Failing Thyroid Health, Reverse T3, Cortisol, Iron-levels, and Your Liver

My thyroid loves to misbehave. I feel I've met with great success with my thyroid health these past 19 months of recovery. I am on a nutritional plan that, for the most part, works quite well. I have even experienced the coveted 40+ pound weight-loss. I don't recall being this low a weight even in high school. However, I have symptoms that have recently cropped up the last few months. At first, they didn't stand out enough to mention to my thyroid doctor. As the months have increased these symptom's severity and/or frequency, I thought it prudent them bring up to my doctor.

New Symptoms

Increased Fatigue
I wanted to start with explaining to my doctor my increased fatigue. I'm starting to get sleepy during homework time. That symptom is an old symptom that would be before meeting this doctor. I'm not going back to that coma-like state. I'm sleeping so hard that there are crease marks on my body and I'm still exhausted? I'm getting the requisite 8+ hours of optimal sleep. Why am I still exhausted? This isn't fair. I'm enjoying my life and excess sleep cuts into that.

Insane Hunger
Plus, for some reason, I'm ravenously hungry. Portions that once filled me for hours aren't sufficient. My body is screaming for food two hours later. What gives? Why is that suddenly making a cameo appearance? Again, that was a symptom I experienced before finding my thyroid doctor. Why is it showing back up 19 months after we've started effective treatment?

The next two symptoms had me rather perplexed.

Anxiety/Severe PMS
My anxiety episodes were creeping back into my life, especially before my period. Believe you me when I say I have been quite happy leaving those symptoms behind and once a month, they've shown back up? This month, I had two episodes within days of each other right before my period (i.e. experiencing such a surge of emotions that I'm too stressed out to handle my day-to-day stress to the point where I'm bawling uncontrollably and distraught with an ensuing depression). I figured that frequency warranted a closer look because it wasn't just "oh you're just PMSing" because the crying episodes before this month did not have the follow-up depression. I used to have anxiety attacks with much more frequency and I always got depressed afterwards. If it's popping up like this now and it's gotten more and more severe with each passing month...then it's time to tell the doctor. Makes me think I should have said something sooner, but I'm ashamed of those moments and we tend to keep those moments tucked away. We don't share them. They're embarrassing and I'm just thankful my husband has put up with them and forgiven them almost immediately.

Profuse Sweat
For some reason, I have started to sweat profusely. I've never been one to sweat, honestly. In fact, I figured that maybe my new ability to sweat as much as I do now means that those times where I became severely overheated in the Texas heat (say, the 20 minutes we have students outside for school dismissal) were a thing of the past. Perhaps my body's thyroid affected my sweat glands enough beforehand to where it wasn't cooling itself off. Ok, well, maybe that's a good thing and I can bring it up to doc. Look! My body is cooling itself off. He can deduce if that's a good sign.

Doctor's Hypothesis

My thyroid doctor took these four symptoms and suggested I get a Reverse T3 lab test done. I will do so in the upcoming week. I made him repeat his information because (as I said to him), "You know I'm going to research this." He smiled at me and explained how severe PMS, profuse sweating (less than 20 minutes of standing at dismissal has sweat dripping down my nose and temple), increased fatigue and hunger were all signs that the body is making a mirror image of thyroid hormone of T3. So, if you're suddenly sweating like mad...talk to your doctor. I'm undergoing many changes and I thought that was a good sign, but I'm glad I brought it up.

Basically, Doc explained to me in these words:. "Your body is fighting you to lose any more weight. It doesn't want to give up any more fat." Really? I work this hard and I'm the Thyroid Diet Nazi giving my poor husband who made dinner the other night a speech of "Yes, I can eat rice, but that does not mean I need to eat a chicken and rice only dinner. Where are my veggies?" He (hopefully) did not take it personal as I scooped my chicken as clean of rice as I could and sliced up squash to nuke in the microwave with olive oil (5 minutes). So, tell me how this body of mine is having it's own anti-weight loss revolution? How is this fair?

No, I'm not in the acceptable BMI range yet, but goodness, I've gotten down to a size 10. I've never been in single-digit jeans since probably junior high (i.e. I don't remember being a size 8 or lower and puberty was still messing with my body and morphing it, so I don't know if that counts). I'm eating low-carb meals, exercising, taking all my prescriptions dutifully and taking the supplements doc has suggested or agreed to. When my doctor asked what I ate and I listed what I eat during the day (all low-carb), it's quite apparent I am not eating any food items that trigger cravings and/or hunger (i.e. sugar and wheat both do that to me).

