Endo visit

[Guest guest]

Hi Sheila and All

I am going to see endo tomorrow (a few of you know who I mean). I

don't really know what to say. I think I am improving and then I have

a bad day or often a good day turns into a bad one quite quickly. I am

on T4 75mcg and T3 20mcg (increased via email request to secreatary 6

weeks ago from 10mcg). It took about three weeks from changing dose

for me to notice any change and then I did very slowly start to feel

better. I have been having horrible cramps in my thighs since October

which were still there but more in the background some days and other

days not there at all. I have been checking my basal temp and this has

been 36.5 - 36.6 at the beginning of my cycle. This morning (day 20)

it was 36.9. My day time temps are 36.8 - 37.3. My last blood test

after meds was T3 6.4 and T4 10 TSH 0.12. I am wondering if I am going

hyper I still have energy slumps but have felt a little jittery last

couple of days. I have been checking my lying and standing Bp and it

has risen on standing between 5 and 15 points most times. Am taking 4

nae. I take all thyroid meds at night and do not have any problem

sleeping. I am unsure whether I should be pushing for an increase in

T4 or a reduction in T4 and an increase in T3. I very much doubt that

he will prescribe me any Armour as he told me it would be the last

thing he would consider. It is so frustrating I so want to feel better

and I do not want to appear awkward and would love to go in and tell

him the T3 worked and I feel fantastic but sadly this is not the case.

I forgot to mention I have really aching knee joints on going up and

down the stairs and I wasn't aware of this at all before being

diagnosed and started on T4 and wonder if this is causing it or if not

having enough T4 is causing it.

What a long rambling message Im sorry if I sound really sorry for

myself I know there are some of you out there really suffering.

I think the thing is you pin all your hopes on an appointment you

have been waiting months for and then come away feeling disheartened

or having forgotten to say something., and then you have months to

wait before trying again.

If anyone can help I would welcome your advice.

Love Lizzie

[Guest guest]

Good thinking Batwoman

I won't go into my h/c history , I am a more complicated case.

Mo

I am not tapering the HC after careful consideration, I am still getting to grips with it, only 2 weeks on 20mcg, the first 3 I gradually increased, just seeing this endo today has sent me in another whirl of thoughts and doubts, but I know what I am doing is right, its too early to say if the HC is helping, I think it may be a bit. All these other symptoms I have are my own anxities but I think they are getting better. How long have you been on HC MO? You are self treating arent you?-

Happy temping!

When you taper the h/c you will be able to see how that is affecting your adrenals.

Ditto if you then substitute some other form of adrenal med.

Mo

Ive ordered a new one of the Bupa website

Google is your friend

That is what I do and look for an easy-read model cos I am going blind as a bat. And I still need to find my specs to be sure, to be sure, to be sure....

There are non-mercury liquid ones also which do as good a job I believe and they are a bit more pricey.

Mo

The sugar just showed in my urine Mo, I did think that the blood one should be fasting, but they took blood for that anyway. No I dont show any symptoms of diabeties apart from the tiredness.

Could you tell me Mo where to order an accurate thermometer from if you know of anywhere?--- On Wed, 24/9/08, moosbornetiscali (DOT) co.uk <moosbornetiscali (DOT) co.uk>

Did you fast overnight for the blood glucose test ?

Mo

Just got back from my appointment, he was actually a nice enough man, but did rubbish my adrenal profile results as very inaccurate, I pointed out the grey areas between s and Cushings but he didnt seem to agree, he has advised I stop the HC so they can do their adrenal tests, when I saw Dr P and he did the adrenal tests on me he didnt seem to think my adrenals were too bad and it was me who asked him if I could start the HC, he didnt tell me at our meeting to start it, so I think I will boost my adrenals in other ways and gradually reduce the HC. The endo did say I could just stop as I havent been on it long, 5 weeks but not at full 20mg dose, but I said I would prefer to withdraw slowly. He took bloods etc and there were traces of sugar in my urine so hes took blood for diabeties too, maybe thats why I havent felt well?! Who knows. He did say I could go back straight on 150mcg of T4 but I said no way! I said I would wait until I get the bloods back from today and see where my levels lie. So all in all I did know what he would say and no surprises really. He did say the 20mcg of HC would be too much if my adrenal were ok and could cause me problems, weight gain etc and I said well it hasnt made me feel any better!I dont think I should have a problen stopping the HC but will taper it anyway

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[Guest guest]



To have sugar in the urine from just an apple would indicate diabetes. The urine sticks do not show sugar in urine until it reaches 10. The only thing is that is was only after an hour and it is usually tested after two hours.

