Aa
hypo thyroid
I have an appointment with an Endro next week. My other Doctor thinks with my family history with hypo plus my antibodies being high I should be checked. I have been on 2 anti-depressants, anti-anxiety, mood stabilizer, levoxyl, arthritis med, medicine for sleep and I would like to get off most of them. I have been told that I am bi-polar but my psych Doc doesn't think I fit that diagnosis. I have been hypo since I was a teen and am now 59.
My mom had Hasimoto and had her thyroid removed. Immune disease runs in the family.
Even though I am on 150 mcg, my other gp doc wants to lower it to 125. I am very confused and wonder if I really have a problem that should be checked.
My mom had Hasimoto and had her thyroid removed. Immune disease runs in the family.
Even though I am on 150 mcg, my other gp doc wants to lower it to 125. I am very confused and wonder if I really have a problem that should be checked.
I just last night found some great info that I think will be very helpful to you. It is even better that it came from a doctor that is highly respected as a great thyroid doctor. For patients that this doctor consults with by phone, this is the letter that is sent to the regular doctors of those patients outlining how they should be treated for their hypothyroidism.
________________________________________________
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.
____________________________________
I think this might help get your doctor's attention and help you get the right treatment.
________________________________________________
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.
____________________________________
I think this might help get your doctor's attention and help you get the right treatment.
COMMUNITY LEADER
T3 uptake is not often done; however, lower levels would indicate hypothyroidism. FT3 is an actual thyroid hormone; the T3 uptake measures the amount of thyroxine-binding globulin (TBG).. Globulin is a protein that binds thyroxine and renders it unusable.
While many doctors run the T3 Uptake, it's usefulness in hypothyroidism is limited.
FT3 and FT4, being the actual thyroid hormones are much more important tests...... Whenever you have labs, you need to make sure your doctor is ordering both FT3 and FT4.
While many doctors run the T3 Uptake, it's usefulness in hypothyroidism is limited.
FT3 and FT4, being the actual thyroid hormones are much more important tests...... Whenever you have labs, you need to make sure your doctor is ordering both FT3 and FT4.
Lightbulb moment, as Oprah would say! That helps me out. I noticed on my first series of blood tests, in addition to an FT3 was a T3 Uptake results at 32 (32-48%) so I was just at the normal level and need to try and raise that up. What is the diff between FT3 and T3 uptake? Thanks again
COMMUNITY LEADER
That's exactly what he's saying --
Quick lesson -- you have a lab report with a result for FT3, beside that result there should be a reference range - it's often in parenthesis beside the result or maybe in a separate column. If your number is not within that reference range, your levels are not right. But even if your numbers ARE in the range, they may too low (or high) in the range to really make you feel well.
If a person's levels don't even fall into the range, as in Sherri's case with FT3 of 2.0, when the range is 2.3 - 4.2 (2.0 is less than 2.3, which is the bottom of the range), there's no way you're going to get well. In addition, her FT4 is only 0.75 with a range of 0.6 - 1.61; this means that level is at the very bottom of the range. It's not likely she will feel much better until her levels are raised considerably.
In my own case, my FT3 and FT4 levels were "in range" for over 2 yrs, but it wasn't until I got my FT3 into the upper 1/3 of its range and FT4 into upper 1/2 of its range, that I actually felt better. This has only occurred over the past 4 months and I feel better than I've felt for years...........
Quick lesson -- you have a lab report with a result for FT3, beside that result there should be a reference range - it's often in parenthesis beside the result or maybe in a separate column. If your number is not within that reference range, your levels are not right. But even if your numbers ARE in the range, they may too low (or high) in the range to really make you feel well.
If a person's levels don't even fall into the range, as in Sherri's case with FT3 of 2.0, when the range is 2.3 - 4.2 (2.0 is less than 2.3, which is the bottom of the range), there's no way you're going to get well. In addition, her FT4 is only 0.75 with a range of 0.6 - 1.61; this means that level is at the very bottom of the range. It's not likely she will feel much better until her levels are raised considerably.
In my own case, my FT3 and FT4 levels were "in range" for over 2 yrs, but it wasn't until I got my FT3 into the upper 1/3 of its range and FT4 into upper 1/2 of its range, that I actually felt better. This has only occurred over the past 4 months and I feel better than I've felt for years...........
