Endocrinologist is at a loss with my case. Help!

[apso]

Hello,

I am a new comer to this great website.

I have been suffering of extreme fatigue since April 2016. I had always put that down to extensive working hours and having 3 kids.

In February this year, I was referred to an endocrinologist who put me on levothyroxine increasing my dose gradually so that I am under 62,5mcg for 5 weeks now.

However, I still feel fatigued, and flu-like most of the time. My mouth and eyes are also dry. I noticed that my fingernails are getting “bad”, and tinnitus has established itself in my right ear 5 weeks ago. My endocrinologist doesn’t seem to know how he can help me and seems lost.

My values are as follows:

Feb 2018 (right before starting Levothyroxine medication)

Tsh 1.88 Range [0.3 4.5]mU/L

FT4 18.42 Range [9.03 23.22]pmol/L

FT3 4.91 Range [3.23 6.47]pmol/L

Vit D 106.5 Range [50 150]mcg/L

Vit B12 625 Range [210 1000]ng/L

Free cortisol (8h) 5.2 Range [10 30]mcg/L

Cortisol (8h) 10.9 Range [7 25]mcg/L

April 2018 (3 weeks into 50 mcg of Levothyroxine)

Tsh 0.81 Range [0.3 4.5]mU/L

FT4 17.12 Range [9.03 23.22]pmol/L

FT3 4.53 Range [3.23 6.47]pmol/L

Folate 9.9 Range [2 12]ng/L

Vit E 10.4 Range [10 19]ng/L

July 2018 (3 weeks into 62.5 mcg of Levothyroxine)

Tsh 1.00. Range [0.3 4.5]mU/L

FT4 20.26. Range [9.03 23.22]pmol/L

FT3 4.41 Range [3.23 6.47]pmol/L

Vit D 38.9 Range [50 150]mcg/L (I had stopped taking supplements since the February results)

Folate 12.6 Range [2 12]ng/L

Vit E 12.5 Range [10 19]ng/L

Free cortisol (8h) 5.2 Range [10 30]mcg/L

Cortisol (8h) 11.7 Range [7 25]mcg/L

[AnnaSo]

Your cortisol is extremely low. However, it should be tested with saliva.

[greygoose]

Well, it doesn't take much to lose an endo, I have to say! But, I can't understand why he put you on levo in the first place. It wasn't low, your TSH wasn't high. Did he not test your antibodies?

Looks to me like your cortisol is the problem, your adrenals, not your thyroid. And your adrenals need further investigation. Goodness! What do they teach these endos in med school these days!

You shouldn't have stopped the vit D in February, just lowered the dose to a maintenance dose. Your result was just fine. But, were you taking the co-factors : magnesium and vit K2-MK7?

Your vit E is a bit low.

Now you need your ferritin tested. Low iron is a major cause of fatigue.

[apso in reply to greygoose]

Thanks.

I was wondering, given that my FT3 were in the lower range before being on Levothyroxine, could it be that I need T3?

I’m saying this because I read somewhere that adrenals need T3 to work properly.

I understand there is a “co-dependency” between low FT3 and low cortisol.

But, I have to say also that I practice a lot of running and each time I had done the blood test it was one or 3 days after running 11k.

My iron, ferritin, magnesium are good.

Don’t know about vit K2-MK7

[greygoose in reply to apso]

Your T3 wasn't low. It was what one expect for someone not on thyroid hormone replacement, and corresponded, more or less, to your TSH.

There's no point in testing magnesium, because it will always be in-range due to the way the body handles magnesium. But, that doesn't mean you're not deficient. Most people are because soils are depleted.

Vit K2 is not normally tested (the MK7 just means that it is derived from natto). People take it with vit D because taking vit D increases the absorption of calcium from food, and the K2 directs it into the teeth and bones, so that it doesn't build up in the soft tissues.

[diogenes Remembering]

If you look at the results consecutively: On increasing T4, TSH goes down (expected) and FT4 goes up (expected) but FT3 remains the same or declines (unexpected). This shows to me that your body is reacting negatively to the T4 by suppressing T4-T3 conversion to FT3, the active hormone. Given your first results not on therapy I don't know why the endocrinologist put you on to T4 in the first place, but it doesn't seem to be doing any good. Further increases in T4 will only make the situation worse, so I suggest you slowly lower your T4 dose and see if there is any improvement after a while.

[apso in reply to diogenes]

Thanks.

I was wondering, given that my FT3 were in the lower range before being on Levothyroxine, could it be that I need T3?

I’m saying this because I read somewhere that adrenals need T3 to work properly.

My iron, ferritin are good.