The blood test they would have done is the HbA1c which will give them an indication of how your blood sugar has been over the previous three months.

If you are having adrenal problems that could affect your insulin levels. Adrenalin blocks insulin, so if someone's adrenalin is running high then it is likely that they will have more glucose in their blood.

Lilian

Re: Endo visitthyroid treatment Date: Wednesday, 24 September, 2008, 7:20 PM

, what did you have to eat about two hours before you went to see the endo?

Lilian

[Guest guest]

Here are the tender points where the pain and

discomfort is felt in those suffering with fibromyalgia. I can't remember

without looking it up, but I believe you have to have at least 8 of these

points

Hi Sheila

No I only really notice it in my thighs, I suppose around my shoulder

blades are a little tender but not so that it bothers me.

Love Lizzie

>

> I wonder if this could be Fibromyalgia. Ask Dr B about this. There are

> specific areas in your body that are tender points with this

disease. Do you

> have pain elsewhere or feelings of tenderness Lizzie.

[Guest guest]

Dear sheila

I couldn't open the attachments you sent me. I have looked up

fibromyalgia though and it talks about widespread pain and severe

fatigue which I don't have. I will see what Dr B says but I bet he

will tell me to stop looking things up on the internet. Oh I do so

hope he shows pity on me and relents and lets me try Armour.

Love Lizzie

>

> Here are the tender points where the pain and discomfort is felt in

those

> suffering with fibromyalgia. I can't remember without looking it up,

but I

> believe you have to have at least 8 of these points

>

>

>

> http://www.fibroandfatigue.com/images/tender-points.jpg

>

> Hi Sheila

>

> No I only really notice it in my thighs, I suppose around my shoulder

> blades are a little tender but not so that it bothers me.

>

> Love Lizzie

> >

> > I wonder if this could be Fibromyalgia. Ask Dr B about this. There are

> > specific areas in your body that are tender points with this

> disease. Do you

> > have pain elsewhere or feelings of tenderness Lizzie.

>

[Guest guest]

Lizzie - there were a couple of points either side of the neck

and two around the area of the collar bone (1 either side) then one point in

the inside of each elbow and one point more or less on the inside of each knee

(all of these at the front) and then at the back are two points at the base of

the skull, a couple of points lower down the side of the neck and two points on

the shoulder blades. Another point in the lower back below the kidneys and

another point at the back of the top of each leg.

Hope that helps.

Luv - Sheila

[Guest guest]

Hmmm! An

Endoprat and a Plonker!

As your

endo told you it is " Notoriously difficult to monitor patients taking

Armour " - you should ignore him and if this was me and doing well and

feeling well on your present dose of Armour, I would most definitely not put my

health in jeopardy through advice from an Endoprat who knows nothing about

natural thyroid extract. Your endocrinologist can recommend your GP to

prescribe Armour but he cannot make your GP do it. If the GP is happy to do so,

and if your local Primary Care Trust is happy to fund it, that is fine, but do

remember Armour is not a licensed medication here in the UK and therefore your

GP would need to take full responsibility if anything should go wrong. However,

there are more and more doctors who are happy to prescribe it because word is

getting around that it works.

Your endo

is a plonker too regarding Vitamin D. Read what Dr Theodore Friedman (one of

our medical advisers) has to say about the Vitamin D/Thyroid connection and

perhaps copy this off and show your endoprat.

Vitamin D Deficiency and Thyroid Disease

Theodore C. Friedman, M.D., Ph.D.

Vitamin D deficiency and thyroid diseases

Vitamin D is an important vitamin that not only regulates calcium,

but also has many other

beneficial actions. Not many endocrinologists realize this, but

several articles published

over 20 years ago showed that patients with hypothyroidism have

low levels of vitamin D.

