Interesting Info on Value of Thyroid Testing

[gimel]

We often talk about thyroid tests:  which tests should be done, what the results mean, and whether being on T4 meds makes any difference in analyzing the thyroid test data.  The following info is from a study from 1986, but I doubt that anything has changed enough to invalidate the conclusions.  This is a link to the study.  All the patients included in the study were receiving thyroxine replacement (T4) meds.  I thought this info might be useful for all members.  

http://www.bmj.com/content/293/6550/808

"The patients were classified as clinically euthyroid, hyperthyroid, or
hypothyroid by the examining physician after a full history and clinical examination and with use of a modified Wayne clinical diagnostic index. The clinical assessments were carried out by three consultants and a
registrar, who were experienced in thyroid disease."


Discussion
"Our major assumption in this paper is that the clinical assessment
of patients receiving thyroxine replacement by doctors experienced
in thyroid disease is correct. We tried to establish the role of
biochemical measurement of thyroid hormone concentrations in
helping in this diagnosis.
At present there is no variable that can readily be measured
satisfactorily to assess the end organ response to thyroid hormone
action in patients receiving thyroxine replacement. The serum
concentration of thyroid stimulating hormone is unsatisfactory as
the thyrotrophs in the anterior pituitary are more sensitive to
changes in the concentration of thyroxine in the circulation than
other tissues, which rely more on triiodothyronine.
Our data indicate that the reference ranges for serum total                                
thyroxine, analogue free thyroxine, and thyroid stimulating                        
hormone in patients receiving thyroxine replacement are different
from conventional reference ranges. It is clear from table IV,
however, that serum thyroid hormone and thyroid stimulating
hormone concentrations cannot be used with any degree of con-
fidence to classify patients as receiving satisfactory, insufficient, or
excessive amounts of thyroxine replacement. There is little dif-
ference between the ability of concentrations of total and analogue
free thyroxine to detect over-replacement; the poor diagnostic
sensitivity and high false positive rate associated with such measure-
ments render them virtually useless in clinical practice. Concentra-
tions of total triiodothyronine, analogue free triiodothyronine, and
thyroid stimulating hormone are also incapable of satisfactorily
indicating over-replacement. The tests perform equally badly in
detecting under-replacement.
A question that remains to be answered convincingly is whether it
is clinically necessary to measure thyroid hormone concentrations in
patients receiving thyroxine replacement. The standard replace-
ment dose in Europe and America was 200-400 [mcg a day until 1973,
when it was halved to 100-200 [mcg a day on the basis of biochemical
measurements of thyroid hormone concentrations.  We are not
aware of any study that has shown that this reduction in the standard
dose has had any clinically beneficial effects. Different groups have
shown changes in sodium metabolism, hepatic enzyme activity in
serum, and systolic ejection time intervals' in patients receiving
high doses of thyroxine, but such measurements have not been
shown to be of any relevance to patient care.
We consider that biochemical tests of thyroid function are of
little, if any, value clinically in patients receiving thyroxine
replacement. Most patients are rendered euthyroid by a daily dose
of 100 or 150 ,mcg of thyroxine. Further adjustments to the dose
should be made according to the patient's clinical response. In our
laboratory 36% of all thyroid function tests are performed to
monitor thyroxine replacement. To stop doing these tests in such
patients would cause considerable saving in the costs of reagents in
laboratories using commercial kits.
Our findings emphasise the need for laboratories to make their
users aware that the reference ranges for serum thyroxine, free
thyroxine, and thyroid stimulating hormone concentrations in
patients receiving thyroxine replacement are considerably different
from the conventional ranges; they should also point out the
limitations of these ranges. This is especially important for general
practitioners and non-specialists, who generally rely on the bio-
chemical findings more than specialist endocrinologists do in
managing these patients."



After reading the last sentence, I just wondered where we could find those specialist endocrinologists who rely less on biochemical findings and more on clinical presentation.  We need them.   LOL

[goolarra]

I don't think you're being flogged!  And I’ve never known you not to be able to take a little flogging…  We agree on most thing thyroid, so perhaps it just seems like flogging when we don't.

