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Help deciphering please

I have been poking around on this site for several years as I've been trying to get to the bottom of what is causing my debilitating symptoms.  I have seen countless doctors, including virtually every specialty, and not one has come up with anything.  I have gained so much weight over the last few years that when all the tests come back normal, they just tell me to lose weight.  I am overweight, but not obese and feel that the weight is a symptom, not the cause since I had the symptoms when I wasn't overweight (although was still gaining weight),

The fatigue and never feeling rested is the most debilitating symptom. That said, here are my main symptoms of concern:

Fatigue (fatigue, fatigue)
Weight gain and can't lose -- like I could eat a cheeseburger and shake or a week's worth of chicken and salad and either way I gain weight
Exercise intolerance -- on the days I manage to do light exercise, I want to pass out when I'm done
Hair loss -- body and head -- dry, brittle, thin and balding
Dry skin -- I must put lotion on at least 10 times a day, slather baby oil after shower, heels are cracked and thick
Constipation
Cold intolerance
Recurrent sinus infections
Miscarriages (although also have kids)
Puffy face, eyes
Muscle aches
Joint pain -- I seen a rhuematologist for a mildly high ANA but other tests are normal.  
Anxiety -- I have some stresses so can explain, but feel it is more intense than necessary.  This also started around menopause (early meno at 46)
Irritable/mood swings
Forgetful, unclear thinking
Insomnia/frequent waking
Restless leg syndrome (self diagnosed)

Sometimes I have a hard time swallowing.  I also have a very small bump on my throat, but it is very near the low, center (in the middle at about the collarbone level) so not thyroid.  I also have small swollen glands in my neck and underarms here and there.  The most recent issue, which don't think has to do with thyroid, is that my legs ache ALL the time.  I can feel painful lumps on the back of my thighs.  My PCP said they were fat deposits, my ob said varicose veins and rhuematologist said possible baker's cyst, but u/s was negative.  PCP can't feel them, but I can run my hands down and feel them and they are not tiny -- maybe b/c they also hurt it is easier for me to tell where they are. My legs feel heavy, tired and achy and I have distinctly gained weight, mostly in my thighs.

I would say that the first symptoms were the fatigue, headache and muscle aches and came shortly after we were rear-ended.  I chalked it up to residual effects of whiplash and having young kids.  But even after several months of physical therapy, nothing improved.

I've had basic, routine thyroid testing done.  My TSH has ranged from 0.94-2.12, but is usually about 1.6.  When my FT4 has been checked it has been 1.1, until recently when it has been a 1.0 the last 3 times.  I've only had 2 FT3s -- 2.7 and 2.8 and one RT3 that was at 17.  These are all the typical reference ranges.

If my TSH rises, isn't it for a push to make more FT3 and FT4, so ultimately they should also go up?  They just seem to hover at the same spot despite TSH fluctuations.  Maybe I'm interpreting this wrong?

The last thing is that I read in one of the posts about myxedema.  I have exceedingly fat arms and cannot pinch any skin (or on my thighs, or really anywhere).  I can wear blouses that fit around but I can't get my arms into.  

Thank you in advance for your input, advice and suggestions.  I know I included a lot, but I am not sure what info is helpful or which info can be overlooked.

Please let me know if you have any questions.  Thanks!

KM
3 Responses
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1756321 tn?1547095325
I have low estrogen so even when I was overweight my thighs looked pretty good lol. That your fat is mostly going to your thighs is a sign of estrogen dominance. I found a very informative website that goes indepth on estrogen dominance and how to treat and reduce estrogen dominance. Your myxedema is a sign your cells are not getting enough thyroid hormone.

Excerpt from Health911 - Estrogen Dominance..

"Here is an extensive list of all symptoms that have been linked to estrogen dominance:

Weight gain (specifically at the hips and thighs)
Sweet cravings
Reduced libido
Increased PMS symptoms
Water retention
Irregular menstrual cycles
Hot flashes
Migraines
Cervical cramping
Chronic fatigue
Allergies
Sinus infections
Irregular moods, mood swings, bouts of depression
Anxiety
Resistant weight loss (aka “stubborn fat”)
Cold hands and feet
Premature commencement of menstruation
Loss of hair
Insomnia
Polycystic Ovarian Syndrome
Infertility
Osteoporosis
Enlarged breasts in men
Broken capillaries, specifically on the stomach, inner arms, and breasts
Swelling of fingers and feet
Irritability
Endometriosis
Low blood sugar"

"Normally, estrogen and T3 and T4 oppose and balance each other; estrogen stores calories as fat, while the thyroid hormones utilize calories as usable energy.  However, a surplus of estrogen in the body triggers the liver to produce thyroid-binding globulin, a compound that binds to and neutralizes T3 and T4 in the blood.  While the thyroid is producing sufficient amounts of hormone an insufficient amount of hormone is making it to the cells, resulting in hypothyroidism."
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3 Comments
Hi RedStar.  Thank you for your info.  I don't think it can be estrogen dominance as I am post-menopausal (early onset) and my last estrogen test registered <2.  These symptoms are years' old, so is it possible to have residual effect even though I no longer have estrogen?
Oh Red Star...haha, congrats on your thighs!  Must be nice.  I think I said it wrong.  All of me is fat, especially my arms and thighs and belly.  It;s just that on my legs, its really just my thighs.  Like I still have these weirdly thin calves.  I do get a puffy spot on the front below my knees.  I think it is water retention because it is not always there, but the fat thighs are!
Yeah my thighs even have a thigh gap in the middle when overweight lol.
That fat is also going to your thighs...hmmm. Something just doesn't add up.

