# Physically & mentally taxed. Please help me.



## Reporter (Mar 17, 2011)

I have been feeling very ill and run down since Sept 2010 with my Internist suggesting anxiety as being the cause. I was prescribed (and took) for 2-3 months anti-anxiety meds but those did not help, quite the contrary, they just caused new, debilitating symptoms.

I eventually went to the endo with the labs results being: 
1/13/2011 12:08 PM

Thyroid Peroxidase (TPO) Antibody H 28.2 (normal: 0.0-9.0) IU/mL

Free T3
FT3 2.69 (normal: 2.00-4.20) pg/mL

Free T4
FT4 0.96 (normal: 0.70-1.90) ng/dL

TSH 0.560 (normal: 0.380-4.000)

I have a goiter, thyroiditis back in April 2010 per ultrasound but the one I had in January 2011 was a better ultrasound, meaning improvement, no concerns. Nodules, yes, but quite small with some being too small to even biopsy I was told.

My concern my endo put me on a low dose of Levothyroxine (.25 I believe) because of my symptoms but the first day taking it I was having ringing in my ears, muscle spasms and by day 4 I awakened with a **pound" in my chest and five minutes later there was a squeezing there I thought I was having a heart attack. I was hospitalized for four days with the determination that it was only a bad reaction to the levo. So that was end of January and I've not been on anything. My endo said we could wait until my thyroid completely failed....or rather since it hasn't completely failed lets do a wait-and-see approach since you had a bad reaction and that in the future perhaps we could try the Synthroid or something more natural like Armour.

My question, seeing my lab results should I be feeling this horrible fatigue, it's a general ill feeling: legs and thigh muscles are weak, my head feels heavy, muscle aches...I do not have the energy anymore to do much. I'm only 38 with a family that I ignore because I'm just too tired to be as 'present' in their lives as I used to be.

Maybe if looking at my labs if someone could say 'yes' (definitely) or 'no' I should or should not be experiencing these symptoms based on the labs.

Over the past 6 months I've had a million-dolllar workup and other than a low Vitamin D level of 15 when normal, I believe, is 30 on up....I guess I don't know if this is Hashi's or the Vit D deficiency or anxiety symptoms.......

I am screaming for help


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## lainey (Aug 26, 2010)

While your labs are not "ideal" ie, the T4 is on the low side of the range, they are normal.

The antibodies, while elevated, fit with the thyroiditis diagnosis. Unfortunately, you cannot treat antibodies, and with your trial of levothyroxine, your experience confirms that it may not yet be time for replacement.

>>perhaps we could try the Synthroid or something more natural like Armour<<

Were you on the generic or Levoxyl? This may or may not have made a difference in such a short time. As for Armour, it is not "natural" in the sense that it contains an unnatural amount of T3 relative to what your cells make on their own. Your thyroid does not make much T3, it makes primarily T4 which is converted by your body. If you had such a reaction to levothyroxine, the added T3 could be quite problematic, as it is several times more powerful.

The low vitamin D can definitely be the source of some of your symptoms. Are you supplementing for that?

Which anti-depressant did you take? There are several classes, and because one did not work doesn't mean that another won't. There are several people in the forum that are better versed in that area than I--so you may wish to put the question out there.


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## CA-Lynn (Apr 29, 2010)

I would be cautious about using Vitamin D supplements until you can rule out autoimmune disease [as more recent studies have demonstrated that Vitamin D supplements don't do much for those with autoimmune diseases and tends to worsend the autoimmune disease].

I've said time and time again that doctors other than psychiatrists and neurologists should NEVER prescribe anti-depressants. They are NOT M&M's and quite frankly, don't do a whole heck of a lot if the issue is psychological.

If you are still on the anti=anxiety meds, do not cold-turkey off them. Instead, see if you can not find a neuroendocrinologist in your area and work with that doctor to get to the bottom of this.

Also, *consider seeing a rheumatologist for the weak muscles. *This could be a sign of another autoimmune disease........or it could be a reaction to one of the meds you're taking.

Sorry, I'm not much help, but I did want to throw these things out there.


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## desrtbloom (May 23, 2010)

Are you sure you don't have Graves' Disease? Have you been diagnosed with a specific thyroid disease or have you just been told you are hyper or hypo?

Your symptoms sound very much like Graves' Disease. The weakness in your legs is one of the symptoms I had when my Graves was really bad. Can you squat and get up from the squatting position without any assistance or without lifting yourself up by using furniture?

Have you had your TSH and antibodies checked regularly to see if there is a fluctuation?


