Taking thyroid meds but still have low energy. Any suggestions?

[shepard515]

After years of hypothyroid symptoms I finally found a doctor who would try thyroid meds with me.  I started them about a year ago and have progressively been feeling better and better.  However, I still get run down and tired very easily and it takes a toll on my quality of life (that said, prior to starting thyroid meds i had horrible headaches, 0 energy, muscle spasms and my digestion was horrible for about 5-7 years. I  could barely tolerate any foods.  Since starting thyroid meds I've been able to eat more foods without as many issues which is great but im not fully back to where id like to be).  I take high quality b vitamins like methyl b12, folate, etc. in a B complex and a high quality vitamin D.  I'm 28 year old male, 6 ft, 200 lbs and currently at 125 mcg.  I've noticed improvements every time my dose has been increased so my doctor agreed to go up to 150 mcg

Here are my test results after being on 125 mcg for several months (tsh is very low now but t3 free and t4 free are still in the middle of the range)

TSH: 0......11 m[iU]/mL (reference range 0.3-4.7)

T3 Free: 3.3 pg/ml (reference range 2.3-4.2)

T4 Free: 1.4 ng/dl (reference range 0.8-1.8)

Testosterone free: 68.9 pg/mL   (reference range: 46.0-224)

Any thoughts as to what I can do to improve my energy?  I'm doing moderate exercise, etc and keeping a healthy diet.  Should I just stay the course and continue to increase my meds until I find the optimal level?  What dosage do you think I might need?

Thanks!

[gimel]

From those test results I'd say that your Free T4 is adequate, but your Free T3 should be higher in the range.  Increasing your dosage may accomplish that by increasing both FT4 and FT3, since it seems that your body is converting T4 to T3 adequately.  If that doesn't do it for you, you might consider asking the doctor to add some T3 med to get your Free T3 toward the upper end of the range.  No need to be concerned about TSH.  The body evolved expecting a continual flow of a small amount of thyroid hormone, so when taking a large dose of thyroid med once daily, the TSH becomes suppressed from that.  In addition, the majority of hypo patients find that their TSH becomes suppressed when taking adequate doses of thyroid med.  Suppression does not mean you are hyper, unless you also have hyper symptoms due to excessive levels of FT4 and FT3.  

D and B12 are very important for you.  D should be about 50, B12 in the upper end of its range.  What are your levels?  Also, although usually not considered as a concern for males, ferritin should be about 70.  Have you tested for that?

[shepard515]

Thanks for getting back to me!  I don't have my ferritin levels but hemoglobin is 13.6 g/DL (reference range: 14-18)

hematocrit 39.7% (reference range 40-54)

I know those levels are a bit low and id like to increase them but unfortunately one of the things im not tolerating well is iron supplements so i end up feeling worse rather than better. any suggestions?  I used to be able to tolerate them years ago but then my digestion got worse.  it's been improving but some supplements still bother me.  I've tried pretty much every iron supplement on the market.  the one that i used to love i can no longer tolerate....

[Barb135]

shepard515...Your thyroid labs aren't too bad, but your FT4 is a little above the recommended mid range, at 60% of its range.  FT3 is, typically, recommended to be in the upper half to upper third of its range and yours it at 53%... it's possible you could stand to drop back on the T4 med and add a small dose of T3, such as cytomel or its generic counterpart, liothyronine.  With your FT3 as high as it is, I doubt you'd need more than 5-10 mcg/day.  That might bring your energy level up where you want it.

TSH is totally irrelevant, in spite of the fact that many/most doctors think it's the end all/be all in thyroid testing/treatment.  It's a pituitary hormone and neither causes nor alleviates symptoms, nor does it correlate with symptoms.

It, also, looks like your testosterone is way too low in the range and this may be the most important thing.  Are you having any other symptoms of low testosterone, such as low libido, muscle wasting, etc?

