natural or synthetic thyroid hormone?

[springnyc]

hi,
i have hashimoto's. started taking levothyroxine july 2010 and never quite got the TSH to normal, but ft3 and ft4 were always normal.

this past july i started taking natural thyroid hormone and since then my levels have been all over the place. my tsh is way too low, my ft4 is in range tends on the low side, and my ft3 is in range, and tends on the high side.

seems that since i've started the natural hormone, i have all three levels that are off, when before just my TSH.

also, is it even possible to conceive with at tsh of .04?

thanks,
sprinnyc

[springnyc]

that's a very good idea. i will do that from now on.
thanks!!!

[Barb135]

For some of us, there's no way to "feel better AND have numbers in balance".  If you're feeling well, don't stress too much over the numbers.  

It's always a good idea to write on your lab report what medication/dose you're taking when the labs are done, and what, if any, symptoms you are having.  By doing that, you keep a running record of your condition and will be able to see where you were in terms of labs, when you felt best.  Those levels will be your "target", but even then,  you might not be right on, all the time.

[springnyc]

thank you everyone! i've decided to go back to synthetic at least for now. i'm trying to get pregnant and don't have time continue baffling over all my numbers. i do believe that, in my case, the various hormones in the natural version are confusing my system. i don't like the idea of totally suppressing my TSH even though it isn't the best marker, but even so, my T4 remained so low on natural and TSH so low, too. even if my FT3 was high because i had taken it a few hours before the blood draw, i still don't like the numbers. in terms of how i feel on one or the other, since i realize that's more important than numbers, i never noticed a difference, but i didn't have those numbers off-balance like that when on levothyroxin. i'd rather feel better AND have numbers in balance.
i'll let you know where it goes from here.
thanks so much again EVERYONE!
best,
springnyc

[goolarra]

Most likely not...when taking meds, TSH is often suppressed, and that seems to be a relatively permanent condition for a lot of people.  However, it is a possibility.

Some doctors say not to take T4 meds before the draw and some say that you should.  It's probably best to ask your doctor so that your results will be consistent with what he's used to seeing with his other patients.  What's most important is to be consistent...either always take T4 meds before the draw or never do, but don't mix it up.

[springnyc]

will the T3 before the blood test also affect TSH? is that why TSH may look low, but actually isn't?
if i switch to T4 only (synthetic) does it matter if i take it before bloodtest? no, right?
Again, thank you, thank you, thank you!!!

[Super_sally888]

Yes, do not take any meds the day of the draw.  Take them after.  It will give misleading T3 results.

I take a combination of dessicated and T4.  Works fine for me.  Just need 2 different pills, instead of 1.

It is not complicated, once you get the dose right.

If you do get pregnant, make sure you are tested monthly and important to keep FT3 and 4 close to the top of their range.  It is usual to have to increase thyroid meds significantly during pregnancy.

[goolarra]

Yes, you shouldn't take any meds with T3 in them before the blood draw.  That's probably why your FT3 looks so high.  I should have asked that question sooner.  Sorry.  I may have to take back a good part of what I've said so far.  Perhaps you really just need an increase in meds.  It's hard to say because taking T3 before a blood draw can really send the T3 skyrocketing.  Could you repeat the blood work?  I'd want to see an unmedicated FT3 and FT4 before making a decision to switch meds.

Many people find that magnesium helps a lot.  Also, magnesium is water soluble, so within reason, what doesn't get used gets flushed (don't go wild).  

The rule on retesting after a dosage change is 4-6 weeks.      

[springnyc]

again, thanks everyone. this is so much more helpful than visiting the endoc! i switched, because i heard that natural is better, more healing and less destructive for the thyroid. but, yes, seems everyone is different. asked yesterday whether or not they had tested FREE and no answer yet, but i'm pretty sure they did.
yes, i did take my dose of hormone about 3 hours before the blood test. will that make a difference?
have not tried magnesium for constipation. just trying to eat right and taking psyllium husks. i'll try magnesium, though, never heard of that....
also, if i switch to synthetic, T4 only, is it then useless to test within 3 weeks? too early?
also, i've heard of mixing natural and synthetic -- seems complicated. anyone have experience with that?
and thanks so much agian!

[goolarra]

Some of us with Hashi's do fine on T4-only meds, some on synthetic T3/T4 combos and some on desiccated.  It's has more to do with us as individuals than the fact we have Hashi's.

There's a lot of material out there on T1 and T2.  Just be careful which sites you visit.  I'd stay away from the body building sites!  

One thought:  had you taken your desiccated that day before your blood draw?

This is so individual.  If you were more stable on T4 only, why not go back to that?  Why did you switch to desiccated to begin with?

