Aa
correct dosage of thyroxne
i was diagonised with hypothyroidism a year ago when my readings were T3 0.99 ng/ml, T4 7.53 ug/dl, and TSH 12.54 ulU/ml. i was then advised to take 25 mg thyroxine once a day. now i have again got myself tested and my readings are T3 0.87 mg/ml, T4 8.49 ug/dl and TSH 7.04 ulU/ml . another related issue is that when i was first diagonised with hypothyroidism i was having stomach pains for more than a month but once the dose was started the pain went away, this year too i was having this stomach pain and while my test was due i started eating 75 mg thyroxine once a day and pain has now gone.
my qoestion is with the present readings what should be my daily dose of thyroxine.
thanking in advance
my qoestion is with the present readings what should be my daily dose of thyroxine.
thanking in advance
Just happened to think that this information I posted today might be of use to you in discussions with your doctor.
T4-to-T3 Conversion and Hypothyroidism: Medical Journals
Purpose of this compilation
To show that the T4-to-T3 conversion process often does not function in hypothyroid patients as it does in euthyroid patients. For these patients, T3 supplementation in addition to T4 is necessary to restore health.
See also the links in the right column as well as in our Desiccated Thyroid References and TSH References sections.
A. T4-to-T3 conversion process
B. Laboratory findings
A. T4-to-T3 conversion process
1. "Thyroid insufficiency. Is TSH the only diagnostic tool?" (Belgium, 2000)
The explanation is that TSH is grossly in feedback with serum T4 only, not so much with serum T3, while the patient's wellbeing depends on the free T3 that is disposable inside the cells. As hypothyroid patients are usually unable to convert inactive T4 into active T3, owing to a lack of 5' -deiodinase in the liver and kidneys, the administration of T4 can eventually correct the serum TSH level, but rarely provides the patient with the T3 needed to be relieved of his symptoms.
Basier VW, Hertoghe J, Eeekhaut W. Thyroid insufficiency. Is TSH the only diagnostic tool? J Nutr Envir Med 2000;10,105-113.
2. "T3 is at least as important as T4 in all hypothyroid patients" (US, 1993)
It is assumed that, except in the 'euthyroid sick syndrome' and certain special situations, such as lithium therapy (10. St Germain, 1987), T4 converts peripherally to T3 in fairly standard amounts and at fairly standard rates. It only takes the consistent measuring of both free-T3 and free-T4 bloodlevels, in all one's hypothyroid patients, every time, to very rapidly dispell this myth. If one believes that both the T3 and T4 hormones need to be in their mid- to high-normal ranges, one soon discovers that, while a certain percentage of hypothyroid patients do convert enough T4 to T3 at a sufficient rate for T4 treatment to be adequate as a source of T3, a substantial proportion of patients require some combination of both exogenous T3 and T4.
Dommisse J. T3 is at least as important as T4 in all hypothyroid patients. J Clin Psychiatry 1993;July.
T4-to-T3 Conversion and Hypothyroidism: Medical Journals
Purpose of this compilation
To show that the T4-to-T3 conversion process often does not function in hypothyroid patients as it does in euthyroid patients. For these patients, T3 supplementation in addition to T4 is necessary to restore health.
See also the links in the right column as well as in our Desiccated Thyroid References and TSH References sections.
A. T4-to-T3 conversion process
B. Laboratory findings
A. T4-to-T3 conversion process
1. "Thyroid insufficiency. Is TSH the only diagnostic tool?" (Belgium, 2000)
The explanation is that TSH is grossly in feedback with serum T4 only, not so much with serum T3, while the patient's wellbeing depends on the free T3 that is disposable inside the cells. As hypothyroid patients are usually unable to convert inactive T4 into active T3, owing to a lack of 5' -deiodinase in the liver and kidneys, the administration of T4 can eventually correct the serum TSH level, but rarely provides the patient with the T3 needed to be relieved of his symptoms.
Basier VW, Hertoghe J, Eeekhaut W. Thyroid insufficiency. Is TSH the only diagnostic tool? J Nutr Envir Med 2000;10,105-113.
