I've done research on both of these - as I've got a T4/T3 conversion problem at cellular level, caused by micronutrient imbalances & estrogen dominance. The information I've read is pretty in depth & complicated. I still can't quite get my head around T3 resistance, the more I research - the more confused I get! Is having a conversion problem & being T3 resistant the same thing?
Yep, your interpretation is similar to mine. From what my Dr told me, my conversion problem is (hopefully) only a temporary thing - just got to fix the imbalances & take supp's that promote a healthy conversion. Added to that, I'm on T3 for the time being - as T4 & NTH just don't work well with me.
I read somewhere that T3 resistance has something to do with 'mutant genes' & theres' about 100 different types. Fascinating, but very in depth reading. Anybody else done much reading on this?
Conversion of T4 to T3 can also be due to the fact that you have a lot of acid in your stomach which breaks down the T4, isnt absorbed properly and is expelled via the bowel instead of being absorbed into the blood stream.
It can also be because you are not waiting at least an hour before eating after taking T4 med or waiting 4 hours before taking vitamins.
It is a complicated issue and I found at one stage I was the same.
My T4 was high and my T3 doing nothing.
So I waited and waited and waited .........and it finally got its act together lol.
Give yourself some time and if no good then get checked again.
Let us know how you go.
You know the more I see people with TT's having problems with the T4/T3 conversion the more I am convinced I am seeing a pattern here. I see that too many of us are being treated as if we still have our thyroids. The thyroid normally converts the T4 into T3, but if we don't have that physical action, then no wonder we don't cope!
I still believe that the medical profession is about 60 years behind the research...and unfortunately we have to suffer!
My T4 is always super high...therefore I HAVE the dose in my body..but why, I ask my endo.....? Oh come back in 4 months after staying on the lower dose...but Doc...each time I lower the dose my T4 is still high.....Oh? Well, stay on the lower dose and come back in 4 months.....................Get my point? They don't know!
To me it is simple..GIVE the patient a bit of T3 after TT and I bet we get better..but as you know being a fellow Aussie, finding a doc here that understands that is almost impossible.
Sometimes, everybody looks for the complex without realising the simple...I think I see the simple..you had a TT I had a TT many of us who complain about the T4/T3 have had TT's.....to me it is simple..No thyroid, no conversion...But tell the docs that? They look at me like I have 5 heads! But I will keep pushing this issue.
Hope you aren't as hot as me down south!
Actually 60 years ago - there were other things brought on the table that seemed to give some patients better treatment options.
Doctor had to listen to the patients then more than depend on labs as much as they do now.
TT's were more common then - RAI is used so much now for Hyperthyroidism/Graves which leaves a patient with a "thought" of what's really left producing with the thyroid.
So putting that into the shuffle - with an unclear knowledge of NOT knowing where you are at and possibly not converting properly. It's a shot in the dark daily for some to feel well.
I read alot on symptoms and conversion theories. Everyone has there opinion on it. Patients - doctors - and whom ever else. I believe as you say Red - I think there are many out there with this conversion question and maybe assisting with T3 could be good.
I am still trying to figure out that question you bring up about why T4 "convert" to begin with - when there is no gland. I brought that question up to my Chief of Endo in Madision last Monday and she simply said T3 would be fine with patients that have no thyroid, BUT it is a short lived medication ( Hormone) and it would be tasky to have to administer it through periods of the day to maintain properly.
She also added that if a missed dosage was done on that T3 med - the patient WOULD FEEL it pretty bad within 4 hrs without the T4 in your system already slowly converting.
SO - I believe her - she is a traditional endo as many have here. She is skilled and does not prescribe T3 or Armour - but open when someone can come to her as I did and speak about my history and illness.
ALSO FOR THE RECORD - You don't want to jump on the band wagon and go get T3 soley either - or for that matter Armour.
Armour "may" slow a sluggish thyroid into not wanting to produce on it's own when it is administered to a "regular" hypothyroid patient. Armour treatment should be watched closely - and I believe T3 should be included.
