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Fatigue, Fatigue, and more Fatigue!

Diagnosed with Hoshimoto's about a year ago, but endocrinologist only wants me taking vitamin D for now. T3 is just a few digits above normal range, but symptoms are life draining! I had primary care doctor prescribe Aderall to fight fatigue, but at 20 mg in morning and 10 mg in afternoon, and even this is no help! All i want to do is sleep or sit. I can barely get out of bed and to wprk an entire day is the worst struggle of my life. I am always bloated/constipated. I sweat like a prostitute in church, and have numbness and tingling in hands and feet all the time. Can someone shed light on how you get doctor to understand this fatigue is not just an I feel tired situation, but an I feel nearly dead one?
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Avatar universal
I think your doctor should have spent less money and time on all those tests and paid more attention to your thyroid result.  From what I see your Free T4 is right at the bottom of the range and since the range is far too broad to be functional for many people, that is a strong indication of you being hypothyroid.  Even though your TSH is within range, TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones Free T4 and Free T3.   And you were not even tested for Free T3.  So I suggest that you go back and get tested for Free T3, and also Reverse T3 at the same blood draw.  Also, In the future you should make sure they always test for Free T4 and Free T3 every time you go in for tests.  

I am a bit surprised that your TSH is within range, since you mentioned a diagnosis of Hashimoto's Thyroiditis a year ago.  What tests were done that indicated Hashi's?

Hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at lest 70, and some say 100.  So you are too low in Vitamin D, a bit low for B12 and ferritin is okay.  You can supplement on your own for D and B12.

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  People typically expect that Endocrinologists are always good thyroid doctors, but that is not the case.  Many of them specialize in diabetes, not thyroid.  And many of them have the "Immaculate TSH Belief", and only pay attention to that.  That is very wrong.   Also, many of them use "Reference Range Endocrinology", by which they will tell you that a test result that falls anywhere within the range is adequate.  That is also wrong.  You can get some good insight from the following link.  I highly recommend reading at lest the first two pages, and more if you want to get into the discussion and scientific evidence for all that is recommended.  Note that the link seems to be down at present, so you will have to try it later.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

After you read some of the link I think it will be evident that you need a good thyroid doctor that will treat clinically, as described above.  Your current doctor seems to be unwilling to do anything until some test results are out of range, even though you have numerous hypo symptoms already.  I have looked through several sources for names of doctors recommended by other thyroid patients, but the closest one I can find right now is in Mobile.  So you may have to give the Endo a copy of the entire link and push him to read it and consider treating you clinically since you already are having hypothyroid symptoms.  Many of us have found that we needed Free T4 to be at least mid-range, and Free T3 to be in the upper half of its range, and adjusted upward from there as needed to relieve symptoms.

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Avatar universal
Since lab results and calculated reference ranges can vary from lab to lab and results need to be compared to ranges, please post the reference ranges shown on the lab report for those test results.
Helpful - 0
1 Comments

All results here unless noted otjerwise were from blood/urine drawn 8/25/16.

Vitamin D =optimal@>30ng/dl
My Result=25

Ferritin Ref=23.0-336 ng/mL
My result=115.0

Testosterone free urine Ref=46-224pg/ml
My Result=69.3

Testosterone blood Ref=400-1080ng/dl  My Result=282 (Low)

FreeT4 Ref= 0.8-2.8
My Result=0.9

FSH Ref=0.7-11.1
My result=1.1

TSH Ref=0.3-3.0
My result=2.860

Cortisol Ref=5.0-25.0
My result=18.2

GGT Ref=9.0-50 IU/L
My result=22.4

Magnessium Ref=1.5-2.5mg/dl
My result=2.5

B12 Ref=200-1000pg/ml
My result=635

Sed Rate Ref=0.0-15 mm/hr
My Result=1.0

Metabolic Profile:
Potassium Ref=3.5-5.5 mmol/L
My result=4.1

Calcium Ref=8.0-11.0 mg/dl
My result=9.4

Chloride Ref=96-112 mEq/L
My result 92.3 (Low)

Sodium Ref=135-148 mmol/L
My Result=140.4

Carbon Dioxide Ref=21-34 mEq/L
My result=29.3

Glucose Ref=60-110mg/dL
My result=97.0
----------------------------------
Anion Gap Ref=5-16 mEq/L
My result= 22.9 (High)