I had a look online further and found this article: The Hormone Diva - 5 Natural Ways to Reduce Hip, Thigh and Under-the-Bra Back Fat. You can google to read the article in full. Here are a few excerpts...

"Estrogen dominance doesn’t necessarily mean having too much estrogen, but rather that the estrogen to progesterone ratio is off in the body. These two hormones (like all hormones) communicate with each other and have a very delicate balance.

If your estrogen levels are high (or low) and your progesterone is way too low, estrogen dominance results."

"The specific mechanism that leads to the extra fat deposition has to do with estrogen receptors. Your legs happen to have a lot of these receptors, so estrogen will deposit here. If your liver isn’t metabolizing and detoxifying estrogen optimally, loads of estrogen can be recirculated and deposited on your hips and thighs.

As this continues to happen over time, fat cells can begin to produce their own estrogen- no ovaries needed- adding to the estrogen dominance situation and the storage of fat on your body."
Avatar universal
Doctors like to believe that TSH tests tell them all they need to know to diagnose and even treat a potential hypothyroid patient.  That is totally wrong.   TSH is a pituitary hormone that is affected by so many things that it is useful as a diagnostic only when it is at extreme levels.   A clinical evaluation for symptoms is a far better indicator of thyroid status.  If that evaluation is indicative of possible hypothyroidism, then biochemical testing should be used to confirm.  

You have many symptoms that are frequently associated with hypothyroidism.  Your TSH is in the reference range, but that only means that with your symptoms, it is an indication of the possibility of central hypothyroidism.  With central hypothyroidism, there is a dysfunction in the hypothalamus/pituitary system that results in inadequate output of TSH to stimulate the thyroid gland to produce the hormone you need.    From the  reference range of .8 - 1.8, your recent Free T4 is only at 20% of its range, which is lower than what most people need.   Along with that your Free T3 of 2.8 is only at 26% of its range, which is also lower than needed by most.  Doctors misunderstand your levels as being "normal"; however, due to the erroneous assumptions used to establish the ranges, they are far too broad to be functional for most people.

In addition doctors think that hypothyroidism is only due to "inadequate thyroid hormone".  In reality a person's thyroid status is determined by the level of Tissue T3 Effect, which is a result of both the supply of, and response. to thyroid hormone in tissue throughout the body.  There are several variables that affect the response to thyroid hormone, including Vitamin D and ferritin.  I noted that your D was terribly low.  It should be at least 50 ng/mL.  You also need to be tested for ferritin and then supplement as needed to optimize.  Ferritin should be at least 100.  So you have a double whammy going:  inadequate thyroid hormone levels plus low Vitamin D  (and I expect also low ferritin).

I agree that the weight is a symptom, not the cause.  I think it is terrible that the doctor would not recognize the possibility of hypothyroidism, with all your symptoms.  One of the main symptoms of being hypo is low metabolism.   If you look at the formula for estimating basal metabolic rate, it is as follows.

BMR (women)  = 655 + (4.35 times weight in lbs.) + (4.7 times height in inches) minus (4.7 times age in years)

When your BMR and calories burned from daily movement and exercise  are in equilibrium with your diet, your weight is stable.  If you develop hypothyroidism and your BMR drops, using the constant for the weight portion of the formula, this means that for every 100 calories that your BMR drops, over an extended period of time, with nothing else changing in diet and exercise, you would gain about 23 pounds (100 divided by 4.35) before your weight again returns to equilibrium with your diet and exercise.

So you badly need a good thyroid doctor that will diagnose and treat clinically, by adjusting your Free T4 and Free T3 levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels .  Symptom relief should be all important, not just test results.  Note the following quote from an excellent recent scientific study. "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. "  In addition, you need to test for ferritin and supplement with a good form of iron to optimize.  You also need to test for cortisol since it affects thyroid so much.  You need to do whatever it takes to get your D up to 50.  And you need to supplement B12 to reach the upper end of its range.  If you think the Naturopath will do all this for you, fine, but if you want help in finding a good thyroid doctor, tell us your location and perhaps we may know of one recommended by other thyroid patients.

If you want confirmation of all this, click on my name and then scroll down and read my journal.
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2 Comments
I will take a look through your journal. Thank you for that.

