Does anyone else have this? One possible cause seems to be if you have an extra cervical rib. I have a cousin who does, so possible I might well have too. I am hypermobile, hypo and have a tendency to having clicky, clunky clavicles on occasion throughout my life. One extra 1st cervical rib, I imagine , would likely anchor the clavicles differently one side to another, possibly causing the clicking and clunking?
Another possible cause might be a thyroid nodule interfering.
A blockage?
Anyone?
I thought everybody had higher BP in one arm than the other. I certainly do. And I don't have any extra ribs - I've counted them!
Seemingly, one arm 30 higher is considered okay if you have white coat syndrome, which I do. The dominant arm will usually be higher than the other. As far as I know , anything over 30 would be suspect!
So is one arm always 50 higher than your other arm? Because I find BP varies a lot from one reading to the next.
It will vary, as you say, from one reading to the next. Sometimes the difference is as much as 57. At other times , in the 40s. There can be times when it is in the 20s.
I attended NHS Endo in December for a 2 nd appointment. At my initial appointment, one and a half years ago, he was off sick and I saw his registrar. When they took my blood pressure before I went in to see the consultant, whom I had never met before, he walked past the doorway as I was getting my blood pressure taken. He is rabidly anti T3 and my health authority does not prescribe it. In the interim one and a half years I have started T3 in addition to T4. The T3 is prescribed by a private Endo. My last private bloods, 4 weeks before the appointment showed FT4 78.33% and FT3 83.78% on T4 68 mcg and T3 7.5 mcg. I was nervous at having to admit I was on T3 , most especially when my levels were pretty high, and he would have a fit.
I had kept T4 at 68 mcg and reduced T3 to 5mcg, 4 weeks before the appointment, just after having had a covid and flu vaccination, which may have been affecting my bloods at the appointment. I had also previously trialled a T4 dose of 68 mcg and T3 at 10 mcg. FT4 was 78.33% and FT3 89.73%. So , previously FT4 had remained the same and only FT3 had reduced, which I think is not what would be expected.
I had hoped that FT4 would stay at 78.33% (as it previously had) and that FT3 might fall to about 77%, though thyroids are not usually that cooperative. Nearly 2 months later when I eventually got my blood results I dodged a bullet as on T3 of 5 mcg , Ft3 was 54.05%. FT4 had dropped this time to 61%. Granted it was a reading on a 4 week dose, at 3.45 p.m. when I usually test at 12.10 p.m. for consistency. I had also eaten and had recent vaccinations.. I tested my thyroid today on this same dose , giving it time to settle properly to see if it is markedly different , though I currently feel I have thyroiditis.
I would very much value any thoughts you have on the above blood results.
My blood pressure at the appointment was 190 over 90. This is what prompted me to start checking my blood pressure on a daily basis since December. I decided to test both arms .
In 2013 at a hospital eye appointment , my top reading was 212. Historically, I have had 3 separate 24 hour blood pressure monitors. One was a fortnight before the 212 reading. No action was taken on the results.
By currently testing both arms, it has dawned on me that the 24 hour monitors were done on my good arm, which is the non dominant arm.
The readings all look good. But the question is: how do you feel? Which dose do you feel best on?
I worked my way up the T3 doses very slowly , starting at 2.5 mcg. It was either 2.5 mcg or 5 mcg as I worked my way up that I most definately felt benefit. I lost the benefit at 7.5 mcg and at 10 mcg. I had hoped that when I worked my way back down slowly to 5 mcg , that that would be the dose I felt benefit. I have held this dose since November to allow it to settle as NHS Endo tested this dose at 4 weeks, on 16/12/24. ( TSH 0.11 (0.27-4.2), FT4 61% and FT3 54.05% at 3.45 p.m. with testing protocol per the forum, but I had eaten)
I feel dreadful and the benefits I felt back at the start have not returned. I think I need to go down to 2.5 mcg again and hope I feel the benefits again. I did lose hearing in my right ear in January which many believe is caused by low T3 ( FT3 61%), however. FT3 was 83.78% on 11/11/24.
I don't understand the steep drop. Do you think that would be sensible, regardless of what the blood results for the test I did yesterday are? Probably next week before they appear. I think I currently have thyroiditis, so really, really keen to see what my bloods are doing now!
