On one site I was reading about cortisol, I found this:
"The most common signs of adrenal fatigue include: continued fatigue, exhaustion, trouble sleeping, trouble getting out of bed, depression, anxiety, sugar and/or salt cravings, weight gain and inability to lose weight, increased effort to do everyday tasks, decreased sex drive, decreased ability to handle stress, light headed when standing up, low body temperature, more prone to colds and flu and less tolerance to stress."
So, can you get a doctor to raise your thyroid med dosage and get back close to the FT4 and FT3 levels of that time? Also can you arrange to get a diurnal saliva cortisol panel of 4 tests done. If not by a doctor, then I suggest ZRT labs. They will send a kit and you take the samples and return. Cost is about $140. I think we would know a lot more from those tests.
Thanks so much Gimel. I do think it's a cortisol issue. I wake up tired and am really sluggish throughout the whole day. I feel more alert in the evening after 7. I sleep decently through the night but the fatigue doesn't seem to abate even after 9 hours. I definitely feel much more energized after I exercise. During the day, it feels like I am always ready to nap. Then I make myself go to bed at night (though fall asleep easily these days).
I have more mental during the day when I feel more energy but I'm generally tired and slogging through the whole day. I'd say activity energizes me though too much and I crash.
I am so grateful for your help. I feel like my doctor has no more to offer so I thank you in advance for your thoughts.
It is unfortunate your doctor did not understand about suppressed TSH not indicating hyperthyroidism unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3. Your April results looked really good and I would not expect you to have hypo symptoms with that unless your RT3 was also high, or your cortisol was low or high, or ferritin was low. Since you stated that you still had symptoms at those levels, then I have to suspect one of the above. Your RT3 result was mid-range, and your ferritin is good, so I think we have to rule those out. That leaves the possible issue with cortisol.
Your cortisol test results were about mid-range. I am not very familiar with serum (total) cortisol test results. If it were saliva (free) cortisol I would want to see the morning result right at the top end of the range. To help with this assessment, please describe your feeling in the morning when awakening. Do you awake refreshed, or do you struggle to wake up and still feel tired? How do you feel as the day goes on? Do you tire, or do you feel better? Does activity during the day energize you or tire you?
Again, not sure where to post this. Following up from my last lab results, we were waiting on my RT3 result. I finally have it. My RT3 was 18 (range is 8-25 ng/dl). All of the other results are posted above. Can anyone help me shed light on what's going on? Ongoing symptoms include fatigue, cold hands, low temperature, and heavy limbs. I have raised my erfa dosage but still feel the same. Would love any advice. Thank you in advance.
One other question.
Did you take your NDT dose before having the blood labs drawn?
Since NDT has a lot of T3 which ramps up in your bloodstream within hours, peaking in about 4 hours after taking it. If you take your dose before you test it can result in a false high reading.
Your Dr freaking out about 3 greains of NDT is a bit of a red flag. 3 grains is not all that unusual at all.
My wife is on 3 grains of Armour and is also had just began taking Synthroid (T4) to help get her FT4 numbers up. This is not at all that uncommon.
Your latest test show your Free T3 to only be 40% of the range. and your FT4 to be only 32% of the range.
I think with your symptoms and if you can correlate increased symptoms with the decrease in dosage AND your blood labs. I think it is a convincing case to go at least back to the 180 mg (3 grains) of NDT and possibly further increase if you were still symptomatic at the 180 grains.
I think the real reason for your Dr's "freak out" was due to your suppressed TSH. Which is almost completely expected when on the amount of NDT you are on. The fact that the Dr was not expecting the TSH to be suppressed is another red flag to me and maybe exploring another Dr would make sense. But I would say first see if you can talk your Dr in to going back to the 180 mg and re-test in a few weeks and report if you feel better. If so then you know that you are on the right track. If the Dr resists, I would recommend looking for a new Dr as the Dr will have proven they are more worried about the TSH number than about if you feel well or not!
