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Avatar universal

Prediabetic A1C, Sick Euthyroid, Headaches, Extreme fatigue -Cause?

My highly motiviated, determined daughter has spent the past 3-4 years with a series of worsening undiagnosed symptoms which has led to chronic headaches and fatigue to the point which she cannot go to school or work.  It started with breathing issues while taking part in basketball and track at 13 years old.  She then began to get debilitating headaches during and/or after exercise.  It continued to progress with extreme fatigue, rashes, strange metallic tastes (after exercise), difficulty falling asleep, extremely cold hands and feet, until this year she developed at headache in February that has never gone away.  Lately at 17 years of age, she can't even bring herself to get out of bed most days.  We have visited a pediatrician, reproductive endocrinologist, endocrinologist, cardiologist, dermatologist, neurologist, allergist, integrative general physician, holistic practitioner....etc.
First, they thought it was linked to elevated A1C (5.7-6.1) and iron-deficiency anemia (had an iron infusion), then her T3 became low, her ALT became elevated, then they found when ruling out PCOS that she has no detectable testosterone...and the list of abnormal tests goes on.  No one has been able to figure out the source Highlights: breathing problems, prediabetic A1C, low T3, no det. testosterone, etc...  Any ideas?
7 Responses
1530171 tn?1448133193
Hi jadamson03.

The following conditions should be ruled out:

--Exercise-induced anaphylaxis.
Also Food-dependent exercise-induced anaphylaxis (It affects one–third to a half of patients with exercise-induced anaphylaxis.

--Subclinical* Pulmonary Edema  (measured in mmHg for pulmonary capillary wedge pressure (PCWP).
* PCWP at 11-12 mmHg.
This finding may put a number of patients at risk,  noting that Pulmonary Edema with  chest imaging  indicating  PCWP 8-12 mmHg is considered normal (grade 0 ) Not all patients at the upper end of the "normal range, are necessarily in the clear !
These numbers are only based on statistical data and in no way guarantee  absence of symptoms and disease involvement for everyone! Insist on revisiting  this, in the event it was already investigated and dismissed.

---Histamine Intolerance

---Mast Cell Activation Syndrome

-- Low Methylation (Conventional doctors know little about this and if the do they usually exercise intentional ignorance.
Easiest way to test is by getting  MMA and Homocystein Tests to check Methylocobalamin B12 and Methylfolate levels.

I hope this helps, however, my comments are not intended as a substitute for medical advice.

Niko

649848 tn?1534637300
In addition to Niko's suggestions have your daughter tested for a Hashimoto's Thyroiditis.

You didn't mention if they treated the low T3 or if they did further thyroid tests.
2 Comments
Good point from  Barb.

I should add that Thyroid-resistance (type 2 ) due to possible undiagnosed  related imbalances needs to be ruled out. Suggested tests are Free T3, Free T4 and Reverse T3

Treating T3 with natural desiccated or synthetic thyroid  meds in this case might backfire, should  underlying  adrenal  issues are causing secondary hypothyroidism.

I won't get into the mechanics of this as it is very technical, but should you proceed with the above tests for her, please post the results  when they come back.

Also any  iron-related deficiencies, would have a direct impact on thyroid function.
This would make sense. should a pulmonary edema dx be considered (even sub-clinical), because of the resultant  decreased hemoglobin (which also plays  a role in the A1C test, giving a possible  false positive , thus erroneously indicating pre-diabetic state).

Keep us posted!

Best wishes,
Niko

Good point from  Barb.

I should add that Thyroid-resistance (type 2 ) due to possible undiagnosed  related imbalances needs to be ruled out. Suggested tests are Free T3, Free T4 and Reverse T3

Treating T3 with natural desiccated or synthetic thyroid  meds in this case might backfire, should  underlying  adrenal  issues are causing secondary hypothyroidism.

I won't get into the mechanics of this as it is very technical, but should you proceed with the above tests for her, please post the results  when they come back.

Also any  iron-related deficiencies, would have a direct impact on thyroid function.
This would make sense. should a pulmonary edema dx be considered (even sub-clinical), because of the resultant  decreased hemoglobin (which also plays  a role in the A1C test, giving a possible  false positive , thus erroneously indicating pre-diabetic state).

Keep us posted!

