Aa
Very Confused and Need Help
In early November, I started having shakes, an enormous amount of fatigue, headaches, dizziness, some eye strain, and occassional bouts where I feel like I was going to pass out. My internist gave me a glucose tolerance test and found that at hour 3, my blood sugar was around 48. So he diagnosed me with reactive hypoglycemia.
I have been managing it with diet for the past month or so, and for the most part, I feel better. I still have some of the same symptoms, just less often.
I have seen 3 endos. 2 have them have backed up this finding for the most part but have indicated that the GTT is not a great test to determine hypoglycemia. At the same time, I have yet to have anything lower than a 76 on my glucometer.
1 endo believes that it could be a hypothyroid issue and is not hypoglycemia. I have TSH's in the 2.92-3.62 ranges. And my free T4 is at about 1.5. This endo wants me to start a round of synthroid. The other 2 endos and internists think it is a mistake.
Needless to say, I'm frustrated and confused. Can you help me? I'll take the synthroid if it is not going to screw me up permanently. What do you think? The endo originally gave me 50mcg to take daily but when I told him I was nervous about it, he said I could start on 25mcg.
I need an unbiased expert to help here. Obviously, I don't want to take a drug if I don't need it. But I also want to get better as soon as possible. I have a daughter on the way. And want to be a great father.
FYI, all other blood work looks great. Cholesterol, EKG, etc. perfect. Ultrasound and CT of my abdomen shows no problems. Thoughts here?
I have been managing it with diet for the past month or so, and for the most part, I feel better. I still have some of the same symptoms, just less often.
I have seen 3 endos. 2 have them have backed up this finding for the most part but have indicated that the GTT is not a great test to determine hypoglycemia. At the same time, I have yet to have anything lower than a 76 on my glucometer.
1 endo believes that it could be a hypothyroid issue and is not hypoglycemia. I have TSH's in the 2.92-3.62 ranges. And my free T4 is at about 1.5. This endo wants me to start a round of synthroid. The other 2 endos and internists think it is a mistake.
Needless to say, I'm frustrated and confused. Can you help me? I'll take the synthroid if it is not going to screw me up permanently. What do you think? The endo originally gave me 50mcg to take daily but when I told him I was nervous about it, he said I could start on 25mcg.
I need an unbiased expert to help here. Obviously, I don't want to take a drug if I don't need it. But I also want to get better as soon as possible. I have a daughter on the way. And want to be a great father.
FYI, all other blood work looks great. Cholesterol, EKG, etc. perfect. Ultrasound and CT of my abdomen shows no problems. Thoughts here?
Sorry if stepped on toes--reading/writing while doing chores--making dinner.
I personally would have left that quote out.
I personally would have left that quote out.
chigirl29:
No disrespect intended, but Isn't that what I said?!
"If hypoglycemia is due to thyroid, its usually connected to hyperthyroidism."
I am Hyper/Graves' and I had problems with low blood sugary, while in the active stage, fast metabolism and losing weight.
I am sure there is a hypothyroid, hyperglycemia/diabetic connection as well.
To the rest:
As far as thyroid levels, the issue is that both TSH and FT-4 are on the high side which relates to possible other health issues.
An F/T-3 level with the other two at the same blood draw, in how they relate to each other tells more about the status.
In other words its not solely dependent on what the TSH or FT levels are, high or low, but rather on how they relate to each other on the thyroid scale or Lab range.
If the F/T-3 was listed and if high as well, could have suggested what the levels might relate.
In their relationship to each other can also tell the doctor if autoimmune is a factor or if a person has the chance to progress to overt hypothyroidism, as well as many other thyroid or non-thyroid issues.
Regardless, personally I'd put off the meds. and test longer to see how level do, worse or better.
GL
February is American Heart Month, National Women's Heart Day,
and 14th National Have-A-Heart Day
No disrespect intended, but Isn't that what I said?!
"If hypoglycemia is due to thyroid, its usually connected to hyperthyroidism."
I am Hyper/Graves' and I had problems with low blood sugary, while in the active stage, fast metabolism and losing weight.
I am sure there is a hypothyroid, hyperglycemia/diabetic connection as well.
To the rest:
As far as thyroid levels, the issue is that both TSH and FT-4 are on the high side which relates to possible other health issues.
An F/T-3 level with the other two at the same blood draw, in how they relate to each other tells more about the status.
In other words its not solely dependent on what the TSH or FT levels are, high or low, but rather on how they relate to each other on the thyroid scale or Lab range.
If the F/T-3 was listed and if high as well, could have suggested what the levels might relate.
In their relationship to each other can also tell the doctor if autoimmune is a factor or if a person has the chance to progress to overt hypothyroidism, as well as many other thyroid or non-thyroid issues.
Regardless, personally I'd put off the meds. and test longer to see how level do, worse or better.
GL
February is American Heart Month, National Women's Heart Day,
and 14th National Have-A-Heart Day
Can you post your FT4 lab results with ranges? That would help see where your numbers fall. Many people on treatment have felt better when their TSH is around 1 and their FT's fall in the 50-80% range. Have you been tested for TPO & TG antibodies? That might also have a bearing on whether or not to pursue treatment.
