Cause of fatigue?

[oneup]

I'm new here. Hope you can give me some advice.
I've been trying to find out what might be causing my fatigue. In 2000 I was diagnosied hypothyroid with a TSH of 7.6. I was also diagnosied with fibromyalgia and CFS. I was place on a low dose of synthyroid .25 mg.
In 2002 I had a bad accident and after surgery I had a major depression. I gained 30 lbs in 3 months. My TSH was 8.7 and was placed on synthyroid .05.  
I was diagnosised with hypoglycemia in 2003.
I switched from synthyroid to Armour Thyroid in April 2004. In September 2004 I was at 2 grs Armour Thyroid. I was still having some anxiety related to my accident.
In April 2005 I started having hot flashes and night sweats. I'm 49 and had a hysterectomy in 1997.
In June 2005 my GYN checked my
estrogen 139 range <50,
progesterone .09 range <.7.
TSH .015 range .40-5.50,
Free T4 .09 range .8-1.8,
Free T3 226 range 230-420.
I increased my Armour Thyroid by 30 mg til I was at 3 grs.
In August 2005 my
TSH .04 range .34-5.6
free T4 .84 range .58-1.64
t4 7.5 range 4.7-13.3
t3 uptake 36 range 23-40
antithyroid peroxidase 307 range <35
ferritin 367 range 10-291
iron 92 range 35-185
TIBC 309 range 250-450
%saturation 30 range 10-53
sodium 137 range 136-145
chloride 108 range 98-107
Bun 7.7 range 7.8- 21.4
Bun/crea 11.12 range 12-20
total bilibrubin 1.4 range .02-1.0
My blood pressure and pulse at rest is 97/54 to 106/65 pulse 57 to 65.
When I try to do the least bit of work I sweat and get weaker until my muscles are shaking like I'm hypoglycemic but my blood sugars are 85 to 95.

[Mark Lupo, M.D.]

The low TSH is likely your body's way of saying the armour dose is too high -- if the empiric increase to 3g did not help symptoms, this would support that the dose is too high.  Hyperthyroidism can cause exercise intolerance and anxiety.  Your blood pressure and pulse are normal.  Other labs c/w post-menopausal state - talk to your doc about options there.

Your blood sugar is normal but you may have fluctuations "relative hypoglycemia" -- eat small meals that are low in sugar and starch about 5-6x/day to avoid fluctuations.

[doodlebug1]

Hi. I'll be curious what Dr. Mark says about a lot of your labs, especially the high Ferritin. But I do have a strong opinion about other things your stated...namely your free T3 and free T4. I have to have my free T3 at the top of the range to completely rid myself of symptoms, and I am definitely NOT alone in this.  No wonder you are tired!!!! Your free T3 is BELOW range! It's the T3 that gives you great energy. I can definitely attest to having shaking muscles at the least bit of work--I had the exact same issue when I was on T4-only meds, and only when I got my Armour up, and thus my free T3 towards the top of the range, did I get rid of that. You may be one of those folks who needs to be on much higher doses of Armour than most, no matter how low it WILL get your TSH. If docs keep dosing you by your TSH, you are never going to have enough Armour that you may need to counter that auto-immune attack on your thyroid.

[ArmourGal]

on the depression after your surgery, I've read that thyroid hormone levels drop after surgery...and if a person is hypothyroid already, it's easy to see that a hypo symptom like depression can manifest or intensify.  A few years before I was diagnosed, I had two surgeries, and I now know the terrible time I had afterwards was because of a further drop in thyroid hormone levels.  

on the exercise intolerance, that's a known symptom of hypo.  Looking at your labs, it's pretty easy to see that with your Free T3 below range, you probably have lots of hypo symptoms still to resolve.  

My Free T3 is at the top of the range and all hypo symptoms have resolved.  I take 4 1/2 grains of Armour in 3 divided doses...are you dividing your dose?  

I have found that most folks who say they are free of hypo symptoms are also at this higher Free T3 level, with their Free T4 being at least at the midpoint of the range.  I imagine your doc freaks at the low TSH, but all the folks I know on Armour tend to have a suppressed TSH but no signs of hyper at all.  I think the input of T3 into the body via Armour just totally disrupts the natural HPT feedback loop and the TSH tanks.  