Redheadaussie I'm with you on this one! Docs treat us like we have a thyroid and I always have to remind them... helloooo? I have no thyroid!!
Are you taking only T4?
I think conversion issues are worse when you don't have a thyroid. Also, you need proper minerals like zinc and selenium, and a whole lot of other vitamins and hormones need to be balanced too.....ferritin, dhea, adrenals etc etc etc list goes on...
Actually I have read that the acid in the stomach is depleted in many thyroid patients - but more potent. Many have a DX of acid reflex and given meds to even lower the acid more - but it is not PH balanced and that is why thyroid meds may deplete or irritate a belly.
I suffered soooo much with acid for years- I could of went broke on the purple pill and everytime I tried going on it - it made me feel even worse. It cut the acid burning - but my digestive system was taking a beating from it too - it is a wonder I still have a gut left - or throat for that matter. I increased my digestive enzymes and looked into PH balancing and I no longer have any belly issues. I do believe getting my digestive system back on track helped me tremendously to balance out my thyroid levels.
Everyone is asking HOW T4 converts when there is no thyroid.
To put it in laymans terms....I will give an example.
When you consume alcohol, the body and cellular sytem CONVERTS this alcohol into Ethanol (a pure form of alcohol). It starts off in the stomach then the acid in the stomach then takes it into the bloodstream and converts it.
How I dont know but I do know that after alcohol is consumed....within hours that alcohol has converted into Ethanol.
The same as Paracetomol and any other drug or medication....the body breaks it down.
So in hindsight, it isnt the thyroid that converts the T$ into T3...it is the body itself.
I was told a few weeks ago by a top Professor that acid does play a big part in breaking down medications in the body before it has time to absorb.
On the other hand the meds are based as an iodine sodium - so if a person still has a thyroid - part of that should be absorbed there too. - At least that is my thought along with the liver processing it too.
When there is no thyroid left to pull in that medication - then I think other parts of the body are required to produce what the thyroid lacks
Here’s a quote from a basic book on I have on thyroid disease:
"T3 is made from T4 when one atom is removed, a conversion that occurs mostly outside the thyroid in organs and tissues where T3 is used the most, such as the liver, the kidneys, and the brain.” The Harvard Medical School guide to overcoming thyroid problems, by Garber, Jeffrey R., New York : McGraw-Hill, c2005.
Now if they should take out your liver, kidneys and brain…well, then you’ve got problems (especially on that last one).
Seriously though, this is why the body can handle itself without automatically needing T3. But obviously there are times when, for whatever reason, the conversion is not taking place and T3 needs to be added. A doctor can, through a configuration, find out if a conversion problem is taking place.
I can also share this: I was reading elsewhere that it is always better to let the body produce and regulate its own T3, if possible. To add in T3 when it’s not necessary can unnaturally suppress the other areas of the body from producing it, thus interfering with their functions. It’s always better to let the body do its own job.
Thankyou all for your replies. It's great that this topic has been discussed & that we've promoted some more awareness about it. Knowledge is power!
I really do feel that T4/T3 conversion problems affect alot of people with thyroid disorders, both with or without a thyroid. Sadly alot of people suffer with conversion problems & aren't aware of it or are misdiagnosed/undertreated because their bloodtests look 'fine' & some Drs just aren't up to date with research or can't be bothered with more tests.
I'm eternally grateful that I FINALLY found a GP who diagnosed my conversion problems, is fixing them with high doses of various supplements/progesterone cream & while I'm healing on the inside - is happy for me to take T3. I cannot put into words how much better I feel. My only gripe is that I spent 2 years very sick & miserable with an undiagnosed conversion problem on T4 meds!
I've done even more research & have come up with these handy, helpful pointers :
* the thyroid gland produces about 80% T4 (inactive storage hormone) & 20% T3 (active hormone, which is 5-7 times stronger).
* the conversion from T4 into T3 takes place in the thyroid, hypothalamus, liver, kidneys & peripheral tissues.
* converting T4 into T3 is essential if your cells are to access the thyroid hormone they require.
