Aa
Feeling of head being in a bubble
I wanted to help my friend out who has been diagnosed with hyperthyroidism, I hope I got that right. She started medicating a few months ago. She complains often about feeling like her head is in a bubble. Trying to explain it to me it sounds like what it would feel like if someone put one of those classic fish bowls over your head.
She’s had brain scans and all kinds of tests done a few years ago. All came out clear. She takes beta blockers for what I think is an arrhythmia and I think it’s mostly to calm her anxiety about it. The head thing came before that though.
Could this be a symptom that will go away when her medication is adjusted? Does anyone recognize this head in a bubble feeling? I don’t have this condition myself and have no idea what it feels like!
From what I understand it is prettt much constant, every day. And was triggered after a fainting spell maybe 8 years ago.
She’s had brain scans and all kinds of tests done a few years ago. All came out clear. She takes beta blockers for what I think is an arrhythmia and I think it’s mostly to calm her anxiety about it. The head thing came before that though.
Could this be a symptom that will go away when her medication is adjusted? Does anyone recognize this head in a bubble feeling? I don’t have this condition myself and have no idea what it feels like!
From what I understand it is prettt much constant, every day. And was triggered after a fainting spell maybe 8 years ago.
I would think that those results deserve further action. The Vitamin D, B12 and ferritin are all too low. D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100. So those need to be supplemented to optimize. Without supposedly any symptoms that occur frequently with hypothyroidism it is even harder to get a doctor to consider treatment with thyroid med since FT4 and FT3 are within range; however, the ranges are far too broad, especially to the low end, due to the erroneous assumptions used to establish them. So being within the low end of the range should still be a reason to suspect hypothyroidism. With those numbers plus the relatively low cortisol results it might point to central hypothyroidism. With central, there is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.
Looking just at the FT4 and FT3 results, note the following statement from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms." The ranges here are slightly different, but the implication is clear.
So the person should make sure to supplement adequately the Vitamin D, B12 and ferritin. Also, should followup with the doctor about the cortisol and Free T4 and Free T3 levels. To have any hope of getting most doctors to consider all this, the person should review the following link and circle any symptoms and use that as the primary thing to try and get the doctor to diagnose and treat.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
Looking just at the FT4 and FT3 results, note the following statement from an excellent thyroid doctor. "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms." The ranges here are slightly different, but the implication is clear.
So the person should make sure to supplement adequately the Vitamin D, B12 and ferritin. Also, should followup with the doctor about the cortisol and Free T4 and Free T3 levels. To have any hope of getting most doctors to consider all this, the person should review the following link and circle any symptoms and use that as the primary thing to try and get the doctor to diagnose and treat.
http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html
1 Comments
Thank you, I have my appointment tomorrow and I’ll bring it up. Because of my adhd diagnosis I’ve never thought about my thyroid and thus a lot of symptoms have been left out when I visit the doctor..
As an excellent thyroid doctor has stated, "dosage is irrelevant, only the physiological effect matters." So the whole objective is to increase her dosage as needed to relieve hypothyroids symptoms, but not enough to create hyperthyroid symptoms. That "sweet spot' is called euthyroidism.
Each person has their own setpoint for thyroid hormone levels that work best for them. So it is not feasible to set specific targets. The patient just has to make sure that cortisol, Vitamin D, B12 and ferritin are optimal and then keep raising their thyroid med dosage as required to relieve hypo symptoms. According to the ATA/AACE Guidelines for Hypothyroidism, daily replacement therapy requires approximately 1..6 mcg per kg of weight. This equates to approx. .73 mcg of T4 per pound of body weight, which is most likely conservative and too low of a dose.
If it is possible to get the doctor to do what she wants, I suggest that she reinforce that by giving him a copy of the one pager I mentioned. That will give him the overview needed and provide a link to more scientific evidence, if he wants to access and read the full paper. That information should provide the doctor more confidence in doing what she needs. She should also refer to the information and ask to be tested for Free T4, Free T3, Reverse T3 (at least once, so that the ratio of Free T3 to Reverse T3 can be calculated), cortisol, Vitamin D, B12 and ferritin. From those we can help interpret and advise further. Along with requesting those tests, I suggest that she should ask for an increase of 25 mcg of her med, and ask to come back for followup tests in 5-6 weeks to determine the effect on her symptoms and her Free T4 and Free T3 levels. At point it would also be a good idea to talk about the need to adjust FT4/FT3 levels as needed to relieve symptoms, as discussed in the paper.
