Treatment based on FT3 levels

[dpleiman]

I'm looking for references of research that has been done to show that hypo/hyper thyroid symptoms coorelate with FT3 levels AND that treatment primarily based on FT3 labs has proven successful at eliminating symptoms..

I'm wanting this information to take to my doctor, she seems very open minded and willing to listen and if this in fact is the case i would like to present this information to her, and get her opinion, but would like to have some references to take with me to back it up.

thank you for any assistance that can be provided.

[jzg]

MAY 17,2010 ARTICLE:
New Study Shows that the Addition of T3 is Superior to Levothyroxine/T4-Only Thyroid Treatment for Hypothyroidism



http://thyroid.about.com/b/2010/05/17/t3-superior-t4-levothyroxine-hypothyroidism-thyroid.htm

[debbie0413]

Here is another article about the relationship between thyroid hormones and antidepressants:

http://www.bellaonline.com/articles/art61573.asp

There apparently has been very little research done in this area.  It is a shame that more is not being done to look at the interrelationships between thyroid and antidepressants.

[debbie0413]

Thanks for the referral about the STTM page.  I have looked at it before.  Unfortunately, I don't think this is the kind of resource that will convince a mainline doc about the importance of using the free T3 test.  Much of it may be true, but I need mainline resources to give to my daughter in order to pursuade her docs.

[debbie0413]

I was just reading articles on the web on thyroid issues and found a pretty interesting one:

http://www.csa.com/discoveryguides/thyroid/overview.php

Here is the part of the article that I am going to highlight for my daughter.  Note the 2 sentences that I have put in brackets:

"Some of the most profound effects of TH imbalance are in the mental arena. Hypothyroid people sleep easily and do not get full refreshment from their sleep. During waking hours, they experience fatigue, apathy, and "brain fog" (short-term memory problems and attention deficits). These problems may affect their daily functioning and cause increased stress and depression.

TH acts as a neurotransmitter. TH imbalance can mimic psychiatric disease because T3 influences levels of serotonin, a neurotransmitter integral to moods and behavior.
[Low levels of T3 can cause depression. Some anti-depressants make hypothyroid patients feel even worse because the medications depress T3 levels.]  Paradoxically, some substances labelled depressants such as alcohol or opiates can increase T3 levels by impairing the breakdown of T3 in the brain, thus lifting mood. This may be one reason why these substances are so addictive."

I will explain to my daughter that this is an EXTREMELY important reason that her psychiatrist and medical doctor should not only be monitoring her TSH but also testing her free T3!  For at least the last week my daughter was started on Seroquel as an add-on anti-depressant and a sleep aid for insomnia, and after a few days they switched her to the timed release form of it.  She is sleeping better, but for the last week our daughter has been experiencing a disconcerting lack of motivation in her interests and treatment.

I'm going to specifically ask my daughter to ask her doctor to test her free T3 levels.  I believe her doctor will respond to her request where he will only do the minimum to appease me.

[redheadaussie]

Read Janie Bowthorpe's book   this is her site     stopthethyroidmadness.com

Take that with you and show the doctor...You are so lucky to have a doc who is willing to listen!
Here in Australia I am banging my head against a brick wall!

[gimel]

Sounds like your doctor has taken a position and is the type that will never consider the possibility of being wrong.  That's too bad, because he is wrong.  Free T3 is at least four times as active as FT4 and you need to know the level of FT3 and patient symptoms in order to assess the need for meds.  

TSH has no function other than as a signal to the thyroid glands to increase/decrease output of the actual thyroid hormones T4 and T3.  The doctor won't be able to provide you a reference that shows that TSH even correlates adequately with FT4, much less FT3.  FT3 levels don't always follow FT4 levels either.  Instead of also assuming that knowing FT4 is adequate to predict the level of FT3, why not just test and be sure?  Aren't you the customer here?  

Would this very good article written by a doctor have any effect on your doctor?

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

[debbie0413]

This research abstract looks very interesting.  Do you know of any more recent studies?  I think the published date of this study is 2000.

My daughter's current medical doctor while she is an inpatient eating disorders program flatly stated to me that the free T3 test was NOT IMPORTANT (even though I disagree from what I am reading from people's experiences on this and other support forums).  He is using a combination of TSH and free T4 to adjust her medication.  He also stated that the use of Armour thyroid was "very unusual."  If I can find some studies in peer-reviewed journals, perhaps he will agree to run the free T3.  Otherwise, we'll have to wait until she is discharged and can get to see another doctor.

Thanks,

- Debbie

[gimel]

There are numerous references to studies that show that the best correlation to symptoms is with FT3.   This is only logical when you consider that FT3 is the most active thyroid hormone and that it largely regulates metabolism and many other body functions.  I am particularly fond of this particular study.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

In this study the researchers got patients to assign their judgmental evaluation number to each of 8 major symptoms of hypothyroidism.  Of course these valuations are very subjective and make it very difficult to adequately correlate with the variables being evaluated.  The researchers were satisfied that the score of these 8 main symptoms is a reliable expression of their illness in 97% of hypothyroid patients.

By running linear regression analysis of the effects of FT3, FT4 and TSH on the cumulative ratings of the 8 symptoms, this was their conclusion.  " In this study symptoms of hypothyroidism correlate best with 24 h urine free T3".   Also, "Other investigators were unable to find any correlation between serum thyroid stimulating hormone (TSH) or serum free T4 and thyroid symptoms."

[dpleiman]

I found some reference on JAMA Publication. There is so much controversy on this matter.. I had no idea.

One study says it helps another says it doesn't.. One study says they didn't do it right, another says the other didn't. WOW...

There is at least one point that i found very interesting and is this:

One problem with the studies is that the ratios of T4 to T3 employed are not those that are secreted by the normal thyroid gland. Animal studies have shown that maintaining normal thyroid values at the tissue level actually required continuous infusion of both T4 and T3. So a sustained-release or timed-release form of T4 or T4/T3 drugs may actually be more likely to achieve normal values and improvement in symptoms.

Definitely keeps you thinking eh? Hopefully one day they will figure this one out and in the mean time we just continue to suffer the consequences of a substandard treatment...