Perhaps my problem is that I'm not a thyroidectomized rat?  Do you suppose that's my fate in reincarnation???

"These studies also demonstrate that it is impossible to achieve normal tissue thyroid levels with T4 preparations such as Synthroid and Levoxyl."  ( There was nothing stated that said that NO patient would ever be happy with T4 only medication)."

"…impossible to achieve normal tissue thyroid levels..."  There's something about "IMpossible" that's pretty absolute.  However, achieving “normal” tissue thyroid levels and being “happy” are not the same things, are they?  Perhaps if the rats could talk, they’d tell us how they felt and if their symptoms had been relieved with sub-optimal tissue thyroid levels.  (I believe we might be back to the mathematician and the engineer here.)

“There was another source that had an opinion based on clinical experience that 70% of patients on T4 only therapy were not really satisfied with their treatment.”

We’ve discussed this, and you know that my feeling is that when numbers get that high (70%), then I have to question whether the criteria for determining “satisfaction” were overly rigorous.  And of course, this still begs the question of whether these same dissatisfied people would be any more satisfied on combination therapy.  

The study did not go the next logical step and add T3 to the rats’ meds to see if exogenous T3 improved tissue thyroid levels.  So, we don’t know if exogenous T3 improves the situation.

I’d also be curious to know how much the human thyroid output T4:T3 ratio (14:1) versus the rat output (6:1) affected the tissue levels.  How does an animal with circulating T3 concentrations that high react differently to exogenous T4 than we do?  Obviously, the rat depends less on conversion than we do so may have a less-efficient conversion mechanism.  I noticed that the doses given to the rats (0.2-8 mcg/100g body weight) would be equivalent to a 150 lb person taking approximately 135-5400 (yikes!) mcg per day of T4 (if my math is correct).  Shouldn't the rat's daly dose have been tailored more to what a rat's thyroid would have produced in a 6:1 ratio?

I'm not really looking for answers, just verbalizing loose ends that I'd like to see tied up.

I’d have thought that this study might have inspired further study in humans.  As the authors concluded, “These results may well be pertinent to patients on T4 replacement therapy.”  I just hope we’re going to replace “may well” with something much more definitive before we throw T4 therapy out with the bathwater.

I trust we can count on you to continue to keep all options open…

[sunrock]

I actually find this discussion informative and a lot of food for thought.
I don't think anyone is flogging anyone here...or at least it doesn't seem to me to be.
Just discussing different opinion ,thoughts and ideas....
I got a lot out of all this...so thank you gimel for posting this study and for Bar135 and goolarra for your posting as well!

Mia

[gimel]

Hey, I posted the info because I thought it would be interesting to note that there was an actual scientific study that had been done from which it was concluded that T4 therapy alone did not result in adequate T3 levels in various tissues.  Here is a link to the actual study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC185993/

It was stated that "These studies add to the large amount of medical literature demonstrating that pituitary thyroid levels are not indicative of other tissues in the body and showing why the TSH level is a poor indicator of a proper thyroid dose. These studies also demonstrate that it is impossible to achieve normal tissue thyroid levels with T4 preparations such as Synthroid and Levoxyl."  ( There was nothing stated that said that NO patient would ever be happy with T4 only medication).  

Then the article went on to state that,  "It is no surprise that the majority of patients on T4 preparations will continue to suffer from symptoms of hypothyroidism despite being told their levels are “normal.” Patients on T4 only preparations should seek out a physician who is well-versed in the medical literature and understands the physiologic limitations and inadequacy of commonly used thyroid preparations."   So this was an opinion, and recommendation based on some science.  

There was another source that had an opinion based on clinical experience that 70% of patients on T4 only therapy were not really satisfied with their treatment.  I really don't think that is a stretch to accept.  But of course that is only my opinion based on my experience, fellow members' experience, and many studies that I have researched.  

So clearly to me, the reality is somewhere between zero and 100%.  If you want to take issue with what was stated in the study, then go and give them the tag team flogging that so far you have reserved for me.  LOL

[goolarra]

"2. Think of the percentage of our members who have trouble converting T4 to T3."  

