Insertion of a unique keyword.
Somewhere on their site Antiagingpittsburg (I will link) has the 2005 study which said reverse T3 needs to be tested. You might think of T4 as a storage form of thyroid hormone. It has 4 iodine molecules in 2 rings. To make T3 an iodine is removed from a ring. If it is removed from the wrong ring you get reverse T3. Reverse T3 is a weaker hormone. T3 is the power house hormone, so it is important to be sure that you are not making too much reverse T3, because it will take positions on thyroid hormone receptors thus blocking T3. Great if you are desperate to survive a famine, otherwise pretty exhausting. (There may be a genetic group(s) that survived famines, precisely because they had too much reverse t3. And it likely did not keep everyone from getting pregnant and carrying to term, & so it lives on...Or they had already had their children.) I do know someone on another forum who makes too much reverse T3.
Thyroid hormone instructs your cells on their metabolism, so you can imagine that if cells are not running their metabolism enuf to keep up with demands, you are going to have pain and other symptoms. Imagine certain systems going without enuf hormone. Maybe that is why adrenal fatigue and hypothyroidism are running buddies sometimes (been there)? But maybe that's not the best example because they are each down stream from the hypothalamus and the pituitary (HPA axis and HPT axis).
Then there are people like me who are not good at converting T4 into T3. How will a dr. know that if s/he runs an incomplete panel? They won't. Several drs did not run enuf labs for me.
Even tho my doctors (several cities) prescribed one of the typical thyroid medicines, like levothyroxine or synthroid, I was always going to feel rotten on that. I need to get some T3 hormone also. The typical Rx meds are T4-only meds. Plus--for me, too much T4 in my prescribed T3/T4 ratio gives me even worse hot flashes day and night. Their intensity is T4-dose dependent. I also even had menstrual periods every 2 weeks pre-menopause on T4 synthroid or levothyroxine. The drs must have been so uneducated, including the endocrinologist who concluded: I must not need that much medicine...not the only time I would hear that. Doctors have not kept up with research. Watch out cuz one endo I saw was really more into diabetes treatment.
To get some T3 some patients use desiccated thyroid hormone. One option is Armour. And I think another is Naturthroid (both desiccated). Others I can't remember....maybe Westthroid? I have read Armour is no longer covered by some insurance. Some people no longer like it since it's reformulation. Some people use cytomel plus a T4 med. I am not really familiar with those. I use a mix from a compounding pharmacy of T3 + T4. I believe I would be doing even better with a time released form. I hate to even learn what the cost would be. I have seen that some patients are on straight T3. (However someone once told me that while tissues do need t3, there are some that do need t4. Honestly, I have not verified that by finding a study that says it is so.)
I feel fortunate that at one point I came across a psychiatrist who told me it was more important in my case to spend my money on good thyroid and adrenal care than to see her. (She had ordered some labs on me.) I was on a T4-only med, but getting on T3/T4 really helped my stubborn years-long depression. Other symptoms improved also. It makes me mad thinking about
all the wasted years that people go thru being improperly tested and under treated. A blogger psychiatrist has written some about
T3 and mental illness at at her site evolutionarypsychiatry. Once upon a time I google searched for actual studies about
it. She doses more conservatively than some drs, but reading her blog may help someone.
If you google: Hypothyroid doctor T3 and also add your city, you may find a doctor on doctor lists kept by a few of the sites dedicated to hypothyroidism.
I still move from city to city, which means doctor hopping. I think you have got to find a better doctor. I don't know if you can afford this, but when I lived in Austin I had to pay out-of-pocket because neither of the two decent doctors I was referred to and read about
, took insurance. Same thing in the next city. It was money well spent.
My doctor in Austin was the most thorough, even tho she was not an endocrinologist. She was a former ER doc who wanted to learn something with more long-term rewards. My next doc in the next city was not an endocrinologist either. There I had to call the only compounding pharmacy in town and ask who prescribed T3/T4. She was the only one. Now I am in another city and again I had to call compounding pharmacies. This one is a naturopathic doctor (...and she takes medicare. yayee.) post edit, I just had another appointment and discovered she is a nurse practitioner to the gynecologist there. But she gets great reviews and I agree she knows a lot. Some people find integrative physicians very helpful, and from what I have read they sound great.
