Borderline hyperthermia and hypothroidism?

[iancpriestley]

Has anyone had a similar experience?

Background: I’m hypothyroid (over 5 years now) and as a consequence of failing to properly convert T4 (increasing Levothyroxine dose > 220 mcg and increasing daily, failed to provide relief) and as local medical practice effectively refused endo referral and passed me on to a (very expensive!) private consultancy, I am now self-medicating using NDT, which has proved a success, restoring me to a `reasonable degree of health and “normal” energy levels.

Other than that, I’m fit and active, with no known health issues save those related to the thyroid condition.

Situation: Last summer I was on holiday with my family on the south coast. On a very hot, sunny day, I was swimming in the sea (at times fully immersed) for about 08-10 minutes, enjoying the water along with many other bathers. I began to get cold, so started to exit, back to the warm beach. As I began to return the 20 m or so to the beach, I increasingly struggled, as my energy just seemed to melt away, very, very rapidly, over just 1-2 minutes.

I ultimately needed help to get out of the water and back to my chair, and was visibly shivering intensely as my core body temperature seemingly plummeted...a paramedic could not get a reading! Because I did not recover fairly immediately, I was taken to A&E, where I warmed up to normal temperature en route. The doctors in A&E assessed me but came up with no firm conclusions save that my hypothyroidism was somehow a factor?

Question: My family are obviously concerned about the prospect of a recurrence, though I should add that we had spent two weeks basically living by the unheated swimming pool in a hotel in the Italian Lakes, only a few weeks prior, (we are all strong swimmers) with absolutely no similar health problems.

So, my question, can anyone relate to this experience and have you got any input as to its possible cause/remedy(ies)?

Thank you

Ian

[humanbean]

Getting very, very cold is hypothermia, not hyperthermia which is what you've put in the title.

Hypothermia is a known consequence of severe, untreated or under-treated hypothyroidism.

journals.lww.com/ccmjournal...

The sea is never warm around the UK coast, even when the air temperature is well into the 30s (degrees C) so the combination of being under-treated for hypothyroidism plus the very cold water could have caused you to develop hypothermia.

[iancpriestley in reply to humanbean]

Thank you for the correction. I agree with your assessment of hypothermia and very cold water being a trigger, that's actually what I thought as well.

However, it does leave me confused because it suggests that I'm still being undertreated? My TSH reading of last summer, was virtually non-existent ...in fact the Blue Horizon medical feedback indicated that I was possibly edging into over-medicating... I did ask the A&E doctor, because they took bloods for testing, but it seemed nothing appeared as being unusual/worthy of note.

As you can read from my original post, I tend to go by my testing results plus how I feel as an indicator of overall health, so I'm wondering now if I'm missing something critical here? I took my normal tablets that day and I split the dosage equally into four - early morning, late-morning , mid afternoon and early evening, so that's not a factor, as far as I know. Hmmm...any thoughts are welcome?

Ian

[SlowDragon Administrator in reply to iancpriestley]

On NDT TSH will almost always become suppressed...even when still on too low a dose

The most important results are Ft3 followed by Ft4

thyroidpatients.ca/rational...

[humanbean in reply to iancpriestley]

The number of possible causes of hypothermia is long and I would only be guessing which one(s) had any relevance to you. The link I gave in my post mentions these :

Causes of hypothermia include cold exposure, medical condition such as hypothyroidism, adrenal insufficiency, sepsis, toxin, and medications. Hypothermia is also complicated by other comorbidities such as arrhythmia, lactic acidosis, coagulopathy, infection, and rhabdomyolysis which are life threatening.

You had been immersed completely in cold water, you are hypothyroid, adrenal issues and heart arrhythmia are common in people with hypothyroidism, and if you had been swimming hard you could have developed lactic acidosis.

Also :

en.wikipedia.org/wiki/Hypot...

gives water immersion a section all by itself as a cause of hypothermia.

...

You haven't posted any blood test results that I can find.

As you can read from my original post, I tend to go by my testing results plus how I feel as an indicator of overall health, so I'm wondering now if I'm missing something critical here?

