Labs - Hypothyroid, Hashimotos, Now Adrenal? Help!

[matt]

Hey to all,

I'm 30, recently got a pretty unexpected blood test back and I'm going to be going down the treatment road. Here's my pertinent details:

-6'1, probably 12-15% body fat, 195lbs, athletic (core lifts 3-4x a week, running a few times a week at 2-3 miles a pop)
-Severe head on car accident (net speed 70+ mph) in 02/2015 resulting in mTBI, I've been told my hormones being out of whack could be because of this
-Around the same time, a couple deaths in the family and relationship issues, a lot of stress
-Severe anxiety, some depression, lethargy, etc. manifested 6 mos later and persisted
-Prescribed 10mg Lexapro, took the easy way out and took it for a while (10 mos) but then tapered off

A buddy recommended I go get a full panel done by a DO here in Ohio, so here's the #s

Growth hormone: 0.1 ng/ml (5 ng/ml)
IGF-1: 198 ng/ml (>200 ng/ml)
IGF BP-3: 3592 ug/L (4000 ug/L)
ACTH: 33 pg/ml

LH: 3.9 (1.7-8.6 mlU/ml)
FSH: 2.8 (7 mlU/ml)
Total Test: 987 (348-1197 ng/dL)
Free Test: 12.4 pg/mL (8.7-25.1 ng/dL)
Estrone: 62 pg/mL (12-72 pg/mL)
Estradiol: 9.8 pg/mL (7.6-42.6 pg/mL)

Cortisol: 10.9 ug/dL (6.2-19.4 ug/dL)

Vit B: 589 pg/mL (211-946 pg/mL)
Vit D: 51 ng/mL (30-100 ng/mL)

TPO/Thyroid Peroxidase: 220 (<35)
TSH: 7.89ulU/mL (high) (.450-4.5 ulU/mL)
T3 free: 3.6 pg/ml (norm) (>2.5pg/ml)
T4 free: 1.21n g/ml (low) (0.82-1.77 ng/ml)
rT3: 18.9 ng/dL (norm) (8-25 ng/dL)
TSH index: 8.05 (HAP) [1.3 - 4.1] (PI)
T3/rT3 ratio: 19 (low) (>20)

So my primary diagnosis was Hashimotos Thyoiditis...which could explain the mental issues I've been experiencing. Treatment right now is as follows:
-WP Thyroid (started on 1gr on 11/9, now up to 1.5gr/day)
-Pregnenelone sublingually 10mg/day to start
-DHEA sublingually 5mg 2x/day

-Brain DHA and ultranutrident multivitamin on the supplement side

I started feeling really great on the NDT med, but then went downhill on 11/18 after a flu shot and round of antibiotics (doxycycline) for a sinus infection. Not sure if those are related, but a day after those I started feeling crappy, flushed, 'fever' (which has persisted...around 99.2-100.0), chills, dry mouth, waking around 3-4am, unable to get back to sleep, etc. I have had these symptoms over the past few months off and on (before the bloodwork) and they subsided on their own.

After about a week of the above, I spoke with doc and they thought a small bump in dosage, and dosing twice a day (vs once in the morning) was a good course of action. I've been doing that since 11/24 with no improvement, actually been a bit worse.

Now I have a diurnal sailva test kit I'll be doing tomorrow, doc wants to look at cortisol (which is a bit low based on blood work) and see what it's doing throughout the day. He did mention adrenal support supplements as a future possibility, though it seems those aren't viewed favorably here...

I'm trying to go after all of this, but still feel really crappy. Wonder how long it takes for any of these meds to make a dent in symptoms? I just wanted to get everyone's thoughts on my labs and course of treatment thus far. Thank you in advance!

 

[InChristAlone]

What is your diet like? How many calories? Might need to slow down on the running, maybe take a walk instead? With some meditation in the ear buds. Low hormones are a wake up call to make lifestyle changes. I took thyroid for a while and it worked to get temps and pulse up but my lifestyle needed major changes to be healthy.

 

[A.R]

I would stop the running altogether or at least drastically cut down on it.

Also you can try topical Progesterone and see if that helps. I would look to change Thyroid aswell if NDT carries on to be ineffective, although if diet is not in check, then no Thyroid in the world will give much benefit.

Did You get Prolactin tested also?

Like Janelle mentioned, how is you diet looking mainly. High protein (100g +) is important.

 

[matt]

What is your diet like? How many calories? Might need to slow down on the running, maybe take a walk instead? With some meditation in the ear buds. Low hormones are a wake up call to make lifestyle changes. I took thyroid for a while and it worked to get temps and pulse up but my lifestyle needed major changes to be healthy.

