# Can exercise throw Hashi's into a tizzy?



## usmc4myson (Sep 26, 2010)

A few days ago, I began to exercise under the guidance of a well trained pro. I have a torn meniscus in my knee, which needs surgery, but I wanted to try and strengthen my core & my quads before I have any kind of surgery, and my ortho said it was ok with him. I used the elliptical for 5 minutes at a time. Then 5 minutes of stretching. for 30 minutes total. 3 days in a row.

I am now experiencing very strange, pronounced symptoms that have gotten worse.

After exercising, my fingers and calves and feet were very puffy and red. It took a while for them to go down. I thought I was staying hydrated!! 
My eyes are burning, and red, but not the allergy kind of discomfort. They also appear listless and dull.
My gums are throbbing. My head feels pressure from the inside out. It won't go away with Advil. Just feels really weird. Tight. 
My thyroid area appears to be swollen and slightly red. It feels as if someone is holding a butter knife gently on my neck. If I try to put my chin on my neck, I feel like gagging. Food feels hard to swallow.

My face is very flushed and feels warm in certain spots. My hands and feet are always very cold...so that's no different than usual, except that my palms are sweaty, while my fingers feel cold!

Is this my hypo hashi's turning hyper?? Is my system rejecting the exercise?? Could my adrenals be to blame? 
I am not having any cardiac symptoms. Just a searing fatigue. More than usual (and I have narcolepsy and take adderall twice a day!!)

I have an appt with my old endo in the city on Thursday morning. At first, he didn't want to see me. His nurse advised me to follow up with the ENT and an opthamologist. Then I explained how my neck felt, and he changed his mind.
I don't know what else to do! He is supposed to be my THYROID doctor. How can I approach him, when he really blew me off the last time? My primary care isn't much better. She would probably just ship me downtown to him!

Can I ask him to run certain labs? Change my meds? His lab slip doesn't even have Ferritin listed as a choice! I have never had certain antibodies run. Is this a good time to ask him to run them? I just don't know. I don't want to sound desperate, but I am, based on the weird things that are happening inside of me, and manifesting themselves on my skin!

Thanks, as always, for any advice. 

~Amy


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## Andros (Aug 26, 2009)

usmc4myson said:


> A few days ago, I began to exercise under the guidance of a well trained pro. I have a torn meniscus in my knee, which needs surgery, but I wanted to try and strengthen my core & my quads before I have any kind of surgery, and my ortho said it was ok with him.  I used the elliptical for 5 minutes at a time. Then 5 minutes of stretching. for 30 minutes total. 3 days in a row.
> 
> I am now experiencing very strange, pronounced symptoms that have gotten worse.
> 
> ...


Amy; it is true. Sometimes a person w/thyroid disease can react very badly to exercise.

Have you had antibodies' tests? Have you had RAIU? Wonder if you flipped hyper and also worry about nodules that might or might not be suspicous.


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## usmc4myson (Sep 26, 2010)

Thanks Andros. I never had a RAIu done. I guess the FNA was enough?? I don't know.

I am worse today. I decided not to go to the endo in the city.
It's an hour drive, 40 copay, and for what?

The last labs I had were from 9/28/10. My TP ab were 203 (<35) and my TG ab were 35 (<20).

I guess I threw off my entire HPA. This is exactly how I felt after the CT scan where I reacted so badly to the iodine, except this time, I didn't come into contact with iodine. It might be an entirely inflammatory response due to my severe myofascial pain. Just isolating some of those muscles through mild exercise could have set off a chain of cascading events? I can actually feel my thyroid throbbing now. My head tightness is constant, and advil does nothing for it.

I have been trying to wait this thing out for almost 5 days.
It's not getting one bit better.

I guess I can go to my primary care and beg her to try me on a T-3 to see if it helps. I may also need Isocort to fix my cortisol. I took my temp this morning before I got out of bed, and it was 96 degrees. Just for the heck of it, I took it a few hours later before I showered. It was 96.5. 
I think my adrenal system has thrown in the towel. It's telling me..."I got nothin!" Right now, my face feels flushed and red. It cycles. My temp at night usually goes to 99.4 around 8pm.

