results say normal, but still symptomatic- should I up synthroid or add cytomel?

[upenn]

Hi,

I wrote awhile back re:side-effects from the synthroid. I am a 30-year old female recently diagnosed w/hashimoto's. I have been on 50 of synthroid for 8 weeks. My new test results are:

TSH- 1.05
Free T4- 1.3 (0.8-1.8)
Free T3-295 (230-420)
Thyroid Peroxidase- 10.9 (< or =35)

Of course doctor says keep everything the same. However, I still feel so bad! I am so fatigued, acne, dry skin, brain fog, irregular periods, weight gain, and depression.

I have an appointment next week w/a new endo. Should I push to increase synthroid to 75 or should I push to add a very low dose of cytomel? I have been reading on this site that most people try to get the T3 into upper third of normal.

Is cytomel safe to use? Can it be used if I become pregnant? What would a low dose of cytomel be? I really would love to get rid of the depression and weight gain.

As an aside- does anyone have an endo they love in the Long Island, NY area????

Thanks in advance!!!

[Mark Lupo, M.D.]

regarding t3 in the upper 1/3 of normal "on this site" - that advice comes from other participants and is not based on large clinical trials.  I would not shoot for that as a goal.

Would exclude other causes of your symptoms - polycystic ovarian disease, cusings, elevated prolactin and depression.

What is the evidence for Hashi? the TPO ab is normal.  Was it a biopsy or ultrasound appearance or another antibody?

Okay - with those comments out of the way, if you are otherwise healthy I would bump the dose to 75mcg if that does not help then I would try a trial of T4/T3 combo treatment.

Don't know any endo's in Long Island - try aace.com.

[ancientmariner]

I felt bad on Synthroid, felt much better when I switched to Armour thyroid, a desiccated porcine thyroid product. It contains T4 and T3 in a more natural form. Synthroid is synthetic T4 and Cytomel is synthetic T3.

[Chocobabe]

Hey, I was struck by your free T3. When mine was that low, I felt AWFUL, and had depression, weight gain etc. And it stayed that low when I was on levothyroxine, which is a T4 like Synthroid. I kept raising it, too, and NEVER got better. It's only when I switched to Armour and was allowed to raise until all my symptoms were gone, NO MATTER HOW LOW MY TSH GOT, did I finally get rid of my hypo symptoms, which were VERY similar to yours. When my symptoms were all gone, we did the free T3, and it was right at the top.  So what folks are saying here is really true. By the way, thyroid patients are saying they are not finding success with Endo's (who tend to rigidly prescribe Synthroid  and dose solely by the TSH) as much as they are other kind of doctors. (Sorry Dr. Mark. You may be an exception! :o))

[nuawlinsyat]

I can't wait to go back to the endo on Jan 12th and ask for the T3. I think I will ask for 1/2 grain as I am taking 50mcg of levoxyl now with no results. I want to start off low. I went all the way up to 175mcg of levoxyl and still gained weight! My blood pressure went up to 140/85 I had heart palps even at 125mcg still was too high but was gaining weight. Weird huh?

[HashiMan]

I'm finding it interesting the number of people on this message board not doing as well on Synthroid and having better results on Armour. This was my situation and my improvement was much better on the Armour 120mg. One of my Dr.s told me it was due there not being enough active hormone in it. He said he has seen this happening more often, the more people he treats.
Wonder why medical associations aren't saying more about this?

[nuawlinsyat]

The funny thing is about this medicine (Armour) is that if it doesn't work for you ....just take something else. It won't hurt you to try it, so why then do they make a big deal out of it? Drug companies maybe... or some other reason that has nothing to do with our health?

[ancientmariner]

The funny thing about Armour is that if it doesn't work for you right away, the doctor changes you to synthetic. With armour, you need to be allowed to take ENOUGH to relieve your symptoms, and most doctors won't allow you to do that. If you feel better for a couple of weeks, and then start to feel bad again, that's a sign to INCREASE the dose, not change to something else. It has worked for me, and for many other people on thyroid groups I belong to.