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## Reporter (Mar 17, 2011)

ANXIETY MEDS

Klonipin and Ativan but I discontinued those just over a month ago because I began to experience horrible new symptoms like internal tremors and the meds were masking, I believe, what is actually going on with me. I was having to take more and more pills also to get relief from the symptoms.

ANA/SED RATE/MRI:
A tests for ANA antibodies or titers (whichever it is) was negative and that was in December 2010 
Sed rate negative.
MRI without contrast end of Sept 2010, negative

BLOOD WORK:
With so many visits to ER and then visiting my reg doctor and the Endo, the basic CBC and metabolic panels have always been fine other than over the past couple years I have been (chronically) slightly anemic which that was finally corrected with Reocyte Plus prescribed by my Endo this past January.

My PCP ran even further testing back in Dec to get to the bottom of the fatigue, muscle pain, occasional joint pain....still nothing.

It wasn't until being hospitalized this past January, end of January, after having taking the Levothyroxine that I discovered my Vitamin D deficiency but they give me one tablet for that with no prescription so I assumed that might have corrected the deficiency, or that it just wasn't too low.

So a week or so ago following up with my Endo again I asked that they check my magnesium and Vitamin D, they did, but just the Vitamin D was low (15) with normal being above 30 (30 -76) I suppose it was. This past monday I began Vitamin D2 50,000 unit, so took that Monday and yesterday. I believe I am feeling worse taking that much Vitamin D though.....I notice that I've been fatigued everyday since Monday with headaches and it lasts for most of the day.

Visit to my PCP on yesterday also so he did some more blood work which after having researched what he was checking for tells me he is clueless as to why I'm continuing with the fatigue. He says could be that it is CFS or fibro because seems nothing else is turning up.

So I don't have lupus and that's great, but what about MS? The MRI without contrast in Sept was normal, so I guess I don't have that either.

I guess I have Hashimoto's Thyroiditis and I know I have a goiter that seems to have increased in size this past year. So does that mean I have thyroid disease even though I'm NOT clinically hypothyroid. Might the thyroiditis or hashi's (they are the same, right), might that cause this chronic fatigue. Which do you all believe it's most likely: thyroid related, Vitamin D, anxiety, or Chronic Fatigue Syndrome.

I know this is a long and disjointed post, but my thinking is not so lucid these days and I worry a lot about my health and how it is affecting my family.

Thank you all for your support and care. It means so much knowing that you would take the time to respond.


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## Andros (Aug 26, 2009)

Reporter said:


> I have been feeling very ill and run down since Sept 2010 with my Internist suggesting anxiety as being the cause. I was prescribed (and took) for 2-3 months anti-anxiety meds but those did not help, quite the contrary, they just caused new, debilitating symptoms.
> 
> I eventually went to the endo with the labs results being:
> 1/13/2011 12:08 PM
> ...


Welcome! I hear your desperation!

So far, no one has run antibodies. Believe it or not, I think you are hyperthyroid. I have seen these kinds of lab results before.

Here are the tests I suggest.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

I also very much recommned RAIU (radioactive uptake scan) as sonograms have limitations.

It is my humble opinion that you are converting your FT4 to FT3 very very fast. You may have had a bad reaction to the Levo in that you "maybe" should not be on it. If you are hyper already, that could tip you over the edge.

Get that TSI test above all else if you will. And while symptoms do cross over, the ones you describe above are typically hyperthyroid. Fatigue comes from the body being in overdrive even while at rest.

Let me know what you think of my input.


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## Reporter (Mar 17, 2011)

Andros I'm from Atlanta, too, but have been living in NC since last Aug.

I truly appreciate the feedback from everyone. Seems you all are extremely plugged in when it comes to this thyroid business.

Andros (Super Moderator) and I believe one other person suggested that I may actually be hyper and I don't question that because many years ago reading about Graves I recall a couple of patient stories where they mentioned leg weakness, particularly though in their thigh muscles--and difficulty driving, pressing on the accelerator, for example.

When I took the levo back end of January, the first day immediately my ears began ringing, and I started having spasms in my neck, my chest was hurting, and while I didn't have palpitations I did get that one huge POUND followed by a squeezing sensation. I knew for sure I was having a heart attack and could not believe what was happening to me. Sad thing I'd called my internist and told him about my symptoms (not my endo because their office had already closed for the day) he thought I need to take an extra Ativan....the very next day I was admitted into the hospital.

