# Anxious, Tired, and Confused.



## yermato (Nov 26, 2011)

Hello all. I found this board looking for thyroid disorders on the web, and I wanted to share my story.

In general, so far I've been healthy all my life to the best of my knowledge, not suffering from any chronic diseases (I'm 18 years old). About two and a half months ago, however, as I was sitting in front of my computer, I sudden;y felt very dizzy and it was as if I couldn't comprehend what was going on. The feeling only lasted a few seconds, and repeated itself again a bit later. I felt worried, but brushed it off. Ever since then, however, I started feeling very tired, exhausted, and nauseous. I went to the doctor and described these feelings, and he thought it was an inner ear infection and gave me betahistine. I started taking it regularly, but I noticed that it made me feel really anxious and irritated. I thought this was due to something else as it wasn't even listed as a side effect! But it turned out that's what it was, though I only found out after I had a terrible panic attack during one of my classes around 2-3 weeks after I had started taking it. Every time, I'd get extremely anxious right after I took the betahistine.

I went to the doctor again, but my blood pressure and temperature were all normal, so he suggested it was all due to stress. I then had some bloodwork done and it was all fine, though foolishly I forgot to test my thyroid. After I stopped taking the betahistine, I gradually felt less anxious, though the confusion, nausea, and tiredness persisted. Then, around three weeks ago, I woke up with terrible brain fog and a headache on the left side of my head that persisted throughout the day. During the next few days, I started getting hot flashes, twitches, and strange sensations, and the fatigue only got worse. Ever since then I feel as if I've been getting worse. Though I can remember things, it takes my brain much more time to recall them than it used to, and my mind feels sluggish. Furthermore, I struggle to remember things I've just read and forget what I'm writing about when I'm doing assignments. About a week ago, I finally had blood tests done for my thyroid, and the results were quite strange.

My serum TSH level is too high - 3.84 mu/L while the range is 0.5-3.6
My serum free T3 level is somewhat high - 6.5 pmol/L while the range is 3.1-6.8
My serum free T4 level is also too high - 20.8 pmol/L while the range is 12.0-20.6

The doctor was perplexed at these results as he said if TSH is high, T4 has to be low and vice versa. So I repeated the tests and while this time the TSH and T4 were not over the limit, they were still high - 2.82 TSH and 19.1 pmol/L. However, the doctor refuses to give me any more advice or medication since they are now within range! What a ripoff. Other things that were abnormal in the results were the bilirubin levels - they were too high at 23 umol/L while the range was 0-21. I noticed that my stool was very pale and yellow in color, so I thought there might be something wrong with my liver. About a week ago, I started a diet with no gluten or sugar, and yesterday, I found that my stool had actually gotten light brown, and I believe I feel a bit better.

However, the fatigue, anxiety, and brain fog are still there, and sometimes I just feel like I'm not myself anymore. This is pretty difficult to handle, and I'm not sure what to do. I've decided to have some pretty extensive testing done, but that can be done in two weeks at the earliest, as that is when I'm going back to my home country (I'm currently studying abroad). I'm sorry if my story was too long or confusing to read, but I'd appreciate any help or input.


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## Andros (Aug 26, 2009)

yermato said:


> Hello all. I found this board looking for thyroid disorders on the web, and I wanted to share my story.
> 
> In general, so far I've been healthy all my life to the best of my knowledge, not suffering from any chronic diseases (I'm 18 years old). About two and a half months ago, however, as I was sitting in front of my computer, I sudden;y felt very dizzy and it was as if I couldn't comprehend what was going on. The feeling only lasted a few seconds, and repeated itself again a bit later. I felt worried, but brushed it off. Ever since then, however, I started feeling very tired, exhausted, and nauseous. I went to the doctor and described these feelings, and he thought it was an inner ear infection and gave me betahistine. I started taking it regularly, but I noticed that it made me feel really anxious and irritated. I thought this was due to something else as it wasn't even listed as a side effect! But it turned out that's what it was, though I only found out after I had a terrible panic attack during one of my classes around 2-3 weeks after I had started taking it. Every time, I'd get extremely anxious right after I took the betahistine.
> 
> ...


Your reaction to the Betahistine tipped me off right away. It is my contention that you are hyperthyroid. Anything adrenergic will tip the hyper person over the edge.

There are binding, blocking and stimulating antibodies and immunoglobulins which are skewing the thyroid panel results. This is a case where in addition TSI, you probably have TBII as well which is targeting the TSH receptor site.

Here is info:

TSI (thyroid stimulating immunoglobulin)http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html,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

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)

Welcome to the board!