[Chocobabe]

You asked why medical associations aren't saying more about this--because it appears that "large clinical trials" and died-in-the-wool scientific lab tests with their faulty ranges have become FAR more important than LISTENING to the VERY patients that doctors make their living from!! When did medical school training, clinical trials, and lab ranges become MORE important than a patients symptoms? What happened to respect going both ways--respect for medical school training, BUT ALSO RESPECT for a PATIENT'S EXPERIENCE??  Additionally, you have the HUGE influence of these mega pharmaceuticals who pour millions of dollars to influence these doctors and medical associations.

If we had waited on "large clinical trials" to prove what apparently thousands of us have found out(because we were allowed to take a proven medication that has been around for more than 100 years, and because we were allowed to dose until the elimination of symptoms and NOT the TSH), we would all still be SICK!! And if you look carefully at each new poster that comes on here, they are still sick because they are still on T4 medications and they are still being held hostage to lab ranges. :o(

[mmfd]

Can you please tell me why you keep insulting the very endocrine physician that has volunteered to answer all our questions?  You don't even make veiled references to what he posts!  You actually quote him and then severely criticize him!  Maybe I am thin skinned, but I sure couldn't take all the flack he gets daily for his PROFESSIONAL comments.

[NURSELPN]

I fully agree with mmfd. I am also on Armour but that does not make me know more than an Endocrinologist or a physican. Can't you Armour advocates get your point across without all the sarcasism & the insults hurrled @ medical professionals. The comments made by some of you are just plain rude. Also what happens if someone gets hurt with some of this advice your giving out? You have no idea what the age or sex is of most of these participants let alone other current medications, or other existing health problems are. Frankly I think it's terrible for you to even give the impression that it is ok to self dose any medications. Your practicing medicine without a license in my book. I don't get it? Your natural thyroid forum may agree with that but in my opinion it's very dangerous. At the least you can start your comments with "I"M NOT A DOCTOR"...which your not. The internet is not medical school. This is a very serious health problem think about it. It's someones life you a playing with.

[HashiMan]

I haven't been on here as of late, long enough to have seen the more overboard remarks being made that you refer to but I certainly agree with you and I surely don't think we should be knocking our health professionals even if we've had a bad experience with one.
I would like to add though that some years ago I was seeing an HMO Dr. who started me on thyroid replacement and I suppose he was not as experienced as he should be on thyroid in spite of being about 60 years old. I kept feeling sick with hypo even with months on the Armour. He tested me and said I didn't need to change a thing but my Tsh was at 4.9 inside the normal range by only one tenth. I looked on a website that I see Dr. Lupo has also referenced to the aace.com and saw that hypo patients are supposed to be below 2.0 and some do better between 0.5 and 1.0.  I went ahead and increased my own dose by only 30mg before going to my new GP and told him I did so. My TSh then got down to 1.44 and this new Dr. said it was good I increased it because I was still suffering hypothyroidism symptoms and he then increased me another 30mg half a griain. If I were not to have realized he was wrong, I would still be sick today.
I whole heartedly agree with you about not putting Dr.s down but I think too that a patient should be aware enough to recognize wrong treatment at the same time. Your remarks I think will be well taken you are right but my experience might shed some understanding as why there are those who went outside of their Dr. until they could get better treatment from one with experience needed to treat the disease. I agree not having a Dr. at all is hazardous and not advized.
Your statements are good.

[NURSELPN]

Hashiman this was not directed towards you in anyway. Thank You for your comments.I knew my post would probably ruffle some feathers & I'd hoped it wasn't just me feeling this way. After posting my comment I had almost wished I wouldn't have addressed it to all Armour Advocates but just the few persons who is bold enough to tell an endocrinologist, specilizing in thyroid disease, that his advice is wrong & they have the only answer. Dr. Mark volunteers to come on this forum to answer questions & better educate us about our disease. Not to be criticized & told he doesn't know what he's talking about. You know many of us find it a blessing that he is good enough to care & volunteer to do this nightly. It would be a shame if we lost him due to the behavior of a few people.
I was not talking about you advocating dosing your own medications. Many statements made implied that long before you posted on the forum. And those making these blank statements do not realize that many people from  multiple countries, age groups, backgounds &, educational status's read this forum. They may have different underlying diseases not disclosed & be on many other unknown medicines. Telling someone your experiences & your treatments is one thing but advicing them not to listen to a Dr. or what medicines to take is going way beyond. I just wished they would stop & think prior to making these blanket statements & disrespectful comments.
Thank You! God Bless & Merry Christmas

[mmfd]

Thank you for your support.  I fully expected to get blasted out of here, but I chose to post anyway.  I just find it incredible how rude people are to Dr. Mark.  This is one problem the internet has created.  People read some stuff and suddenly they are experts and know more than those with decades of training and experience.  There are many, many intricacies to treatment that lay people do not/cannot understand no matter how much they read on the internet.  I am an RN, although I hesitate to say that too b/c so many that frequent the internet medical areas hate all medical people!  I had posted before about how dangerous it is for people to dose themselves.  Not all the Armour advocates do dose themselves, but it is implied way too often.  The cardiac side effects from overdosage are too serious to be taken lightly.