Your Ferritin is high...and there is a condition called Hemochromatosis associated with that - but I don't know the particulars...but you may want to check on that.
Cindi

[ArmourGal]

one other comment...your low blood pressure and heart rate are indicators of hypo.  
cindi

[oneup]

Thanks for your comments.
It's like I told my doctor if I were hyper thyroid then I would be loosing weight and my blood pressure and pulse would be up. That's not happening.
My fibromyalgia has gotten better on the higher doses of Armour. My memory, concentration and fatigue hasn't. I feel better than I did a year ago.
I do use a natural progesterone cream for the high estrogen even thou the GYN doctor wouldn't treat me.
I'm seeing a hematologist about my high ferritin cause my regular internal med doctor wouldn't address it. The hematologist really wasn't that concerned about my ferritin either. He's checking for hepatitis B and C. Also doing genetic
testing for hemachromatosis. He doesn't think thats it either even thou I had almost all the symptoms. He's also going to do an ultra sound for fatty liver disease.
I had often wondered if I had myxedema from low thyroid. I had read that you don't have to be in a coma to have had it.
I have to change doctors pretty frequently cause doctors give up and say you have fibro and CFS without doing further tests.
I wonder if my liver problem has something to do with the T4 not converting to T3 reason for low T3. I had also read that low TSH low T4 and Low T3 could be caused from a pitutary problem. Since the pitutary tells the thyroid how much TSH to put out. Could I have central/secondary hypothyridism?
I can't get any doctors to refer me to an endo. or test for adrenal or cortisol.
I almost forgot my thighs have been feeling swollen like for years. Last week my lower legs and feet became swollen for the first time and their still slightly swollen in the mornings. More short of breath on exertion.
I had a heart murmur when I was 19 and started with palpitations in my early 20's. When I had my hysterectomy I had an abnormal T wave. I've had palpations off and on ever since. However they do seen to have gotten less frequent with the high dose of Armour.
I had a hysterectomy cause of heavy periods. Doctor thought I had endometrosis. According to pathology report there was nothing wrong. Now I wonder if if wasn't thyroid related.
I do believe I may have more that one thing going on.

[oneup]

I also for got I had cravings for something salty or sometimes something sweet for a couple years. I have dry mouth and have to have something to drink always close by. I have to go to the bathroom frequently late at night but here lately its not every night. I also no longer have the cravings and don't want anything sweet or salty. I wonder if that the reason for the swelling or is it low thyroid.
I have a cough but not chronic. My vision has gotten so bad I can't see without glasses. I get lightheaded sometimes. Before I got sick 5 years ago I was very active and could lift quite heavy objects. Now I can't do any of that. I have headaches more now than I used to.

[doodlebug1]

Oneup, you seem like someone who can think on their own two feet. I, too, was just like you, and because of that, I figured out on my own, and with the assistance of learned folks on the net, what I needed to do for my continuing and debilitating symptoms---symptoms that screamed for help for years, but not one doc really listened to what was obvious. When I figured things out ON MY OWN, I found a doc to switch me to Armour, and I then found a doc who allowed me to dose by SYMPTOMS and the free's, NOT the TSH--the latter which I have noted over and over can be a BAD reason to increase or decrease meds. SYMPTOMS COUNT. And in my opinion, so do your free's, which are VERY low in range.

You mentioned CFS--did you know that CFS came about AFTER the TSH and it's range was created, AND when folks were primarily treated with T4-only meds? In other words, some very learned doctors are noting that CFS is most probably UNDERtreated (because of forcing folks to stay in the TSH range) and poorly treated (because of being on T4 only) hypothyroid!!!

And yes, it is also my understanding that a low TSH along with low free's can point to a pituitary problem--another reason why ONLY looking at the TSH without paying attention to obvious symptoms and the free's doesn't work! There's a few gals on the natural thyroid hormones group on Yahoo who are like that!

Please...don't worry about not being referred to an Endo. There ARE good docs out there, and they are not Endo's. And by the way, you called 3 grains a "high" dose. I am on 3 1/2 grains, and notice that lots of folks are MUCH higher than I. My 3 1/2 grains is not "high"--it's just optimal, just as their higher amounts are optimal for them. Our "optimal" amounts are what have removed ALL of our hypo symptoms.

[ArmourGal]

Lots of folks think fibro and CFS are just untreated/undertreated hypo.  However, those particular symptoms of hypo, if present for a long time, can be rather hard to totally get rid of from what I've experienced and observed.  If you search "Dr. Lowe + fibromyalgia" you'll find his site.  I agree with him when he talks about a "cellular resistance to thyroid hormone" being responsible for fibro...and I think it comes from being hypo so long.  Dr. Peatfield (The Great Thyroid Scandal and How To Avoid It) talks about this too.  

