Strange array of symptoms - Being Dismissed by Endocrinologist
I do not know if this is the correct forum. If not, please redirect me.
I am being dismissed by the Endocrinologist. Going by my continuing symptoms, I hope for a suggestion as to where to turn next . . . see another Endocrinologist, or perhaps a Rheumatologist.
I am a 48 year old, white male, 6'1'', 203lbs. I have historically been more fit than most. I have been a rock and alpine climber for over 30 years. Until last year, I worked out regularly but modestly using a versaclimber, modest weights, and climbing four or more days a month. I sleep 7.5 to 9 hours per day. My sexual desire and performance has always been strong.
Beginning about a year ago I have had mounting symptoms that include
*cold intollerance (a problem for winter mountaineering - now need a sweater in a 69 deg room and am cold for the first hour in bed),
*muscle weakness and reduced muscle mass (turning to flab),
*reduced mental sharpness and reduced memory,
*low sexual desire,
*injuries do not heal (numerous joint injuries, and also cuts and scrapes), and
*trouble focusing on tasks to completion.
Every one of these symptoms presented in the last twelve months. There was no known "event" that occured twelve months ago that could be a cause of anything.
I have had blood tests done three times in the last several weeks. Some overlap testing, some not. I am hoping something looks out of place to someone who knows what they are looking at. A filet of the test results is as follows:
First Test (4/21/08) - Done in connection with annual physical
Fasting Glucose - 96
T4 Total - 11.9
TSH w/ free T4 - 2.93
Testosterone Total - 179
Lyme Disease - Negative
Second Test (5/5/08)
FSH - 9.2
LH - 4.5
Prolactin - 7.7
Testosterone Total - 201
Sex Hormone Binding Glob - 21
Third Test (5/15/08) - By a lab the Endocrinologist "trusts"
Adrenocort. Hormone - 14
FSH - 10.7
Prolactin - 5
Testosterone Total - 337
Testosterone Free - 9.4
Sex Hormone Binding Glob - 26
Insulin Growth Factor 1 - 185
Insulin Growth Factor BP3 - 4.8
I don't know what any of this means other than to know which of these number is within and outside of what somebody defined as "normal" for me.
Any suggestions as to what I should do next would be appreciated, including any suggestions for physicians in Connecticut I should contact.
I don't know what most of those results represent without lab ranges provided by the lab that processed the tests, but I will comment on what I can comfortably.
First, all your symptoms sound like either Hypothyroidism, or adrenal fatigue. Adrenal fatigue is not really recognized as a treatable condition, although it is. Adrenal insufficiency is a recognized disorder, but by the time simple blood tests show an adrenal problem, it is a serious problem that should have been stopped before it progressed to the stage of near adrenal failure.
The first test;
Have no idea what your fasting glucose should be. I'm guessing if it wasn't flagged on the test, you are OK.
The T4 Total I am guessing is just below upper limit on the lab scale (14?), but it measures your TOTAL T4, and that is an old test that needs about three others to go with it to make any sense.
What you want to have run is a Free T4.
When your thyroid releases the hormones T4 and T3, it releases more than the body needs, and half of it or more is bound by a protein in the blood and made useless. It is then converted to a waste product and expelled.
So you don't care how much total T4 or Total T3 you have. You want to know how much Free T4 and Free T3 you have in your blood.
Your TSH should be between 0.8 and 1.8, with most people falling between 1.0 and 1.5. If your TSH rises more than a point above what is normal for your body, you will get symptoms of hypothyroidism.
However, unless certain criteria is met, most doctors will not treat you unless your TSH rises above 5.0 or higher. TSH also fluxuates slightly throughout the day, and you can have slightly different levels every day of the week, but the variation should be less than half a point.
So... your TSH is a little high. The way it is written on the test, it makes it look like they tested your Free T4 as well, but that is not the case.
There is only one way to measure TSH these days, but it is written up on tests using various terminology.
I can't comment on your Testosterone, other than to say it seems to jump around, which may be the product of various labs, and once again there is a total Testosterone and a Free testosterone, which I did not know.
The second test;
FSH, LH, and prolactin are hormones produced by the Pituitary. They govern sexual development and health. The only reason I can think of to run these tests in your case is to look at Pituitary function. Prolactin is often run as a follow-up to a low Testosterone level.
The third test;
adrenocortical hormone is looking at your adrenal glands. don't know what the test results mean.
Here is what I think. I think your Endo puts too much trust in a Total T4 test. I think you are mildly hypothyroid, and he is looking at your Pituitary and Adrenals because he thinks your Thyroid is fine.
You should ask for the following tests.
TPOab Thyroid Peroxidase antibodies
TGab Thyroglobulin antibodies, or antithyroglobulin antibodies (it has two names)
A saliva cortisol test. it is more acurate than cortisol blood tests. It will detect an adrenal problem while it is in an early stage, if that is the problem. The doctor may think it is voodoo, but it really is a better test.
If you don't have thyroid antibodies, then good for you! If you do, it may make the Doctor look at your thyroid numbers a little harder.
You need to have your Free T4 and Free T3 checked. Free T4 is converted to T3, and then some of it is bound, and some of it remains "free" to be used by the body. Every cell in your body uses T3, and cannot get along properly without it. If you are low on free T3, your whole body suffers.
Your Free T4 and Free T3 will probably show a little low, but well within lab limits. A normal Free T3 will be above mid-point on the lab range, but no more than two thirds up the scale from low to high.
Unfortunately, unless you have high antibodies and a thyroid ultrasound shows an abnormal physical structure of the thyroid, a TSH of 2.93 is probably not going to get you any treatment.
It varies from doctor to doctor, but most doctors will not treat you with thyroid hormone repacement unless your TSH is above 5.0 and you are symptomatic.
Some doctors will treat based on symptoms, or by slightly depressed hormone levels, but not very many will.
I glossed over a lot of the tests because of lack of ranges, and lack of knowledge. It seems as though the Endo you saw thinks your TSH is fine, as he ran several tests looking at the next most likely problems, your Adrenals and your Pituitary, but I may be misinterprating something.
Bottom line is, your TSH is high, which means your Free T4 or Free T3 is low, and you are hypo enough to have exactly the symptoms you describe. If you have antibodies in low numbers, but above lab limit, you could go another year like this before your TSH goes high enough to be a red flag.
Rule out an Adrenal issue, and then seek a doctor that will treat mild hypothyroidism rather than let you hang for another year, if tests show that is the problem.
I'm not a doctor or an expert, and if any member thinks I am wrong or missing something, I would hope they will say so.
If your doctor doesn't want to run these tests, I would suggest finding a doctor that will.
I agree with AR-10, at first read I wondered why your endo did not include full thyroid function tests. Symptoms seem very much a hypothyroidism. It's your health so you know your self better than anyone. Doctors are not gods and they often presume a person is histrionic when the tests show 'nothing wrong' If the right tests are done instead of their guessing then you will find the answers. Good luck!
AR I am at a loss of words......... can't add a thing.
His advice is the best you can get at this time. Get the Frees tested and check out those adrenals. I think those adrenals are the issue for you and a saliva test is what is needed to get a clearer picture on them.
If they are off - the whole system is out of whack and you are experiencing the symptoms that associate with the adrenals.
I hope this posts to my own question, as I want to thank you all for the prompt and in-depth responses. As I begin searching for answers, there is consolation in the support of community. It looks like I have some digging to do.
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