# Thinking I possibly have hypo symptoms.



## Paul99004 (Mar 17, 2018)

Background:

Have had CFS-like symptoms for the past 12+ years. Fatigue. Brain Fog. Mild numbness in extremities. Sinusitis that never goes away. Symptoms (other than the sinus symptoms) have occasionally remitted for periods as long as 2.5 months, but always return to some degree and have been much worse lately in terms of a roller-coaster of unpredictable day-to-day malaise.

I've had blood work like CBC/CMP done when symptoms were at their worst with everything coming back "normal". On occasion, I've had slightly high cortisol and eosinophils, leading to the diagnosis of eosinophilic sinusitis without any further investigation as to the type of infection or if it actually is an infection or allergic condition.

Recently, I was dieting (I am a bit overweight for my age/height) as well as taking daily store-branded fluticasone nasal spray for approx 3 weeks. When I quit the fluticasone, I believe it must have caused a type of HPA-axis imbalance as I spent three days with constant shivering tremors. When I had a blood workup during this, the only thing out-of the ordinary was a TSH that was only minutely "high" at 3.75 with a test range of 0.36 to 3.74..

Several weeks later, blood work including a more in-depth thyroid panel the results of which were:

T3, free 2.9 (range 2.0-4.4)

T3 90 (range 80-200)

TSH 1.54 (range 0.270-4.2)

T4 6.3 (range 4.7-11.3)

Thyroglobulin Autoantibody 2.5 (range 0.0-4.0)

Thyroid Peroxidase Autoantibody 2.6 (range 0.0-9.0)

Morning cortisol was 9.9 (range 2.7-18.4)

I also had a saliva diurnal cortisol test done which showed a slightly "low" level throughout the duration.

I brought-up with the doc that my T3 and T4 were on the low-end of the ranges and asked if there was anything I could do to improve conversion but nothing was recommended as the numbers were "within normal range".

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## jenny v (May 6, 2012)

Your Free T3 is very low in the range, indicating hypo. Your TSH is a little high, too, which is also hypo (most of us feel best around 1.0). Can you call back and push your doctor into giving you a trial of thyroid meds? I know he says you are "in the range" but given you have symptoms and you're about to fall out of the FT3 range, you have a good reason to try meds. If not, I would look for another doctor, unfortunately.


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## kris90 (Dec 13, 2013)

Interesting results. Seems like a case of adrenal fatigue. I hate to use the term adrenal fatigue, because the mechanism is usually not at all related to the adrenal glands themselves, but a central issue that often begins in the hypothalamus of the brain.

Your TSH is inappropriately low by looking at your T3 and T4 levels. Normally, in someone with primary hypothyroidism (meaning a problem within the thyroid gland itself), the amount of TSH secreted by the pituitary gland would be much higher in order to stimulate the thyroid gland indicating a broken feedback loop. This is not the case. Your pituitary is not responding to upregulate thyroid hormone production as it should. That is typically a classic case of brain dysregulation.

Given that your cortisol is low as well, this would make sense. An ACTH stimulation test would rule out a problem with adrenal glands vs hypothalamus/pituitary. Most cases of adrenal fatigue are actually due to a chronic stress response in the PVN (paraventricular nucleus). When the PVN is overactivated due to chronic stress, neurons are firing constantly and you get a lot of free radical production leading to oxidative stress. As a protective mechanism overtime, the PVN shuts off until the stress is over. If the stress is chronic, you wind up with debilitating fatigue which is often classified as adrenal fatigue.

Back to TSH and thyroid labs. The leptin receptor in the brain is what controls the release of TRH to regulate the feedback loop for thyroid hormones. When you are leptin resistant, you cannot activate the receptor, and lose thyroid function. Leptin resistance is caused by chronic stress (back to that story). You can read more about the connection here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC377492.


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## Paul99004 (Mar 17, 2018)

Update:

Found a new doctor. Had labs redone. Haven't had hypo symptoms for approx 1.5 weeks. My T3 (total) at this test was still on the low end of the range at 88, and T3 (free) was 3.0. TSH was 2.39. Testosterone was rock-bottom at 244 (total) and 25.5 (free).

Was put on Levothyroxine 25 mcg. and re-upped on Testosterone. Also have been taking 3 mg LDN for several weeks . After a few days, I seem to have more energy, but not sure what it will be like long-term. Trying not to overdo it right out of the gate.



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