Just in looking at your labs and knowing how they compare to labs of folks who are rid of hypo symptoms, I really feel your memory problems and such as just because your Free T3 is so low.  Gosh, my cognitive problems were pretty severe at your levels.

And yes, the heavy menstrual periods could well have been hypo related.  I've been amazed on my thyroid forum (yahoo's Natural Thyroid Hormones if you want to join) how many women have had unnecessary surgeries.  I also had heavy menstrual periods for years before being diagnosed, but they normalized within 3 months of starting Armour.  

As for the central hypo you mentioned, I would ask for thyroid antibodies to see if you have Hashimoto's first.  I have a feeling you may just have been hypo for a while and perhaps had a sluggish pituitary from it being hypo.  The pituitary can become enlarged itself from that and not work well.  Which is why I continue to be amazed that docs worship that TSH number often without taking into account Free levels and patient symptoms.

Quite a few hypo women I know have had fatty liver just from hypo...and their labs become normal after optimal treatment. The cough is also quite common in hypo.  I even had an asthma diagnosis for 10 years before being diagnosed hypo.  It's unreal to me what docs don't know about hypo symptoms.  

If you want to do your own saliva testing, I know some folks do the 4x a day saliva testing from ZRT Labs.  Some of your symptoms do sound adrenal...like that salty craving.  

To me, you sound like so many other undertreated hypo ladies that have come to my thyroid forum...what has happened for almost all of us is that symptoms go away once that Free T4 is over the midpt. of the range and the Free T3 at the top of the range or slightly over.  You're a long way away from that.
Cindi

[ArmourGal]

on your myxedema comment...i'd say anyone with severe hypothyroidism with multiple body system problems and severe mental deterioration is probably myxedemous.  I sure qualfied and also had the fluid all over my body that puffed me up.  I hardly recognized my face when it finally all went away.  That's one good thing about Armour - it has a diuretic quality.  So I think I'm saying that myxedema is just severe hypothyroidism.

[oneup]

WOW! Thanks for all that information. I thought I was on the right track.
I had to trick the doctors into ordering the Armour thyroid. I mentioned changing doctors frequently. When I switched from Synthyroid to Armour I told a doctor I was on Armour Thyroid when I was on Synthyroid. He ordered the one gr Armour and I took that pill and cut it into halves to get the half gr doses I needed.
But I wasn't sure when to quit upping the dose. I have tried taking several small doses a day but I get hyper every time. Its weird I can take 3 grs at 7 am but I can't take 30 mg at 4 pm. By 7 pm my heart rate is 115 and b/p is 130/90.

[ArmourGal]

it sounds like you're one of the ones who just need most of their Armour in the morning then...there are some folks like that...I know a couple of folks who take 4 grains all in the morning.  It amazes me.  I take 2 in the morning and if I took any more than that in the AM I would have hyper symptoms.  I know that because I've tried...and I just have to multi-dose 3x a day.  2 in the AM, 2 about 6 hours after that, and 1/2 around 7 PM.  and lots of folks take some right as they go to bed and swear it helps them sleep better.  

I guess Armour is sorta weird like that...in that it does take some playing around with the dosing to figure out what is best for your body.  I imagine that's another reason why docs don't like Armour...they actually might have to work with the patient to determine the best dosing schedule for it.  But I don't think thyroid hormone is a quick fix and I do believe that some tweaking has to occur to get it just right for the individual.  

Congrats to you for being smart enough to know Armour would be better for you.  Your brain must not be too bad.  smile.
cindi

[jds1]

I also have hypothyroidism and have been taking synthroid and cytomel. I noticed a remark about a connection of low ferritin levels and thyroid disease. My most recent tests show TSH .69, T-4 1.42, T3 4.61, and Ferritin 32. My doctor said my ferritin level is fine and within the 7-250 range but I still have symptoms of fatigue and brain fog. I've been searching on the internet to find a more specific range for a healthy ferritin level. Does anyone know what that is?

[ancientmariner]

From what I've read, your ferritin needs to be at least 85 for you to feel well. I also have heard that it takes several months to get the ferritin levels high enough so the thyroid begins to work. I also am a proponent of natural desiccated thyroid, because it has worked for me. Have you thought about it at all? It may make you feel better than what you're taking now, but probably nothing will work until you get the ferritin higher. Anyway, if you're interested in learning more, there's a great Natural Thyroid Hormones group on yahoo, with lots of information on Armour and other natural thyroid brands...