Chronic fatigue even after taking medication

[october07]

Hi,
My husband was diagnosed with hypothyroidism in february 2010.His TSH was 20 but T3 and T4 was normal.The doc put him on synthroid 175 mcg. within a week he started feeling better and it was like everything was coming to normal.Before he started taking the medication he was tired very often,had severe acne,and many other symptoms of hypothyroidism,but these were the two which was affecting him the most.So after a month of taking medication he started getting back the thyroid symptoms. A blood work was done and his TSH level was found to be 3. The doc reduced his dosage to 150mcg.But after a week his symptoms started to worsen.The doc then increased his dose to 200mcg but his symptoms doesnt seem to improve.day by day he is feeling more and more fatigued, is feeling cold even though its very hot out here.Is it because of overdosage of synthroid? Pls help as this is affecting our life very badly.

Regards

[october07]

Thank you all so much for your suggestions. My husband has started feeling better now.We are waiting for the test results.

[Barb135]

It doesn't surprise me to learn that your husband has Hashi's.  His symptoms sort of pointed in that direction.  You are very lucky to have a doctor who is willing to research/listen in order to learn.

Do ask for the Free T3 and Free T4 tests; those are the ones that will tell whether or not your husband has a problem converting T4 (synthroid) to the usable T3 hormone.  

Yes, it is possible to have both Graves and Hashi's; fatigue can be a symptom of both.

It's always best to start thyroid med(s) at a low level and work up slowly.  The fact that the started him at such a high dose right off the bat, could have something to do with his issues as well.  It could have sent him directly to the hyper side.  Again, that's where the FT3 and FT4 will come in.  Do NOT under any circumstances let the doctor treat him based only on TSH.......

Since it's determined that your husband has Hashi's, I would strongly recommend that you request a thyroid ultra sound to check for nodules.  It's possible for nodules to leak hormone independently of the thyroid, which can make him swing from hypo to hyper, with no way to control it.  With Hashimoto's, the antibodies will eventually destroy the thyroid and he will be completely dependent on the med.  

Also, please note that you don't HAVE to have an endo; you can use any type of doctor who is willing to work with you, testing the FT's and dosing your husband in such a way as to alleviate symptoms and help him feel good again.

[debbie0413]

You are getting good advice from all around on the forum.  Glad some things are being discovered.  Since the endocrine doc is not available until Sept., maybe you can report what area you are from.  Sometimes someone on the forum may be from your area and then they can private message you about docs who can pursue all of the thyroid, adrenal, nutrient, and gluten sensitivity clues.

Here are a few other thoughts to add to your list:
1) When the vitamin test comes back, be sure to ask about the magnesium level.  The doc has to order a specific test, I think it is called a RAB magneseum test.  If the standard test (serum magneseum?) is run, it won't measure the actual level.  My daughter was found to have the lowest magnesium level that her thyroid doc had ever seen in a LIVE person (and at risk for a seizure)!  Just google "low magnesium levels" to see the myriad of symptoms that can occur with critically low magnesium levels.
2) In addtion to checking out the thyroid particulars when your husband sees a specialist, be sure to ask if Grave's antibodies were tested for (since some people can have both Grave's and (Hashimoto's) Thyroiditis antibodies.  The Grave's makes the thyroid overproduce hormone, and the Hashimoto's destroys the thyroid.  People with both conditions (like it is suspected my daughter has) can cycle between hyper and hypo either every few weeks, days, or sometimes even hours.
3) Once you get a doc who understands all of these complexities, ask if your husband shows a pattern of not being able to convert standard thyroid supplement (T4) into usable T3.  This could be another reason why your husband was not responding to the Synthroid.

You are a champ for asking all of these important questions on your husband's behalf!  I know how heartbreaking it is to see a loved one struggle with all of these complex conditions that produce such a drain on the physical as well as the emotional/mental parts of the person, but I feel your dedication to unraveling these mysteries will pan out in the end.

[Super_sally888]

He should also have his adrenals tested.  They can do cortisol testing for this.
Best if your doctor can find the saliva test, but morning cortisol would give an initial indication.

[Super_sally888]

Please ask the Doctor to Test FT3 and fT4.  These are the Free T3 and Free T4, the active hormone.

We can help guide you to some resources for your doctor.  She can manage him (it appears she is willing to learn and research)...... doesn't necessarily have to be an endo.

let us know his latest results once you have them and we can also see what advice we can give.

[october07]

Dear Barb135
Thanks a lot for ur valuable information and advice. Yesterday my hubby went to the doc to know why he was getting tired inspite of taking meds and during this visit we happened to find out that from the previous test an antibody called THYROID PEROXIDASE AB is way to high in his blood 1332 unit/mL (normal range is 0-60).Again T3(total) was 1.02ng/mL, Free T4 was 1.1 ng/mL and TSH was 3 uIU/mL.

