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Some questions related to Hyporhyroid
Hello,
I have a few questions related to Hypothyroid that are nagging me for sometime now.
I would comments please ...
1) I understand that the TSH has inverse relationship to thyroid harmones in the system. Is TSH based on T3 or T4 levels. I ask this question because, if it is based on T4 then one can have normal T4, normal TSH and low T3
2) How does RT3 (reverse T3 work)?
I have a few questions related to Hypothyroid that are nagging me for sometime now.
I would comments please ...
1) I understand that the TSH has inverse relationship to thyroid harmones in the system. Is TSH based on T3 or T4 levels. I ask this question because, if it is based on T4 then one can have normal T4, normal TSH and low T3
2) How does RT3 (reverse T3 work)?
COMMUNITY LEADER
sharanbr is in India and like des900, may not have access to T3 medication...
The hypothalamus/pituitary output of TSH is affected by both Free T4 and Free T3, not Total T4 and Total T3. This is logical because T4 and T3 that is bound to protein is not biologically active. Also, you can see that TSH correlates somewhat with both Free T4 and free T3 by looking at the graphical data in this link.
http://www.clinchem.org/content/55/7/1380/F2.expansion.html
Since you are still suffering with joint pain I will tell you about my experience. I was having bad pain in my knees mainly. I could not get up from a chair without using my arms to push my body up. After hearing my complaints for several days my wife suggested that since I was suspicious it could be hypothyroid related, why not just try a dose increase. I increased my Armour thyroid so that I was getting some T3, and 3 days later I showed her that I could now do knee bends without pain.
From your test results, I think you need to increase your T3 dosage, and get your Free T3 into the upper third of the range, or as needed to relieve symptoms. Also supplement as needed to make sure that Vitamin D is about 55 miin, B12 in the upper end of its range, and ferritin is about 70 minimum.
Your high TSH is another indication that your med dosage is inadequate. The majority of hypothyroid patients find that their TSH becomes suppressed to low end of range, or below, when taking adequate thyroid med.
http://www.clinchem.org/content/55/7/1380/F2.expansion.html
Since you are still suffering with joint pain I will tell you about my experience. I was having bad pain in my knees mainly. I could not get up from a chair without using my arms to push my body up. After hearing my complaints for several days my wife suggested that since I was suspicious it could be hypothyroid related, why not just try a dose increase. I increased my Armour thyroid so that I was getting some T3, and 3 days later I showed her that I could now do knee bends without pain.
From your test results, I think you need to increase your T3 dosage, and get your Free T3 into the upper third of the range, or as needed to relieve symptoms. Also supplement as needed to make sure that Vitamin D is about 55 miin, B12 in the upper end of its range, and ferritin is about 70 minimum.
Your high TSH is another indication that your med dosage is inadequate. The majority of hypothyroid patients find that their TSH becomes suppressed to low end of range, or below, when taking adequate thyroid med.
1 Comments
Also understand that as gimel points out. That if or when the TSH becomes suppressed, the majority of Dr's will freak out and want to decrease your dosage. When in fact a further increase MAY still be required to propertly get your symptom free. This is exactly why you must RUN away and find another Dr if they are ONLY looking at TSH. Because they will almost assuredly keep you feeling less than well, if not downright crappy or on a roller coaster ride up and down as they "chase" TSH.
TSH can vary as much as 70% within a single day. So how reliable of an indicator is it really? Could you keep your car's gas tank at about half tank when the fuel gauge changes it ready by 70% at any given time you check the fuel gauge? I don't think so. Well that is exactly what happens with Dr's who only use TSH. Only you and your symptoms are the yo-yo and not simply a indication of the gauge.
I love the idea of a simple "flow chart" that would precisely give the status of a person's thyroid condition. But if it were that simple this entire forum would be completely unnecessary as the Dr's would use it and we'd all feel great! As with most things in life it is more complicated than that. And this is why we are having the problem we are today especially with Thryoid treatment.
Dr's are taught that the magical test numbers are exact and precise. But they do not call it medical "practice" for no reason. Medicine is a combination of BOTH; 1) Science and 2) Art.
the lab test results are the science part. The "art" side is being able to utilize the science results IN COMBINATION with symptoms and experience to arrive at a proper treatment that alleviates the symptoms and the person feels well.
Today's medicine is all about the Science and they have mostly forgotten about the "art" side.
And the real answer is the balance between the art and science.
In the music field we have all heard how a musician can play each and every note exactly right and on tune. He has the "science" of the music down pat. Yet it sounds like junk. While another musician who also plays them correctly can make it sound absolutely beautiful. That is a person who has blalance both the "art" and science of music.
