Fatigue

[Don Schultz]

I am a 56 year old male and have been on a 4 year journey to try to figure out why I am tired, abnormally so I believe. My quality of life is clearly not what it should be. I am about to schedule an appointment with my doc and want to be prepared. Having been around these forums for a while I believe I have the basics down. Possible factors in fatigue:

1. T: check, I am on TRT and T is above 700

2. E: check, I am on Anastrozole

3. Thyroid: check, I am on levothyroxin

4. Sleep Apnea: check, I am on CPAP

5. Exercise: check, run a 5k 5 days a week for the past 10 years.

6. Psychological factors: I believe I have these in check.

7. Adrenal function: Limited knowledge. I need to check into this. Any advice is appreciated.

8. Cortisol: Limited knowledge. I need to check into this. Any advice is appreciated.

9. Lipitor: Yes, I am on Lipitor. Had 5 stents placed 2 years ago and both my cardiologists have insisted upon this. I am aware that some have reported fatigue with Lipitor but I have been on Lipitor for 10 years and I don't think its a factor. Any advice is appreciated.

10. Plavix: on Plavix following the stents in sept 2012

Am I missing anything that I should have my doc test?

 

[Gene Devine]

Adrenal fatigue could be a factor.

Need to get Cortisol tested and make sure your Doctor understands adrenal fatigue, how to diagnose it and treat it.

Good site to learn: http://www.adrenalfatigue.org/what-is-adrenal-fatigue

 

[HarryCat]

Definitely would recommend 4x saliva cortisol test.

Also post your latest thyroid labs. Under-treated hypothyroidism could also be an issue. That was my biggest problem when I was in a similar situation as you.

 

[Don Schultz]

This is from a blood test I had a while back:

CORTISOL, FREE, LC/MS/MS 0.21

8:00 - 10:00 AM 0.07-0.93 mcg/dL
4:00 - 6:00 PM .0.04-0.45 mcg/dL
10:00 - 11:00 PM 0.04-0.35 mcg/dL


According to this I might be okay on Adrenal fatigue. If I understand this correctly, I should have the saliva test to get a more clear picture of what is going on through out the day.

 

[Don Schultz]

I am feeling slight despair over this today because its beaten me down a bit over the past 4 years. All of the things I have tried on the list above with the addition of supplements and diet have not provided much relief. Really, the only way I am getting through the day is with moderate use of caffeine. As I write this I have zero faith that my Insruance doc (So CA Kaiser) has any knowledge what so ever that will be of any use. Zero. In fact, I am not even going to schedule it, its a pure waste of time. I really don't have a clue as to what kind of a doc I would look for that would have knowledge of of all of the areas on my list and could put everything together. I am also tired of trying to learn all of this on my own as well. I guess what I want is a "super doc" that can put all of this together and get me back on track quickly.

 

[HarryCat]

I feel for you. I spent about 6 years in the exact same position as you. I'd always feel the worst in the morning right after waking up, kind of felt like I was run over by a bus. Took most of the day to get going, maybe by 4pm I'd start to feel somewhat functional. No way to live.

I saw many doctors during this time, tried everything under the sun. Finally earlier this year I accidentally stumbled across a solution, while I don't feel like I'm 20, at least I don't feel like I'm 90. For me the answer was finding a thyroid med that my body could actually absorb. I tried 3 different types of NDT and 4 types of Levothyroxine before I found one that worked. All the while my thyroid labs said I was fine. Obviously something about the binders and fillers didn't agree with me.

It may not be thyroid in your case, you just need to keep trying things and trying to find a doc that will help. I've found that every doc has there pet treatment protocols and if that doesn't work for you you're better to move on that try to convince them otherwise.

 

[Don Schultz]

I am going to follow up on the thyroid because, like you, I do start to feel better at 4 or 5 in the afternoon. Thanks for the tip!

 

[Vettester Chris]

Don, get the 4x saliva test so we can review the circadian profile. As for your thyroid, you are taking a synthetic T4 only medication. For many people that just doesn't make a dent. There's nothing mentioned about your dosages and protocol. Regardless, labs will tell the tale .. Would like to see Free T4, Free T3, Reverse T3, TPO & TgAb antibodies, and of course the 4x saliva cortisol as previously mentioned.

 

[Don Schultz]

Sent my SoCal Kaiser Doc the questions about further testing of thyroid. I received this email reply:


I am the covering physician for Dr. Narayan as she is out of the office.
Your TSH is within normal limits on thyroid medication. TSH is used to titrate levothyroxine dose. I do not recommend the other thyroid labs you have mentioned as TSH is the most sensitive test for hypothyroidism.
Also, I don't believe in adrenal fatigue. It is not recognized by the medical professionals as a disease. One may be adrenal insufficiency however. If you would like to discuss this, you can make an appointment for screening. However, reading your prior clinic notes, my suspicions are low for you having adrenal insufficiency.