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## yermato (Nov 26, 2011)

Thank you very much for your reply. So in my understanding, I should have tests that check for the presence of TSI and TbII? I definitely will, thanks for reassuring me I'm not some kind of medical abnormality as even the doctor was confused at my results (guess he's not such a great doctor)! Cheers!


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## Andros (Aug 26, 2009)

yermato said:


> Thank you very much for your reply. So in my understanding, I should have tests that check for the presence of TSI and TbII? I definitely will, thanks for reassuring me I'm not some kind of medical abnormality as even the doctor was confused at my results (guess he's not such a great doctor)! Cheers!


Absolutely get those 2 tests; you should have none of either.

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

Let us know when you can! And get results w/ the ranges for us!


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## yermato (Nov 26, 2011)

Oh dear! I forgot to mention that I did infact have my Thyroid peroxidase levels tested, here's the result.

Thyroid peroxidase antibod lev = 9.5 iu/mL (range 0-35)

I'm not quite sure how to interpret this. Other than that, things only seem to be getting worse - my brain fog is terrible, I can't seem to remember anything anymore! I'm having trouble sleeping, and I just don't feel like myself . What a nightmare! Anyway, I'll try to hang in there, and I've got more tests scheduled for next week, hopefully measuring TSI and TBII as you suggested. From what I've gathered, though, the most likely explanations for these results are thyroid hormone resistance or a pituitary tsh-secreting adenoma, the latter of which sounds scary ...

Anyway, I'll write back when I (hopefully) get some more results.


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## Andros (Aug 26, 2009)

yermato said:


> Oh dear! I forgot to mention that I did infact have my Thyroid peroxidase levels tested, here's the result.
> 
> Thyroid peroxidase antibod lev = 9.5 iu/mL (range 0-35)
> 
> ...


It is my opinion that this is most likely thyroid related.

A good place to start when you get back is TSH, FREE T3, FREE T4, TSI and TBII.

And a sonogram of the thyroid.

Make sure you get the FREES; not the TOTALS

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=3

How do you interpret the TPO Ab. Exactly what the references say. You should not have any. The healthy person has a lot titer of TPO and no TPO Ab.

Bottom line here. Even if the TPO Ab is low, it still means something is "lurking" behind the scenes.

Also, these things wax and wane big time. Main reason is that there are binding, blocking and stimulating antibodies and immunoglobulins which cause a rise or drop in the numbers depending on which team is winning.


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## yermato (Nov 26, 2011)

Andros, thank you for your reply. I also suspect my thyroid is the culprit behind these issues, and I intend to find the truth! Anyway, I will make sure to get these tests done ASAP. I guess my tiredness and fogginess could also stem from the fact that I stopped taking Zyrtec-D for my allergies a couple of days ago. It didn't seem to help me at all, and now I'm suffering because of it. Oh well, I'll hang in there and post the results of the tests whenever I get them. Again, thank you for your help.


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## yermato (Nov 26, 2011)

An update on my situation. I did have various tests for TSH-secreting antibodies including TSI and TBII, but I do not seem to have any. Further, I had a brain and pituitary MRI which showed nothing out of the ordinary. I also had a thyroid ultrasound which revealed several 3mm nodules, however the doctor said they are too small to be causing any symptoms. My TSH, again, was slightly above norm, and my free T4 was fairly high, as before. I'm starting to get confused. Is it possible that the nodules are to blame? Or could it be something else altogether. I'd accept it was a purely psychological condition if it wasn't for the abnormal TSH and T4 levels. I'm open to suggestions.


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## Koof (Nov 9, 2011)

yermato said:


> An update on my situation. I did have various tests for TSH-secreting antibodies including TSI and TBII, but I do not seem to have any. Further, I had a brain and pituitary MRI which showed nothing out of the ordinary. I also had a thyroid ultrasound which revealed several 3mm nodules, however the doctor said they are too small to be causing any symptoms. My TSH, again, was slightly above norm, and my free T4 was fairly high, as before. I'm starting to get confused. Is it possible that the nodules are to blame? Or could it be something else altogether. I'd accept it was a purely psychological condition if it wasn't for the abnormal TSH and T4 levels. I'm open to suggestions.


Can you post your results? TSI and TBII have a range by the lab to help track it, but you should have none. A doctor might say you are fine, but if you have TSI or TBII, even under the range, you still HAVE it. I have a TSI which is under the range of 140, but I still am symptomatic (I'm waiting on my darn doctor to send me the slip for TBII). So, please double-check that.