My wife has rhuematoid arthritis and has been gluten free (due to celiac) for the past couple years. So gluten was mostly cutout, it is for cutout good as of a few weeks ago. Thanks for the tip, I'll try some more "relaxing" exercise!

Here is what I typically eat, varies a bit from day to day but this is representative of the norm:

Post workout
Muscle Pharm Combat Powder (gluten free protein shake, 25g protein)

Breakfast
4 whole eggs
OJ
Banana

Snack
Wella Bar (13-15g of protein)
Yogurt (5g protein)

Lunch
Chicken (usually) or fish (smoked salmon)
Salad, broccoli, or peas usually

Dinner
Chicken or ground turkey usually
salad
potatoes

I'm not sure what total daily protein intake is, I think it's close to 80-100g, but I need to check. I use the MyFitPal app but I can't get logged into it right now

 

[matt]

I would stop the running altogether or at least drastically cut down on it.

Also you can try topical Progesterone and see if that helps. I would look to change Thyroid as well if NDT carries on to be ineffective, although if diet is not in check, then no Thyroid in the world will give much benefit.

Did You get Prolactin tested also?

Like Janelle mentioned, how is you diet looking mainly. High protein (100g +) is important.

Sorry for my ignorance, what will Progesterone help? Not sure how to interpret my levels on that (0.1 ng/mL with range of 0.0-0.1)

Prolactin was low/normal at: 8.4 ng/mL (range: 4.0-15.2)

 

[matt]

As I said earlier, I have been under a lot of stress over the last 18mos, but have been feeling much better over the past 6mos or so. But then I get these bouts of being feverish, insomnia, dry mouth, etc. which bring me back to the anxiety and stress thanks to the physical reminders I just mentioned.

Does it sound like this is the cumulative built-up of stress from the last year now making itself known? Or could still be some withdrawal effect from the SSRI I was on? I ask because I feel like I'm trying to live better now, and with less stress, and I am hoping if I address the issues I have physically, my body will correct itself.

 

[InChristAlone]

Could you track temps and pulse for a while? Those are key when you are taking thyroid. It sounds like a high protein diet but how many carbs?? Many of us here eat at least 200-300 g a day. 4 eggs might need a quart of OJ for some of us!

 

[matt]

Could you track temps and pulse for a while? Those are key when you are taking thyroid. It sounds like a high protein diet but how many carbs?? Many of us here eat at least 200-300 g a day. 4 eggs might need a quart of OJ for some of us!

Sure can, how often/what time(s) of day? I have a temporal thermometer, is this sufficient?

I also am taking a Nature's Way Kelp supplement (400mcg Iodine - 267% DV), and think some of my temp/feeling heart pounding may be to iodine overdose, so I'll be cutting that out. Also have read that people with hashimoto's can trigger a flare up with iodine. AND I just read that NDT meds already have 195 mcg of iodine in there already. For a daily total of 595mcg... Oy, this alone could be the reason I feel crappy. Thanks to my doc who said an iodine supplement was good to go.

Current pulse (sitting) is 72-80bpm, way high for me. I'm typically in the 48-55pbm range! On 11/18 when I got the flu shot and antibiotics discussed above my numbers were great, 110/55 and pulse of under 60.

 

[A.R]

Have a read through this

http://raypeat.com/articles/articles/progesterone-summaries.shtml

 

[Blossom]

I think this might apply to your situation too.

What Is Wrong With My Diet?

I get a response from Ray Peat. Amazing !!!

My question was identical to this post, and his response:

“I think the ratio of phosphate to calcium is high. Two liters of low fat milk would improve your calcium/phosphate ratio, and provide more protein. The higher calcium intake will probably incease your temperature and metabolic rate.”

 

[matt]

I think this might apply to your situation too.

What Is Wrong With My Diet?

Thank you!

 

[matt]

Could use some more help, saliva cortisol results came back and they are low then high at night, hence why the thyroid meds make me feel like garbage. Taking WP Thyroid during this test, and was very sleep deprived.

5am: 6.2ng/mL (range 3.7-9.5)
Noon: 1.9ng/mL (range 1.2-3.0)
6pm: 0.9ng/mL (range 0.6-1.9)
9:30pm: 3.1ng/mL (range 0.4-1.0)

I started ashwaghanda (250mg Sensoril at night) and that has helped with relaxation at night and my sleeping has improved (I wake maybe once but now can go back to sleep!)

They're suggesting adrenal cortex supplement for morning and lunch time, does this make sense? I've cut out caffeine completely as well.