This may lead to some of the bone problems related to

hypothyroidism. It was thought that

one of two mechanisms may explain the low levels of vitamin D in

patients with

hypothyroidism, 1) the low levels of vitamin D may be due to poor

absorption of vitamin D

from the intestine or 2) the body may not activate vitamin D

properly. Other articles have

demonstrated that patients with Graves disease also have low

levels of Vitamin D.

Importantly, both vitamin D and thyroid hormone bind to similar receptors

called steroid

hormone receptors. A different gene in the Vitamin D receptor was

shown to predispose

people to autoimmune thyroid disease including Graves’

disease and Hashimoto’s

thyroiditis. For these reasons, it is important for patients with

thyroid problems to

understand how the vitamin D system works.

Sources of Vitamin D

Vitamin D is really two different compounds, ergocalciferol

(vitamin D2), found mainly in

plants and cholecalciferol (vitamin D3), found mainly in animals. Both of these hormones

are collectively referred to as vitamin D, and they can either be

obtained in two ways. One

is by exposure of the skin to the ultraviolet (UV) rays of

sunlight or also from dietary intake.

Vitamin D is found naturally in fish (such as salmon and sardines)

and fish oils, eggs and

cod liver oil. However most Vitamin D is obtained from foods

fortified with Vitamin D,

especially milk and orange juice. Interestingly, as breast feeding

has become more popular,

the incidence of Vitamin D deficiency has increased as less

fortified milk is consumed.

Vitamin D deficiency may also occur in patients with malabsorption

from their intestine,

such as in the autoimmune disease called Celiac Disease, which

occurs frequently in

patients with thyroid problems. Multivitamins also contain Vitamin

D, as does some

calcium supplements like Oscal-D and Citracal plus D..

Different Forms of Vitamin D and How To Diagnose

Vitamin D

Vitamin D itself is inactive and needs to get converted to the

liver to 25-hydroxy vitamin D

(25-OH vitamin D) and then in the kidney to 1, 25-hydroxy vitamin

D. It is only the 1, 25-

OH vitamin D which is biologically active. This form of vitamin D

acts to allow for

absorption of calcium from the intestinal tract. Therefore,

patients with low vitamin D

levels will have low calcium and in severe cases get rickets (in

children) or osteomalacia (in

adults) which is when the bone bows out and is poorly formed. In

mild cases of vitamin D

deficiency, osteoporosis occurs.

The conversion from the 25-OH vitamin D to the 1, 25-OH vitamin D

that occurs in the

kidney is catalyzed by parathyroid hormone, also called PTH.

Therefore, patients with low

vitamin D levels will have relatively high PTH levels along with

low calcium levels. This is

similar to patients with primary hypothyroidism having elevated

TSH levels while having

normal thyroid hormone levels. Additionally, the 25-OH vitamin D

form which is the

storage form and is much more abundant that the 1, 25-OH vitamin D

form which, although

is active, is less abundant. Therefore, in states of vitamin D

deficiency, low levels of 25-OH

vitamin D are found, but the 1, 25-OH vitamin D levels are either

normal or actually slightly

high. They are slightly high because the excess PTH that is

stimulated by the low 25-OH

vitamin D levels stimulates the conversion up to 25-OH vitamin D

to the 1, 25-OH vitamin

D. Thus, patients that are vitamin D deficient usually have a low

25-OH vitamin D level, a

high PTH level, a low normal calcium, and a normal or an elevated

1, 25-OH vitamin D

level.

Dr. Friedman usually recommends measuring PTH, calcium, and 25-OH

vitamin D to

determine if a patient does have vitamin D deficiency. The 25-OH

vitamin D assay has a

normal range of approximately 20-60 ng/dL. However, this range may

be too low for many

patients. Additionally, the assay may not be that good at

measuring the low levels of

vitamin D. In general, Dr. Friedman would recommend treatment of

patients that have a 25-

OH vitamin D of less than 30 ng/dL, but these patients should have

a PTH in the high

normal range. Optimal levels of 25-OH Vitamin D for patients with

thyroid diseases are

probably 35-60 ng/dL.

Treatment of Vitamin D Deficiency

There are several ways to correct for the depletion of vitamin D,

and these would involve

either increasing sunlight exposure or increasing dietary intake.

