Should I take Vitamin E supplements?

[Bird_42]

Hello. I am a 45-year-old male, and I have autoimmune hypothyroidism.


In early November 2018, I started the following dosage of Synthroid: (137 mcg, 3 times per week, and 125 mcg, 4 times per week). Also, I stopped taking Vitamin D supplements in June 2012.


In mid-December 2018, my endo ordered some blood tests, and the results were as follows:

FT4 = 1.64 (normal range = 0.82 - 1.77)

FT3 = 3.1 (normal range = 2.0 - 4.4)

TSH = 0.077 (normal range = 0.450 - 4.500)

Vitamin B12 = 739 (normal range = 232 - 1245)

Vitamin D, 25-Hydroxy = 22.2 (normal range = 30 - 100)




In late May 2019, my endo ordered some blood tests, and the results were as follows:

FT4 = 1.55 (normal range = 0.82 - 1.77)

FT3 = 3.4 (normal range = 2.0 - 4.4)

TSH = 0.041 (normal range = 0.450 - 4.500)

Vitamin B12 = 785 (normal range = 232 - 1245)

Vitamin D, 25-Hydroxy = 20.4 (normal range = 30 - 100)


Also in late May 2019, I paid for Selenium (serum or plasma) and Vitamin E (serum) blood tests, and these tests were done from the same blood draw as the one used for the five endo-ordered tests.




After seeing the results from the late May 2019 tests that she ordered, the endo said the following:

1) The TSH is more suppressed now than it was in mid-December 2018. Thus, she recommends that I reduce my Synthroid dosage to 125 mcg, 7 times per week.

2) Because my Vitamin D is low, she recommends that I take 800 IU of Vitamin D per day. I have told her many times that I do not take Vitamin D supplements because Vitamin D supplements always lower my FT3 and FT4 levels. Yet, she is recommending that I take 800 IU of Vitamin D per day.

When the endo made these comments, the Selenium and Vitamin E results had not yet come in. I told the endo that I would wait for those results to come in, and that the endo and I could then discuss the results of her tests and the Selenium and Vitamin E tests. The endo reminded me that she usually does not interpret results from tests that she did not order.




The results of the Selenium and Vitamin E tests were as follows:

Selenium (serum or plasma) = 135 (normal range = 91 - 198)


Vitamin E (Alpha Tocopherol) = 6.7 (normal range = 7.0 - 25.1)

Vitamin E (Gamma Tocopherol) = 0.6 (normal range = 0.5 - 5.5)




My Selenium result of 135 would have been in the lower 25% of the previous normal range (79 - 326), but the 135 result is in the middle of the current normal range (91 - 198). I am not sure as to why the normal range was changed. However, because excessive Selenium can be toxic, and because my Selenium value is at mid-normal range, I probably should not take any Selenium supplements at this time.

My Vitamin E (Alpha Tocopherol) result of 6.7 would have been in the lower 15% - 30% of previous normal ranges, but the 6.7 result is below the current normal range. My Vitamin E (Gamma Tocopherol) result is at the lower end of normal range.




The fact that the Alpha Tocopherol is below normal range, and the fact that the Gamma Tocopherol is at the lower end of normal range, probably mean that I have a Vitamin E deficiency. From what I have read online, it appears that a Vitamin E deficiency is bad, and that taking Vitamin E supplements to treat the deficiency is also bad. Apparently, Vitamin E supplements increase the risk of heart failure. Supposedly, the answer to Vitamin E
deficiency is eating foods that are rich in Vitamin E.

If I do take a Vitamin E supplement, I would need a supplement that does not contain soy (which interferes with thyroid levels) and that does has a low dose (which would minimize the risk of heart failure). Now Foods makes the soy-free Sun-E 400 (400 IU), but 400 IU may be too high a dose. Solaray makes Dry E (200 IU). The Solaray product's label states that there are no ingredients in the product other than the ingredients listed on the label, and soy is not listed on the label. However, the label does not explicitly say that the product is soy-free.




I have not yet mentioned the Selenium or Vitamin E results to my endo, and she probably won't give me any advice on these results anyway. But perhaps the people on this forum can give me some helpful information. Do I have a Vitamin E deficiency? Should I take Vitamin E supplements? Do these supplements pose a real risk of heart failure? Given my FT4 and FT3 results, is there a problem with FT4-to-FT3 conversion? If there is a conversion problem, would increasing my Vitamin E levels cure that problem?


Thank you for any information.

[gimel]

There is much to discuss, but while I am still reading your long message, LOL, please give us the following info:    Did you take your T4 med the morning of the blood draw for tests?  If so, how long afterward was the blood draw?   For a number of reasons symptoms are far more important in diagnosis and treatment of hypothyroidism than blood tests results.   So please tell us about all symptoms that you have.  

[Bird_42]

I always take my T4 med AFTER the blood test.