Flyingfool answered your question about when during the day to take meds.  T3 is not subject to the same food restrictions as T4.  You don't have to take it on an empty stomach, nor do you have to fast for half to one hour after.  

Have you tried magnesium for the constipation?

Flyingfool, those look like FREE ranges to me.  

[flyingfool]

First off.

You need to determine if you have actually gotten the FREE T4 and FREE T3 tests. If not you NEED to get those done.

Total counts both "free" hormone AND those that are bound to a protein and are useless.  Also in terms of T3's.  Total I believe will count both FREE, bound and possibly even reverse T3's (RT3).

reverse T3 occurs during conversion of the T4 into T3's.  The body will make a mirror image molecule of T3 thus the name "reverse T3".  However the body's cells can NOT use the RT3 molecule.  So by using only the "total" T3 count it would not indicate if you might have this issue.  A test can be done to obtain the RT3 level. I understand it is pretty costly but it can be done.

If your FT3 is high and your FT4 low.  I would say that the only option may be synthetic T4.  

This is because natural dissected Thyroid has T3 in it and you may not  need any more T3.  

Even with a T4 med  you may have to be concerned about your T3 level.  As your body MAY convert the T4 into T3 which you state is already elevated.

As far as multiple dosing throughout the day.  If you are on a straight T4 medication it is not necessary. T4 is the storage hormone and it takes up to 6 weeks to stabilize.  It is very long shelf life. Part of this is because the body ONLY uses the FT3 hormone.  And T4 must be converted to T3 and that takes time.  The bottom line is for something that takes weeks to level off, whether you take it once during the day or twice doesn't matter.

Using a straight T3 or even Natural Dissected Thyroid which has a T3 component in it however is different.  Since there is T3 directly in the medicine and thus that portion of the medicine is IMMEDIATELY available for use by your body's cells.  It has a shelf life of hours, not days or weeks. So taking it in multiple doses can be an advantage for most people.  Most will take it in the morning and then in the early afternoon.  Because of the T3 boost available. You should not take it much closer  than about 6 or 7 hours prior to going to bed or you may have trouble getting to sleep.  T3 is a natural stimulant.

As far as natural dissected possibly being or supporting Thyroid.  It may be because of the T1 & T2 that is present in natural Thyroid products that is not in pure synthetics.  I have not been able to find much data as to what T1 & T2's do.  But if your thyroid is still alive, you may already have that. If your Thyroid is completely dead or removed, then even if T1 & T2 do help thyroid there is nothing left to help so it becomes moot.

[springnyc]

also....
is it better to take thyroid hormone, regardless of synthetic or natural, over the course of the day or just once? i've heard spreading it out is better and easier on the body, but since we have to take it 1 hour away from food and 3 hours away from iron, calcium or high fiber, seems difficult to find good times in the day after the early morning. i eat throughout the day and i do take supplements, as well as psyllium husks....
thanks again!

[springnyc]

thank you very much. this is very helpful!
i have heard that people with hashimoto's do better on synthetic hormones or T4 only, but do not know why... has anyone heard about this?

my thyroid is not dead, though it is very weakened from the hashimoto's and looks like a typical hashimoto's thyroid on ultrasound (heterogeneous rather than even).

what i want to understand is how the dessicated contributes more to a healthy thyroid than synthetic, if that's the case, assuming one is taking the right dosage.

as for symptoms, T3 high, T4 on low side, i can't say. hard to tell. my one symptom has always been sluggishness. and i feel fine now. constipation is a permanent problem since i've been small, so i just live with that and do what i can. i've never noticed the thyroid hormones helping alleviate that in any way.

as for taking natural and synthetic, yes, that's a possibility. just seems a bit more complicated and everything already seems so complicated as it is! honestly, when i took synthetic, i never roller-coastered like this with my numbers... but i'll talk to my doctor about it...

thanks so much again.

[goolarra]

It is possible to conceive with your numbers.  It may not be advisable, though.  It's best to stabilize your thyroid condition before becoming pregnant.  Pregnancy and childbirth put even greater demands on your thyroid, so you have to be monitored carefully throughout pregnancy and after.

Your TSH is quite low at 0.04, but once on meds, TSH is often suppressed and is no longer a reliable indicator of thyroid status.  What's more concering is your FT4 and FT3.  FT3 is quite high in the range.  Is that causing any hypER symptoms?  At the same time, your FT4 is very low.  Any hypo symptoms from that?

As mentioned above, there's a lot more T3 relative to T4 in desiccated than our thyroids produce.  One of the drawbacks of desiccated is that the T3 and T4 can't be manipulated separately.  So, if you lower your dose, you'll get your FT3 down a bit, but your FT4 will fall also.  Likewise, if you were to raise your dose to get your FT4 a little higher, your FT3 would be moving into dangerous territory.