So, yes, this can be frustrating and perhaps defeating to fight hunger of this nature (never mind you just stuffed your face) if you don't understand that you're not stuck in this situation. Your body is fighting you. Your body thinks you need more fat for whatever crazy reason. It's getting its messages crossed. It has NOTHING to do with willpower. I think if I didn't know what I know about thyroid, I'd be doing my best to eat thyroid-friendly foods and probably starving most of the time and STILL gaining weight anyway and be constantly distracted by severe hunger pains...and at some point I'd overeat an extremely big meal (to the point of discomfort) just to shut it up for a little while. In fact, I used to. I have things to do. I can't be distracted with nagging hunger all the time and you can only ignore it for so long. The body is really good at driving you insane this way (all those with thyroid health issues are probably nodding their heads here).

I recall speaking with those with perfect thyroid health (before I was a confirmed thyroid patient) that would say that they could ignore their hunger easily and just pop aspirin when their head hurt. Or the comment, "I just forgot to eat." What planet are you from? I couldn't understand that. Even as a child/teenager, I was never fully sated. I was always hungry a few hours later. Mom described my eating habits as a "grazer." I don't eat large meals, but what I'm eating should satisfy for longer than 2 hours.

Then it happened to me. The last four or so months, my body was in that "I forgot to eat" state. What used to be a 2-hour pause between hunger became 5 or 6. I wouldn't feel the hunger all that much. I might even get too busy and miss eating a meal on time. Then suddenly at maybe hour 5 or 6 since the last meal, I'd feel extremely hungry and I would get a roaring headache. That has NEVER occurred before in my entire life. I have always fought excessive hunger. I thought that meant maybe I had reach a pinnacle of thyroid health. Yes! I've made it! Woo hoo!

Then my body decides to go "Surprise! You just thought you did."

Reverse T3 Explanation

If nothing else, I can be called a proactive person. In positive circles, the term is called dedicated, but let's call a spade a spade. I'm stubborn. I do not take "it's just how things are" as an answer. Ever. There is always an explanation of some kind and I bet you somewhere in this world someone has experienced these things and have written about it and probably have a great solution. I can benefit from other's hard-work. So, I'm a research-aholic. I become obsessed with learning about these things.

What I've recently researched about Reverse T3 is that our bodies constantly convert T4 into rT3. You may have heard of thyroid lab tests where the doctor measures T4 and T3 levels. Reverse T3 (rT3) is the body's way of getting rid of too much T4. Our bodies have their own checks and balances system. The liver produces rT3 when the body senses too much T4 in the blood stream. On a daily basis, the liver converts 40% T4 into T3 and 20% of T4 into rT3. The issues pop up when those percentages get out of balance. It's an large domino effect.

If 50% or more of T4 is converted to rT3, we have a problem. T3 amounts shrink and shrink as a result (thus why my doctor called it "mirror T3" because your body thinks you have plenty of T3 too, so it sends out the message "Quit making T4 and T3").

Possible Reverse T3 Causes

Why would my body produce too much rT3? Well, it all starts with your body thinking it needs to conserve energy, like when we're sick. We are so sleepy, but our sleep provides our body with the ability to use the energy in our body to heal itself. We can't be walking around or anything because that energy needs to be used on healing. Other situations cause our bodies to go into this mode, healing from surgery, broken leg, trauma, etc. Some possible reasons a person with thyroid-health issues might experience this "conserve energy" situation can include the following:

• adrenal issues (cortisol)
• iron levels
• low B12
• chronic inflammation
• other health issues

What scenarios cause these above reasons? Let me explain a few.

Scenario #1
One situation is where a thyroid patient receives inadequate thyroid treatment. Some doctors only measure and treat T4 and TSH (pituitary) levels. This can keep you in a perpetual hypothyroid state and, as a result, your body works overtime to compensate for what it doesn't have. It does this by producing high amounts of cortisol.

Scenario #2
Another possible scenario is your body is producing less cortisol or is fluctuating between high and low levels of cortisol. This basically causes adrenal fatigue. Symptoms include chronic anxiety, poor coping skills, paranoia, easy nausea, sensitivity to light and sounds, and psychological issues. When all that hullabaloo happens with your cortisol levels, your thyroid hormone floods your blood stream and pools there. Your body's Command Center starts delivering orders to your blood cells "There's too much T4 and T3, start converting that T4 into rT3 and stop creating any more. We have flooding in tunnels 43K and 15D. She doesn't need that much. What moron is in charge of that Thyroid Center?"

On a side note, when I learned the above information, that pinpoints for me that my body is playing tennis with my cortisol levels. Recently, I've had nausea out of the clear blue and I didn't realize that was something to share with my doctor. I feel I'm dealing with increased anxiety like my pre-treatment days and that I have poor coping skills with everyday tasks and burdens that do not cause me stress...and they suddenly develop? I'm having a fantastic school year and I'm enjoying each school day because we're having fun with writing. My girls are well-adjusted and funny little squirts and my husband is so loving and helpful. My brother lives in my garage apartment and BBQs once or twice a weekend and he buys me and the girls a meal at least once a week (two this week) because he knows I'm strung out and come Thursday, I don't have it in me to cook towards the end of the week. Why am I not coping well all of a sudden? I have great support systems and loving people in my life. I have a great work place and a fulfilling job. Why am I not coping well? I was coping just fine a week ago.

