Thyroid supplements?

[Bearika]

Hello,

I am hypo and was not responding to Armour so my dr recently switched me to a combo of Levo & generic Cytomel.  I haven't been on long enough to retest or notice an improvement yet.

I saw a nutritionist who suggested taking a thyroid supplement (iodine, selenium etc).  Has anyone taken something similar with good results?

Most importantly, should I wait to add this until I see if the new meds are helping first? I am hesitant to try too many things at once in case I can't isolate what is working. At the same time, I just want to feel better soon.

Thanks!!

[Bearika]

Thanks so much!! This is so helpful.

[gimel]

With continuing symptoms, you need to continue to raise your Free T4 level to the middle of its range or above, and increase your Free T3 level as necessary to relieve symptoms.  Free T3 has been shown to correlate best with hypo symptoms.  You also need to get your Vitamin D, B12, ferritin, and DHEA to optimal levels.  

I do have some good links about TSH, that I previously gave to another member, as follows.


You might have more success with your doctor by explaining that trying to dose a hypo patient based on TSH only doesn't work.  As evidence of that, following are scientific studies, with conclusions immediately following each.  

http://www.ncbi.nlm.nih.gov/pubmed/3687325

"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."

http://www.ncbi.nlm.nih.gov/pubmed/12481949

"Suppression of TSH by thyroid replacement to levels below 0.1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p < 0.0001). In conclusion, in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus, insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment."


http://www.bmj.com/content/326/7384/311


"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 "


In addition, you can make the doctor aware of this scientific study that concluded that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

http://informahealthcare.com/doi/abs/10.1080/13590840050043521



You might give a copy of these studies to the doctor and try to get her to understand that medicating hypo patients based on TSH only does not work.  That hypo patients taking adequate doses of thyroid med necessary for symptom relief often find that their TSH becomes suppressed below range.  That doesn't mean that you are hyperthyroid, unless you also have hyper symptoms, due to excessive levels of Free T3 and Free T4.  

A good thyroid doctor 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 also get some good insight from this link written by a good thyroid doctor.

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

[Bearika]

I am still struggling with fatigue and a few other symptoms, although it has improved since starting medication.  

Do you have any articles you could recommend regarding the TSH that I could bring to my appointment? I'm hoping it won't be needing it, but I would like to be prepared.  

Thanks!

[gimel]

Those results may not be optimal for you yet, but certainly greatly improved from last tests.  The key question is:  How are you feeling?  Still have any symptoms?

No reason for concern about the suppressed TSH.  Scientific studies have shown that to be a regular result when taking significant doses of thyroid med.  

[Bearika]

Hello Gimel,

These are my most recent (3/25) labs:

FT4 1.14 (range 0.82-1.77)
FT3 3.3 (range 2.0-4.40)
TSH 0.013 (range 0.45-2.50)
DHEA 126.9 (range 57.3-279.2)

I would love to know your thoughts. It looks pretty optimal now?  Everything improved from last time, except for the TSH which was 3.03.  Should I be concerned that it is so low? I have read this becomes suppressed on medication.

Thanks so much for all of your help!

[Bearika]

Thanks, will do!

[gimel]

The key questions regarding timing for new tests are always, how you are feeling  and how long since last increase in meds.  Since you are feeling better, but still having symptoms, and it has been more than the minimum four weeks since lasts, I think you should go back for a new set of tests.  

While you are there, it would be a good idea to test for Vitamin D, B12 and ferritin.  Hypo patients are frequently too low in the ranges for those, which can cause symptoms, as well as affect metabolism of thyroid hormone.  

[Bearika]

Hello Gimel,

Thanks for the advice.  I've been splitting the T3 pills as you suggested and it seems to be going well. My most recent increase was to 75mcg of T4 and to 15mcg of T3 (in January).

As a reminder, my most recent labs were:

12/19 on 5mcg generic Cytomel & 50 mcg L-Thyroxine
FT4 1.04 (range 0.82-1.77)
FT3 2.3 (range 2.0-4.40)
TSH 3.03 (range 0.45-2.50)

My doctor suggested retesting in June, but I'm wondering if you think it would be beneficial to retest now.  I still feel quite fatigued, albeit improved from December.  I think she would be fine with that, but I'm not sure if that would be advisable to retest now.  Thanks so much!

[Bearika]

Thanks.

[gimel]

Sounds like a good plan.  Going from 50 to 75 mcg of T4 is fine.  I would be a bit more cautious about the T3 increase, and perhaps do it in two steps.  Start with 5 mcg  in the morning and 5 in the afternoon, and then after 2-3 weeks, to accommodate the change,  I'd split one of the 5 mcg tablets and take 7 1/2 mcg doses twice a day, to even out the effect over the day.  

[Bearika]

The dr is raising my L-thyroxine from 50 to 75, & my Cytomel from 5 to 15 (5 in AM and 10 at lunch). Does this sound like a good plan? Thanks!

[gimel]

Optimal levels can vary from one hypo patient to another.  All we generally say is that Free T3 seems best when it is in the upper 1/3 or 1/4 quarter of the range. so say, about 3.8 for you, or as necessary to relieve symptoms.  For Free T4 it should be at the middle of the range, at minimum.  Vitamin D is best around 55-60.