[Chocobabe]

I have no doubt that your posts are in reaction to mine. LOL. I do want to say this: I cannot change how I feel when I state that it's sad when clinical trials become more important than patients symptoms, because they HAVE!! That statement by me does NOT take away what Dr. Mark has to offer. He is valuable and I agree with you! But......it does express my disappointment in a reality that keeps rearing it's ugly head! Even Mary Shoman states something along the line of "Treat the patient, not the labs". And she's right! HOW MANY patients go to a doctor with one hypo symptom after another, only to be told that "your labs are in range. It's not your thyroid." YET, it frequently IS the thyroid, and it frequently IS the result of being on T4-only meds, and it frequently IS the result of being held hostage to a TSH lab which is more and more being challenged!!

I stated above "What happened to respect going both ways--respect for medical school training, BUT ALSO RESPECT for a PATIENT'S EXPERIENCE?? "?  I don't think that is rude: I think that is a LEGITIMATE question!! We have patients coming on here telling their experiences (and note I said "their experiences: that is not "advice"), yet an experience is pooh-poohed because it does not square with "large clinical trials"??? That is not respect in both directions, nor does it give credence to patient's experiences, which can be valuable BEFORE a large clinical trial has proved it!!

Yes, medical school training is to be HIGHLY respected. I see answers that Dr. Mark gives to many people here, and it's mind-boggling what he knows! BUT......that does NOT mean that he or other Endocrinologists are getting everything right!! And those of us who were once on T4-only meds, and switched to Armour, KNOW they aren't always right. Because it is frequently Endocrinologists who tell you "stay on T4", "dose by the TSH", and "it's not your thyroid"---when all the latter were WRONG! WE EXPERIENCED IT. Even Hashiman stated "If I were not to have realized he was wrong, I would still be sick today".  ME, TOO. And so are THOUSANDS of HYPOTHYROID PATIENTS who are joining groups like the Natural Thyroid group in droves. They are finding out that their doctors were WRONG!

Now granted, I am NOT, NOT, NOT saying all doctors are ALL wrong. Dr. Mark, for example, is obviously giving some excellent advice on here. But when it comes to thyroid treatment, there is a HUGE problem going on...and it's going on with the doctors. T4-only meds are leaving the vast majority of folks with hypo symptoms, and the TSH lab range is being used FAR too rigidly, and "clinical trials" and "labs" are being made WAY too important over the continual and remarkable experiences of thousands of patients.

[NURSELPN]

I agree. I even contacted Med Help International per e-mail re: these problems but I guess when we see this happening we just have to speak up. I noticed you have done it before to another participant but to no avail either. I felt the same way @ that time, too.
You & I both know, after their referral, many thyroid pts. have to wait months for their initial visit w/ an endocrinologist & this forum is so important for them. When this disease is out of hand it is very scary & just a little solid knowledge & reassurance helps so much.
I'm very thankful that Dr. Mark takes time for us. He has really tried to respond kindly & pacify those who think they have all the answers but their persistance is unrelenting & really hard to ignore isn't it. You & I know it's not all the Armour Advocates but just a few. And it's to bad because some of them have really good info. But the rudenss is a turn off & outways anything offered. Ignorance may be bliss but alittle knowledge in the wrong hands is dangerous. I couldn't live with myself if I thought I might hurt another person w/ misguided advice! I guess I have just enough knowledge to know better. That's just the nurse in me <}:) I know enough to ask the someone with more training than I have. The Doctor.
I appreciate your response. I'm a thyroid pt. too & I still have many questions that's for sure. I read this forum daily & have learned alot.        Thanks Again, Jean

[nelsonchatham]

you said:  Not all the Armour advocates do dose themselves, but it is implied way too often. The cardiac side effects from overdosage are too serious to be taken lightly.