Each person has their own setpoint for thyroid hormone levels that work best for them. So it is not feasible to set specific targets. The patient just has to make sure that cortisol, Vitamin D, B12 and ferritin are optimal and then keep raising their thyroid med dosage as required to relieve hypo symptoms. According to the ATA/AACE Guidelines for Hypothyroidism, daily replacement therapy requires approximately 1..6 mcg per kg of weight. This equates to approx. .73 mcg of T4 per pound of body weight, which is most likely conservative and too low of a dose.
If it is possible to get the doctor to do what she wants, I suggest that she reinforce that by giving him a copy of the one pager I mentioned. That will give him the overview needed and provide a link to more scientific evidence, if he wants to access and read the full paper. That information should provide the doctor more confidence in doing what she needs. She should also refer to the information and ask to be tested for Free T4, Free T3, Reverse T3 (at least once, so that the ratio of Free T3 to Reverse T3 can be calculated), cortisol, Vitamin D, B12 and ferritin. From those we can help interpret and advise further. Along with requesting those tests, I suggest that she should ask for an increase of 25 mcg of her med, and ask to come back for followup tests in 5-6 weeks to determine the effect on her symptoms and her Free T4 and Free T3 levels. At point it would also be a good idea to talk about the need to adjust FT4/FT3 levels as needed to relieve symptoms, as discussed in the paper.
1 Comments
Thank you tons. Now she feels more confident to pursue her treatment a bit more aggressively and hopefully it’ll lead to some relief!
I’m wondering if I could ask you also what your reaction would be to:
TSH: 1.93 (0.34-3.88) iu/mL (1y later 2.51)
FT3: 3.3 (2.1-4.0) pg/mL (1y later 2.9)
FT4: 1.0 (0.8-1.8) ng/dL (1y later 0.9)
Ferritin: 32.0 (6.4-167.1) ng/mL
Cortisol: 9.7 (5.0-17.9) ug/dL (1y later 7.5)
Can’t find B12 but:
Potassium: 3.7 (3.6-5.0) mEq/L (1y later 3.8)
I’ve heard that can be low due to deficiency in B12.
The numbers above are from the same test.
These are from a separate test taken a couple of years later when B12 and D was checked:
Vitamin D: 34 (50-250) nmol/L
B12: 300 (150-650) pmol/L
Doesn’t really stand out right, thyroid wise? I know what you said about medical history and symptoms but let’s say the patient doesn’t have any suspicion and has for example ADHD which can cause a lot of the same symptoms so they’re not even considered to be caused by something physically, would the blood work make you think otherwise?
I’m wondering if I could ask you also what your reaction would be to:
TSH: 1.93 (0.34-3.88) iu/mL (1y later 2.51)
FT3: 3.3 (2.1-4.0) pg/mL (1y later 2.9)
FT4: 1.0 (0.8-1.8) ng/dL (1y later 0.9)
Ferritin: 32.0 (6.4-167.1) ng/mL
Cortisol: 9.7 (5.0-17.9) ug/dL (1y later 7.5)
Can’t find B12 but:
Potassium: 3.7 (3.6-5.0) mEq/L (1y later 3.8)
I’ve heard that can be low due to deficiency in B12.
The numbers above are from the same test.
These are from a separate test taken a couple of years later when B12 and D was checked:
Vitamin D: 34 (50-250) nmol/L
B12: 300 (150-650) pmol/L
Doesn’t really stand out right, thyroid wise? I know what you said about medical history and symptoms but let’s say the patient doesn’t have any suspicion and has for example ADHD which can cause a lot of the same symptoms so they’re not even considered to be caused by something physically, would the blood work make you think otherwise?