What is your exact vitamin B-12 level?  Vitamin B-12 should be kept at/near the top of its range in order to keep symptoms of deficiency at bay.  Fatigue/lack of energy are the prime symptoms of vitamin B-12 deficiency.   If you haven't had B-12 tested, you should.  

My first thought for your low energy level is your testosterone level being too low, even though it's "in range"; second thought would be to try to increase your FT3 level and the third thing would be the vitamin B-12...

[shepard515]

Hi barb, thx for the quick response!  I've tried t3 once before but didn't tolerate it very well.  I may give it another shot now that im on a high dose of t4 and generally tolerating foods, etc better.  In regards to testosterone i recently tried DHEA but didn't tolerate that well either (my digestion got kind of screwed up years ago when dr's loaded me up with psych meds and told me i was making up my issues :(... they've since improved since getting on thyroid meds but still a ways to go)    anyways, digestion is improving but DHEA still doesn't sit well with me.  Would it be worth talking to my doctor about a prescription for those testosterone gels or injections?

[Barb135]

...

[gimel]

I think it would be important for you to  find a way to incorporate DHEA-S.  Also, to boost your Free T it would be far better to try the natural route with supplements, rather than gels and injections.   You can do some researching on your own, but here is a link to some info on that.  

http://www.livestrong.com/article/266254-how-to-get-higher-levels-of-free-testosterone/

Your low hemoglobin may indicate that you have low ferritin.  I suggest that you test and supplement as needed to raise ferritint to 70.  

[shepard515]

Sounds good.  I'm going to keep looking around in hopes I can find an iron supplement that works for me.  In the meantime, I'll cook more with cast iron and make sure I eat beef, liver and lots of greens.  I've considered talking to my doctor about testing out some prescription testosterone meds.  Could these be helpful?  Like a low dose gel/injection.  I feel like my thyroid problem is a result of a pituitary issue so if it is a pituitary issue I imagine that is effecting many of my other hormones too and some additonal meds may help support those?

[Barb135]

Can you, please, describe what kind of trouble you're having with your stomach, as far as tolerating supplements, etc?  Some of us find that we don't have enough acid in our stomach, so things don't sit well, there.  I had the same issue for quite some time and I had horrible acid reflux/GERD, plus upset stomach a lot.  

Contrary to popular belief, we actually need "more" not less acid.  I found that drinking dill pickle juice, vinegar water with a dash of honey, hot water with lemon juice, taking peppermint oil pills or drinking peppermint or ginger tea helped immensely.  I eventually began taking Betaine HCL with pepsin, with meals to bring up my acid levels.  Once my level got where I needed it, I stopped the Betaine, but I do have to supplement, occasionally, if my acid level goes too low.  You can research how to do this.

Another thing you can try is to make sure you get gel caps or liquid supplements, as they seem to be dissolved/absorbed better than pills or capsules.  I do have absorption issues, so I've had to experiment with all types of things.

Starting at the smallest doses possible and working up slowly as tolerated might help, as well vs trying to start a therapeutic doses right off the bat.  It takes longer to get where you're going, but at least, you get there... This is true with, both, the iron and DHEA, as gimel suggested.

It's best to talk to your doctor, before trying anything new...

[shepard515]

Ya, it's tough to describe but it's as if my body isn't breaking it down right or something and i get a strange kind of dull headache in the center of my brain.  It just feels like my body isn't processing  it right and even when taking things in small amounts... if i get that effect it just continues to get worse with no upside the longer i take something (even in small doses).  It's frustrating and tough to describe.  It used to happen with a lot more stuff but now since being on thyroid meds I'm handling a lot more foods and supplements that were previously an issue.  I can try the DHEA again but I tried it in a very small dose and it had this negative effect.  That's why I thought maybe talking to my doctor about a prescription for a testosterone gel/injection may work better.  There doesn't seem to be too much rhyme or reason to the things I can or can not tolerate so I just have to experiment and see what works and what doesn't.  I could definitely see stomach acid as part of the issue and have been trying to improve that for awhile now.  I will look into some of the options you mentioned that I have yet to try