I'm not arguing that point at all.  All I'm saying is that there are a lot of people out there on T4-only therapy, and as Barb pointed out, if they are satisfied with their treatment they don't get on forums and tell you that.  

"3. Maybe some patients are getting their T3 level high enough to relieve the worst of their symptoms, but only by driving their T4 level extremely high.  That is what happened to me for 25 years, but I still had lingering hypo symptoms.”

I don't think we can infer from your experience that one has to drive FT4 levels extremely high to alleviate symptoms.  You did, but I certainly haven't had to.  There are people comfortable in the lower ends of the ranges.

"So in that light it may not be so hard to accept that T4 doesn't work in most cases."

No, it's impossible for me to accept that.  You're asking me to invalidate my whole experience.  I am not unique as a thyroid patient; I'm in the distinct minority on this forum for the reasons already stated.  

"Of course there are exceptions to everything, but it is hard to argue too strongly against a scientific study of FT3 levels in different tissues of the body when taking T4 meds."

Aren’t FT3 levels in different tissues of the body equivalent to symptoms, i.e. inadequate FT3 levels will cause symptoms?

For every study you pull up proving T4 doesn’t work, I can pull up three that will prove there is no benefit to adding T3 to T4.  I don’t think we want to get into “dueling studies” (do I hear banjos?).  I’ve gotten to the point where until I know who paid for a study, I really have to question its credibility.  Empirical evidence based on practical experience in the medical treatment of real cases, and not on applied theory or scientific proof can be compelling.

“But I ask them: "Do you feel normal?"  7 times out of 10, they will say something like, "No, I don't feel normal. I'm always tired. I'm often depressed and I've had to take antidepressants. My legs swell. And I gain weight even when I exercise and eat well."

And where are those people’s levels?  Do they simply need their T4 dose tweaked?  I doubt they’re all sitting at the upper limits of the FT4 range.  Do they even know their FT4 levels (not to mention FT3), or are their doctors treating on TSH?

I think there are a lot of questions here, the main one being if it’s the therapy per se that doesn’t work or its application by inept doctors using inadequate tests and disregarding symptoms.  

[Barb135]

"Think of the percentage of our members who have trouble converting T4 to T3."  

Some of us have said this before, but it needs to be said again: possibly, the reason we see so many patients who don't convert properly, is because the ones who do, are happy with their treatment and don't seek out forums like this.  While we have a lot of members on this forum, we're only a drop in the bucket of thyroid patients.

I have a sister who was dx'd hypo shortly before I was; she was put on T4 only med (levo), within weeks, her symptoms were alleviated, the weight she'd gained dropped off and she's feeling great.  More proof that T4 only med does work, for some.

"Maybe some patients are getting their T3 level high enough to relieve the worst of their symptoms, but only by driving their T4 level extremely high.  That is what happened to me for 25 years, but I still had lingering hypo symptoms."

Not true and I can attest to that personally.  On my last labs, my FT4 was nearly perfect, but FT3 was less than I wanted.  My endo gave me an increase in my T3 med, so I could bring up FT3, without sending FT4 soaring....... By taking synthetics, I can control my levels a lot easier than taking a med with a set amount of each.

"The other possibility is that their remaining hypo symptoms do not impact their lives enough for them to pursue the problem. "  I think that is the most likely answer, along with their doctors telling them that any remaining symptoms are not due to thyroid , but due to aging, menopause, etc...................., you fill  in the blank."

There ARE people who simply aren't impacted much by minor issues.  

It's true that many doctors will tell us that our symptoms are not thyroid related, when they may be, but WE need to keep in mind that thyroid is not the only thing that can that can cause weight, energy, mood or other issues and sometimes, our doctors do know what they're talking about.

Like goolarra, I'm open to all types of thyroid treatment and across the board statements that EVERYONE must use one treatment, tends to get me a little riled up, too.  We are all so different, that we need to keep any and all options for treatment open to everyone.

