New to thyroid probs. 1143 TPO/ab. Westhyroid?

[K9.lover]

Hello! I am 47. After 20 years of seeking answers to my symptoms, I finally have answers as of May 2015. I am a total newbie in the thyroid disorder department, and want to make sure my ND has recommended the correct meds.

TSH = 1.76 (.4 - 4.0)
Free T3 = 3.0 (2.3 - 4.2)
Free T4 = 1.12 (.84 - 1.51)
TPO/ab = 1143 (0.0 - 60.0)

I have been diagnosed with auto immune Hashimoto's. Thyroid symptoms: enlarged thyroid (benign), enlarged tongue, foot pain, neck/upper back/shoulder pain (but I have a minor disk bulge C5-6, so this might be the cause. Or is it?), fine hair and thinning on top a bit, fatigue, other body pain. Recent weight gain of 5 lbs (which is a lot for me).

I'm including this info in case it is helpful. I was diagnosed with Fibro March 2015 (but do I really have this, or is it my thyroid or neck/shoulder injury talking??). I also have interstitial cystitis (diagnosed 2000, but symptoms 10+ years prior). Cervial polyps removed 2006 and 2013. Uterine fybroids. I get migraine's sometimes and they are muscular/skeletal in origin.  I also have MTHFR gene mutation A1298C and megabolastic anemia (B12 deficiency) and leaky gut. I take methylfolate and methyl B's. I am also being treated for candidae overgrowth, and I am on month 3 of oral suspension Nystantin, swish 4x daily.

Interestingly, my foot pain diminished when I realized I am likely selenium and iodine deficient (due to the narrow diet that I eat because of IC).........

I am supplementing: methyl folate and B's, selenium, D3, magnesium malate, Gaia Thyroid Support (has selenium and iodine), SAM-e, 5-HTP, calcium, multiple vitamin.

My question: As of Friday, May 22, 2015, my ND just started me on 2 - 1/4 grains (16.25 mg) per day Westhyroid,  which has 2.25 mcg T3 and 9.5 mcg T4 per pill. Total per day = 4.5 mcg T3, and 19 mcg T4.

Is this the correct dose? What sorts of improvements should I see and how soon could I see them?

Thanks in advance for your response!

[Barb135]

Hashimoto's is an autoimmune disease and while you will read a lot about various diets that "claim" to cure it, so far there's no real science behind those claims.  As far as I can tell, the same goes for IC. except that some of the things you mentioned have a tendency to cause inflammation and by eliminating or limiting them, you reduce inflammation.  I find that eliminating or limiting certain foods, helps my peripheral neuropathy, but does nothing for my IC.

While reproductive and thyroid hormones all have to "play well together", estrogen dominance does not CAUSE Hashimoto's.  Same goes for adrenal insufficiency.  When the thyroid begins to fail, the adrenals kick in to help take up the slack, but adrenal insufficiency does not cause cause Hashimoto's.  Once a person is on thyroid medication and the body re-balances, the adrenals will usually go back to normal.  

There's always a possibility of pituitary involvement... but that's not Hashimoto's - that's Central Hypothyroidism and with your antibody count, you clearly have Hashimoto's, so there's no reason to believe you have a pituitary involvement.

Most of us who have been around the thyroid world for any length of time are familiar with Wilson's Temperature Syndrome.  While low body temperature is often a symptom of hypothyroidism, there are other things that can cause changes in temperature as well.  Wilson's Temperature Syndrome is not a recognized medical condition.  

By the same token, treatment with T3 medication is, typically, not done with Hashimoto's because the idea is to keep treatment as close to what your thyroid would do, if it could and your body does not produce just T3.  While there are some temporary thyroid conditions that resolve themselves, Hashimoto's isn't one of them.  Once you have an autoimmune disease, you have it for live and once you have one autoimmune, the chances of getting another are greater.  For instance, I have Pernicious Anemia and Hashimoto's - both autoimmune.  

Hashimoto's is progressive in that it eventually destroys your thyroid so it will produce nothing and you will be completely dependent on the medication.  We've had a members who tried to get off medication and were not successful.

Autoimmune diseases also tend to run in families, though the entire family doesn't necessarily get the same disease.  For instance, as I noted, I have PA and Hashimoto's, my son had Type I Diabetes and my daughter has Lupus - again, all autoimmune.

