# What to do next....



## lizzm (May 21, 2012)

Currently taking brand Levoxyl 100mcg, Metformin ER 500mg, Ocella. Diagnosed hypo early 2009 put on Levothyroxine 50mcg, after switching doctors 4 times because I was told it was all in my head & the only problem was that I was depressed I was bumped up to 75mcg, got heart palpitations dr. wanted to lower it back to 50mcg, told the nurse I was still feeling really bad & having hypo symptoms I got sent to an endo towards the end of 2011. Endo immediately switched me from the 50 Levothyroxine to brand Levoxly 88mcg. Endo ordered blood work went back towards end of Nov. 2011 & was told I had Hashi's but it was no big deal,also diagnosed me with insulin resistance & pcos (which is where the other meds came from) told her I was feeling bad again & she bumped me up to 100mcg. Told the endo I had pain in my neck she said the thyroid doesn't cause any pain but said my thyroid felt enlarged so ordered an ultrasound. Had bloodwork done again & ultrasound went back to endo she said my numbers were good & she wanted me to go back down to 88mcg. I told her I was still really tired, suffering from dry skin, concentration & memory problems, etc. etc. I was told I could continue the 100 for a couple months but only because I was saying I was still tired she said that I won't ever have any energy because I have 4 kids so to get used to it. I needed to start taking the ocella so that my hormones could regulate & the insulin resistance get better & I should be able to lose weight (yeah right I've been hearing that for months) & to come back in a couple months. :/ So I paid the $60 a month for those stupid birth control pills I don't see a difference. I had to contact my PCP for the results from the ultrasound & she said that it's enlarged but nothing to worry about (besides the fact that I can't swallow sometimes, but no big deal)

I have been reading a lot of the other questions & answers & noticed that a lot of people have more blood tests done. I don't know what else this dr. should be looking at but I feel like there is something else she can do for me. I feel horrible my bones hurt, my joints hurt, my neck hurts I have radiating pain that comes from the front, I am always tired doesn't matter how much I sleep, my memory is horrible along with my concentration, always cold, sometimes it feels like food gets stuck in my throat, the BC Pills were supposed to help fix my period too but it's still out of whack. Horrible dry skin & nothing helps to make it better. A new symptom that popped up is I can't handle stress anymore as soon as I start to get overwhelmed & too much stress I get shaky, hot, sweaty, & nauseated.

I just want to feel like myself again I want to be able to be a good mother to my children I want to wake up in the morning & feel good, refreshed & have the energy to take them out for a walk or to the park & not be tired after doing a load of laundry & being stuck on the couch. I know what I felt like before I became hypo & I want to at least feel 90% better. What these doctors don't realize is it's not just the patient who suffers it's their whole families. For those of you who have already been through this & have personal knowledge on what worked for you I would appreciate your opinion or example on what other tests I should have ran and/or if I should talk to my PCP again about going to see a different endo.

test results:
11/2011

T4, Free(Direct) 1.29 reference 0.82-1.77
TSH 2.000 reference 0.450-4.500
Vitamin D, 25-Hydroxy 20.6 reference 32.0-100.0
Thyroid Peroxidase (TPO) Ab 288 reference 0-34
Testosterone, Total, LC/MS 32.3 reference 10.0-55.0
Testosterone, Free 0.18 reference 0.10-0.85
% Free Testosterone 0.56 reference 0.50-2.80
LH 7.4
FSH 5.8

3/2012

T4, Free(Direct) 1.64 reference 0.82-1.77
TSH 0.333 reference 0.450-4.500
Vitamin D, 25-Hydroxy 31.2 reference 30.0-100.0
Testosterone, Total, LC/MS 37.1 reference 10.0-55.0
Testosterone, Free 0.27 reference 0.10-0.85
% Free Testosterone 0.74 reference 0.50-2.80
Hemoglobin A1c 5.5 reference 4.8-5.6

The tests she ordered for the next time I go in are:
Vitamin D, 25-Hydroxy
HbA1c
Testosterone, Free/Total MS
TSH
Free T4


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## Lovlkn (Dec 20, 2009)

Your FT-4 looks in good range. I'm sorry but I cannot help you on the testerone - no experience.

Vit D - what is your treatment for the low Vit D levels?

I took 35K IU daily for 6 weeks - reduced to 3K IU daily and found that even that amount wasn't enough and now have to take 5K IU daily.

Vit D impacted my energy levels so much I could hardly believe it.