2. "T3 is at least as important as T4 in all hypothyroid patients" (US, 1993)
It is assumed that, except in the 'euthyroid sick syndrome' and certain special situations, such as lithium therapy (10. St Germain, 1987), T4 converts peripherally to T3 in fairly standard amounts and at fairly standard rates. It only takes the consistent measuring of both free-T3 and free-T4 bloodlevels, in all one's hypothyroid patients, every time, to very rapidly dispell this myth. If one believes that both the T3 and T4 hormones need to be in their mid- to high-normal ranges, one soon discovers that, while a certain percentage of hypothyroid patients do convert enough T4 to T3 at a sufficient rate for T4 treatment to be adequate as a source of T3, a substantial proportion of patients require some combination of both exogenous T3 and T4.
Dommisse J. T3 is at least as important as T4 in all hypothyroid patients. J Clin Psychiatry 1993;July.
The doctors you have met are absolutely wrong about there being no specific medicine for increasing your Free T3 level. Don't forget this info I found previously.
After I wrote that, I took a quick look through the Top Thyroid Doctors List for India, and I saw this in one of the Doctor's info. "I went to Dr. Sahgal without much hope. A close friend nagged me constantly to consult him. He believed my story and ordered a fistful of hormone tests. Three days later the results came, and I had my answer. I was suffering from Hypothyroidism caused by Hashimoto’s Thyroiditis. Dr. Sahgal prescribed a combination of T3 and T4 medication." So at least it appears that someone got T3 meds at one time, so maybe there is hope.
I think you should also give to your doctors a copy of this link that I previously copied above. It talks about the fallacy of using TSH as a diagnostic. The letter also talks about clinical treatment to get FT3 into the upper part of the range and FT4 to around the midpoint of its range. Maybe this might influence your doctors to reconsider and find a way to give you a T3 med.
http://hormonerestoration.com/files/ThyroidPMD.pdf
After I wrote that, I took a quick look through the Top Thyroid Doctors List for India, and I saw this in one of the Doctor's info. "I went to Dr. Sahgal without much hope. A close friend nagged me constantly to consult him. He believed my story and ordered a fistful of hormone tests. Three days later the results came, and I had my answer. I was suffering from Hypothyroidism caused by Hashimoto’s Thyroiditis. Dr. Sahgal prescribed a combination of T3 and T4 medication." So at least it appears that someone got T3 meds at one time, so maybe there is hope.
I think you should also give to your doctors a copy of this link that I previously copied above. It talks about the fallacy of using TSH as a diagnostic. The letter also talks about clinical treatment to get FT3 into the upper part of the range and FT4 to around the midpoint of its range. Maybe this might influence your doctors to reconsider and find a way to give you a T3 med.
http://hormonerestoration.com/files/ThyroidPMD.pdf
hi thanx for your comments and advice i am also slowly coming to the conclusion that your are suggesting , however my problem are the doctors i have consulted quite a number of doctors and their main points are if TSH is okay nothing else matters and secondly stomach pain has got nothing to do with hypothyroidism. my other problem is that in india all doctors are (atleast the ones i have met) quite convinced that their is no specific medicine for T3.
on the other hand i see that as my TSH has gone down my FT3 has also gone up slightly to be just below the 50 % value. so i am thinking that as i continue to have medicines given by the gastro specialist for IBS i may eat 75 mcg thyroxine for six weeks and get tested again.
thanx ones again.
on the other hand i see that as my TSH has gone down my FT3 has also gone up slightly to be just below the 50 % value. so i am thinking that as i continue to have medicines given by the gastro specialist for IBS i may eat 75 mcg thyroxine for six weeks and get tested again.
thanx ones again.
I know you are going to have trouble with your doctor about the dosage, but personally I would not reduce the meds, unless it is done in conjunction with a med change to include T3. . Frequently patients taking large doses of thyroid meds find that their TSH becomes suppressed. This does not mean mean that you are hyper. You are hyper only if you are having hyper symptoms, due to excessive levels of Free T3 and Free T4, which you do not have. Notice this quote from a link that I gave you previously on clinical treatment.
