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Thyroid Diseases

Hypothyroidism and Test Results

05/07/2007

Question:

I am hypothyroid and have been taking synthroid 50mg. for a few years. I am 33 yrs. I`m 5`1" and about 108 lbs. (but just a little over the proper fat levels according to my docs chart). I still have a "fluish" feeling (achiness, soreness of skin, and terrible intolerance to cold). I have recently had several tests done including saliva hormone testing and these are the results: I was told that all the thyroid levels are fine and even a little higher (but not high enough to "mess with the dosage" of the medication), the triiodo-thyronine was 1.65 (high), and the L-Thyroxine is 0.32 (normal). Testosterone and estrogen are normal(which is odd because I have good marriage but no sex drive except during ovulation!).

I suspected that I had adrenal burnout and that I had neurotransmitter problems because of sluggish thinking. I recently got SEVERAL tests done with these results: My seratonin and dopamine are extremely low and my GABA is 100points below normal. My cortisol is very high in the am, plumets in the afternoon and shoots straight back up (instead of gradually going down in the pm). The test papers say "anabolic support and cotisol augmentation suggested" though I don't know what that is and my doctor didn't mention it. I was deficient in omega 3 (though I had been taking suppliments) Vitamin A, zinc , Vitamin B12 and Vitamin B2(B2 known to cause thyroid problems).

health issues are: nonspecific hepatitis when i was 17 due to chemical exposure(liver tests in past showed up "normal"), endometriosis and ovarian cyst(resolved since I had a child), bowel troubles (now resolved), constant acne (not resolved), and asmah (on occasion though I don't take meds), constant yeast infections (not resolved), intolerance to cold, sore skin and achiness most every day especially by 3 PM (still a big problem), brittle hair, nails and saggy skin, and facial wrinkles (I believe appearance is indicative of overall health).

Since having these tests, I have been on very good vitamins with amino acids, aloe, garlic, omega 3`s the works! I was on them for a month but am not on them presently bc of the cleansing program recomended by my doctor). I have switched to decaf since caffeine is supposed to affect thyroid and cortisol negatively. I have not eliminated, but have cut down on alcohol consumption(usually a glass of red wine a day or every few days), and I am drinking a lot more water to flush my system.

My doctor's solution for all this was the $200 "Isogenix" program. He says the cleansing will help with the toxicity and the amino acids will help with the low seratonin etc. He says the B Vitamins in it will help to restore normal cortisol patterns and get my adrenals working normally. After I quit caffeine, I have been hungry every 2 to 3 hours but still have had a really good 2-3 weeks (minimized aches pains and cold), but now it's back again and started one day BEFORE I started the Isogenix program, so I don't think it's related to Isogenix. I have gotten frustrated with feeling so bad and trying to treat it naturally and have started the program.

I am on day 2 of the 9 day program and starving! I don't see how a "once in awhile" treatment like this can help. Also, the doctor suggests that I stay on a "maintenence program" after the 9 day program which just means taking these shakes every day instead of food. I don't think that was the way we were designed to function. I have tried to do my own research for years and at least knew what tests to ask for but I still feel bad. Is possible that the liver damage from the past has caused an inability to process synthroid and other hormones properly? Is it possible I could get off synthroid all together with vitamin B2 therapy? Could the corisol levels and neurotransmitter problems be causing the achiness etc instead of thyroid problems? I know this is a lot but I know its all connected. HELP!

Answer:

1. The only salivary hormone testing I know of that has been demonstrated to give reliable diagnostic information is the midnight salivary cortisol, used to test for adrenal gland hyperfunction ("Cushing's syndrome). I don't know how to interpret the other salivary hormone levels you had done.

2. I don't think any research has been done that would allow us to understand the meaning of low blood levels of serotonin, dopamine, or GABA, nor what to do with a patient who demonstrated such levels. To my knowledge, these blood tests are not standard diagnostic tests for any recognized disease. I have heard of disorders in which serotonin and dopamine might be high, but not low.

3. Adrenal insufficiency is not diagnosed with random cortisol blood levels - not even three of them. It is diagnosed with an ACTH stimulation test, or sometimes with an insulin tolerance test. Since cortisol is secreted in a pulsatile fashion, I don't think anyone can tell you what the significance might be of the AM, afternoon, and PM cortisol levels you had drawn. I would certainly not prescribe hydrocortisone (which is the same thing as cortisol) on the basis of these blood tests. Incidentally, it is normal for cortisol to drop from the morning to the afternoon, but it usually doesn't shoot back up again at night. If anything, this would suggest Cushing's syndrome to me, rather than adrenal insufficiency. I'm not even sure what "anabolic support" means.

4. I am not aware of any effect of vitamin B2 (riboflavin) deficiency on the thyroid. I tried looking up the symptoms of riboflavin deficiency, and it didn't day anything about the thyroid. I tried looking up riboflavin and vitamin B2 in the index of a thyroid textbook and couldn't find them. I also don't know of any effect of caffeine intake on either thyroid hormone or cortisol. I have never heard of taking B vitamins to restore normal cortisol secretory patterns or adrenal function.

5. I have never heard of the isogenix program, and I share your skepticism.

6. Liver damage in the past should not affect your body's ability to respond appropriately to thyroid hormone or cortisol.

7. Most forms of hypothyroidism are permanent. Assuming the diagnosis was made correctly, I don't think taking B vitamins will allow you stop taking thyroid hormone.

8. If a doctor has checked your blood levels of Thyroid Stimulating Hormone and Free Thyroxine, and they were normal, then I don't think the thyroid has anything to do with your symptoms. I don't know what is causing your symptoms, but if the blood tests are normal then I don't think it's your thyroid.

9. Adrenal insufficiency could cause achiness. It could also cause poor appetite, nausea, vomiting, abdominal pain, weight loss, feeling faint when you stand up. If you feel that you have symptoms of adrenal insufficiency you should probably be evaluated by an endocrinologist and perhaps have an ACTH stimulation test.

10. I don't know what symptoms might be caused by low levels of serotonin, dopamine, and GABA. I am not aware of any specific syndromes for which low levels of these substances would be diagnostic.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University