Thyroid Issues

[lauralee175]

I was diagnosed with Hypothyroidsm about 20 years ago, but have never felt normal even after taking Synthroid. I am have been getting prescribed higher and higher doses of Synthroid and have been taking 224mcg for about 3 years. My recent Thyroid tests have come back as TSH 0.186 (low), T4, Free 1.83 (high), and my TPO is 118. My doctor recently switched me to Armour synthroid (after these results). I'm going to a specialist in a couple weeks, but still don't really understand what all this means. If my thryoid meds are working, it doesn't feel it at all! My previous Thyroid results (on 10/17/13 on 224mcg of Synthroid) were: TSH 0.991; T4 13.1 (high); T3 uptake - 31; and Free Thyroxine Index 4.1.
My daughter is 17 and she also was taking 75mcg of Synthroid (TSH - 4.820 (high); T4 - 1.43; and T3 - 219 (high), but because it wasn't working we switched her to Armour thyroid and now some of the symptoms seem to be better She has also been diagnosed with severe depression, personality disorder, anxiety disorder, along with all the other symptoms of hypothyroid (currently takes Prozac, Concerta, and Diazepam along with her thyroid meds). My son also has Type 1 Diabetes, so obviously autoimmune diseases run in my family.
I'm just trying to make sense of all this and especially try and help my daughter who is too depressed to even get out of bed most days!!!
Thank you!

[Barb135]

Wheat isn't the only grain that has gluten, so make sure you're sensitive to gluten and not allergic to wheat. They're 2 different things.  I have a friend who is allergic to wheat, but can eat other gluten containing grains with no difficulty.

Additionally, there are other things that can cause edema, so make sure you aren't eliminating the wrong thing from either your or your daughter's diet.  Whole grains can be an important part of a healthy diet, since they contain high quality protein, fiber and a variety of vitamins/minerals.

[lauralee175]

Thanks! We are gluten sensitive, though. My legs swell up like balloons if I eat wheat products, and I feel sick. Same thing with my daughter. I will do some more research on it though :)

[Barb135]

The book you're reading has some good information in it, but you do have to be careful.  Though a lot of people have jumped on the gluten free bandwagon, there is no scientific proof that gluten has anything to do with Hashimoto's/hypothyroidism.  Going gluten free will only help if one has a sensitivity to gluten, but don't be disappointed when it doesn't change your hypothyroidism, Hashimoto's or antibody levels.

[lauralee175]

I plan to let her Psychologist know at her next visit. The book I'm reading does mention all of the tests you suggested - "Why Do I Still Have Thyroid Symptoms? When My Lab Tests are Normal" by Dr. Kharrazian. He also talks about the strong connection between gluten sensitivities and Hashimoto's disease/Hypothyroidism. We had already started cutting back on wheat products, but this week I cleared my house of anything that had gluten.
Thanks again for your advice!

[Barb135]

Not sure what book you ordered, but not all of them will recommend the proper tests, since many doctors believe that TSH is all that's needed to reflect actual thyroid hormones.  Many of us, myself included, can attest to the fact that TSH does not correlate with thyroid hormone levels.  

Your daughter's psychologist should be updated on the proper tests, though; could save his patients a lot of grief down the road.

[lauralee175]

Her psychologist did require thyroid testing, which is how we found out that she had hypothyroid; however, he did not request the lab tests that you recommended. I ordered a book about Thyroid issues and plan to let him know that the tests he's recommending to patients may not be adequate.

[lauralee175]

Thank you Ahmee! I've also heard that. I'll read the article and see if I can learn enough to educate my daughters Psychiatrist during our next appointment. Hopefully it will help his other patients who may be experiencing the same issues.

[ahmee]

T3 has been prescribed for some time now by some psychiatrists as an alternate treatment for serious depression. You can search "T3 augmentation". Here is one interesting study: http://www.ncbi.nlm.nih.gov/pubmed/1737734

The link between certain manifestations of mental health issues and thyroid hormone deficiency is so strong it's very unfortunate/scary that more doctors are not aware of it.

