# Brain Fog Issue



## peter99

I'm posting on behalf of my wife. I am a newbie to this site.

About a year ago my wife developed a bad brain fog that has not lifted. The last 4 months have been difficult. She is afraid to drive and seems very depressed. She has also not been able to work due to the dizzy feeling.

She was diagnosed with Graves eight years ago and had a Thyroidectomy.

She did state she did have brain fog 8 years ago but it was very brief.

Our recent test results have been very strange. Our family doctor thinks it is an anxiety issue, and sent us to a Psychologist. The Psychologist told us she has a gut feeling its a chemical issue...not anxiety. We have asked her to write a note to our family doctor.

Here are the results from the December 8 LAB that the doctor stated was normal. These were the results with wife taking 125mg Synthroid for 2 months:

TSH-4.5 mU/L
Free T4-19.4 pmol/L
Free T3-3.9 pmol/L

Here are the October 28th LAB results. 1 month of 125mg Synthroid:

TSH-3.2 mU/L
Free T4-15.1 pmol/L
Free T3-4.0 pmol/L

What concerns me is the results are within range...but don't seem right. TSH quite high..yet T4 also high. T3 almost the same.

I may ask doctor to prescribe Cytomel to increase the T3. I hear that low T3 is usually the cause of brain fog. I just have to convince doctor. If that fails we would like to try the natural dessicated thyroid.

Any feedback on the lab results?? Very difficult few months.

Thanks,


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## lavender

I am sorry to hear that your wife is so ill. I have graves as well and was unable to drive for several months due to the brain fog. Anxiety issues go hand in hand with thyroid issues. I am glad to see that she saw a psychologist who was astute enough to suggest further testing.

Did your wife have a total thyroidectomy?

It's hard to give you feedback on the labs without the reference ranges. Different labs have different ranges. A T4 of 15 would be very hyper according to my lab, yet you say it is within range. Also, people tend to find that they feel best at a certain point within the range. We are not all the same.

It does seem strange that her TSH has gone up along with the T4.

I am glad to hear you are so supportive of your wife and eager to help her out, especially with the docs. Support is essential when we are going through illness.


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## desrtbloom

Has she had her estrogen levels checked? I don't know how old she is, but if she is having pre-menopausal/menopausal symtoms that can cause bad brain fog and other weird symptoms. You might have the docs check her Ferritin (iron), her pituatary, her estrogen levels, her adrenal levels and do a comprehensive CBC with plateletes. I would suggest getting as much blood work done as possible.

You are a good man for being so supportive. 

Best of luck!
Patti


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## CA-Lynn

Definitely a good man for being so supportive. She needs you in her corner.

DesertBloom gave you a good idea as to which tests should be run. I'd also add tests for autoimmune thyroid [TPO, TSI]. Additionally, I am in favor of a complete metabolic panel as well as AM Cortisol. Would probably add a few more, based on symptoms.

Is your doctor a neuroendocrinologist? Hard to find, but they're pretty good at zeroing in on brain fog causes. In any case, the first rule of any psychologist is to rule out organicity, which is what yours is having you do.

Good luck!


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## peter99

Thanks for the replies!! It's good to have support. It's unbelievable how hard thyroid issues are to resolve.

More info for everyone. I was incorrect. She did not have a Thyroidectomy. She had Radioactive Iodine treatment. She is 29 years old. We are currently seeing a family doctor and Psychologist....but also have an Endocrinologist at our disposal....but she is very busy. Usually a month wait to see. I recently got involved 3 months ago because it was difficult for my wife to keep track of all the appointments, different medication, due to the brain fog and anxiety etc...we also started seeing a new family doctor 2 months ago. The last doctor was not very understanding.

Here are the Reference ranges in Canada for our TSH,free T3,T4.

TSH: 0.38-5.5 mU/L
Free T4: 10.5-20.0 pmol/L
Free T3: 3.5-6.5 pmol/L

There was also the following warning on the LAB result from December 8th, "TSH values of 3.5-5.5 may be associated
with preclinical hypothyroidism in
some cases."

