Wednesday, January 23, 2013

Part Two: Thyroid, Adrenals, and Hormones - My Personal Battle


Part Two: Thyroid, Adrenals, and Hormones - My Personal Battle 



In Part One of this three part series, I talked about some of my symptoms that slowly crept on over the past few years. I knew something was wrong with me, and I suspected that it was my thyroid and/or hormones, but truthfully - I was scared shitless. I had heard horror stories of people with these types of problems and how once they were diagnosed it was a roller coaster ride trying to find the right dosage of this and that, and to be honest, I was in denial. 
I kept telling myself, "I eat so healthy and try to take such good care of myself... how could anything be seriously wrong?"

I sought out a Naturopath (ND) in Salt Lake City during the summer of 2012 when my PMS got so out of control that I couldn't handle it anymore - a woman that specialized in females and hormones - and I also got a second opinion from an ND in Maryland that is basically a genius when it comes to interpreting lab results. 

We ran a full hormone panel using salivary tests, which required my filling up four tubes with saliva at four different times throughout the day. We tested my estradiol, testosterone, androstenedione, DHEA, cortisol, progesterone, and SIgA levels. We also ran a standard thyroid panel, which is TSH and T4. 

** A quick note about cortisol testing: cortisol is a rhythm. It should start high in the morning and slowly taper off as the day goes on. Doctors that test cortisol using only one test don’t get the full picture. They are simply given a snapshot of where your cortisol is during that exact moment in which the test was ran. This isn’t thorough because lets say you run a test for cortisol in the morning and it shows high like it should, the doctor would never know if your cortisol doesn’t decline throughout the day like it needs to because they only ran one test. For this reason, multiple tests throughout the day are necessary in order to give a much more accurate depiction of what your cortisol rhythm is doing. 

Are you taking notes? There will be a quiz at the end. 



So what turned up? 

August 2012 Thyroid and Hormone Results


My hormones were WHACKED OUT. Elevated estradiol, high testosterone, extremely low DHEA, and low cortisol across the board. 

My basic thyroid test of just TSH showed that things were within range (which is admittedly quite skewed to begin with, but more on that in Part Three). 
** Important note: We only ran a basic thyroid test at this point, which is just the typical TSH test. 

My blood tests showed that some of my liver markers were abnormal, my blood glucose was in the tanker (I was borderline hypoglycemic), and my Vitamin D was low. 

August 2012 Treatment


Both of my doctors are convinced that all of this mess was brought on by my extreme dieting and exercise from years ago. They believe that because I've taken such good care of myself with solid nutrition and staying active post-Figure show that I was able to cover up the symptoms to a certain degree over the last few years, however it eventually caught up with me. 

I'm going to say it again for emphasis: This was brought on from extreme dieting and training like a wild banshee, with the mindset that days off are for the lazy. Learn from my mistakes! 

The first thing my doctor did was advise me to cut back on my training, to the tune of 2 - 3 sessions per week, max. Initially I was devastated because I had always preferred to train 4 - 5 days per week, but I realized I felt so awful that I wasn’t physically able to train more than two or three times each week, even if I wanted to. 

The thought behind backing my training down is fairly simple. Training at a high intensity stresses the body. The fact that my adrenals were suppressed and cortisol output was low showed that my body was extremely stressed out and we needed to eliminate as much of that as possible. I was also instructed to focus on relaxing. Meditation, leisurely walks, baths, being happy as much as possible, watching a ton of Grey’s Anatomy, and munching chocolate whenever the opportunity presented itself. Okay, fine. I made those last two up, but seriously, McDreamy = stress-free. Can I get a witness?

Another reason for decreasing my training is that strength training can slightly increase testosterone levels in a woman. Normally this is a good thing for fat loss and performance, however my testosterone was too high and we didn’t want to exacerbate it. 
Also regarding testosterone, I was advised to back down my consumption of saturated fat due to the fact that it can elevate testosterone. This meant substituting some of my grass-fed beef and coconut oil with fish, turkey, and olive oil. Again, some saturated fat is healthy, but I was consuming too much and my testosterone was too high. 

As for the elevated estrogen and severe PMS, my IUD (the Mirena) was the suspected culprit, and in conjunction with my abnormal liver markers, Dr.W suspected that my liver wasn’t detoxing excess hormones like it should. He advised that I remove my IUD immediately and start a heavy supplementation protocol for liver support. I took his advice, got my IUD taken out and started the supplements. 

