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Thyroid  (Expert Forum)
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Dr. Mark, I have CFS symptoms, with Hashimoto's well treated.
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Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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MedHelp Member's Question

Dr. Mark, I have CFS symptoms, with Hashimoto's well treated.

by LowMac, Oct 04, 2005 12:00AM
Dr. Mark, I'm a male Hashimoto's patient in my 40s but with my TSH from combo t-4/t-3 treatment, kept persistantly between 0.5 to 1.0, I still have symptoms of those listed for CFS and emotions are not the cause. Most possibilities have been ruled out. Negative blood tests: diabetes, RA, Adrenal, gout, anemias, ANAs, testosterone, ESRs, TIBC, B-12, ferritin, folic acid, serum iron, EKG-stress test.

Adrenal function is normal but cortical is just inside the low normal. I do have neurally mediated hypotension and extreme chemical sensitivities, low tolerance for physical/mental exertion, intermitant joint pain.

My last two Chem-26 tests, did show elevated ALT/SGT levels, just above normal ranges and both showed my salt level at borderline high and this last one also flagged my chloride level high. These are apparently electrolyte imbalances and possibly something to do with liver function. Could these be causing my CFS symtoms? Can CFS be comorbid with Hashimoto's Disease? Thank you in advance for your reply, I also welcome input from other patients.
Doctor's Answer

by Mark Lupo, M.D., Oct 04, 2005 12:00AM
The Hashimoto's appears to be well-treated.  Mild "salt" level abnormalities (electrolyte imbalances) usually don't cause significant chronic fatigue.  From an endocrine standpoint - the other tests to check would be ACTH stimulation test to definitively exclude adrenal insufficiency and an IGF-1 to screen for growth hormone deficiency.



Hashimoto patients tend to have chronic fatigue but usually this is treatable with aggressive treatment as you are undergoing.  Testing for hepatitis is important with the liver function abnormalities.



Some patients with neurogenic hypotension have other neurologic diseases and perhaps a complete neuro eval is indicated.



CFS is a descripition, not a disease entity, in my opinion.
Member Comments (16)

by LowMac, Oct 04, 2005 12:00AM
To: Dr. Mark
I also want to mention I do not drink alcohol and I do not take any medication other than thyroid hormones. The first test I had done showing elevated ALT/SGPT, was in 2003, @ 66, normal range- 33 to 65.  When I got a second one done this month, 2005, it was still elevated @ 46, normal range-<45.

My elevated Chloride this recent test was @ 110, normal range- 98 to 109. Sodium was @ 146, normal range- 136 to 146.

I have also had a slightly low WBC and elevated eos, on my last three CBCs.  Don't know if there's a connection to my symptoms??

by Mark Lupo, M.D., Oct 04, 2005 12:00AM
Your labs are pretty close to normal - the increased eos are likely okay but could be allergies, adrenal glands or other immune disease -- BUT only if really elevated (ie greater than 800 for an absolute eosinophil count)

by LowMac, Oct 05, 2005 12:00AM
To: Dr. Mark
Thanks for the advice. Yes I have had my free t-3 checked recently, it was # 3.5, range- 2.3 tp 4.2 and with this reading, my dose was increased a little and not re-checked after that, simply because it was close to optimal before the increased med dose.

I wish it were as simple as dose needs but I can tell by the intesnsity of this thing, it is something else. I probably need to do as thr Dr, said and check for hepatitis.

Dr. Mark if you see this and can comment, can hepatatitis stay in your system for years like this??

by Mark Lupo, M.D., Oct 05, 2005 12:00AM
Hepatitis can be chronic.



Following the free T3 in a patient on combo t4/t3 is not a reliable way to treat a patient.  It can be done if the level is checked about 3 hours after ingestion of t3 -- however the TSH is a better reflection of the thyroid balance in the body -- proven in multiple well-designed studies.

by ancientmariner, Oct 05, 2005 12:00AM
There have also been multiple, well-designed studies that refute the use of TSH as a diagnostic tool once you are on thyroid replacement. The basic explanation in lay terms is as follows: In a normal situation, your thyroid puts out a little bit of hormone continuously during the day, and your pituitary checks it continuously and tells the thyroid when it needs to make more or less (TSH = Thyroid Stimulating Hormone). But, when you're on thyroid replacement, you're dumping a whole lot of thyroid into the system at one time. The pituitary senses it and drops the TSH level, trying to keep the thyroid from producing more. So, when you're on replacement, your TSH will logically be very low, even if you are symptom-free.

I think this makes sense, and here's why: After RAI, I had a lot of hypo symptoms, and the endo adjusted my Synthroid only until the TSH was in range. After that, with the SAME symptoms still plaguing me, all of a sudden it wasn't my thyroid any more. In fact, the endo tried to tell me I needed antidepressants, pain and cholesterol meds and I needed to diet and exercise, which I was already doing and it wasn't working!

by LowMac, Oct 05, 2005 12:00AM
To: doodlebug1
Thanks for your replies, I agree with you. Imentioned to the Dr., that my TSH is kept between 0.5 to 1.0 but actually, it has been staying down at about 0.3. I wasn't trying to be inacurate with the Doc, but have had fluctuations up to about 0.7, so wanted to use 'under' 1.0 as kind of a cut-off. The 0.3 that I stay slightly under most of the time, is slightly below the new TSH range that came out recently.

As you said I might have other issues, the elevated liver enzyme count, apparently has stayed above normal for over two years. I feel this means something and plan to get checked for possible hep. virus. I just found info on Hep-C and this one can do, just what I've been going through and elevate the ALT/SGPT, just as mine has been.

I appreciate you guys for being so studied, I get a lot of good info, just by reading on here.

Thank you again.

by LowMac, Oct 06, 2005 12:00AM
To: AmourGal-Doodlebug1
Thanks so much for the search recommendation, I will most definately check that subject out. I just also read that Hepatitis C is more common with us Hashi patients as well! I did not know this and have never been told about the prevalence of other diseases like these and other autoimmune diseases with thyroid patients. Instead, Dr.s try to make you believe you are having emotional issues. I was told this before tests showing I have Hahimotos. The Dr. insisted I had anxiety & depression and placed me on Paxil. I kept getting worse and kept requestion tests, till I got them.

Doodlebug1, my TSH got down to .006 once and I never had hyper symptoms from it, so I believe for sure there is something important in what you are saying! On the other hand my symptoms didn't improve either which is why I believe there may be a co-existant illness, so will try to rule out or confirm whether there is.

Thanks All, I'll keep reading on here and occassional imputting.

by Mark Lupo, M.D., Oct 07, 2005 12:00AM
To: ARMOURGAL
PLEASE CITE RERENCES THAT REFUTE TSH YET FOLLOW PATIENTS FOR AT LEAST 5 YEARS TO DOCUMENT THAT A PERSISTENTLY LOW TSH (IN CONTRAST TO MY GOAL OF 0.5-1.5) DOES NOT CAUSE HEART PROBLEMS AND OSTEOPOROSIS.