My TSH is below yours (2.48 is the highest I've gotten), but my FTs are in the low normal range and I have antibodies, symptoms and a family history. Based on that, I've chosen to start treatment with 25 mcg Levoxyl to see if I can optimize my FTs. I'm currently waiting for my first round of labs since starting treatment to see how things are going. As long as my FTs respond to the meds and don't climb over the top of the range, I think it's going to be worth it. My doc goes very slowly with increases to achieve that, and is looking to get me around a TSH of 1.
Be sure and look at adrenal function and vitamin D, B12 and iron levels as well, as being off in those areas can also cause similar symptoms.
Read as much as you can about thyroid function so you understand how the TSH and FTs function together, it will help you decide whether it's worth trying in your situation.
I hope this helps! :)
My TSH is below yours (2.48 is the highest I've gotten), but my FTs are in the low normal range and I have antibodies, symptoms and a family history. Based on that, I've chosen to start treatment with 25 mcg Levoxyl to see if I can optimize my FTs. I'm currently waiting for my first round of labs since starting treatment to see how things are going. As long as my FTs respond to the meds and don't climb over the top of the range, I think it's going to be worth it. My doc goes very slowly with increases to achieve that, and is looking to get me around a TSH of 1.
Be sure and look at adrenal function and vitamin D, B12 and iron levels as well, as being off in those areas can also cause similar symptoms.
Read as much as you can about thyroid function so you understand how the TSH and FTs function together, it will help you decide whether it's worth trying in your situation.
I hope this helps! :)
I don't know what Grave's Lady is talking about--no disrespect intended.
I have been hypoglycemic when hyper, and I am STILL hypoglycemic.
I would wait and monitor TSH for the next few months like Kitty suggested. I have thyroid problems, and I did not take anything right away. I had many labs done over a space of two years. Don't worry about being slow about the decision unless the situation becomes dire.
Small frequent meals do help--and avoiding fake sugars (many kinds) helps too. They trick your body into thinking more sugar is available than there actually is.
I have been hypoglycemic when hyper, and I am STILL hypoglycemic.
I would wait and monitor TSH for the next few months like Kitty suggested. I have thyroid problems, and I did not take anything right away. I had many labs done over a space of two years. Don't worry about being slow about the decision unless the situation becomes dire.
Small frequent meals do help--and avoiding fake sugars (many kinds) helps too. They trick your body into thinking more sugar is available than there actually is.
Good point above about your free t4 level. According to my lab range, it is close to the upper limit of 1.8. Some upper limits go up to 2.1. Do you have the reference range?
Ask the endo who says you are hypo what would happen to the free t4 if you took the low dose. You wouldn't want to go above the free t4 range. However, it does take a fairly large change in TSH to change the free t4.
My free t4 levels were at the very bottom of the range, so my situation was different.
You could always choose to wait and monitor the TSH over the next few months.
Post-prandial (reactive) hypoglycemia can be a less common symptom of hypothyroidism.
Did they recommend small, frequent meals?
Ask the endo who says you are hypo what would happen to the free t4 if you took the low dose. You wouldn't want to go above the free t4 range. However, it does take a fairly large change in TSH to change the free t4.
My free t4 levels were at the very bottom of the range, so my situation was different.
You could always choose to wait and monitor the TSH over the next few months.
Post-prandial (reactive) hypoglycemia can be a less common symptom of hypothyroidism.
Did they recommend small, frequent meals?
If hypoglycemia is due to thyroid, its usually connected to hyperthyroidism. Hyperglycemia is connected more to Hypothyroidism. Although, there are those who break the rule.
There are also other, more rare causes of a low blood sugar. Some symptoms are those like thyroid symptoms. Two types of hypoglycemia can occur in people who do not have diabetes: reactive (postprandial, or after meals) and fasting (postabsorptive). Reactive hypoglycemia is not usually related to any underlying disease; fasting hypoglycemia often is.
I won't go into them for its another whole subject.
If it were me with TSH level as yours, I would not want to be treated and take pills.
There are too many variables, some which are as follows:
Your TSH and FT-4 are on the high end of range, which could mean another matter altogether, especially if your F/T-3 is also high. Suggest checking further into this before taking any thyroid medication.
Data do not confirm clear-cut benefits for early therapy.
Early levothyroxine therapy does not alter the natural history of the disease, if there is disease.
Levels can go back to normal or change for the better. Plus levels fluctuate for various reasons and you might take the chance of over dosing yourself with over medication, when you actually don't need the meds. with such a good TSH level in the first place.
Level might be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations and would be misidentified as having hypothyroidism.
Treatment is not a 100% guarantee a cure-all for all symptoms.
Symptoms that seem like thyroid actually be a result of another low-energy disease and need to be corrected first before thyroid. Other illness or health conditions can worsen thyroid levels. To achieve lasting improvement you may have to treat more than one condition at a time. It is important that you obtain a full and complete diagnosis and treat in the appropriate order all conditions that may be contributing to your health
issue(s)".
