Guest guest Posted July 23, 2011 Report Share Posted July 23, 2011 Hi Tony, Firstly (sorry to someone - joke - private), why did your wife have the part thyroidectomy. Presumably there was something in one half of the thyroid that needed to be removed - what was it? The autoantibodies are very high. Where are they now? The normal process would be to fully explore T4 - really fully - down to fully suppressed TSH so that it was totally clear that T4 was not going to do the trick. In parallel, to this process all the other considerations would be fully examined: 1) iron levels, B12, folate , vitamin D any other mineral or vitamin deficiencies that could be an issue. Any low levels would be totally addressed with supplementation or dietary changes. 2) Digestive issues such as gluten intolerance, dairy intolerance, candida and other issues would be looked at. This might include checking for any blood sugar imbalances perhaps using a glucose tolerance test. Histamine issues might also be looked at. 3) Adrenals of course can have a part in all this. There is a great deal written about this and so I won't bore you with detail here. OK, at the end of a long road of trying a good range of T4 dosages and then determining that all the other aspects relating to thyroid and adrenal metabolism are in a good state THEN and ONLY then would someone normally progress to either T4/T3 or natural thyroid. The choice might depend on how easy it was to get natural thyroid. NT would be the drug of choice when T4 had failed. It works brilliantly for many people as it is close (not perfect but close) to human thyroid production. Only after fully exploring all of the above and FAILING clearly would someone progress to T3. T3 is the thyroid medication of last resort. It works superbly when all else fails and when used correctly - but it is a lot of hard work compared to the other thyroid meds. It isn't something I recommend to people lightly. So, when you say that her TSH was somewhat suppressed on 100 mcg of T4 - how suppressed was it and do you feel that you experimented with a high enough dose of T4 to begin with. Natural thyroid hasn't been tried - this works well for some people. In terms of combining T3 with T4 - how many divided doses of T3 has your wife typically used and how many is she using today? This is key. Every time a divided dose of T3 is taken it is possible to create a wave of T3 into the cells that is so high it can cause problems including instantaneous and sustained TSH suppression. Did you know that the rate of T4 to T3 conversion is partially geared to the level of TSH? A lot of endos don't even know this - yet it is clearly and definitively documented in research which I can drag up if needed but I have documented this elsewhere. The liver is aware within some structures that are involved in conversion of T4 to T3 of the TSH level. If TSH is high then conversion of T4 to T3 tends to be higher. IF TSH is suppressed then conversion of T4 to T3 will lower to the minimum - it will still occur but at less than an optimal level. So, for all of us it is important to only take the level of thyroid hormone that we need to be healthy and no more - any more and TSH is suppressed and conversion rate will be affected. So, titration of T3 even in cases when it is combined with T4 is key. It is better to take more smaller doses of T3 in the day than one or two larger doses. This is a massive generalisation and does not work for some people who desperately need huge amounts of T3 injected into their cells for them to feel well. However, for the majority of us we just need to have the extra T3 we need - but no more. So, let me know how many divided doses of T3 your wife is using with the T4 and what times of the day she takes them - there may be more options that can be used. In terms of your specific question about upping the T4 to 150 - why didn't she just do this when she was on T4 only? If you are going to fully explore T4 then it may be better to do this whilst only on T4 and not on T4/T3. At least then you'll have a definite answer on how T4 is working? I have no idea what upping the T4 will do. I do know that taking T3 in two big doses a day (yes I consider 10,15 or 20 mcg of T3 in one go to be a big dose) can have profound effects on TSH and T4 conversion. So there is plenty of room for experimentation with T3 divided doses along with T4. There may be plenty of room for experimentation with just T4 or with natural thyroid. I also don't know if all the nutrients and other issues have been explored correctly and that these levels are healthy (not a 'normal' result as pronounced by a GP - which is often just a marginal level of iron or B12 - but a truly healthy result with good serum iron, good ferritin, good B12, folate and vitamin D levels etc.). Sorry for the really long answer but this stuff isn't easy - it is really hard and complex. There is no way to make it less than this because that's what it is. You've got quite a bit to chew on here - I'll leave you do it. My very best regards to you. > > Just wondering what you make of this Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2011 Report Share Posted July 23, 2011 p.s. just in case someone tries to pick me up on the issue of higher levels of thyroid hormone like T4 (or NT or T3) causing a lower conversion rate: If you continue to increase the level of T4 or other thyroid hormones passed the point of TSH suppression into excess thyroid hormone levels then at this point the minimum conversion rate that has been reached will not deteriorate. So, it is possible by increasing any thyroid hormone to a very high level that extra T3 will be forced into production. Whilst this may feel good in some respects it forces the cellular clearance of excess thyroid hormone to go to an extreme level. I have had to experiment on my own body on a number of occasions in the past 20 years in order to understand some aspects of thyroid hormone metabolism. This may sound crazy but in the absence of information I have been determined to learn certain things that I have since found research references to that have verified my own findings. Using thyroid hormone such as T4 to excess (supra-physiological doses) can work very well in generating adequate levels of T3. I have been able to regulate many physiological systems in my body by using T4 to a supra-physiological level but any less than this and T4 is a total disaster for me). However, there are severe dangers in pushing thyroid hormones to excess (beyond the point where TSH is already suppressed for most people - unless they have hypopituitarism). In my case I began to have blood pressure problems - which I don't have on T3. I