I was also advised to start getting some sunshine and supplementing with Vitamin D.

About 45 days went by and things improved dramatically. My skin cleared up, my brain was functioning better, and my PMS had vastly improved (woohoo!), however I still didn’t have much energy and continued to wake up each night at 2 or 3am. 

Back to the doc I go...



My doc in Maryland requested that I redo my hormone tests and also run a more extensive thyroid panel (which is what we should have done from the get-go), which included TSH, Total T3, Free T3, Free T4, Total T4, reverse T3, and thyroid antibodies. 

I was in Kentucky at the time and had to request that my doctor in KY order the additional thyroid labs. To say he fought me on this would be a vast understatement. He flat out refused, saying that additional labs weren't going to change the fact that my thyroid "was just fine" according to my TSH results. I basically told him I wasn't going to take no for an answer and he finally relented, if for no other reason than to get me out of his office. I had the labs ran and sent the results out to my doctors in Maryland and Salt Lake City. 


October 2012 Test Results 


Hormones were much better! Estradiol and testosterone were now well within range (!!!), which was great news and meant that removal of my IUD and the liver supplementation definitely helped. However, my DHEA remained quite low, cortisol was still slightly depressed, and now progesterone was a smidge low. 

My thyroid was also pretty messed up. Borderline low Free T3 and Total T4, and extremely low Total T3, which is a biggie and explained 80% of my symptoms. The fact that my TSH and antibodies tested normal ruled out the chance of Hashimotos Disease, which was a relief. 

** Important note: The same doc that initially refused to run the extensive thyroid panel got the results and called me the next day and said, "You need to be on medication immediately." Go figure.  Remember that I ran the basic thyroid test of TSH back in August, and it showed that it was within range, however we didn't discover that I had serious thyroid problems until we ran much more extensive testing! When you go to your doctor to get your thyroid checked, it's absolutely imperative that you ask them to run more than just the standard TSH and T4. Specifics on this in Part Three. 

October 2012 Treatment 


My doctors made the decision to start me on a thyroid medication which is dessicated pig thyroid (of course my best friend has mad jokes about this and refers to it as my “piggy meds”). I was instructed to run this medication for 30 days and retest my levels. 


Mid-November 2012 - It’s All Worse


Retested my thyroid again, and this time all of my thyroid results were significantly worse. Every single thing had decreased across the board. My formerly borderline low Free T3 and Total T4 were now even lower, my Total T3 had, much to my dismay, dropped even lower, and now my TSH was borderline low, too, which is a common side effect of taking the thyroid medication. 

::sigh::

Back to the drawing board


We backed down my dessicated thyroid medication and added another one to the arsenal, which is a very low dose of T3. The interesting thing about the thyroid is that a dosage can be just fine for a few days and then WHAM! it’s too high for the next few days. This is exactly what happened to me. I was taking it for about a week and felt fine and then all hell broke loose. My heart was pounding so hard that I could hear it in my ears and feel it in my eyeballs! 

We immediately backed my dosage way down, and I also started taking a natural thyroid supplement along with it, which includes selenium, iodine, etc. 


They also instructed me to bring my carbohydrate intake up. I am an innate low-carbbie. I love meats, fats, and veg and because of that my daily carb intake had been <25g/day for months and months. I was to shoot for at least 100g carbs/day, as it's crucial for T4 to T3 conversion. 

The also advised me to back down my intake of raw kale, cabbage, and other goitrogens, and when I did consume them they had to be cooked. I am a veggie junkie so this was a huge change for me as I was used to munching raw kale, cabbage, spinach, and other goitrogens multiple times per day. 

I was instructed not to fast, and to make sure I was eating every few hours. 

I was told to take my temperature every morning using an old school mercury thermometer, which, according to my docs, are the only ones worth a damn in regards to accuracy. 


Over the next few weeks, I started feeling good. Then better than before. Then better than I had in the last year. My energy increased, my cognitive function had noticeably improved, my feet weren’t freezing anymore, my drain wasn’t always full of hair and I went 30 full days without desperately needing a mid-day nap. I think we are on to something! 

January 2013 Thyroid Testing... Yes, Again! 