[gimel]

So you are taking 150 mcg of Synthroid, but still having hypo symptoms.  Please post your thyroid related test results and their reference ranges shown on the lab report so that we can assess the adequacy of your testing and treatment.

[bunny917]

do u ever feel normal again ;so far not so good;I miss old me!150synthroid -3months now should be close aha?2pots coffee not even a wave!

[gimel]

And don't forget the quote I provided above.


"Millions of people take thyroid medications like Synthroid®, Levoxyl®, or levothyroxine. These are all forms of the T4 thyroid hormone, i.e., a thyroid hormone molecule containing 4 iodine molecules. Maintaining normal thyroid hormone levels are important for control over metabolic rate and weight control, energy, mood, cholesterol, and many other aspects of health.  



But I ask them: "Do you feel normal?"



7 times out of 10, they will say something like, "No, I don't feel normal. I'm always tired. I'm often depressed and I've had to take antidepressants. My legs swell. And I gain weight even when I exercise and eat well."

[gimel]

My only thoughts are as follows.

1.  goolarra is unique.  We all know that already.

2.  Think of the percentage of our members who have trouble converting T4 to T3.

3. Maybe some patients are getting their T3 level high enough to relieve the worst of their symptoms, but only by driving their T4 level extremely high.  That is what happened to me for 25 years, but I still had lingering hypo symptoms.  

4.  "The other possibility is that their remaining hypo symptoms do not impact their lives enough for them to pursue the problem. "  I think that is the most likely answer, along with their doctors telling them that any remaining symptoms are not due to thyroid , but due to aging, menopause, etc...................., you fill  in the blank.  Besides, we really have no quantification of what percentage of hypo patients on T4 meds are truly euthyroid.  We are assuming it to be the normal, but It might be a small percentage.  So in that light it may not be so hard to accept that T4 doesn't work in most cases.  Or that T4 and T3 together would work even better.    Of course there are exceptions to everything, but it is hard to argue too strongly against a scientific study of FT3 levels in different tissues of the body when taking T4 meds.  I personally believe that a lot more hypo patients would be symptom free and happier, if they were taking both T4 and T3.  I know that I am since I switched.  

[sunrock]

I agree with goolarra 100%

I may be one that can take T4 only...as I watch my Free T3 raise to higher then high level.

Then maybe God  willing I ask to have at least 10 years of feeling good!!
Mia

[goolarra]

I agree with you that TSH is seldom a useful measure of hypothyroidism and treatment decisions should not be based on it alone.

However, (bet this is a big surprise to you!), I do take umbrage with the following:

"These studies also demonstrate that it is impossible to achieve normal tissue thyroid levels with T4 preparations such as Synthroid and Levoxyl."

How to explain, then, those of us on T4 only who are asymptomatic?

"It is no surprise that the majority of patients on T4 preparations will continue to suffer from symptoms of hypothyroidism despite being told their levels are “normal.”

1) Is that true?

2) Assuming for a minute that it IS true, isn't that because most doctors practice "reference range endocrinology" (RRE) and don't adjust T4 meds until symptoms are relieved?  

3) Have you considered that the same doctors who have a tendency to prescribe T4 only also have a tendency to practice RRE?  Is the problem with the mode of therapy (T4 only) or the mode of application (RRE)?

Since T4 only is the therapy of choice in a good part of the world, it's going to take some convincing to make me believe that it is doomed to failure from the start and most treated thyroid patients are running around hypo.  The implication is that they are too ignorant to know it (we usually don't have to be told when we are sick).  The other possibility is that their remaining hypo symptoms do not impact their lives enough for them to pursue the problem.

I'm living proof that T4 only CAN work.  You know, gimel, that I am open to all legitimate therapies because I see different ones helping different people.

A blanket statement that "T4 doesn't work" gets my hackles up a bit.  There are lots of blogs out there saying that nothing but desiccated works; they get my hackles up, too.  

I maintain that what works for one of us doesn't work for another.  We have very few treatment options...T4-only, synthetic T3/T4 combos, desiccated.  I've yet to be convinced that any one of those should be eliminated as a possibility.  