You are implying that Armour advocates overdose themselves.  Just because they use an older previously established method of treating hypothyroidism does not mean it is overdosing.  In fact it appears that Armour advocates are quite satisfied patients and aren't reporting any signs of overdosage.  

It would be wise to remember the cardiac side effects from underdosage are quite serious too.  Heart failure is one that comes to mind.  

So I suppose the goal is to eliminate hypothyroidism symptoms without inducing hyperthyroidism.  Would you agree to that?

[NURSELPN]

Chocobabe,

You know Dr. Mark has stated many times that labs & symptoms dictate how he cares for his pts...Many hypo & hyper symptoms are the same. Why do you have such a chip on your shoulder. Doctors are not perfect & busy family doctors do not always keep up with the newest in endocinology but Dr. Mark does not speak for other Dr's. as he has stated & some of the statements you make to his responses to questions are very defense & rude & that's a fact. It's a very big turn off. You certainally could get your point across without all the sarcasim & negativity.

Nelson Chatham

I'm sorry but that post to me said nothing about Armour Advocates overdosing. It said recommending SELF dosing. It's not appropiate to recommend that it's ok for anyone to self dose. It can be very dangerous. If the ones implying this wants to do it,go ahead, who cares. That's their choice. But do not recommend it on a public forum to unknowledgable participants.

[NURSELPN]

The above post does not imply that you , yourself are advocating self dosing but their are some that do imply it. Just wanted to get that straight. The phase some Armour Advocateswas used instead of names. Sorry for the misunderstanding.

[Chocobabe]

I think you misunderstand. This has nothing to do with a chip on the shoulder or with expecting perfection in doctors! I think you need to reread my posts. What it has to do with observing and experiencing that patients are being UNDERTREATED with T4-only meds, and held hostage to labwork and "clinical studies" even when their symptoms SCREAM hypothyroid! There is a huge problem going on when patients keep having hypothyroid symptoms on T4-only meds, and keep being told they need to stay in a range, when staying in that range results in continued hypothyroid symptoms! I am raising my hand! I am one of those patients, and it appears there are THOUSANDS upon THOUSANDS of us.

In fact, Nurselpn, when you stated that doctors are not perfect--you are right! They are certainly not! You and I agree! And BECAUSE doctors are not perfect, perhaps NEITHER are T4-only meds, and NEITHER is the TSH range, and NEITHER is dosing solely by the TSH to the exclusion of continuing symptoms. Wouldn't it be a blessing for doctors to be open-minded about PATIENT EXPERIENCES and PATIENT SYMPTOMS, rather than dismiss them because "clinical studies" haven't proven it! That's not sarcasm. That's a positive wish, Nurselpn. :o)

[NURSELPN]

Chocobabe,
You misquoted Hashiman in the prior post. He said quote "I kept feeling sick with hypo even with months on the Armour. He tested me" (his HMO Dr) "and said I didn't need to change a thing but my Tsh was at 4.9 inside the normal range by only one tenth."(the old standard) "I looked on a website that I see Dr. Lupo has also referenced to the aace.com and saw that hypo patients are supposed to be below 2.0 and some do better between 0.5 and 1.0. I went ahead and increased my own dose by only 30mg before going to my new GP and told him I did so. My TSh then got down to 1.44 and this new Dr. said it was good I increased it because I was still suffering hypothyroidism symptoms and he then increased me another 30mg half a grain. If I were not to have realized he was wrong, I would still be sick today." This had nothing to do with doing away or not considering the TSH.

Then you quoted me as saying "Doctors are not perfect" & left out the rest of the message of what I said. "Doctors are not perfect (maybe I should have said family Dr's although there is no human perfect) & busy family doctors do not always keep up with the newest in endocinology but Dr. Mark does not speak for other Dr's. as he has stated & some of the statements you make to his responses to questions are very defense & rude & that's a fact."

You twisted what was said to fit your agenda...but we could debate this all day & it wouldn't change things.

Much of the info you present is very good & you know if you look back through the posts Dr. Mark has agreed with some of your points but not all. He corrects what he sees as misguided information. He doesn't make the rules but uses what the Thyroid community has deemed as proven. I probably shouldn't be speaking for him.