I have also requested an archive of all blood test results since 2007 from the lab. If I can find some results from before the brain fog symptoms, we could find a reference point for T3/T4 levels that worked.

I've spent hours researching TSH/T3/T4. I've also found very good studies published in some medical journals. I will give to the Psychologist on Wednesday to read through and send a letter to our doctor and Endocrinologist.

Thanks for all the great tips about the different types of tests.

Thanks again.


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## lavender

Ok, I get it now. Thanks for the reference ranges. Her T3 is desperately low, even though it is within the reference range, making her hypothyroid-which explains the high TSH. Synthroid only replaces T4 and relies on the body to convert it into T3, the active thyroid hormone. She seems to not be converting T4 to T3. It could be an adrenal issue, or she may need a T3 supplement (not sure what it's called in Canada) or a natural dessicated thyroid supplement that would include T3 and T4-I think it's called Erfa in Canada. Some docs are reluctant to prescribe T3 or dessicated thyroid, but I think it is worth asking for. 
I am in the same boat right now with a low T3, high T4 and high TSH, waiting to get into see a new doc who is willing to try a different treatment. Can't remember anything, too tired to function. I can relate.


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## peter99

Thanks for posting Lavender.

It definitely sounds like we are in the same boat. I'll keep everyone informed of what happens.

Hopefully we can lower the synthroid dose, to maybe 112.5mg from 125mg, then add 5-10mg of Cytomel to bring up the T3.....but the doc will have to confirm...

In Canada, ERFA makes Thyroid(TM). It is the natural dessicated product. Equivalent to Armour.

Here is a good position paper written by an ERFA doctor.
http://thyroid.erfa.net/index.php/en/scientific-papers.html

There seems to be a small group of people that can't convert the T4 to T3.


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## Andros

peter99 said:


> I'm posting on behalf of my wife. I am a newbie to this site.
> 
> About a year ago my wife developed a bad brain fog that has not lifted. The last 4 months have been difficult. She is afraid to drive and seems very depressed. She has also not been able to work due to the dizzy feeling.
> 
> She was diagnosed with Graves eight years ago and had a Thyroidectomy.
> 
> She did state she did have brain fog 8 years ago but it was very brief.
> 
> Our recent test results have been very strange. Our family doctor thinks it is an anxiety issue, and sent us to a Psychologist. The Psychologist told us she has a gut feeling its a chemical issue...not anxiety. We have asked her to write a note to our family doctor.
> 
> Here are the results from the December 8 LAB that the doctor stated was normal. These were the results with wife taking 125mg Synthroid for 2 months:
> 
> TSH-4.5 mU/L
> Free T4-19.4 pmol/L
> Free T3-3.9 pmol/L
> 
> Here are the October 28th LAB results. 1 month of 125mg Synthroid:
> 
> TSH-3.2 mU/L
> Free T4-15.1 pmol/L
> Free T3-4.0 pmol/L
> 
> What concerns me is the results are within range...but don't seem right. TSH quite high..yet T4 also high. T3 almost the same.
> 
> I may ask doctor to prescribe Cytomel to increase the T3. I hear that low T3 is usually the cause of brain fog. I just have to convince doctor. If that fails we would like to try the natural dessicated thyroid.
> 
> Any feedback on the lab results?? Very difficult few months.
> 
> Thanks,


Peter99; welcome to the board. If I could see the ranges for the lab results, I could better help you. Different labs use different ranges. I know you would not want me or anyone else to guess when it comes to our wife's health!

She may not be converting but I cannot tell w/o the ranges.

Thanking you in advance and once again, welcome.


