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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for abdominal bloating, swelling on feet and tightness in the rib cage

Answered by
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2279 Questions

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Posted on Thu, 1 Sep 2016 in Thyroid Problem and Hormonal Problems
Question: In January of this year I started an exercise program because I quit smoking, I hired a personal trainer and began rigorous exercise to lose the 10 pounds I have gained. Within the first couple weeks I was feeling great and lost 5 pounds, then that suddenly changed. I started noticing my stomach was bloating every time I worked out, by the time I was done working each day, my pants and bra were so tight and felt like it was pushing up against my diaphragm and made it very uncomfortable to sit upright. I had gained all the weight I lost plus a few extra pounds. So I worked out harder and felt worse, stomach enlarging, leg swelling, so I called a doctor. Regular blood test showed I had a TSH of 20.34 so I was started on Levothroxine for hypothyroidism. I continue to feel worse everyday, worse than when I started being treated, feet swelling, stomach bloating with pain and tightness in my rib cage, I'm cold.. almost every symptom of Hypothyroidism I now have. In the last 8 weeks, I have had only 4 days where I actually felt normal again. When I exercise I seem to feel a little better, but then worse again. My TSH is now at .9 and they now have tested my T4 Free at 1.3, but I have never felt this horrible in my life.
My medical history: Had a auto immune disorder several years ago that mimicked RA but suddenly went away in 2010. Took steroids for that for 3 years and IV infusions of Remicaide. My son (32 years old) had thyroid cancer in 2013. My regular doctor thinks I am crazy and I just want to cry!
doctor
Answered by Dr. Mirjeta Guni 35 minutes later
Brief Answer:
If the hormonal level is normal, than is not the thyroid the cause of your symptoms.

Detailed Answer:
Welcome and thank you for asking on HCM!
I read carefully your concerns, reviewed the reports and understood your query.

The symptoms you've described seem to be related to hypothyroidism. Usually it takes 4-6 weeks after starting the treatment with Levothyroxine, to see the improvement. If after 6 weeks the hormonal level ( TSH, Ft4 and Ft3 ) is within the normal ranges and the symptoms persist, another cause should be tried to find out (eg. high cortisol level ).

Regarding your concern to thyroid cancer, i would suggest you to do an ultrasound of the thyroid gland. The hormonal level gives us information about the thyroid function, but the structure of it is seen with the help of ultrasound. So to have a full evaluation of the thyroid gland both of them are needed.

Hope the information will be helpful.
Kind regards,
Dr.Mirjeta


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Mirjeta Guni 39 minutes later
Is T3 supposed to be tested? No other tests have been done, and I was refused a referral to Endocrinology. What about auto immune diseases, can they affect the thyroid?

Can high cortisol levels effect your thyroid function?
It just seems like something went wrong during my workouts that sent me spinning to all of this.

Is there any conditions that would make a person feel worse when taking levothyroxine? It is like everything I take has an opposite reaction.
They prescribed a water pill to reduce my blood pressure and fluid retention in July, but when I take it, I hardly urinate at all.

I just want to feel better...Please


doctor
Answered by Dr. Mirjeta Guni 53 minutes later
Brief Answer:
See below;

Detailed Answer:
Welcome back,

The most probable cause of the hypothyroidism is an autoimmune disease called Hashimoto thyroiditis and It is not related to cortisol production. Cortisol is produced by adrenal glands and an over production is manifested with obesity, high blood pressure, high blood glucose level etc.

When the TSH and Ft4 are within the normal ranges and the symptoms persist Ft3 is recommended to be checked.

In rare cases levothyroxine may cause intolerance that is manifested with palpitations, tremor etc. In these cases, it is recommended to start the lowest dose and to increase it gradually. I don't think it is your case.

I would also recommend to do an abdominal ultrasound if you haven't done it lately (during the last year) to exclude any cause for your abdominal bloating.

You should monitor also the blood pressure and if it persists in the higher range with the actual therapy, then probably some changes need to be done.


Kind Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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