I would be thinking more about the steep rise than the steep drop. There was no way your dose was ever going to give you and FT3 of over 83% through the range. You have Hashi's so the rise was probably more to do with that than with your dose. But it's only temporary, and now it's gone down to hypo again.
I don't really think it would be a good idea to go back to 2.5 and start again. I think I would start slowly increasing again, 2.5 mcg at a time, leaving several weeks between increases.
Ah! Relieved now that I asked your advice, then!
24/2/22 TSH 4.02 (0.27-4.2), FT4 5.5 (12-22), FT3 6.5 (3.1-6.8). I always have negative tpo and tgab antibodies, so far, on testing. Genetically, I have all the bad double mutations associated with susceptibility to Graves disease/Trab antibodies. I have never been over range so far for TSH, FT4 or FT3. All blood tests are hypothyroid results.
Really appreciate your input. Glad you have pointed out that that dose shouldn't raise FT3 to that extent unless thyroid under attack. I 've tied myself in knots trying to figure out what is going on, but it didn't dawn on me that that was why FT3 has been dropping down into the 40s%, and FT4 plummetting. TRab antibodies haven't been checked by NHS Endo, nor will they be as they refused to even test ferritin and folate on the basis that I had had them checked a year and half previously, and they have nothing to do with thyroid! In a letter to my G.P., initially, the NHS Endo has said I have possible Central HYPERthyroidism. Waited one and a half years for 2 nd NHS Endo , 10 minute appointment and appointment cut short as his previous patient had passed out and Consultant said he had to go, to attend to them. He advised ME to go straight home without thyroid bloods being tested as I would have quite some considerable wait! I said I'd wait, and waited a few minutes!
Had 1 (MRI brain scan), then 2 , then 3 nodules on previous thyroid ultrasounds. (1 private and 1NHS) NHS saying my thyroid is normal, I will develop many more nodules, and capable of working normally. Probably have more nodules as currently awareness of feeling of fullness in my neck. I did a thyroid blood test on Monday which includes TPO and TGAB antibodies, but don't think I will have any.
10/7/23 TSH 0.09 (0.27-4.2), FT4 21.9 (12-22), 99%, FT3 5.5 (3.1-6.8),64.86% on T4 levo only at 75 mcg.
5/12/23 TSH 0.31 (0.27.4.2), FT4 17 (12-22), 50%, FT3 4.6 (3.1-6.8), 40.54% on T4 levo only at 63 mcg.
18/3/24 TSH 0.20 (0.27-4.2), FT4 20 (12-22), 80%, FT3 4.9 (3.1-6.8), 48.65% on T4 levo only at 72 mcg.
In these 3 tests on T4 Levo only where only 9 and 12 mcg differences in dosages, is that more likely to be attacks on my thyroid and hypo again 5/12/23, rather than a possible tipping point in doses where one dose may be a top-up , whereas 75 mcg is a full replacement dose, type of thing?
One of the many things that confuses me is that on 5/12/23 , FT4 is 50% and FT3 is 40.54%, and TSH is in range, just. I have been told by the NHS , when I specifically asked the question, that my thyroid is normal , and if I have a signalling issue , it is healthy and I would have normal function if it received a proper signal . I suspect they still think it is transitory. As it is often quoted on the forum that a normal , healthy thyroid would supply approximately 50% FT4 and 40% FT3, had I showed this private blood test to the NHS they may have thought it was perfect. I did not feel well at all on this dose and it was an experiment , on my part, to see if TSH would come into range if I reduced my dose to T4 , 63 mcg.
TSH came into range but nothing tracked on my right hand side (knee, hip,shoulder). I was hobbling and everything was clunking and clicking.
It makes more sense of the erratic fluctuations when T4 dose unchanged if it is because thyroid under attack. Until now, I had been attributing it more to signalling problems, and despite boxes of notes taken on all things thyroid, I am still at a loss on how best to proceed.
I can see the sense of not reducing T3 down to 2.5 mcg again, where it seemed it was the only time I felt huge benefit. The last testing that I had before starting combo at the beginning of May, and introducing 2.5 mcg T3, was the 18/3/24 one where FT3 was 48.65%. So if FT3 as low as this , or lower, when I introduced T3, it makes sense that I did feel undoubted benefit.