Oh Lord...please give me wisdom and strength to know what to do...:sad0049:


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## Elegant_Phoenix (Feb 26, 2011)

I'm going to say that yes - it is true.

I used to be a marathon runner and a triathlete. Now walking a few miles takes days to recover from. I think the only thing that is keeping my muscles strong is that I am a massage therapist. Some days after several massages, I'm a complete wreck and can't get up in the morning. I purposely book my clients in the afternoons specifically for that reason.

I'm sorry you feel so cruddy. I can completley relate. Even with the idiot doctors. ((hugs))


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## CA-Lynn (Apr 29, 2010)

Of COURSE you can ask for some tests. Most doctors will gladly order them if they're not constrained by your insurance guidelines. I'm fortunate to have good insurance and my doctors always ask me if there's anything else I want run. I don't ask for tests unless I feel I need them.

So go ahead and ask.


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## usmc4myson (Sep 26, 2010)

Elegant_Phoenix said:


> I'm going to say that yes - it is true.
> 
> I used to be a marathon runner and a triathlete. Now walking a few miles takes days to recover from. I think the only thing that is keeping my muscles strong is that I am a massage therapist. Some days after several massages, I'm a complete wreck and can't get up in the morning. I purposely book my clients in the afternoons specifically for that reason.
> 
> I'm sorry you feel so cruddy. I can completley relate. Even with the idiot doctors. ((hugs))


Wow...I know some runners, and they would be devastated if they couldn't run anymore...and I know what you mean about the mornings!!! Some days are much harder than others. I have narcolepsy, and I have to say...ever since they put me on adderall XR, I have been able to function fairly well (that's relative, of course!!)
This whole thing has really thrown me for a loop.

I don't have good doctors, and CA-Lynn, you are so blessed to have a doc who asks you that! Who does that??! Amazing. They're out there, but it is terrible when you have to go through a handful, and still not find one who accepts your insurance plan. 
My PCP prides herself on being old school. She still makes house calls, but she is NOT a willy nilly lab runner or a test order-er. I guess that's good- but I think I need some labs run! I guess I should go in there expecting her to run them, and if she doesn't, then I will ask her to.

Thanks for the input, everyone. I am going to try and get more than 4 good hours of sleep!


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## Andros (Aug 26, 2009)

usmc4myson said:


> Thanks Andros. I never had a RAIu done. I guess the FNA was enough?? I don't know.
> 
> I am worse today. I decided not to go to the endo in the city.
> It's an hour drive, 40 copay, and for what?
> ...


Also had myofacial pain; peripheral neuropathy. Throbbing? I am wondering here.

Refresh my memory please. FNA said what?

Hugs and more hugs,


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## usmc4myson (Sep 26, 2010)

Andros,
The FNA report said "the specimen is hypocellular and consists of follicular cells, (predominantly in flat monolayers), Hurthle cells, macrophages, colloid, and blood. The findings are compatible with nodular goiter. Recommend clinical correlation."

What does clinical correlation really mean?? Nothing was said or done afterwards, except I was given a script for a few labs (TSH, lipid profile, ALT, and basic metabolic panel) and a follow up ultrasound in 8 months.

I am just not feeling well at all, and it just seems so weird that exercising could be the cause. I also was reading all about adrenals and the HPA axis, and the article said that people with adrenal fatigue should NEVER drink gatorade. It had to do with the potassium/sodium connection and balance. Well, two out of those three days, I drank a large container of powerade while exercising. One day, I added a teaspoon of salt to it, because the article talked about why people with adrenal fatigue retain water. Sodium depletion was the culprit. I probably should have just had plain old water with a little bit of salt in it. Maybe adding the salt to the powerade really messed me up?!

This is all so complex!

My temp this morning was 96.5. I have a weird feeling of nausea. It's not really in my stomach. It's like a heaviness and a sick feeling in my entire abdominal region. It just will not go away. It is just constantly dull sickness. My head is still very tight. My calves are starting to feel crampy in the back.

I just don't know if my PCP can figure all of this out. 
Maybe I am not converting the T-4 into T-3?

I am trying to just breathe deeply.