TSH can vary as much as 70% within a single day. So how reliable of an indicator is it really? Could you keep your car's gas tank at about half tank when the fuel gauge changes it ready by 70% at any given time you check the fuel gauge? I don't think so. Well that is exactly what happens with Dr's who only use TSH. Only you and your symptoms are the yo-yo and not simply a indication of the gauge.
I love the idea of a simple "flow chart" that would precisely give the status of a person's thyroid condition. But if it were that simple this entire forum would be completely unnecessary as the Dr's would use it and we'd all feel great! As with most things in life it is more complicated than that. And this is why we are having the problem we are today especially with Thryoid treatment.
Dr's are taught that the magical test numbers are exact and precise. But they do not call it medical "practice" for no reason. Medicine is a combination of BOTH; 1) Science and 2) Art.
the lab test results are the science part. The "art" side is being able to utilize the science results IN COMBINATION with symptoms and experience to arrive at a proper treatment that alleviates the symptoms and the person feels well.
Today's medicine is all about the Science and they have mostly forgotten about the "art" side.
And the real answer is the balance between the art and science.
In the music field we have all heard how a musician can play each and every note exactly right and on tune. He has the "science" of the music down pat. Yet it sounds like junk. While another musician who also plays them correctly can make it sound absolutely beautiful. That is a person who has blalance both the "art" and science of music.
COMMUNITY LEADER
I forgot to mention that when it's all said and done, the TSH level is actually the least important part of the process, because it's merely a messenger to the thyroid. It neither causes, nor alleviates symptoms. Diagnosis and/or should never be based, solely, on TSH; it should always include Free T3 and Free T4, whenever they are available.
2 Comments
Barb,
Thanks.
I have tried to see if there is a flow diagram of T3/T4 -> TRH -> TSH but I haven't found any. We all know this whole thing is a sort of feedback system but I would like to know what is fed back?
is it T3 or T4?
is it FT3 or FT4?
if it is T4 then there is always an issue of people having low T3 and normal TSH and T4 levels.
If it is T3 then it can still be an issue if it is based on FT3 because FT3 is what is eventually needed by the body.
My recent lab reports show FT3 - 3.31 (2.3-4.2)
FT4 - 1.36 (0.89-1.76)
TSH - 3.19 (0.5-6.0)
I continue to suffer from joint aches almost all the time.
Thanks.
I have tried to see if there is a flow diagram of T3/T4 -> TRH -> TSH but I haven't found any. We all know this whole thing is a sort of feedback system but I would like to know what is fed back?
is it T3 or T4?
is it FT3 or FT4?
if it is T4 then there is always an issue of people having low T3 and normal TSH and T4 levels.
If it is T3 then it can still be an issue if it is based on FT3 because FT3 is what is eventually needed by the body.
My recent lab reports show FT3 - 3.31 (2.3-4.2)
FT4 - 1.36 (0.89-1.76)
TSH - 3.19 (0.5-6.0)
I continue to suffer from joint aches almost all the time.
Thanks.
My recent lab. reports show as follows,
FT3 - 3.31 (2.3-4.2)
FT4 - 1.36 (0.89-1.76)
TSH - 3.19 (0.5-6.0)
I continue to have body aches. I don't know if it is less FT4 or less FT3. I take Vit D and B complex supplements currently.
This is the reason why I am trying to understand the reason for high TSH
My recent lab. reports show as follows,
FT3 - 3.31 (2.3-4.2)
FT4 - 1.36 (0.89-1.76)
TSH - 3.19 (0.5-6.0)
I continue to have body aches. I don't know if it is less FT4 or less FT3. I take Vit D and B complex supplements currently.
This is the reason why I am trying to understand the reason for high TSH
COMMUNITY LEADER
You're correct... TSH does have a relationship with T3 and T4... In a perfect world, when the body needs thyroid hormones, the pituitary gland signals the thyroid by producing TSH and the thyroid obliges by producing the right amounts of, mostly T4, but some T3... The T4 is then converted to the active T3, as needed by the body. This is all done without our even knowing what's happening. We take the whole process for granted until things start going awry.
When we become hypo, they pituitary starts calling for more thyroid hormones, by producing the TSH, but the thyroid doesn't respond adequately, therefore the TSH keeps going higher and higher in an attempt to get the thyroid to "wake up"... In this case, TSH goes higher and thyroid hormones go lower...
When we become hyper, the opposite happens - the thyroid produces more and more hormones, so the T4 and T3 keep going higher and higher, and TSH goes lower and lower in an attempt to make the thyroid stop its production...
