Hypothyroidism and T4

[horsenflower]

I have Hashimoto's disease and am having heart palpatations.  I use a compound med of T4 and T3 and have been doing wonderful for about two years with occasional adjusting according to blood work and how I feel.   I had a blood test taken two days ago and it showed that my TSH was under 1 and my dr. thought we should lower T4 a bit.  There was another time about four years ago when I was using Armour that I had some arrythmias and put on a heart monitor, it showed nothing just the arrythimias. They finally did some blood work and my TSH was 40 and high was 15 at this lab.  Just wanted to give a little history. So could too much T4 cause palpatations I always thought it was too much T3.  Thanks

[Mark Lupo, M.D.]

Too much of any thyroid hormone can cause palpitations - T3 is more stimulating than T4 so that T3 more classic for palpitations.  Sounds like lowering the dose makes sense to see if that helps the palpitations - if decreasing the T4 doesn't help then try decreasing the t3 (and going back to previous t4 dose).

[Rella48]

I was taking T4 alone for a long time. Heart palps, aching joints, etc. I was miserable. Decreased T4, added T3 and the symptoms worsened. Rollercoaster. Switched to Armour and couldn't tolerate it either. The symptoms returned when I started taking 2 Grains (120mgs). I was desperately ill. I finally talked doctor #1 into ordering an ACTH test after the AM Cortisol test was low normal. Doc #1 said I had normal adrenal function. Doc #2 said the ACTH results proved adrenal fatigue. I couldn't recover from the slightest emotional upset for days, and any physical exertion sent me to bed for a week. Since I've been taking Cortef (natural cortisol like the adrenals produce), I've had no hyper or hypo symptoms and I've increased to 6 Grains. (I have no thyroid.)

There's a huge problem with how doctors read the ACTH test results and I believe the lab range is way off! I've heard (numerous times) that your adrenals need to be nearly dead to fail that test! Doctors #3 and #4 looked at my test results and disagreed just as the first 2 did! (The lab report clearly says "any increment over 7 is reassuring for normal adrenal function". Neither of my increments were over 3!) Most doctors don't believe adrenal fatigue exists and don't know that one must have sufficient cortisol before thyroid hormone can enter the cells (especially T3) to promote metabolism and allow one to tolerate thyroid hormone replacement - and be symptom free.
Here's an article about adrenal fatigue you should read:

http://www.medical-library.net/sitesd/_adrenal_fatigue.html

Horsenflower, I think you should consider getting an AM cortisol test and/or an ACTH test and see how well your adrenals are functioning. Then switch back to Armour if your doctor gives you an Rx for Cortef. The following article points out the importance of treating hypO patients' adrenal fatigue so their bodies can utilize thyroid hormone replacement. It also says that T4 only will be most tolerated by those with untreated adrenal fatigue. It doesn't say how well tolerated, though.
I hope you can get adrenal testing and proper treatment if that is what's causing your symptoms, and I hope you feel better  real soon!---------------------------------------------------
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This is a news release from the Anti-Aging Association of France dated Sept 29, 2005). It specifically rebukes the false ideas that most doctors have about natural thyroid hormone, Armour. It firmly states that the combination of T3 and T4 therapy is the International Hormone Society's Consensus Group of Experts on Hormone Therapies FIRST choice of therapy for treating hypOthyroidism providing the patient does NOT have untreated adrenal fatigue. It says T3 and T4 combined have widespread health benefits over T4 alone in those who have sufficient adrenal function. At the end of the article, a statement is made that stresses the importance that doctors have the option to treat with T3 and T4 combined, and not with - what seems to be the current "standard of care" in the US of T4 alone.

http://www.fsaam.com/article.php3?id_article=22

T3 et T4

Thierry Hertoghe
The International Hormone Society’s Consensus Group of experts on Hormone Therapies Consensus nr 1 on “Thyroid Hormone Therapy of Hypothyroidism”of the 29-9-2005

After having reviewed the scientific literature and exchanged experiences between physicians from all over the world and who are competent in hormone therapies, we, members of the Consensus Group of Experts of the International Hormone Society, think the time is ripe to reconsider current concepts on thyroid treatment of hypothyroidism.

