TSH, T3 & T4

[kookers]

For 25 years I have had Hoshimoto's.  I have been on 50 mcg Levothyroxine keeping my TSH right in the mid normal range.  I have been about 30 lbs overweight, sluggish with no energy and developed nerve tingling, sinus tachycardia with extra beats from the upper and lower chambers of the heart, along with chest pain over the last one and one half year.  Treatment for that consists of Propranolol ER 80 mg.  I also was not taking my levo on a daily basis, with food, &  all hours of the day.  Totally forgot the am empty stomache thing.

I started seeing a naturalpath doctor who suggested Naturethroid 65mg, which I did. My TSH level after a month was low 0.09 or 0.90 can't remember. But, my T4 is still low at 0.80.  Normal was 0.82 & up.  My T3 is in the normal range.  My internest is adament that I cut my Nature Throid back, but the Naturalpath M.D. says to increase it to get my T4 into the normal range.  Ignoring the TSH level altogether.  Sighting, I feel better, have lost 15 lbs without even trying, and have less brain fog & more stamnia.  WHO DO I BELIEVE????  They are both respected doctors with two different perspectives.  I work with animals and we do not even bother with TSH levels, we use T4 levels to determine thyroid function.  

Please advise?

Susan

[kookers]

Yes, I have had the heart problem for a year or two, and just wore the 30 day event monitor & found sinus tachycardia, with other things I can't remember right now.  I have backed off on my dose of Nature Throid for now, which will bring my Tsh into normal range, but my T3 & T4 will still be off.  So, I guess we will have to see about Cytomel at that time.  I have never had normal levels of T3 or T4 on Levothyroxine.  Which I think is why I have been so sluggish, with a bad case of brain fog.  Real bad!  At 47, I feel worse than my 87 yr old mother in law?  In the past I lost hair on my scalp when my Tsh is high, and T3 is low.  Now, I have been losing hair when Tsh is low, as well as low T4.  So, it must be from both too high, or too low?  Is acne associated with low Tsh?  All of a sudden I have acne everywhere as well.  Very strange.

Thank You for your time.

Regards,

Susan

[Mark Lupo, M.D.]

Would ask you doc about transitioning to levothyroxine and cytomel then see if you can taper off the beta blocker once off the high T3 that is in the nature-throid.  You may have an underlying heart problem independent of thyroid (as you suggest based on timing of symptoms) - in this case, it is key to keep TSh in normal range and minimize excess T3.

[kookers]

I think I am having some heart reactions now just the last few days.  Should I stop taking the nature throid for a week or so to let my tsh level come back up?  I have heard not taking thyroid medicines can also make the heart react.  How do I safely lower the nature throid without stopping it cold turkey?  Is stopping nature throid abruptly and going back on levo quickly, ok as well?

While I was on levo alone, my T3 was always low.  How do I find the right balance?
My temperature is always in the 97's, and about 15 lbs overweight now.  I have been
diagnosed with sinus tachycardia with extra heartbeats from the upper and lower chambers of the heart as well.  BEFORE I switched to Nature Throid.  I am taking a beta blocker Propranolol.  Which is helping a great deal with that.

Regards,

Susan

[Mark Lupo, M.D.]

Naturethroid is from pig thyroid - so it is not the same T4 and T3 ratio as human thyroid -- the T4 will be slightly low.  The TSH must be used, else the heart will be overstimulated by excess thyroid hormone if one ignores the low TSH.  We no longer prescribe any dessicated pig thyroid or compounded thyroid due to inconsistency and problems with adverse heart reactions.  However, sometimes adding some cytomel (ie 5mcg)  to levothyroxine may help -- still, the TSH must be watched to keep things safe.