# Exercise Intolerance



## AnnaBell (Nov 2, 2016)

Hello All! Through out my whole journey, I have noticed at times severe exercise intolerance. Does anyone else have this? If so, what do you do? I love being active and even walking sometimes brings my mood, energy, and speed and clarity of thinking down. My vision also blacks out if I stand up to fast on occasion.

My last labs are from November 30th on a dose of 75 mcg Levothyroxine and 5 mcg Liothyronine. TSH 0.5 (0.3-5.00), FT4 1.18 (0.71-1.85), and FT3 2.7 (2.3-4.2). Around 4 weeks ago, I had my Liothyronine raised to 10 mcg and it has not made a difference. Just got new labs done yesterday after calling my doctor with concerns about this post-exertional malaise (waiting for results). Currently supplementing with 4,000 IU Vitamin D every day. Vitamin B12 level from last spring was 482 pg/ml (range 211-946). Total Serum Iron from October 97 mcg/dL (range 40-190 mcg/dL). Cortisol level at 11 AM was 11.6 mcg/dL. ACTH was 25 pg/mL.

Any help would be appreciated!!


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## Lovlkn (Dec 20, 2009)

> TSH 0.5 (0.3-5.00), FT4 1.18 (0.71-1.85), and FT3 2.7 (2.3-4.2). Around 4 weeks ago, I had my Liothyronine raised to 10 mcg and it has not made a difference.


Your lab results meaning - FT-4 and FT-3 are quite hypo. Being hypo and exercising would naturally wipe someone out and possibly the other symptoms you describe.

Do you take levothyroxine as well? Your FT-4 is below mid range.


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## AnnaBell (Nov 2, 2016)

Thank you for your observations! Oh wow, I didn't realize that. Yes, I take 75 mcg Levothyroxine every day except 1/2 a pill on Sundays. It's interesting because my original labs without any medication had my TSH around 5.4 (range 0.3-4.2), FT4 1.3 (0.8-1.6), and FT3 2.5 (2.0-4.4), so except for the TSH, all of the medication hasn't actually helped much.

Thank you for your obsWhat is a good way to bring those levels up without sinking my TSH and being "hyper" (at least on paper)? My endo is pretty cooperative and open to ideas...


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## Lovlkn (Dec 20, 2009)

> Thank you for your obs What is a good way to bring those levels up without sinking my TSH and being "hyper" (at least on paper)?


Make sure to lab in the morning and take your replacement's after the lab draw.

When do you lab?

The Free's are really what matter - not TSH which can be impacted by antibodies or when you take your med's. I for one have a suppressed TSH due to having TBII antibodies with in range Free's.



> Around 4 weeks ago, I had my Liothyronine raised to 10 mcg and it has not made a difference.


It should have -

When is the last time you tested D levels? Ever had Ferritin vs total iron count? I never showed anemic until they tested Ferritin levels. Your total iron count is low so you probably should consider a ferritin lab. Note when in your monthly cycle lab is drawn and cycles do effect result.



> My endo is pretty cooperative and open to ideas...


Lucky you -


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## AnnaBell (Nov 2, 2016)

The posted thyroid labs were in the morning without taking medication. My labs that were taken on Wednesday (no results yet) were in the afternoon but I did not take any medication that morning (my schedule got messed up that day, thus afternoon labs). I do have some antibodies present (3 with the range being <9, don't remember units). My D levels were last checked March 2016 but I consistently supplement in an attempt to maintain those levels. I just got a Ferritin test on Wednesday, which was right after my period ended. The Liothyronine I think helped some for the first couple weeks but then things slid back down to my current state.

I had just sort of been bumping along, doing alright but not great, and then after having a particularly active and busy week, I was so tired I spent two days in bed. My body felt unnaturally heavy. I called in sick to work both days and shortened my planned vacation for the next week. I got concerned because I haven't had a bout of fatigue that bad in a long time...


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## BurntMarshmallow (Feb 26, 2016)

How was your complete blood count (CBC)? Low blood volume or other types of anemia could cause exercise intolerance, and that feeling you are having when you stand up too fast.

