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Medication and stopthetyroidmadness site
In anticipation to being officially diagnosed with Hypo soon when I see my doctor next week, I am trying to understand as much as I can before I see her. I came across the stopthethyroidmadness site and would like to know what is the general consensus around here on the type of meds the author recommends and her point of view. Is it true that everyone should take i.e. medication that contains T3, etc? Or does it depend on each specific case/person?
I would like to understand this better so I can discuss with my doctor when the time comes. I expect her to be more conservative medication-wise, backing up what the medical community believes in general.
I would like to understand this better so I can discuss with my doctor when the time comes. I expect her to be more conservative medication-wise, backing up what the medical community believes in general.
sounds good, thanks a lot. I probably have a long journey ahead... the adjusting and constant lab exams... all seems so complicated, I am exhausted even before starting... :/
I agree with starting with T4 med. It is much easier to administer and regulate. Just keep in mind that many hypo patients find that when taking significant dosages of T4 meds that they eventually do not adequately convert the T4 to enough T3. So you need to continually monitor your Free T3 levels and relate that to your symptoms, and see if you ultimately need to add T3 to your meds.
thanks goolarra, I think this sounds like the correct thing to do indeed. not forcing all the possible hormones to start with and just see how it goes first on T4-only med first.
Here's how I suggest proceding if you're starting on T4-only meds:
Increse T4 until FT4 is midrange. While doing this, monitor FT3 and FT4 levels every time meds are changed. FT3 should be following FT4 up. Some of us have found that FT3 can lag FT4 a bit and needs time for conversion to ramp back up, i.e. FT4 is stable, but FT3 continues to rise.
Once at midrange, and having given FT3 its chance to catch up (and symptoms to resolve as the body heals), if you still have hypo symptoms, take a hard look at FT3. FT3 should be higher in its range than FT4 is in its (as a percentage of range, not as raw numbers).
If symptoms continue despite adequate FT4 levels, then it's time to add some T3, synthetic or desiccated. If you go the synthetic route, and symptoms still do not resolve, try desiccated.
I'm not indicating a preference of one type of meds over another, but you indicated that your doctor was fairly traditional, so I'm assuming she'll start you out on T4-only meds, and i think this is the way to give that a fair chance.
Increse T4 until FT4 is midrange. While doing this, monitor FT3 and FT4 levels every time meds are changed. FT3 should be following FT4 up. Some of us have found that FT3 can lag FT4 a bit and needs time for conversion to ramp back up, i.e. FT4 is stable, but FT3 continues to rise.
Once at midrange, and having given FT3 its chance to catch up (and symptoms to resolve as the body heals), if you still have hypo symptoms, take a hard look at FT3. FT3 should be higher in its range than FT4 is in its (as a percentage of range, not as raw numbers).
If symptoms continue despite adequate FT4 levels, then it's time to add some T3, synthetic or desiccated. If you go the synthetic route, and symptoms still do not resolve, try desiccated.
I'm not indicating a preference of one type of meds over another, but you indicated that your doctor was fairly traditional, so I'm assuming she'll start you out on T4-only meds, and i think this is the way to give that a fair chance.
so gimel, you do believe as this doctor and the stopthemadness site that the natural dessicated thyroid should be used then?
thanks everyone! so, from all the great answers, my understanding is that it may be better to start on T4-only meds first and see how it goes. right?
I agree with the good advice given by other members. I just wanted to provide you with this additional info. This is a letter written by a good thyroid doctor that I have the highest respect for. It is written for patients that he sometimes consults with from a distance. This letter is then sent to the PCP of the patient to help guide treatment. Sorry I can't get the link to work, so I'm providing the full text. I think the letter will help you get prepared for the doctor appointment.
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.
I'm living proof that T4-only meds DO work. So are any number of other people on this forum. Bear in mind that T4-only therapy is very often the first approach in traditional medicine. People who do well on the traditional approach don't spend their time on forums asking why they feel so good. Nor do they read STTM.
Our thyroids, when working properly, produced both T4 and T3. The ratio of T4 to T3 coming out of our thyroids is about 20 to 1. The rest of T3 must come from conversion.
Some people convert more slowly than others, and they require T3 meds in addition to T4 meds.
T3 can come in synthetic (Cytomel) or desiccated form (Armour, NT, ERFA, etc.). Desiccated contains both T3 and T4.
As with everything else with thyroid, what works best for each of us is very individual.
T4-only meds are arguably the easiest to take and to control and offer the most even levels of hormone, IF (the big fat IF) we convert well. The natural conversion process is maintained.
However, if labs show poor conversion, then a direct source of T3 often makes all the difference in the world. Both synthetic T3 and desiccated have their advantages. Desiccated has a lot of T3 in it (T4 to T3 ratio of about 4.5 to 1). That's too much for some people.