[gimel]

Continuation of above.


Fraser et al investigated the correlation between tissue thyroid activity and serum blood tests (TSH, free T4 and T3) and published their results in the British Medical Journal. The study authors concluded that “The serum concentration of thyroid stimulation hormone is unsatisfactory as the thyrotrophs in the anterior pituitary are more sensitive to changes in the concentration of thyroxin in the circulation than other tissues, which rely more on triiodothyronine (T3).” They found a suppressed or undetectable TSH was not an indication or a reliable marker of over replacement or hyperthyroidism. They state,

    “It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement…The poor diagnostic sensitivity and high false positive rates associated with such measurements render them virtually useless in clinical practice…Further adjustments to the dose should be made according to the patient’s clinical response.” (121)

The positive predictive value of the TSH, which is the likelihood that as suppressed TSH indicates over replacement or hyperthyroidism, was determined to be 16%. In other words, a suppressed TSH is not associated with hyperthyroidism or over-replacement 84% of the time, making it an inaccurate and inappropriate marker to determine appropriate replacement dosing. Additionally, the TSH becomes an even worse indicator the optimal replacement dose in the following situations: if a person has insulin resistance or obesity (68,69,70,71,106); is a chronic dieter (4,51,66,72,112,113,114,115,116,117,118); has diabetes (69,73,74,75,76); has depression (73,77,78,79); has bipolar depression (73,77,81,82); has a neurodegenerative diseases (73,83,84,85,86,87); is of older age (73,74,88-100); has chronic fatigue syndrome (73,101,102); has fibromyalgia (73,103,104); migraines (73); has a chronic infections (MT63)(73); is stressed or anxious (73,79,80); has heart failure or cardiovascular disease (73,99,104,105,108); suffers from migraines (73); has inflammation or a chronic illness (73,109,110,111); or has high cholesterol or triglyceride levels (57,58,60,72,106,107,114).

In a study published in the British Medical Journal, Meir et al also investigated the correlation of TSH and tissue thyroid effect. It was shown that the TSH level had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose. The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.” They stated that signs and symptoms of thyroid effect and not the TSH should be used to determine the proper replacement dose (122).

Alevizaki et al also studied the accuracy of using the TSH to determine the proper thyroid replacement dose in T4 treated individuals. The study found that such a practice of using the TSH, although common, results in the majority of tissues being hypothyroid, except for the pituitary. They conclude, “TSH levels used to monitor substitution, mostly regulated by intracellular T3 in the pituitary, may not be such a good indicator of adequate thyroid hormone action in all tissues (123).”

In a study published in the Journal of Clinical Endocrinology and Metabolism, Zulewski et al also investigated the accuracy of TSH to determine proper thyroid replacement. The study found that the TSH was not a useful measure of optimal or proper thyroid replacement, as there was no correlation between the TSH and tissue thyroid levels. Serum T4 and T3 levels had some correlation, with T3 being a better indictor than T4. In contrast, a clinical score that involved a thorough assessment of signs and symptoms of hypothyroidism was shown to be the most accurate method to determine proper replacement dosing. The authors also agreed that it is improper to use the TSH as the major determinant of the proper or optimal doses of thyroid replacement, stating “The ultimate test of whether a patient is experiencing the effects of too much or too little thyroid hormone is not the measurement of hormone concentration in the blood but the effect of thyroid hormones on the peripheral tissues [symptoms] (124).”

[gimel]

While perusing this link again, I got into other sections and found some very interesting info.

http://nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/

Treatment

Levothyroxine (T4)-only replacement with products such as Synthroid and Levoxyl are the most widely accepted forms of thyroid replacement. This is based on a widely held assumption that the body will convert what it needs to the biologically active form T3. Based on this assumption, most physicians and endocrinologists believe that the normalization of TSH with a T4 preparation demonstrates adequate tissue levels of thyroid. This assumption, however, had never been directly tested until two studies were published (119,120). The first study investigated whether or not giving T4 only preparations will provide adequate T3 levels in varying tissues. Plasma TSH, T4 and T3 levels and 10 different tissue levels of T4 and T3 were measured after the infusion of 12-13 days of thyroxine.

