Is it really possible to feel this bad? Brain fog, Tinnitus, Head rushes

Hello,

I'm a fairly recently diagnosed Hypothyroid patient. I'm also new to this forum and have been reading for a while and truly appreciate all of the insight I have gained from doing so. I'm going to give the long story and hopefully somebody will have the patience to read and give me some answers.

Last July (about 6 months ago) I lost all my motivation and started sort of resting a lot and not really caring about my goals and such. I thought maybe it was just a "lazy spell" which I've had many times in life before and eventually come out of them and get back to my projects and my goals. I still felt healthy, just unmotivated and was sleeping and resting a lot besides going to the gym consistently. Then one day I sort of noticed something was happening with my ability to think, almost a cognitive sort of issue, and it was accompanied by almost a sort of dizziness/vertigo type of feeling, a fog if you will. My vision became sensitive to light and almost hard to focus. My tinnitus almost doubled. I also started getting more head rushes and felt a lot more fatigued than I had been just a few weeks before. I started sleeping even more, like 12+ hours a day, and still felt tired and foggy after many hours of rest. Finally one day at the gym I was doing my usual cardio I had done a million times and I just had to stop because I felt like I was going to fall over and pass out.

A million things went through my mind as to what this could be, needless to say, I went to the Doc and she took a look in my left ear and apparently saw an middle ear infection. I had no pain or any other symptoms but she put me on Amoxicillin for 10 days and said that my dizziness should abate within a few weeks. My symptoms never went away and in fact sort of continued to get worse. I was very scared and didn't have any idea what was going on and continued to see other doctors for any possible diagnoses. I went and saw an eye doctor and an ENT and got a clean bill of health from both. But I still felt terrible and foggy, and just rotten. Just did not feel like myself. My Doctor started talking about psychological disorders, and thought disorders, and a bunch of nonsense. Then finally one day I was complaining to my parents about the way that I felt and my Father said hey, that sounds like exactly what your Sister went through when she had Thyroid problems.

So, in October a few months after the symptoms first started, I asked for a full panel blood and thyroid test from my Doc and here is the result for the Thyroid:

October 2012
TSH 4.2 (.36 - 3.74)
FT4 1.05 (.76 - 1.46)

Doc saw the elevated TSH, did NOT fulfill my request for a full panel Thyroid test. Given family history and my symptoms he diagnosed me Hypothyroid and I went on Synthroid for about 6 weeks 25 mcg. Couldn't tolerate it and after about a week went down to 12.5 mcg for the remainder of the 6 weeks. Did not help any of my symptoms. Had another lab drawn in November, TSH and Morning Cortisol only:

November
TSH 6.27 (.36 - 3.74)
Cortisol 12.6 (no lab range available)

TSH had gone up slightly. I still felt like crap. The brain fog, tinnitus, fatigue, the works. At this point Doc switched me to Armour partly by request and also because he thought the added T3 would help with my symptoms. Titrated up from 1/2 grain every two weeks to 1 grain, after 2 weeks at 1 grain and a total of 6 weeks on Armour, I took another lab with FT3/FT4 and Antibodies (this was yesterday and the antibodies are not available yet, I will update later).

TSH .35 (.36 - 3.74)
FT4 .99 (.76 - 1.46)
FT3 4.0 (2.18 - 3.98)

So as you can see my labs seem to be in range now. I'm sure they are not perfect and will still vary and need some tweaking. I still feel just awful. Pretty much every symptom I started with is still here. I'm beginning to worry that this could be something else. I honestly don't feel any better really. I try to be in a good mood and I feel that I have really made great efforts to be active and move forward in life, but DANG, I just feel so spacey and out of it. My anxiety is all over the place. I get little enjoyment out of life anymore. All I really want to do is watch Netflix and search through forums trying different word combos in Google for my symptoms haha! I mean it's like I'm a happy person trapped inside a body and brain that isn't functioning right or something. Anyway, thank you so much for reading my rant. Here are my questions:

Is it possible to still feel no change after that much treatment?

Is brain fog a really stubborn symptom?

Does a borderline TSH even sound like it could cause my symptoms?

[FTB4]

Thyroid Disease is hereditary and cances would be in favor of you too having it, your Free T4 is 32.85% in its range, but your Free T3 is high at just over 100%, I would back off just a hair on the Armour and wait about 4 or 5 weeks and ger retested, I think you are rushing things a little, changing doses every week or two is pushing it. You may still have symptoms because your body needs to catch up and heal. You don't get rid of symptoms that quick. Don't get discouraged, the process takes a little time. The T3 should give you a little more energy than you had before, in the mean time have your MD run a CBC and Vitamin D, Magnesium and B12, and see if you are deficient. Wait and see how the Antibody tests come out and post them when you get them, it seems you are on the right track with the MD doing the right tests, that is half the battle sometimes. Best Wishes FTB4

[FrankDrebin]

Thank you for your response. I can't tell you how nice it is to hear from somebody regarding these issues. What is a CBC? And How much do you think I should back off the Armour? I take 1/2 grain in the am and 1/2 grain in the pm. Yeah my doc seems to half listen to me. I seem to have to push for certain things like the antibodies and cortisol. I was surprised when he suggested doing the FT3 and FT4 after being on Armour a while.  