This may sound crazy. Theoretically, do you think it may be possible that by keeping the T4 dose as high as 68 mcg and not reducing to, say, 50mcg, the body might instigate an autoimmune attack on the thyroid to balance FT3 with FT4 more, though still giving me a higher FT3 than FT4. I have two DIO1 mutations. One is a poor converter, the other a rapid converter for liver and kidneys. One is for T3 higher than T4 , the other T4 higher than T3.
I have eventually managed to get my hands on a thyroid test result done at a Rheumatology appointment in 2013 when B12 deficient and feeling at rock bottom:
TSH 0.4 (0.2-5.0), FT4 19.4 (9-21), 86.67%!
Would you recommend keeping T4 dose at 68 mcg, increasing it slightly, or lowering it? I have liquid levo, so this is easily done. I'll update you , if you don't mind, when I get my test results , probably Monday coming. Right now I feel incredibly stupid!!!
Happy belated birthday.
24/2/22 TSH 4.02 (0.27-4.2), FT4 5.5 (12-22), FT3 6.5 (3.1-6.8). I always have negative tpo and tgab antibodies, so far, on testing.
I’m a little confused by your response. I’m sure I read somewhere in one of your threads that you have Hashi’s.
Genetically, I have all the bad double mutations associated with susceptibility to Graves disease/Trab antibodies. I have never been over range so far for TSH, FT4 or FT3. All blood tests are hypothyroid results.
I didn’t know there were any double mutations associated with Graves. Do you have high TRAB?
But if you’re hypo, you must have been over-range with TSH because that’s what hypo is: high TSH with low FT4/FT3.
TRab antibodies haven't been checked by NHS Endo,
So, you don’t have high TRAB? You do realise that TRAB are basically Graves’ antibodies, don’t you? Why would the test for them when you are hypo?
In a letter to my G.P., initially, the NHS Endo has said I have possible Central HYPERthyroidism.
I honestly don’t think there is such a thing. How would that work?
One of the many things that confuses me is that on 5/12/23 , FT4 is 50% and FT3 is 40.54%, and TSH is in range, just. I have been told by the NHS , when I specifically asked the question, that my thyroid is normal , and if I have a signalling issue , it is healthy and I would have normal function if it received a proper signal .
So, were you taking levo on 5/12/23? If so then that was why your results were euthyroid. But having euthyroid levels when taking levo does not mean that your thyroid is ‘normal’.
The ‘signalling issue’ they are talking about is the TSH, produced by the pituitary. And that is the definition of Central hypo (NOT hyper!): the thyroid is fit and healthy but it’s not getting the stimulus it needs from the TSH because either the pituitary or the hypothalamus are not functioning correctly. So, what they are saying is that you have Central Hypo. But there’s nothing that can be done about that except take thyroid hormone replacement, which you are doing.
But, there’s no reason why you shouldn’t have both Central Hypo and Hashi’s. But that would mean that your thyroid was being slowly destroyed so would no-longer be normal for very long.
This may sound crazy. Theoretically, do you think it may be possible that by keeping the T4 dose as high as 68 mcg and not reducing to, say, 50mcg, the body might instigate an autoimmune attack on the thyroid to balance FT3 with FT4 more, though still giving me a higher FT3 than FT4.
No, I don’t. Immune system attacks on the thyroid have nothing to do with your dose of levo. Impossible to know what triggers them. And the results are only temporary, anyway. So, what would be the point?
Would you recommend keeping T4 dose at 68 mcg, increasing it slightly, or lowering it? I have liquid levo, so this is easily done. I'll update you , if you don't mind, when I get my test results , probably Monday coming. Right now I feel incredibly stupid!!!
Happy belated birthday.
68 mcg is only a tiny dose. So increasing it might help. Try it and see.
It would probably be a good idea to post your new test results in a new thread because this one is getting long and complicated. Difficult to navigate.
There is no reason to feel stupid. You aren’t stupid. It’s all very confusing, I know. And I could be wrong!