Hugs and thanks Andros...


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## Andros (Aug 26, 2009)

usmc4myson said:


> Andros,
> The FNA report said "the specimen is hypocellular and consists of follicular cells, (predominantly in flat monolayers), Hurthle cells, macrophages, colloid, and blood. The findings are compatible with nodular goiter. Recommend clinical correlation."
> 
> What does clinical correlation really mean?? Nothing was said or done afterwards, except I was given a script for a few labs (TSH, lipid profile, ALT, and basic metabolic panel) and a follow up ultrasound in 8 months.
> ...


I really think this should be followed up. Hurthle and follicular don't sound so good to me.

Here is something that I hope you read.....................

http://www.thyroidmanager.org/Chapter6a/chapter6d.html

clinical correlation
When interpreting a biopsy, or an imaging study (xray, CT, ultrasound, or MRI, among others), sometimes a particular finding can mean different things in different clinical situations. When a lab technician or radiologist comes across a finding which may mean multiple things, they say "please correlate with clinical findings" or "clinical correlation requested" or "clinical correlation essential" to indicate that the finding may mean several things, in different circumstances. For an eg: in a biopsy it may say Acantholysis, Dyskeratosis, and Spongiosis consistent with Grovers Disease. But these three results can be found in many other skin conditions, especially bullous (blistering) conditions.

In medicine, "clinical findings" are observable signs of a particular condition or disease, along with symptoms as reported by the patient. A test, as explained above, is "correlated" or "compared to" or "compared with" the observable signs and reported symptoms before a final diagnosis is made. Clinical findings can be made any time a physician examines and interviews a patient; most often, this occurs in a doctor's office or while a patient is in the hospital.

http://wiki.answers.com/Q/What_does_clinical_correlation_reccomended_mean

I truly think you have a situation that needs further attention.


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## usmc4myson (Sep 26, 2010)

Thank you Andros.

Earlier today, I faxed a letter to my PCP. I have an appt with her this evening at 5:30. I will attempt to attach a copy of the letter. It is a template I found on the STTM website, and I modified it to fit my situation. I felt so much better after sending that fax. I hope it helps my doctor understand where I am coming from.

The more I understand about the adrenal system, the more some of my problems make sense. Nobody really addresses adrenal fatigue though. Probably because the one thing that can actually help it is...adrenal cortex extracts, and we know how modern medicine feels about THAT class of drugs. Instead, millions of needless diabetics are walking around...and cancer is on the rise. Stress is a really bad thing...especially when it is ongoing. Add an autoimmune disease or two, and voila...you've got ME! I'm not the only one either. It makes me want to move to Wyoming and raise a few chickens!

Thank you Andros. Your presence on this board is invaluable.


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## Andros (Aug 26, 2009)

usmc4myson said:


> Andros,
> The FNA report said "the specimen is hypocellular and consists of follicular cells, (predominantly in flat monolayers), Hurthle cells, macrophages, colloid, and blood. The findings are compatible with nodular goiter. Recommend clinical correlation."
> 
> What does clinical correlation really mean?? Nothing was said or done afterwards, except I was given a script for a few labs (TSH, lipid profile, ALT, and basic metabolic panel) and a follow up ultrasound in 8 months.
> ...


Very excellent! I am a very interest party in your well-being here so I will be anxious to hear from you when it is convenient. Probably tomorrow as I generally log out around 4 PM EST.

God bless and you are in my prayers for all of this.


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## usmc4myson (Sep 26, 2010)

This is the letter I faxed. She called me. Basically, she was very nice, and told me that she honestly thinks the armour will do more harm than good. She wants me to give her a chance to help me, since I have only been seeing her since December. She has no problems ordering the labs I talked about, but I do not think she will give me anything but synthroid. She wants me to follow up with an endo. She said she does not think it is my thyroid that is causing the weird symptoms....but to get it checked out. She was very nice, of course, because she is a nice person, but she is really not even open to the IDEA of trying a dessicated product. 
So I feel like I am back at square one.
Square one is not a comfortable place to be...because nothing gets done on square one! I guess I will think about things tonight and go from there.