The bottom line is. If you want to change things you could use the internet to an advantage. Rally the support of your natural thyroid group along with the many physicans & experts, that have written books, which your forum members refer to & contact aace. along with the American Thyroid Association. They are the ones who set the standards for treatment... Not individual Dr's... That's the only way you are going to see any effective change in the treatment of this disease. Otherwise your just blowing hot air into the wind. Goliath is the enemy not David!

[NURSELPN]

Prior post addressed to Chocobabe.

[Chocobabe]

Nurselpn, you are right--Hashiman's quote had nothing to do with doing away the TSH...and neither was I implying that! I was emphasizing his experience that even doctors don't have it all right--and if he 'had listened, he would still be sick'.

And because Hashiman has experienced the above....and because I have experienced the above....and because a growing body of thousands are experiencing the above...it DOES sadden me that the medical profession is continuing to make clinical trials and lab ranges more important than continuing symptoms (of patients on T4 only meds) and patient experiences (of patients who have switched to Armour)! And if expressing that comes across as "rude", perhaps it falls in the same category as any open expression which eventually creates thought and good dialogue...and perhaps CHANGE!

(And Hashiman, I do not mean to throw you in the pile of us "Armour advocates", as we are called--LOL--but just want to emphasize the common ground of finding out that doctors don't have it all right with their over-reliance on lab ranges)

Nurselpn, I can only keep my fingers crossed that sooner than later, doctors will take note of what PATIENTS are experiencing, EVEN IF "clinical trials" have not proved it. We HAVE found out that a free T3 in the lower half of the range (as was true of the poster who started this mess--LOL) WAS the problem, and that when we raised that free T3 towards the upper 1/4 of the range, our symptoms ended. :o)

[HashiMan]

I'm not trying to enter a debate of any kind just giving out what my experience was and what my Dr.s did. These messages are all so interesting but right now I'm stll learning and much of it is over my head right now. Your debates are a little strong but I'm glad you are all being considerate of eachother. I saw a little about free t-3 and though another thing my newest Dr. has said on this that might add to these messages. He had me get that one done and said it will be the one done from now on. He cancelled all the other and until now I wondered why. He said it was the most important. I started going to this endocronologist from a referal by an aunt who he practicley did miracles for but I had another MD who also refered me to him.
I know my dose of medicine for hypo is right now so I'm really more concerned about the adrenal fatigue part now and am going to ask a new question of Dr. Mark I hope today or tomorow. I hope this new message helps in this. I'm trying to stick to experience i've had instead of opinion of mine because my learning is far behind you others on here. I'm glad to be learning as much as I can. Your messages are helping much.

[Chocobabe]

Hashiman, if your doctor is of the understanding that the free T3 is important, all I can say is GOOD FOR YOU!! :o)  I have experienced that over and over. When I was started on Armour, my doc was the same. We were watching my free T3, but I was also allowed to make my raises according to the elimination of symptoms. We stopped doing labs when I got up to 2 grains...I then went up about 1/4 grain at a time. When I got up to 3 1/4 grains, and held it for 4-5 weeks to allow the T4 in Armour to fully build, I told her that I think I had finally gotten to an amount that rid me of EVERYTHING. So we did labs, and that's where we discovered that my free T3 was right at the top. I am now holding at 3 1/2 grains (I went up the extra 1/4 grain due to estrogen dominance). By the way, I never needed adrenal support, but those that do did the 24 hour adrenal saliva test to confirm it. The one time blood test didn't always catch it.

[mshypo]

just my two cents on the debate going on here...but it seems nurselpn doesn't realize that the "armour advocate" method is just the old way of treating hypothyroidism...and there are lots of case studies on the issue...and lots of 2005 doctors are writing about this very subject.  But anyone who has ties to the associations who are funded by Abbot are going to be resistant to accepting Armour is a superior treatment.  And anyone who says so will be attacked.  Look what is happening to Dr. Hotze on this issue.  And it looks like people here have disappeared due to advocating Armour.

As for self-dosing being dangerous...I suppose it is if you're just popping pills without knowing anything about what you're doing.  But if you're monitoring blood levels and symptoms, I think it would be far less dangerous than being untreated or undertreated for hypothyroidism.  