After 40 days of running the most recent medicinal and supplementation protocol, and making the other dietary/lifestyle changes I mentioned above, we retested my thyroid once again, running another extensive panel: TSH, Total T3, Free T3, Total T4, Free T4, and reverse T3 and...



In part three of this blog series, I’ll share my most recent test results with you, along with a summary of my symptoms, the dietary & lifestyle changes that I believe caused it and then helped it, what I think you should be watching for, and anything else that I think of that might help you or somebody that you love! 

23 comments:

  1. Your story sounds soooo similar to mine...except I am feeling bad again. I am on piggy meds too but they worked quite well for me.. so I never really needed to pay attention to my labs. I cannot wait for part 3. How are your adrenals? I think mine may be out of whack again... sigh..

    Thanks you so much for posting your story!! It means so much to know I am not alone in this insanely similar battle!

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    1. Hi there!

      From what I understand, it is quite common for your thyroid levels to fluctuate, which is why it's crucial to get an extensive thyroid panel ran at the first sign of any odd symptoms.
      I encourage you to get in there and get re-tested so that you can feel better again! :) All it may take is some minor tweaking to your medication dose.

      As for the current state of my adrenals, I'm not sure. My guess is that they have vastly improved, as I feel a lot better and my heart isn't always racing anymore. However, I am re-testing my cortisol rhythm in about 2 months so we will see.

      You may already know this, but if you suspect that your adrenals are out of whack, please take it easy. No caffeine or stimulants, or long duration high intensity exercise. Take time for YOU - baths, leisurely walks, restorative yoga, meditation - it's important!

      You are certainly not alone! We battle together and help each other learn what works and what doesn't. :)

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  2. Thank you so much!! My adrenals had been low about two years ago but I am somewhat back to my old habits. (too much coffee, some stimulants in the form of pre workouts) and then I am starving an make the wrong food choices. I have many food sensitivities and I believe its all related. I have been putting off going to the doctor but I am going to call right now and make an appointment!!!
    Thanks for the inspiration! :)

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    1. I am a coffee & stim lover myself, so I understand how it's extremely hard to give that stuff up.
      So pleased to hear that you are calling to make an appointment! Excellent decision! :)

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  3. I have complained to my thyroid doctor that things do not feel normal for the last several years. In 2006 I had half of my thyroid removed because I had a 5.5cm cyst and my thyroid levels were up and down. Since then I feel like my meomory and concentrataion have gone downhill, and are currently getting worse. I go through a month here or there were tons of hair falls out and then I'm normal again. My weight fluctuates pretty easily and my energy levels are so low. The last time I saw my doc I asked about the "piggy" hormone because someone told me she thought she felt better on it than synthroid.

    My doc told me that people often get a high when they take it first thing in the morning that slowly goes away throughout the day, so he didnt want me taking it. He said synthroid works more evenly throughout the day. Funny thing is that he hasn't run all of the tests you mentioned. I know he has done Free T3 and T4, and of course TSH. I think that's about all he tests. He did want me off birth control so he could check out something related to my pituitary. I have been off since July. I called them yesterday to schedule more tests.

    Thanks for sharing your story. It helps to know I'm not the only one! On top of all this I am working on muscle imbalances in my core and low traps :( It feels like it's taking forever to get back to a routine I enjoy. My PT has taken yoga from me and I really feel I could use that right now! When my core is better she will let me add it back.

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    1. Hi Codie,
      Have you considered getting a second opinion? I highly recommend that you get somebody else on board to get a fresh set of eyeballs on your situation.

      One of the biggest lessons I have learned throughout all of this is that there are several different ways to treat thyroid woes - most of which aren't wrong, but they are just different approaches. The key is to find the sweet spot for you and your body.

      I know it's a big pain in the butt to transfer all labs to a new doctor but it could very well be worth it. All doctors treat this stuff quite differently. What have you got to lose? :)

      Also, I don't have any knowledge regarding thyroidectomies, but I've read quite a bit by Melissa Joulwan. She had her entire thyroid removed and has gone various routes seeking relief. You may be interested in checking our her posts. Maybe some of it will be helpful to you:

      http://www.theclothesmakethegirl.com/tag/thyroid/

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    2. Thanks! I have considered seeing someone else. I already drive 2 hours to see my specialist in Spokane. It might be worth going to Seattle when I visit family.

