Just diagnosed w/ Hypothyroidism?!?, what now?
So I've been struggling for the past 4 months to stay healthy and consistent in training through the JOS and into Adv IM for IMCDA, actually struggle is understatement... I've gotten sick 4 times (about every ~3 weeks after I get well again) since the new year. Head cold, chest cold, bronchitis, sinus infection, massive fatigue, shortness of breath, dizziness, etc. After the second time, I started thinking there might be something actually wrong, since I went the entire year last year only getting sick once.
Long story short, lots of Dr visits and tests later, virtually everything is normal except for my TSH level which came in at 9.5uIU/ml. Technically sub-clinical, but since I do have symptoms (constantly feeling cold, brittle nails and hair, muscle cramps, shortness of breath, fatigue), the doctor wants to treat even though my T3,T4, and TPO are normal. I'm willing to try, but skeptical since it seems that the usual indicators are not really in line. In a 41 yo Male active male Hypothryoidism is somewhat unusual.
I guess the real questions for those with experience in med and thyroid:
- What else might it be? I know thats really broad, but I'm looking for ideas, and I think I've tapped out the GPs experience. (We've done full blood work, no anemia or deficiencies, and ECG, Echo, Stress Echo, CTA, Chest Xray, nothing abnormal, except for a classic Athletes Heart, and breaking the heart center's record on the Stress Echo!)
- Need some feedback on salvaging my year too. Should I continue on training for IMCDA (6 weeks out) while starting the L-Thyroxine treatments, or am I just asking for more problems by adding stress to my system and just kiss off IMCDA? The doctors here are more of the mindset that no-one should be doing Ironman races or training at that level, and so I get no sympathy or understanding there. I do have IMAZ on tap for November, which is really important to me to do well in. I've maintained my VDOT and FTP since last IMAZ, but I don't really have the long hours in, I've missed half the long workouts in the past 6 weeks.
Comments
Here's what I can tell you:
-- The American Academy of Clinical Endocrinologists revised the "normal" TSH range in 2003, right around the time I was diagnosed. It's now 0.3 - 3.0, yet the majority of labs and GP/PCP's are still using the 0.5 - 5.0 range. So, no, you are not technically "sub-clinical" and IMHO, you should be getting treatment.
-- Have you been tested for anti-thyroid antibodies? In my case, I was fluctuating between hypo and hyperthroidism.... My original test came back with a TSH of 5.xx, and my GP didn't see a need to treat. I sought a second opinion from an endocrinologist, had another thyroid panel done, and it had shot up to over 50 (yes, fifty)! He had me retest in a couple of weeks, and it was down to 0.2. I was diagnosed with the autoimmune disorder Hashimoto's Thyroiditis - he wanted to, and I quote, "zap" me with radioactive iodine. I sought a THIRD opinion from an endocrinologist who exclusively treats thyroid patients. He put me on Synthroid, and essentially forced my body into a state of constant hypothyroidism where it's now dependent on an outside source of thyroid hormone. Not ideal, but much, MUCH better than being exposed to radioactive iodine!
-- My T3 and T4 were considered within "normal" ranges in my first test, too. From what I understand, mildly elevated TSH with normal T3 and T4 is, well, normal. This doesn't necessarily mean there isn't anything going on and you shouldn't consider treatment. You could be tested next week or the following and all of your levels could be outside normal ranges. The fact that your TSH is already elevated AND you are symptomatic is an indicator that something is amiss...
-- Synthroid is one of the few medications that you should absolutely NOT under any circumstances replace with generic. Do not accept Levothyroxine. It just doesn't work. Even my pharmacist brother will back me up on that one (and he never backs me up on anything... ;-) I knew this, and I tried it for a couple of months anyway and I experienced firsthand how ineffective it is. I've also forgotten to take my Synthroid for couple days in a row and I've felt that brain fog/been run over by a Mack Truck feeling. If you start taking Synthroid, it'll take a month or so until it really makes a difference, but you won't suddenly feel like you can conquer the world (oh... how I wish I did!). But if you forget it for a few days, believe me, you'll know!
-- I have absolutely no idea what else it could be... but just to throw it out there, the brittle nails/hair could be a digestive enzyme issue. Even after years of Synthroid I still had brittle nails until I started taking a digestive enzyme supplement. And cramping... do you take magnesium? My only other less than educated guess would be a B-12 deficiency (which I've also had the pleasure of experiencing... it's SO awesome.).
As far as IMCdA... you're awfully close and any treatment you receive likely won't have an effect until your taper. I think it depends on how cool you are with just going out there for the fun of it. Having been there (with the thyroid AND missing a LOT of long workouts before an IM), you can definitely do it, but you have to be mentally prepared and ready to accept a long day in which you're not racing to your ability (sorry for stating the obvious. It's a gift... ;-)Hope this was somewhat helpful! Good luck!!!
Wow! Thanks Jess! Thanks for lots of great info!
I will look into getting Synthroid, next round, as I am on generic levothyroxine. Yes I came up clean on thyroid antibodies, which was another reason to wonder if this is really hypothyroid vs some other endocrine system issue. Read some things that seemed to say that TSH levels fluctuate much more than they thought, and can respond to body stress temporarily without necessarily being a disorder.
How have you found your TSH,T3,T4 levels and Synthroid dosage under training load, do you find you need to adjust your dosage as you ramp up for race season?
I'm still leaning towards gutting it out for IMCdA treating as another training day, and just for fun. The alternative is doing a reboot at this point and rolling to a Get Faster Plan through the summer till August and picking up the IM plan for AZ then. I just don't know what the best tactic is balancing both health and performance....
I'd maybe consider adrenal testing, too... It's a pain in the arse, but with the amount of training stress your body is absorbing, it might not hurt to look into. In all honesty, though, from what I understand, adrenal testing usually doesn't show much unless you're deep in a hole of adrenal fatigue. This is where I get a little controversial: I have a friend who is a chiropractor and very knowledgable about holistic health and nutrition - I take a boatload of supplements during training to help my liver process the added cortisol/lactic acid/etc due to training, and I take an adrenal support supplement as well. I know that many will argue that there's not a lot of efficacy to such supplements.... but I've felt significantly better since I've started taking them, and felt the adverse effects when I've run out or forgotten them when traveling, etc... Sorry - that's a total tangent! But thought I'd mention it if you don't seem to get what you need from a prescription med!