As for my symptoms, these days, my symptoms are the following:  1) Occasionally, I get a cramp in  in one foot or the other. 2) Sometimes, I don't speak as clearly as I should. I think I may have some kind of voice dysphonia (voice disorder), and I've read that these voice disorders can be caused by hypothyroidism. 3) Sometimes, I may not be thinking as clearly as I should be.

[telus2]

FT3/FT4 ratio equals 4.77 divided by 21.1 equals 0.226

[telus2]

Oops, here is the whole thing...

I'll comment on 2 things.

Vitamin D:
You are low and that is not a good thing. I take thyroid hormones (synthroid and compounded T3). I have taken nearly 7000 IU (seven thousand) vitamin D for several years and have not detected any effect on my thyroid hormone levels. You could have a look at the 2018 paper which I cite below, where they concluded, "Overall, the current study demonstrated that vitamin D supplementation among hypothyroid patients for 12 weeks improved serum TSH and calcium concentrations compared with the placebo, but it did not alter serum T3, T4, ALP, PTH, and albumin levels."

Is there a FT4-to-FT3 conversion problem?
There is an easy way to determine this and I will illustrate it below so that you can do the calculation in the future. The units of your labs results are ng/dL, so you must convert to pmol/L.

for your mid-December labs:
FT4 1.64 ng/dL times 12.871 equals 21.1 pmol/L.
FT3 3.10 ng/dL times 1.54 equals 4.77 pmol/L.
FT3 to FT4 ratio equals 4.77 divided by 21.1 equals 0.226

for your May labs the FT3/FT4 ratio equals 0.262

The second study cited below shows that the ratio of FT3 to FT4 is higher (0.32 - 0.33) in people with normal thyroids, compared to people taking synthroid (0.24 - 0.27). For males under 60 years old the median ratio is 0.25 for those taking synthroid.

Your FT3 to FT4 ratios of 0.226 and 0.262 are very close to the 0.25 value which indicates that your FT4 to FT3 conversion is very normal for someone taking synthroid.

Sorry, I don't know anything about Vitamin E.

The Effects of Vitamin D Supplementation on Thyroid Function in Hypothyroid Patients: A Randomized, Double-blind, Placebo-controlled Trial
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166548/

Levothyroxine Monotherapy Cannot Guarantee Euthyroidism in All Athyreotic Patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148220/

[Bird_42]

telus, unfortunately, your calculations are incorrect.

Here are the correct calculations:

mid-December 2018 labs:

FT4  =  1.64 ng/dl   =   1640 pg/dl  =  16400 pg/L

FT3 =    3.1   pg/ml    =   3100 pg / L

FT3/FT4  =   3100/16400  =  .189


late May 2019 labs:

FT4  =  1.55   ng/dl   = 1550  pg/dl  =   15500 pg/L

FT3  =  3.4   pg/ml  =   3400  pg / L

FT3/FT4  =  3400/15500  =   .219


So, it would appear that my conversion rates are low even for Synthroid users.

[Bird_42]

telus, my apologies.

I see that you calculated the ratio of (quantity of FT3 molecules) to (quantity of FT4 molecules), and that the study did the same thing. I calculated the ratio of (mass of FT3 molecules) to (mass of FT4 molecules).

It does appear that, according to that study, my FT3-to-FT4 ratio of late May 2019 is normal for a Synthroid user.

I was under the impression that my Synthroid treatments were supposed to make me the same as a person with a normal thyroid. I did not know that having a lower conversion rate was "normal" for Synthroid users.

So, does that mean that I should NOT try to increase my FT3 level with Vitamin E and/or Selenium supplements?

[gimel]

Why would you think you might need to supplement with Vitamin E?    Are you still on the same dose of T4?   Please tell us about any symptoms you have.  Also, what are your Free T4 and Free T3 levels and their reference ranges shown on the lab report?    Are you supplementing with Vitamin D currently?  

[Bird_42]

I've had the same dose of T4 since early November 2018. I have not had any Vitamin D supplements since June 2012.

Why supplement with Vitamin E?

For a long time, I have felt that I may have an issue with FT4-to-FT3 conversion. I have read that conversion issues can be caused by deficiencies in Vitamin E and Selenium. That is why I have been buying Vitamin E and Selenium tests.

My current Selenium value seems to be in the middle of the current normal range. But my current Vitamin E (Alpha Tocopherol) value is below the current normal range, and my current (Gamma Tocopherol) value is at the lower end of the current normal range. So, I thought that Vitamin E supplementation might be appropriate.

[gimel]

Sorry for the redundant questions.  Somehow when I saw your post, it was short, with no prior answers, not like shown now.

[telus2]

Hi Bird,
Here are some fundamental points that thyroid sufferers need to know.

#1 You state: "I was under the impression that my Synthroid treatments were supposed to make me the same as a person with a normal thyroid." As you have learned, the ratio of FT3 to FT4 is lower in people taking synthroid than those people with a normal functioning thyroid. The implication of this fact for people taking synthroid is that in order to get their FT3 up to the mid-point of the reference range, they have to get their FT4 to above the mid-point. A high percentage of doctors and endocrinologists are not aware of this fact.