The type of doctor she needs is one that understands that due to the numerous processes and variables involved, there is no biochemical test that can be used as a pass/fail decision about a person's thyroid status. Diagnosis should result from a comprehensive review of all patient evaluations: a full medical history of the patient, evaluation for signs/symptoms that occur more frequently with hypothyroidism, and extended testing. Once there is a tentative diagnosis of hypothyroidism, then there needs to be a therapeutic trial of thyroid medication to adequately increase Free T4 and Free T3. If symptoms ease, then the diagnosis is supported and dosage can be increased as needed to relieve symptoms.
Thyroid med dosage should never be determined based on TSH levels. There is scientific evidence that most hypo patients taking thyroid med adequate to relieve symptoms will find that their TSH becomes suppressed below range. If the doctor doesn't understand about this, often the reaction will be that the patient is now hyperthyroid and med has to be reduced. This is wrong. Our bodies evolved with the expectation of a continuous low flow of thyroid hormone. When we take our daily dose all at once, it completely changes the equilibrium among TSH, Free T4, and Free T3. The once daily dose tends to suppress TSH for almost a day, I have read. So the med dose cannot be based on just getting TSH within range. That results in under-medication.
Also note that the daily dose of thyroid med should be deferred until after the blood draw for tests, in order to avoid false high results. Your friend's Free T4 level was at 50% of the range, and her Free T3 was at 48% of the range. I expect that she took her med before the blood draw, so those numbers are likely a bit high; however, I am surprised that they would be that high since she is only taking 50 mcg of T4 med. Of course there are other variables that affect thyroid status beyond just thyroid hormone levels, such as cortisol, Vitamin D and ferritin. So she needs to get re-tested for Free T4, Free T3, Reverse T3 (if possible), cortisol, and Vitamin D. Her Kobalamin (B12) was good. I am not sure bout her ferritin result. Ranges I normally see are 3 times higher than what you show, which I believe is 7 - 120 micrograms per liter. If correct that converts to the same numbers expressed in nanograms per milli liter. My own test report shows 20 - 380 ng/mL. At any rate her ferritin is low and needs to be supplemented with a good iron supplement like ferrous fumarate, ferrous sulfate, or ferrous bisglycinate. Along with about 25 mg of the iron she should take some Vitamin C to avoid stomach distress from the iron. Do you think she can get these tests done?
If you want to confirm what I have suggested, click on my name and then scroll down to my Journal and you will find a one page overview of this material, plus a link to the full paper that supports everything with scientific evidence. I highly recommend that your friend read and learn as much as possible from the information given. If she has trouble getting the tests needed, and also getting treated clinically, as described, then she can give the one pager to her doctor and try to get him to read and reconsider her treatment. If that doesn't work then she will need to find a good thyroid doctor that will do so.
Thyroid med dosage should never be determined based on TSH levels. There is scientific evidence that most hypo patients taking thyroid med adequate to relieve symptoms will find that their TSH becomes suppressed below range. If the doctor doesn't understand about this, often the reaction will be that the patient is now hyperthyroid and med has to be reduced. This is wrong. Our bodies evolved with the expectation of a continuous low flow of thyroid hormone. When we take our daily dose all at once, it completely changes the equilibrium among TSH, Free T4, and Free T3. The once daily dose tends to suppress TSH for almost a day, I have read. So the med dose cannot be based on just getting TSH within range. That results in under-medication.
Also note that the daily dose of thyroid med should be deferred until after the blood draw for tests, in order to avoid false high results. Your friend's Free T4 level was at 50% of the range, and her Free T3 was at 48% of the range. I expect that she took her med before the blood draw, so those numbers are likely a bit high; however, I am surprised that they would be that high since she is only taking 50 mcg of T4 med. Of course there are other variables that affect thyroid status beyond just thyroid hormone levels, such as cortisol, Vitamin D and ferritin. So she needs to get re-tested for Free T4, Free T3, Reverse T3 (if possible), cortisol, and Vitamin D. Her Kobalamin (B12) was good. I am not sure bout her ferritin result. Ranges I normally see are 3 times higher than what you show, which I believe is 7 - 120 micrograms per liter. If correct that converts to the same numbers expressed in nanograms per milli liter. My own test report shows 20 - 380 ng/mL. At any rate her ferritin is low and needs to be supplemented with a good iron supplement like ferrous fumarate, ferrous sulfate, or ferrous bisglycinate. Along with about 25 mg of the iron she should take some Vitamin C to avoid stomach distress from the iron. Do you think she can get these tests done?