BUN Ref=8-25 mg/dL
My result=9.2

Creatinine Ref=0.6-1.2 mg/dL
My result 1.0

GFR=89.4

Hepatic Function:
ALB Ref=3.5-5.2g/dL
My Result=4.6

Total Protein Ref=5-9 g/dL
My result=7.1

ALP Ref=34-114 U/L
My result= 75.6

AST Ref=10-40U/L
My Result=21.1

ALT Ref=0.0-34.0 U/L
My Result=26.8

Direct Bilirubin Ref=0-0.2 mg/dL
My Result=0.0 with 0.4 Indirect bili
Total Bilirubin Ref=0.2-1.4 mg/dL
My Result=0.4

*CBC* R=Reference Range M=My Result
Units: K/uL
------------
WBC R=4.1-10.9
M=7

LYM R=0.6-4.1
M=2.2

MID R=0.0-1.8
M=0.4

GRAN R=2.0-7.8
M=4.3
-----------
RBC R=4.2-6.3
M=5.5

HGB R=12-18g/dL
M=17.5

HCT R=37-51%
M=53 (HIGH)

MCV R=80-97fL
M=96.3

MCH R= 27-32 pg
M=31.8

PLT R=142-424K/uL
M=362

MPV R=0.0-99.8 fL
M=7.9

LYM% R=0.6-50%
M=32.0%

MID% R=0.0-24%
M=6.1%

GRAN% R=2.0-92%
M=61.9%

Urine microalbum R=0.0-20 mg/dL
M=0.4

Aldosterone,LC/MS/MS R=ng/dL
My result=5

ALDO/PRA Ratio R=0.9-28.9
M=3.2

Plasma renin activity
LC/MS/MS R=0.25-5.82 ng/mL/h
M=1.54

Metanephrines, Free R=<=57pg/mL
M=52

Normetanephrine Free R= <=148pg/mL
M=87

Osteocalcin, N MID R=9-38ng/mL
M=28

Lipase R=7-60 U/L
M=21

Cortisol, Free, LC/MS/MS
R=0.07-0.93 8:00-10:00AM
M=0.6










Note: See below for a previous blood test upon ER visit for high BP on 8/19/16,prior to above blood work.

WBC R=4.0-11.0 10e3/ul
M=10.5

RBC R=4.7-6.10 10e3/ul
M=5.51

HGB R=13-17 gm/dl
M=17.5 (high)

HCT R=39-49%
M=50.9

MCHC R=31-36g/dl
M=34.4
Creatinine Ref 0.8-1.3MG/DL
My result= 1.52 (High)

ALP Ref=46-116 U/L
My Result 139 (High)

GLU Ref=74-106MG/DL
My result=106

BUN Ref=7-18MG/DL
My result=7

BUN/CRE= 4.6

NA Ref=136-145MMOL/L
My result=145

TSH R=0.36-3.74 uIU/ML
M=2.90

FT4 R=0.76-1.46
M=0.78

TP R=6.4-8.2
M=8.0

MG R=1.8-2.4MG/DL
M=2.2

GFR R=NULL UNITS=ML/MIN/1.73m2
M=55

BILT R=0.0-0.8 MG/DL
M=0.19
Avatar universal
Before discussing further, please post your thyroid related test results and reference ranges shown on the lab report.  Also, if tested for Vitamin D, B12, ferritin, and cortisol, please post those as well.
Helpful - 0
1 Comments
Thanks for reply!!!  Here is what I have, not that I know what any of this means! Endocrinologist just said you have Hoshimoto's and will need to have blood drawn every 6 weeks and take vitamin D liquid and stay off caffeine! He explained nothing and certainly does not understand I AM TOTALLY EXHAUSTED 24x7! I may sleep 17 hours some days! Also to note, I have always had optimal blood pressure, but in past few years it has skyrocketed to over 219/105 and sometimes higher out of nowhere. Heart races at times, numbness and tingling in hands and feet, profuse sweating at times, contipation and bloating beyond belief! Age:38

thyroglobulin 25.3
testosterone free 69.3 (urine I believe)
Free testosterone (blood) 5.92
Testosterone 282
Free T4 0.9
Dehydroepiandrosterone 465
Vitamin D status 25-OH
Cortisol 18.2
B12 635  (taking supllements as this has been way low on previous blood tests)
Prolactin 4.29
Human Sex Hormone binding globulin 18
Anti-thyroid Peroxidase Antibody <10
Estrone 21
Transferrin (mg/dl) 268
Iron 86
LDH (U/L) 163
Methylmalonic Acid 0.17
Direct TIBC 387
Transferrin Saturation % 22
Insulin like growth factor1= 260
MTFR (C677T)= C/T Intermediate Risk
MTHFR (A1298C)= A/C Intermediate Risk
CYP2C19*17= *1/*17 Intermediate Risk


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