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Old 01-08-2013, 09:03 AM   #1
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Brain Fog, Fatigue, Tinnitus but Good Labs?

Hello,

I've been reading around these boards for months and you all have been extremely helpful and I've learned a ton. Sorry if I drop the ball on the proper etiquette here but just wanted to get some support and ask a couple questions.

I'm a newly diagnosed Hypo, went to the doc complaining of slight dizziness, brain fog, tinnitus, and tired all the time, anxiety, all the good things, I've been miserable most days. All of this came on fairly quickly over a couple of months time and previous to this I had been going to the gym regularly for about a year and always felt pretty healthy and energetic.

I had been to a few Docs before and none of them had an answer. Thyroid runs in my family and my Sister actually suggested I get the test done so I asked for the test.

My diagnosing lab was taken in October:

TSH 4.2 (.36 - 3.74)
FT4 1.05 (.76 - 1.46)

Went on Synthroid for about 6 weeks 25 mcg. Couldn't tolerate it and after about a week went down to 12.5 mcg due to insomnia/anxiety. Did not help any of my symptoms. Had another lab drawn in November, TSH and Morning Cortisol only:

TSH 6.27 (.36 - 3.74)
Cortisol 12.6

Doc switched me to Armour partly by request and also because he thought the added T3 would help with my symptoms. Titrated up from 1/2 grain every two weeks to 1 grain, after 2 weeks at 1 grain and a total of 6 weeks on Armour, I took another lab with FT3/FT4 and Antibodies.

TSH .35 (.36 - 3.74)
FT4 .99 (.76 - 1.46)
FT3 4.0 (2.18 - 3.98)
TPO 0.5 IU/ml (0.0 - 9.0)

I kept on hoping I would feel better when I got the FT3 high and the TSH below 1, but I still feel foggy and tired. Now the doc is saying to hold at 1 grain for 3 months. Is it possible that symptom relief is lagging a bit as I've only been at 1 grain for 2 weeks? Maybe it's wishful thinking haha! All I know is that I'm very frustrated and I don't feel anywhere near how I used to feel. I actually think I feel worse than I did when I was diagnosed. Any thought or ideas are welcome and thank you in advance.

Last edited by Frank157; 01-10-2013 at 10:24 AM. Reason: Lab result came in

 
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Old 01-08-2013, 01:11 PM   #2
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Frank157

Yes it can take as long as 6-9 weeks to see symptoms change.

Also it takes 4-5 weeks to get full build-up of the meds in your body. So after only 2 weeks on One grain, your labs are reading low compared to what you would get if you had waited 4 weeks. I would suggest getting new labs a lot sooner than 3 months, to see what is going on.

Also it is possible that your own thyroid is not stable. Your TSH increased from 4. 2 to 6.27 in Nov, indicating going more hypo; but your latest labs with the FT3 high relative to FT4 could possibly indicate you were going thru a hyper period. TPO test may tell the tale...

 
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Old 01-08-2013, 03:23 PM   #3
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Thanks for your response. Good call on getting labs sooner. I will push for that. I'll post back with the TPO, interesting thought on the hyper phase. One other concern I've had is that it seems I've read story after story about how 1 grain is not enough haha! Is it possible to get symptomatic relief from 1 grain?

 
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Old 01-08-2013, 08:42 PM   #4
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Yes, about 3 grains seems to be required if your thyroid was completely shut down or removed.

But if your own thyroid is still producing some thyroid hormone, then you may require less than 3 grains. It would seem to me that you are presently in this position because I don't think one grain would be enough to push your FT3 up to 4.0.

However the ability of your thyroid to produce could change and so you need to get labs on a regular basis.

 
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Old 01-09-2013, 06:55 AM   #5
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Quote:
Originally Posted by telus View Post
Yes, about 3 grains seems to be required if your thyroid was completely shut down or removed.

But if your own thyroid is still producing some thyroid hormone, then you may require less than 3 grains. It would seem to me that you are presently in this position because I don't think one grain would be enough to push your FT3 up to 4.0.

However the ability of your thyroid to produce could change and so you need to get labs on a regular basis.

Good call again. Do you think I should be concerned that my FT3 will become too high since I've only been at 1 grain for 2 weeks before labs? I have been feeling a bit more anxiety these past few days but maybe that's just anxiety. I've been able to sleep which has been nice. How much time do you recommend leaving between last dose of Armour and lab work so that the FT3 is not artificially high?

 
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Old 01-09-2013, 07:49 AM   #6
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

What exactly do you mean by "anxiety"? Could it be a hold-over hypo symptom?

I think it would be reasonable to wait until you are at 4 weeks on 1 grain, then repeat tests, or only 3 weeks if you start to feel really bad.

Yes, if you took your Armour in the morning of your blood tests, then that could give the elevated FT3.

It is best to be consistent with the time of day for taking the blood sample for your lab tests. After you take your Armour pill, your FT4 and FT3 will go up and TSH will go down for several hours (at least 8-10 hours). Do NOT take the pill in the morning and go give the sample at 8 - 9 am, then take your pill. Do it the same every time.

 
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Old 01-09-2013, 10:49 AM   #7
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

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Originally Posted by telus View Post
What exactly do you mean by "anxiety"? Could it be a hold-over hypo symptom?

I think it would be reasonable to wait until you are at 4 weeks on 1 grain, then repeat tests, or only 3 weeks if you start to feel really bad.

Yes, if you took your Armour in the morning of your blood tests, then that could give the elevated FT3.

