FAQ, sort of

July 12, 2006

For all the new folks to the list, welcome aboard. The following is a

collection of old posts (some from other lists) that address many of the

questions people seem to ask when first joining the list. This is not

intended to silence your questions; it should just give them some

context while I hope it provides you with preliminary answers. It

includes some links to standard background information. I would invite

those with " alternative " views to post the web sites for that

information as well.

Most of us got here from one of four causes: (1) an autoimmune attack on

the thyroid gland and its hormones, a condition called Hashimoto's

thyroiditis; (2) surgical removal or radioactive destruction of the

thyroid gland for a medical reason such as goiter or cancer; (3) an

idiopathic (don't know what causes it) familial pattern, in which the

thyroid simply stops working; or (4) an endocrine or protein binding

malfunction involving other hormones, that results in some sort of

imbalance or conversion insufficiency.

You can find the basics in the following links. These sites often have

an ax to grind and may not agree on the best courses of action. However,

they tend to have a lot of useful information that is made accessible to

people new to the subject.

Symptoms:

http://www.womentowomen.com/hypothyroidism/symptoms.asp .

How the thyroid works and what can go wrong:

http://www.btf-thyroid.org/index.htm .

Summary of treatments, although with lots of editorial views:

http://thyroid.about.com/od/thyroiddrugstreatments/ .

We share a common medical condition, eventually affecting up to about

10% of all women, although a lesser percentage of men. If you are in one

of the first three categories, clearly indicated as hypothyroid by

tests, your doctor probably gave you a prescription for a synthetic T4

replacement and told you to come back in 4-8 weeks for more testing.

That process is called titration.

If your doctor is conservative (the 8-week variety), he probably gave

you a low starting dose, in which case you won't notice much relief for

months, when the dosage finally gets close to optimum. In between, you

may have temporary improvement after each dosage increase that will fade

as your system adjusts. Eventually, you are likely to feel normal again,

that is, if you are one of the lucky majority. Many on the list, though,

are here because they weren't one of the lucky ones.

If your doctor is cautious, allowing your levels to stabilize and

checking the side effects before increasing the dose, you might want to

show up a little early. The recommended interval is a minimum of six

weeks. However, if you are young and otherwise healthy, there is no

reason not to push that a bit. The sooner you get to full replacement

and get it stabilized, the sooner you feel normal again. The incremental

increases only help briefly and then seem to fall off until the next

increase.

You will probably be on the medication for the rest of your life. The

few cases of restored thyroid function I have read about sound like mild

partial impairment which stops. Hashimoto's can sometimes do that, as

can endocrine malfunctions. Most of the time, everyone that reaches the

full replacement dose seems to stay there.

Autoimmune conditions can stop and go into either temporary or longer

lasting remission. However, the more usual progression is cyclic

recurrence, once they have been triggered. In the case of the thyroid,

this usually results in permanent loss of function. Other systems are

sometimes more resilient. Nobody knows the cause for the immune system

to attack the body it is supposed to protect, although this is a very

active field of research today.

The big distinction of Hashimoto's from the other causes is that thyroid

function can go up and down again, alternating hyperthyroid with

hypothyroid under the same dosage, until the gland is finally,

permanently destroyed. This means the gland stops functioning entirely,

stops collecting iodine and producing the T4 and T3 from it that you

need. There is also a small reduction in organ size, the only sort of

weight loss associated with hypoT. To me a goiter sounds worse,

because it results in disfigurement.

Once you get your dosage stabilized, you should feel as well as ever,

with a couple of caveats. For example, I've noticed an intolerance to

heavy exercise, which seems to use up the T3 faster than usual. My

system can't keep up for more than about three hours of work, then I

become a vegetable for a short period. Several of us on the list call

this " hitting the wall. " It is much like what a marathoner runs into

when the liver's supply of glucose runs out. Either that or I've just

become lazy with age.

Really, you can still exercise, but you have to pace yourself. Where

before you could " party all night " and pay the piper later, now you tend

to pay up front.