This study demonstrated that the normalization of plasma TSH and T4 levels with T4-only preparations provide adequate tissue T3 levels to only a few tissues, including the pituitary (hence the normal TSH), but almost every other tissue will be deficient. This study demonstrated that it is impossible to achieve normal tissue levels of T3 by giving T4 only preparations unless supra-physiological levels of T4 are given. The authors conclude: “It is evident that neither plasma T4 nor plasma T3 alone permit the prediction of the degree of change in T4 and T3 concentrations in tissues…the current replacement therapy of hypothyroidism [giving T4] should no longer be considered adequate…(119).”

The second study compared the plasma TSH, T4 and T3 levels and 13 different tissue levels of T4 and T3 when T4 or T4/T3 preparations were utilized (120). This study found that a combination of T4/T3 is required to normalize tissue levels of T3. The study found that the pituitary was able to maintain normal levels of T3 despite the rest of the body being hypothyroid on T4 only preparations. Under normal conditions it was shown that the pituitary will have 7 to 60 times the concentration of T3 of other tissues of the body; and when thyroid levels drop, the pituitary was shown to have 40 to 650 times the concentration of T3 of other tissues. Thus, the pituitary is unique in its ability to concentrate T3 in the presence of diminished thyroid levels that are not present in other tissues. Consequently, the pituitary levels of T3 and the subsequent level of TSH are poor measures of tissue hypothyroidism, as almost the entire body can be severely hypothyroid despite having a normal TSH level (120).

These studies add to the large amount of medical literature demonstrating that pituitary thyroid levels are not indicative of other tissues in the body and showing why the TSH level is a poor indicator of a proper thyroid dose. These studies also demonstrate that it is impossible to achieve normal tissue thyroid levels with T4 preparations such as Synthroid and Levoxyl. It is no surprise that the majority of patients on T4 preparations will continue to suffer from symptoms of hypothyroidism despite being told their levels are “normal.” Patients on T4 only preparations should seek out a physician who is well-versed in the medical literature and understands the physiologic limitations and inadequacy of commonly used thyroid preparations.

[gimel]

Bump

[gimel]

Well, I guess that for some reason it is being blanked out.  Sorry.  Here is a copy of the text.



"Millions of people take thyroid medications like Synthroid®, Levoxyl®, or levothyroxine. These are all forms of the T4 thyroid hormone, i.e., a thyroid hormone molecule containing 4 iodine molecules. Maintaining normal thyroid hormone levels are important for control over metabolic rate and weight control, energy, mood, cholesterol, and many other aspects of health.  



But I ask them: "Do you feel normal?"



7 times out of 10, they will say something like, "No, I don't feel normal. I'm always tired. I'm often depressed and I've had to take antidepressants. My legs swell. And I gain weight even when I exercise and eat well."



I then tell them about the T3 thyroid hormone, what I call the forgotten thyroid hormone because few people take it. Conventional thinking among many doctors is that, when given the T4 thyroid hormone, the body automatically converts T4 to the T3 thyroid hormone simply by removing one iodine molecule. This conversion must occur to achieve normal thyroid function, since T3 is the true active thyroid hormone, not T4.



This is a contentious issue among thyroid experts: Some say that T4-to-T3 conversion can be impaired and that T3 supplementation is necessary to fully correct thyroid status. Others argue that T3 is unnecessary. There are studies supporting both sides of the argument, with some studies showing improved mood and energy with T3 added to T4, while others fail to show any improvement.



My experience has been most consistent with the first side of the argument: When someone responds "No" to my question about whether they feel normal, I will ask them to consider adding T3 thyroid hormone to their T4. (This is done by either adding a T3 preparation, liothyronine or Cytomel®, or by switching to combination preparations like Armour® thyroid or Naturethroid®.) With rare exceptions, within a week they feel energized, mood improves, excess weight starts to drop.