To comment on your post:

antinuclear antibodies were negative, sed rate has been normal, those other thyroid tests that you mention, wow, that's a lot of testing. I know that my doctors in Atlanta performed the Scan and Uptake. My doctor here never once mentioned doing so and sees no reason to biopsy so I'm making an appointment in Atlanta just for a second opinion.

QUESTION/COMMENTS:
I believe in your or someone's reply that based I my lab results posted here, no antibodies test was performed. Is the TPO not an antibody test to determine if I have Hashimoto? See my labs above, out of the normal range.

Free T3 was done as was Free T4, on the low end so do those not indicate I'm border hypo?

TSH is low which actually means I'm hyper right?

I'm so confused. Are my labs not typical of most of the Hashi sufferers out here. Should that TSH be higher indicating that I'm hypo???


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## lainey (Aug 26, 2010)

Your labs right now are neither--they still fall in the normal range.

You had TPO antibodies run, but not the others. Having one or more sets of antibodies may give some indication as to which direction your labs may be headed. While many people report being symptomatic with antibodies, the issue will remain treating you with medication before your labs are out of range.


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## Andros (Aug 26, 2009)

Reporter said:


> Andros I'm from Atlanta, too, but have been living in NC since last Aug.
> 
> I truly appreciate the feedback from everyone. Seems you all are extremely plugged in when it comes to this thyroid business.
> 
> ...


Okay; this is a complex field. There are binding, stimulating and blocking antibodies AND autoantibodies!! Aaaaaaaaaaaaaaaaargh. These guys are so busy trying to keep your thyroid numbers in line (TSH, FT3 and FT4) thus giving false results relevant to what is "really" going on in your body.

TPO only suggests Hashimoto's not to mention a myriad of other things.
TPO
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

And ANA is not always present in thyroid disease. They are more commonly found in autoimmune such as RA, Sjogrens, Lupus, MCTD etc..

Here is info on myopathy.
Myopathy from hyper.
http://www.medicalonly.com/2007/07/27/thyrotoxicmyopathy_hyperthyroidism

I know that is a lot of testing but this is the only way to get to the bottom of this. If I had to chose 1, I would chose TSI. And if I could chose 2, I would chose the TSI and Thyroglobulin Ab which if present could "suggest" cancer. Please note the word "suggest."

Here is info on that Vitamin D stuff.
Vitamin D
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

Hugs to a fellow Atlantan!!


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## lavender (Jul 13, 2010)

Klonopin and Ativan are usually only affective for treating anxiety in the short term, like two weeks max. They do not treat depression. They are highly addictive meds, and even if one is not prone to addiction, it is possible to become physically dependent on them very quickly. Higher and higher doses are necessary, and withdrawal is as dangerous as alcohol, except that it takes longer.

Anxiety and heart palpittions/elevated heart rate are symptoms of Graves disease and hypothyroidism. TSI can tell you if you have hyperthyroidism. Then you can treat that instead of treating the symptoms.


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## midgetmaid (Jul 22, 2010)

My husband and I both had symptoms even though our labs were normal. We were eventually diagnosed (him with hashi's and me with graves) when symptoms and labs worsened. I had weak muscles-especially the legs.

Renee


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## Reporter (Mar 17, 2011)

Thank you all....I am contacting my endo now with a request to have those labs.

I will be in touch.


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## Reporter (Mar 17, 2011)

MidgetMaid thanks for that information.

I did not see your reply until after I'd posted.

I feel so weak today and don't know how I manage at times. This time last year I was running 23 miles a week. These days I can barely stand at the stove to prepare a meal for my family. My legs are weak, arms are weak and I feel heavy-headed. Also recently I've had more ringing in my ears.

It really helps to read these posts though; I feel less alone in this.


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## Andros (Aug 26, 2009)

Reporter said:


> MidgetMaid thanks for that information.
> 
> I did not see your reply until after I'd posted.
> 
> ...


Oh, you are not alone!! Guarantee'd!! Please keep us advised; very worried about you.

Take care and hope to hear from you soon!


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## Gam87 (Feb 5, 2011)

Midget maid.....just curious....how long did you have symptoms before your labs reflected your Graves? Do you mind sharing your normal labs prior to diagnosis? I am in this situation right now.....normal labs, every hyper symptom in the book, elevated but not over range TSI.