~Amy

Dear Dr. ,
I am aware that just over 4 decades ago, a major shift started in the treatment of hypothyroid disease like my own. Namely, patients like myself were either switched to T4-only medications like Synthroid, or these medications were newly prescribed once their hypothyroid was diagnosed. Also, around 1973, I have read that the labwork for TSH was created, with a range that has repeatedly shrunk to detect more cases of hypothyroid.
It all sounds medically advanced and good. 
But&#8230;&#8230;I am noting, as are a large body of thyroid patients, that T4-only medications like Synthroid, Levoxyl, Levothyroxine, etc are NOT completely removing our symptoms. Neither are our symptoms removed when we are kept within the TSH range. In effect, our TSH is being treated, but not us. Thus begins the cascading effect of visiting different specialists for the sometimes debilitating symptoms, being labeled a hypochondriac, emotionally frustrated, and maybe even depressed. For me personally, the last 11 years have been hell on earth. 
Since I have been on levothyroxine, I continue to have the following hypothyroid symptoms (for the past 10 years) : fatigue, inability to lose weight, mental fogginess, severe myofascial pain, fibromyalgia, very cold hands and feet, temperature swings, soaking night sweats, and many other annoying smaller symptoms, such as excessive sweating of palms and feet while sitting at my desk. I have tried to get help for these symptoms, all to no avail. It appears that levothyroxine is not working for my body.
As you know, I tried to begin an exercise program last week. I am now experiencing some very strange symptoms. For the past 5 days, I have had a heavy, sick feeling throughout my entire abdominal region. It's different from true nausea. My appetite is totally gone. My head feels very tight, from the inside out. Sometimes it throbs, but the tightness never goes away, not even at night. Not even with taking 600 mg of Advil. My fingers and feet and calves get swollen and red when I am sitting down for an extended time, when I wake up, and when I finished exercising. My eyes look dull and lifeless, even when I try to smile. They don't "smile" with me. Either the nodule on my thyroid is swollen, or my thyroid is swollen, which is causing me to feel a strange throbbing in that area. I feel like there is someone holding a butter knife gently against my throat. It is like a constant pressure and fullness. When I swallow, I feel like there is a lump of oatmeal stuck in the bottom part of my swallow. The skin in that area is slightly red, and when I gently try to touch the area around my clavicle, the skin reddens. The muscles in the back of my calves feel crampy, and I tire very easily when climbing the stairs in my home. I have taken my basal temp for the past 3 mornings, and the results were, 96, 96.5, 96.5. Then, sometimes later in the afternoon, I will get a flushed feeling all over my face. My temp at that point was 99.4.

I believe that adrenal fatigue could explain some of these problems. I have had chronic stress for the past 18 years, and my Hashimoto's was diagnosed back in 2000. 
I know that you can recommend that I increase my levothyroxine, or that I take other prescription medications to "help" my other symptoms. I also know that you can recommend that I add Cytomel to my regimen.
But Dr. , I would prefer to go on a medication called natural desiccated thyroid. It meets the stringent guidelines of the U.S. Pharmacopeia, and many patients were successfully taking it before T4-only medications were ever widely used. Natural dessicated thyroid gives me exactly what my own thyroid gives me-T4, T3, T2, T1 and calcitonin. That makes a lot of sense to me. For 11 years, I have never been given the chance to try this medication, to see if it is effective at keeping my TSH levels down, as well as remediating many of the debilitating, painful, chronic troubles I have been experiencing since then. 
I have heard that some doctors say that natural dessicated thyroid is unregulated, inconsistent, unreliable, or outdated. But apparently, many many patients who have been switched to this product are finding the opposite to be true. They state that they feel MUCH better on natural dessicated thyroid than on T4-only medications. I would like that opportunity too. 
When I start on natural dessicated thyroid, it is my understanding that one grain or so is a safe starting amount. After 1-2 weeks on my starting dose, I would like to raise my dose approx. 1/4 to 1/2 grain every few weeks according to the elimination of symptoms, and NOT by the TSH range, since the TSH is simply a pituitary hormone, and thus doesn't accurately measure my thyroid levels with the addition of oral thyroid hormones. Once I get up to approx. 2-3 grains, I'd like to hold each dose about 4-5 weeks to allow the T4 to build in my system, and get more accurate symptom & lab results. This protocol has worked for many people. 
As far as labs, I'd prefer to keep track of my free T3 and free T4. Patients on dessicated thyroid are stating that when they completely rid themselves of symptoms, they have a free T3 towards the top of the range, a mid-range free T4, and a suppressed TSH, with no hyper symptoms whatsoever. (When I do labs in the future, I will NOT be taking my dessicated thyroid ahead of time to give a more accurate reflection of my T3 levels.) I will also be splitting my medication into two or more doses a day, since the T3 in this medication peaks within 2 hours after I take it, then falls. This is more consistent with what is happening inside of my body, and I feel that this will be much gentler on my adrenal system.

