back the small 10mg dose with a catabolic match would surely help some of us with has hasimotos whose autoimmunity started with poor adrenal function or am I hooked on a theory which I’ve heard but can’t prove!!!!
HI.BEEN ON thyroid mere for 32yrs. Recently went in for a tic bite and asked for thyroid test. Had results mailed to me. They do TSH test only. Was 6.83 and docs comments said to stay on current dose 100mcg & retest in 6 mo. Icalled a month or so later and told nurse I thought this was off and could she ask doc to change. Was changed to 112mcg. I’ve had breathing problems: weakness; right neck pain; extreme aches. Am 54. Menopause at 46-47. High cholesterol mere were added at recent visit but have not taken Cuz I believe thyroid is off. I was prescribed a antiboitic for the tic bite as had a ring around it. This was in July 2012. This is the worst I’ve felt. Any help or suggestions would be appreciated.
For last 3.5 yrs since my daughter I’ve been breaking out with hives on my legs. They come and go and are worse in the winter. My family doctor has sent me to a Allergist (that I would NEVER recommend) and he ran some blood tests and put me on allergy shots. The hives never went away. Also since my daughter was born I’ve not been able to lose the 40lbs I gained during pregrancy even with diet and excercise. Now I found out that I borderline diabetic and suffering from Hypertension. I did have my thyroid checked a few yrs back but it came back normal. My OB/GYN also said my thyroid felt very off the other day. I’m waiting for the test results and it comes back normal again what should be my next step? I should mention that I’m only 32 yrs old with no family health history and I’m by far the healthiest in weight, diet, and exercise then my parents and siblings. Any help would be apperciated.
I have classic hypothryroid symptoms but test results of TSH 1.44, FT4 1.34 and FT3 3.1. I am so sick of feeling fatigued, of my thinning hair, my growing intolerence for cold, my overall sluggish feeling both physically and mentally, low body temperature and so forth. How do I need to approach a doctor about these symptoms? Any help is appreciated
I feel the same way as you, Susan. Almost identical test results. I have every single symptom of thyroid issues but no doctor will help me. I am at a complete loss as to how to find help. I’ve lost my teaching career over this.
HOW do we get doctors to help us? I even paid very large sums of money out of pocket to see two Integrative doctors here in Florida, but neither of them think it’s thyroid since my labs are normal. I know they are wrong. I even had a thyroid scan and it showed that I have an inhomogeneous thyroid, but nothing was explained as to what that is. I also have TPO antibodies, but was told they were low enough( below range ) and not an issue.
Symptoms: Extreme fatigue/lethargy, hair loss/brittle/dry, super dry skin, dandruff, cold intolerance, menstrual problems, low ferritin that is difficult to raise, high cholesterol, weight gain and near impossible to lose even 1 pound unless I just stop eating, scalloped tongue, abdominal pain ( lost my gallbladder last summer ), brain fog, depression ( who wouldn’t be?), gritty eyes, spine pain, sore knees, sore heels, ridged nails, puffy/frumpy face.
But I always just get antidepressants thrown at me and told I’m just aging. I’m 45 and my health fell apart when I was 37. I have very little quality of life because of this.
Chris….please…help
I’d suggest checking out the Recovering with T3 book and FB groups. Also stopthethyroidmadness.com. You can get good doctor referrals from these places. It sounds like you may be a person that does well on T3 only rather than combination therapy.
Hi Chris, I wonder if you could shed any light on this, I had my levels checked for my annual test while on levothyroxine and my TSH is 0.02 so the doctor dropped my meds. I agree it’s very low but so is my FT4 and FT3 – both bottom end of range. Do you know what could cause the TSH to become so low without FT4 going high? I have to go back for follow up bloods and if the FT4 and FT3 go lower still as I suspect I’d like to know what tests to ask for next as I got the impression the doctor didn’t really know why the result was like this but just wanted the TSH to come back up. She actually asked me if I had been taking my medication.
Hello Chris,
I’m sure your super busy. My question if it’s possible at all to answer. I was tested for thyroid and my results were TSH.49 . freet4 .73 and freeT3 2.19. My symptoms are super cold,10lb weight loss that I’m happy about, rapid heart rate although in the normal range even though it is faster then it has ever been. Sleep issues, waking up, up for hours tired in the morning. I scared to go on medication because I model,normal size not skinny, if I gain weight I can miss out on lots of jobs. My freet3 was considered low. I am on birth control ortho novum 777 and my diet is not very good although I’m improving. I eat alot of suger but am thin because I run 5 miles a day. Any thoughts? I’m more then happy to switch drs if i need to as i am in the sf/sj area:)
bottom line what to do if my daughters that is 15 has been tested for Thyroid , TSH and according to her pediatrician all thyroid test have been done and keeps coming out normal. However my daughter is overweight has tried every diet , excercise nothing works. She also has trouble sleeping, has anxiety, depression and has loss of hair. Desperite please help! What do u recommend when everything comes out normal but these symptoms dont go away. no family history either.
