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Effects of Synthroid Reduction
Hi - my mom is 80 and she has been on Synthroid for quite some time. Her doctor is reducing her medication because of bone density and her age. She is in excellent health. Since they have reduced her medication she has had horrible depression. Is this something anyone else has experienced?
Also, after reading several posts, I noticed that a lot of people mention that the T3 and T4 levels are important. I am asking for myself on this one. My blood levels are below normal on every part of the T7 results with the exception of the TSH. The TSH is low but not out of range. 3 out of 4 doctors say I need to be on thyroid medication. Unfortunately, number 4 that says it is fine is the one who has to be the one to prescribe it.
If you could help me with any information for my mom, I would truly appreciate it.
Thanks.
Also, after reading several posts, I noticed that a lot of people mention that the T3 and T4 levels are important. I am asking for myself on this one. My blood levels are below normal on every part of the T7 results with the exception of the TSH. The TSH is low but not out of range. 3 out of 4 doctors say I need to be on thyroid medication. Unfortunately, number 4 that says it is fine is the one who has to be the one to prescribe it.
If you could help me with any information for my mom, I would truly appreciate it.
Thanks.
COMMUNITY LEADER
I've had osteopenia for years (long before developing hypothyroidism). I'm on both T4 and T3 med and my TSH is suppressed to < 0.01; it never comes up and I have actually rebuilt bone that I'd lost to osteopenia, with a combination of 1200 mg calcium/day, along with magnesium and vitamin D, which aid in absorption of calcium, plus and adequate amount of exercise.
Be persistent and get your mom's hormone med back up where it needs to be.
Also agree that you need to be tested for the Free T3 and Free T4, as well as TSH. Why can only one of your doctors prescribe thyroid med? I have an endo, a pcp and a cardio; any one of them can prescribe my med.
Be persistent and get your mom's hormone med back up where it needs to be.
Also agree that you need to be tested for the Free T3 and Free T4, as well as TSH. Why can only one of your doctors prescribe thyroid med? I have an endo, a pcp and a cardio; any one of them can prescribe my med.
I am sure that your prior T4 test was for Total T4, which is not nearly as useful as a Free T4 test. Also, the T3 Uptake test is somewhat outdated and not very useful. So be sure to get tested for FreeT3 and Free T4. It would be a good idea to also test for Vitamin D, B12, and a full test panel for iron anemia.
Understand that even though your TSH is in the range, that does not mean all is okay. TSH is a pituitary hormone that is affected by so many variables, that it is totally inadequate as the sole diagnostic for thyroid. At best, it is an indicator, to be considered along with more important indicators such as symptoms, and also the levels of FT3 and FT4. Many patients have secondary hypothyroidism, with which the TSH is in range, but the actual thyroid hormones are also too low, and symptoms result.
A good thyroid doctor will treat a patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is then sent to the PCP of the patient to help guide treatment. You are going to need to find out if your doctor is going to be wiling to treat you clinically. Perhaps a giving a copy of this letter to your doctor might be a good conversation starter.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
.
Understand that even though your TSH is in the range, that does not mean all is okay. TSH is a pituitary hormone that is affected by so many variables, that it is totally inadequate as the sole diagnostic for thyroid. At best, it is an indicator, to be considered along with more important indicators such as symptoms, and also the levels of FT3 and FT4. Many patients have secondary hypothyroidism, with which the TSH is in range, but the actual thyroid hormones are also too low, and symptoms result.
A good thyroid doctor will treat a patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is then sent to the PCP of the patient to help guide treatment. You are going to need to find out if your doctor is going to be wiling to treat you clinically. Perhaps a giving a copy of this letter to your doctor might be a good conversation starter.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
.
Thank you so much for the information. After looking at my current blood work, I was tested for T3U, T4 and TSH. I don't see anything for Free T3 and Free T4. I now can give my dr more information. I know it is not possible for them to know everything. T3U and T4 are the only ones lower than normal range. The TSH is 1.39 based on a range of 0.45 - 4.50. I have had low results in the past two years and have experienced depression, anxiety, lethargy and a recent and significant weight gain. Again, thank you for the information.
Vitamin D3 and K2 can assist in prevention of bone density along with weight bearing exercise.
Reducing your Mum's medication so she is depressed is so wrong. Am assuming that she was not over medicated based on h er blood work (which should have included FT3 and FT4 - with ideal levels being in the upper 1/2 of the reference range).
Please be agressive on getting this addressed. Thyroid requirements in older persons need to be monitored closely as the requirement for thyroid meds may increase as they get older.
Staying well is so important for quality and quanity of life.
totally agree that reduceing meds for purpose of bone density is not appropriate....there are other ways to address bone density...
Reducing your Mum's medication so she is depressed is so wrong. Am assuming that she was not over medicated based on h er blood work (which should have included FT3 and FT4 - with ideal levels being in the upper 1/2 of the reference range).
Please be agressive on getting this addressed. Thyroid requirements in older persons need to be monitored closely as the requirement for thyroid meds may increase as they get older.
Staying well is so important for quality and quanity of life.
totally agree that reduceing meds for purpose of bone density is not appropriate....there are other ways to address bone density...
Just to add a bit to the good info from Red_Star, this is a quote from a good thyroid doctor that I highly respect for his knowledge and experience.
"Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies."
So your Mom needs to get her med increased back to the prior level or higher. She also needs to correct the deficiencies that are really causing her bone loss problem. She also needs to be tested for Free T3 and Free T4 (not Total T3 and Total T4), in order to her determine if her thyroid levels are optimum to relieve her hypo symptoms. Free T3 is the most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.
For yourself you should also get tested for FT3 and FT4. Also, what symptoms of hypothyroid do your have?
"Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies."
So your Mom needs to get her med increased back to the prior level or higher. She also needs to correct the deficiencies that are really causing her bone loss problem. She also needs to be tested for Free T3 and Free T4 (not Total T3 and Total T4), in order to her determine if her thyroid levels are optimum to relieve her hypo symptoms. Free T3 is the most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate.
For yourself you should also get tested for FT3 and FT4. Also, what symptoms of hypothyroid do your have?
T7 (also called free T4 index) is an old and inaccurate thyroid lab test. From a December 2007 Clinical Laboratory News: Outdated Lab Tests:
Brian Jackson, MD: “This is a pretty clear- cut case of something being really obsolete. The free T4 index is an estimate that requires a calculation. It became obsolete as soon as good free T4 assays became available.”
Not enough thyroid hormone in the body is a noted cause of depression. It is pretty clear that your mother needs an increase in thyroid hormone. The doctor is playing it safe in regards to bone density but in my opinion your mother's mental health should take precedence. A bone building nutrient program is highly recommended. One such program is listed on this article: "Jeffrey Dach MD Reversing Osteoporosis Naturally."
Brian Jackson, MD: “This is a pretty clear- cut case of something being really obsolete. The free T4 index is an estimate that requires a calculation. It became obsolete as soon as good free T4 assays became available.”
Not enough thyroid hormone in the body is a noted cause of depression. It is pretty clear that your mother needs an increase in thyroid hormone. The doctor is playing it safe in regards to bone density but in my opinion your mother's mental health should take precedence. A bone building nutrient program is highly recommended. One such program is listed on this article: "Jeffrey Dach MD Reversing Osteoporosis Naturally."
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