      I do see an osteopath that has helped me with my gut issues, but I never really pushed the thyroid issue with her. She has run the basic panel just to check things, but nothing beyond that. She does like to push a crap ton of supplements. I also went throuhg an elimination diet while seeing her. I did feel pretty good on the diet, but it didn't get rid of my issues and I even stayed off everything for 8 weeks!!

      I do appreciate your story :) and all that you do for Girls Gone Strong. You are an inspiration! I so can't wait to lift heavy again! (I started and that's when I discovered muscle imbalances)

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    3. Have you read any of the thyroid books out there? Any worth taking a peek at? Thanks!

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    4. Definitely get a second opinion when you go visit your family! For awhile there, I was visiting 3 different doctors in 3 different states! Whatever it took to get things moving in the right direction.

      I'd flat out ask her to run the extensive labs, especially before starting heavy supplementation.

      I haven't read any books on the thyroid yet!

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  4. Jen,

    Thanks for sharing; what an enlightening story and I am glad you are brave enough to tell us your story. I am interested on your take on cruciferous veggies...do you recommend to consume them cooked?

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    1. My pleasure! I was a little leery of putting my entire medical story out there for the entire world to see but I am optimistic that it will help people!

      Cruciferous veg are near and dear to my heart. Anybody (and mostly my coaching clients) can tell you that I am a die-hard lover of all things veggie. It was a bummer when I learned that I needed to substantially cut back on my intake of goitrogens - many of which are vegetables that I eat.

      From what I understand, there are two schools of thought regarding goitrogens and thyroid function. Some experts believe that cooking them (even a light steam) will inactivate the harmful compound and you are free to eat them. Other experts think that they should be avoided at all costs if you have an existing thyroid condition.

      Personally, I have found myself somewhere in the middle. I have cut way back on goitrogens, however I NEVER eat them raw anymore. When I do consume them, it is a non-negotiable that they are cooked.

      If you don't have a thyroid condition, you shouldn't worry about them unless you are eating pallets of goitrogens per day - then that can be problematic. However, if you suffer from thyroid disfunction, I'd whittle them back to a few times per day max and make sure that they are always cooked.

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  5. May I ask how has ur weight been through all of this if you don't mind sharing thanks

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    1. Some small fluctuations, but the biggest factors for me were lacking energy, losing hair, brain fog and digestive issues. Something that is to be said about my weight and thyroid though is that I could diet quite hard with little to no results. In other words, it's been far to difficult for me just to maintain than it should be.

      Interesting because whenever anybody hears about thyroid problems, they immediately think of body composition, when the thyroid controls so much more than that!

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    2. Jen, that sounds too eerily similar to myself. I have had to bend over backwards with training and nutrition to maintain body-comp after going through a prolonged period in a hypocaloric state similar to contest dieting. Diet hard, minimal results….difficult to maintain, etc.. :(

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    3. We all have to remember that extreme dieting leads to downregulation of our metabolism. It's extremely common for people to have to employ stricter and stricter dieting/training tactics in order to get lean over and over again. Our body will fight it every step of the way, and each prep typically gets tougher. I see this happen with competitors all of the time!

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  6. Jen, first thank you for sharing this on your blog. Most unfortunate yet glad to see that most of what I have experienced (minus the PMS, female problems) is/has been by others.

    The first doc I went to tried to discredit my past and dietary history claiming thyroid issues are purely hereditary and was only going to run TSH/T4 test for my follow up. After some interwebz digging I realized that was not good enough, found a new DR who is GREAT!

    I just got on T3 so we’ll see how this goes and how my panels turn out in a few weeks. One thing she recommended to me was to get involved with as much relaxing/calming activities as possible to try to really bring my bodily stress down, my TSH has been above 2x the high end of the threshold at sometimes.

    I like you used to have the attitude of “no days off” over the past year or two have realized how foolish that is, yet still training 5x week between weights/sports. Hopefully you will discuss more in the next blog how you changed your training and other biofeedback factors you picked up on from changing that aspect of the equation?

    also what do you feel helped the most with digestive/GI issues? That is something I have not been able to pinpoint yet in the mist of this mess.

    sorry for the lonnnng reply

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    1. Hey!

      So glad that you got to see a great doc and have an action plan. That is the first step! I also agree wholeheartedly with your doc's recommendation to focus on relaxation; it's imperative for overall health.