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## midgetmaid (Jul 22, 2010)

Hi Gam87! I felt bad for 6 years prior to diagnosis. GP couldn't find a cause and sent me to a rheumatologist (the symptoms pointed to autoimmune). Tests were normal. I never got copies of labs during that time, so I don't know what was checked. Then my brother-in-law, who is a lab tech, ran labs where he works. All was in the normal range, but TSH was sitting on the bottom. Four months later I found out I had gluten sensitivity on Monday and hyperthyroidism on Thursday (while in the hospital for chest pains, racing heart, etc...) So I'm not sure which problem was causing some of the symptoms.

I know the waiting is hard, and I hope you get a diagnosis soon so that you can get proper treatment and get on with life!

Renee


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## Andros (Aug 26, 2009)

Gam87 said:


> Midget maid.....just curious....how long did you have symptoms before your labs reflected your Graves? Do you mind sharing your normal labs prior to diagnosis? I am in this situation right now.....normal labs, every hyper symptom in the book, elevated but not over range TSI.


Are you receiving medical intervention for your hyper symptoms?

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Do you have exophthalmos, pretibial myxedema, goiter and thyrotoxicosis all of which determing Graves' as per Dr. Robert Graves?

Have you had RAIU to make sure there are no suspicious nodules and to establish the rate of uptake?


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## Gam87 (Feb 5, 2011)

MidgetMaid... Wow 6 years! I am so sorry... that is awful. I have been not well for about 14 months and I thought that was bad. It is sad when you are wishing for abnormal labs to confirm what you already know. I see that you are in Georgia. I am too....Marietta. Are you happy with your doctor? I am searching for someone who can help me. Thanks so much!

Andros....I am the one who has been looking for a good MD here in the ATL area. I saw one who prescribed Armour which I have not taken because I don't know how that will play into my hyper symptoms and TSI (100). He said my TSI means nothing which I know is not true. I just cannot find someone who seems to have a knowledge of Graves. My labs are definitely normal...actually more hypo looking but I have raging hyper symptoms, family history, and TSI. So no I am not receiving any treatment right now and I am not sure what to do at this point. I am frustrated to say the least!


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## Andros (Aug 26, 2009)

Gam87 said:


> MidgetMaid... Wow 6 years! I am so sorry... that is awful. I have been not well for about 14 months and I thought that was bad. It is sad when you are wishing for abnormal labs to confirm what you already know. I see that you are in Georgia. I am too....Marietta. Are you happy with your doctor? I am searching for someone who can help me. Thanks so much!
> 
> Andros....I am the one who has been looking for a good MD here in the ATL area. I saw one who prescribed Armour which I have not taken because I don't know how that will play into my hyper symptoms and TSI (100). He said my TSI means nothing which I know is not true. I just cannot find someone who seems to have a knowledge of Graves. My labs are definitely normal...actually more hypo looking but I have raging hyper symptoms, family history, and TSI. So no I am not receiving any treatment right now and I am not sure what to do at this point. I am frustrated to say the least!


Thank you for refreshing my memory; so many posters. You are right not to take it. This is so discouraging. I wish I could better help you finding just the right doctor.

Yes; the labs are skewed because of stimulating, binding and blocking antibodies. They are putting forth an effore to right the body and it shows in the numbers but that is not really what is going on behind the scenes.

This is some heavy stuff and I in no way purport to understand it all but if you are like me, you will get the gist of it.
http://books.google.com/books?id=Yk...es, blocking, binding and stimulating&f=false

Wonder if you should try to find an immunologist?


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## BarbC (Mar 26, 2011)

Your thyroid does not make T3, it makes T4 which is converted by your body.Your thyroid does make T3! The thyroid makes both T3 (10-20%) and T4 (80-90%). T4 is converted into T3, the active form (what gets into the cells) by the deiodinase enzymes. Just wanted to clarify!


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## BarbC (Mar 26, 2011)

> Your thyroid does not make T3, it makes T4 which is converted by your body.


Your thyroid does make T3! The thyroid makes both *T3*(10-20%) and *T4*(80-90%). T4 is converted into T3, the active form (what gets into the cells) by the deiodinase enzymes. Just wanted to clarify that!


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## Andros (Aug 26, 2009)

BarbC said:


> Your thyroid does make T3! The thyroid makes both *T3*(10-20%) and *T4*(80-90%). T4 is converted into T3, the active form (what gets into the cells) by the deiodinase enzymes. Just wanted to clarify that!


Welcome BarbC!!


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## Reporter (Mar 17, 2011)

All of these months....I gave up on 'whatever' was going on with me, just getting back to this. Wow, thanks, for all the advice and concern.

I have a ton of reading to do. The article on thyrotoxic myopathy...just amazing. I am sure that explains what I couldn't explain to my GP all this time.


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