chronic fatigue

I'm at 5 years post thyroid cancer.  Just had my 3rd radioactive iodine and complete body scan, no recurrence of the disease.  My concern is neither my endochronologist, or surgeon told me the issues I would face following a complete thyroidectomy.  I had fatigue that I have never experienced, and poor short term memory & concentration.  Since they told me I should be fine, I have forced myself everyday to work full time.  I sleep poorly because of heart palpatations, hot flushes and my endo tells me this is menopause NOT thyroid related.  I was post menopausal almost 10 years ago following a hysterectomy.  These symptoms occurred after my thyroid was removed, I have never been the same, and feel more fragile emotionally then ever.  I sunk in a depression, felt anxious because I was supposed to be fine, yet each day was a battle.  I finally ended up in the hospital treated with depression and have been off work.  Now I feel much better and realize that I can't work full time, yet the MDs say the opposite.  I know we all can get depressed from time to time, but I truly believe I've never been the same. I am on vitamin D 5000 iu od, and a multivite.  On thyroxine .250mcg. od.  any suggestions?  Maybe I need a new job.
Nicoel


This discussion is related to Issues after Total Thyroidectomy.

[gimel]

As a result of Hashi's I was gradually increased in meds until I reached 225 mcg of Synthroid.  My FT4 got to slightly above the top of range and my TSH has been about .05 for over 25 years.  In spite of this I still had lingering hypo symptoms until I learned on this forum about the importance of FT3.  FT3 is the thyroid hormone that largely regulates metabolism and many other body functions.  An FT3 result in the lower end of the range is inadequate.  The ranges are far too broad.  Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.  After I learned about the importance of FT3, I was able to get my meds changed to a dessicated type T4/T3 med and now I feel best ever.  My FT4 is just below midpoint of its range and FT3 in the upper third of its range.

A good thyroid doctor will test and adjust levels of FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test results.  This link is to a letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient, to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf  

[goolarra]

Do you have thyroid labs to post?  FT3, FT4 and TSH?  If so, please do along with reference ranges which vary lab to lab so have to come from your own lab report.

It sounds like your meds are not well adjusted properly.

[nicolenurse]

My levels are always in the safe range.  TSH is low .03 to .06, but that is the range my endo wants to keep me to avoid recurrence.  I understand that. He won't give me anything else.  Now I am on celexa to treat depression, and have been off work for 4 months. I'm afraid to return and find that I feel the same way after a few months.  I was extremely active, working full time, taking courses, attending conferences and gave my job 110%.  I know we all age, but this was a drastic change, and all after the thyroidectomy.

thanks for your comment, Nicole

[gimel]

As a result of Hashi's I was gradually increased in meds until I reached 225 mcg of Synthroid.  My FT4 got to slightly above the top of range and my TSH has been about .05 for over 25 years.  In spite of this I still had lingering hypo symptoms until I learned on this forum about the importance of FT3.  FT3 is the thyroid hormone that largely regulates metabolism and many other body functions.  An FT3 result in the lower end of the range is inadequate.  The ranges are far too broad.  Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.  After I learned about the importance of FT3, I was able to get my meds changed to a dessicated type T4/T3 med and now I feel best ever.  My FT4 is just below midpoint of its range and FT3 in the upper third of its range.

A good thyroid doctor will test and adjust levels of FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test results.  This link is to a letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient, to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf  

[goolarra]

Just because levels are in reference range does not mean that you will feel well.  That's because we all have our own, personal comfort range.  Finding that and staying in it are key to feeling well.

If you post actual lab numbers, we can comment a lot more specifically.  Without those, we're just guessing.

[Barb135]

If your doctor is only testing TSH, and is using that result, alone, to adjust your medication, you really need to find a different doctor, as he's going to keep you ill for a very long time.

As gimel said, you need a doctor who will adjust FT3 and FT4 in such a manner as to alleviate symptoms, regardless of anything else.

[nicolenurse]

thank you for the information.  I am getting my T3 & T4 tests done as well.  I don't have access to my previous levels, but will get my blood work this week and see him April 4. I am not sure if the answer is taking antidepressants for the rest of my life rather than thyroid medication.
Nicole

[gimel]

Just make sure those tests are for free T3 and free T4, not total T3 and total T4.  I'd even go so far as to ensure that the lab people know they are to test for the Frees, not the Totals.  You'd be amazed at how often they operate on auto pilot and do what they usually always do, which is not FT3 and FT4.  

When you have test results available, I suggest that you get a copy of the lab report and post results and their reference ranges so that members can help interpret and advise further.   Also be aware that FT3 and FT4 results in the lower half of the range are frequently not adequate to relieve symptoms.  The ranges are far too broad for that to be the case.  The ranges for FT3 and FT4 have never been revised, as was done for TSH over 8 years ago.  If the data bases for these tests were purged of suspect hypo patient data, like done for TSH, the revised ranges would look more like the upper half of the current ranges.  As such, the current ranges should be considered as guidelines within which to adjust levels as necessary to relieve symptoms.  Unfortunately many doctors consider results that fall anywhere within the ranges as adequate, resulting in many patients being inadequately medicated.  .  