Let's also add to it that I wear tinted blue eye-glasses because fluorescent lights, LED screens, and a cloudless summer day all give me migraines. I have severe sensitivity to sounds at times and I didn't realize it, but last week when I took my mother to dinner, the waitress sat us in the middle of the restaurant and the noise bothered me considerably. I hadn't experienced that in ages and I didn't put that on a sticky note to remember for later. It didn't stand out enough for me to inform my Doc. I'm glad the symptoms I did share informed him enough to say it's time to run rT3 tests.

Scenario #3
The third possibility is low iron levels, which is a common thyroid symptom. I didn't know that little fact prior to today. Iron or low-iron is responsible for transportation troubles with thyroid hormones. Those same thyroid hormones start to pool in the bloodstream and your body has the same reaction as the second scenario above. "Quit making T4 and T3 and start converting it to rT3! We have too much T4!" My body has the worst command centers, sheesh. I'm giving them all the tools they need to work optimally and still, we're having issues.

My Doctor's Response

My thyroid doctor explained an ideal T3 and rT3 ratio. Once upon a time, I was a math teacher, so I know individuals in my circle who don't mind working this math. My doctor is looking for a T3 and rT3 ratio 0.2 or lower. I believe your average healthy thyroid produces a number in the 0.23 or 0.24 range. Basically, take T3 and divide it by rT3 to get your body's ratio. One source I researched stated any number below 0.1 is worrisome. I'm glad my doctor knows to look to see how close I am to 0.1, not just "the number everyone looks at for in range." Enough of us thyroid patients are tired of hearing "Everything's in range. You're fine," and send you on your miserable way.

If I am found to have excess rT3, there are several options my doctor may take (which I will post at a later date in October).

1. Doc could lower my NDT (Natural Desiccated Thyroid), but I'm already on the lowest dose. I doubt he'll take that route.
2. He could identify the causes (high/low cortisol, low iron) and treat them.
3. A liver cleanse/support product and add selenium as a supplement. The liver is the converting household for the rT3. Giving the liver nutritional support, if this is the case, seems a wise step.

My doctor opts for natural approaches whenever possible. I'm on NDT and I use my daily diet to improve my health. I do not eat the work office donuts. EVER. I take care of my little butterfly in my throat even if it revolts against me like an ungrateful, angst-riddled teenager. I'm on a mega-probiotic to improve my gut health (and I notice a difference in bowels when I do not take it, constipation can be a constant companion for those with thyroid nevermind my daily diet is meat and vegetables...enough fiber to give my husband the runs and I'm constipated). I'm on ThyroCare since my thyroid is allergic to itself (talk about pitfalls in life) and as a result likes to swell, making talking and swallowing painful. If I forget my daily ThyroCare dose, my joints scream in pain and my muscles tighten up. Both are rather unpleasant, so I listen to my body and take it daily like a good little girl. I can see my doctor choosing the above options, but most likely 2 or 3.

Resources

If you're wanting to learn more about this yourself, a great resource would be Stop The Thyroid Madness website or purchase the book. The book is available as an ebook. I also feel Dr. Hotze's Hypothyroidism, Health, and Happiness book is a fantastic read.

I still believe that old School House Rock cartoon when I was child that sang, "Knowledge is Power!" If you enjoy my version (I'm obviously a writer by trade either by writing daily or teaching writing), by all means allow me to break down research material for you. If you enjoy researching, here are a few options. I find the Stop the Thyroid Madness book is best read in small pieces as a reference book. It's very heavy and technical, but it's information is extremely valuable. If I enjoy research and could not read the book cover to cover, that denotes a reference book. Keep it handy and when you're befuddled as to why you're feeling a certain way, find a chapter in that book that might offer some insight. It's a very good book at telling you what test to request at the doctor's office or what other path to take to find effective medical help.

I read Dr. Hotze's book cover to cover in a matter of days. Doctors are not always able to speak in layman language, opting to speak in medical jargon. Dr. Hotze's book is an excellent read. It was the first (and perhaps only) research-based book I found that stated for a fact that hypoglycemia is a symptom of thyroid malfunction. It gave me immense hope that I was on the right track and I would get better. I circled that passage and cried. A general practitioner would look at my glucose tolerance test and see pre-diabetes, but my symptoms just didn't match. I'm so glad there are quality thyroid doctors out there and they're writing this information for the general public so we have the POWER to harness our health and live our lives.

That's all I ever wanted. I just wanted to live my life. I didn't want to sleep through it or cry through it. I didn't want to have to sit and go nowhere fun because I got dizzy or had vertigo all the time or I'd get too fatigued too soon (and then ruin everyone's fun). For that reason alone I created this blog. I have to share this information because one of you out there needs it and it may give you the power to improve your health and as a result, improve your quality of life.

Knowledge is Power!