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Advice:
Prednisone and hypothyroid
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So I am hoping someone out there can give me some advice. Iused to be a very healthy gym rat, I worked out 3x a week and was 195lb with ~14% bodyfat... Then I became hypothyroid undiagnosed for probably 3 years til it got so bad i couldnt work out, was sleeping 14hrs a day and I gained 50lb. I was diagnosed with hypothyroid several years ago and started out on 25 mcg levothyroxine and felt great for a while. But my dose quickly became 50, 75 and I'm now up to 137. I also have CVID and have been repeatedly tested for thyroid antibodies and came back negative, but it may be meaningless as my self made antibodies are very low. I still have chronic fatigue, fogginess, muscle fatigue, insomnia, panic attacks etc. but I work out when I am able. The day that I work out I feel pretty good but I am wired that night, like I had lots of caffiene (I can't handle the stuff anymore). The following day I feel like a zombie, my neck is sore around my thyroid and I am exhausted but can't sleep that night. The zombie state persists for a couple of days. And now a new wrinkle I have started to have what I suspect is central sleep apnea. My resting HR is 55 and my sleeping HR goes as low as 35BP but I sometimes awake with my heart racing at over 135, even on my CPAP machine. My TSH is 2.55. Any ideas about the metabolic roller coaster or apnea? My resting temperature is ~96.8
Posted on 03/19/12, 04:29 am
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Advice:
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Reply #1 - 03/19/12  4:36am
" Sorry, last tidbit that I forgot was that I had to take prednisone 10mg for a couple of weeks and I felt great and all these symptoms went away for about a month. I know prednisone suppresses the thyroid, so why would I feel better? I also can feel it if I am late on my levo dose, and feel a kick within half an hour of taking it. My primary says that's impossible... I sometimes wonder if he gets whiplash from ignoring reality... "
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Reply #2 - 03/19/12  8:45am
" Sorry to hear of your struggles.

About 20% of people with Hashi's will test negative for the antibodies. Diagnosis can be confirmed via biopsy. Since hypothyroidism is treated the same regardless of the cause, biopsy isn't necessary.

I can't really explain why prednisone helped you feel better but, I can tell you that it doesn't look like you're optimally medicated for your thyroid.

Most people who are optimally medicated on T4 meds such as levothyroxine will have TSH 1.0 or lower.

The fact that you are reporting a mixture of hypo and hyper symptoms leads me to believe that your actual thyroid hormone levels haven't been optimized.

Very often, when people take T4 only meds such as levo, their FreeT4 level is high in the range.

But, if those people are having trouble converting their T4 storage hormone into T3, the active hormone, they will have a low FreeT3 level....and a mixture of symptoms.

Has your doctor ever checked these levels?

"Thyroid for Dummies" confirms the importance of these tests as does many other medical references including this PubMed article:

http://www.ncbi.nlm.nih.gov/pubmed/...$=relatedreviews&logdbfrom=pubmed

You will note that the final sentence reads: "TSH determination is diagnostically misleading and only free hormone measurements are reliable for thyroid function assessment."

(the free hormone measurements are the FreeT4 and FreeT3 tests)

The FreeT4 test might look like this on a lab slip: T4 (or thyroxine), free, direct......and the FreeT3 test might look like this: tri-iodothyronine, free, serum

If you can get those tests run and post the results here, we can show you how to interpret them. You'd need to post the reference ranges for each result since different labs use different ranges and your result can only be properly interpreted within the context of your lab's ranges. The ranges are usually listed to the far right of the result on the lab report. "
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Reply #3 - 03/20/12  2:12am
" Cd3764, thanks for your reply. I just got a copy of my latest tests, no T4 tested, but Free T3 is 3.3 with a range of 2.0 to 4.4. I will check with my doc when i see him on Wednesday to see if/what my free T4 was tested at. "
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Reply #4 - 03/20/12  7:55am
" Your FreeT3 level indicates that you are converting well which is great.

However, it is a bit lower than the type of level a healthy person would have.

Based upon your lab's ranges, a healthy person would have a FreeT3 level of 3.4 - 3.8.

Since you are normally quite active, you would probably need a FreeT3 level closer to 3.8 to feel well.

I suspect your FreeT4 level is lower in the range - thus, the reason for your too-high-for-someone-on-levothyroxine TSH.

Once you confirm your FreeT4 level, I suspect you'll want to talk to your doctor about a dose increase.

You shouldn't be dealing with all the symptoms you have if you are optimally medicated. "
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Reply #5 - 03/23/12  1:40am
" So I saw my doc again yesterday and the last time he tested my free T4 was over a year ago. Back then I felt much better and it was 1.56 with a range of 0.5 to 1.75. Time to get it tested again. "
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Reply #6 - 03/23/12  6:46am
" this is a strange question, but have you ever been tested for lupus? Prednisone is an anti inflammatory medication. if taking anti inflammatory medicine helps your symptoms, then that means you are having things that are inflamed. i know lupus, an autoimmune disease, causes inflammation of organs and other parts of the body, that make you feel sick and stuff a lot. I think they even give prednisone to some lupus patients. Be careful though, b/c that medicine can have nasty side effects, you are never supposed to take it for long. But i just thought i'd mention it, since autoimmune diseases like to come in pairs, and you sound like you might have a systemic inflammation problem? I am not a doctor or anything though, this is just what i've read about lupus personally. Google it and compare your problems to it and see if anything pops up "
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Reply #7 - 03/25/12  1:21am
" It could be something else too besides Lupus. I thought I had it, got tested and it was negative, but they found inflamation in my stomach, they still don't know why, but any inflammation anywhere will make you feel better once treated. There are tons of other autoimmunes out there, it's a good idea to get tested for at least the most common ones like lupus. "
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Reply #8 - 03/25/12  2:43am
" You could have Hoshimotos, that is an autoimmune disease of the thyroid which causes the thyroid to go low and you can also have spikes in you tsh every now and then. I had it and had my thyroid removed omg it was the worse I have ever felt. Moody, hot all the time, anxiety through the roof, also if it is hoshitmotos that may be why you felt better with prednisone, it stopped the antibodies from attacking the thyrod. Mine never showed up in blood work at all, just when it spiked up, then the specialist I seen suspected it and it was comfirmed after the pathology test when I had it removed. I also had thyroid cancer that we were unaware of. Blood test dont always pick up thyroid conditions it is better to have a biopsy done. Hope you feel better soon. "

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