"As the TSH was usually normal initially, it is frequently suppressed when thyroid levels are optimized clinically. FT3 and FT4 are usually within the ranges, ruling out significant thyrotoxicosis."
My own TSH has been about .05 for well over 25 years without ever having hyper symptoms. In fact I continued to have hypo symptoms until learning about the importance of Free T3 and testing and finding mine to be in the very low end of the range, even though I was taking 200 mcg of T4 meds. When I switched to a combo T4/T3 med (Armour thyroid) and adjusted to optimal, I now feel best ever.
As for you still having some hypo symptoms, recall what I mentioned back in March, "FT3 is the most active thyroid hormone. As previously stated, it largely regulates metabolism and many other body functions. As also previously suggested, I think you need to add a source of T3 in your meds, to raise the FT3 level as necessary to relieve symptoms.
If your T4 med increase continues to give you symptom relief, that is what is most important, but I expect that at some point you will need to increase your FT3 level."
I think you have reached that point, where you need to add some T3 to your meds, either with a T3 only type med, or by switching to a T4/T3 type med. Have you asked your doctor about the possibility of adding some T3 to your meds? Are you going to be able to persuade him to forget your TSH level and focus on symptom relief by prescribing some T3 med and getting your FT3 level into the upper third of its range, or as needed to relieve symptoms? If not, then I don't know what options are available to you for finding a good thyroid doctor that will treat you clinically until symptoms are relieved, but that is what you need.
"As the TSH was usually normal initially, it is frequently suppressed when thyroid levels are optimized clinically. FT3 and FT4 are usually within the ranges, ruling out significant thyrotoxicosis."
My own TSH has been about .05 for well over 25 years without ever having hyper symptoms. In fact I continued to have hypo symptoms until learning about the importance of Free T3 and testing and finding mine to be in the very low end of the range, even though I was taking 200 mcg of T4 meds. When I switched to a combo T4/T3 med (Armour thyroid) and adjusted to optimal, I now feel best ever.
As for you still having some hypo symptoms, recall what I mentioned back in March, "FT3 is the most active thyroid hormone. As previously stated, it largely regulates metabolism and many other body functions. As also previously suggested, I think you need to add a source of T3 in your meds, to raise the FT3 level as necessary to relieve symptoms.
If your T4 med increase continues to give you symptom relief, that is what is most important, but I expect that at some point you will need to increase your FT3 level."
I think you have reached that point, where you need to add some T3 to your meds, either with a T3 only type med, or by switching to a T4/T3 type med. Have you asked your doctor about the possibility of adding some T3 to your meds? Are you going to be able to persuade him to forget your TSH level and focus on symptom relief by prescribing some T3 med and getting your FT3 level into the upper third of its range, or as needed to relieve symptoms? If not, then I don't know what options are available to you for finding a good thyroid doctor that will treat you clinically until symptoms are relieved, but that is what you need.
hi i had a few trouble free weeks , again my stomach pain started in jun and i met the gastro specialist who has put me on some medicine for IBS as far as my thyroid is concerned i got my self tested on 06 aug and my readings are TSH 0.12 (0.30-5.5) FT3 2.88 (1.7-4.2) FT4 1.55(0.70-1.8) . since my TSH has gone below the range i am being advised to lower my thyroxine does , i may add that i was taking 125 mcg from 11 mar . therefore my view is that i should reduce my dose to 75 mcg, any advice
thanx, i am reassessing and will try 112.5 mcg for some days and if there is relief then stick to this dose till my next test.
Yes, you can safely take the increased dosage of T4 Thyroxin. It should have some beneficial effect by raising your FT4 level and also your FT3 level; however it is unlikely to change the imbalance of FT4 to FT3 that you continue to have. I am also surprised that you felt such a fast response to a T4 med.
FT3 is the most active thyroid hormone. As previously stated, it largely regulates metabolism and many other body functions. As also previously suggested, I think you need to add a source of T3 in your meds, to raise the FT3 level as necessary to relieve symptoms.
If your T4 med increase continues to give you symptom relief, that is what is most important, but I expect that at some point you will need to increase your FT3 level.