[childrenrtreasures]

Actually I read a study on Pubmed when I was pregnant that suggested for optimal fetal wellness and development the maternal TSH should be maintained between 1-2 and the FT4 should be in the upper third of the range.

I don't know if there are any studies to support that treatment goal in nonpregnant patients.

Kelly

[ancientmariner]

I am an "Armour Advocate", and I have tried not to be sarcastic when making my point. I have not hurled insults at medical professionals, or other posters, either. I have noted that I felt let down by the medical profession at large when I was told by doctor after doctor "it is not your thyroid" because my labs were in normal range. I felt that I was doomed to be miserable for the rest of my life. If I had not begun to research thyroid conditions on my own, I would not have found Armour; Armour is giving me back my life. I can concetrate at work, I don't sleep all the time. I am no longer depressed, and *tada* I am beginning to lose weight! Armour has shown me that it was indeed my thyroid - I certainly lost faith in the doctors who told me it was NOT.  

I haven't seen one instance where anyone, *Armour Advocate* or not, has told Dr. Mark he was wrong. Can you point out a post in the archives, perhaps? I don't  understand why you both insist on attacking some of us at every opportunity.

I don't see many of the posts giving even a cursory H&P, so I am wondering about what you said to Chocobabe: "You have no idea what the age or sex is of most of these participants let alone other current medications, or other existing health problems are." Does Dr. Mark have access to that information if the poster does not include it in the post?  

As for starting every comment with "I'm not a doctor", is that really necessary? Doesn't everyone already know that? It was my understanding that comments are just that, and that everyone knows they are not from a medical professional. So why are we stomped on for telling people about Armour. I have not advocated self-treatment, but if I found it to be necessary for me to LIVE, I would not hesitate to do it.  

Ultimately it is up to each of us individually to choose what "advice" to take, what point of view to believe. I think it would be remiss of any of us NOT to research any advice given here BEFORE we follow it, regardless of the source.

[mmfd]

My post of 12/16 was directed at Chocobabe and referred to her post directly above mine on 12/16.  He/she MOCKED Dr. Mark's reference to large clinical trials more than once.  That alone is enough for me, or rather, too much for me.  I can see where you do choose your words carefully.  Perhaps you could explain to me why the Armour *people* even come to a traditional medical website with a board certified endocrine physician as our leader??  Your philosoghy regarding treatment for hypothyroidism  goes against theirs in most ways!  Is it just to try to convince others to see it your way b/c you feel you have had so much success, even though it counters what Dr. Mark, the board certified endocrine physician, says?  Frankly, that gets a little bit old after the first 100 posts!  And, yes, I do have a choice whether to even come on this board.  But I guess I will keep reading in hopes that I may glean new insights re: treatment for Amiodarone-based hyperthyroidism!  I could liken it to the zillions and zillions of PVC questions on the cardiac board....they can send me wild after the first year or two!

[ancientmariner]

I can't speak for anyone else, but I can tell you why I come here, and to other forums. My motive is to offer information about treatment alternatives that weren't immediately offered to me. It took a lot of researching for me to find out about Armour and even longer to find a doctor who would prescribe it. I also want to offer hope by holding up my experience as an example of how GOOD a hypothyroid patient CAN feel.

[NURSELPN]

The above messages did not pertain to you... As I stated in an above post Armour Advocates was probably the wrong term to use.
But I used that instead of naming names. It was a mistake & I apologize for any misunderstanding. It was comment 2 & comment 7 (esp. comment 7) in light of what Dr. Mark's comment was to the question.
Your posts are very informative without the undertone of sarcasism exhibited there. I probably just tried to say it in too many ways.

[childrenrtreasures]

Here is the study I had referred to earlier...wanted to make sure it was okay to post it (it is :) ):

1: Eur J Endocrinol. 2004 Nov;151 Suppl 3:U45-8. Related Articles, Links  


The sequelae of untreated maternal hypothyroidism.

Mitchell ML, Klein RZ.