It isn't ALL based on T4; it's a combination of T4 and T3... you can have all three, T4, T3 and TSH in the normal ranges, and still be hyper or hypo, depending on where, in the ranges, each of these might fall.
For instance, say the TSH is at the upper part of the range and T4 is at the lower part of the range, with T3 in the middle... The person can still be hypo, because, while they are producing "some" T4, they aren't producing "enough"...
And let's not forget the Free T4 and Free T3 vs Total T4 and Total T3, plus the conversion process.
Most of the Total T4 in the body is bound by protein and can't be used, which is why we test for Free (unbound) T4. The Free T4 must then be converted into T3, which is the active (usable) hormone...
As with T4, most of the T3 is bound by protein and can't be used, which, again, is why we test for Free (unbound) T3. Free T3 is the hormone that's used by every single cell in the body. Without adequate Free T3, one will become hypo.
One must, however, maintain a balance between Free T4 and Free T3, which is why the recommendation is, typically, for Free T4 to be about mid way in its range and Free T3 to be in the upper half of its range. Free T3 should be higher in its range than Free T4 in its. This the area that we find most people feel the best, though it doesn't hold true for everyone. We each have to find our own "spot" via trial and error with our meds.
When reporting labs, if not specified as "Free", it's assumed that T4 and T3 are the Totals, which are considered to be obsolete and of little value. We do recognize that in some countries, Free T3 and Free T4 tests are not available.
T4 is converted to either Free T3 or Reverse T3 (rT3). This is a normal process. I've read that rT3 is part of the body's mechanism to help prevent hyperthyroidism - when T4 levels are too high, the body converts more to rT3 than to T3; however, the ratio between FT3 and rT3 must also remain in balance.
Some say that if rT3 becomes too high, it blocks cell receptors so FT3 can't get in. I believe this to be somewhat controversial, as I've read articles to the contrary, as well. Suffice to say that FT3 and rT3 need to be in balance, just as FT4 and FT3 need to be in balance, along with other hormones in the endocrine system.
When we become hypo, they pituitary starts calling for more thyroid hormones, by producing the TSH, but the thyroid doesn't respond adequately, therefore the TSH keeps going higher and higher in an attempt to get the thyroid to "wake up"... In this case, TSH goes higher and thyroid hormones go lower...
When we become hyper, the opposite happens - the thyroid produces more and more hormones, so the T4 and T3 keep going higher and higher, and TSH goes lower and lower in an attempt to make the thyroid stop its production...
It isn't ALL based on T4; it's a combination of T4 and T3... you can have all three, T4, T3 and TSH in the normal ranges, and still be hyper or hypo, depending on where, in the ranges, each of these might fall.
For instance, say the TSH is at the upper part of the range and T4 is at the lower part of the range, with T3 in the middle... The person can still be hypo, because, while they are producing "some" T4, they aren't producing "enough"...
And let's not forget the Free T4 and Free T3 vs Total T4 and Total T3, plus the conversion process.
Most of the Total T4 in the body is bound by protein and can't be used, which is why we test for Free (unbound) T4. The Free T4 must then be converted into T3, which is the active (usable) hormone...
As with T4, most of the T3 is bound by protein and can't be used, which, again, is why we test for Free (unbound) T3. Free T3 is the hormone that's used by every single cell in the body. Without adequate Free T3, one will become hypo.
One must, however, maintain a balance between Free T4 and Free T3, which is why the recommendation is, typically, for Free T4 to be about mid way in its range and Free T3 to be in the upper half of its range. Free T3 should be higher in its range than Free T4 in its. This the area that we find most people feel the best, though it doesn't hold true for everyone. We each have to find our own "spot" via trial and error with our meds.
When reporting labs, if not specified as "Free", it's assumed that T4 and T3 are the Totals, which are considered to be obsolete and of little value. We do recognize that in some countries, Free T3 and Free T4 tests are not available.
T4 is converted to either Free T3 or Reverse T3 (rT3). This is a normal process. I've read that rT3 is part of the body's mechanism to help prevent hyperthyroidism - when T4 levels are too high, the body converts more to rT3 than to T3; however, the ratio between FT3 and rT3 must also remain in balance.
Some say that if rT3 becomes too high, it blocks cell receptors so FT3 can't get in. I believe this to be somewhat controversial, as I've read articles to the contrary, as well. Suffice to say that FT3 and rT3 need to be in balance, just as FT4 and FT3 need to be in balance, along with other hormones in the endocrine system.
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