* the thyroid hormone has to get into the cells to be used. Peripheral or cellular resistance (conversion problems) can prevent this from happening.
Conversion problems can be caused by :
* estrogen dominance (an imbalanced ratio between estrogen & progesterone) can affect conversion by making the liver sluggish.
* other liver &/or kidney problems.
* insufficient cortisol (hormone produced by the adrenal glands) can cause peripheral resistance.
* micronutrient deficiencies & imbalances (vitamins & minerals) can cause cellular resistance. Vit A, Vit E, zinc, selenium & essential fats are required for healthy conversion.
* certain medications & consuming food too quickly after taking thyroid medications can impair absorption & therefore affect conversion.
* reverse T3 (RT3) prevents T3 from entering the cells. During famine or stress, the bodys' defence mechanism (against hyperthyroid states) can slow down the metabolism. The body may turn T4 into RT3 instead of T3. RT3 attaches to the receptors where T3 normally would & prevents T3 from entering the cells. Other new research suggests that RT3 can also be caused by mutant genes - possibly up to 100 different types.
You should be taking the T4 med on an empty stomach and not eat for at least an hour...2 if possible.
So thats why I changed my meds to night time as its hell going to work with no brekkie in me lol.
I have been on thyroxin now since end of july 2008 and up until then took it in the morning (as much as a pain it was) but changed it over to night time and it doesnt interfere with any food issues now.
I feel 100% and am back working fulltime as a medical admin and also studying a distance online course too.
So it looks like my thyroxin and body is getting its act together.
I was 55 kgs before diagnosis...went to 71kgs prior to RAI and nearly 8 months post RAI, I am 65.5kgs.
I gave up trying to lose weight and just eat healthy......nothing packaged or processed.
Plus I also steer clear of anything with iodine in it as tuna sends me hyper lol (I found out the hard way).
How do you tell if you have conversion problem, I have always suspected that somehting was missing and that is why I felt so miserable. I just switched to Armour 2 weeks ago. I was on 112mg of Synthroid right before the switch. This was the lowest dosage in 15 years and my highest TSH since TT in 1994.
Free T4 1.68 (.61-1.76)
Free T3 2.8 (2.3-4.2)
T3 104 (85-205)
Since Free t4 on high end and t3's on lower end, doesn't that confirm my suspicions that T3 is needed? If not, does anyone know how you compute? Thanks,
Was the blood test done BEFORE taking T4 med?
If you took the T4 med , that would explain the high T4.
I always fast before bloods and was always told that it is best to do that.
If the labs were done before T4 med then your T4 isnt converting as it should.
There are a number of reasons why that happens.
Start by eliminating each one.
Sorry for confusion, that was my blood work on last day of Synthroid (T4) only, so I was just wondering if by those lab results could I tell if I was right about needing T3. I was fasting. I have not been tested yet on Armour and will ask to test after 4 weeks. I am on 120mg of Armour (which I am splitting 60 in AM and 60 in afternoon).
Unfortunately I didn't find this board until after the switch, (which was just 2 weeks ago), since I didn't start slowly as many of the posts suggest, I am concerned that I am going to have more problems. I don't feel well and want to make sure I do everything i can or should to help the process. I wondered if I jumped to fast to Armour (very ironic that I would say that after a decade of being miserable on it and seeking alternatives). I guess I am just paranoid or brainwashed after so many endo's refused to let me try t3 in any form. Since cytomel caused me strong cardiac symptoms (heart jumping), I thought switching to Armour was next and only option. Which I still am hopeful and I keep telling myself its only been 2 weeks+.
When I read about conversion and its mention many things can cause this, it makes me wonder if I something else has been overlooked. But I have no idea what those things are, I read adrenals, but since I have already made the switch should I still get checked? I take supplements especially Calcium, Vit D & Calcitriol since Parathyroid doesn't work. By the way, with splitting dosage of Armour, very hard to figure out when to take calcium 2 or 3 times a day! Also take b-complex and Omega.