Absolutely. The ranges are so broad that just being in the low end is frequently not sufficient to relieve symptoms, and symptom relief is what is important, not test results. FT3 and FT4 ranges should be considered as guidelines within which to adjust levels as necessary to relieve symptoms. Have a look at this form letter that this good thyroid doctor sends to doctors of people that he is working with.
http://hormonerestoration.com/files/ThyroidPMD.pdf
http://hormonerestoration.com/files/ThyroidPMD.pdf
I am a newbie and trying to learn. What do you mean by her FT3 and FT4 being below range? What #s in the FT3 and 4 should we be shooting for? Is it different for each person? When I was feeling the worst recently my FT3 was 2.83 (2.50-3.90 pg/ml) and my FT4 was .94 (.58-1.64 ng.dL). Are you saying you can be in range and it may not be right for you? Thanks
Those ranges confirm what I suspected. Your FT3 is even below range and your FT4 is very low in the range. Both of these results are consistent with being hypo still. With your symptoms and those labs, you definitely need an increase in meds, not a decrease.
Recall what I said above that in my opinion the best way to treat a hypo patient is to test and adjust levels of the biologically active thyroid hormones, free T3 and free T4, with whatever medication is necessary to relieve symptoms, without being constrained by resultant TSH levels. In your case I think you may need to add in to your meds a source of T3, since the levels seem somewhat unbalanced, indicating inadequate conversion of T4 to T3. Symptom relief should be all important, not TSH levels. 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.
What you need is a good thyroid doctor that is willing to treat you clinically (for symptoms), by adequately adjusting FT3 and FT4 levels, with T4 and T3 meds as necessary. If your doctor is unwilling to do so, then you need to find a good thyroid doctor that will do so.
By the way, just because your Tuesday appt. is with an Endo, don't assume that he will be a good thyroid doctor. Many of them specialize in diabetes, not thyroid. Many have the "Immaculate TSH Belief" and don't want to go further. Some test beyond TSH, but are reluctant to treat a thyroid patient clinically as I described above. To avoid wasting a lot of time with the Endo, I suggest that you should ask if he is willing to test and adjust FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You should also ask if he is willing to prescribe desiccated (T4/T3) thyroid meds rather than T4 only types. If the answer to either is no, then you will need to keep looking for a good thyroid doctor, which we can possibly help with.
Regarding your question about reverse T3. Under some conditions the body will convert T4 to reverse T3, instead of T3. RT3 is the mirror image molecule of T3, and it goes into receptor cells, but is not biologically active, so there is no effect from it. I would not be concerned with that just yet. Wait until you get your FT3 and FT4 levels increased and see what it looks like then.
So please keep us tuned in and let us know if we can help in any way.
Recall what I said above that in my opinion the best way to treat a hypo patient is to test and adjust levels of the biologically active thyroid hormones, free T3 and free T4, with whatever medication is necessary to relieve symptoms, without being constrained by resultant TSH levels. In your case I think you may need to add in to your meds a source of T3, since the levels seem somewhat unbalanced, indicating inadequate conversion of T4 to T3. Symptom relief should be all important, not TSH levels. 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.
What you need is a good thyroid doctor that is willing to treat you clinically (for symptoms), by adequately adjusting FT3 and FT4 levels, with T4 and T3 meds as necessary. If your doctor is unwilling to do so, then you need to find a good thyroid doctor that will do so.
By the way, just because your Tuesday appt. is with an Endo, don't assume that he will be a good thyroid doctor. Many of them specialize in diabetes, not thyroid. Many have the "Immaculate TSH Belief" and don't want to go further. Some test beyond TSH, but are reluctant to treat a thyroid patient clinically as I described above. To avoid wasting a lot of time with the Endo, I suggest that you should ask if he is willing to test and adjust FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You should also ask if he is willing to prescribe desiccated (T4/T3) thyroid meds rather than T4 only types. If the answer to either is no, then you will need to keep looking for a good thyroid doctor, which we can possibly help with.
Regarding your question about reverse T3. Under some conditions the body will convert T4 to reverse T3, instead of T3. RT3 is the mirror image molecule of T3, and it goes into receptor cells, but is not biologically active, so there is no effect from it. I would not be concerned with that just yet. Wait until you get your FT3 and FT4 levels increased and see what it looks like then.
So please keep us tuned in and let us know if we can help in any way.
Thank you so much. What I hear you saying is what my Doc who is sending me to a Endro said. I am so upset with the Doc who has been hounding me for years to lower my levoxyl. I think she should have sent me to Endro since she is only a Physicians Assistant and not an expert.
