I am 78 male ,suffer from PMR, last 2 years, have reduced from 20 to 15 mg pred. Also suffer from under active thyroid gland. severe fatigue

since OP pre med required reduction 200cmg to 150 thyroxine. (20 years sufferer) 6 weeks ago. THS 0.2/FT 25.2

Last 2to 3 week very tired .Does this sound like too bigger drop after so many years with tests. Any relationship to PMR/Pred or stress concerning operation -which went well. Normally active ,swim etc -just feel tired -no 'oomph

thanks John

[humanbean]

I can't help you with the prednisone - it isn't something I'm familiar with.

I do think the drop in your thyroid meds was too much, too quickly - and I'm not clear on why it was required? Did you have thyroid function tests before your operation? If you did, you should ask your doctor or the hospital for a copy of the tests including reference ranges and post them here. You are entitled to a copy of test results.

Another thing that comes to mind... Assuming your operation was done under general anaesthetic, it is possible that one of the gases used was nitrous oxide. If it was, then it may have stripped your body of usable vitamin B12. If you search on the web for "nitrous oxide anaesthetic vitamin B12" or some combination of these terms you will find lots of information about it.

ncbi.nlm.nih.gov/pubmed/825...

As a result you really need to ask your doctor for a vitamin B12 test. There are two kinds of vitamin B12 test - the "traditional" one which isn't very good but is the one the NHS uses most of the time, and the Active B12 test which is much more accurate. If you could persuade your doctor to test your levels it may highlight a deficiency. Don't start supplementing until after you have been tested - and ask (here) for advice about the type of vitamin B12 you need - some supplements are better than others.

The other thing that happens to many people with an under-active thyroid is that their mineral and vitamins levels can drop quite dramatically. So as well as asking your doctor for an active vitamin B12 test, please also ask for an iron panel, ferritin, vitamin D, and folate levels to be tested.

In each case ask for the results including reference ranges and post them here. What a doctor thinks are normal levels, and the levels a hypothyroid person really needs are quite different.

[Hidden in reply to humanbean]

Thank you humanbean .The thyroid function test was part of the pre med prior to the OP-4 weeks later. Results -THS 0.2/FT 25.2. My Dr seeing the results of the pre med changed the thyroxine dosage prior to the OP-without knowing what anaesthetics I would be having.I am checking now what I did have exactly. I have also asked for another thyroid function test..Thanks for the tip re the

supplements- particularly the B12 - actually my Mother had that problem of B12 deficiency.I do take D3 regularly as part of the treatment of PMR and pred-it is a steroid which is nasty with bones.John

[Hidden]

Agree with excellent post above. I would not waste time trying to get b12 from the nhs - i had v low b12 and they fobbed me off. Went private and found I had pernicious anaemia.

I self inject now from my own supply as nhs rations you to a useless dose. You will not get it on nhs unless you have p anaemia but it is v useful for fatigue. While there may be other issues that need to be addressed, i think it would give you a good boost to have a loading dose (1 shot every other day for 5 or 6 shots) then a shot a month. B12 amps are not expensive on private script, however the private consults are.

You could meanwhile start immediately on d3 tabs and b12 tabs, but get a good, high strength one without mag sulphate.

I had an op under GA in Jan 13 and it took me over 3 months to recover. Based on my own research i found that fentanyl, midazolam and ondansetron are all contra indicated with adrenal fatigue - but since the nhs doesnt recognise adrenal fatigue.... well you get my point

[shaws Administrator]

Hi scubadiver

I am sorry you are feeling unwell. One most possible reason is a reduction of your levothyroxine from 200mcg to 150mcg if it was reduced only on the result of your TSH alone. The reason it may have messed up your metabolism. Unfortunately, nowadays, doctors have been informed that the TSH is the 'exquisite' test (wrong) - it should be by how the patient feels and if he/she feels fine nothing should be done. Excerpt:-

A study by Fraser,[44] for example, showed that the TSH and free T4 tests—which Guttler uses—are in fact highly fallible. Fraser studied patients on T4-replacement. Of 108 patients who were free from hypothyroid symptoms—and any signs of overstimulation—53 (49%) had TSH levels below the lower end of the reference range. This was a TSH level that thyroid specialists such as Dr. Anthony Toft have falsely designated a "thyrotoxic" level.[47,p.91]

The endocrinology specialty has intimidated most conventional doctors into accepting without question Toft’s false designation. As a result, most doctors would have had Fraser’s patients—who were free from hypothyroid symptoms but had low TSH levels—reduce their T4 dosages. Of course, this would have raised the patients’ TSH levels. And most likely, it would have caused them to begin suffering again from hypothyroid symptoms.

web.archive.org/web/2010103...

Read the first q/a on this

web.archive.org/web/2010103...

[Hidden]

Thank you Shaws I will look into this aspect of relying on the test only. In real terms I am now surprised the dosage was reduced just before the OP. When the body is possibly subject to hormonal changes just thinking about the OP. John