(Based on what I have found, there is a wonderful new generic version of natural dessicated thyroid. It is made by a small pharmaceutical company called Acella. I would prefer to be on this particular medication rather than Armour, due to the recent reformulations in the Armour product that added much more cellulose, making it harder to break down. I plan on crushing my medication with a mortar and pestle, and adding it to a little honey to make it taste better. The people who are on this particular product are extremely pleased with how they feel.) 
As far as what is happening within my body right now, I would also like to test my Reverse T-3. Perhaps my body is not converting the T-4 in my levothyroxine into T-3, which the Reverse T-3 test would reveal. I would also like to test my RBC Magnesium and Potassium levels, my Ferritin levels (as well as the rest of the iron labs), and my vitamin D (25-hydroxyvitamin D). Also, as far as antibody testing goes, I have never been tested for Thyroid Stimulating Immunoglobin (TSI). My Peroxidase antibodies have risen quite a lot since 2000, but my Thyroglobulin Ab have remained high, but stable. 
Also, I'd like to test my adrenals with a 24-hour cortisol saliva test, which I know you do not put much faith in, but I am able to order this test online from a very reputable lab, and pay for it out of pocket. The serum cortisol only reflects one time of day, and the 24 hour test will give a bigger picture of what is happening with my body as I go about my day. The reason I'd like to do a Ferritin test is because low Ferritin (below the 40's) appears to be common in thyroid disease, and may cause issues as I try to raise my dessicated thyroid dose. If it is low, I can easily add a good iron supplement to get it where it should be. I have already been taking fiber, as you recommended to me months ago, so that should negate any constipation from the iron.

Finally, I am hoping that you and I can be a true team-integrating your medical knowledge with my intuition of what is happening within my own body. I have never written a letter to my doctor before, but I am a good writer, and I express myself better with words on a page than words out of my mouth!! This was the best way I could explain everything to you, and I hope you take it in the spirit in which it was written. I want to be understood, and I feel that this letter best reflects who I am and how I am feeling. Sometimes, when I get into an exam room, I literally choke up. This might be because I have been in and out of so many exam rooms over the last 12 years, I am burnt out. Something needs to change. I need to take charge of my own health, and if not me, then who? I have done many hours of research on what I am proposing, and if you can work with me to help me in this initial course of labs and discovery, I am very hopeful that I will be on the path to health, instead of on a slow road to disability. Please give me the opportunity to try and see if this natural dessicated thyroid will be effective in my body. I know it is not a miracle drug, and it will not work overnight. I am willing to do whatever it takes to feel better, and thus, live better. I am ready to get to work.

Your Patient,
Amy


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## HeidiBR (Apr 4, 2010)

Why are you adverse to taking Cytomel and only want natural dessicated? The Cytomel can be tweaked to have more of the the naturally occurring T4/T3 ratio easier than the dessicated. I wouldn't be so sure that dessicated is the only route for you. If what you are lacking is T3, and your doctor is willing to give you T3, why not try that?

Dessicated works well for some, and for others it doesn't; too much T3. My endo didn't want me to take it as I have Hashimoto's. I just started taking Cytomel, and WOW. what a difference. I only needed a small amount of T3 to get the ball rolling.

I curious about your doctor's reaction as you really were telling her how you plan to treat yourself?

