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Hyperthyroidism?
My mother is displaying classic sign of hyperthyroidism. She recently received her latest lab results and they are as follows: TSH .07, t4 free 1.73, and t3 2.4. Her gp insists that these numbers are "normal", but I disagree. We have been referred to an endo for further testing. She also recently had an ultrasound, yet no results as of yet. Again, she displays classic signs of hyperthyroidism and feels terrible. Help?
Mom received the results of her ultrasound today. She does have 3 nodules on her thyroid. They each measure less that 1.5cm....She did get into the endo on Wednesday. Thank goodness..Hopefully, we can figure this out soon! Any thoughts on the nodules? Is this related to the blood work showing the conversions problem?
COMMUNITY LEADER
I'm sorry your mom had to have the stent, but hopefully, the appointment with the endo will get moved up, so the thyroid issue can be resolved as well.
Many doctors are reluctant to put a patient on a T3 medication if they have a heart issue, but as long as the Free T3 is not allowed to go too high, it should not be a problem. Just don't let them go, solely, by TSH, since that's a pituitary hormone and neither causes, nor alleviates symptoms.
Please keep me informed of her progress. Thank you.
Many doctors are reluctant to put a patient on a T3 medication if they have a heart issue, but as long as the Free T3 is not allowed to go too high, it should not be a problem. Just don't let them go, solely, by TSH, since that's a pituitary hormone and neither causes, nor alleviates symptoms.
Please keep me informed of her progress. Thank you.
Mom did end up having a stent put in her heart today...That is one piece of the puzzle solved. We are working with her cardiologist to move that appointment with endo up. Looks like she had a few things going against her. We will figure it out! We are her advocates now and will not quit until she is on the mend!
COMMUNITY LEADER
Yes, prod the cardiologist... thyroid health can affect heart health. Cardiologists can be our friends in thyroid. Good that your sister can advocate for your mother if you can't, as she understands the needs.
Happy Thanksgiving to you and yours, as well.
Please let me know how it goes for your mother.
Happy Thanksgiving to you and yours, as well.
Please let me know how it goes for your mother.
I do not live in the same state, but my sister will help her. I am sure they will take all new labs. She will certainly mention the conversion difficulty. I really appreciate your help! She has an angiogram tomorrow. If all looks good, we may prod the cardiologist to work his magic and try to get her in to endo sooner. It is worth a try! Thanks so much! Happy Thanksgiving!
COMMUNITY LEADER
No, I'm not a physician. I have conversion issues, myself and had some of the same problems. My own TSH has been at < 0.01 for the past 6.5 yrs and I had a lot of hyper symptoms, such as heart palps, rapid heart rate and anxiety, but I was never hyper; I had them when I was very hypo.
Much of the conversion of FT4 to FT3 is done in the liver, some is done in other organs, but a lot of it also done in individual cells. In addition, the pituitary converts what it needs, which is why the TSH is low, but peripheral conversion is inadequate. I don't believe the stomach bacteria would contribute to the conversion problem.
Please note that we need some stomach bacteria, but if there is a stomach problem, you might have your mother take a probiotic or eat foods such as yogurt, kefir or other foods with life cultures to replace the "good" bacteria in the stomach. This will help get rid of the "bad" ones.
I think it's a very good idea to try to get placed on a cancellation list to try to get in to the endo sooner, if possible.
I necessary, you can talk to your gp about cutting back on the Synthroid... your mother could try taking just a half Synthroid for a few days to see if that relieves any of the symptoms she's having, though it will, most likely bring back a lot of the obviously hypo symptoms.
Is your mother able to explain her needs to the endo or will you be able to go with her to explain the thoughts about the conversion issue? Not all doctors will bring that up -- they often need prodding. I know, because I've been there, done that.
Much of the conversion of FT4 to FT3 is done in the liver, some is done in other organs, but a lot of it also done in individual cells. In addition, the pituitary converts what it needs, which is why the TSH is low, but peripheral conversion is inadequate. I don't believe the stomach bacteria would contribute to the conversion problem.
Please note that we need some stomach bacteria, but if there is a stomach problem, you might have your mother take a probiotic or eat foods such as yogurt, kefir or other foods with life cultures to replace the "good" bacteria in the stomach. This will help get rid of the "bad" ones.
I think it's a very good idea to try to get placed on a cancellation list to try to get in to the endo sooner, if possible.
I necessary, you can talk to your gp about cutting back on the Synthroid... your mother could try taking just a half Synthroid for a few days to see if that relieves any of the symptoms she's having, though it will, most likely bring back a lot of the obviously hypo symptoms.
Is your mother able to explain her needs to the endo or will you be able to go with her to explain the thoughts about the conversion issue? Not all doctors will bring that up -- they often need prodding. I know, because I've been there, done that.
