My Chronic Fatigue and Low Body Temperature
I could sure use some help here. Some of you may recall that I posted in May 2011 that I was having trouble with what seemed like Thyroid problems, fatigue, low body temperature and problems recovering from exercise. I still have these problems and they seem to be getting worse and I need some help on how to goose my medical team into action on this. At this point, all I get is head scratching, here take this pill for symptoms and "it must not be serious if you are still alive."
I had a whole bunch of tests done which seemed to rule out the simple things like Hashimotos and basic primary and secondary hypothyroidism and in October I was found to have Obstructive Sleep Apnea (OSA). So I spent the next six months trying to get effectively treated for the OSA and finally I have a machine which has gotten me to the point where I only wake 7-8 times/hour. The sleep doctor feels that is the best we can achieve and has now prescribed a "stimulant" to address my fatigue.
But I think this may be a big mistake. My basic symptoms are unchanged but my blood sugar is out of whack, particularly my Darn Phenomenon and my insulin requirements are up 25%. I think I may have some sort of adrenal problem already and a stimulant may be the last thing I need.
Here are the basics of my test results.
Test |
|
Ref Range |
TSH |
1.3 |
.4-4.5 |
Free T4 |
1.3 |
0.8-1.8 |
Total T3 |
87 |
76-181 |
DHEA-S |
293 |
25-240 |
Cortisol |
14.5 |
4-22 |
Ferritin |
131 |
20-380 |
Iron |
72 |
45-170 |
TIBC |
334 |
250-425 |
Iron Sat |
22 |
20-50 |
B12 |
745 |
211-946 |
My body temperature is highly variable, between 93 and 95 deg F in the morning and on average 95 deg during the day, but it has swung as high as 97 deg F. I have checked my temperature daily (sometimes multiple times) with three different thermometers over more than a year. These are actually my temperatures and they have been confirmed on doctor visits.
My vitamin D is fine, I have regularly had it tested and I supplement.
So I could use your help in how to engage my endo in trying to track this down. I have an endo visit in two weeks. What test results should I ask for? Should I press for certain treatments? Should I see another specialist? Should I press for X-Rays or ultrasounds of my "glands?"
Tags: Diagnose, Fatigue, Hypothyroid, Low Body Temperature, Test
Replies to This Discussion
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Permalink Reply by Holger Schmeken on -
I can relate to your problems. I have not monitored my temperatures like you did but I am always on the lower side. As a desk worker I have down-regulated my metabolism too. But I still think it is related to the Thyroid but like you my TSH, T3 and T4 is normal. Vitamin D can be ruled out for you and for me it did not make any difference. The following might be helpful but I am not convinced. For the following orchestration to go wrong it needs neurological problems on a more severe scale in my opinion:
The hypothalamus gland, located at the base of the brain, controls internal body temperature. This gland responds to sensory signals from temperature receptors in the skin and deep inside the body. The hypothalamus establishes a "set point" for the internal body temperature, then constantly compares this with its own actual temperature. If the two temperatures do not match, the hypothalamus activates temperature-decreasing or temperature-increasing procedures until the temperatures are equalized.
Sources: Guyton, Arthur C. Textbook of Medical Physiology, 8th ed., p. 802; Selkurt, Ewald E. ogy, 5th ed., p. 169.
The following conditions should be considered too:
-Raynauds phenomenon
http://en.wikipedia.org/wiki/Raynaud%27s_phenomenon-Wilson’s Temperature Syndrome
http://www.wilsonssyndrome.com/-Addison’s disease
http://www.merckmanuals.com/professional/endocrine_and_metabolic_di...
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Permalink Reply by Brian (bsc) on
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Thanks Holger. There may well be something with my hypothalmus or pituatary, I just don't know how to test and diagnose for it. My endo has queued up an IGF and GH test, but I don't know what they would say.
I doubt it is Raynaud's, that generally affects blood flow and temperature regulation in the extemeties.
And I sorta ruled out Addison's. From your link:
Addison's disease is an insidious, usually progressive hypofunctioning of the adrenal cortex. It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis with cardiovascular collapse. Diagnosis is clinical and by finding elevated plasma ACTH with low plasma cortisol. Treatment depends on the cause but generally includes hydrocortisone and sometimes other hormones.
I have hypertension and no hyperpigmentation and I seem to have elevated cortisol. And the other results don't seem to match, I have normal electrolytes and I am not hypoglycemic. Still it is worth asking the doctor.
And the whole Wilson's Temperature Syndrome. Oh boy. The American ThyroidAssociation has denounced it and I don't want to argue about an unrecognized condition. But in either case, I do have a low T3 and low body temperature. In truth, I might respond to T3 treatment just as recommended by Wilson.