Thank you for the birthday wishes! I had a very nice birthday. 🙂
I am certain in my own mind I have Central Hypothyroidism, and fulfil the criteria as i have had normal range TSH and under range FT4. Persani 2018, European Endo Guidelines defines this as Central HYPOthyroidism and , from memory, I think Persani says a double mutation at TRHR (Thyrotrophin Releasing Hormone Receptor), may cause it. I have the bad double for this. I don't know if I have Hashi's or not. I don't need to have over range TSH to be HYPO as in Central Hypo you can have in range TSH with under range FT4. The NHS Endo thinks homozygous is a single mutation , when it is a double. I did tell her she had it the wrong way round. I looked up Central HYPERthyroidism as I had never heard of it. It is when you have a single TRHR mutation (heterozygous). Also, as you aware, the U.K.s NHS , as soon as you have under range TSH and in range FT4 and FT3, will tell you you are hyperthyroid as they worship TSH. When I had my 1st NHS Endo appointment TSH was 0.09 ( 0.27-4.2), FT4 21.9 (12-22), 99%, FT3 5.5 (3.1-6.8), 64.86% on a dose of T4, 75 mcg only, when I was not taking T3.,
The double mutations associated with TRab are TSHR( Thyrotrophin Stimulating Hormone Receptor). I have the bad double here too. You can be Hypo if you have TRABs as TRABs can be blocking or stimulating, and if blocking are predominant you are, for want of a better term- Graves/Hypo, as TRABs always seem to be considered as Graves, but you would be Hyper, if you had Graves. So, I am HYPO, haven't had TRABs tested and could have them if I have blocking antibodies. Blocking and stimulating can "dance about".
This is so confusing , I know. I actually have good genes as far as my susceptibility to developing both Hashimoto's or Graves autoimmune diseases. I am not genetically predisposed to either. ( TNF-a-Inflammation) It is signalling and feedback issues I am genetically susceptible to. (Central Hypo)
Also for signalling, I have the bad double mutation for PDE8B which is for TSH signalling. This is found in the thyroid, but not the pituitary and thought to decrease the response of the thyroid to TSH stimulation. High TSH levels would be needed to produce normal to low thyroid hormones.
So, my TSHR controls the thyroid gland's receptivity to TSH, and I don't do this well. It is associated with TRAB antibodies.
My TRHR is responsible for receptivity to TRH, which stimulates secretion of TSH from the pituitary gland ,so that TSH can stimulate the production of thyroid hormones from the thyroid gland. I am likely to have higher circulating TSH: T3/4 ratio due to delayed reduction of TRH and TSH in the presence of healthy thyroid hormone levels - less efficient response to changing thyroid hormone requirements.
To further complicate things my DIO1 is one rapid converter FT4 to T3 and another which is poor conversion T4 to T3 in plasma and surrounding tissue!
My results on a dose of T4 68 mcg and T3 of 5 mcg taken since November 2024 and done at 12.10 p.m.are:
TSH 0.154 (0.35-5.5), FT4 16.0 (11.91-21.6), 42.21% , FT3 5.56 (3.11-6.8), 66.4%. TPO and TGAB antibodies negative. TPO 9.58 (>34), TGAB 13.4 (>115) .
On this same dose at the 4 week mark FT4 was 61%, and Ft3 54.05%.
Really don't know what dose of T4 or T3 I should try!!!! I 've posted the results here to get the full picture in the one post. I have never gone beyond T4, 75 mcg which gave me FT4 99% consistently.
A hair mineral analysis test came back saying that although any thyroid blood results I would have would look good, that I was actually very HYPO and I had cellular resistance in that it was not getting into the cells. My levels did look good at TSH 0.04 (0.35-5.5), FT4 78.33%, and FT3 89.73%. I felt dreadful. I think it was mainly the zinc/copper ratio which determined this, but it could have been that in conjunction with other ratios. It could be that since you are on T3 only and have cellular resistance , a hair mineral analysis test might point to reasons for it. DippyDame I did a lot of blood tests at the same time and the hair test agreed with the blood results. e.g progesterone and testosterone dominant, and low oestrogen.
I'm not disagreeing with you on any of that. Does look like you have Central Hypo. But it also looks like you have Hashi's:
When I had my 1st NHS Endo appointment TSH was 0.09 ( 0.27-4.2), FT4 21.9 (12-22), 99%, FT3 5.5 (3.1-6.8), 64.86% on a dose of T4, 75 mcg only, when I was not taking T3.,
There's no way you could have results like that on just 75 mcg levo. And not all Hashi's people have over-range antibodies.
Yes, you can have high TRAB with Hashi's as well as with Graves'. Just as you can have high TPOab/TgAB with Graves'. But it doesn't change much.
I don't know very much about genetic testing but as I understand it, positive results mean that you have a disposition to poor conversion, etc. Not that you are automatically going to get those things.