Thank you
Dr. Park

 

[Carlos]

The Dr. doesn't believe in adrenal fatigue because it's not a recognized disease but he is suspiciousthat you have adrenal insufficiency. I am confused.

 

[Vettester Chris]

Don, I'll post some additional comments on the thyroid subject, but I'm curious with what your initial take is with the doctor's response? And just for the argument of a descriptive diagnosis, would we now call it "Addison's Insufficiency", since various autoimmune and pituitary complications can lead to adrenal cortex disorders? I think some of the heavyweights in the industry like Dr. James Wilson, Dr. Michael Lam, Dr. Bruce Rind .. etc., might disagree with his assessment.

 

[Don Schultz]

My initial take is, as I suspected, that the doc is full of s#^*! Kaiser docs can do NOTHING except their Kaiser protocol. The docs have NO latitude what so ever. My Kaiser doc will not let me self inject T, even though I had been self injecting for 2 years before coming to Kasier (required by my work-I had been on Anthem before) and my Kaiser GP wants me to do every 2 weeks on my T shots...basically all antique protocol and it does you no good to talk because they have no authority to go outside the protocol required by Kasier. I was a little surprised in this case, especially since they Kaiser Endo that responded was aware of HarryCat's situation. At a minimum I thought she would approve the additional testing.

My daughter, son and wife are on Kaiser and its been fine for them but they really have not needed any treatment that required fine tuned knowledge or knowledge of current thought and protocols.

I am currently using my Anthem Endo and Empower for T, HCG and Anastrozole but it has been difficult to get the blood tests that I should have.

I emailed this doc back and asked her what her recommendation for my fatigue issues would be. I can't wait to hear what she says because I was pretty much left with the notion that she expected me just to live with it after reading her email response.

Since it looks like the test I need are going to be paid by me, I will be looking for the least expensive options.

 

[HarryCat]

Sent my SoCal Kaiser Doc the questions about further testing of thyroid. I received this email reply:


I am the covering physician for Dr. Narayan as she is out of the office.
Your TSH is within normal limits on thyroid medication. TSH is used to titrate levothyroxine dose. I do not recommend the other thyroid labs you have mentioned as TSH is the most sensitive test for hypothyroidism.
Also, I don't believe in adrenal fatigue. It is not recognized by the medical professionals as a disease. One may be adrenal insufficiency however. If you would like to discuss this, you can make an appointment for screening. However, reading your prior clinic notes, my suspicions are low for you having adrenal insufficiency.

Thank you
Dr. Park

This is exactly why thousands of thyroid patients are still suffering. Can't blame the doctor entirely because that's what they are taught in medical school.

You need to get educated and find a new doctor.

Start with http://www.stopthethyroidmadness.com/

and http://tiredthyroid.com/ (her book is excellent by the way)

and even Mary Shomon's site: http://thyroid.about.com/

you could take a look at her doctor directory too http://thyroid.about.com/cs/doctors/a/topdocs.htm

 

[Vettester Chris]

OK, good, I'm glad you're not getting reeled in ... Those statements should be respectfully challenged when there's an abundance of information that is relevant and supporting on the contrary. Just so you know, I am also a KP guy in So Cal. I have a litany of my own experiences, especially with a certain endo in Fontana, but I'll spare the drama. My relation with my GP has actually grown stronger over the years, and she even picks my mind quite a bit about the nuances of my protocols. However, my HRT and wellness support related thereof is completely outside of KP.

On the thyroid, it would be good if the TSH regulation feedback loop could be used as an absolute marker for diagnosing the thyroid, but unfortunately that's not the case. Here's one of the pages from STTM.com regarding the TSH lab (you don't have to get carried away with it, but you can see the point they're trying to make) .. http://www.stopthethyroidmadness.com/tsh-why-its-useless/

There are different degrees of hypothyroidism, ranging from overt, subclinical, central, and autoimmune disorders like Hashis can play into it, as well as a multitude of nutrient deficiencies and genetic conditions. In many cases of estrogen dominance the pituitary production TRH-> TSH, and central related issues will cause it to suppress just the same. This isn't even tapping into situations where T4 might be optimal or upper range, effecting the TSH reading, but then to find out T3 is to the left (or lower range), or mid/upper range, but not effectively reaching the cells.