[Barb135]

Did your daughter's psychologist put her on any of those meds?  If so, s/he can take her off them, if/when the situation warrants.  It's unlikely that the endo will be willing to take her off drugs prescribed by another doctor, but that's something to discuss with her/him.  S/he can tell you how to handle that, when labs are optimal and your daughter is feeling "normal" again.  Those drugs can't be stopped cold turkey; you have to step down on them and it needs to be done very carefully.  

Actually, you'd be surprised at how  many psychologists/psychiatrists actually send their patients for thyroid testing prior to prescribing anti-depressants. Some psych's are better thyroid doctors than actual thyroid doctors.

[lauralee175]

Thanks for the advice. I will order all of these tests for us on our next lab visit, and I'll post our results so maybe you will have a bit more advice before we see the specialist. I would have researched the Thyroid issues more if the Doctors weren't telling me that it's not her Thyroid causing the problems, she just has mental issues. When the tests are coming out normal half the time and abnormal the other half, they just increase the medication and assume it's working. Well....I'm not just going to accept their answers anymore at face value!! We have both suffered enough!

[lauralee175]

Also, do you think the Endocrinologist  will be able to recommend how to get my daughter off all the other medications she's taking (Prozac, Concerta, Valium)? Or is that going to be another battle we're going to have finding a different type of Doctor that knows about Thyroid Meds AND psychological medications. Her Psychologist probably knows very little about Thyroid issues.

[Barb135]

There's not a lot I can say about the previous testing that both of you had, because so much of it was obsolete.  Your FT4 was actually over range, which would tend to bear out the fact that you aren't converting adequately, but again, without a Free T3 test, it's impossible to say for sure.

You've already had the TPOab, which is a test to confirm/rule out Hashimoto's.  Your elevated result would confirm Hashimoto's.  You don't have to have TPOab done again, but you do need to have the TGab done, since you haven't had that yet.  Antibody tests only need to be done once, because once you have Hashimoto's, you have it for life, even if antibodies go into remission after healthy thyroid tissue has been destroyed.  

Here's what you need:  Naomi:  Free T3, Free T4, TSH, TPOab, TGab
You:  Free T3, Free T4, TSH and TGab.

It may take a while to get used to taking the med with T3 in it, but insomnia can be a symptom of both hyper and hypo.  

I fully agree that it's really pathetic that doctors would rather feed their patients anti-depressants, etc than to take the time to run a few simply, inexpensive thyroid tests.  

It's always advisable to research and learn as much as you can about any condition you have, in order to be your own advocate because you're all you have and right now, you're all Naomi has, as well, so you'll have to advocate for her, too.

[lauralee175]

"You both need to have Free T3 and Free T4 tested every time you have a TSH. That would be the 2 antibody tests, TPOab and TGab."

So we need to have Free T3, Free T4, TSH, TPOab and TGab.

Is that correct??
Sorry, I posted this to myself so if you got it twice I didn't mean for that to happen.

Also, please don't think I'm dramatizing my daughters issues...they have been severe! And it doesn't help that my sister committed suicide when she was my daughter's age. I have been scared to death for her! My pain and suffering is bearable and adults can muddle through with all the side effects, but children don't have our coping skills.

[lauralee175]

"You both need to have Free T3 and Free T4 tested every time you have a TSH. That would be the 2 antibody tests, TPOab and TGab."

So we need to have Free T3, Free T4, TSH, TPOab and TGab.

Is that correct??

[lauralee175]

No, neither of us has been tested for Hashimotos. We are both going to a endocrinologist on May 5th. We've been seeing our primary care physician (and he's not a Thyroid doctor). We are going to have labs redrawn in 2 weeks, since it will be about a month since we both switched to Armour Thyroid (sorry, not Synthroid). I want to makes sure we have the right tests done because that's what we're going to take to our appointment with the specialist.
Here are our full most recent lab results BEFORE switching from Synthroid to Armour:

Naomi (taking 75mcg of Synthroid) - Thyroxine (T4) Free, Direct 1.43 (0.93 - 1.60); TSH 4.820 (0,450-4.500); Triiodothyronine (T3) 219 (71-180).