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## lavender

Andros, he posted the ranges in another posting. (I asked the same thing)



peter99 said:


> TSH: 0.38-5.5 mU/L
> Free T4: 10.5-20.0 pmol/L
> Free T3: 3.5-6.5 pmol/L


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## peter99

Here are the results from the December 8 LAB that the doctor stated was normal. These were the results with wife taking 125mg Synthroid for 2 months:

TSH-4.5 mU/L (TSH: 0.38-5.5 mU/L)
Free T4-19.4 pmol/L (Free T4: 10.5-20.0 pmol/L)
Free T3-3.9 pmol/L (Free T3: 3.5-6.5 pmol/L)

Here are the October 28th LAB results. 1 month of 125mg Synthroid:

TSH-3.2 mU/L (TSH: 0.38-5.5 mU/L)
Free T4-15.1 pmol/L (Free T4: 10.5-20.0 pmol/L)
Free T3-4.0 pmol/L (Free T3: 3.5-6.5 pmol/L)

There was also the following warning on the LAB result from December 8th, "TSH values of 3.5-5.5 may be associated
with preclinical hypothyroidism in
some cases."

**Ranges in Brackets**


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## Andros

peter99 said:


> Here are the results from the December 8 LAB that the doctor stated was normal. These were the results with wife taking 125mg Synthroid for 2 months:
> 
> TSH-4.5 mU/L (TSH: 0.38-5.5 mU/L)
> Free T4-19.4 pmol/L (Free T4: 10.5-20.0 pmol/L)
> Free T3-3.9 pmol/L (Free T3: 3.5-6.5 pmol/L)
> 
> Here are the October 28th LAB results. 1 month of 125mg Synthroid:
> 
> TSH-3.2 mU/L (TSH: 0.38-5.5 mU/L)
> Free T4-15.1 pmol/L (Free T4: 10.5-20.0 pmol/L)
> Free T3-4.0 pmol/L (Free T3: 3.5-6.5 pmol/L)
> 
> There was also the following warning on the LAB result from December 8th, "TSH values of 3.5-5.5 may be associated
> with preclinical hypothyroidism in
> some cases."
> 
> **Ranges in Brackets**


Thank you so much; it is such a huge help to have the ranges.

Okay. As of December, TSH of course is waaaaaaaaaaaaaaaay too high. Most of us like it around 1.0 or less. FT3 very much below the mid-range of 5.0.

This tells me your wife is undermedicated because the FT4 and the FT3 should be above mid-range; preferably 1/2 way between the mid-range and the top of the range.

The doctor should increase her Synthroid. Leaving her in this state is unconscionable. If the current doctor won't titrate further, I suggest you find a doc that will.

You wife cannot be feeling well at all. I am 100% positive of this. FT3 is the active hormone. T4 Synthroid) converts to the FT3.

Your wife needs a hug and you are a gem for helping her.


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## peter99

Thanks for the info Andros.

In regards to your statement, "FT4 is smack dab in the middle of the range (15. and a smidgeon) with FT3 very much below the mid-range of 5.0." Did you mean 19.1, or were you looking at the wrong lab result?

Her December Lab showed her T4 almost at the top range of 20.
TSH-4.5 mU/L (TSH: 0.38-5.5 mU/L)
Free T4-19.4 pmol/L (Free T4: 10.5-20.0 pmol/L)
Free T3-3.9 pmol/L (Free T3: 3.5-6.5 pmol/L)

Could this be to high if her Synthroid dose is increased?

My wife thinks the brain for is either caused by the high TSH or low T3. It seems people feel much better with a lower TSH.

Is is possible she could Hypo due to TSH and Hyper due to FT4?

Thanks again!!


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## peter99

Just a heads up. I've requested all archives of blood work from the hospital and Labs going back to 2007.

Maybe we can get a reference for TSH/T3/T4 levels when she didn't have brain fog.

She has been to the Emergency four times in the last year. They kept trying to put her on antidepressants, and told her she was having panic attacks. One doc was good. He ordered all blood tests....but no one ever told us if they were out of range.


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## Andros

peter99 said:


> Thanks for the info Andros.
> 
> In regards to your statement, "FT4 is smack dab in the middle of the range (15. and a smidgeon) with FT3 very much below the mid-range of 5.0." Did you mean 19.1, or were you looking at the wrong lab result?
> 
> Her December Lab showed her T4 almost at the top range of 20.
> TSH-4.5 mU/L (TSH: 0.38-5.5 mU/L)
> Free T4-19.4 pmol/L (Free T4: 10.5-20.0 pmol/L)
> Free T3-3.9 pmol/L (Free T3: 3.5-6.5 pmol/L)
> 
> Could this be to high if her Synthroid dose is increased?
> 
> My wife thinks the brain for is either caused by the high TSH or low T3. It seems people feel much better with a lower TSH.
> 
> Is is possible she could Hypo due to TSH and Hyper due to FT4?
> 
> Thanks again!!