New England Newborn Screening Program, University of Massachusetts Medical School, 305 South Street, Boston, MA 02130, USA. marvin.***@****

The concept that gestational subclinical hypothyroidism could have deleterious effects on the intellectual outcome of progeny was championed more than three decades ago by Evelyn Man in a series of publications. Her studies lay fallow until the Spanish group directed by Morreale de Escobar and the Dutch group headed by Vulsma provided the rationale for her results. Although the findings of the Spanish and Dutch groups elucidated the pathophysiologic basis for Man's conclusions, questions remained regarding the reliability of her biochemical measurements and possible bias in patient selection. In view of the uncertainty surrounding the validity of Man's work, we decided to try to confirm her findings. Our initial goal was to obtain an estimate of the prevalence of subclinical hypothyroidism in an unselected population living in New England. We accomplished this with two separate prospective studies involving 12 000 pregnant women residing in Maine. We found that 2.3% had TSH concentrations of >6.0 mU/l and 0.3% had TSH values of >12 mU/l at 17 weeks' gestation. We next did a retrospective study, utilizing sera that had been stored at -20 degrees C for 8 years, obtained in week 17 of gestation from 25 000 women. We identified 62 women with subclinical hypothyroidism and 124 matched controls. Fourteen of the hypothyroid mothers had been diagnosed and treated before and during pregnancy on a dosage of thyroxine that was unchanged. WISC IQs of the offspring of the 124 control and 62 hypothyroid mothers were determined at 8+/-0.5 years. The mean and s.d. of IQs of the children of the 124 control and of the 14 treated hypothyroid mothers were significantly higher than those of the children of the 48 untreated hypothyroid women. More than twice as many children of the untreated mothers had IQs of >1 s.d. below the control mean, and four times as many of the children had IQs 2 s.d. below the control mean, as did the children of the controls. A comparison of the mean hormonal values of the treated and untreated mothers at 17 weeks showed no significant difference in any of the biochemical markers. We surmise that the circulating level of thyroxine was normal in the treated mothers at a critical time before 17 weeks' gestation, but by 17 weeks it was insufficient to meet the growing demands of pregnancy. Treatment should begin as early as possible in pregnancy with the goal of maintaining free thyroxine (FT(4)) in the upper half of the normal reference range and TSH in the lower half of the normal reference range. In view of these data, we believe that all pregnant women should be screened for hypothyroidism as early in pregnancy as possible (or even before conception). To be cost-effective, screening programs should be based on those designed for congenital hypothyroidism, in which filter-paper blood specimens are forwarded to regional laboratories for thyroid function determinations.

PMID: 15554886 [PubMed - indexed for MEDLINE]

This particular sentence is what I was referring to:

"Treatment should begin as early as possible in pregnancy with the goal of maintaining free thyroxine (FT(4)) in the upper half of the normal reference range and TSH in the lower half of the normal reference range."

I realize this is in the context of pregnancy but is it legitimate to say that if optimal thyroid function in pregnancy is as stated above, then the same goes for nonpregnancy? Optimal thyroid function is just that regardless of our condition (?).

Any thoughts on this...just wanted to bring it up since it goes along with what the poster had originally written and Dr. Mark had commented on it.

Thank you!

Kelly

P.S. Here's the web address if you'd rather read/study it there:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15554886&itool=iconabstr

[NURSELPN]

Just a suggestion. You should probably post your comments & web site up above either on your question or even higher. I'm not sure Dr. Mark would read this far down on the threads.
Merry Christmas

[upenn]

Hi

I just picked up my test results and the test the Doctor used to say it was Hashimoto's was THYROGLOBULIN AB which was 132 (<20). It seems high to me. As my other results are "normal," do you think Cytomel would be a help for me?

I am also really nervous about being at a higher risk for MS or lupus b/c my antibody levels are so high.

Thanks to Dr. Mark and everyone for your suggestions and advice!

[Chocobabe]

I was unsure if your last sentence was thanking us for "continued" comments or simply what had already occured. But just in case it's for continued comments--thought I'd tell you my experience--that namely, yes, having T3 in my treatment made a HUGE difference, and it has for LOTS of us. I am personally of the opinion that adding Cytomel to Synthroid is definitely superior to being on Synthroid alone--even your own thyroid gives you direct T3! But I've also been reading from those who went to Armour from the Synthroid/Cytomel combo that Armour was even more beneficial. I can only guess it has something to do with the "natural" aspect of Armour, plus the T2, T1 and calcitonin which is in it---again what your own thyroid gives you. And though it's controversial, most of us really have discovered that when we became totally asymptomatic, our lab results were in certain places--the TSH below range, and the free T3 in the upper part. "Normal" results didn't always result in loss of symptoms. Good luck!