Laura - (taking 224 mcg Synthroid) TSH 0.186 (0.450-4.500); T4, Free - 1.83 (0.82-1.77); Thyroid Peroxidase 118 (0-34).
My tests from 6 months ago  - TSH 0,9991 (0.450-4.500); Thyroxine (T4) 14.1 (4.5 - 12.0); T3 Uptake 31 (24-39); Free Thyroxine Index (4.1 (1.2-4.9)

Naomi is now taking THYROID (ARMOUR) 0.5GR (30MG) TABS
I am taking THYROID (ARMOUR) 1.5GR (90MG) TABS

We both seem to be dong better with Armour. Naomi's psychological symptoms have decreased, mood is better, and more energy. She was suicidal, injuring herself, and had panic attacks that would keep her in bed for days. I'm so angry that Doctors would rather pump people full of narcotics rather than do some research to help us! I almost lost my daughter because of her Thyroid issues. I just want to make sure that we are having the right tests done so that we can get well.

The only negative effects that I'm having since starting the Armour Thyroid is insomnia...and I've never had trouble sleeping through the night unless I've had bad PMS symptoms.

Thanks for taking the time to give me such a detailed response!!!! I wish that I could learn more about this and help people, too. So much unnecessary suffering because not very many Doctors seem to understand Thyroid issues.

[Barb135]

What's the reference range for your Free T4?  Ranges vary lab to lab and have to come from your own report. Unfortunately, it appears that neither you, nor your daughter have been tested for the active thyroid hormone, Free T3.  

It's kind of hard to deal with 2 people in the same post and I'm a bit confused, but I'm sure you can get me unconfused..lol.  You've been on Synthroid for 20 yrs, and were recently switched to Armour?  Your "Armour synthroid" threw me.  Your TPOab count of 118 would warrant a diagnosis of Hashimoto's.  You should also have Thyroglobulin Antibodies (TGab) tested; that's another antibody indicating Hashimoto's.  Some of us have only one of the 2 antibodies, some have both.

What dosage of Armour are you on and how for how long have you been on it?

I'm sorry, but I lose all respect and trust in any doctor who prescribes a med with a T3 component, such as Armour without testing Free T3 levels. In my opinion, that borders on malpractice.  

None of the tests run on your daughter are very useful.  The T4 is total T4 and it, along with T3 uptake and Free Thyroxine Index, is considered obsolete and of little value.  You both need to have Free T3 and Free T4 tested every time you have a TSH.  

TSH is pituitary hormone that stimulates the thyroid to produce hormones.  It can vary by as much as 75% over the course of a day and there are many things that affect it, besides thyroid hormones.

The thyroid produces 2 main hormones; those are T4 and T3, but mostly T4.  Of the total T4 produced, approximately 90-95% is bound by a protein and is unavailable for use.  The Free (unbound) T4 is the most important.  

The body can't use Free T4, directly; it must be converted to T3.  Like T4, most of the T3 in the body is bound by protein and can't be used.  The unbound, Free portion is that which is used by individual cells. Most of the conversion of FT4 to T3 is done in the liver, though some other organs convert small amounts as well.

Sometimes, people taking a T4 only med, don't convert adequately, so FT4 will continue to rise, while FT3 stays low.  Since FT3 is the hormone used by individual cells, a shortfall is what causes the remaining hypo symptoms.  This is what I suspect has happened to you, but without an FT3, there's no way to know for sure.

Depression, personality disorder, anxiety, etc are all symptoms of hypothyroidism.  Too often, it's easier to throw anti-depressants at someone, than to medicate enough to bring thyroid levels high enough to alleviate symptoms.

While T4 meds take several weeks to reach full potential in the blood and they stay with you for a long time.  T3, on the other hand, is fast acting, reaches it's peak within a few hours and then leaves the body.  Most of us on a T3 med, find that we have to take it in multiple doses/day, in order to keep FT3 levels stable throughout the day.  Are either/both you/your daughter splitting your total dosage into more than one?  For instance, I'm on synthetic generic T3 and I take 5 mcg in the morning, and 5 mcg around noon.

Has your daughter been tested for Hashimoto's?  That would be the 2 antibody tests, TPOab and TGab.