In general, Dr. Friedman

feels there is an ongoing battle between endocrinologists and

dermatologists about sunlight

exposure, and mild sunlight exposure probably does not have that

much of an increased risk

of skin cancer yet would be helpful to prevent vitamin D

deficiency. Because of our busy

schedule, many of us do not go outside during the day much and our

sunlight exposure is

minimal. When we do go outside, we are usually covered up with

clothes. Blacks and other

dark skinned patients absorb less Vitamin D and need more sunlight

exposure. Dr. Friedman

recommends a patient to be exposed to the sun for 15-30 minutes a

day, especially in the

morning, to correct for vitamin D deficiency. However, in northern

latitudes, little light of

the proper wavelength goes through the atmosphere in the winter,

so this exposure needs to

occur in the spring and summer at which time stores of vitamin D

are built up. The body has

mechanisms so that too much vitamin D can not be synthesized by

prolonged sun exposure.

An alternative is to go to a tanning salon for approximately three

times.

When it comes to replacing Vitamin D, again we have to understand

the difference between

D2 (ergocalciferol) and D3 (cholecalciferol). Even though both

forms of vitamin D are fat

soluble, studies have shown that if you take D2, your levels rise,

but then fall back to almost

baseline in a few weeks. In contrast, after D3, the levels stay

high for awhile. Dr. Friedman

and other doctors frequently prescribe a high dose (50,000 iu) of

vitamin D weekly for 8

weeks, but this is D2 and in many people the levels drop down to

normal after nor taking it

for a few months. This needs to be given by a prescription.

Vitamins and preparations like

Oscal D contain D3, however the amount in these preparations are

small. For example, each

multivitamin contains 400 international units of vitamin D3 so a

total of 800 international

units of vitamin D will probably prevent Vitamin D deficiency and

may correct mild cases

of low vitamin D levels. For more severe levels, the patient can

take 50,000 international

units of vitamin D orally once or twice a week.

Dr. Friedman finally found a product that has high doses of D3

that could be used to rapidly

restore vitamin D levels in patients that are deficient and keep

the levels up. This product

50,000 iu d3 is sold in bottles of 12 by bio-tech-pharm.com and is

catalogue # 36212A. The

website is http://www.bio-tech-pharm.com/catalog/product_info.php?products_id=77

For a 25-OH vit D level less than 20, Dr. Friedman recommends

taking one pill a week for

8-12 weeks, then checking a 25-OH vitamin D and serum calcium

level. If levels are in the

normal range, then you can take one pill a month for the next 6

months for maintenance.

After 6 months, you should be adequately treated. For patients

with 25-OH vit D level

between 20 and 25, one pill a week for 6-8 weeks is recommended

and for patients with 25-

OH vit D level between 25 and 30, one pill a week for 4-6 weeks is

recommended. In both

cases, you should check a 25-OH vitamin D and serum calcium level.

If levels are in the

normal range, then you can take one pill a month for the next 6

months for maintenance.

Please take the pills weekly and not daily.

The main side effect of vitamin D therapy is overtreatment leading

to hypercalcemia.

Patients with kidney problems cannot convert vitamin D to the

active 1, 25-OH vitamin D

levels and need to take calcitriol which is 1, 25-OH vitamin D.

Additionally, patients with

hypoparathyroidism are usually placed on the calcitriol as well.

Conclusion

Vitamin D appears to have many effects besides being related to

calcium and bone health.

Some patients with low vitamin D levels have fatigue and bone

pain, which is easily

reversible with proper replacement of vitamin D. Vitamin D may

protect against heart

disease and some types of cancer. Vitamin D may also have some

role in regulating the

immune system and also reducing blood sugar levels in patients

with diabetes. Proper

vitamin D levels are needed to prevent osteoporosis. In

conclusion, proper vitamin D levels

are essential for one’s health, especially if you have

thyroid problems. Unless a patient is

exposed to sunlight or foods containing vitamin D, screening for

Vitamin D deficiency is

recommended for all thyroid patients.

This article is not intended to offer medical advice and is

offered for information purposes

only. Do not act or rely upon information from this article

without seeking professional

medical advice. For more information about Dr. Friedman or to

schedule an appointment,

When I told my endo that I felt that the Vit D had enabled my body to

metabolise the thyroid hormones in Armour more efficiently, hence the

need for less, he laughed and said this is rubbish!!!!