May I add endrocronologist 2 of them say she is fine all she has to do is eat well to lose the weight . She has been eating very well now for 2 yrs vegetables , fruits all organic even almond milk and nothing. No weight loss no changes in symptoms.
Hi Chris,
I realize you may not be able to respond directly to me, but I’ll try nevertheless because I’m frustrated with my current health situation. I am a 30-year-old male who was diagnosed with hypothyroidism at age 17. Ever since, I have had a steady dose of Synthroid which has helped stabilize my thyroid hormone levels. However, I still have many autoimmune symptoms with no diagnosed cause. My skin is the worst part – I get lesions and deep sores all over my body which don’t go away and which cause me immense pain (not to mention loads of shame). I have joint issues, general body pain and stiffness, abdominal pain/cramping/constipation/diarrhea, dry eyes/mouth/skin, constant fatigue, trouble concentrating, irritability/depression/anxiety, and trouble getting a good night’s sleep.
I have no family history of autoimmune or thyroid diseases. I exercise regularly and eat a balanced, low-fat, low-salt diet. There are no structural problems with my organs which would suggest a problem with them. I am neither coeliac nor lactose intolerant. My blood work is always impeccable, so doctors never go further in investigating the causes of my problems.
If there is any suggestion you can offer in terms of how I can go about getting properly diagnosed/treated, it would be very much appreciated. I’m at the end of my rope!
Thank you.
Hi im desperate for help!I I started experiencing unexplained weight gain over a year ago,Ive always been healthy and active.I visited the gym regularly and would run 4 miles about 3 to 4 times a week.I eat healthy and for some reason have gained a stone,which is impossible to lose.having to eat low calorie diet to try to maintain weight but if I was too eat 3 normal square meals a day i put on 4/6 pounds overnight,I weigh myself daily!I started getting dizzy spells last year with pins and needles in my hands and wrists,also around this time my memory started getting worse and worse.I visited docs and she tested tsh level which was 0.7 and tpo was 9.8 she said these were perfect and sent me on my way.Pins and needles disapeared but memory remains awful,i feel foggy all the time and cant remember putting things down a second after ive done it!Four weeks ago i developed an irregular hearbeat,went to doctors and they said my cholestrol was high it was 5,referring me to cardiology at hospital.I am convinced it is to do with my thyroid and worry about heart damage.Feel tired,shaky most days and totally no sex drive for last year(poor husband!)Any ideas I would be most grateful for.thankyou!
I know how you are feeling. My symptoms started back in November. I don’t know your age but I am 45 and am entering menopause . My thyroid is a bit under active and I gained weight. I am having all my hormone levels tested and it shows my adrenal gland is low and my testosterone an progesterone is also low. I have all the same symptoms as you. I have went on a 2 hr a day workout and very clean diet. No sugar or caffeine and off bad carbs. I lost 20 lbs and feel better but not 100%. I have a dr. Who does bio- identical drugs. I can’t use the progesterone because I am one of the rare people who react to the cream but I am hopeful I will find my treatment for the hormones. As for thyroid, I have Graves’ disease and through my life it has caused trouble and now I am a bit under active . I think going into menopause throws the thyroid out so you might want to check into that . Hope this helps
I was told by my doctor that I have Hashimotos and that from my test results my T4 isnt converting enough T3. Im on a combination of both T3 AND T4 but since had to get off medication due to the Low Dose Naltraxone Im on for my Urticaria. The LDN is also suppose to help Hashimotos and is suggested that you go off your thyroid meds to avoid hyperthyroid symptoms. Now that Im into my second week of the using this new medicine im more tired than normal. Do you he any info on LDN?
I am 43, normal weight, reasonably healthy eater, work full time. I have a problem with my spine that restricts me from a very high level of physical activity, but I am not ‘dormant’ and I move about as much as I can every day, moderately active. I have had serious depression in the past dealing with a particular problem, and overcome this with CBT and I am now good at managing any mood difficulties. For the last four years I have noticed a deterioration in my energy levels and general feeling of fitness and well-being. My mood also deteriorated, and for the last 12 months depression crept up on me and I am on antidepressants again for the last three months, although this feels very different to previous depression – there is nothing I am depressed about, I just feel all the symptoms. My mood has improved, however. But I am exhausted so much of the time and I cannot trace it to anything in my lifestyle – I seem far more tired than I should be for my age and health and activity. I have never needed more than 5-6 hours sleep, but in the last 12 months seem to need more and more, and after significant activity fall asleep within minutes and can sleep for 15 hours at a time, so deeply that I miss alarm clocks and people trying to wake me – this is absolutely out of character for me. Even after little or moderate activity I am physically exhausted, not necessarily sleepy, and have to sit or lie down. My concentration is appalling, although a bit better since taking the antidepressants. I am always freezing cold, with cold extremities and cold skin all over most of the time – I wear layers and layers of clothes whilst those around me are in shorts and t-shirts. In the last 3 months I have started having headaches, and I have never suffered from headaches.
