Subclinical Hypothyroidism, mono and vitamin deficiency

[ktr19]

First of all I would like to say thank you to all the wonderful advice given here. I’ve been lurking here for a while and have taken much of the advice given by modifying my supplements to include more B & D vitamins and selenium, avoiding soy and some of the bad foods that affect the thyroid.  I’ve been waiting on my most recent results before I proposed some questions I have.

A bit of background. I'm a 44 year old man who prior this past year was in pretty good health. I work out at least six times a week and for the past 9 years my weight had never fluctuated more than 5lbs beyond 178. Prior to that I weighed 240lbs which I slowly gained after college. I then cut out most carbs and lost over 60 pounds. I began a pretty aggressive workout routine ten years ago and stuck to it ever since and  that kept my energy level pretty high. Unfortunately I come to find out that that low carb diet included many protein bars that contain a lot of soy! (oops!!!).

I couple of years ago I began to have stomach issues (bloating, cramping, constipation) that affected my sleep and brought on some anxiety attacks and heart palpitations. I even went to the ER once after a few glasses of wine after I began to pass out and they diagnosed me with "slightly" low blood pressure. I got all the tests…  from gall bladder, upper GI, even a heart stress test...and passed them all with flying colors! The doctors seemed to think it was stress related since I was going through a divorce at that time.

But then after the stress of the divorce passed things seemed to level out until last October when I contracted Mononucleosis (guess that’s what I get for becoming single again). My white blood counts and antibody reactions were of course all out of whack. The fatigue, headaches and body aches from the Mono lasted over a month and my workouts slowed considerably but I still went to the gym (slowly) to keep up the routine (I’m a very routine person). It wasn’t until the winter that I realized that the fatigue, dry skin, eye-crossing tiredness (even after a full night’s sleep), constipation and muscle weakness...along with the newly gained 10-12lbs, that something wasn’t just right. On top of that I was cold. And I NEVER got cold unless I stood outside in the thirty degree weather in a tee shirt for a long time, which I use to do a lot…. Not to mention using more hand lotion in three months than I ever have my entire life!

So I went back to the doctor in February of this year and there it was, slightly elevated TSH!  At that time, and after reading these forums and reading the long list of Hypo symptoms, that I figured out I had many of those symptoms.  So my doctor diagnosed me with subclinical Hypothyroidism,  prescribed 25mcg of Levothyroxine and to follow up in a couple of months. It seemed to bring my numbers down and alleviate some of my symptoms (about 80% of them). But I still have a few. Namely slow bowel function and constipation, dry hands, and although not as bad and not as frequent,  I still get tired and my workouts are nowhere what they use to be.  And I simply can’t lose the ten extra pounds!  

So here are my results:

Initial diagnosis                                                                                                                                                          02/13/2012:  
TSH= 4.55 (0.450-4.500 1IU/ML)                                                                                                                                   FREE T4=  1.07 (0.82-1.77 ng/dl)

04-13-12:  (after starting Levo for two months):                                                                                                                                                                     TSH =1.99 (same range as above)                                                                                                                                FREE T4 1.13

07-12-12:
TSH=2.230
T4= 1.13

Now I understand that I appear to have reacted well to the very low dose of the Meds and that the TSH could be lower and that the T4 is not in the upper part of the range,  and as a result of those numbers it could be the cause of my lingering symptoms (Sorry they don’t run T3). But here are a few other things that stood out to me on my blood tests…

Last October my Neutrophils were low and Lymph and Monocytes were high,  but given the Mono I had,  I think that was normal. Those antibodies were still slightly off in February even though my Mono was no longer showing as high.

But here are some of my other blood results from that time that stood out to me:

Part of the CBC:
MCV= 96 (79-97 fl) October, 2011
MCV = 93 (79-97 fl) Feb 2012
MCV= 98  (79-97 fl)HIGH  July, 2012

MCH= 33.0 (26.6–33.0 pg) July 2012

From what I read it appears that Vitamin B and thyroid issues will affect MCV and MCH results…does this mean I am deficient?

Also my Vitamin D in February = 35.7 (30-100.0 ng/ml) and on July 12 2012 = 42.5 (30.0 -100.0 ng/ml) which also appeared low at the time my TSH was high from what I can tell.

My doctor seems satisfied that the low dose of the Levothyroxine is sufficient for now and wants me to follow up in 6 months. I am already taking 2000 IU of Vit D and a super B complex vitamin. Does anyone think I can increase those numbers by supplementing more?  And as far as the thyroid goes, is it possible that the Mono caused my thyroid to start acting up and thus caused me to go Hypo? Or perhaps sped up its decline? I do have a family history of thyroid problems (my older sister has been on Synthroid for 20 years).  

Beyond selenium (which I take a small amount),  is there any way to increase my thyroid function and T4 levels  beyond the small  amount of Levothyroxine dose I’ve been prescribed? And is it possible that the Hypo symptoms, a possible Vitamin B and/or vitamin D deficiency may be causing overlapping symptoms?

Sorry for the long post, but any advice would be welcome!

[jacrjacr]

whatever happened...my son was just diagnosed with low thyroid of 4.6 also but negative for antibodies, normal t4 and low b12.......he doesn't want to take thyroid meds and thinks it is the  low b12 and himnot eating enough red meat getting no tyrosine and b vitamins since is a poor eater....