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## Andros (Aug 26, 2009)

lizzm said:


> Currently taking brand Levoxyl 100mcg, Metformin ER 500mg, Ocella. Diagnosed hypo early 2009 put on Levothyroxine 50mcg, after switching doctors 4 times because I was told it was all in my head & the only problem was that I was depressed I was bumped up to 75mcg, got heart palpitations dr. wanted to lower it back to 50mcg, told the nurse I was still feeling really bad & having hypo symptoms I got sent to an endo towards the end of 2011. Endo immediately switched me from the 50 Levothyroxine to brand Levoxly 88mcg. Endo ordered blood work went back towards end of Nov. 2011 & was told I had Hashi's but it was no big deal,also diagnosed me with insulin resistance & pcos (which is where the other meds came from) told her I was feeling bad again & she bumped me up to 100mcg. Told the endo I had pain in my neck she said the thyroid doesn't cause any pain but said my thyroid felt enlarged so ordered an ultrasound. Had bloodwork done again & ultrasound went back to endo she said my numbers were good & she wanted me to go back down to 88mcg. I told her I was still really tired, suffering from dry skin, concentration & memory problems, etc. etc. I was told I could continue the 100 for a couple months but only because I was saying I was still tired she said that I won't ever have any energy because I have 4 kids so to get used to it. I needed to start taking the ocella so that my hormones could regulate & the insulin resistance get better & I should be able to lose weight (yeah right I've been hearing that for months) & to come back in a couple months. :/ So I paid the $60 a month for those stupid birth control pills I don't see a difference. I had to contact my PCP for the results from the ultrasound & she said that it's enlarged but nothing to worry about (besides the fact that I can't swallow sometimes, but no big deal)
> 
> I have been reading a lot of the other questions & answers & noticed that a lot of people have more blood tests done. I don't know what else this dr. should be looking at but I feel like there is something else she can do for me. I feel horrible my bones hurt, my joints hurt, my neck hurts I have radiating pain that comes from the front, I am always tired doesn't matter how much I sleep, my memory is horrible along with my concentration, always cold, sometimes it feels like food gets stuck in my throat, the BC Pills were supposed to help fix my period too but it's still out of whack. Horrible dry skin & nothing helps to make it better. A new symptom that popped up is I can't handle stress anymore as soon as I start to get overwhelmed & too much stress I get shaky, hot, sweaty, & nauseated.
> 
> ...


Metformin depletes CoQ10 which turn causes terrible tendon and muscle pain; sometimes even rupture. Cholesterol meds and Quinalones do the same thing.

Consider taking CoQ10

http://www.drhoffman.com/page.cfm/155


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## jenny v (May 6, 2012)

Have you ever had your B12 levels tested, too? I had low Vitamin D and B12 levels and that was adding to the exhaustion that my Hashimoto's caused. My doc gave me a B12 shot in the office and then I took D and B12 supplements after that and that has helped. It won't cure the exhaustion you get from Hashi's but it might help some of it.


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## CA-Lynn (Apr 29, 2010)

What was your A1C *BEFORE* you began Metformin?

Most people will be advocates of Vitamin D replacement. I am not. I found that it exacerbated all my arthritic autoimmune diseases.


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## CA-Lynn (Apr 29, 2010)

For years I stayed away from coffee. For the past couple months I drink just one cup of caffeinated coffee daily and it's amazing the energy I have.


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## lizzm (May 21, 2012)

I am taking vit D 5000 IU/day. I haven't had my B12 levels tested so I'm going to talk to my PCP about that. And I'm also going to look into the CoQ10,hopefully that will help. 
As far as my Ac1 the endo only ordered that test in March I didn't have it checked before all my PCP would check was my TSH & T4 levels. I'm not even sure how she determined I had pcos because i've read that to be diagnosed with that they have to do an ultrasound to confirm you have cysts.


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## Andros (Aug 26, 2009)

lizzm said:


> I am taking vit D 5000 IU/day. I haven't had my B12 levels tested so I'm going to talk to my PCP about that. And I'm also going to look into the CoQ10,hopefully that will help.
> As far as my Ac1 the endo only ordered that test in March I didn't have it checked before all my PCP would check was my TSH & T4 levels. I'm not even sure how she determined I had pcos because i've read that to be diagnosed with that they have to do an ultrasound to confirm you have cysts.


You should be able to find tons of info on CoQ10. I am glad you are going to look into it.


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## CA-Lynn (Apr 29, 2010)

Maybe I'm missing something here. What precipitated the Metformin prescription?


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## CA-Lynn (Apr 29, 2010)

You asked about diagnosis of PCOS: here's a bit from MedicineNet.com. I wonder if PCOS was the initial "rule out" disease.

The diagnosis of PCOS is generally made on the basis of clinical signs and symptoms as discussed above. The doctor will want to exclude other illnesses that have similar features, such as low thyroid hormone blood levels (hypothyroidism) or elevated levels of a milk-producing hormone (prolactin). Also, tumors of the ovary or adrenal glands can produce elevated male hormone (androgen) blood levels that cause acne or excess hair growth, mimicking symptoms of PCOS.