The recommended dosage for selenium is 200 mcg/day... selenium is toxic if you get too much.  While some studies have shown that selenium may reduce antibody counts, by up to 20%.  That's really a losing battle, because if you do reduce them by 20% you still have the other 80% doing their damage.  It's not the raw number that really counts; it's the simple fact that antibodies are positive that counts.  Your count of 1143 doesn't mean that you have a worse case of Hashimoto's than someone with a count of only 500.

The "side effects" of T3 and T4 are, typically, those of either under medication (hypothyroidism) or over medication (hyperthyroidism).  Very rarely, we've had members who have reacted to the fillers/binders/dyes in the pills.  

[K9.lover]

Hi Barb,

Thanks for this info, too. Yes, I am a bit concerned about this, hence my questions as to being able to treat Hashi's via diet alone, as opposed to with meds. If TSH goes too low, what are the implications?

thanks again!

[K9.lover]

Hi gimel, thank you for your response.

So, I am wondering if there is a different and better way for me to get my T3 and T4 up into the range that it should be, and to get my TPO/ab lowered? Is there a different recommended protocol?

My new primary care physician is an MD. For the last 10 every time I've had my TSH tested it has been around 1.5, and I was "normal". A doctor a few years ago noted that my thyroid was slightly enlarged. I had been trying all of last year with numerous docs to get someone to order me a US and also to test my TSH. A rheumatologist this spring tested it at 1.02 on the same scale, said I was "normal". Finally, two months later, I was able to get into see my new primary. He listened to my list of symptoms, agree my thyroid was enlarged, ordered a US. He only wanted to test TSH, T3,T4. I instructed him to test TPO/ab and TG/ab. If I hadn't, I wouldn't know what I know now. He doesn't know anything about thyroid issues, so referred me to an Endo. I was already working with this fabulous ND, so she is the one who is really getting to the bottom of this.

My primary did refer me to an Endo, but so far they are all booked out for about 3 months. Do I really need to see one??

Yes, I am getting D3, ferratin and iron panel this week.

Thanks again for your reply!

[K9.lover]

Hi Barb,

Thanks for your response. Before I get too far, has anyone ever heard of curing Hashi's through nutrition alone? If so, how? I am not so excited about being on meds for the rest of my life. Couldn't my Hashi's be caused by: estrogen dominance or adrenal fatigue? What about a pituitary disorder? I will be testing my estrogen and adrenals when I am on day 19 of my cycle, in early June.

Are you all familiar with Wilson's Low Temperature Syndrome? I qualify for that. The protocol for Wilson's is T3 therapy. The idea here is it's a temporary therapy until the thyroid rectifies itself, and then you don't need T3 anymore. I have low basal body temp and low blood pressure. My BP was 115/55 last Friday. I have symptoms of both hypo and hyper. Yes, I agree that my T3 and T4 are too low. I pointed this out to my ND. She decided I should try Westhyroid.

I agree that iodine is contraindicated for Hashi's. However, I was likely deficient as my diet lacks sources of iodine. I do not eat processed foods, nor do I salt my food. For whatever reason, my foot pain disappeared within two days of taking the OTC Gaia Thyroid Support supplement.

Yes, I have read that supplementing 400 mcg selenium can help reduce TPO/ab levels. So, I am taking additional selenium.

People with IC typically eliminate foods that trigger their disorder. I do not take any meds for IC, as I am virtually pain and symptom free by eating a fairly narrow diet. There are so many foods that trigger IC pain and frequent urination that I have eliminated all of the ones that cause me issues. I mean, why wouldn't I?. My first hyro-distention procedures in 2000 worked for 10 years. The second one in 2012 did not help and was very irritating. Perhaps this doctor used something that irritated me. I then tried weekly heparin infusions, and that was even worse. So I quit that, did research on IC diet, eliminated all irritants, and here I am. I eat very, pure and bland:
- no citrus, rare occasion other fruits
- no asparagus, tomatoes, corn
- no soy
- no spice, no salt. occasionally a tiny bit of garlic salt.
- no wasabi, hot peppers, black pepper
- no processed foods
- no dairy
- no gluten or wheat

I eat: fish, chicken, turkey, whey protein, eggs, rarely beef; oat meal, quinoa, barley; lettuce, coconut products, broccoli, kale, probiotics, sauerkraut, some nuts. I rarely have: blue berries, pears. I only drink: water, black coffee, red wine 0-2 glasses weekly.