What does this have to do with your heart? There's no question that low thyroid hormone levels act as a potent risk factor for coronary heart disease. While we've known for years that people with congestive heart failure or are seriously ill have abnormally low T3 hormone levels, two studies have recently found that people with coronary heart disease also have low T3 levels. These two studies now raise the question of whether low T3 by itself could be associated with increased risk for heart disease.



The million dollar question: If people with coronary artery disease have low T3 thyroid hormone levels, does increasing T3 levels reduce future risk for heart disease? This question remains unsettled. However, having watched many people add T3 to T4 feel more energetic, exercise more, be happier (which is part of a heart healthy program), and lose weight, I don't think that it's a big leap to predict that adding T3 to T4 for most people enhances health substantially, heart and otherwise. It's worth asking your doctor about it."

[gimel]

Sorry, somehow the link I gave didn't work right.  Try this.

http://www.*************.com/heart-disease/c/1435/95058/t3

[RebaSWorks]

Apologies... I was reading two posts and wrote a hybrid answer.  This is my first post to this online community and maybe the 3rd ever anywhere.

I'm happy to say that I paid labs directly for the tests that I want to know about; I've found out something useful and interesting in each & every test. My Dr suggested some & I've researched and had additional test too; genetic testing is next. Plus, I simply want to learn & kinda find out for myself.  Insurance will reimburse for some--depends on your insurance and provided diagnosis codes. I see my Dr as a consultant--and to provide assistance to validate the info I've discovered about me through the tests I've chosen to have done & help w/direction.

I search PubMed and associated research sites... & even have gone to training specifically for MDs/DOs (I'm not a one) & even the presenting Drs (world experts in hormones) talk about how they go by how a patient/person FEELS & they are searching the research for answers--there's published research out there, but it's very specific (T4 or combo of T4/T3,thyroid hormones&various cardic issues,bone density,etc).  Many of the Drs presented specific patient case studies which very much interested many of the attendees--part science (lab tests), part antecdotal.

Anyone can search medical research
http://www.ncbi.nlm.nih.gov/ (choose pubmed or anything else you are interested in) and you can even find out about medical trials in progress
http://www.clinicaltrialssearch.org/

The only thing I can say is I feel really good--but likely, my path to feeling good is as unique as yours or any one else's.

[gimel]

Thanks for your input.  But I don't need best wishes for weight loss.  I don't have that problem, because I am fortunate enough to have an MD that is willing to test and adjust Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Didn't change anything else about my lifestyle except my thyroid meds and didn't even have to do all that additional testing and cleansing you mention.  

I am all for a doctor that will do the right kind of thyroid testing. My concern is that a general impression that many doctors, such as you mention, push patients to do extensive testing and cleansing for food and environmental allergies because they make lots more money that way.  My question is how does a patient really know if the considerable cost of all this is necessary or not? How do you really know if you have benefited from anything other than getting your thyroid levels adequate to relieve hypo symptoms?  Rather than anecdotal information, I would be real interested in any statistically valid scientific studies that show accrued benefits.

[RebaSWorks]

Find a Dr who's knowledgeable in bioIdentical hormones &/or one that is/calls themselves "Integrative" (M.D. or D.O. that considers the best of conventional and alternative medicine)  These types of Dr (and more are being trained OUTSIDE of Medical School every year--at least in the US)
are also refered to as/advertise as Anti-Aging and/or Regenerative Drs.

These Drs are working with patients so the patient FEELS better (and of course according to correct medical practice).  They are also likely to test beyond TSH, T4, T3 and also look @ Reverse T3 (rT3) and the RATIOS of the various thyroid hormones.  They can also help to look at Estrogen dominance, Progesterone deficiency, Testosterone levels, Cortisol, DHEA, Pregnenolone, & the various metabolites of these steroid hormones (steroid hormone imbalances can be assocaited with weight loss difficulties). They can also look at the ratios between various steroid hormones and thyroid hormones--that could be another part of the picture of weight gain.  Most/Many endocrinologists may not be willing to do this testing--but if you have an endo who REALLY wants to work with you--U may need to educate & point out research to get what you want from your Dr.  I found an INTEGRATIVE Dr on my health plan--unfortunately, he is 120 miles from where I now live--WORTH IT!!!!