FT3 is the most active thyroid hormone. As previously stated, it largely regulates metabolism and many other body functions. As also previously suggested, I think you need to add a source of T3 in your meds, to raise the FT3 level as necessary to relieve symptoms.
If your T4 med increase continues to give you symptom relief, that is what is most important, but I expect that at some point you will need to increase your FT3 level.
hi i have got my report and it is as follows
TSH 1.99 ulU/ml range - 0.30 - 5.5
FT3 2.38 pg/ml range - 1.7 - 4 .2
FT4 1.23 ng/dl range - 0.7 - 1.8
i have some issues with this report first is that the range differs with every lab so it is difficult to compare , secondly when i got myself tested in january the lab told me not eat my morning dose prior to giving blood however this time i was told eat your medicine and then only give blood. having said this i want to add that my FT3 was 8.9 % above the minimum range in Jan and is 19% above the minimum range now however my thinking is that this change is due to the fact that i had taken my morning dose. FT4 there is no change ,as far as TSH is concerned from 46 % above the minimum it has reached 32.5 % above the minimum.
i ate 125 mcg throxine in the last two days and my constant stomach ache vanished .
my question is simple can i safetly eat 125 mcg throxine or it will have some adverse effect on my body.
my own view is that i should eat 125 mcg for next six weeks, monitor my symptoms and then get tested again.
thanx.
TSH 1.99 ulU/ml range - 0.30 - 5.5
FT3 2.38 pg/ml range - 1.7 - 4 .2
FT4 1.23 ng/dl range - 0.7 - 1.8
i have some issues with this report first is that the range differs with every lab so it is difficult to compare , secondly when i got myself tested in january the lab told me not eat my morning dose prior to giving blood however this time i was told eat your medicine and then only give blood. having said this i want to add that my FT3 was 8.9 % above the minimum range in Jan and is 19% above the minimum range now however my thinking is that this change is due to the fact that i had taken my morning dose. FT4 there is no change ,as far as TSH is concerned from 46 % above the minimum it has reached 32.5 % above the minimum.
i ate 125 mcg throxine in the last two days and my constant stomach ache vanished .
my question is simple can i safetly eat 125 mcg throxine or it will have some adverse effect on my body.
my own view is that i should eat 125 mcg for next six weeks, monitor my symptoms and then get tested again.
thanx.
thanx , have been tested again waiting for my test results, will try and get T3 specific medicines
thanks for taking the time to post all that information. That makes it much easier to track your test results and meds.
From that data, it is clear that your body has responded to the med changes, as far as FT4 and TSH levels. However, your FT3 is still too low, and those levels are associated with being hypo. Many of our members here report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. Symptom relief should be all important, not test results. The main value of test results is as an indicator of your status during diagnosis, and then as a tracker of progress as meds are increased toward achieving symptom relief.
You doctor is wrong in saying that there are no specific meds to raise FT3 levels. There are two types, the T4/T3 combo types such as Armour thyroid, Nature-Throid, and Erfa. Then there is the T3 types like Cytomel. Of course these are the names used here. I don't know what they might be called in India. If there are no sources for T3 meds in India, then maybe you should start a new business as a distributor of T3 meds. LOL
After I wrote that, I took a quick look through the Top Thyroid Doctors List for India, and I saw this in one of the Doctor's info. "I went to Dr. Sahgal without much hope. A close friend nagged me constantly to consult him. He believed my story and ordered a fistful of hormone tests. Three days later the results came, and I had my answer. I was suffering from Hypothyroidism caused by Hashimoto’s Thyroiditis. Dr. Sahgal prescribed a combination of T3 and T4 medication." So at least it appears that someone got T3 meds at one time, so maybe there is hope.
So my only advice is to somehow find a source for a T4/T3 type med and change to that and increase slowly until symptoms are gone. Since patients with hypothyroidism frequently also have deficiencies in other areas, I suggest that if you haven't already been tested, then you should test for Vitamin D, B12, and selenium.
Best to you, rajbir.