Aaaaaaaaaaaack; sorry about that! I "actually" do need new glasses.

Yeah; I do think adding a small bit of Cytomel rather than increasing the Synthroid would be the best bet over all. About 5 mcgs. would be a good starting dose to see how she responds.

Sorry about the error. I think I was looking at the October FT4.


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## peter99

Ok, got good news.

We saw Psychologist, she agreed to write a letter for us to show our family doctor the issue is not an anxiety issue, but a Thyroid/other issue.

We also saw our Endo today. We explained that we feel my wife's TSH is still to high, and the T3 is still low and has not changed. She agreed to lower the Synthroid to .100mg from .125mg.

She also agreed to add .005mg of Cytomel.

How long do you guys think the Cytomel takes to make a change in symptoms?


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## Andros

peter99 said:


> Ok, got good news.
> 
> We saw Psychologist, she agreed to write a letter for us to show our family doctor the issue is not an anxiety issue, but a Thyroid/other issue.
> 
> We also saw our Endo today. We explained that we feel my wife's TSH is still to high, and the T3 is still low and has not changed. She agreed to lower the Synthroid to .100mg from .125mg.
> 
> She also agreed to add .005mg of Cytomel.
> 
> How long do you guys think the Cytomel takes to make a change in symptoms?


Cytomel is fast acting. She should feel some difference in a few hours. It takes 72 hours for the dose to fully build up in the system.

5 mcg. is a good starting dose. Let us know how she does. She should get labs in about 8 weeks for further titration of Cytomel if needed.

The lack of T3 severely affects the limbic system in the brain. I am so glad the psychologist has validated that. Very glad!!!

This may interest you. http://www.clinicalneuropsychiatry.org/pdf/01_liappas.pdf


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## lavender

So glad the psychologist was on the ball and willing to intercede on your wife's behalf. I hope the cytomel brings some much needed relief SOON!


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## peter99

Just a quick update. My wife was feeling better by the second day being on Cytomel. But today and yesterday(day3/4) she said she has not been feeling too great. She says she has been very dizzy....

Hopefully the feeling goes away..


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## Andros

peter99 said:


> Just a quick update. My wife was feeling better by the second day being on Cytomel. But today and yesterday(day3/4) she said she has not been feeling too great. She says she has been very dizzy....
> 
> Hopefully the feeling goes away..


It may not be the Cytomel; this is hard to say. How many days has your wife been on the cytomel. Is she taking it with a bit of food prior such as a piece of toast?

Unfortunately, dizzy has many possible causes.

When is the wife due for labs?


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## peter99

Been a while since last post. We went back to family doctor. He said again it's a mental health issue. Even after showing the Psychologist note stating my wife does not have any signs of a mental issue.

Anyways, we're seeing a Naturopathic Doctor now.

We are also seeing an Endocrinologist.

Here are latest labs:

TSH 9.6 ref:0.38-5.5mU/L (This result is compatible with hypo-thyroidism.)
Free T4	13.7 ref:10.5-20 pmol/L
Free T3 4.2 ref:3.5-6.5 pmol/L

Last option we have to try is the dessicated thyroid. Does anyone feel better on the natural ?thyroid(armour)?

We are out of options. We may try to increase t4 and t3 again.

Thanks,


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## Andros

peter99 said:


> Been a while since last post. We went back to family doctor. He said again it's a mental health issue. Even after showing the Psychologist note stating my wife does not have any signs of a mental issue.
> 
> Anyways, we're seeing a Naturopathic Doctor now.
> 
> We are also seeing an Endocrinologist.
> 
> Here are latest labs:
> 
> TSH 9.6 ref:0.38-5.5mU/L (This result is compatible with hypo-thyroidism.)
> Free T4	13.7 ref:10.5-20 pmol/L
> Free T3 4.2 ref:3.5-6.5 pmol/L
> 
> Last option we have to try is the dessicated thyroid. Does anyone feel better on the natural ?thyroid(armour)?
> 
> We are out of options. We may try to increase t4 and t3 again.
> 
> Thanks,


Your wife is in dire need of getting that TSH waaaaaaaaaaaay down and increasing the FREE T3.