FT3 getting to the cells (for the most part) is where the rubber hits the pavement .. It's important to know that you have enough supporting storage T4, and that not only you have adequate levels of FT3, and that it is effectively reaching the cells and promoting ATP and all the benefits that go with it.

Therefore, the FT4 & FT3 with reference ranges will tell us where these hormones sit, and a Reverse T3 lab will give us a good indicator if T3 pooling is evident, or if other areas might need addressed (iron, ferritin, cortisol, D3, electrolytes ...), where T4 conversion to RT3 is excessive. Even illnesses and disease can cause a spike in RT3, so this is definitely a good maker for a physician to use when making decisions for your health.

I look at it this way, if not for KP, I would have never got this deep into the whole HRT and endocrine thing. Like you, I needed to grab hold of my program and figure out what it all means. You get one doctor saying inject 100mg every 2 weeks, one saying 50mg a week, one says look at E2, the other says, "Don't bother." I personally had enough and decided it was on me to learn as much as possible, then to find a physician that I could align with that would be a not only a good doctor, but a partner for my long-term health plan.

 

[Vettester Chris]

Forgot to mention in the desired labs part of my post ... Getting the TPO & TgAb antibody labs will help ensure that autoimmune issues are or are not in play. It's not completely uncommon that the immune system through antibodies can turn on the enzymes or proteins within the thyroid gland.

Some good information posted by HarryCat!

 

[a_crossfitter]

I feel for you. I spent about 6 years in the exact same position as you. I'd always feel the worst in the morning right after waking up, kind of felt like I was run over by a bus. Took most of the day to get going, maybe by 4pm I'd start to feel somewhat functional. No way to live.

I saw many doctors during this time, tried everything under the sun. Finally earlier this year I accidentally stumbled across a solution, while I don't feel like I'm 20, at least I don't feel like I'm 90. For me the answer was finding a thyroid med that my body could actually absorb. I tried 3 different types of NDT and 4 types of Levothyroxine before I found one that worked. All the while my thyroid labs said I was fine. Obviously something about the binders and fillers didn't agree with me.

It may not be thyroid in your case, you just need to keep trying things and trying to find a doc that will help. I've found that every doc has there pet treatment protocols and if that doesn't work for you you're better to move on that try to convince them otherwise.

Hi HarryCat,

Could you elaborate on what thyroid medications you tried and which one works for you? I'm curious. Please.

 

[HarryCat]

Could you elaborate on what thyroid medications you tried and which one works for you? I'm curious. Please.

I'm a little hesitant because what works for me may not work for you.

First a little background and some examples of what people experience when a thyroid med that was working for them is reformulated or becomes unavailable. The reformulation of Armour in 2009 is perhaps the most famous recent example. See: http://thyroid.about.com/od/thyroiddrugstreatments/a/armour-reformulation.htm

Another example is when Levoxyl was removed from the market, see here.

And if you want to do a really deep dive into why people can have such vastly different experiences on different formulations, read through the "State of the Art" section of the patent for Tirosint here. It gives you the impression that it is a minor miracle that any oral thyroid medication actually works for anybody.

As far as what I've tried, I started with old formula Armour, when that became unavailable I tried desiccated thyroid from a compounding pharmacy, then Natur-Throid. Although I felt somewhat better on these I was still suffering.
I was off thyroid meds for a few years then found a new Doc and started on combination of Tirosint and compounded desiccated thyroid. That didn't work very well so I tried Synthroid for a short while. That was worse so I went back to Tirosint, but when the price of Tirosint more than doubled last year I went on Unithroid. That was far worse than anything I had tried before so my Doc said to try Sandoz, since a lot of his patients were reporting good results with that. I tried it and for the first time in years I feel good again. My sleep has vastly improved, my energy level, mood, brain fog, it has been a lifesaver.

Sandoz is one of the generics so if you do decide to try it you have to make sure the pharmacy doesn't sub one of the other generics. This happens to me almost every time I go for a refill.

Good luck.

 

[HarryCat]

One other thing, I've also found that after being on Sandoz for a while I've been able to drop my compounded desiccated thyroid, seemingly without any ill effects.

 

[Michael McAlister]

You run 5K 5 times a week? Have you considered exhaustion? I always hate to be the one to state the obvious but you're not 22 anymore. Over training WILL bite you in the asp. Consider cutting back to 3x/wk. See if that helps.

 

[Nelson Vergel]

I agree with Michael. I wish I was as tired as you! However (all kidding aside), all of us have different baseline states that we compare ourselves to. I do agree that one of the hardest things to do is to accept that our bodies may not perform as well as years past.

Are you sure that your CPAP has been optimized?