I am sorry I feel like I am babbling, I just want to do all I can and I am so appreciative of any and all comments! Thanks so much to everyone.
Forgive me if I am wrong but hasnt Armour got T3 in it and isnt it safer to take Cytomel if you have heart issues as with Armour, the dosage of T3 cannot be precise whereas with Cytomel (T3) it can be dosed accordingly.
Sorry for asking but here in Australia, Armour is banned because of the inconsistancy of just how much T3 is in it.
I am not saying it is wrong to take it but I would be very careful if you have heart issues.
According to the cardiologist, I don't have any heart issues. Just missed and skipped beats. (Of course, I don't trust him any more than I trust any of the other many doctors that have misdiagnosed me time and time again.) It was just too much for me when I was on Cytomel. As for Armour, about 3 weeks now, have felt little palpitations but nothing like that of Cytomel. I am feeling better, actually hyper at times, but after feeling like I have been a sleep for months (years), I welcome it. I have cut back a little on the dosage, but its hard to be consistent since pills aren't cutting evenly for me. I am still nervous about the change, but I don't feel like I have anything to lose at this point. I have lost years!!
I found this forum - one of my GP's suggested exploring T3/T4 combo but worried how my ENDO will react so researching and researching! Hoping beyond hope the mix will help me back to my old life pre getting this "good cancer"!!!!!
Weight gain and tiredness big problems and their insistance I lower my T4v dose to make the "numbers" right!
I have been studying this problem for a very long time. One thing that I know is that desiccated Thyroid is much, much better at being useful in the body. Try reading "Overcoming Thyroid Disorders" By David Brownstein, MD. He encompasses the whole issue of blood tests. Why less people are being diagnosed with Thyroid issues is because doctors have moved to accepting only blood tests as signs of the problem and not their own eyes.
This book covers both western meds and holistic treatment options.
You should also consider wether or not their is adrenal failure along with this problem as in my case. If their is weight loss is impossible and exhaustion is the only way of life along with stress and sugar cravings.
Good luck everyone who suffers with this problem.
My T4 is 22.1 and TSH 2.8 at 100 dose of Levothyroxine, I had symptoms of being toxic with the Levo, dizzy, freaking out, restless sleep, palpitations, blurred vision etc. My endo told me today that I may need to raise my T4 above the normal range to suppress my TSH. How mental is that!? T4 levels above normal and feeling ill! I asked if this could indicate that I need less T4 and actually have a conversion issue of T4 to T3...he said maybe but probably just need more levothyroxine! Am I in a parallel universe where logic no longer exists!?
No, logic does not exist within the hypothyroid patient universe, where the vast majority of people do not have doctors that understand how best to test, diagnose and treat hypothyroidism. Within that universe Doctors slavishly follow the "Immaculate TSH Belief" they learned in med school, and also use "Reference Range Endocrinology" rather than accepting that neither works well for many of their hypo patients, and then spending the time and effort necessary to find out what really does work for them. It may be of small comfort, but you have millions of fellow travelers.
If you want to break out and join those who feel good again, you will need to find a good thyroid doctor, by which I mean one that will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this info written by a good thyroid doctor. This doctor absolutely believes that "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
Beyond our commiserating, I strongly urge you to find such a good thyroid doctor. If you will give us your location, perhaps we could even provide a recommendation for one.
Beyond that, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, due to the effects of hypothyroidism on stomach acid levels and associated absorption. Many doctors don't readily recognize that using "Reference Range Endocrinology" to interpret test results for these 3 tests does not work well either. If not tested for the 3, I heartily recommend doing so.
I'd just like to add some personal experience to gimel's good advice.
My TSH hovers around 20.0 all the time. I've never seen it go below the high teens. After many doctors attempted to get it to go down, my endo finally realized that something else was going on when I was overmedicated, had hyper symptoms and my TSH still refused to go down. I have Pituitary Resistance to Thyroid Hormone (PRTH), and my TSH never will go down. My best advice: If you feel hyper, you probably are. Now, we just ignore it and go by FT3, FT4 and symptoms.
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