- Genetic tests can also give you some idea of what's going on.  Heavy Metal Testing (urine), and food and environmental allergy testing is also encouraged to get a better picture (some testing at your own expense)

A really good Dr will also help you access your TOTAL toxic load (liver, colon, kidney, etc); if you are toxic (and this doesn't generally show up in any kind of lab test) lossing fat will be difficult--your body is holding and potentially adding more fat to protect you from toxins.  

I have (and seemingly working on had) lots of foods allergies and environmental allergies.  Colonics, liver, and gallbladder cleansing, juicing, removed foods I'm allergic to from my diet have helped.  Along with having many mercury amalgum fillings removed (safely) & chelation (I was high in mercury, lead, and various other heavy metals--including uranium--which in in drinking water in some parts of the country)

I am finally starting to loose weight -- about 1 to 2 lbs/week and my skin is looking really good.

Unfortunately, these Dr's are rarely on health plans (but some are, so worth the research)  Many of these test aren't covered in health plans, nor are the supplements, so it's an investment in yourself, and can be quite a bit of work initially--but from my perspective--WORTH IT!!!!

Becuase the thyroid is thought to be the most negatively charged organ in the body, the likelyhood that it is being damaged by heavy metals and/or toxins, makes sense to me.  My rT3 and total and free T3 ratios were very off (yet all within range INDIVIDUALLY) and I had high thyroid antibodies (Hashimotos). My thryoid antibodies (in most recent blood test) are half of what they were 6 months ago, and my rT3 levels went down (299 to 198) and total and free T3 ratios have improved significantly.  My TSH remains between .9 and 1.2.  To help w/the rT3, I took 5mcg of slow release T3 (for ONE month only--I asked the Dr for this)

Next is Genetic testing, so hope to find out more from these results.

Best wishes in your weight loss.

[gimel]

This link doesn't relate directly to the original post on this thread,  but I thought it would be interesting to members, especially those whose doctors will only prescribe T4 meds. .

www.*************/heart-disease/c/1435/95058/t3

[gimel]

And all 6 of those different drugs are much more profitable than thyroid meds.

[flyingfool]

before they invented blood tests and TSH in particular, Dr's had no choice but to diagnose and treat based soley on symptoms and clinical response.

I contend that patients were treated MORE effectively then today.

Fibromalygia and chronic fatigue syndrome etc.  ONLY came to be I believe because of all the untreated or undertreated people for Hypo. I also think all those anti depressants prescribed would also be lowered with Thyroid medication.

Damned blood tests and "normal" ranges.  People not being treated because they are within this test range B.S. So they are left suffering because the Darn Dr's won't THINK.  Too busy worrying about being sued.  It is hard to explain to a board of review when they added medication or increased dosage when the patient was "in the normal range".

Technology is supposed to improve society and our lives.  The  invention of the TSH test was a HUGE set back.  But the big drug company's don't care.  They can make FAR more money selling 6 different drugs to cover 6 symptoms rather than one generic Thyroid drug that would solve all 6 symptoms.

[goolarra]

You don't have any idea how lucky you are...very hard to find that kind of doctor.

When you come right down to it, we (patients), once we have a little experience, don't need blood tests.  We know how we feel and whether we're hypo or hyper or euthyroid.  It's the doctors who need the tests because they can't get inside our bodies and see how we feel.  

Your doctor sounds like a keeper...

[valdab]

At my recent appointment with my new Endo, after listening intently to my symptoms and history, she declared that she wanted to monitor the changes she proposed more by how I was feeling than what my bloods showed.
Although I'm aware from my time on this forum that this is a valid approach, I still came away feeling a little uncertain. Having relied on and aspired to a certain set of numbers for such a long time, it felt like a huge leap of faith to be told to largely disregard them.
The above eases my worries and makes me appreciate how lucky I am to have someone looking after me who is apparently singing from the same song sheet as the wise people here.