It could be that since you are on T3 only and have cellular resistance , a hair mineral analysis test might point to reasons for it.
I don't have access to that sort of testing here in France - testing is very limited. And I don't really care why I have cellular resistance. Now that I know about it, I can deal with it. It was all those years being force-fed with levo only and doctors telling me there was nothing wrong with me that ruined my life and shaped my attitudes. Hopefully, that's all over, now. 
Thank you, greygoose, for taking the time to help with all that.
I suspected you may be happy to just deal with your T3 as you have been forced to all these years. I think from your posts you may have said that you now have long Covid, just to add to the mix! The hair mineral test comes with an explanation of what it all means, and you can email any questions you have about the results. It seems that you could do it from France, as it is not one of a long list of countries which are excluded. Seems to be an extra £30 if outside the UK. The test ends up in America to be done. It was Mindovermetal Hair Mineral Analysis Test I did at £77. So looks as if the basic test would be £107 for you. There is an example of the report you would receive on their website. If you have a look I think you would be pleasantly surprised at what you get for your money. I did blood tests too which confirmed a lot of the hair test results. From the long Covid point of view it might be invaluable to give you an insight into what could be out of whack and causing you problems. As far as molybdenum, selenium, copper and zinc are concerned, my results for these are totally different from blood results. I believe the hair results are the ones to act on. I am over range for Selenium in a blood test but need to supplement with Selenium in a hair test. When I supplement Selenium my thyroid readings look very good. I have a problem genetically with Selenium ( double CBS mutation) and am currently supplementing with quite high dose SELENIUM SELENITE on professional advice, rather than the commonly available Selenium Methionine I tried back in 2022. (thyroid bloods looked great then, but felt terrible) This is likely why I was / am achieving the high FT4 and FT3 readings. I need functional B12 to benefit from these excellent looking blood results. I have severe functional B12 deficiency even though my B12 levels were 995 in a blood test. In the hair test, my cobalt is undetectable, which means functional B12 deficiency where it is not biologically active. When you have no cobalt available the body will use Manganese. I am 0% in the hair test for Manganese, though I don't think they highlighted this. TiggerMe said in an old post to keep the forum updated if I used Selenium Selenite , and more or less, followed the " B12oils protocol," which I am doing.
The b12oils site points out that even the "active B12 test" cannot predict if you are B12 deficient.
The B12oils site spells out that if you have severe enough functional B12 deficiency, you will become Vit B2 deficient.( Previously , I thought B2 deficiency caused B12 deficiency, so had this the wrong way round ). I am Vit B2 deficient even when supplementing the maximum recommended amount of B2 (10 mg), in the Thorne Basic B supplement. By supplementing an additional 25 mg Vit B2 , muscle tone I had not had since at least 2007 when I had spinal surgery, returned. I almost instantly knew muscle groups were contracting and relaxing, when previously they weren't. I am taking much higher B2 now. TiggerMe is not B2 deficient as her urine is bright yellow. This info. prompted TiggerMe to read up on the b12oils protocol, which stipulates you must use Selenium in the hard to find, Selenite form, and which TiggerMe noticed. This is why I have tagged her.
So without functional B12 my thyroid can't work properly, and I am trying to rectify this with transdermal oils from Australia. The " protocol" stipulates to use Adenosylcobalamin and Methylcobalamin. It doubts that sub lingual supplementation will work. Injection is best but both these forms are difficult to get in injectable form.
Any progress on the b12 protocol is monitored by hair mineral analysis and Organic Oats Test, which is urine. The OAT goes to America. As far as I can see, it looks as if you can do it from France. I intend doing both these tests in May.I think results reflect your previous 2 month period.
You do not have to suspect you have a B12 problem to do these 2 tests, Greygoose. My personal belief is that these 2 tests are the best way forward to finding out where there is dysfunction in the body. More than likely dysfunction will stem from inborn errors of metabolism, some of which it may be possible to reverse, or work around. It is , as far as I can make out, mainly B12 and folate which are involved in methylation. It is methylation which turns genes on and off. The CBS mutation I have is partly a methylation problem , which Izabella Wentz says will adversely affect B12 and make the thyroid underactive.