Wonderful! Are you a physican?? This sounds like some of the info I was googling. I hope the endo is on the right page with this... I agree with this possibly being a conversions issue. She also tested for bacteria in her intestine? Could this have something to do with the conversion?? This has been going on since 2010...GP kept saying all was well...
Her endo appointment is not until early January, though she will call tomorrow to be placed on a waiting list in case any openings become available. Thank you very much for your help!
Her endo appointment is not until early January, though she will call tomorrow to be placed on a waiting list in case any openings become available. Thank you very much for your help!
COMMUNITY LEADER
Well, she's not really hyper... what's happening is that she's not converting the T4 (Synthroid) to Free T3, which is the actual hormone that's used by the individual cells. So while her Free T4 is very high and she's having hyper symptoms, she's really still hypo, because of the lack of Free T3.
I'll explain... Free T4 is a storage hormone and can't be used directly. It must first be converted to Free T3, which is the hormone used by individual cells. If one doesn't convert adequately, they get symptoms of hyper, but remain hypo on a cellular level.
She needs to decrease the T4 med (synthroid) and add a T3 med, such as cytomel. That will decrease the Free T4 level and increase the Free T3 level so there's hormones that her cells can actually use.
When introducing a T3 med, it's customary to decrease T4 med by 20-25 mcg for every 5 mcg T3 added. For instance, if 5 mcg cytomel were prescribed, Synthroid would be decreased to 125 mcg, then if cytomel were increased to 10 mcg, Synthroid would be decreased to 100 mcg. Of course, this is all dependent on how well her Free T3 and Free T4 levels respond.
Is her current doctor willing to reduce her Synthroid, at this point?
Have her ferritin levels been tested? Ferritin is an iron storage hormone and iron has been shown to help in the conversion of FT4 to FT3. If she's low on iron, that could be a factor. Can you get her doctor to test ferritin? Iron should only be supplemented under a doctor's supervision and when needed.
Selenium has also been shown to help in the conversion process. You might consider having her supplement with 200 mcg selenium/day. I find this most helpful.
I'll explain... Free T4 is a storage hormone and can't be used directly. It must first be converted to Free T3, which is the hormone used by individual cells. If one doesn't convert adequately, they get symptoms of hyper, but remain hypo on a cellular level.
She needs to decrease the T4 med (synthroid) and add a T3 med, such as cytomel. That will decrease the Free T4 level and increase the Free T3 level so there's hormones that her cells can actually use.
When introducing a T3 med, it's customary to decrease T4 med by 20-25 mcg for every 5 mcg T3 added. For instance, if 5 mcg cytomel were prescribed, Synthroid would be decreased to 125 mcg, then if cytomel were increased to 10 mcg, Synthroid would be decreased to 100 mcg. Of course, this is all dependent on how well her Free T3 and Free T4 levels respond.
Is her current doctor willing to reduce her Synthroid, at this point?
Have her ferritin levels been tested? Ferritin is an iron storage hormone and iron has been shown to help in the conversion of FT4 to FT3. If she's low on iron, that could be a factor. Can you get her doctor to test ferritin? Iron should only be supplemented under a doctor's supervision and when needed.
Selenium has also been shown to help in the conversion process. You might consider having her supplement with 200 mcg selenium/day. I find this most helpful.
So if the tsh is so low and the t3 is in the lower part of the range, along with symptoms, you would think hyper?? She sees her endo in early Jan (earliest appointment) and they may start with reducing the Synthroid? Probably 25 mcg at a time?
Yes, she is taking 150 mcg of Synthroid..Thanks so much! Her gp said she is fine...Numbers look good! NOT! She is being referred to an Endo in her area. Also, she had diabetes as well...She really needs a doc that specializes in hormones....
COMMUNITY LEADER
Her Free T4 is very high in the range but her Free T3 is very low in the range. Free T3 is the hormone that, typically, correlates best with symptoms. Her symptoms are consistent with hyperthyroidism.
Is your mother taking a thyroid medication of any kind?
Is your mother taking a thyroid medication of any kind?
Her Free t4 was 1.73 the range is .82-1.77. Her Her t3 free was 2.4 the range is 2.0-4.4. Her tsh is .07 the range is .82-1.77. She has the following symptoms: irregular, rapid heart rate, anxiety (never a problem before), difficulty swallowing food or meds, heat intolerance, some weight loss, terrible headaches, chest pains. She did have an ultrasound yesterday, but we do not have any results yet. She will also be having an angiogram tomorrow to check for any blockages. Any input would be great!
COMMUNITY LEADER
What are the reference ranges for the Free T4 and the T3? Reference ranges vary lab to lab and have to come from your mother's own report. Is that Free T3 or Total T3?
Exactly what symptoms does your mother have? Some symptoms of thyroid conditions can also apply to other conditions.
Exactly what symptoms does your mother have? Some symptoms of thyroid conditions can also apply to other conditions.
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