Body temperature is an especially good indicator of metabolism. HypoT

folks feel cold because they are cold. Other symptoms can be important

indicators, and you should memorize the list of both hypo-T and hyper-T

symptoms, just in case. However, if you expect a comment with more

content than " That's too bad, " we would also like to see your blood test

results. These should include the reference ranges for each test as

reported by your lab.

Don't be shy about sharing this information. Most of us have done these

tests over and over for years. They don't indicate your IQ or anything

really personal. They just give clues on what is causing your condition.

Also, these are YOUR test results. You have a right to ask for a copy

from your doctor.

I tend to ask for a test myself at least every six months, but I am

paranoid about my health. A year would work if you had no symptoms for a

long time. My mother went several years before checking her dosage. It

nearly killed her once, when they changed the formulation of Synthroid

and didn't tell the doctors.

A summary of the various tests you may be asked to take:

http://vitamvas.tripod.com/lab.html

For most of us, increasing the available T4 by taking a synthetic

replacement adequately supports the FT3 level. If it doesn't, you could

have poor conversion from T4 to T3. Or, you could have excessive binding

of both T4 and T3, so the free components are too low. Another possible

problem is that antibodies are making your other tests invalid,

indicating within the normal range when they are actually outside.

One possible solution for all of these is to drive TSH lower than the

reference range, or to increase T4 to higher than its reference range.

You can do that with either more T4 or by adding T3 to the mix. Again,

the reference ranges are valid for initial screening and perhaps for

initial titration. After that, interpretations vary depending on the

physician, many of whom do not believe the published lab guidelines. Two

major professional groups have issued recommendations about LOWERING the

reference ranges for people on the medications.

We seem to agree there is a list of foods to avoid, especially if you

have at least some thyroid function left. This includes goitrogen foods:

http://www.ithyroid.com/goitrogens.htm .

I personally eat many of the goitrogens, particularly nuts and raw

broccoli, but I have no thyroid function left, nothing left to lose. I

still avoid soy, because it apparently goes after thyroxine in serum. I

have not noticed any effect from the other goitrogens, since I am on a

full replacement dose of thyroxine.

I also try to minimize consumption of fluoride. This is another bad

actor that is toxic to both an active thyroid gland and thyroid hormones

in the blood. Black tea is particularly rich in fluoride, so the only

tea I have any more is green tea, and that is pretty rare, coffee being

an essential nutrient, at least to me. Herbal teas are not a problem for

fluoride. The amount in city water supplies is a concern. Check with

your public water company.

Although some on the list recommend taking iodine supplements in

addition to the replacement medications, iodine is toxic if you get too

much, and it has especially bad effects for those with Hashimoto's. It

seems to stimulate the antibody attack. Levothyroxine (T4) IS an iodine

supplement with four iodine atoms in each molecule. I personally would

not take iodine (e.g. kelp) unless you have evidence of a deficiency.

That could be the case for someone with untreated symptoms, or someone

not taking hormone replacements, which, in fact, are a concentrated form

of iodine.

As to what TO eat, most of us are fighting weight problems. HypoT also

puts us at risk of high-cholesterol induced cardiac and stroke and type

II diabetes. Diet is probably where the widest range of controversy

lies. Many of us have tried the extremely low carbohydrate diets and

lost some weight. However, I found that after about 10 months, even the

extreme induction form of the diet no longer worked. I think my

metabolism had simply adapted. It just took longer than it takes to

adapt to a low fat diet.

OTOH, hypothyroidism seems to make us particularly susceptible to the

effects of high glycemic index foods. So, I still try to minimize sugars

and simple or refined starches along with saturated and especially trans

fats. We have had a couple of testimonials for coconut oil, but it did

absolutely nothing for me.

Some on the list will give you a long list of supplements they swear by.

I think some of us could stock a health food store with what is in their

medicine cabinets. However, some things seem to be on everyone's list.

The first is selenium, since it helps with T4-T3 conversion. As with

iodine, though, too much selenium is reputed to be toxic. Make sure you

aren't getting it from multiple sources.

Another supplement that is frequently mentioned is vitamin B-12. For me

it helps with energy level if taken or injected intermittently. Too

often, and I get jittery, can't sleep, and feel rather wiped out and

uncomfortable.