If you want to confirm what I have suggested, click on my name and then scroll down to my Journal and you will find a one page overview of this material, plus a link to the full paper that supports everything with scientific evidence. I highly recommend that your friend read and learn as much as possible from the information given. If she has trouble getting the tests needed, and also getting treated clinically, as described, then she can give the one pager to her doctor and try to get him to read and reconsider her treatment. If that doesn't work then she will need to find a good thyroid doctor that will do so.
1 Comments
Thank you again for such a detailed answer. I’m sitting here with her now and going through it all with her. Some of it she recognizes from a thyroid group on facebook but the doctor seems to be a bit “so what do you want us to do?” Like she should have the answers which she didn’t.
She says she had not taken her medicine the day of the blood test, she took it in the morning the day before so more than 24 hours had passed. She is gonna push for the vitamin D. Her B12 was low a year ago down at 200 something so she has restored that on her own with supplements and also supplemented vitamin D but she wants to test.
But it sounds pretty straight forward, need to take the levaxin so the TSH are suppressed below range so the FT4 and FT3 can meet the levels you said, which is at least 50% for 4 and 65% up for 3? Then she should start feeling relief when the iron catches up as well?
Is there a range dosagewise which is what’s needed? Like a ballpark. Since you think 50 sounds low are we talking 150-200mg a day or way higher dosages?
At this moment it feels like she can get the doctor to “do what she wants” which is a plus, it’s just a bit sad that she feels like she’s an annoying, naggy, overreacting patient but just because it isn’t life threatening it doesn’t mean it doesn’t affect your life in a major way..
She says she had not taken her medicine the day of the blood test, she took it in the morning the day before so more than 24 hours had passed. She is gonna push for the vitamin D. Her B12 was low a year ago down at 200 something so she has restored that on her own with supplements and also supplemented vitamin D but she wants to test.
But it sounds pretty straight forward, need to take the levaxin so the TSH are suppressed below range so the FT4 and FT3 can meet the levels you said, which is at least 50% for 4 and 65% up for 3? Then she should start feeling relief when the iron catches up as well?
Is there a range dosagewise which is what’s needed? Like a ballpark. Since you think 50 sounds low are we talking 150-200mg a day or way higher dosages?
At this moment it feels like she can get the doctor to “do what she wants” which is a plus, it’s just a bit sad that she feels like she’s an annoying, naggy, overreacting patient but just because it isn’t life threatening it doesn’t mean it doesn’t affect your life in a major way..
There is a well known symptom description called "brain fog". Regardless, the fact that she was diagnosed as hypothyroid and started on medication is a strong indication that her test results were positive for Hashi's. Now comes the important part, which is getting the doctor to treat clinically, by testing and adjusting Free T4 and free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results and especially not TSH results when already taking thyroid med.
Hypothyroid patients starting on thyroid med typically find that feel no better because their Free T4 and Free T3 levels stay about the same. The 50 mcg she started on does not increase FT4 and FT3 because it reduces TSH, which then results in less output of natural thyroid hormone from the thyroid gland. Since serum thyroid levels are the sum of both natural thyroid and thyroid med, the net effect is very little until the dose is high enough to basically suppress TSH. After that, further increases in dosage will start to raise FT4 and FT3 levels. Many of us have found that we needed Free T4 at mid-range at least, and Free T3 in the upper third of its range and adjusted from there as needed to relieve hypo symptoms.
So if she has been tested for Free T4 and Free T3 can you get the info and post results and reference ranges? In addition, hypo patients are frequently deficient in Vitamin D B12 and ferritin. So she needs to test for those and then supplement as needed to optimize. D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin shold be at least 100. All 3 are important for a hypothyroid patient.
There is more to discuss, but first please tell me about any thyroid related test results she has and also if tested for Vitamin D, B12 and ferritin.