I do not have cravings for sweets or anything else.

Foot pain can be a rare side effect of thyroid issues. My foot pain came on suddenly last fall and was non-stop. It presented like plantar fasciitis. Once I started supplementing with the OTC Gaia Thyroid Support, my pain went away in two days and hasn't returned in the three weeks that I've been taking it.

Regarding T3 vs T4, what side effects/symptoms are each of them responsible?

Thanks again for your response!

[Barb135]

I forgot to mention that I'm pleased to see that you found an ND that recognizes hypothyroidism, even when TSH isn't elevated and is willing to treat the symptoms... Just be aware that the Westhroid will cause your TSH to go even lower and your doctor might freak out if it gets too low... try to keep her/him calm, because TSH neither causes nor alleviates symptoms; it's a messenger hormone only and once on thyroid replacement many of us have suppressed TSH, including myself.

[gimel]

That is nothing more than a starting dose.  Rather than see an increase in your Free T4 and Free T3 levels, you may see little/no change other than a reduction in TSH, which then will reduce your output of natural thyroid hormone.  Meds may have to be increased several times before your serum levels start to rise.  So you may feel some slight improvement but many of us say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms.  Free T3 has been shown to correlate best with hypo symptoms.  

As you proceed, keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good insight from this link written by a good thyroid doctor.

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

You should plan on going back for re-testing in about 3 weeks.  That will be long enough for most of the effect on serum levels to show up.  While you are there you should ask the doctor if he is going to be willing to treat clinically, as described.  If the answer is no, then you will need to find a good thyroid doctor.  

Also, since hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, you should request tose to be tested as well.  Low levels of those can cause symptoms that mimic hypothyroidism.  D and ferritin are also important for metabolizing thyroid hormone.  D should be about 55-60, B12 in the upper end of its range, and ferritin about 60 minimum for ladies.  

[Barb135]

Hi Portland, I have friends in your city...

For starters, I'll confirm that both your FT3 and FT4 are lower than most of feel optimal... Rule of thumb is for FT4 to be at about mid range and yours is only at 42% of its range.  Rule of thumb for FT3 is upper half to upper third of its range and yours is only 37%, so you're quite a bit short of that.

Your symptoms are consistent with hypothyroidism, as well, though some of your back problem could be from the disk bulge and you can probably expect that to get worse.  Have you had bone density scan to test for osteoporosis?

As far as fibro is concerned, some people do get angry with me, but there are some doctors who believe that is simply un or under treated hypothyroidism and often symptoms are relieved when thyroid hormone levels are raised to what the patient needs for their own body.

I might jump around a little bit now, so you'll have to bear with me... Iodine is, typically, contra-indicated when one has Hashimoto's because it can make the autoimmune reaction much worse.  In addiition, I believe the Gaia Thyroid Support you're taking is simply an OTC supplement that's probably not that useful, so you might want to think about stopping that. Selenium has been shown to be helpful in the conversion of the FT4 storage hormone to the active FT3 hormone that's used by every cell in your body, but you can get very good selenium supplements by themselves.

I, too, have IC and I'm not sure why you're on such a limited diet because of it.  I'd be interested to hear about that.  

Could you describe your foot pain?  I, too, am B-12 deficient (Pernicious Anemia) but I do weekly injections; is your foot pain related to neuropathy?

As far as the Westhroid dosage your doctor has prescribed, it's fine for a starting dose, but don't expect it to be a final dose.  The T3 is fast acting, so you could start seeing some improvements relatively soon, but the dose is so small that those will be minimal.  The T4 takes 4-6 weeks to reach full potential in your blood, and again, the dose is very small, so improvement will be probably be small.

Because Hashimoto's is progressive, in that it's constantly attacking the thyroid, causing it to produce less and less of its own hormones, med dosage, typically, has to be adjusted periodically as you go.

You'll have a lot more questions, so we'll be here to answer them...