Sorry...Did you type the folate, exactly, as it's typed on the lab report? It looks like the > 45 would be the reference range and the 12 would be your result. This means you're deficient and should be supplementing, but don't get just a synthetic folic acid; you need 5-MTHF, which is body ready folate. I don't have the exact ingredient in front of me, but I'll post it for you tomorrow.
Your vitamin D looks good. If you're supplementing, you could go to a maintenance dose.
Your DHEA-S is on the low side... I'm not well versed in that, but I do know that DHEA is precursor to testosterone. I did take it for a while, but my testosterone levels tend to be on the high side, and I had some unwanted symptoms, so I stopped.
I left this as a comment too but not sure which is the right spot.
I got a few more results today. Still missing Reverse T3. The folate range (or lack thereof) seems strange. It did say that folate deficiency could only be tested when fasting.
- DHEA-S 3.5 (1.5 - 13.0 umol/L)
Vtiamin D (25-Hydroxy) 175 (80-200 nmol/L)
- Folate, Serum >45.4 >=12.1 nmol/L
I will post the RT3 when I get it. Thank you.
Quite often, there's more than one thing causing symptoms, but I agree with gimel; I'd like to see the rest of the blood test results before commenting further.
Before commenting further I'd like to see your additional test results when they are available.
Barb,
Thank you so much for all of this information. I had really no idea what to do with that B12 result. I wonder if that means I should keep supplementing like I was. It didn't feel like it was making much of a difference but maybe I wasn't actually supplementing enough? I wonder...
Yes, I am splitting my dose. One half first thing in the morning and the other partway through the day. I was thinking of playing around with trying it sublingually though I know the jury is out on that.
My doctor actually did test me for folate in this latest round. That's one of the results I am waiting for so hopefully it will tell something.
I'm just feeling so frustrated. It feels like the thyroid isn't the whole answer but I have no clue what is.
Thank you for your help. I will post the next results when I get them.
Thanks Gimel.
I reduced because the endo I saw really freaked me out. She told me all sorts of horrible things (that I mostly know aren't true) about how I was on a dangerously high amount of the medication and I was at risk of all sorts of things. She specifically said that if I got pregnant, the baby would have serious birth defects.
I was worried that the levels were too high so I lowered the dosage. I kept raising it thinking that I just needed to get a higher dose in order to stop feeling symptoms but didn't realize my numbers were so high.
Continued symptoms include: fatigue, heavy limbs, cold temperatures, brain fog. The fatigue is really the biggest thing for me. I am tired so much of the time. The only thing that seems to give me energy is working out which I still do religiously and it makes me feel good (though sometimes it takes all my willpower to make myself do it).
With my latest results, I am thinking I should raise again but it still doesn't feel like it's the whole answer.
Any thoughts? Thank you so much for your help.
Not everyone has to have FT3 in the upper third of its range... yours is at 40% so I agree that it's probably a bit low.
It's not unusual for some on desiccated hormones to have low FT4, such as yours. Many end up taking additional T4 medication, such as Synthroid, levothyroxine, Levoxyl, etc to bring the FT4 up to the mid range point. Once FT4 is at the mid range point, you could see if your FT3 tracks up and if not, you could consider a higher dose of desiccated...
Another thing I'd have to wonder is how you're taking your desiccated medication... Are you taking it all at once in the morning or are you splitting it into 2 equal doses - one in the morning and one around mid day, which is what we recommend when one takes a med with T3, such as the desiccated hormones.
Your B-12 isn't "crazy high"... your lab is using an odd reference range!! Most labs use a range of something like 200-900 or 200-1100. My lab uses the 200-1100 and I, personally, find that I have to keep my level at/above the 1100 mark in order to keep symptoms of deficiency from being present. Fatigue is major symptom of non-optimal B-12; however, with your B-12 where it is, you shouldn't be having symptoms of deficiency...
It might be worth your while to ask your doctor to test your folate level. Folate deficiency can cause similar symptoms as B-12 deficiency.
Vitamin D deficiency can also cause hypo-like symptoms, so it will be interesting to see what your vitamin D level is.
Your April 18 test results on 180 Erfa looked really good to me. What symptoms, if any, did you have at that time and why was the dosage reduced?