Armour, absolutely. I have been on it for so many years I have lost count (12 maybe?); it would be a good choice right now for your wife.

Then, when her numbers are in range.............you are going to see a new woman. She cannot function cognitively with numbers like what she has now.

As far as I am concerned, it is NOT mental. Bearing in mind that I am not a doctor.

Most of us feel best w/TSH @ 1.0 or less and FT3 above mid-range of the range given by the lab so long as it is not over the top of the range and the patient feels fine.


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## lavender

I am soooooo glad you found that natropath. The endo may be of some use as well, but many are unwilling to waiver from the synthroid only camp. I ended up firing my endo in favor of an alternative medicine doc.

Your wife's blood work is clearly hypo. I would not be able to function with a TSH of 9.6.

I too was told I was depressed while on sythroid. After one month on armour, all my "depression" symptoms have lifted. I feel alive again. I can get off the couch, and I actually want to be active. I think it's just cruel for a doc to not look at all the possible options for thyroid replacement when a patient is clearly not doing well on the standard synthroid. I physically looked sick while I was on synthroid, and I look a lot healthier now according to many friends.


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## peter99

Thanks for the support!!! Here is the TPO test the Naturopath ordered. What do you guys think?

Thyroperoxidase Ab 427 IU/mL Range:<35 IU/mL

Just got it today.

Endo increased Synthroid to 125 from 100. 2 weeks ago.

Cheers,


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## Andros

peter99 said:


> Thanks for the support!!! Here is the TPO test the Naturopath ordered. What do you guys think?
> 
> Thyroperoxidase Ab 427 IU/mL Range:<35 IU/mL
> 
> Just got it today.
> 
> Endo increased Synthroid to 125 from 100. 2 weeks ago.
> 
> Cheers,


That is high. How is the wife feeling? How are you?

Does your wife have nodules?


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## peter99

Thanks for the reply.

My wife does not seem to feel any better, but she is optimistic and hopeful. She wasn't as depressed this week as she was last week. Maybe the increase in Synthroid may be helping. We are seeing a Naturopath as well. We took some blood work. My wife is now taking Vitamin D pills as well.

She does not have nodules. The Endo did check for that.

March 4th is next apt with Endo.


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## Andros

peter99 said:


> Thanks for the reply.
> 
> My wife does not seem to feel any better, but she is optimistic and hopeful. She wasn't as depressed this week as she was last week. Maybe the increase in Synthroid may be helping. We are seeing a Naturopath as well. We took some blood work. My wife is now taking Vitamin D pills as well.
> 
> She does not have nodules. The Endo did check for that.
> 
> March 4th is next apt with Endo.


Keep an eye on that FREE T3 because it needs to come up. It ideally should be at 75% of the range given by the lab you use. (give or take)

Good to hear from you. It does take 8 weeks for T4 (Synthroid) to build up so we shall see what we shall see.


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## lainey

peter99 said:


> Thanks for the support!!! Here is the TPO test the Naturopath ordered. What do you guys think?
> 
> Thyroperoxidase Ab 427 IU/mL Range:<35 IU/mL
> 
> Just got it today.
> 
> Endo increased Synthroid to 125 from 100. 2 weeks ago.
> 
> Cheers,


and:

>>She does not have nodules. The Endo did check for that.<<

and:
>>She was diagnosed with Graves eight years ago and had a Thyroidectomy.<<

There should not be a concern over antibodies or nodules if she doesn't have a thyroid.

Her numbers give you plenty of room to titrate the dosage of both T4 and T3 upward.

Have her iron and female hormones been checked? B vitamins? Problems with any of these can exacerbate the symptoms.


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## peter99

Your support here is awesome.

some positive news. After 1.5 years of hell, my wife's TSH,T3,T4 look ok after 6 weeks on new dose. She still has dizzy feeling though...