#2 You state, " I did not know that having a lower conversion rate was "normal" for Synthroid users." Your ratio of FT3 to FT4 is not lower because you have a lower FT4-to-FT3 conversion rate. Your conversion rate is the same as a normal person. Your FT3 is lower because your thyroid is no longer directly producing T3. A normal thyroid produces both T4 (to be converted to T3) and about 6 micrograms of T3 daily. You are not getting that extra T3 and that is what makes up the difference in the FT3 to FT4 ratio. Again, it seems that this is too complicated for some doctors to understand and that is why they toss out such comments as 'you must be a poor converter'.

#3 If you put #1 and #2, above, together, you have just discovered the reason why some people opt to take a combination of synthroid (T4) and T3, rather than T4 alone. That way they can get their FT3 to mid-point without ramping up their FT4 (or driving down their TSH).

#4 What's wrong with driving up your FT4? T4 is converted to both T3 and Reverse T3 (RT3) in approximately equal amounts. If a synthroid user drives up his T4, eventually he will reach a point where his RT3 will be above it's mid-point. The end result is that he has lowish FT3, highish FT4 and highish RT3 which is not a normal situation. There are those that believe (including me) that highish RT3 has a dampening effect on metabolism, i.e. the opposite of T3, and is to be avoided.

#5 Lastly, can you get by on synthroid alone? The endocrinologists say yes you can. I took 125 synthroid for over 20 years, but I think now that that had long term negative impact. You obviously are looking at your intake of vitamins and minerals. I'd like to draw your attention to another interesting paper (see below). The author points out that over time humans have often suffered shortages of some essential vitamins and mineral. He hypothesises that humans have evolved and developed a mechanism to allocate shortages. But the allocation of the scarce resource favours short term survival at the expense of long-term health. Now my personal hypothesis (and remember I'm not a doctor) is that a similar principle may apply to thyroid hormones - short-term our bodies may adapt and we may be able to function with FT3 to FT4 a little out-of-whack, but maybe it will have long term detrimental effect on our health in old age. You will have to decide for yourself.

Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage, Bruce N. Ames
https://www.pnas.org/content/103/47/17589

[Bird_42]

"Your conversion rate is the same as a normal person."

So, if I take Selenium and/or Vitamin E supplements, will these supplements increase my conversion rate, thereby increasing my FT3 level? Or will my conversion rate stay the same because the conversion rate is already normal?


"If you put #1 and #2, above, together, you have just discovered the reason why some people opt to take a combination of synthroid (T4) and T3, rather than T4 alone."

Well, I tried taking Liothyronine (the generic version of the T3 medicine Cytomel) back in 2012, and the results were bad. There were issues with my heart. Liothyronine caused me to produce an EKG result that showed possible signs of the heart condition known as LVH (left ventricular hypertrophy). I had to have an echocardiogram. The echocardiogram showed that there was no LVH. However, the echocardiogram did show trace or trivial regurgitation in three heart valves and mild atrial dilation. I discussed all of this extensively on this forum back in 2012.

The bottom line is that I'm not sure whether T3 medicine is safe for me.

[telus2]

1. Why do you want to increase your FT3
2. I don`t know if Selenium and/or Vitamin E supplements will change the conversion rate, but I would guess not significantly. I would say however that if you ate deficient in either one that you ought to take supplements to get it up to normal.
3. Did you take a T4 & T3 combo. How much of each. What form was the T3; was it compounded slow release. How long did you take the combo.

[Barb135]

..

[Red_Star]

Vitamin E deficiency is rare and usually the result of an underlying condition...usually issues with fat malabsorption. Examples of conditions that cause vitamin E deficiency include cystic fibrosis, gastric bypass, Crohn's disease, celiac disease, chronic pancreatitis.  

As you have autoimmune thyroiditis, then celiac disease in particular would be highly suspect as autoimmune thyroid disease is associated with celiac disease.

[telus2]

The paper that I cite above indicates that 93% of the U.S. population ingests less than the EAR for Vitamin E from food.

The estimated average requirement (EAR) is the amount of a nutrient that is estimated to meet the requirement for a specific criterion of adequacy of half of the healthy individuals of a specific age, sex, and life-stage.

[Bird_42]

I was tested for celiac disease in 2009. The exact test was ENDOMYSIAL ABS,S (IGA). The test was negative.

[Barb135]

Again, our bodies change over time and you were tested for celiac 10 yrs ago.  Autoimmune conditions can develop over a period of time, so even though you didn't have celiac when you were tested in 2009, you might have developed it since then.   Or if you don't have actual celiac, you could have gluten intolerance - meaning that your body still reacts unfavorably to it, even if you don't have the autoimmune condition.  Another test might be a good idea, or at the least, an elimination diet, to see if that helps.