From that data, it is clear that your body has responded to the med changes, as far as FT4 and TSH levels. However, your FT3 is still too low, and those levels are associated with being hypo. Many of our members here report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. Symptom relief should be all important, not test results. The main value of test results is as an indicator of your status during diagnosis, and then as a tracker of progress as meds are increased toward achieving symptom relief.
You doctor is wrong in saying that there are no specific meds to raise FT3 levels. There are two types, the T4/T3 combo types such as Armour thyroid, Nature-Throid, and Erfa. Then there is the T3 types like Cytomel. Of course these are the names used here. I don't know what they might be called in India. If there are no sources for T3 meds in India, then maybe you should start a new business as a distributor of T3 meds. LOL
After I wrote that, I took a quick look through the Top Thyroid Doctors List for India, and I saw this in one of the Doctor's info. "I went to Dr. Sahgal without much hope. A close friend nagged me constantly to consult him. He believed my story and ordered a fistful of hormone tests. Three days later the results came, and I had my answer. I was suffering from Hypothyroidism caused by Hashimoto’s Thyroiditis. Dr. Sahgal prescribed a combination of T3 and T4 medication." So at least it appears that someone got T3 meds at one time, so maybe there is hope.
So my only advice is to somehow find a source for a T4/T3 type med and change to that and increase slowly until symptoms are gone. Since patients with hypothyroidism frequently also have deficiencies in other areas, I suggest that if you haven't already been tested, then you should test for Vitamin D, B12, and selenium.
Best to you, rajbir.
hi i am posting a small table regarding my readings till date
Date TSH Range FT3/T3 Range FT4/T4 Range Medicine
29/07/09 2.55 0.270-4.20 0.848 0.846-2.02 3.71 5.51-14.06 nill
29/09/09 9.23 0.270-4.20 0.880 0.846-2.02 not recorded nil
21/12/09 12.54 0.5 -6.5 0.99 0.8-2.1 7.53 5.5 -13.5 25 mcg throxine
19/11/10 7.04 0.5-6.5 0.87 0.8-2.1 8.49 5.5 -13.5 incd to 75 mcg
21/01/11 2.498 0.550-4.780 2.47 2.3-4.2 1.09 0.70-1.51 incd to 100 mcg
Based on the above readings i have seen that my TSH though has reduced after i started taking medicine and has come within range after i was put on 75 mcg, however my T3 has always been just above the minimum of the range and T4 has been somewhere in the centre of the range, what i have read till now it appears that the functions of the body are carried out mainly by T3 and thus i can sumrise that my problems are due to low T3. i have only the following symptoms (a) i feel very cold (b) stomach ache (c) lost outer part of eyebrow. i have met a few doctors but here ( that is India) the doctors rely only on TSH and are saying that there are no specific medicines specially to boost T3.
well i am trying to meet some more doctors, any advice
thanx
Date TSH Range FT3/T3 Range FT4/T4 Range Medicine
29/07/09 2.55 0.270-4.20 0.848 0.846-2.02 3.71 5.51-14.06 nill
29/09/09 9.23 0.270-4.20 0.880 0.846-2.02 not recorded nil
21/12/09 12.54 0.5 -6.5 0.99 0.8-2.1 7.53 5.5 -13.5 25 mcg throxine
19/11/10 7.04 0.5-6.5 0.87 0.8-2.1 8.49 5.5 -13.5 incd to 75 mcg
21/01/11 2.498 0.550-4.780 2.47 2.3-4.2 1.09 0.70-1.51 incd to 100 mcg
Based on the above readings i have seen that my TSH though has reduced after i started taking medicine and has come within range after i was put on 75 mcg, however my T3 has always been just above the minimum of the range and T4 has been somewhere in the centre of the range, what i have read till now it appears that the functions of the body are carried out mainly by T3 and thus i can sumrise that my problems are due to low T3. i have only the following symptoms (a) i feel very cold (b) stomach ache (c) lost outer part of eyebrow. i have met a few doctors but here ( that is India) the doctors rely only on TSH and are saying that there are no specific medicines specially to boost T3.
well i am trying to meet some more doctors, any advice
thanx
I don't know what meds are available to you, but there are two options for meds to increase your FT3 level. First would be a natural, desiccated type T4/T3 combo type med, like Armour thyroid or Nature-Throid. One grain (60 mg) of this med is the equivalent of about 75 mcg of your thyroxine. It contains 38 mcg of T4 and 9 mcg of T3. One grain would probably be a good starting dose for you, then after a month or so of getting acclimated to the change you could consider increasing by a quarter grain and then monitor how you are feeling with that dosage. Then I think you would want to be re-tested. Further increase should be dependent on your symptoms.