It is best to be consistent with the time of day for taking the blood sample for your lab tests. After you take your Armour pill, your FT4 and FT3 will go up and TSH will go down for several hours (at least 8-10 hours). Do NOT take the pill in the morning and go give the sample at 8 - 9 am, then take your pill. Do it the same every time.
I didn't take the dose in the a.m. before the test, I took my last dose 14 hours prior in the p.m. There was about 14 hours of time between the last dose of Armour and the blood draw. I will definitely try to be consistent with each test. Times/prior doses.

I'm not sure what a hold-over symptom is but I am about to do some research.

By anxiety I mean I feel a bit on edge, a bit nervous and anxious for no reason. Anxiety runs in my family. It's usually pretty tolerable for me, even nonexistent, but maybe the last 3-4 days it has been noticeable about half of the time. I guess I was just curious if that could be an FT3 being too high sort of thing, or if it's just par for the course and I'm still adjusting and possibly having an amplified symptom. I emailed my doc about possibly dropping down 1/4 grain to a total of 3/4 grain for a bit to see if that brings my FT3 back down a touch but haven't heard back from him yet. He may just want me to hold at 1 grain.

 
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Old 01-09-2013, 11:41 AM   #8
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

By hold-over I mean a symptom that is still sticking around from when you were definitely hypo. Because as I noted earlier, it can take a long time for symptoms to alleviate and you mentioned in your first post that you had had some symptoms for quite a while.

Do you have a sports watch with a heart rate monitor, such as a Garmin? If so put it on and record your heart rate for 12 or 24 hours; ******** it to your computer. Keep notes of how you feel thru the day. What does your beats-per-minute do when you don't feel right? If it spikes high, palpitations or tachycardia, that can be caused by being hypothyroid, as well as hyperthyroid. If this is happening you should show it to your doctor. He would probably order a electrocardiogram (ECG) for you. However it won't show anything unless you are actually having tachycardia at the time of this brief test. Or he might order a Holter monitor test, which records for 24 hours. Been there - done that.

You're right, it just seems to happen randomly for no reason at all. In which case it's not "anxiety attacks" - it's tachycardia caused by high or low thyroid.

I want to add a warning that there a lot of doctors that do not know that tachycardia can be caused by being hypothyroid.

Last edited by telus; 01-09-2013 at 11:43 AM. Reason: add last sentence.

 
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Old 01-09-2013, 12:55 PM   #9
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Quote:
Originally Posted by telus View Post
By hold-over I mean a symptom that is still sticking around from when you were definitely hypo. Because as I noted earlier, it can take a long time for symptoms to alleviate and you mentioned in your first post that you had had some symptoms for quite a while.

Do you have a sports watch with a heart rate monitor, such as a Garmin? If so put it on and record your heart rate for 12 or 24 hours; ******** it to your computer. Keep notes of how you feel thru the day. What does your beats-per-minute do when you don't feel right? If it spikes high, palpitations or tachycardia, that can be caused by being hypothyroid, as well as hyperthyroid. If this is happening you should show it to your doctor. He would probably order a electrocardiogram (ECG) for you. However it won't show anything unless you are actually having tachycardia at the time of this brief test. Or he might order a Holter monitor test, which records for 24 hours. Been there - done that.

You're right, it just seems to happen randomly for no reason at all. In which case it's not "anxiety attacks" - it's tachycardia caused by high or low thyroid.

I want to add a warning that there a lot of doctors that do not know that tachycardia can be caused by being hypothyroid.
You are kind of reading my mind and life haha! I did notice that my BPM went up to the 80's earlier when I was feeling sort of anxious and then went back down to my usual 64-68 when I feel more normal. It seems to come and go in waves during the day. I think it's been kind of doing that on and off but I don't have any solid proof yet. I will have to pick up one of those watches. I think I did experience the same thing before I started treatment but I don't think it was as noticeable. Did this level out for you eventually? Also, did you ever experience any orthostatic hypotension, I think they call it? Sometimes even just from a seated position if I get up, I can sort of feel blood pumping through my head and even sometimes get a slight head rush. My BPM also sometimes rises when that happens. I had that a little bit before I went Hypo but it seems to have become way worse with Hypo.

 
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Old 01-10-2013, 10:32 AM   #10
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

Quote:
Originally Posted by telus View Post
Frank157

Yes it can take as long as 6-9 weeks to see symptoms change.

Also it takes 4-5 weeks to get full build-up of the meds in your body. So after only 2 weeks on One grain, your labs are reading low compared to what you would get if you had waited 4 weeks. I would suggest getting new labs a lot sooner than 3 months, to see what is going on.

Also it is possible that your own thyroid is not stable. Your TSH increased from 4. 2 to 6.27 in Nov, indicating going more hypo; but your latest labs with the FT3 high relative to FT4 could possibly indicate you were going thru a hyper period. TPO test may tell the tale...
Don't know if you wanted to add anything. TPO came in today and I added to the lab results posted in original post.

Doctor's note with the result result read: No antibodies to the thyroid suggesting possible temporary thyroid under activity. Will monitor going forward and taper as needed. This is likely hypothyroid due to viral thyroiditis, not autoimmune thyroiditis.

Thought this was maybe good news but I am still wanting to take every precaution necessary to be as healthy as possible regarding my recovery and symptoms so if you have anything to add I would still much appreciate it. And thank you in advance.

 
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Old 01-10-2013, 11:51 AM   #11
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Re: Brain Fog, Fatigue, Tinnitus but Good Labs?

I'm afraid I am not qualified to comment on TPO and the conclusion that your doctor has reached. Perhaps someone else will wade in here.

I would say however that because of the big swings in your labs that you should continue to get labs to monitor the situation (say every 4 weeks?). And always get TSH, FT3 and FT4.

Also it would be a good idea if you are not already doing so, get a notebook and keep a daily diary of your symptoms and their time periods. So there's no guessing when you go to the doc.

 
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