Hypothyroid? Something else?

[kayare]

Hi All,

I hope I can get some ideas please. My MC has been under control for the most part, and my joint pain is much improved. I now need to turn my attention to some ongoing, increasing troublesome symptoms.

About seven years ago, I was at an event where I had to climb several flights of stairs during the evening. I noticed my legs were weak (not tired), and it frightened me. Since that time, I have noticed the same muscle weakness in both my arms and legs from time to time although it seems to be happening more frequently and intensely now. I realize that MC, severe joint pain, and a busy work schedule has limited my exercise, but this seems different.

On occasion, my left hand will tremble and sometimes I feel generally shaky. I believe my hair is thin, my blood pressure and body temperature are low, fatigue is common, and I'm usually cold, but these can be subjective. I can't touch a plant in my yard without breaking out in an itchy rash that lasts for weeks.

I do have some 5 mg Prednisone. I took one for two nights a week ago. I felt much better for two days.

My blood work from July 26, 2013 shows TSH 1.47 (0.350 - 5.500)
Free T4 0.73 ((0.76 - 1.76)
Cortisol Total 12.2 mcg/dL (4.0-22.0)

My diet is very basic - GF, SF, EF, CF - Basically rice, potatoes, seafood, Larabars, almond butter, and a few veggies and fruits. I take two Benadryl at night.

Any ideas or suggestions are welcome!

Thanks! Kathy

[tex]

Free T4 0.73 ((0.76 - 1.76)

You are in the same situation that I'm in, low Free T4. That means that you are definitely hypothyroid, but the bad news is that most doctors don't even recognize the problem (because they apparently don't understand what low Free T4 implies), and consequently they wouldn't have the foggiest idea how to treat it even if they did recognize it.

When Free T4 is low, the proper way to treat it is to ignore the TSH and treat the Free T4. Unfortunately, treating by TSH is so ingrained in most doctors' training that they worship it as if it were some sort of pagan god, and they can't bring themselves to ignore the TSH.

Years of untreated hypothyroidism and low cortisol also go together.

How Adrenals Can Wreak Havoc

Are you by any chance taking a statin? If so, it could be the cause of your muscle weakness. If not, the weakness is probably due to the hypothyroidism.

Tex

[kayare]

Thanks, Tex.

No, I'm not taking a statin. You're so right about doctors not recognizing the problem. My PCP said she wanted to watch my low free T4 number and another doctor said my thyroid function was normal.

What is the proper treatment? Do you have any advice for getting a doctor to help me with this?

Kathy

[tex]

The proper way to treat it is to take a thyroid supplement and experiment with increasing the dose until the Free T4 results are far enough into the normal range to resolve your clinical symptoms. It takes roughly 2 weeks for the thyroid chemistry to stabilize after a dose change, so you need to wait at least that long before doing a followup blood test. Taking a dose that resolves your symptoms may or may not push your TSH to below the normal range, but if it does, that worries the heck out of most doctors.

I was lucky. I had an old country doctor at the time, and he was willing to let me try a minimum dose, and when that didn't have much effect, we doubled the dose.

Here's a link to an excellent (but long) article that covers such non-typical thyroid issues in detail. If you scroll down the page to the section where it says:

4 Interpretation of TSH and T4 assays

4.1 The TSH-T4 relationship

You'll find a lot of valuable information about the relationship between TSH and T4.

Clinical Strategies in the Testing of Thyroid Function

I don't know if it would do any good to print that article for your doctor or not. It's difficult to persuade them to read long articles, but she or he might read some of the more important parts, if you point them out.

Figure 4, for example (under the heading that says: 4.3.1 Steady-state conditions.), and the caption under that graph, describes the basic idea of treating for T4 rather than TSH.

Tex