The second alternative would be to add a T3 med to your current dosage of T4. Taking that approach, you would probably want to start with 5mcg, taken twice a day. Then I would want to re-test and increase the amount based on your symptoms and also blood test results of FT3 and FT4.
The second alternative would be to add a T3 med to your current dosage of T4. Taking that approach, you would probably want to start with 5mcg, taken twice a day. Then I would want to re-test and increase the amount based on your symptoms and also blood test results of FT3 and FT4.
hi i have read your comments and am planning to meet my doc aonly after i get myself tested again in the second week of Mar, what i would like to know is that to improve my FT3 should i take some other specific medicine for FT3 only and discontinue thyroxine what i am taking now , and if yes how much should be the dose based on my last readings, this is for my information only as i will start the medicine only after consulting the doctor
thanks
thanks
This is the letter.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
For Physicians of Patients Taking Thyroid Hormones
I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long- term health. If there were clear improvements, I maintained the thyroid supplementation. Mild-to- moderate thyroid insufficiency is common and an unrecognized cause of depression, fatigue, weight gain, high cholesterol, cold intolerance, atherosclerosis, and fibromyalgia. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels.
Your patient’s TSH may be low or undetectable, even though their free T3 and free T4 are within the reference ranges. Why? We are taught that the TSH always perfectly reflects a person’s thyroid hormone status, supplemented or unsupplemented. In fact, we have abundant evidence and every reason to believe that the hypothalamic-pituitary axis is NOT always perfect. In clinical studies, the TSH was found not useful for determining T4 dose requirement.i The diagnosis of thyroid insufficiency, and the determination of replacement dosing, must be based upon the patient’s symptoms first, and on the free T4 and free T3 levels second. The TSH test helps only to determine the cause. Even here, “normal” may not be good enough. The labs’ reference ranges for free T4 and free T3 are not optimal ranges; but only 95%-inclusive statistical population ranges. The lower limits are below those seen in studies of healthy adults. They define only 2.5% of the population as “low”, but hypothyroidism is more prevalent than that.
T4-only therapy (Synthroid, Levoxyl), to merely “normalize” the TSH is typically inadequate as the H-P axis is often under-active to begin with, is more sensitive to T4, and is over-suppressed by the once-daily oral thyroid hormone peaks. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, NACB guidelines call for dosing T4 to keep the TSH near the bottom of its RR (<1) and the FT4 in the upper third of its RR; but even this may not be sufficient. The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose.
Excessive thyroid dosing causes many negative symptoms, and overdosed patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, excessive sweating, etc. The most serious problem that can occur is atrial fibrillation. It can occur in susceptible patients with any increase in their thyroid levels, and is more likely with higher doses. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolic rate and therefore the rate of the current bone formation or loss. Most older people are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism or bisphosphonates; one should correct the hormone deficiencies.
Fraser WD et al., Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement? Br Med J (Clin Res Ed). 1986 Sep 27;293(6550):808-10.
The best advice I can offer is to find a good thyroid doctor that will treat you clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Your Endo gave you the classic response from physicians who have the "Immaculate TSH Belief". In other words, your TSH is in range, and your FT3 and FT4 are within range, so you don't have a problem, according to them. Too bad about your symptoms, must be something else.
We hear this many times every day on the Forum. The problem with it is that TSH is a very poor diagnostic for thyroid, and the ranges for FT3 and FT4 are way too broad to assure that test results within their range mean that you are okay. Many of our members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. Your FT3 is too low.
If you have any doubts about this approach, then read this letter written by a good thyroid doctor, like you need. When consulting with patients who live in other areas, the doctor sends this letter to the Primary Doctor, to help guide the treatment of the patient.