      My digestive issues were partially due to my thyroid, so as that has gotten better, so has my stomach. Also, I had some extensive food allergy testing done, and while these results typically show a laundry list of allergies, mine only showed 3: chicken, eggs, and almonds, all due to overexposure. I cut those foods out for the last 6 months and feel like things have improved quite a bit from it as well.

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  7. Jen,

    Thanks for sharing! Have any of your doctors mentioned anything about iodine? I've suspected my thyroid is off and upon doing some research that the underlying cause could be an iodine deficiency. Since we eat such healthy diets, we don't get the normal (iodized) salt content of the SAD (standard american diet). I've tried incorporating natural sources of iodine in my diet, namely seaweed, but it's too soon to see results. Just curious if that came up with you at all during your journey.

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    1. Hi!
      Yes, iodine is in one of the supplements that I take, but so is a hefty dose of selenium. It is my understanding that (depending on what you have going on) too much iodine alone can be harmful without the presence of selenium.

      You may be interested in this article by Chris Kresser that discusses this topic specifically: http://chriskresser.com/iodine-for-hypothyroidism-like-gasoline-on-a-fire

      I'd like to encourage you to get to a doc to get some panels ran so you know for certain :)

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  8. Hi Jen
    I wanted to touch more on my question about weight as I asked how this has been affected
    The reason I ask is a symptom of thyroid is weight gain and if u have taken corrective measures has it helped in that area at all. Thanks for all ur support and answers just trying to get as much advice from all directions in terms of the issue and things u Hve tried to help correct them ...I have the whole list of all ur symptom n plan soon to see doctor but one big thing is the weight with me and the feeling of no budge anywhere
    I went from stage weight to 150 in 4-6 months I maintain a clean diet and have my occasional refuel at times.
    I am still looking deeper into my thyroid as I feel is the culprit to all my symptoms.
    So I guess I just ask as u started to feel more energy and just better all around did u feel ur weight started to budge but easier or better.
    *** forgive me typing from my little phone so if there and confusion *** thanks so much

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    1. The thyroid can absolutely play a huge factor when it comes to weight in some people, but some people experience certain symptoms more than others.

      I've had some small fluctuations in weight, but this is a very multi-faceted situation. I've got a sluggish thyroid and had suppressed adrenals. Because of those two factors, I've had to back down the intensity/frequency of my training and substantially increase my carbohydrate consumption. Those were two pretty big lifestyle and dietary changes for me that will inevitably lead to some change in body composition - more for some and less for others.

      Weight isn't a focus for me at all at the moment (I haven't weighed myself ONE TIME since November of 2011!) because my health has to be my priority.

      Some people, as they get their thyroid levels balanced, have an easier time learning out, while others continue to struggle a bit. It's all so individual that there is no way for me to guarantee you one way or the other that getting your thyroid fixed will help you lose weight. Does that make sense?

      I wish I could give you a firm answer, but unfortunately our bodies just don't work on absolutes. ;)

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  9. Who did you see in SLC, if you don't mind me asking?

    I have Hashimoto's and adrenal and hormone issues and am going out of my mind trying to figure it all out. Your story hits very close to home. Almost a mirror image of many of the things I am experiencing. I am dying to find somebody who can really help and have tried many doctors who want to provide a pill, but don't treat all the symptoms.

    Thank you for sharing your story. If you have a referral, I would appreciate hearing who you saw. But I am very sad my beloved raw kale may not get to stay in my future. For the love. . .

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    1. Hi Amy,
      I'm so sorry to hear that you are dealing with all of this. It really is so incredibly frustrating!

      Regarding kale (which in my post I'm actually referring to cruciferous vegetables), there are some doctors that believe a ton of cruciferous veg can hinder thyroid production due to goitrogens.
      With that being said, there are many other docs that believe goitrogens don't play a part at all. The more doctors you see, and the more research you do, will show that thyroid treatment is more hotly debated than politics and religion.

      Check out this post/podcast from Chris Kresser:
      http://chriskresser.com/the-healthy-skeptic-podcast-episode-4

      I'd advise getting a second opinion, and even a third, until you find a doctor that you feel comfortable with.

      I'd also advise checking out Dr.Brooke (www.facebook.com/betterbydrbrooke), as she specializes in PCOS, Hashi's and Adrenal issues.

      Often with these issues, it takes quite a bit of trial and error to find your sweet spot with medication and dosing.

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