Other things that can cause exercise intolerance are low electrolytes: magnesium, potassium, phosphorus, chloride...

Taking vitamin D can raise blood calcium levels. This means you have a higher requirement for other minerals the kidneys need to keep calcium levels balanced, including potassium. Low potassium and magnesium can cause light headedness upon standing.

Try adding an electrolyte powder to your water when you exercise. I like "Ultima Replenisher" because it has more potassium and is sugar free.


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## AnnaBell (Nov 2, 2016)

Lovlkn said:


> When is the last time you tested D levels? Ever had Ferritin vs total iron count? I never showed anemic until they tested Ferritin levels. Your total iron count is low so you probably should consider a ferritin lab. Note when in your monthly cycle lab is drawn and cycles do effect result.


I did have my Ferritin checked and it was 44 (range 10-150 or something like that). I understand that's not quite optimal. Is there anything I can do to raise it?


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## AnnaBell (Nov 2, 2016)

BurntMarshmallow said:


> How was your complete blood count (CBC)? Low blood volume or other types of anemia could cause exercise intolerance, and that feeling you are having when you stand up too fast.
> 
> Other things that can cause exercise intolerance are low electrolytes: magnesium, potassium, phosphorus, chloride...
> 
> ...


My CBC and electrolytes are all normal, except for a borderline high calcium level, probably due to taking Vitamin D. I do take Magnesium supplements. As I mentioned above, however, my Ferritin is low-normal. Would that make a difference? The vision blacking out upon standing up seems to coincide with increased constipation. Dehydration has been mentioned by a doctor in the past but I drink a lot of water. Does being hypo, even slightly, make it harder to stay hydrated?


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## Lovlkn (Dec 20, 2009)

AnnaBell said:


> I did have my Ferritin checked and it was 44 (range 10-150 or something like that). I understand that's not quite optimal. Is there anything I can do to raise it?


Iron supplement - they are OTC

Floridex is liquid that absorbs better and causes less intestinal upset.

Avoid thyroid hormone replacements 4 hours either side of comsumption


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## Sabrina (Aug 30, 2016)

AnnaBell said:


> I did have my Ferritin checked and it was 44 (range 10-150 or something like that). I understand that's not quite optimal. Is there anything I can do to raise it?


Mine is 13, and I just started taking ferrous gluconate.


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## AnnaBell (Nov 2, 2016)

Lovlkn said:


> Iron supplement - they are OTC
> 
> Floridex is liquid that absorbs better and causes less intestinal upset.
> 
> Avoid thyroid hormone replacements 4 hours either side of comsumption





Sabrina said:


> Mine is 13, and I just started taking ferrous gluconate.


So since you both suggested supplements, I have been supplementing as well. For two weeks I took Floradix and then I switched to an elemental iron 65 mg with Vitamin C. My most recent ferritin level actually dropped to 32.8! Why would it do that?


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## Lovlkn (Dec 20, 2009)

Ferritin levels drop when you have your monthly cycle. Sometimes they drop to the very bottom - then you start again with the iron supplements. Viscous circle.


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## Sabrina (Aug 30, 2016)

If you supplemented for two weeks I'm not sure that's enough. I was told my recovery might take six months coming up from 13, although labs after three weeks indicated a raise to 22 in just that time so I'm encouraged. I've also been eating more red meat than ever in my life.

Also, to maximize absorption take the iron with Vit C (I have it with grape juice yum!) and do not take four hours either side of thyroid meds or other supplements, I think calcium interferes too. I found I can take mine with just the grape juice and one cracker before I go to sleep. I understand the more empty your stomach can be the better the absorption, although I do have to have something because it really hurts my stomach. I think I read that having it with a meal decreases absorption potential 40-60%.  I'm taking 20mg.


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## AnnaBell (Nov 2, 2016)

Thanks Sabrina! I took supplements for 6 weeks before retesting but I usually don't take them on an empty stomach and I'm not sure the supplement contains enough Vitamin C to really help the absorption. I think I'll try the grape juice method, that sounds pretty good  Thanks for the advice!


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