Has your doctor checked other hormone levels? It is my understanding that they thyroid is inter connected with other systems and while I'm not sure a problem elsewhere can cause high TSI, it might??? It still sounds like your symptoms are thyroid. Also, has your digestive system been checked? How about vitamin D and other vitamin/minerals?


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## Andros (Aug 26, 2009)

yermato said:


> An update on my situation. I did have various tests for TSH-secreting antibodies including TSI and TBII, but I do not seem to have any. Further, I had a brain and pituitary MRI which showed nothing out of the ordinary. I also had a thyroid ultrasound which revealed several 3mm nodules, however the doctor said they are too small to be causing any symptoms. My TSH, again, was slightly above norm, and my free T4 was fairly high, as before. I'm starting to get confused. Is it possible that the nodules are to blame? Or could it be something else altogether. I'd accept it was a purely psychological condition if it wasn't for the abnormal TSH and T4 levels. I'm open to suggestions.


Do you have a copy of your lab report? I don't get the "seem" part. Either you do or you don't. I hope you will get a copy as this is very very important.

Also would like to see the TSH and FT4 results with the ranges. That is if you care to share.

Nodules are not psychological.


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## I DClaire (Jul 31, 2011)

All my internist talked about initially was that I had a couple of little nodules, nothing to worry about, we'd watch them with ultrasound and nuclear scans every 6 months, etc., but I KNEW how bad I felt and I KNEW I was getting progressively worse. Over the next 2 1/2 years, I saw one endocrinologist who said my problem was depression (incidently in the same practice with my original internist).

Later I found an endocrinologist who took a real interest in helping me and ultimately I had my thyroid removed almost 3 months ago.

It doesn't sound like you're willing to be treated too slowly and that's good. I wish I'd known more about thyroid disease when I was initially diagnosed. Be your own advocate - you seem to have a good understanding of the test results and you know how you feel. My best advice is hang in there and keep doing exactly what you're doing - find answers that you know make sense.


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## bigfoot (May 13, 2011)

Yermato, your situation sounds very familiar. Like Andros mentioned, there shouldn't be any TSI or TBII present, at all, in your blood. Finding a doctor who can properly interpret this is very hard. I have had zero luck so far myself in that arena. Heck, just finding a doctor who is somewhat knowledgable about thyroid issues is tough. But they are out there, somewhere.

In the meantime, continue to be persistent and stubborn. Be a total pain the the you-know-what. You are 18 years old. These doctors absolutely need to "throw the book" at you and turn over every stone they can find. Simply passing your problem(s) off as psychological is taking the easy road. Been there, done that, got the T-shirt.

This is a total long shot, but you might want to ask about getting your liver checked in a little more detail, or perhaps see a gastroenterologist. I say this because I recently discovered autoimmune hepatitis lurking in the background. It sure is interesting that all of a sudden various "autoimmune" conditions have cropped up. I know I've read here and elsewhere that where there's one of 'em, there's usually more.

hugs3


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## Octavia (Aug 1, 2011)

bigfoot said:


> Been there, done that, got the T-shirt.


Love that phrase...made me laugh! 

And I agree with what you've said.


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## yermato (Nov 26, 2011)

Thank you to everyone for your replies. I am definitely trying my hardest to get to the bottom of this, I assure you. Anyway, here are my lab results.

TSI: <0.30 IU/L (lab says anything below 1.5 IU/L is considered negative)
TSH: 5.26 (range is 0.27 - 4.2)
FT4: 15.73 (range is 9.3 - 17)
Tg Antibodies 10 IU/ml (range is 0-115)
TPO Antibodies 7.48 IU/ml (range is 0-34)

At this point I'm leaning towards hypothyroidism as my diagnosis, though I'm not sure how to explain my hyper symptoms. One of the endocrinologists I visited prescribed me 25mg of levothyroxine to lower my TSH levels, though I'm not sure whether this dose is big enough to have any effect. Meanwhile, I'll keep visiting doctors until someone takes me seriously!


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## Andros (Aug 26, 2009)

yermato said:


> Thank you to everyone for your replies. I am definitely trying my hardest to get to the bottom of this, I assure you. Anyway, here are my lab results.
> 
> TSI: <0.30 IU/L (lab says anything below 1.5 IU/L is considered negative)
> TSH: 5.26 (range is 0.27 - 4.2)
> ...


It would be a good idea to see if you have TBII.

blocking antibodies
http://www.suite101.com/lesson.cfm/19330/2899/4

TBII (Thyrotrophin Binding Inhibiting Immunoglobulin)
http://www.ncbi.nlm.nih.gov/pubmed/1969138 (good test for TSHR)


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