T4/T3 Conversion problems & T3 resistance........

[RavingMad]

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?

Rach  : )  

[goolarra]

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.

[gimel]

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."

http://www.hormonerestoration.com/Thyroid.html

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.

[Breenymachiney]

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!?

[baxterrocks]

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.

[Sirius55]

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!
Cheers Liz

[Kimemitch]

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!!

[Smilerdeb]

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.

[Kimemitch]

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.

[stella5349]

What is your dosage of Armour ? You said you have been on that now for two weeks?

If your doctor prescribe Armour correctly with the switched from Synthroid - your T4 would be still in the upper ranges due to the Synthroid T4 possibly still in the system.

It takes at least 4 weeks to rid Synthroid out and test accurately with just Armour.

I think you tested to soon to actually get true results.

[Smilerdeb]

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.

[Kimemitch]

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.

TSH:             2.396
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,

[RavingMad]

The more info - the better! If anyone does any more research on these topics.........please feel free to add it here!  : )

[stella5349]

Lots of info here - Good Post!

[Smilerdeb]

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.
Weight?
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).

[RavingMad]

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.  

Hope this helps!

Rach  : )

[Thypatient]

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.

[redheadaussie]

http://www.webnat.com/articles/Thyroid.asp

http://www.altsupportthyroid.org/t3/t3refs1.php

Hopefully those two links will come up....I found them interesting.

[Barb135]

I've read quite a few articles that say the liver is what converts most of the T-4 to T-3 and most doctors figure if you have good liver function, there should be no problem with the conversion.  

I haven't had a TT but apparently have a conversion problem.  T4 normal, T3 low, TSH very low, yet I have good liver function so there has to be something else too.  Recently started on cytomel.  

[blondee028]

I didn't know that?  I take my synthroid in the morning when I wake up, then I walk in the kitchen, have my coffee and toast. My t4 has trouble converting to T3, I wonder if thats why?

[stella5349]

I think AR has done alot of this research - I hope he responds

[Smilerdeb]

Interesting subject Stella......worth trying to find out more too.

[stella5349]

I do see that conversion being right Deb -

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

[Smilerdeb]

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.

Food for thought.....

[stella5349]

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.