[Bearika]

Thanks for your thoughts.  I don't have the #s handy, but my Vitamin D is also low and I have been supplementing for that.

I am a little unclear how to calculate what my target Free T3/T4 numbers should be.  Would you be able to tell me what goal #s I should have based on the ranges I gave?

[gimel]

When you look back at your 6/20 levels, and compare to current, there has not been much change in your Free T4 and Free T3 levels.  We previously explained that it is quite common for levels to not change very much at the beginning, until meds are raised enough.   Your symptoms are due to your Free T3 and Free T4 still being too low.  So, you need to get your doctor to continue to raise your meds, as necessary to relieve those symptoms.

I know there were other posts from you but I don't recall if you have tested for Vitamin D.

[Bearika]

OK, I got my labs back and my frees look much better (finally). But, my TSH doubled from last time? I thought this was supposed to go down on thyroid meds.

Any interpretation of these results would be welcome - thanks!! I have an appt with the doctor this Friday to discuss next steps.  She is very receptive to working with me based on symptoms.  My energy is much better but I am still struggling with sensitivity to cold, brain fog and weight gain.

6/20 no thryoid meds
FT4 0.90 (range 0.82-1.77)
FT3 2.20 (range 2.0-4.40)
TSH 2.16 (range 0.45-2.50)
DHEA 116.9 (57.3 - 279.2)
Ferretin 52 (range 15-150) - up from 11 at last test (taking iron)

9/3 on 1/2 grain Armour
FT4 0.76 (range 0.82-1.77)
FT3 2.00 (range 2.0-4.40)
TSH 1.56 (range 0.45-2.50)

10/23 on 1 grain Armour
FT4 0.71 (range 0.82-1.77)
FT3 2.00 (range 2.0-4.40)
TSH 1.54 (range 0.45-2.50)

12/19 on 5mcg generic Cytomel & 50 mcg L-Thyroxine
FT4 1.04 (range 0.82-1.77)
FT3 2.3 (range 2.0-4.40)
TSH 3.03 (range 0.45-2.50)
DHEA 87.2 (57.3 - 279.2)

[Bearika]

Hello Gimel,

Thanks. I am waiting for my latest results and will post them when I receive them.

I did look into the doctors you emailed me, but unfortunately, one of the doctors is no longer practicing (they are now at a specialized clinic) and the other was 1.5 hours away, so it's not feasible to use them if you live in the Seattle area.    

[gimel]

What are your latest test results, along with ranges?  Did you pursue seeing either of the two doctors that I gave you?

[Bearika]

Hello,

If I initially tested negative for both antibodies this summer, how often should one retest those #s? My free T3 and T4 keep dropping despite medication.  Could Hashimoto's appear later on?

Thanks!

[Bearika]

Thank you!  I was tested for both antibodies.  I'm on Levo of 50mcg and was on 1 grain of Armour when I switched.  My naturopath is conservative because my TSH is normal (but my FT3 and FT4 are both low).

I think I saw somewhere there that someone keeps a list of rec'd doctors. I'm in the Seattle metro area.

Thanks again for all of your help!

[Barb135]

I've read that one can have Hashimoto's without having positive antibodies.  Some people have been diagnosed via inflammation/nodules on the thyroid as seen on ultrasound, since those tend to be "trademarks" of Hashimoto's.  Were you tested for both of the antibodies that confirm a diagnosis for Hashimoto's?

I can't see what dosage of levo you're on.  It seems that your doctor is being overly conservative with your meds, considering that you switched from Armour to levo and T3, since Armour has so much T3.  

Even at 5 mcg, you can split the pill into 2 doses to keep your levels more stable throughout the day or take the entire pill a bit later in the day.  

I agree with what gimel said in the other thread - I'd push for testing at the 4 week mark vs waiting till the 6 week mark... I don' think your doctor is doing you any favors.  

[Bearika]

My apologies, and thank you for the response! I am still trying to figure out this website.

My antibodies tests were negative, so I believe that means I don't have Hashimotos.  The doctor thinks it is a pituitary cause.

I am only on 5 mcg of T3 once in the morning. I can definitely feel when it wears off.

[Barb135]

You asked a similar question previously and were given a response.  You should try to keep all your questions/information together in order to prevent us from having to keep asking the same questions and you having to give the same information.

The other thread can be accessed via the following link:
http://www.medhelp.org/posts/Thyroid-Disorders/Newbie-Labs-Qs/show/2365511#post_11471798

Do you know if you have Hashimoto's?  If so, iodine is contraindicated, as it can make the autoimmune reaction much worse.  

Selenium has been shown to be beneficial in the conversion of the storage hormone FT4 to FT3, which is the hormone used by the individual cells.  There would be no reason you couldn't begin using that immediately.  Recommended dose is usually 200 mcg/day.  I take selenium on a daily basis.  Be sure to find a good brand that provides for maximum absorption.

Make sure vitamins/minerals are taken at least 4 hours apart from thyroid hormones.

Are you splitting your daily T3 dosage into more than one/day or taking it all at once?