[ktr19]

That would be great, thank you

[gimel]

There are some lists that are fairly helpful, but the best way is to get a recommendation from a member that has direct experience with a doctor.  I have a doctor that is highly recommended, that is just north of Atlanta.  If that is of interest, I'll send name by PM.

[ktr19]

Red_Star I’m inclined to agree with you when it comes to converting the T4 to T3… even on the small dose I was given I could tell a difference within a week of starting it. I didn’t realize that back in February how little oil and sweat my body was producing. That was one of the first things I noticed after starting the Levo was that I was beginning to sweat at the gym more like I use to do. Now if I can just keep it going though out the day. I can tell when I’m running low because I get tired about the same time my hands feel dry. I think I have a good indicator that I need more T4.  

And I went out at lunch and just got some sublingual B12… with as slow as my digestive track seems to be lately it may very well be an absorption issue… I guess the extra B12 beyond the supplement pill I take couldn’t hurt.

[ktr19]

Gimel… Good question and I’ve been asking myself the same thing. I may not wait...however I may need to find a good doctor here in the Atlanta area that will look at more than just TSH and T4 and their reference ranges.  I really do like my family doctor, but with the way I’ve been feeling, knowing I’m not 100%, I may have to do that. Are there any lists of doctors for specific areas who specialize in treating Hypo symptoms?

[Red_Star]

As 80% of your symptoms have improved, there would not be any major issues with conversion of T4 to T3 and at a cellular level. A slight increase in T4 medication may resolve lingering hypothyroid symptoms.  There may be other factors involved but an slight increase of medication is worth trialing to see if you improve.

Your vitamin D levels are high enough not to be causing symptoms. Vitamin D council recommend a minimum of 50ng/mL up to 80ng/mL for optimal health.  Higher MCV and MCH may be due to hypothyroidism but you may have low folate and/or low vitamin B12 as well.  There are other causes as listed below*.

Stress is a foremost factor in triggering Epstein Barr Virus (EBV) flareups. Most thyroid diseases are autoimmune disorders (Hashimoto's thyroiditis or Graves' disease) and stress is one of the known triggers of autoimmune thyroid disease.  

***

*Excerpts from Dr Kaslow's website...

"The MCV relates to the average size of the red blood cell. MCV increase or decrease along with an increase or decrease in MCH is a significant finding for folic acid and/or B12 need (increase) or iron, copper or vitamin B6 need (decrease). MCV and MCH should always be viewed together.

Optimum values 87.0 to 92.0 cu. microns.

The MCV is increased in:

Hereditary anemia(s).
Megaloblastic Anemias (pernicious, folic acid deficiency, B12 deficiency)
Reticulocytosis (acute blood loss response; reticulocytes are immature cells with a relatively large size compared to a mature red blood cell)
Artifact (aplasia, myelofibrosis, hyperglycemia, cold agglutinins)
Liver disease
Hypothyroidism
Drugs (anti-convulsants)
Zidovidune treatment (AIDS)"

"The amount of hemoglobin in a single red blood cell is indicated by the MCH. It is a variation of the MCV measurement.

Optimum values: 28.0 to 32.0 micrograms.

The MCH is increased in and decreased in the same conditions as the MCV."

***

Excerpts from the article "Suite101: Thyroid Disease Triggers: Environmental and Lifestyle Factors in Thyroid Disease" by Elaine Moore..

"Autoimmune thyroid disorders occur in people with specific immune system and thyroid regulatory genes that predispose them to developing thyroid disease in the presence of certain environmental triggers. Many people have these predisposing genes but only a fraction of them develop autoimmune thyroid diseases. Certain environmental triggers are known to trigger or induce thyroid disease in these people."

"Known triggers include cigarette smoke, stress, low selenium levels, seasonal and food allergies, sex steroids particularly estrogens, excess dietary iodine, and trauma. Thyroid cells may also be injured by oxidative stress related to the immune system's response to low antioxidant levels. Suspected environmental triggers include retroviruses, Yersinia and other enteric bacteria, and aspartame in artificial sweeteners."

[gimel]

What is waiting 6 months going to do for you?  Given your family history, your symptoms, and blood test results, the first thing I would suggest is that you go back for more tests.  Specifically I would test for Free T3 and Free T4 (not the same as Total T3 and T4), Reverse T3, and TSH they always want to check.  If your doctor resists and gives excuses that these are not necessary, just insist on them and don't take no for an answer.  Free T3 is the thyroid hormone that largely regulates metabolism and many other body functions.  

Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  Without testing for Free T3 specifically, you cannot know if your body is adequately converting T4  to T3.  Other studies have indicated that the best tests to determine tissue thyroid levels are the Free T3 to Reverse T3 ratio, so that is why I suggested including the Reverse T3 test.

Also, would be good to test Vitamin A, D, B12, ferritin, and a full iron test panel.  I would also test for the thyroid antibodies associated with Hashimoto's Thyroiditis.  Those tests are TPO ab and TG ab.

When test results are available, if you will please post results and reference ranges, members will be better able to assess your status and see if there are other areas that need to be pursued.