There are different diagnose levels for; hyperthyroid and hypothyroid, and different types of thyroid conditions. There is not just one set of diagnose level for all thyroid conditions. As well as target levels for each are different.
I can give you a bunch of URLs to reputable sites (see below) as Medicals, Thyroid Associations and Thyroid Originations that have done trials and test on thyroid patients that conclude different regarding levels that are declared herein by others.
AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006 - Clinical Implications of the New TSH Reference August 15, 2006 Presentation: "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."
US Government 2004 Guidelines
UK 2006 Guidelines,
American Thyroid Association
The Endocrine Society - Albert Einstein College of Medicine, New York. September 23, 2004 .
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004 Revised Date: April 1, 2007
Good Luck!
There are also other, more rare causes of a low blood sugar. Some symptoms are those like thyroid symptoms. Two types of hypoglycemia can occur in people who do not have diabetes: reactive (postprandial, or after meals) and fasting (postabsorptive). Reactive hypoglycemia is not usually related to any underlying disease; fasting hypoglycemia often is.
I won't go into them for its another whole subject.
If it were me with TSH level as yours, I would not want to be treated and take pills.
There are too many variables, some which are as follows:
Your TSH and FT-4 are on the high end of range, which could mean another matter altogether, especially if your F/T-3 is also high. Suggest checking further into this before taking any thyroid medication.
Data do not confirm clear-cut benefits for early therapy.
Early levothyroxine therapy does not alter the natural history of the disease, if there is disease.
Levels can go back to normal or change for the better. Plus levels fluctuate for various reasons and you might take the chance of over dosing yourself with over medication, when you actually don't need the meds. with such a good TSH level in the first place.
Level might be due to minor technical problems in the TSH assay, circulating abnormal TSH isoforms, or heterophilic antibodies; normal individuals with serum TSH concentrations and would be misidentified as having hypothyroidism.
Treatment is not a 100% guarantee a cure-all for all symptoms.
Symptoms that seem like thyroid actually be a result of another low-energy disease and need to be corrected first before thyroid. Other illness or health conditions can worsen thyroid levels. To achieve lasting improvement you may have to treat more than one condition at a time. It is important that you obtain a full and complete diagnosis and treat in the appropriate order all conditions that may be contributing to your health
issue(s)".
There are different diagnose levels for; hyperthyroid and hypothyroid, and different types of thyroid conditions. There is not just one set of diagnose level for all thyroid conditions. As well as target levels for each are different.
I can give you a bunch of URLs to reputable sites (see below) as Medicals, Thyroid Associations and Thyroid Originations that have done trials and test on thyroid patients that conclude different regarding levels that are declared herein by others.
AACE Thyroid Guidlines ENDOCRINE PRACTICE Vol 8 No. 6 464 page 9 November/December 2002/2006 - Clinical Implications of the New TSH Reference August 15, 2006 Presentation: "TSH between 0.5 and 2.5-3.0 mIU/L is the recommended target for L-T4 replacement dose adjustment."
US Government 2004 Guidelines
UK 2006 Guidelines,
American Thyroid Association
The Endocrine Society - Albert Einstein College of Medicine, New York. September 23, 2004 .
The Johns Hopkins University School of Medicine and
Sinai Hospital of Baltimore, David S. Cooper April 20, 2004
"(the panel concluded that the upper limit of normal for serum TSH should remain at 4·5 or 5 mU/l, and not be lowered to 3 or 3·5 mU/l as had been advocated by some professional organizations (Baloch et al., 2003))". Medscape Today
Thyro Link, Merck KGaA, Darmstadt, Germany 02.02.2005
American Family Physician May 1, 2005
The National Academy of Clinical Biochemistry hypothyroid 2006 guidelines
British Columbia Medical Association and adopted by the Medical Services Commission - Guidelines and Protocols Advisory Committee Effective Date: October 1, 2004 Revised Date: April 1, 2007
Good Luck!
I would start conservatively with the 25 mcg dose and retest in 4-6 weeks. I think this endo is more foreward thinking than the other 2.
It may not even lower the TSH by much.
For example 25 mcg lowered my TSH by less than 2 points. Another 25 only lowered the TSH by 1 more.
Everyone is different, but there isn't much risk of trying the 25 mcg dose as long as you restest.
My endo believes ( and he is a thyroid expert) that the upper end of the normal TSH range should be no higher than 2.5.
Here is a great article concerning the reference range:
http://jcem.endojournals.org/cgi/content/full/90/9/5483
I would keep the endo who is recommending the med. You can give it a trial run and see how it goes.
Hope this helps you in your decision. At this point it is yours.
It may not even lower the TSH by much.
For example 25 mcg lowered my TSH by less than 2 points. Another 25 only lowered the TSH by 1 more.
Everyone is different, but there isn't much risk of trying the 25 mcg dose as long as you restest.
My endo believes ( and he is a thyroid expert) that the upper end of the normal TSH range should be no higher than 2.5.
Here is a great article concerning the reference range:
http://jcem.endojournals.org/cgi/content/full/90/9/5483
I would keep the endo who is recommending the med. You can give it a trial run and see how it goes.
Hope this helps you in your decision. At this point it is yours.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