It sounds like your doctor is fairly traditional, so my guess is that she'll want to start you on T4 meds. Just insist on FT3, FT4 and TSH tests every time blood is drawn, keep your own lab history, and if you should have a problem converting, you'll have the labs to back that up.
Our thyroids, when working properly, produced both T4 and T3. The ratio of T4 to T3 coming out of our thyroids is about 20 to 1. The rest of T3 must come from conversion.
Some people convert more slowly than others, and they require T3 meds in addition to T4 meds.
T3 can come in synthetic (Cytomel) or desiccated form (Armour, NT, ERFA, etc.). Desiccated contains both T3 and T4.
As with everything else with thyroid, what works best for each of us is very individual.
T4-only meds are arguably the easiest to take and to control and offer the most even levels of hormone, IF (the big fat IF) we convert well. The natural conversion process is maintained.
However, if labs show poor conversion, then a direct source of T3 often makes all the difference in the world. Both synthetic T3 and desiccated have their advantages. Desiccated has a lot of T3 in it (T4 to T3 ratio of about 4.5 to 1). That's too much for some people.
It sounds like your doctor is fairly traditional, so my guess is that she'll want to start you on T4 meds. Just insist on FT3, FT4 and TSH tests every time blood is drawn, keep your own lab history, and if you should have a problem converting, you'll have the labs to back that up.
Some people seem to do fine on T4 only meds. I saw a huge improvement after adding cytomel(T3) to synthroid. Still trying to find a dr who will let me try armour. Does your dr test FT3? If this is low, you may need to add a T3 med.
About the "desiccated Natural thyroid".....
First off, I think it is all about what works for you and how you feel, that is the best way to go. It is not just a black and white choice...many, many shades of gray.
It works for some people and others not....some folks do okay on T4 alone.
It takes some patience (time, blood tests, time, time and some time) to find what works for you.
IMO....there is nothing natural about pig and cow products unless they are Certified Organic. The way they are fed and slaughtered is something I would (myself here) not want to try. I am in the farming community and raise meat. What you don't see wrapped up in your Grocery store meat department...is called by-products. Having seen the amount of unnatural feed, vaccines , hormones, and antibiotics, etc fed to pigs and beef cows and milk cows....it is a real eye opener. Even though I raised my kids on a real tight budget, I still made sure the milk was organic and as much of the meat they ate as well.
So for me I decided to stick with the non-natural thyroid treatment. I also do better with added T3....synthetic... So add another thing to think about...
Mia
First off, I think it is all about what works for you and how you feel, that is the best way to go. It is not just a black and white choice...many, many shades of gray.
It works for some people and others not....some folks do okay on T4 alone.
It takes some patience (time, blood tests, time, time and some time) to find what works for you.
IMO....there is nothing natural about pig and cow products unless they are Certified Organic. The way they are fed and slaughtered is something I would (myself here) not want to try. I am in the farming community and raise meat. What you don't see wrapped up in your Grocery store meat department...is called by-products. Having seen the amount of unnatural feed, vaccines , hormones, and antibiotics, etc fed to pigs and beef cows and milk cows....it is a real eye opener. Even though I raised my kids on a real tight budget, I still made sure the milk was organic and as much of the meat they ate as well.
So for me I decided to stick with the non-natural thyroid treatment. I also do better with added T3....synthetic... So add another thing to think about...
Mia
thanks paperpest, I know about Mary Shomon and will check her site again.
but I think my main question is regarding the author of that site claim, that:
"T4-only meds don't work"
she claims that we need to take "desiccated natural thyroid" which works much better in her opinion.
is that true?
but I think my main question is regarding the author of that site claim, that:
"T4-only meds don't work"
she claims that we need to take "desiccated natural thyroid" which works much better in her opinion.
is that true?
You question was the first time I had heard of that site. I have been subscribing for years to Mary Shomon's site at http://thyroid.about.com/
I was diagnosed in the late 1980's with hypothroidism. I still take levothyroxine, the generic form of Synthroid. Mary's website is loaded with information. It's important to realize that you won't feel instantly better if you take thyroid medicine. It can take weeks before there can be an effect. I had great trouble losing weight, I was about thirty pounds overweight. I discovered that for me cutting down on carbs was the key.
I was diagnosed in the late 1980's with hypothroidism. I still take levothyroxine, the generic form of Synthroid. Mary's website is loaded with information. It's important to realize that you won't feel instantly better if you take thyroid medicine. It can take weeks before there can be an effect. I had great trouble losing weight, I was about thirty pounds overweight. I discovered that for me cutting down on carbs was the key.
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