[FTB4]

A CBC is a Complete Blood Count, it includes White and Red blood cell counts, Creatine that detects inflamation (inflammation) in the body, you can look it up on line and look up definitions of each test if you like, but it is a standard group of blood work and ranges. I don't want to intercede for your MD, what did he say about your Free T3 level, the Free T4 should pop up a little higher in a short period. When was the last time you increased your dosage prior to the last blood work?

[FrankDrebin]

You know, I did get a standard blood test done along with my initial TSH in October. It had the blood cell counts, the hemoglobin, the creatinine and all that. The only stand outs were low creatinine level and high ALT.

The last time I increased was a little over two weeks ago to 1 grain. So the current lab reflects a total of about 6 weeks on armour but only the last two weeks of that on 1 grain. I started at 1/2 grain, went up to 3/4 grain then 1 grain.

My doc didn't even flinch at my labs and just said to wait 3 months at current dose before another lab and at that time if my mood had not improved then we would talk about some new treatment ideas. I sent him an email asking if he thought I should back off just slightly on the Armour since I've only been at 1 grain 2 weeks and the FT3 is high, I haven't gotten a response to that yet but my guess is he will probably want me to just stay where I am at 1 grain. I was kind of thinking of trimming 1/8 or 1/4 grain off of the evening 1/2 grain that I take.

[FrankDrebin]

Oh also, what did you mean by the FT4 should pop up a little higher in a short period? Does mine look abnormally low?

[FTB4]

I would just do 1/2 in the am and 1/4 in the afternoon, the other issue I would have is the three month wait, that is not right, if someone is having symptoms of hypothyroid, a three month wait is too long, he should have you back every six weeks until you are stable, most Hypo's feel best when the Free T3 is at 2/3rds up in its range, Free T4 at 1/2 way up and TSH supressed below 1.0, when you get to that point, then just tweek the meds up or down a little according to how you feel. The 3 month period would be appropriate for someone who is on the money and having no symptomsThe blood work (CBC) you mentioned is a CBC, so he saw nothing to be concerned about?   Regards FTB4

[FTB4]

I am sorry I miised the question about FT4 "Popping Up" When you are taking increased dosages in short spurts like you did, it takes Free T4 longer to show up on blood tests, that is why most wait 36 weeks between labs, this way it gives your system time to "Catch up", So when you take your next lab, the FT4 will be higher in most cases. FT3 stays in your bosy for a shorter period of time, that is why I said to cut back to 1/2grain in the am and 1/4 grain in the afternoon, the FT3 portion of the Armour is much lower than the FT4, so the FT4 gets stored up, and could catch up to you, you don't want it flipping you to hyper, then you have to start all over again trying to figure out where that perfect spot is.   Best Wishes FTB4

[FrankDrebin]

Ok. Well that's good to know. I will take that into consideration. I may ask my doc one more time if he thinks I should drop that dose down, or maybe at least do a follow up test sooner than later, maybe a few weeks. I did want to throw one more thing at you if you have time to respond. I got my TPO results back today with a Doctors note. It seems he just wants me to stay at current dose but here are the results again with update of TPO and Doc's note:

TSH .35 (.36 - 3.74)
FT4 .99 (.76 - 1.46)
FT3 4.0 (2.18 - 3.98)
TPO 0.5 IU/ml (0.0 - 9.0)

Doctor's note with the result result read: No antibodies to the thyroid suggesting possible temporary thyroid under activity. Will monitor going forward and taper as needed. This is likely hypothyroid due to viral thyroiditis, not autoimmune thyroiditis.

Thought this was maybe good news but I am still wanting to take every precaution necessary to be as healthy as possible regarding my recovery and symptoms so if you have anything to add I would still much appreciate it. And thank you in advance.

[flyingfool]

I think FT4 above mentioned testing to be 36 weeks. I think that was a typo and he actually meant 3 to 6 weeks.

T4 is a "storage" hormone. Meaning that it stays in the blood basically unused UNTIL your body calls for more thyroid. In which case the body converts the stored T4 into T3.

It takes about 6 weeks for T4 to build up and stabilize in the blood stream.  So your last test result basically is indicating the Free T4 level from the dosage you were taking 6 weeks ago.  Since you've increased dosage every 2 weeks, you should see a blood level response of increasing of the Free T4 levels in the coming weeks due to these additional dosage increases.