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Permalink Reply by Shawnmarie on -
I don't have any advice, but this does make me wonder whether diabetics tend to have lower body temperature. I've always run right around 96 or so. I do have hypothyroidism, but even when my thyroid numbers are good, my temp is low. I also have very low blood pressure. How's your BP? Sounds like you're dealing with quite a puzzle.
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Permalink Reply by Brian (bsc) on
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Thanks. I do think you are right, as diabetics we are at higher risk of hypothyroidism. I have had slightly high blood pressure, but much of that could be the OSA which clearly raises blood pressure. And if I do have some adrenal problem that can cause high BP.
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Permalink Reply by smileandnod on -
Weird...my temperature has always run in that range as well.
Bsc, your mention of pituitary made me think of my youngest brother, who is not diabetic but has had similar symptoms for the last couple of years. He's been doctor to doctor trying to figure out what it is.
Part of my brother's puzzle lead to him finding that he has low testosterone. I don't know if you've had your testosterone level checked? Although my brother's bg level has been normal thus far, I have read that there is a link between Type 2 diabetes and low testosterone.
My brother's doc did an MRI of the pituitary when his bloodwork showed low testosterone to check for some kind of pituitary tumor that could cause this but he didn't find anything -- I've talked to a couple of other men who have been through this process and I think the MRI is one of the screening steps for diagnosis.
I don't know if it's realted in any way, but my brother was also diagnosed with severe sleep apnea and has the machine also. When he went to the sleep lab, they woke him up and put the mask on him before the night was over because it was so bad.
I really empathize with you. The hardest part sometimes is finding the right doctor to make the connection. My brother still hasn't completely diagnosed his issues. Like you, his bloodwork is in normal ranges (other than his testosterone level).
I don't know that any of this helps but I wish you the best in finding some answers.
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Permalink Reply by Brian (bsc) on
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About 7 years ago I submitted to statination and my testosterone dropped like a rock. At the time, I had X-rays of my pituitary to look for tumors and then was started on hormone replacement. That caused side effects, most notably extremely high blood pressure, I ended up having to stop the statins and my testosterone and other symptoms all got better. I have had recent testosterone tests and it is normal. I do think that low testosterone is common when you have diabetes.
Thanks for your thoughts.
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Permalink Reply by Super_sally on -
Hello,
looking at your results I suspect you may indeed have a thyroid problem. yes, your tsh looks ok at 1.3,
Your FT4 looks okish at 1.3 - slap bang middle of range (though some people do feel better with FT4 a bit higher in the range. But your total T3 is right low on the bottom end of the scale. This may mean that your body is not converting t4 to t3. Quite common in persons with diabetes (Dr. Bernstein talks about this too, including that TSH is quite useless for detecting thyroid problem, particularly with persons with diabetes).
You should actually measure FT3 (not Total T3). Total T3 includes T3 that is protein bound and not available. So test FT3 for Free T3. If your FT3 is also very low in range or below range, then this means you have a conversion problem.
Your doctor should possibly also measure RT3 - reverse T3. This is T3 that can't be used. RT3 montitoring is not quite mainstream yet. BUT FT3 measurements are.
IF your FT3 is below the middle of the range, it may explain your stmptoms. Treatment would be supplementing T3 to get your levels at least to mid-range.
In short, follow up the thyroid angle further...
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Permalink Reply by Brian (bsc) on
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Very astute observations. I see you have really been studying this. My Free T3 was last tested a year ago. It sounds like I should really get a Total T3, Free T3 and reverse T3. Has anyone been successful getting a reverse T3 test ordered from a mainstream doctor?
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Permalink Reply by Super_sally on
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No need to test TT3, FT3 and FT4 will do. Worst case if you can't get RT3, then start with the FT3 alone.
I am hypothyroid for 12 years now and don't fit the 'standard' presentation so I learnt a lot very fast. I take a desicated thyroid (T3/T4 replacement) and just monitor FT3 and FT4 for dose adjustment.
Do you eat lots of soy? If you do, cut it. Soy is well known for ability to suppress thyroid function.
Glad to help a little.
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Permalink Reply by Brian (bsc) on
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Thanks, it is my understanding that if I know my total T4 and the Total T3 I can get an idea of how much Reverse T3 I have since the T4 will convert to either T3 or Reverse T3 and the Reverse T3 is roughly T4 - T3. Is that true?
ps. I avoid soy almost completely as well as being almost gluten free.
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Permalink Reply by Super_sally on
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I'm not an expert on RT3. So can't really answer that. It's not available here for me to test, so I didn't bother reading up.
Am so glad that your Dr. agreed to the testing and you're going to look into that further. :)
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