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POSTED
2021-11-30
07-081940
08-47148
09-081966
10-31

So I guess I maybe have hyperthyroidism.


Labs

Date TSH (uIU/mL)
0.450 - 4.500
Free T3 (pg/mL)
2.0 - 4.4
Free T4 (ng/dL)
0.82 - 1.77
Thyrotropin
Receptor Ab (IU/L)
0.00 - 1.75
Thyroid Stimulating
Immunoglobulin (IU/L)
0.00 - 0.55
Total Testosterone (ng/dL)
264-916
Sex Hormone
Binding Globulin (nmol/L)
16.5-55.9
Vitamin D (ng/mL)
30.0 - 100.0
Comments
2015-06-16 2.01         718   86.5  
2016-07-13   2.8 1.2         110  
2019-01-30 2.1   1.26     713      
2021-11-10 <0.01                
2021-11-18 <0.005 5.7 2.03 <1.10 <0.10 905 62.3 137.0 pursuant to low TSH test
2021-11-29 <0.005 4.7 1.88           after 6 days of discontinuing all supplements,
most notably, Iodoral, Vitamin D, Vitamin B7 (Biotin)
2022-01-03 0.050 3.4 1.38   <1.0     59.3 after another month of discontinuing all supplements,
most notably, Iodoral, Vitamin D, Vitamin B7 (Biotin)

Narrative

Introduction

Gosh, well, I guess I might have developed hyperthyroidism in the last few years. I wonder if it's the result of the intense stress I've been under. But the symptoms of hyperthyroidism certainly match my experience, particularly my chronic fatigue, high activation energy requirements (really, it takes a lot of whiteknuckling to get almost anything done), and general malaise and depressive anxiety. It's not that I'm that way all the time, but it sure does feel like it's a lot more difficult to really live. I often say how much I Feel like I need to sleep for a week. I've even been relatively disinterested in weightlifting in the last few months (mostly because I've been busy with the new house), but that's really unusual for me. On the plus side, my weight has remained relatively stable.

One thing to think about here, as I consider how to address this, is the whole issue of medical causation, since the last thing that I want to do is just treat the symptom by popping a pill, if there's something I've been doing that led to this in the first place and which I could correct through lifestyle changes.

Maybe There's a Problem

On 2021-11-10, I got some routine bloodwork done as part of my annual physical. It revealed that my "TSH is low as hell". I haven't had any unusual weight loss recently, no tremors, no elevated heartrate, but my sex drive in the last few years had been pretty inconsistent and lower than usual, which I guessed was connected to stress and worried was connected to low testosterone (which is something I worried about before as an explanation for how difficult it is for me to put on muscle, given how hard I work and how diligent I am at the gym and with diet). My doctor ordered some thyroid-specific followup labs.

Definite Signs of Hyperthyroidism

On 2021-11-18, I had those thyroid-specific labs done, including a few things related to testosterone and Vitamin D. (A friend pointed out Association of High Vitamin D Status with Low Circulating Thyroid-Stimulating Hormone Independent of Thyroid Hormone Levels in Middle-Aged and Elderly Males and High vitamin D status in younger individuals is associated with low circulating thyrotropin, so it made sense to check, even though my Calcium levels were just fine.) Well, my T3 and T4 were pretty high, well outside the reference range. But thankfully, no sign of Graves's disease (which would have been suggested by high levels of Thyroid Stimulating Immunoglobulin). My Vitamin D was also very high (reflecting my daily 10,000 IU supplementation), but that's been pretty normal for me, and it's been correlated with much better immune function for me over the years, without any (other?) sign of adverse effects. My testosterone was also happily on the high side of the normal range: "holy shit your testosterone levels haha"; "That's higher than most steroid users btw"; "ON steroids lol". That's fabulous, but it raises more questions about why putting on muscle is so difficult for me, but that's not going to be my primary focus here...

So I immediately discontinued all my supplements, including most notably my Vitamin D, my Vitamin B Complex (since it includes Vitamin B7 (Biotin), which can lead to the false measurement of thyroid hormone), and Iodoral (iodine/iodide, since it's not included in salt I use, and I don't eat seafood). I also stopped using any melatonin or Z-12 as sleep aids.

I secured an appointment with an endocrinologist for 2021-12-13, and meanwhile, I set up labwork for the following Monday.

Incidentally, a medical student friend of mine did not detect any nodules.

Discontinuation of Supplements Correlated with Lowering of T3 and T4

My 2021-11-29 labwork showed a marked lowering of T3 and T4, but still really low TSH. That leads me to wonder how much is a function of (a) discontinuing some of the supplements, (b) natural variability in hormone levels, (c) test measurement error/variability, or some combination of the those. I have a feeling the supplements are a major factor, and I wonder if with more time of not taking any supplements, the T3 and T4 levels would lower to being within the reference range, and my TSH would similarly go back to normal.

Meanwhile, I'm feeling much the same. I wonder what the appointment with the endocrinologist will yield.