T3 on the other hand works almost immediately.  Armour has BOTH T4 and T3 component.  T3 is available to be used by your body immediately and it is used up in about  5 to 7 hours.  This short half life is the reason why you want to split the dosage throughout the day so that it better levels out the available FT3 instead of getting a huge blast in the morning and then tapering off. If you take a 2nd dose about 5 hours after the initial dose it helps to bump up the level as the remainder of the morning dose wears off and helps keep the blood level more constant.

Your natural Thyroid gland produces both T4 and T3.  But mostly T4.  Armour which is made from pig thyroid has significantly more T3 in it as a proportion than a human thyroid gland produces.  This can be a good thing for people who need more T3.

It is extremely common for TSH to be suppressed when taking any thyroid medication but especially when taking T3 medication.  Thus TSH should essentially be totally disregarded when on a synthetic T3 medication or Armour (Natural dissected thyroid) which has a T3 component is taken.

As mentioned many here and FT4 mentions above, have found that simply being "somewhere" in the range is NOT good enough.  The better target seems to be found somewhere near FT4 to be in the MIDDLE of the range (50%) AND - that means in addition the FT3 to be in the UPPER 1/3 of the range (66.7%).

Notice that this is considerably higher than just somewhere in the range.

This 50% and 67% is just a target rule of thumb that seems to be a better target, but understand every person is different.  The best approach is to start low and slow on dosage.  And bump up dosages after testing every 6 weeks or so. Again in slow/small increases.  Continue to monitor blood labs and also symptoms.

Also keep in mind that symptoms can lag the blood labs by several weeks.  This is why when you start to appear to be getting close to optimization for YOU.  Smaller increases or longer times may be in order to let things truly stabilize.  It is possible that while you have a few remaining symptoms.  That simply changing nothing and even the blood labs could stay the same may result in continued reduction of symptoms because of this lag.

Too many people are too impatient and understandably want to get results FAST.  And this ends up being a big mistake and puts you on a roller coaster ride of hell.  Often the medicine is not able to be tolerated by the too fast of increase and/or they overshoot because of the lag and bounce from Hypo to Hyper.  Now you're really messed up.

Your body ONLY uses the Free T3 hormone at the cellular level and symptoms are best correlated to FT3 levels which makes total sense.  However many people here have found out that even if they get the FT3 levels in what appears to be the optimum zone,  If their FT4 level is not somewhere near 50% and are at one extreme or the other of the range they still have symptoms.

In your case, it is entirely possible that you need to have a small decrease in the Armour as your FT3 level seems high.  AND you MAY ultimately have to add a synthetic T4 medication to get your FT4 balanced out. That is one idiosyncrasy of Armour is the inability to tweak T4 and T3 individually because it is a combination drug.  So to get the numbers optimized for you, you may or may not require taking in addition to Armour  a synthetic T4 supplement. Some people have the exact opposite situation where they take Armour, get their FT4 at 50% and need to add more T3 synthetic medication to get their FT3 optimized.

Anxiety is one of those symptoms that cross over to BOTH Hypo and Hyper.  So it's hard to tell if your anxiety is a result of a too high of FT3 and being Hyper or if it is still a lingering hypo symptom.

My thought and I may be wrong is that IF your FT4 is going to continue to increase over then next few weeks due to your increases in dosage, AND your body still converts that into FT3.  It is possible that your FT3 level could go up as well and you could go Hyper.  What is more likely to happen is that your body will sense that you have plenty of FT3 and will convert the FT4 into useless inactive reverse T3.  (RT3).  This is the body's safety valve to attempt to keep you from going Hyper.  However your body can do nothing about the T3 you put directly into your blood by medication.  It only has a chance to affect the conversion.

Just my long winded thoughts.

[FTB4]

Long but on the money!  and I did mean 3-6 weeks lol not 36 weeks, sorry for the typos.  FTB4

[FrankDrebin]

That's good stuff. Thank you. It seems my doc wants me to stay tough on my current dose of Armour. He doesn't seem to be concerned that I'm going to go hyper. I am going to try and get in for a new lab at 6 weeks on 1 grain which will be about 4 weeks from now. Is that enough time to go "hyper" or do you think that if an adjustment needs to be made at that time I can avoid going hyper? I suppose at that point I could also suggest adding the t4 if needed like you said?

[FrankDrebin]

Yeah no probs. I actually did interpret that as 3-6 weeks. Thanks for clarifying though. I really appreciate both of you for giving me some insight here.

[flyingfool]

Since I'm not a Dr it is usually good to follow your Dr's recommendations.

I would however think trying to "sneak" in and get a blood test in 6 or 8 weeks would be fine.

I would also just keep an eye out for Hyper symptoms. If you start to have more of these you then can call your Dr and report that information to him and maybe he will adjust.  It is also possible that your FT3 levels won't go any higher and your FT4 levels will rise to about mid range by not changing a thing.  Then you can see where you are and if a decrease is necessary just like your Dr suggests.