[Barb135]

Antidepressants are often thrown at us, as a way to alleviate symptoms; less work for the doctor, I guess, as it's easier to shove the prescription at you, than do proper testing and evaluation to actually help you.  Just my little bit of cynicism for the day!!

No, the answer is not to tak antidepressants for the rest of your life, rather than thyroid medication.  Your thyroid issues will only continue to get worse if not addressed properly.

[nicolenurse]

I saw my endochronologist, and he said my levels are fine and any symptoms I am experiencing are NOT thyroid related.  He tells me this each time and says he is only concerned about my TSH levels, the rest he says does not matter much.
My blood work is:  TSH .3132  Free T4 18.1  Free T3 3.6  Thyroglobulin  <0.8 Anti-TG 12

my total body scan post radiation is negative for reoccurrance of disease.

I take 5000 IU of Vit D, multivites and Thyroxine 125 mcg OD.  Celexa 20 mgs OD

[gimel]

Want reply later, but have to go right now.  Could you please post the reference ranges shown on the lab report for those tests.  Results vary from lab to lab and accordingly they use slightly different reference ranges.  Also, in your first post you mentioned 250 mcg of Thyroxine.  Today you said 125 mcg.  Please clarify.

[kl42]

you sound low in thyroid med. id check that maybe you just need an increase!

[nicolenurse]

Hello Gimel,

  sorry, I am on 125 mcg. OD.  
TSH                             .3132      mIU/L   0.50 - 4.2
FREE T4                       18.1       pmol/L    9-21
FREE T3                         3.6       pmol/L    3.62 - 5.79
THYROGLOBULIN           <0.8     ug/L 1.4 - 78
ANTI -TG                         12        <115 IU/ml

My endo is not concerned about the other lab values, his goal is to keep my TSH as low as possible.  thank you  Nicole

[gimel]

Ahhhhhh.  Now we are getting somewhere.  That Free T3 level is way too low.  Many of us on the Forum have found that symptom relief required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  

You are on a heavy dose of T4 meds.  This frequently results in suppressed TSH, which is okay, and what your doctor wants.  However it also frequently results in low Free T3, due to lack of conversion of the T4 med to T3.  I fought the same thing for many years until learning about the importance of Free T3 on the Forum and finding that mine was low in the range.  I got my meds revised from Synthroid to a T4/T3 combo (Armour thyroid) and now I feel best ever.

I don't know what your doctor's philosophy might be about dessicated type thyroid meds like Armour, but I think that is what you need to do to bring up your FT3 level.  I went from 200 mcg of Synthroid to 2 1/2 grains (150 mg) of Armour.  Compared to a range of 2.3 - 4.2 Pg/ml, my FT3 went from 2.6 up to 3.8.

Next time you go in for testing I suggest that you should also test for Vitamin A, D, B12, RCB Magnesium, iron/ferritin, and selenium.Hypo patients frequently find these to be low as well.

[Barb135]

I completely agree with gimel, that you need a source of T3, since your FT3 is barely in range.  I'm on a T4 med, called Tirosint, and add a small dose of T3 daily.  Like gimel, my FT3 went from 2.5 to its latest of 3.7 (range 2.3-4.2).  My TSH stays very low, as well, last was < 0.01.  

[nicolenurse]

Hello,

  I wish I had this information before I had my 6 month follow up, he absolutely has refused to agree that any of my symptoms are thyroid related and insists it is something else.  I am desperate to try other things, as I don't have the stamina to work full time and having difficulty getting my insurance company to approve the medical claim.  Right now, I am simply being treated for "depression".  well, I will take this information to my GP and also call the endo's nurse and ask if I can trial this Armour.  You sure are on a high dose of synthroid, compared to me.

thank you, Nicole

[gimel]

If you run into resistance from the doctors, you can throw this scientific study at them.  It shows that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.  

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

When you think of it, this is only logical, in that FT3 is the thyroid hormone that largely regulates metabolism and many other body functions.  How could an FT3 level that is at the very bottom limit of the range possibly be as good for your body as one that is at least midpoint, or higher as needed to relieve symptoms?  Likewise, how could a low TSH be bad for you when it causes no symptoms, and it is only an indicator of the thyroid hormone levels.  Your hormone levels are not excessive.  In actuality your FT3 is at rock bottom.

[nicolenurse]

I'm just curious gimel, how old are you?  I ask because people I spoke with who had thyroid ca, did not have the fatigue symptoms I have, and they are much younger than I am.  

[gimel]

Maybe the people you spoke with had higher levels of FT3.  I didn't have much energy until getting my FT3 increased to the upper third of the range.  

I'm not posting my age on the open Forum. Let's just say that I'm older than you.   LOL  Sent PM.  LOL