Useless Endocrinologist Appointment

On 2021-12-13, I had an appointment at the Endocrinology, Diabetes & Thyroid Specialists of Colorado. I had provided them all my labwork in advance, as well as details about my supplements, lifestyle, and symptoms. I was instructed to arrive 10 minutes early, but the doctor was running 15 minutes late. Then, our appointment felt very rushed. The doctor was not at all familiar with my case, and we had to go over everything from scratch. I tried to ask all my questions and list out all my symptoms that I thought might be connected, but she kept cutting me off and wanting to move on. In the end, her recommendation was to just redo the labwork and see if my T3 and T4 numbers continue trending in the right direction. If not, she said we could do an iodine uptake test or something and then maybe go on meds. She made zero effort to help me to understand anything about any of this, but seemed to just be cranking me through a script. For the pleasure of this useless appointment, where the doctor's advice was to do what I was going to do anyway and which basically amounted to "let's wait and see" (which itself could have been conveyed without an appointment), I was charged $453.12, which is beyond even the upper range that was shared with me in advance. This was deemed a "moderate complexity" office visit because the doctor spent so much time with me. No amount of appealing that classification yielded any results, but at least there was a cash discount rate of 50%, so I ended up paying only $226.56. (My health plan was of no help here, since it was a new plan and exactly $0 of my deductible had been met, and the contracted rate was also 50%.)

Contrast this with the great experience I had at The Facility Denver the previous week on 2021-12-09, where I went into a 1.5-hour meeting with the doctor and dietician both, who not only carefully read the documents I had provided in advance, but also "stalked" my MyFitnessPal food log and other parts of my website to get a sense for my lifestyle and how I think about things. They then proceeded to explore my constellation of symptoms with me, all the while trying to help me to understand various biological mechanisms in my context of knowledge. This was definitely one of the best doctor experiences I'd ever had.

T3 and T4 Return to Normal

Pursuant to the recommendation of Dr Rasmussen at The Facility Denver, on 2022-01-03, I redid not only my thyroid labs, but an entire "Comprehensive Bioscreen". Good news: T3 and T4 are back to normal, and TSH is trending correctly (which I understand is a lagging indicator and can take a few more months to normalize).

But now we've uncovered that I have elevated iron levels. That's properly the subject of a new post on my now-battle with hemochromatosis, but in short, I'm needing to find out whether I have the offending genes (thankfully, no family history I've been able to uncover), whether it could have been drinking well water for a month while the reverse osmosis system was offline (as there is such a high iron content in the ground water that water spots often left rust dust), and whether I can bring myself to donate blood (which is the only known short-term treatment for high blood iron levels). Fun fact: Gays still can't donate blood, unless they abstain from gay sex for three months, and while I'm not exactly getting laid left and right, I'll be damned if I'm going to further restrict my sexual activities so that I can experience the joy of regular vasovagal episodes. Sigh.

Context

A friend of mine recommended The Facility Denver to me, and after getting in touch with them, one of their folks directed me to a video by Dr Mitchel Rasmussen, Thyroid Disorders: What Your Doctor Isn't Telling You. Based on some of the areas of health the video identified as being related to thyroid function, I figured I'd write up a bit of context on each area:

  • chronic fatigue
    And how. This was one of the first things I described as feeling for a few years now, before these recent labs and the first symptom that came to mind before I learned the symptoms typically associated with thyroid dysfunction.
  • brain fog
    Not so much. I typically feel very sharp and have great mental acuity. But sustained focus and concentration have been much more difficult of late.
  • constipation/diarrhea
    Not either one of these, I don't think, but I saw a gastroenterologist about some of my GI symptoms back in 2019 in SF, and she recommended psyllium husk capsules as a way of getting more fiber. I don't think it had a meaningful effect, but I've continued supplementing with them, since I don't typically get much fiber in my diet.
  • acid reflux
    Incidence of this went down significantly after going Paleo in 2009.
  • food/environmental allergies
    Hard to say about food allergies, since I cut out a bunch of stuff (most notably gluten and a ton of various types of non-animal oil) when I started eating Paleo in 2009, but that change in diet sure did lessen my allergies to cats, dogs, dust, pollen, and mold. I used to get horrifically itchy eyes and a runny nose, and now that's relatively rare.
  • nutrient deficiency
    Gosh, I hope not. That's why I was supplementing so much!
  • holding on to 10 extra pounds
    Nah. I know exactly what I need to do to lose the weight I want to lose, when I want to lose it.
  • anxiety
    Yup. Just like the chronic fatigue above.
  • dry skin
    Okay, but that could just be because I live at 9000 feet at < 30% humidity. But I do have a few skin issues, including some flakiness.
  • hair changes
    Uh, maybe my horrible eyebrows? But that thinning happened in my mid- to late-20s (before which I had normal eyebrows). Dermatologists couldn't figure anything out for over a year back in 2017-2018ish, but that coincided with normal TSH/T4 levels. I get a sense that maybe my previously thick head hair is now thinning, too, but that could all just be in my mind. I'm not sure.
  • muscle aches and pains
    Lower back? I have to be super careful / avoidant of squats and deadlifts as a result. (There's also my knee issues.)
  • poor sleep
    Yeah, sleep apnea, for which I typically wear an oral appliance since mid-2020. (CPAP didn't work for me, despite a valiant effort since early 2019.)
  • always cold
    During the day, usually quite the opposite, but at night, I often struggle with temperature regulation in both directions, more often trending toward being too cold.