In summary, diet won't help much with the primary symptoms unless the

hormone levels are properly balanced. For most of us, that means getting

the dosage or combination of replacement hormones right. Once that is

fixed, the main concern is choosing a " healthy diet " that controls the

weight gain. However, we have lots of conflicting opinions on what that

means.

Calcium carbonate has been shown in several well reviewed tests to

interfere with T4 absorption when taken up to three hours after the T4.

However, the form of calcium in milk should not do this. It is not

carbonate. Iron is another nutrient with this interference capability.

Calcium carbonate is in a lot of other medications and supplements as a

binder. You should not take any food within an hour after or two hours

before your T4, longer for iron, calcium, or fiber.

Don't take these anywhere near the same time as your T4. Most of us take

the hormone first thing in the morning and other medications after

breakfast or in the evening. Fiber is not nearly as bad as calcium

carbonate or iron. These will affect absorption even after three hours.

I would also suggest waiting for the dosage to settle before starting a

low carb diet. That shuts down the intestines independent of thyroid

status. The two together could be a real problem. One final possibility

is that a lot of the non-dairy creamers have soy in them. Soy will also

interfere long after you take the Synthroid.

It is also possible that iodide added to salt could aggravate autoimmune

thyroiditis, actually making your T3 lower. However, this is usually a

slower, longer term effect. Another caution is that a gross excess of

iodide can burn the thyroid. Again, this is usually a longer term

effect, not something that would affect a selected afternoon and then go

away. It would also take a fairly large slug of iodide, more than is

usually available in table salt.

" Subclinical " means that a set of indicator symptoms are not confirmed

by chemical tests. Before T3 and T4 assays became widely available, the

main or only test used was TSH. Thus, at one time, subclinical meant

symptoms with a high normal, or slightly above normal, TSH. With other

tests and other protocols for each test, the accepted definition has

necessarily changed.

One major issue with a subclinical diagnosis is whether the tests you

had are reliable or relevant. Free T3 is the one that really controls

the symptoms, so a normal Total T4 or Total T3 test may not be

completely meaningful, particularly if conversion to T3 is messed up or

if too large a fraction of T3 is bound by albumin and globulin.

The other big issue is the effect of antibodies, which may or may not

change the other readings. If you had no antibodies detected, this is

less likely, unless you are in a very early stage of thyroid

deterioration. If so, a small supplementation in either or both T4 and

T3 might help with symptoms or their anticipated progression. Just watch

for hyperT symptoms. That would tell you to back off the dosage.

Again, welcome aboard, and I hope these comments help. If you object to

any of the " standard model " information I included, please concatenate

some rebuttal posts and web pages, and I'll formulate a two sided FAQ

message that we can post every so often for new members.

Chuck

July 12, 2006

Thanks for this FAQ Chuck. I found out that green tea has just as

much and possibly more fluoride than black tea. I have been a tea

drinker all my life and I love Japanese green teas but I gave them

all up also once I found this out.

Fluoride Content of Teas (13)

Type of Tea - Fluoride (mg/liter)* - Fluoride (mg/8 ounces)

Green 1.2-1.7 0.3-0.4

Oolong 0.6-1.0 0.1-0.2

Black 1.0-1.9 0.2-0.5

Brick tea 2.2-7.3 0.5-1.7

http://lpi.oregonstate.edu/infocenter/phytochemicals/tea/

On Jul 11, 2006, at 5:05 PM, Chuck B wrote:

>

> I also try to minimize consumption of fluoride. This is another bad

> actor that is toxic to both an active thyroid gland and thyroid

> hormones

> in the blood. Black tea is particularly rich in fluoride, so the only

> tea I have any more is green tea, and that is pretty rare, coffee

> being

> an essential nutrient, at least to me. Herbal teas are not a

> problem for

> fluoride. The amount in city water supplies is a concern. Check with

> your public water company.

July 12, 2006

Chuck, that is great. I have it saved and would suggest anyone with an

interest in hypothyroidism do the same.

..