TSH 1.4 0.38-5.5mU/L
Free T4 16.9	10.5-20.0pmol/L
Free T3 4.6	3.5-6.5pmol/L

I asked Endo what else could be wrong. She sent us for a ton of bloodwork. There was a flag on the AM Cortisol being high. I'm not sure if this may be the cause......any suggestions? Can this be fixed? Is it Thyroid related? Is this extremely high?

AM Cortisol result: 968 nmol/L range: 140-690 nmol/L


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## Andros

peter99 said:


> Your support here is awesome.
> 
> some positive news. After 1.5 years of hell, my wife's TSH,T3,T4 look ok after 6 weeks on new dose. She still has dizzy feeling though...
> 
> TSH 1.4 0.38-5.5mU/L
> Free T4 16.9	10.5-20.0pmol/L
> Free T3 4.6	3.5-6.5pmol/L
> 
> I asked Endo what else could be wrong. She sent us for a ton of bloodwork. There was a flag on the AM Cortisol being high. I'm not sure if this may be the cause......any suggestions? Can this be fixed? Is it Thyroid related? Is this extremely high?
> 
> AM Cortisol result: 968 nmol/L range: 140-690 nmol/L


Boy her numbers look better!! Try to target getting the FT3 above the mid-range of 5.0 in the range given and TSH down around 1.0 (or less); this could make a huge difference even still!

Dizzy? Ferritin......................please have it checked.
Ferritin http://www.thewayup.com/newsletters/081504.htm Ferritin should be 50 to 100; the closer to 100, the better.

Good to hear from you and this is awesome that your wife is regaining her health.

It is a slow process.

It is hard to say about the cortisol as it does peak in the AM.


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## peter99

Her Ferritin was checked in January.

result: 171 ug/L

range:15-180 ug/L

Thanks again guys!!


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## Andros

peter99 said:


> Her Ferritin was checked in January.
> 
> result: 171 ug/L
> 
> range:15-180 ug/L
> 
> Thanks again guys!!


Wow!! I don't ever recall seeing anyone on the boards w/ferritin that high. Wonder if she should be checked for Hemochromatosis?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001368/

That is astounding. I do think it should be checked. In my most humble opinion.


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## peter99

ok, the endo said that all tests for thyroid and cortisol look good. She said there is nothing else she can do for us.

My wife also saw an Opthomologist/Nuerologist. He tested her and diagnosed her with Migrane associated Vertigo. He prescribed meds to try for 3 months to see if dizzy feeling goes away.


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## Andros

peter99 said:


> ok, the endo said that all tests for thyroid and cortisol look good. She said there is nothing else she can do for us.
> 
> My wife also saw an Opthomologist/Nuerologist. He tested her and diagnosed her with Migrane associated Vertigo. He prescribed meds to try for 3 months to see if dizzy feeling goes away.


Is your wife remaining on thyroxine replacement?

I still worry about that high ferrtin.
http://www.haemochromatosis.org.au/symptoms.htm

While it is not over the range on the day of labs, it is so high, it does make me wonder.


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## northernlite

Dizziness and vertigo were both hypothyroid symptoms for me. They are gone completely now that I have my dose of Levothyroxine correct. I was touching up some paint on the wall next to the baseboards today with my head upside down, I couldn't have done that two months ago! I do have my TSH below 1 now.

Best of luck to your wife.


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## peter99

Feretin still in OK range.

Naturopath said tests indicate my wife is very sensitive to dairy.

Wife is taking Topimax. Dizzy feeling still, but wife said it's easier to deal with than before. We will take another T3.,T4, TSH test to ensure everything is still ok.


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## Andros

peter99 said:


> Feretin still in OK range.
> 
> Naturopath said tests indicate my wife is very sensitive to dairy.
> 
> Wife is taking Topimax. Dizzy feeling still, but wife said it's easier to deal with than before. We will take another T3.,T4, TSH test to ensure everything is still ok.


Good to hear from you! What is the Topimax for? I see only that it is not available in the U.S.?

Or is it Topamax?


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