Have you asked your doctor about lowering your desiccated a bit and adding in just a little synthetic T4 to get a better balance?  That's another alternative to going to straight synthetics.  

Any thyroid med will "shut down" the thyroid if taken in excessive doses, and any med will support the thyroid if taken in proper doses.  If you supplement hormones and stop trying to force your thyroid to produce more than it can, you usually reduce inflammation (goiter) and nodules.  Some of the trace hormones and other substances in desiccated may contribute to a healthier thyroid.  However, if your thyroid is effectively "dead", whether due to disease, surgery or RAI, this will not benefit you.

Good luck!      

[flyingfool]

I don't think there is any evidence that synthetic "shuts down" the Thyroid.

Also it really doesn't make sense.  The actual chemical hormone is exactly the same molecule. So whether it comes from a pig or whether it is a direct chemical doesn't seem to make much sense.  At least not to me.

I think some adverse affects or side effects people tend to have with synthetic medicines have little to do with the hormone itself.  Rather they have difficulty with the fillers and buffers that are in the pill itself.  One synthetic that is said to reduce or eliminate this is a straight T4 med called Triosint. This is a liquid capsule or gel and it doesn't have fillers and powders other T4 meds have.  Some people have had good results with this for that very reason.  It is also more absorptive since it is a liquid so the dosage can sometimes be reduced to get the same effect as a powdered pill would have.

natural dissected Thyroid also has T1 and T2's in i which the synthetics do not.  But there is very little information as to what those do.  So I'm not sure exactly what benefit they offer.

[springnyc]

thank you. i will inquire further and also find out if this is free or total t3 and t4. i'm guessing it's free - that's usually what they've tested, as i remember.

but doesn't the synthetic have more adverse effects in the long run? i've heard it shuts down the thyroid whereas natural supports the thyroid. hard to know....

thanks so much again!

[flyingfool]

I assume that those are TOTAL T3 and TOTAL T4 since it was not specifically noted that they were "free".

Tests for "total" are outdated and not of much use.  You really need the Free T4 and Free T3 to be useful.

But the tests you show are a bit odd in that the T3 is off the upper end of the range while the T4 are on the very low part of the range.  While it is the goal to get the T3 higher in the range than the corresponding T4 in the mid range, it is not common to see this divergent spread of the two polar extremes like you have.  At least not in my experience.

I've read that natural dissected Thyroid can have approximately 80% T4 in it with the remaining 20% being T3.  

It would seem logical that yo may not need the T3 component since it is off the top of the range.  So going to a straight T4 med may be an option you want to discuss with your Dr.

[springnyc]

thank you for your replies.
in terms of how i'm feeling.... i feel pretty good, not sluggish as i have before. but with nearly the same numbers (lower T3, though, 3.9 instead of 5.04 - see ranges below) on a SLIGHTLY different dose (50 five times a week and 75 2x a week instead of alternating daily) i felt tired a lot.
i'm taking natural thyroid from germany, where they don't use grains... sorry if confusing.
here are my numbers:
TSH 0.04
T3: 5.04 (range is 2.2-5.3)
T4: 9.28 (range is 9-19)

i took too much at one point, which shot my system out of what, so the endoc is being careful to not change my dose just yet, as body takes time to recuperate, maybe?

also, is pregnancy possible with these numbers?
do some people on natural revert willingly back to synthetic. seems easier somehow, as it's only T4 and not a cocktail that includes T3....
thanks.

[flyingfool]

You mention your labs being low or high.  But we need to have the actual test results.

Also while you mentioned what you believe your labs are but did not indicate how you are feeling.

The numbers are less important than how you are feeling.  If you feel great then the only thing you should worry about with the numbers if in the future you start not feeling so great you know what numbers to shoot for to get back.

As Barb said.  Mid range FT4 and upper part of the range for FT3 is usually pretty good for most people.  Everyone is different however.

TSH is basically useless information.  It is a screening tool at best.  It can NOT be used to adjust the dosage level of medication.

[Barb135]

Many people on thyroid medication find that TSH stays very low. Mine stays at < 0.01.

Can you post the actual results of your latest thyroid lab tests?  Please be sure to include reference ranges, since these vary from lab to lab and must come from your own report.  

It's not always good enough to be "in range", with the labs; you need to find levels that are good for YOU.  

TSH is a pituitary hormone and is not necessarily indicative of thyroid function. .  You should pay most attention to the FT3 and FT4 levels.

Many people find that they feel best when FT3 is in the upper 1/3 of its range and FT4 is around mid range.  

Low TSH does not mean you are hyper. You are only hyper if you have hyper symptoms; however, the T3 in dessicated thyroid hormones is about 4 times what your body would normally produce, so that may be too much for you.