It sounds from your description that you need some T3. Why not try the Cytomel if she is willing to prescribe it and work with you?


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## usmc4myson (Sep 26, 2010)

Heidi,
I never asked her about the Cytomel. You have only been diagnosed for a few months...how did your doctor know to put you on Cytomel so quickly?

I am open to trying Cytomel. I would just rather have one med that contains both T3 and T4...but I am open to trying ANYTHING at this point. I guess my doctor understood where I was coming from...having seen so many specialists over the last 11 years, and not feeling good. Chronic pain and chronic stress. It is a vicious cycle, and I guess I have a little trouble trusting that a doctor really has my best interests when for the past 11 years I have been trying to understand what is wrong with me, and getting fed the same old line. From what I have been researching, the adrenal system is the most complex, but misunderstood system. Doctors only want to treat you if you have Addison's or Cushing's, even though adrenal fatigue-when it is ongoing- does horrible things inside the body at the cellular level, which then cascades into muscle problems, electrolyte balance, and a host of other aches and pains. My new doctor does seem to understand why I feel the way I do.

Did you do a reverse T-3 test to find that your body wasn't converting the T-4 from levo into usable T-3? 
I'm glad to hear that you are responding to the cytomel. That must feel awesome!!!

~Amy


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## CA-Lynn (Apr 29, 2010)

Just out of curiosity, have you been taking any form of steroids?


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## HeidiBR (Apr 4, 2010)

Actually I was diagnosed a year ago. It has taken a year of bouncing around - too much Sythroid raised the the T4 too much, and then the T3 bottomed out. So, my endo had no problem trying a 3 month trial to see if the Cytomel helped.When I first started last year with just Synthroid, my body really responded. Then, over time, and one big stressor when my husband was ill, it seemed like the Synthroid was less effective. I also gained weight, but that was from stress eating and not my thyroid. I started taking Prozac and that also did a number on my T3 level. So... weaning off the Prozac and starting the Cytomel seems to have really helped my situation. I feel like I am metabolizing as I should based on what I eat and my level of activity.

If you ask your doctor for a low-dose trial of Cytomel, maybe she will be open to it.


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## HeidiBR (Apr 4, 2010)

And, (If forgot to add) if your adrenals are the issue, that needs to be addressed before changing your thyroid treatment.


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## usmc4myson (Sep 26, 2010)

Yes, the adrenals do need to be addressed first. 
CA-Lynn-I am not taking any steroids, but from what I have read, it seems like I might need to take something like Isocort. My cortisol levels are very low. I haven't had them tested (saliva) since 2000. Back then, my DHEA was too high in the morning, and undetectable at 5pm. My cortisol was low in the morning and extremely low at 5pm. My estradiol levels were almost nonexistent, along with my progesterone and testosterone. Significantly low. I never really knew what those results meant back then, since I had ordered the tests myself through a company I found in a hormone book I was reading. None of my doctors ever thought it was even remotely significant, since none of them believed the validity of saliva testing! Now, looking back, I can see how naive I was. I have had rupturing ovarian cycts, mesenteric adenitis, and just generalized hormonal issues over the years, but nothing was ever done about it except ultrasounds and CT scans. 
Knowing what I know now, if I was so deficient in cortisol-and all the other hormones back then, and my stress levels have risen ten fold since then, I can only imagine what they are now.

I was studying all about the adrenal system this weekend, and wow. What an intricate, delicate, amazing system...

I also found a new PCP. She is an MD, but their practice is Integrative Medicine, and they take my insurance. My appointment is May 10th, for a complete physical and bloodwork. I guess I can hold on till then. I finally feel like I will be treated as a person, and not just a bunch of unrelated symptoms and numbers. 
I probably shouldn't have sent my doctor that letter, in retrospect. However, if it did only one thing, it brought out her true feelings about how she is stuck on synthroid like glue, and I realized that I would never get well under her care. Yes, I believe she truly cares about trying to help me, but that help has a limit. The definition of insanity comes to mind. Doing the same things over and over and expecting a different result. I'm getting off that rollercoaster.
Been there, done that. 12 miserable years later, I can't do it any more. And they all lived happily ever after...


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