thyroid controversy

JLH · Post by **JLH** » Sun Jul 24, 2011 9:23 am

http://thyroid.about.com/b/2011/07/23/g ... oversy.htm

dgshelton · Post by **dgshelton** » Sun Jul 24, 2011 11:39 am

All I can say is, wow, what an idiot! I am so glad she wasn't my doctor when I was trying to get pregnant and after 4 failed IVF rounds was found to have anti-thyroid antobodies. My TSH was 3.5, which was within the normal range at that time. A low dose of thyroid medication allowed me to get and stay pregnant. Without it, I would not have the little boy with the huge smile everyone saw in the fish picture.

I know, as someone with Hashimotos that I feel best when my TSH is around one or even slightly below. I had mine tested 3 months ago while in the middle of having D 10-15 times a day and it was 3.2. I didn't lose a single pound even though everything I ate was going straight through me. So, no one can tell me that it thyroid medication does not help.

Hugs,

Post by **tex** » Sun Jul 24, 2011 12:26 pm

That article may end up biting Good Houskeeping Magazine in the butt, before all is said and done. Dishing out dangerous health advice is risky business, (ask any medical insurance company).

TSH level is of little value to me, (though my doctor thinks it's the best thing since sliced bread). The amount of thyroid hormone supplement that I take, doesn't seem to make much difference on my TSH level, (or whether I take none at all), my TSH result is always in "mid-range", and my doctor, (and the lab he uses), still use the old range.

That means that my doctor is happy, no matter what dosage I use.

I regulate my dose by my Free T4 level. With no supplement, my Free T4 is below the normal range. With 60 mg of Armour per day, my Free T4 is still near the bottom end of the normal range, but at least it's in-range, (so my doctor is happy.

) I've always assumed that Free T3 will follow the Free T4 level, but I think when I have my next CBC, I'll request a Free T3 test, also.

Part of Dr. Holtorf's response caught my eye:

Another study published in the journal Clinical Cardiology (3) found that low free T3, regardless of TSH, was associated with 2.5 times the risk of cardiac mortality.

Thanks for the link.

Tex

Kemah · Post by **Kemah** » Sun Jul 24, 2011 2:50 pm

I was diagnosed with hashimotos rather easily when a doctor noticed that I had an enlarged thyroid (I was around 30). She gave me a prescription which lowered my TSH under 5.0 and said I was in good shape. Being very naive about doctors, I believed her. Unfortunately I spent the next year and a half going to every doctor under the sun because I was having so many problems. I thought I had lupus! I had a fever every afternoon, severe hair loss, hives, itchiness, bitchiness ;) etc.
Finally I happened to be the doctor's office in the afternoon one day instead of morning and I had a low grade fever. The doctor was shocked even though I had told her about this many times. She said, "oh, well you probably need a higher dose of synthroid."
Simple as that. My symptoms disappeared, the world was instantly and literally brighter, and all it took was the doctor to see one of my symptoms, rather than actually listening to me.

sarkin · Post by **sarkin** » Mon Jul 25, 2011 6:29 am

Kemah,

You have had quite a run of doctor luck. I'm wishing you better health fortunes, in every way.

dgshelton · Post by **dgshelton** » Mon Jul 25, 2011 9:21 am

Tex - I have always relied on TSH. I am seeing my endocrinologist to tomorrow. Do you think I should ask for the free T4 and T3 tests? What will those tests show?

Hugs,

sarkin · Post by **sarkin** » Mon Jul 25, 2011 9:28 am

Denise,

Timely question! I was just adding details to my "ask the doctor" note.

I wrote down (I believe from the linked article, but I am a bit of a wanderer on the web): TSH, free T4, free T3, reverse T3, anti-TG antibodies, and anti-TPO antibodies. That checks thyroid function in a richer way, and also looks for autoimmunity.

I look forward to the feedback you'll get on this. I was thinking if my doctor wouldn't go for the autoimmune angle, she might at least be willing to add T4/T3. Your doctor seems very accessible. I hope mine will be, too.

Love,
Sara

Post by **tex** » Mon Jul 25, 2011 10:03 am

Denise wrote:Tex - I have always relied on TSH. I am seeing my endocrinologist to tomorrow. Do you think I should ask for the free T4 and T3 tests? What will those tests show?

Monitoring thyroid function by means of TSH values works for most people, so long as everything else is working properly, and the reason for the thyroid hormone deficiency is simply low thyroid gland function. As you probably know, the body makes T3 from T4, (assuming that mechanism is working properly - however, some people are not able to make the conversion, so they require a T3 supplement).

Free T4 measures the free, unbound thyroxine levels in your bloodstream, (IOW, thyroxine that is not bound to proteins). This result shows whether or not your body has a sufficient supply of unbound T4 available for making T3.

Free T3 measures the amount of free triiodothyronine in your bloodstream, (IOW, triiodothyronine that is not bound to proteins). This result shows whether or not your body actually has a sufficient supply of free thyroid hormone available for all it's needs. As you're probably aware, T4 is not active thyroid hormone, (that is, it's not in a finished form, that can be utilized without further conversion by other body organs) - it's an intermediate product.

For anyone who wants some background information on this:

The thyroid produces both T4 and T3. However, T3 is the active form, (and it's several times more potent than T4). T4 is converted into T3 within cells, by means of special enzymes. If those enzymes are deficient, then the conversion will be incomplete.

There are three common ways in which there may be inadequte amounts of the thyroid hormone for normal metabolism. The one which all doctors are aware of is primary hypothyroidism, in which there is a raised TSH and a low T4 and low T3. This is due to failure of the thyroid gland itself, possibly due to autoantibody disease, possibly due to toxic stress or possibly due to iodine deficiency.

The second, and in my view the most common cause of thyroid failure, occurs at the pituitary level. In this condition there is inadequate thyroid stimulating hormone (TSH) produced from the pituitary and so one tends to see low or normal TSHs, low T4s and variable T3s. This condition I see most commonly in my patients with chronic fatigue syndrome, where there is a general suppression of the hypothalamic-pituitary-adrenal axis.

The third type of under-functioning is due to poor conversion of T4 to T3. This requires enzymes and co-factors, in particular selenium, zinc and iron. In this condition there are normal or possibly slightly raised levels of TSH, normal levels of T4 but low levels of T3. This requires micronutrients and also T3 to correct.

http://www.drmyhill.co.uk/wiki/Thyroid_ ... T4_and_TSH

Sara, you may already be aware of this, but in case you're not familiar with it - Free T4 and Free T3 are not the same as T4 and T3. T4 and T3 tests measure the total amount of those components in the bloodstream, including the percentage that is unavailable, because it is bound to certain proteins. You can have plenty of T4 and/or T3, and still be symptomatic, because there is insufficient Free T3, or insufficient Free T4 available for use in synthesizing T3.

Tex

dgshelton · Post by **dgshelton** » Mon Jul 25, 2011 10:10 am

Thanks, Tex. I already know that I have autoimmune hypothyroidism, so I'm not sure the free T3 or free T4 will tell me anything. I'm sure my dr. would be willing to do them if I want her to, though.

Hugs,