The doc didnt inform us during the previous visit as she herself didnt know the importance of it and yesterday she tells us that my hubby has autoimmune thyroiditis.The reason iam saying this is because she was searching the internet to know what it meant. However she has said that she would refer him to an endocrinologist as soon as possible. But the thing is no docs are available till September.Meanwhile they are running a complete blood test on him to check for any vitamin deficiencies. My poor hubby, he was so fatigued that he fainted while the blood was taken out. Iam so worried about him..

[Barb135]

The Total T4 and Total T3 are obsolete and pretty much useless tests. Part of the T3 and T4 in the blood is bound by protein and is, therefore, unavailable for use by the body.  Testing the FREE T4 and FREE T3 will tell how much of each of these hormones are actually available for immediate use.

I'm understanding that your husband did NOT have any antibody tests done, is that correct?  Antibody tests would indicate whether or not he has an autoimmune disease, in which antibodies eventually completely destroy the thyroid.  This would be a very important step, although many doctors don't think it's necessary since it's treated pretty much the same way; but there are things that can be done to help, if one knows exactly what they are dealing with..

I agree that testing only TSH is not enough.  Any doctor who is basing a diagnosis and med(s) on only TSH is doing a great disservice and will ultimately keep your husband ill for a long time.  I had a doctor who did this, so I speak from experience.  

I'd also like to point out that just because lab results are in the "normal range", doesn't mean they are "normal" for the individual.  Some doctors believe that the only thing that counts is to get the results into the normal range, then their work is done.  Not so; and again, any doctor who is doing this, is doing a disservice.

I also agree that your husband should have his vitamin B12 and D tested, along with iron.  I have pernicious anemia (vitamin B12 deficiency) and am on regular shots, plus take additional vitamin D, along with my thyroid meds.  

You are correct that hypothyroidism is generally associated with weight GAIN and hyperthyroidism associated with weight LOSS; however, there are always exceptions, so there are those who lose while being hypo as well as those who gain while hyper.

All of that said -- please understand that synthroid is not the only med available for treating hypothyroidism.  I was started out on synthroid and later switched to generic.  I've done much better on the generic than I did on synthroid.  Others can only take synthroid.  Different manufacturers use different fillers, etc; many people find that they can't tolerate the filler(s) in one med, but another is fine.  

We are all different, so what works for me, might not work for someone else and visa versa.

Your husband clearly needs further testing done and if his current doctor is not willing to work with him to alleviate his symptoms, I'd strongly recommend shopping for a new doctor.  Any doctor who is willing to keep a patient sick deserves to be kicked to the curb.

[october07]

My hubby also has sleep apnea and snoring which i think r symptoms of hypothyroidism.

[tkd4u2]

I'm sort of in a similar boat. Always tired, no energy what so ever but not losing weight. TSH is about 2.6 never had the FT3 and 4 before so just got that ordered. So what about sleep disorders for your husband. Sleep Apnea has many of the same symptoms as Thyroidism does. I've had both for many years and between managing the sleep apnea and thyroid it seems to be a balancing act.

[Super_sally888]

hi,

your hubby needs to be tested for FT3 and FT4 as well as TSH.  TSH alone is not enough.  TSH of 3 is still high.  Target TSH would normally be 1 - 2.  FT4 should be at least mid range and FT3 should be upper half of the range.

Given his symptoms I'd think he should also be tested for B12, Vit D and Iron.

does he have any gastrointestinal sympotms?  If so better be tested for celiac and/or trial a gluten free diet to see if it helps how he feels.

[october07]

Sorry Barb135, the normal ranges somehow got deleted.here they are

T3: (71-180)
T4: (0.82-1.77)
TSH: (0.45-4.5)

[october07]

Hi Barb135,
Thanks a lot for the reply.His T3 and T4 were done "total" and the results are as follows

T3: 122ng/dL  (normal range  )
T4: 0.92 ng/dL (normal range  )
TSH: 19.54 uIU/ml (normal range  )

The above results were when he was tested in the beginning.Recently when his blood work was done again the doc said that his TSH had come down to 3 but she didnt mention anything about T3 or T4.My husband also had a thyroid ultra scan but the doc didnt find anything wrong in the scan.She said that he didnt have any thyroid masses and that he only had to take synthroid for the rest of his life.
One more thing i would like  to mention is that, my husband is also losing weight and has become very weak and thin.But what i have heard is that hypothyroidism results in weight gain.Dont know whats happening..

[Barb135]

What other tests are being done, besides TSH?  Are the T3 and T4 tests that were done "free" or "total".  If the lab report doesn't say "free" or FT, then the results are total and pretty much useless.

That said - can you post the results along with the lab's reference ranges, since these are lab specific and must come from the lab report?  It's important to note that even though one's levels fall within the "normal" range on the lab report, they might not be "normal" for the individual, since we all feel better at different levels.

Has your husband had a thyroid ultra sound and/or been tested for antibodies to see if he has an autoimmune issue going on?  

Fatigue can be a symptom of both hyper (in this case, over medicated) or hypo (under medicated).  Being cold is generally thought to be a symptom of hypo, but it's impossible to say without further information (i.e. lab results and reference ranges).