The view that hypothyroidism is best treated by thyroxin alone is not based on solid scientific evidence. The studies with comparison of the efficacy of thyroxine alone versus that of associations of thyroxine and triiodothyronine medications have in general not shown superiority of thyroxine alone above the associations of thyroxine with a smaller dose of triiodothyronine. On the contrary, a few studies have shown significantly greater efficacy of combined thyroxine-triiodothyronine medications compared to the use of thyroxine alone in humans on such divergent parameters as serum cholesterol, mental and physical symptoms, and in animals on goitre formation and intracellular triiodothyronine(T3)-euthyroidism, just to name some of the greater benefits. The fact that T3 is the major intracellular thyroid hormone, that it is the low serum level of T3 that forms, more often than serum T4 (thyroxin) or TSH, the critical parameter in mortality studies, especially cardiovascular, and that the absorption of T3 is much more efficient and stable than that of T4, give credit to the view that associations of thyroxin with triiodothyronine may better fit the hypothyroid patient.

The evidence is sufficient to guarantee the physician a freedom of choice in thyroid medication : either thyroxin alone, either thyroxin and triiodothyronine.

As hypothyroidism has serious adverse consequences on the quality of life and health of patients, we recommend physicians at the light of the solid evidence here collected, to first try with hypothyroid patients a combined thyroxin and triiodothyronine preparation.

As the association treatment contains the immediately active triiodothyronine, we recommend physicians to follow some safety guidelines, next to the classical ones such as avoiding overdoses, when they administer thyroxin and triiodothyronine medications. Following these measures increases the safety and tolerance of the treatment. The first guideline is to start the treatment at very low doses and then to slowly and gradually increase the dose until clinical euthyroidism is reached. The second guideline is to tell their patient to avoid all caffeinated and similar stimulating drinks that may increase the orthosympathic activity. The third guideline is to regularly follow-up the patients with a good clinical interview and examination and laboratory tests every two to twelve months depending on the patient’s needs. The forth guideline is to carefully screen for adrenal deficiency in hypothyroid patients as patients with low or borderline low cortisol levels may poorly tolerate any type of thyroid medication, and in particular thyroxin-triiodothyronine combinations. The intolerance may come from overactivity of the orthosympathic nervous system that often accompanies states of low cortisol, and an excessive and rapid conversion of thyroxin to triiodothyronine that puts these patients easily into a state of excess T3 and thus hyperthyroidism, and further increases the orthosympathic activity. In patients with cortisol deficiency, we recommend the physician to treat the low cortisol state prior or concomitantly to the thyroid treatment. If not, thyroxin alone may be the better treatment of hypothyroidism in the presence of an untreated cortisol deficiency. In most other states, thyroxin and triiodothyronine remains the first, but not exclusive, choice for treatment of hypothyroidism for the International Hormone Society’s consensus group.

Concerning the debate about which association treatment works best : synthetic T3-T4 or dessicated thyroid, the consensus group states the following. Reports of patients feeling better on dessicated thyroid may have scientific evidence as these preparations contain next to T3 and T4 also a number of other substances that may have some thyroid activity as diiodo-and monoiodo-thyronines. In addition, the binding of much of the thyroid homones to the bigger thyroglobulin molecule permits a slower intestinal absorption and, later, once arrived in the bloodstream, a slower release of thyroid hormones in the blood, thereby insuring a more persistent action and a better tolerance by spreading the action over a longer time. Thus, dessicated thyroid may work better. The view that the potency of thyroid preparations of animal origin may have more fluctuations has arguments. For this reason, preference is given to preparations that are officially registered and well-controlled. It must be said that the frequent FDA-recalls of poorly reliable, less potent than announced thyroxin preparations of various pharmaceutical firms in the USA, makes thyroxin not a better alternative. In the light of the Mad Cow’s disease, the International Hormone Society does not recommend the use of dessicated thyroid of beef origin. For these reasons, the position adopted by the consensus group members of The International hormone society is that both type of T3 -T4 preparations have their pros and cons, and the freedom of choice between these two should be left over to the physician.