We hear this many times every day on the Forum. The problem with it is that TSH is a very poor diagnostic for thyroid, and the ranges for FT3 and FT4 are way too broad to assure that test results within their range mean that you are okay. Many of our members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range. Your FT3 is too low.
If you have any doubts about this approach, then read this letter written by a good thyroid doctor, like you need. When consulting with patients who live in other areas, the doctor sends this letter to the Primary Doctor, to help guide the treatment of the patient.
hi , have finally met a endochronologist and she is a HOD in a reputed hospital, she saw my readings of 21 jan and was of the opinion that i should stick to 75 mcg thyroxine, she also said that stomach ache had nothing to do with hypothyroidism. i asked her about special medicine for FT3 but she said not required. on the other hand i have this stomach pain and if i reduce the dose to 75 mcg do not know what will happen.
any advice ?
any advice ?
T4 meds are slower acting than T3 meds, so I would not be concerned about taking the med before the test.
Rather than just increasing your thyroxine, do you have access to any meds with T3 in them, such as T4/T3 combo meds such as Armour thyroid? Or possibly a T3 type med such as Cytomel? I ask this because your FT4 level is adequate, but I think you need to increase your FT3 level enough to relieve symptoms..
Rather than just increasing your thyroxine, do you have access to any meds with T3 in them, such as T4/T3 combo meds such as Armour thyroid? Or possibly a T3 type med such as Cytomel? I ask this because your FT4 level is adequate, but I think you need to increase your FT3 level enough to relieve symptoms..
i am still taking 100 mcg of thyroxinw however the stomach pain has not completely gone some slight pain continues to occue i therefore think that i should start 125 mcg of thyroxine.
one more thing has troubled me and that is should one take the dose of that day before giving blood for the test, for my earlier doctor had said take the medicine before giving blood for the test, however this time i was advised not to take the dose before the test, therefore this time i did not take the dose before the test therefore i think my readings are slightly wrong ???
one more thing has troubled me and that is should one take the dose of that day before giving blood for the test, for my earlier doctor had said take the medicine before giving blood for the test, however this time i was advised not to take the dose before the test, therefore this time i did not take the dose before the test therefore i think my readings are slightly wrong ???
From your description of symptoms, I think that you do need to supplement your meds with some T3 type medication. I say this because your FT4 is right at the midpoint of the range, yet the most active thyroid hormone, FT3, is at the lower end of the range. This is indicative of inadequate conversion of T4 to T3, which is not unusual when only taking T4 meds. In conjunction with that you might consider having your selenium tested at next visit. Selenium has been shown to aid in the conversion of T4 to T3. If your selenium is low, then it should be easy to find an over-the-counter supplement to increase the level.
A good thyroid doctor will treat a patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by TSH levels. The best approach is clearly outlined in the last link I gave you. If your doctor is not willing to treat you in this manner, then you will need to find a doctor that will do so.
Best to you.
A good thyroid doctor will treat a patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by TSH levels. The best approach is clearly outlined in the last link I gave you. If your doctor is not willing to treat you in this manner, then you will need to find a doctor that will do so.
Best to you.
i have been examined again by a new surgeon and he has said no hernia, as far as pain in stomach is concerned i had started having some pain before i got my thyroid test done and after i increased my dose to 100 mcg the pain has now gone.
as far as the symptoms of hypothyroid are concerned my appreciation is that there may be some classical symptoms but every person has his own issues , as far as i am concerned my eyebrows have lost lots of hair and the next one i presume that i have is the stomach pain issue ( which the doctors think is not related to hypothyroid) however i think that the metabolism becomes slow which results in undigested food and what follows is stomach pain.
as far as the symptoms of hypothyroid are concerned my appreciation is that there may be some classical symptoms but every person has his own issues , as far as i am concerned my eyebrows have lost lots of hair and the next one i presume that i have is the stomach pain issue ( which the doctors think is not related to hypothyroid) however i think that the metabolism becomes slow which results in undigested food and what follows is stomach pain.
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