We all feel fortunate if we are lucky enough to have you comment on our posts as you have such a wealth of knowledge and experience, and have really been through the mill. You give your time so unstintingly to forum members, and your advice is always highly prized and appreciated . I thought it would be nice, on Mother's Day, to try to point you to a possible route where you MIGHT find some answers, and possible ways to mitigate your long Covid , if not your cellular resistance. I in no way would want to cause offence by suggesting a hair mineral analysis test and an OATS test in your situation. I know that , in France, you seem to be cut off from being able to carry out private testing. It looks as far as I can make out, as if , if you used Mindovermetal, you could do these 2 tests from France-if you felt inclined to???
From going down a rabbit hole on the b12oils site somewhere, I think molybdenum very much is involved where T3 is concerned. B12oils recommends a hair test to get Molybdenum levels . ( Izabella Wentz a fan of molybdenum) He stipulates that if Molybdenum needed it has to be in the form of Molybdate and not include citric acid ( I think) within the supplement. I am supplementing this. TiggerMe , I know has tried Molybdenum or Molybdate in the past, but I think it was a formulation the b12oils site says to avoid as I think it may have citric acid or similar. See excluded supplement section he recommends avoiding, as I think the brand you took is listed.
I have a lot of private thyroid blood tests which I should really list on my profile page. When you see the results and dosages it really makes me suspect that I am Graves/Hypo with blocking antibodies dominant , but stimulating antibodies possibly counteracting them at times? I think the rapid converter and poor converter at DIO1 may also be switching dominance, back and forth at times:
21/11/22 TSH 0.97 (0.27-4.2), FT4 68%, FT3 75.86% on 75 mcg , T4 only-had been supplementing 200 mcg Selenomethionine. Stopped after this as blood Selenium almost toxic levels.
20/3/23 TSH 0.14 (0.27-4.2), FT4 83% , FT3 56.76% on 75 mcg T4 only
10/7/23 TSH 0.09 (0.27-4.2), FT4 99%, FT3 64.86% on 75 mcg T4 only
11/9/23 TSH 0.15 (0.27-4.2), FT4 81%, FT3 59.86% on 75 mcg T4 only
5/12/23 TSH 0.31 (0.27-4.2), FT4 50%, FT3 40.54% on 63 mcg T4 only
18/3/24 TSH 0.20 (0.27-4.2), FT4 80%, FT3 48.65% on 72 mcg T4 only
2/9/24 , have reached word limit.
Thank you for all that information. I shall have to have a think about all that.
Just commenting on the BP readings. 190 systolic ought to be investigated, even if the reading in the other arm is in more normal range. I don't know about the factor of having an additional rib, but my understanding is that - usually - a big difference in readings between right and left might be an indicator of arterial blockage. Personally, if it were me, I'd be requesting a vascular scan, just to be on the safe side.
Hi there, at 190/90 (if I understand correctly was your December blood pressure reading?) your blood pressure is high and needs to come down. You didn’t mention if you are on blood pressure medicines, but your GP should address this. Both values are high.
Good luck
Never ever been on high blood pressure medication. My high blood pressure doesn't seem to be functional, per NHS nurse who gave me my 24 hour monitor results. He said it is situational as my blood pressure very high on hospital premises and lowering as I left the hospital.
That’s quite a common reaction, called the “White coat effect” . As long as your regular blood pressure readings are not higher than 140 for the upper reading and not higher than 85 for the lower reading then you are alright. Anything higher than those levels would necessitate medication.
Good luck
I am regularly over that in the right arm. They don't medicate me. They look at the average on a 24 hour monitor, and as blood pressure is lower when I am sleeping, this brings down the average! If monitor in the course of a day with an ordinary blood pressure monitor they average the readings out.
My readings really do go from one extreme to the other. When I have had the good arm 90 over 66 and the other is 149 over 75 , medication may not be a good idea. Sometimes the bottom reading is over 85. Often the top can be in the 150s.
Hmm. Thanks for the explanation, I still think it would be a good idea to get a cardiologist to review this.
You may well be right!
Should get cardiology review as a 50 points difference is too much. Coarctation of the aorta and patent ductus arterious need to be ruled out. Most unlikely if you are elderly.
Thank you. My aorta was looked at by ultrasound, I think it was, in 2013. Told it looked okay. Would that rule out the 2 possible problems you have mentioned? I am 67.
Should do but I would still think another echo would be warranted.
Myasthernia gravis
Low Dose Naltroxene - LDN
Hashimoto's encephalitis - has anyone heard of this?
Addison's disease or adrenal fatigue 