I have had blood tests and I have low iron and now take an iron supplement and have that monitored frequently. I also have had thyroid blood tests, and they are in normal range. Every female on the maternal side of my family has under-active thyroid, my mother, her sister, my grandmother, and 4 female cousins. My GP said I have raised TSH but normal thyroxine.
I feel like a fraud when I talk to the GP about how I feel, because I am told ‘everything is normal’, and especially because I had depression previously and I think GPs automatically think it can account for everything, whereas on this occasion I feel like the depression is a symptom of something else, rather than is the central problem.
I don’t know what to do, but I am becoming unreliable and I think my job might be at risk.
I would actually like to think this is not a thyroid problem and work out what else it might be, but I am running out of explanations. I don’t know how to proceed. Thanks for any advice
My husband is 66 years old and was diagnosed with a tumor on his pituatary gland about 22 years ago. He seems to have all of the symptoms that you describe in the 1st dysfunction. They just recently tested his thyroid and of course the test showed nothing. He is on a lot of medications including testostorone injections, anti depressants, acid reflux medicine and sleep medicine just to name a few. He has been tested for everything under the sun and no one has been able to really help him. Physically he is in great shape. Although it is a struggle he works out just about everyday. He recently has had a lot of trouble urinating and his bowels are irregular and have been for a while. He will be seeing his doctor next week. Do you think we should bring you article to the Doctor?
OK, Let’s cut through this mess.
1. What tests should be taken to determine the type and severity of hypothyroidism?
2. Is there a list of doctors that could act as advisors?
Every Endocrine doc I have seen just looks at former tests. I paid out of pocket for the 4 X a day saliva test. Then they started to take me seriously.
I have been seen by 3 of the best docs in the world when I lived in the Washington DC area.
The Synthetic stuff makes me higher than a kite after one dose. I am now living out of my truck and on food stamps because this illness has caused me to lose DoD contractor jobs. I need help! I am tired of being mollified and patronized by young and older male doctors and older women doctors, as well as LPN and interns.
So again what tests should I take and how do I find a doc that will correct my situation quickly.
thanks for being there
I have number 1 elevated cortisol levels from being pregnant. I have all the symptoms of hypothyroidism but all my test come back great except for my cortisol and B12 levels. I felt as if my doctor blew me off, she stated we would watch it. I definately feel different sometimes I have no energy and other times I feel extremly energtic, but not good energy. I never feel normal. What to do?
We really need to be very cautious when dealing with the thyroid. I went off off of my levothyroxine cause I felt I was feeling betterwith special focus on diet. My TSH ahot through
My TSH shot up through the roof and I was heading into thyroid storm. Be very careful when playing with the thyroid.
I am sure my thyroid issue is an autoimmune and felt I could heal through diet and natural supplementation, did not work. Just my own personal experience.
My daughter has had problems since she was in high school with her periods, very severe cramps. She seems to me to have symptoms of mild hypothyroidism, very sluggish and fatigue. At times, we thought maybe she was hypoglycemic. Nothing has ever tested out. She is 30 now and experiences infertility and yeast infections and bladder infections. She did get pregnant after 4 rounds of AI. Her tests show no signs of hypothyroidism but I am not convinced. I have hypo and hyperthyroidism in our family on both my mother and fathers side. My daughters doctor says her tests are fine. She is not fine and cannot get pregnant. Where do we go to find a doctor that will treat her old school? Should she go to a nutritionist? I am thinking this could be the reason she isn’t getting pregnant. In 8 years and 10 AI’s she has had one pregnancy. Any advice?
After years of working with the :best” in the world (D.C.), I still was mis prescribed. pay for the tests from your pocket. do your own research. and ask for second, third, and fourth opinions. Try to find a doctor who listens to ALL of your ailments. After looking at my blotchy calves. I was told that I was allergic to the synthetic thyroid medicine. and I needed to go to Armour thyroid. Drs get kick back from Abbott labs thats why they prescribed the synthetic. I also found out it was my adrenal gland as well affected. Consider looking for a doctor that is an MD as well as a homeopathic.
you know you……. trust yourself.
Good luck with finding these docs. The one’s that seem to know this stuff, interrupt test properly, etc seem to be a precious few, (and or) charge outrageous fee’s. And that doesn’t mention the cost for the testing, supplements, trial and error, and so on.
Perhaps it would be useful if people start making recommendations in their area’s of these “rare” docs. List their experiences. As Chris said the immune system is very complex. It’s very difficult for a layman to sort through all this clutter by theirself.
Thank you so much! After reading this article, I printed a copy for my Doctor. We discovered I have Thyroid resistance due to chronic stress. We are working on adjusting my dosage and lowering my stress and supporting my adrenals. I feel so hopeful!
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