Expert: Suzan Jackson - 3/26/2010

Question
Hi madam,

  i was diagnized with hypothyroidism 10yrs back(then my age is 19).I took synthroid for 9mon.After my TSH test came normal i stopped using syntroid.But since then i used to feel breathelessness and fatigue for small activities like cooking for 10mins,vaccuming.My appetite is very bad i used to eat small quatity of foods and eat only certain foods.At that time i even went to doctors but they told to take multivitamin and eat well though i told  them my appetite problems.
     Since then i limited doing many works like going out, socializing .Five yrs back  after my duaghters birth i started having panic attacks.My physician put me on paxil for 3yrs.Since then my symptoms like fatigue,appetite problem... are improved.I am able to do many physical activities which i cant do or scared todo in past.I even did part time job.
  Now iam not tolerating antidepressants and since 3weeks iam not taking any medication.Now again i feel dizzi,tired,cold intolerence ,low appetite,cofusion.low concentration and nauseous .Now again cooking,taking care of my daughter , going out and socializing became tough tasks to me.When i woke up in the morning i dont feel refreshing.It taking me 2 to 3 hrs to come out of bed and start my daily activities.I went to therapist,but it hasnt helped me.I even took appointment with another psychiatrist as current doctor not helping with my symptoms.
 My question is do i have CFS thatswhy theraphy not helping me and  not tolerating antidepressants.I even went to physician TSH and iron level and Vit D levels  r normal.I tried yoga,meditaion also.These are also not helping me.
  Thanks

Answer
Dear Sruthi -

I will try to answer your questions, but I am not an expert on either hypothyroidism or panic attacks, so I can not address those issues.

Yes, CFS is certainly a possibility, though the fact that you've been previously diagnosed with hypothyroidism and panic attacks makes CFS less likely.  The symptoms you listed still sound very much like hypothyroidism, so you should go back to your doctor and request more extensive testing.  I've heard that thyroid problems aren't always obvious from just the TSH result.  Here's what I read:

"To make matters more difficult, if the thyroid is under active because the hypothalamus is suppressed, the TSH test, which most doctors rely on for thyroid function, is almost useless and may appear to be normal, or even suggest an overactive thyroid in a hypothyroid patient. Fortunately, more doctors are finally starting to catch on. In two studies done by Dr. G.R. Skinner and his associates in the United Kingdom, patients who were felt to have hypothyroidism because of their symptoms had their blood levels of thyroid hormone checked. The vast majority of them had technically normal thyroid blood tests. Dr. Skinner then did another study in which the patients with normal blood tests who had symptoms of an underactive thyroid were treated with thyroid hormone. A remarkable thing happened when this was done (well, maybe we’re not surprised!). The large majority of patients, despite being considered to have a normal thyroid on blood testing, had their symptoms improve upon taking thyroid hormone. These two studies, plus another one showing that thyroid blood tests are only low in about 3 percent of patients whose doctors sent blood tests in (and this is at an HMO—where the doctor really suspected that the patient had thyroid problems!), confirm what we have been saying all along. Our current thyroid testing will miss most patients with an under active thyroid. If you suffer from chronic fatigue, pain, heavy periods, infertility, constipation, easy weight gain, cold intolerance, dry skin, thin hair, or a body temperature that tends to be on the low side of normal, you should consider a therapeutic trial with a low dose of thyroid hormone. "

So, you should tell your doctor about your symptoms and try synthroid again to see if it helps.

As for CFS, here is a self-quiz:

http://www.cfids.org/about-cfids/do-i-have-cfids.asp

If your symptoms seem to fit, then you should see a doctor regarding a possible diagnosis.  There is no test for CFS yet, so it is diagnosed by symptoms, plus extensive testing to rule out other, similar conditions (including hypothyroidism).  This article on diagnosing CFS includes a long list of similar conditions that should be tested for and excluded before settling on a diagnosis of CFS:

http://www.cfids.org/about-cfids/diagnostic-testing.asp

Here's more information on CFS symptoms:

http://www.cfids.org/about-cfids/symptoms.asp

What is critical is that you continue to follow up with a doctor.  It is clear that something is wrong and something has changed.  Regardless of the normal test results, do not give up until you find the cause of your symptoms.  Tell your doctor just what you told me - how severely your daily life is being affected by these symptoms.  If your doctor isn't willing to fully investigate and find the cause of your condition, then switch to a new doctor.  Don't give up!  Something is obviously changed, and you need to find out what is causing these debilitating symptoms.

Here are two lists of doctors that understand CFS, in case you need to find one:

http://www.co-cure.org/Good-Doc.htm

http://www.chronicfatiguetreatments.com/wordpress/treatments/chronic-fatigue-doc...

Good luck getting some answers and some relief.

Sue Jackson

www.livewithcfs.blogspot.com