Other laboratory tests can be helpful in making the diagnosis of PCOS. Serum levels of male hormones (DHEA and testosterone) may be elevated. However, levels of testosterone that are highly elevated are not unusual with PCOS and call for additional evaluation. Additionally, levels of a hormone released by the pituitary gland in the brain (LH) that is involved in ovarian hormone production are elevated.

The cysts (fluid filled sacs) in the ovaries can be identified with imaging technology. (However, as noted above, women without PCOS can have many cysts as well.) Ultrasound, which passes sound waves through the body to create a picture of the kidneys, is used most often to look for cysts in the ovaries. Ultrasound imaging employs no injected dyes or radiation and is safe for all patients including pregnant women. It can also detect cysts in the kidneys of a fetus. Because women without PCOS can have ovarian cysts, and because ovarian cysts are not part of the definition of PCOS, ultrasound is not routinely ordered to diagnose PCOS. The diagnosis is usually a clinical one based on the patient's history, physical examination, and laboratory testing.

More powerful and expensive imaging methods such as computed tomography (CT scan) and magnetic resonance imaging (MRI) also can detect cysts, but they are generally reserved for situations in which other conditions that may cause related symptoms, such as ovarian or adrenal gland tumors are suspected. CT scans require X-rays and sometimes injected dyes, which can be associated with some degree of complications in certain patients.


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## lizzm (May 21, 2012)

At my first visit with the endo in Oct. we went over my symptoms & treatments I had been receiving. She asked if I craved sugary foods & I told her I did as well as salty food. She wrote me the script for the metformin twice a day but told me to just take 1 a day and see how I felt. Went for blood work in Nov. & saw the endo again end of Nov. or early Dec. can't remember but that's when I was told I had hashi's, pcos & insulin resistance. I'm not sure how she determined I had insulin resistance & PCOS I feel like it was based only on the fact that my periods are irregular because I don't have any of the other symptoms of PCOS like the extra facial or body hair, acne, infertility. When I look at the lab work the only things highlighted that weren't within range was my vit d & the thyroid antibodies. Now I know that when your thyroid isn't functioning right you can have problems with your period. I just want to make sure these doctors are doing the right things I hate taking pills especially if I might not need them. And I also want to make sure that my thyroid is functioning well because I know it can affect so many other things..


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## CA-Lynn (Apr 29, 2010)

I guess I'm a little stunned that a doctor would toss Metformin at you without running some tests. [Kind of validates my opinion that there are some doctors who toss pills out like M7M's.]

Sure, a doctor can assume there's insulin resistance by observing certain features in the patient, but it's not validated without a GTT [glucose tolerance test].

Even perfectly healthy women have notoriously irregular periods.

I'm not a fan of taking pills if you don't have to. If you're overweight, odds are if you reduce your weight by as little as 7% or greater you'll get rid of any insulin resistance.....assuming you have it.


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## lizzm (May 21, 2012)

I didn't put much thought into a lot of it I was just so desperate to feel better I was just about willing to do anything... The endo kept filling me with false hopes about how much better I was going to be feeling & that I would finally be able to lose weight. Since I have been sick with my thyroid I have gained over 40 lbs... I wish I had the energy to go to the gym..


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## allowingtoo (Mar 31, 2012)

Sigh. I wish I could take Metformin but - alas - that's one of those drugs that doesn't play nice with the liver. There's a book out called Syndrome W (you can read some of it in Google Books) that talks about gaining a LOT of weight just in your stomach after you've been thin all your life. And taking Metformin for it, along with diet and exercise of course. I can't remember what the dosages of Metformin were she recommended. You might can view that in the Google book portion. I bought the book but gave it to my Doctor for her bookshelf.


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## CA-Lynn (Apr 29, 2010)

I'm one of those for whom statins, quinalones, and Metformin all act on the muscles. Can't take any of them. And I'm a diabetic.

I want to throw a couple things out there. This coming for someone who has multiple autoimmune diseases, COPD, and Diabetes:

Vitamin D typically runs low in people with autoimmune diseases and often all the mega-Vit D treatments in the world don't do much at all. To this day my Vitamin D runs [over the past year]:
22.2, 28.5, 28.8, 22.1, 24.7, 26.9
[Low end of normal is 33.] Mega-dosing never got me in the normal range and I was lucky if I hit 30. It only exacerbated a lot of my aches and pains.

So I got out there and walked, three times a day, no MATTER HOW LITTLE ENERGY I HAD OR HOW MUCH I HURT, and it caused me to lose 51 pounds in one year. It brought my A1C down to the normal range, too. And no, I did nothing to change my diet. NADA. 3 times a day, half a mile each time. Just walk at your own pace.

To give you the idea of the pain I was in, every single weight-bearing joint was killing me. I even had 2 epidurals in the lower back 4 weeks apart. But I knew that if I just walked off the pain eventually I would lose weight and a lot of my problems would be controllable. And today they finally are.

Honestly, if I can do it, so can you. You have an opportunity to make things better for yourselves, so go for it!

Good luck!


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