Have you ever heard of the reverse T3?
the test ranges are: TSH 0.50-8.90 mcIU/ml results 2.38
free T4 0.60-1.61 ng/dL results were 0.75
free T3 2.3 - 4.2 pg/mL results were 2.0
Tsh hypersens 0.50-8.90 mcIU/mL results 0.08
reverse T3 11-32 ng/dL results 26
estimated GFR? 60 or greater results 54
THY PEROXID AB less than 35 IU/mL 56
Hope this helps give you a better picture. My appointment is Tuesday so I may or may not have more information then.
Thanks again,
Sherrill
Have you ever heard of the reverse T3?
the test ranges are: TSH 0.50-8.90 mcIU/ml results 2.38
free T4 0.60-1.61 ng/dL results were 0.75
free T3 2.3 - 4.2 pg/mL results were 2.0
Tsh hypersens 0.50-8.90 mcIU/mL results 0.08
reverse T3 11-32 ng/dL results 26
estimated GFR? 60 or greater results 54
THY PEROXID AB less than 35 IU/mL 56
Hope this helps give you a better picture. My appointment is Tuesday so I may or may not have more information then.
Thanks again,
Sherrill
Please post the reference ranges also. They vary from lab to lab and need to come from the lab report for your tests.
Beyond that, with your symptoms, I can't see why your doctor wants to lower meds. TSH is in range but TSH is a pituitary hormone that is affected by so many variables that it is a poor diagnostic by which to medicate a thyroid patient. Of much greater importance is your FT3 and FT4 levels. I expect that when compared to the ranges we will see that both FT3 and FT4 are too low. FT3 is the most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that FT3 correlates best with hypo symptoms, while FT4 and TSH did not correlate. Many of our members report that FT3 needed to be adjusted into the upper part of its range and FT4 had to be adjusted to at least midpoint of its range in order to relieve symptoms. Symptom relief should be all important to you. And you certainly still have many hypo symptoms.
In my opinion the best way to treat a hypo patient is to test and adjust levels of the biologically active thyroid hormones, free T3 and free T4, with whatever medication is necessary to relieve symptoms, without being constrained by resultant TSH levels. In your case I think you may need to add in to your meds a source of T3, since the levels seem somewhat unbalanced, indicating inadequate conversion of T4 to T3. I think you can get a lot more understanding about this if you read this link.
http://www.hormonerestoration.com/Thyroid.html
In addition, hypo patients frequently report having low Vitamin D, B12 iron/ferritin, and selenium.So it would be a good idea to get those tested as well.
Beyond that, with your symptoms, I can't see why your doctor wants to lower meds. TSH is in range but TSH is a pituitary hormone that is affected by so many variables that it is a poor diagnostic by which to medicate a thyroid patient. Of much greater importance is your FT3 and FT4 levels. I expect that when compared to the ranges we will see that both FT3 and FT4 are too low. FT3 is the most important because it largely regulates metabolism and many other body functions. Scientific studies have shown that FT3 correlates best with hypo symptoms, while FT4 and TSH did not correlate. Many of our members report that FT3 needed to be adjusted into the upper part of its range and FT4 had to be adjusted to at least midpoint of its range in order to relieve symptoms. Symptom relief should be all important to you. And you certainly still have many hypo symptoms.
In my opinion the best way to treat a hypo patient is to test and adjust levels of the biologically active thyroid hormones, free T3 and free T4, with whatever medication is necessary to relieve symptoms, without being constrained by resultant TSH levels. In your case I think you may need to add in to your meds a source of T3, since the levels seem somewhat unbalanced, indicating inadequate conversion of T4 to T3. I think you can get a lot more understanding about this if you read this link.
http://www.hormonerestoration.com/Thyroid.html
In addition, hypo patients frequently report having low Vitamin D, B12 iron/ferritin, and selenium.So it would be a good idea to get those tested as well.
TSH 2.38
Free T4 .75
Free T3 2.0
THY AB 56
Reverse T3 26
I am depressed that is why I am on 2 anti depressants, anxiety, tiredness, weight gain soon after doc lowered my med to 125 from 150, moody, sleeping 10 hours, loss of memory, less interest in most things, irritable, constipation,
Free T4 .75
Free T3 2.0
THY AB 56
Reverse T3 26
I am depressed that is why I am on 2 anti depressants, anxiety, tiredness, weight gain soon after doc lowered my med to 125 from 150, moody, sleeping 10 hours, loss of memory, less interest in most things, irritable, constipation,
Please post your thyroid test results and reference ranges shown on the lab report. Also, please tell us about any hypothyroid symptoms that you have. If you aren't sure what those might be here is a checklist of hypo symptoms.
http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm
http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm
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