Hypothyroid patients starting on thyroid med typically find that feel no better because their Free T4 and Free T3 levels stay about the same. The 50 mcg she started on does not increase FT4 and FT3 because it reduces TSH, which then results in less output of natural thyroid hormone from the thyroid gland. Since serum thyroid levels are the sum of both natural thyroid and thyroid med, the net effect is very little until the dose is high enough to basically suppress TSH. After that, further increases in dosage will start to raise FT4 and FT3 levels. Many of us have found that we needed Free T4 at mid-range at least, and Free T3 in the upper third of its range and adjusted from there as needed to relieve hypo symptoms.
So if she has been tested for Free T4 and Free T3 can you get the info and post results and reference ranges? In addition, hypo patients are frequently deficient in Vitamin D B12 and ferritin. So she needs to test for those and then supplement as needed to optimize. D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin shold be at least 100. All 3 are important for a hypothyroid patient.
There is more to discuss, but first please tell me about any thyroid related test results she has and also if tested for Vitamin D, B12 and ferritin.
1 Comments
You’re fantastic. The doctor isn’t clicking with her very well or explaining very well. I’m also wondering if people with these conditions should go to a specialist rather than a GP?
I have her test results now, these are her latest ones from the end of February:
TSH: 0.40 (0.4-4.0) mIE/L
FT4: 16 (10-22) pmol/L
FT3: 4.6 (3.3-6.0) pmol/L
Ferritin: 21 (7-120) ug/L
(Iron: 14 (9-34) umol/L
Kobalamin: 592 (156-672) pmol/L
I also have her results from when she was tested for the first time, before treatment. Vitamin D hasn’t been checked for some reason. The iron and ferritin is within range but low and the doctor has marked them.
I also suspected it was brain fog that she tried to explain to me. She’s had it for so many years that she is starting to really be affected mentally by it.
Her ALAT has also been slightly elevated since before the medicine, that’s the liver though and its latest score was 0.90 (0.15-0,75) ukat/L. I know it’s only slightly raised and it can get that from medications I believe? But thought I’d mention it just Incase it can be connected because it’s a bit scary for us without the knowledge to see anything raised.
I have her test results now, these are her latest ones from the end of February:
TSH: 0.40 (0.4-4.0) mIE/L
FT4: 16 (10-22) pmol/L
FT3: 4.6 (3.3-6.0) pmol/L
Ferritin: 21 (7-120) ug/L
(Iron: 14 (9-34) umol/L
Kobalamin: 592 (156-672) pmol/L
I also have her results from when she was tested for the first time, before treatment. Vitamin D hasn’t been checked for some reason. The iron and ferritin is within range but low and the doctor has marked them.
I also suspected it was brain fog that she tried to explain to me. She’s had it for so many years that she is starting to really be affected mentally by it.
Her ALAT has also been slightly elevated since before the medicine, that’s the liver though and its latest score was 0.90 (0.15-0,75) ukat/L. I know it’s only slightly raised and it can get that from medications I believe? But thought I’d mention it just Incase it can be connected because it’s a bit scary for us without the knowledge to see anything raised.
Can't really provide much information for your friend without getting some additional details. Since she was diagnosed as having Hashimoto's Thyroiditis, what thyroid medication is she taking and what is the daily dosage? Can't say that I have ever heard of anyone describing a symptom like that. In trying to assess a person's thyroid status, symptoms are the most important indicator. Does she have any other symptoms?
Also of importance are the biologically active thyroid hormones, Free T4 and Free T3. If tested for those or any other thyroid tests, please post results and reference ranges shown on the lab report.
Also of importance are the biologically active thyroid hormones, Free T4 and Free T3. If tested for those or any other thyroid tests, please post results and reference ranges shown on the lab report.
1 Comments
She’s been diagnosed for just over 1 year. I think it’s called Levaxin and 50mg. The doctor hasn’t said that it is related and he is a bit confused by the symptom while I’mwondering if it perhaps could be related but perhaps it takes people with the actual condition to answer that.. if you know what I mean? Like maybe they’d use other words but say “yeah I have that too”. I feel that a lot with other things that sometimes the doctors don’t really find it a “duuh” symptom but the sufferers recognize it.
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