After getting dr names, always take it one step further and look at sites with local doctor reviews. I am happiest if I find results on Yelp, because there I can also look up the reviewer and see if I think it was really a patient.
My dr in Austin would run TSH, total T4 (it is "bound"...bound to a protein), and free T4. She said you can think of "free" as "available". She also ran free T3 and total T3 and reverse T3. Maybe a doctor doesn't choose to run every one of those, and may not do a full panel every time tests are run but running only TSH is going to miss some problems in some people. For example, TSH is thyroid stimulating hormone from the pituitary. If a dr. runs only TSH, they may have no indications if it is the pituitary that is under performing. A low TSH would make the Dr think you are fine, when in some cases the pituitary just wasn't putting out enuf TSH to point toward low output of free t3. In some patients the problem can be higher up in the HPT axis (hypothalamus, pituitary thyroid). I read that one fibromyalgia study finds hypothalamus problems, and perhaps the pituitary is more of a suspect in CFS patients. (Info from the Holtorf Group's site).
You may want to check out these sites to verify info: stopthethyroidmadness and I think another one I read from was the National Acadamy of Hypothyroidism. That one might have been the one that pointed out the problems with how the so-called "normal" range is decided upon. I have also read that people with diabetes, fibromyalgia or on a reduced calorie diet have problems with transporting hormone onto cells' receptors.
Mary Shoman at about
.com has written some books and at about
.com she says that some people feel better getting their TSH down to the lower end of the normal range. (I think she said the "normal range" has been shifted lower in the U.S., so always get a copy of the lab report, see for yourself what their range is. Plus they will screw up and not order something and you can't trust that it's all getting run. They especially skip running my antibodies!) The trick is to find a doctor with enuf common sense to account for symptoms and give those symptoms weight when trying to figure out your optimal dose. So not relying 100% upon lab results. We are still individuals.
Dosing does get trickier if someone also has adrenal problems because that also shares a couple of symptoms of hypothyroidism, like fatigue and even higher pain, if cortisol is too low. Other conditions that cause fatigue may also make it a challenge to figure out when to increase the dose.
As long as tests are being run, it is a good idea to also check for autoimmune thyroid disease also. I have Hashimoto's which the TPO test revealed. The other test is TgAb (≤≤-- thyroglobulin antibodies). Antibodies were initially run by a new dermatologist, of all people. Good thing he ran it. Sometimes with Hashi's your thyroid hormone levels can kind of drift (I've read that some people even make quick drifts into hyperthyroidism and then back to being hypo (low). And It helps to understand why a dose that used to work doesn't sometimes.
Happy doctor trails to all of you.
Nat'l Acadamy of Hypothyroidismhttps://www.nahypothyroidism.org/thyroid-hormone-transport/http://www.antiagingpittsburgh.com/services/thyroid-optimization/ https://labtestsonline.org/understanding/analytes/t3/tab/test/
post edit 4/12/19
I am seeing mast cell patients report that their mast cell expert Dr. thinks it is over active mast cells that are responsible for their thyroid disease.
I am now on Nature-throid, after reading a blog from Dr Jeffery Dach. (follow on facebook). I like it. He says their product is consistent and that a benefit to taking dessicated porcine is that it also has calcitonin. (Another doctor that makes me pay out-of-pocket. Augh! when are they ALL gonna learn this stuff? Thanks Yelp, for helping me find people.)
Calcitonin is involved in calcium metabolism, bone maintenance and prevents osteoporosis. Thyroid disorders, including hashimoto's, cause destruction of calcitonin cells.
[^^See Part 2 for more info. It has info on bone effects. It's linked below.].
This article is part one of a series.
Part 1: https://jeffreydachmd.com/why-natural-thyroid-is-better-than-synthetic/
part 2: https://jeffreydachmd.com/why-natural-thyroid-is-better-than-synthroid-part-two/
Post Edited (Rockon) : 4/12/2019 1:00:27 PM (GMT-6)