Many doctors believe that hypothyroidism is a simple disease (the majority of patients are women so it must be simple *sarcasm*) with few symptoms, with a simple test (TSH) and a simple treatment (Levothyroxine). Many doctors only really seem to "believe in" a very few of the symptoms that patients complain of, such as fatigue and depression.

Compare these lists of symptoms :

From NICE :

cks.nice.org.uk/hypothyroid...

Short list from Thyroid UK, the charity that runs this forum :

thyroiduk.org.uk/tuk/about_...

Long list from a Thyroid website :

hypothyroidmom.com/300-hypo...

There are people who come on to the forum who are taking all sorts of drugs for the various symptoms they have when the underlying problem is having levels of thyroid hormone which are too low.

Another problem is that nutrient deficiencies are very common in people with thyroid disease, and they can cause an enormous number of symptoms in their own right.

Adrenal issues are also a common problem.

Without further information I don't think anyone can give any suggestions as to the cause of your hypothermia.

[Jazzw in reply to iancpriestley]

When on NDT, the most important blood test result is FT3. You’re looking for it to be high in range. Out of interest, what was it on your Blue Horizon check last year?

TSH will nearly always be suppressed on any amount of NDT and it’s common for FT4 to be lowish too. A suppressed TSH doesn’t mean you’re overmedicated, it simply means that your pituitary gland isn’t sensing a need to produce thyroid stimulating hormone.

2 grains of NDT isn’t a particularly large dose so there could well be room for an increase.

[iancpriestley in reply to Jazzw]

Firstly, my thanks re input from Jazzw, humanbean and SlowDragon.

Attached are results of bluehorizon tests, taken 01st September 2019, a few days later, when we were home.

TestResult Range

1)Biochemistry

hs-CRP 2.52 mg/L <5.0 mg/L

Ferritin 160.0 uG/L 30-400 uG/L

2)Thyroid Function

TSH - L <0.005 mlU/L 0.27-4.20 mlU/L

T4 Total - 132.0 nmol/L 66-181 nmol/L

Free T4 - H 28.00 pmol/L 12.0-22.0 pmol/L

Free T3 - H 16.80 pmol/L 3.1-6.8 pmol/L

3)Immunology

Anti-Thyroidperoxidease absH195.0 klu/L <34 klu/U

Anti – Thyroglobulin AbsH 1818 klu/L <115 klu/U

4)Vitamins

Vitamin D (25 OH) - 58 nmol/L Deficient < 30, Insufficient 30-50,

Consider reducing dose > 175 (nmol/L)

Vitamin B12H - 579 pmol/L Deficient < 145, Insufficient 145-300,

Consider reducing dose > 569 (pmol/L)

Serum FolateL - 8.04 8.83 - 60.8 nmol/L

FT4 and FT3 are both flagged as being High, hence my thought that I was over medicating.

Not sure about drawing any more conclusions re Immunology High results, except that I'm hypothyroid!

I'm also taking vitamin supplements, as per Seaside Suzie's advice, its been a long battle re maintaining adequate Ferritin and folate levels!

Jazzw - Sorry, I didn't say I was taking only 2 grains of NDT, I'm not sure what a grain represents, in this context?

My standard dosage is/was actually 10 x 60mg tablets of Thyroid-S (NDT) - split x3 early am, x3 mid-morning, x3 mid afternoon and x1 - early evening.

Hope this additional data helps...any input welcomed re hypothermic situation, of a few days previous - being thyroid condition related or just a personal mis-judgement of sea water temperature?

Ian

[Jazzw in reply to iancpriestley]

Hi Ian. I’ve no idea where I got “2 grains” from—sometimes I look at previous posts when someone asks a question to see if I can pick up more info—but still can’t see how I got there, sorry!

Anyway... a grain is an old-fashioned measurement for dessicated pig thyroid. Usually, a grain is about 60-65mg of NDT. I believe a Thyroid-S tablet tablet is equivalent to a grain.

But that would mean you’re on 10 grains a day. And if so, I think that might be the highest dose of NDT I’ve ever seen...

How did you settle on such a high dose?