I saw the naturopath and he has not ruled out that it could be thyroid even with my normal labs, but feels that I may have an absorption issue that in turn is causing me to not use the thyroid hormones properly.  He's running some min/vit deficiency tests to see if anything else turns up as well as some other tests.  I didn't ask what others since he said he views labs differently than a PCP or even the endo and things may be in range but not optimal.  I figure I'll do the tests and see what he figures out and go from there.

He wants me to go back on magnesium for the aches and constipation.  He is also suggesting an elimination diet and something called ultra inflamx.  I'm considering it, but I've already tested negative for celiac and don't have digestive issues other than the constipation.  He thinks it may reset my system, which might be nice.

I think I calculated my BMR at 1535.  Does that seem right?  And so you're saying that if I eat more than 1535 calories, I will continue to gain weight?  So the only answer is to exercise more?  If I lost weight (haha), then I would have even fewer calories, right?  Is there math?  Then I am confused!

Please let me know your thoughts on a mineral/vitamin deficiencies causing sub optimal thyroid absorption.  Thanks.  And, your take on this approach.  Thank you.

I hope he checks my B12 and D -- or I'll ask my PCP to.  I was taking liquid B12 last year and went in for bloodwork and didn't know they were checking it that day and it came back really high.  They freaked out and I stopped taking it for a while.  That said, I never really felt more energetic when it was higher.  The tingling did seem to improve but that was about it.

Thanks,
KM
Yes, if your BMR is 1535 and you add more calories you will continue to gain weight.   To lose weight you can exercise more, eat less calories, or if hypothyroid, you need to get your BMR up to where it should be.   The average BMR for an American woman is about 1,400 calories, while for a man its about 1,800.   Just for info, to factor in your activity level:

1. Sedentary (little or no exercise) – BMR x 1.2
2. Lightly active (light exercise/sports 1-3 days/week) – BMR x 1.375
3. Moderately active (moderate exercise/sports 3-5 days/week) – BMR x 1.55
4. Very active (hard exercise/sports 6-7 days/week) – BMR x 1.725
5. Extra active (very hard exercise/sports & a physical job) – BMR x 1.9

Assuming no change in diet or exercise level, if you want to know your BMR that would get you to your desired weight,  take the number of pounds you'd like to lose, and divide it by 4.35 and that is the number of calories you would need to increase your BMR in order to achieve your desired weight.    When you are hypothyroid, the most effective way to increases your metabolism is to raise your thyroid levels adequately and assure your Vitamin D, B12 and ferritin are optimal.

You are correct about dieting being a difficult way to lose weight effectively and maintain it .  For every pound you lose your BMR would go down by 4.35 calories per day.    In addition, when a person goes on a strict diet to lose weight, frequently the body will  react as though you are starving and will respond by converting more T4 to Reverse T3, in order to slow down metabolism and conserve calories.

Not quite sure why the doctor was reluctant to tentatively diagnose you as hypothyroid.  I expect that what he was referring to was not absorption but inadequate response to thyroid hormone at the tissue level    You are having hypothyroid symptoms because your thyroid hormone levels are too low and I expect you will also find your Vitamin D, B12 and ferritin levels are also too low resulting in less than optimal response to the available thyroid hormone.

Hopefully when the test results come back, he will proceed with prescribing thyroid medication, and continue to raise your dosage in order to get your FT4 to around mid-range, and your Free T3 into the upper third of its range.   If that is not the plan, you should push him to recognize all the symptoms you have that are frequently related to being hypothyroid, mainly as a result of your FT4 and FT3 being too low in their ranges.  Also, if you are tested for Vitamin D, B12 and ferritin, then you can supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.
Avatar universal
There is much to discuss, but first please post the reference ranges shown on the lab report for the Free T4 , Free T3, and Reverse T3 results.
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1 Comments
4-17      TSH   1.86  (0.5-4.5)
             FT4     1.00 (0.8-1.8)
             FT3     2.8    (2.3-4.2)

12-14   TSH   1.62  same
            FT4    1.1     same
            FT3    2.7    same
            RT3    17     (8-25)



I have one in between from another doc with a TSH of 1.6 and FT4 1.0 -- I believe its the same range since its the same lab, but I can't put my hands on the report at the moment.  I have many more dating back to when I first started complaining of symptoms but they are virtually the same results.  If you want them, I can share but it's a lot of info.

I should have also mentioned that I had low B12 (low 200s) and was taking injections and then switched to B12 liquid drops and have been battling low Vit D -- as low as 9 and 13 and fight to get it up to the 50s.

I haven't been rechecked in a while because I'm just tired of being told that all of this is because I need to lose weight.  I believe the weight is a symptom not a cause.  

I've almost given up but I did find a naturopath in my area and am hoping this last ditch effort will help me sort out what is going on.  I just want to be clear before my visit if there is any strong support either way.

Thanks for your help.

KM
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