Best wishes,
Niko

649848 tn?1534637300
I agree, somewhat, that treating  the low T3 without treating any accompanying adrenal issue can cause further issues, but it's normal for the adrenals to kick in and try to take up the slack when the thyroid isn't working right, so quite often if low thyroid hormones are replaced, the adrenals will rebalance themselves.  

Tests needed to determine Hashimoto's are Thyroid Perxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb)), along with thyroid function tests Niko recommended (Free T4, Free T3 and TSH).  

Adequate iron is necessary for the conversion of Free T4, which is considered a "storage hormone" (because it isn't used directly by individual cells) to Free T3, which is the active thyroid hormone because it's used by nearly every cell in the body.

Has the diet been changed in an attempt to alter the pre-diabetic state back to normal?  

Has your daughter been tested for digestive issues that may prevent absorption of nutrients or for issues such as H. Pylori or other internal parasites/"bad" bacteria or allergic reaction to foods?
Avatar universal
Thank you Barb and Niko.  

Followup

Thyroglobulin AB  <1
Thyroid Peroxidase AB 1

TSH = 1.05
T4 = 1.02
T3 = 2.7 Low

EBV (Epstein Barr ) Early AG IGG <5
EBVNuclear Antigen IgG 575 u/ml
EBV VCA IgG 165u/ml
EBV VCA IgM < 10

Cortisol 11 ug/dl

Prior to Iron infusion
hemoglobin 11.5 g/dl
hematocrit 35 %
ferritin 18
Mcv 79 fl  Low
Mch 26.2 PG  Low
Mcvc 32.9 g/dL  Low

Candida IgG, IgA, IgM  - all neg

B12 normal

Hemogloblin A1c 5.5 -6.1 over past 2-3 years

ALT = highest its been 99
AST = highest its been is 121

She has had allergy testing 3 years ago.  Nothing significant came up.

She just had a celiac blood test today.

We are considering more allergy testing as this past weekend.  She randomly got a swollen throat.  She also spent the prior weekend with irritated skin,  lips cracked and cracks in the corners that would not heal up.

She has heterozygous SLC19A1 and FOlR2, MTHFD1, Mthfrc677T gene and is on a methlyfolate supplement

homozygous for TCN2 - takes methyl B12 but she got a high B12 result once after taking the methyl B12 ?? but we are trying to rule out if she was getting B12 from a multi at the same time.



Avatar universal
Hit send too quickly.  Want to THANK YOU for taking the time to comment.  This is been tough year for her.
1530171 tn?1448133193
Hey jadamson03.
You need to get to the bottom of the low iron/ anemia status.
Is it low grade pulmonary edema, diet-related  deficiencies or other?

She should be taken off Multivitamins. Usually the cheaper forms of many vitamins contained in them may do more harm than good. Like cyanocobalamin and folic acid or folate  for example.
Normal B12 may not reflect accurately her B12 levels. It might be an indication actually of LOW bioactive B12 (methylocobalamin), specially in light of her genetic mutations.
Methylfolate and P5P (bioactive B6) supported by magnesium would also help  increase her methylation.

ALT and AST levels should be monitored over time, the same with the levels of other nutrients/markers.

Negative candida  IgG, IgA, IgM findings are kinda useless, when candida has suppressed the immune system, and the level of antibodies shows low.
A comprehensive stool analysis test (like the GI MAP stool analyis which may have less false negatives ) may  be the way to go for this.
Beneficial  gut bacteria to pathogenic bacteria ( yeast, parasites and harmful bacteria) should be in a ratio of roughly 85/15.

Allergy testing is like a shot in the dark unfortunately. Some hits and some misses....
When I had a consultation with and ENT surgeon for a health issue a number of years ago, I asked for the cause. He mentioned likely allergies but according to him,  it would be pointless to pursue it, since he had little success using conventional  allergy testing.
Well, lo and behold, I identified the offending substance by doing my own Dr. Coca's
Pulse Test (free down load), which was an allergy to any pork products.
The elimination of these from my diet, helped me avert repeat surgery (which otherwise would be necessary every 4-5 years, according to the ENT surgeon).

Never rely only on A1C for blood sugar issues.
Have the doctor run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid and triglycerides.

Have to go now, but I'll continue when I get a chance, possibly tomorrow.
Best wishes,
Niko
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