also began to have severe depression and mood swings. These were so bad that ........... I will never, ever use T4 or any thyroid hormone to excess again. So, please be aware of the effect of thyroid hormones on TSH and conversion. Please also be aware that we can't cheat our way out of this by just taking more. Taking what we need is what we need to aim for and no more. This includes the right amounts of the right hormones for us. Please notice that I'm also not pushing T3 as a solution - because for many people T3 isn't what they need. Have a good weekend everyone. I've just had an appalling afternoon of tennis and am now drowning my sorrows. I'm too b****y old to play better. I want to play like I was 18 again and I play like my age (older than 18!). Take care, > > Just wondering what you make of this Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 HI , I notice you mention thyroid antibodies - I have Hashi's and even though I am on thyroid meds now - have dealt with my vit/min deficiencies - although still low on iodine - I can't seem to get my antibodies down from 800 (I was previously before treatment 1200 ++) - I am on HC - and I have Lupus but it is not active. Any ideas why this is happening? Best wishes Mandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 Many thanks for the very detailed and interesting comments . However, given that my wife now feels back to normal on 50T4/40T3, we're inclined to think we should leave well alone. Introducing T3 made a big difference coupled with Dr P's later recommendation that she should drop down to 50T4 (when we had been expecting him to recommend increasing T4 or taking Armour). She takes the T3 as a whole 20mcg tablet first thing in the morning, 10mcg early in the afternoon and a final 10mcg at about 7pm. She's also taking various supplements such as selenium, magnesium, B5, B12 and D3. She had the partial thyroidectomy because of the presence of a mass of indeterminate character on scanning. It proved to be benign but, by then, it was too late to put the half thyroid back! TonyC > > Hi Tony, > > Firstly (sorry to someone - joke - private), why did your wife have the part thyroidectomy. Presumably there was something in one half of the thyroid that needed to be removed - what was it? > > The autoantibodies are very high. Where are they now? > > The normal process would be to fully explore T4 - really fully - down to fully suppressed TSH so that it was totally clear that T4 was not going to do the trick. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 I was just trying to provide a broad and thorough answer. If your wife feels perfect then no changes are needed. If she has any symptoms remaining then some fine tuning may be needed. If it is only fine tuning then there are alternative modes of using T3 as outlined. Gathering data is always the first place to start though. I try never to answer with too narrow a solution space as it is open to misinterpretation. I prefer to present all the possible options so that the people involved can work with their own doctors and select something suitable for themselves. Good luck, > > Many thanks for the very detailed and interesting comments . However, given that my wife now feels back to normal on 50T4/40T3, we're inclined to think we should leave well alone. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 It can take a long time. Are you on vitamin D? Are you certain that all of your nutrient levels are in the upper half of normal - or is it just your doc that has said they are normal? Iron, B12, folate and D are key. Also there is the question of other sources of immune stress - gluten, dairy, life stress etc. Even then there is no guarantee that all the sources of immune system stress have been identified and people vary - it can take months or years for the autoantibodies to drop. Sorry - like a lot of this there is no mechanical guaranteed process that always works in a predetermined way. Take care, > still low on iodine - I can't seem to get my antibodies down from 800 (I was Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2011 Report Share Posted July 25, 2011 HI , Yes understand - have you any idea if Iodine being low can have an effect on thyroid antibodies? Be grateful for your advice Thanks Best wishes Mandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2011 Report Share Posted July 28, 2011 Hi Tony, I think is better to answer this, as you suggest. He has studied the subject, whereas I only have my personal experience. However, We have to remember your wife still has half a thyroid and its likely she still is able to do all the conversion etc at the cellular level. For many people it seems as though whilst they may at first be ok on T4 only they do eventually find this isnt the case in the long term. However, if you have found a place where things are at their optimum then I would suggest sticking with that. The other thing I would suggest is to consider supporting adrenals. Whilst it maybe that she feels ok in that area for now, due to her surgery and thyroid hormone support 'hiccup' this may prove to be problematic in the longterm. In your wifee's case I wouldnt suggest using any of the stronger supplements but stick with Vitamin C's etc. There are list in the FILES I believe. I hope she gets sorted soon. Sally xx Just wondering what you make of this , especially as you're in the process of writing a book relating to the use of T3.My wife had a hemi-thyroidectomy about 20 months ago. moderated to remove old messages.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2011 Report Share Posted July 28, 2011 Hi Mandy, There are really mixed views on iodine. Some people swear by it and others believe that it overstimulates the system and is a bad idea. I have looked at many reports and personal experiences regarding iodine and can find nothing that convinces me one way or another. Personally, I know that iodine used to have a bad effect on my own thyroid and caused it to work harder and produce more T4. In my case T4 is an extremely undesirable hormone and so the iodine was very unhelpful. For others it may work well. Most people in the UK have no iodine shortage but I haven't got a strong view on this I'm afraid. I do wonder if causing the thyroid to work harder might aggravate the thyroid gland and cause a higher autoimmune reaction but if someone were short of iodine then it might do the reverse. I really don't know the answer to this I'm afraid. You may need to do a short trial and see what it feels like - if you really feel you need to explore it. Quote Link to comment Share on other sites More sharing options...
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