Re: Finding the right medication regime

[Guest guest]

Hi Bill,

First off, without lab values for Free T3 and Free T4 (and lab

ranges - each lab has slightly different ranges), it's really hard

to tell how effective your treatment has been. However, as you know,

the inability to lose weight is a hypo symptom (in particular if you

are a healthy diet and exercising).

It is well known that lipid abnormalities, High cholesterol,

increased heart disease risk all go along with undiagnosed or

undertreated thyroid disease. And, as you've seen the labs will

improve when you're given thyroid hormone. The most effective way to

get that HDL up is exercise. As far as taking cholesterol lowering

medicine, I would be on the fence about that. One thing I wonder

based on the fact that your cholesterol did go to 202 at one point

is whether these are fasting labs - that's the only way to even get

close to an accurate level and you can have spikes depending upon

what you had eaten in the last 24 hours.

So, my suggestion would be to ask your doctor to run the Free T3 and

Free T4 and antibodies (TPO and Anti-thyroglobulin). The Frees are

most important because that's the thyroid hormone that is available

for your body to actually use. If you have antibodies, then ideally

your TSH would likely need to be near one (this is document in the

online thyroid book).

Also, you don't mention whether your T4 was measured before or after

you took your thyroid hormone for the day - it can be falsely

elevated as it gets into the blood stream.

I have had the best luck getting the right dosage by making sure my

labs are run in the a.m. and are fasting (no thyroid hormone). Also,

your TSH declines during the day, which is why morning is better.

Also, I ask for the lab slip so I can get labs run 2 weeks before my

appt so my dosing can be based on the most recent information.

Endocrinologists tend to be the worst doctors for treating thyroid

disease (in particular autoimmune) as they're trained to treat end

stage diseases and I would guess that you won't find a single one

that thinks you need more or a different dosage of your thyroid

hormone. Of course, this is very much YMMV, I just haven't heard of

anyone that sees an endo for hypothyroidism that's doing well.

Good luck!

B.

>

> I'm a 51-year-old man. I am currently 5' 8 " tall and weigh 230

lbs. I

> gained the last 50 lbs fairly quickly in 2003 and 2004 while

taking an

> anti-depressant.

>

> In January 2008 I was diagnosed as hypothyroid. My TSH was 7.18.

> Although I had physical exams every 3-4 years prior to this, there

had

> never been a prior diagnosis of thyroid issues.

>

> I was also diagnosed at that time with high cholesterol. My total

> cholesterol was 235, triglycerides were 143, LDL of 159, and HDL of

> 47. Prior to this my total cholesterol had been in the 160s to

180s.

>

> My doctor prescribed Synthroid 125 mcg / day.

>

> In March 2008, my TSH was 2.18, cholesterol was 219, triglycerides

> were 138, LDL of 144, and HDL of 47. Total T4 was 10.9, FTI was

3.7,

> total T3 was 150, T3 uptake was 34. As you can see, my TSH was now

in

> the normal range and blood lipids were all improving.

>

> My doctor upped my Synthroid to 150 mcg / day.

>

> In May 2008, my TSH was 1.94, cholesterol was 202, triglycerides

were

> 159, LDL of 130, and HDL of 40. Total T4 was 11.0, FTI was 3.6,

total

> T3 wasn't reported, T3 uptake was 33. Except for triglycerides, all

> blood lipids improved.

>

> In July 2008, my TSH was 1.48, cholesterol was 251, triglycerides

were

> 200, LDL of 166, and HDL of 45. Total T4 was 12.1, FTI was 3.9,

total

> T3 was 149, T3 uptake was 32. All of my blood lipids had reversed

> direction and increased by 25 - 27%. They were worse than when I

began

> treatment.

>

> In October 2008, my TSH was 1.40, cholesterol was 240,

triglycerides

> were 184, LDL of 163, and HDL of 40. Total T4 was 12.2, FTI was

4.3,

> total T3 was 168, T3 uptake was 35. My blood lipids were starting

to

> trend back down, but my T4 and FTI were at or over the top of the

> " normal " range. Same for T3 uptake.

>

> My doctor has since added Vanachol in an effort to get my

cholesterol

> under control.

>

> Does anyone have ideas as to what is going on with my thyroid and

> blood lipids?

>

> I have an appointment with my doctor in late January. I'm going to

ask

> him to reconsider my thyroid meds and/or refer me to an

> endocrinologist who specializes in thyroid disorders.

>

> Bill

>

[Guest guest]

We need the reference ranges and the exact name of each test.

I would note that your doc has run the older thyroid panel. What you need is Free T3 direct and Free T4 direct. FTI (Free Thyroxine Index) is an obsolete test, actually a calculation which yields an estimate of Free T4 levels. T3 Uptake measures thyroid binding globulins, not T3 levels.

Free T3 and Free T4 tests would be the first thing to ask for. Your Frees could be a lot lower than your Totals.

Your lipids would suggest that you may be undermedicated. Elevated triglycerides, however, can be due to what you ate the previous day, or they can be the result of elevated blood sugar. Hopefully your doc has run a fasting blood glucose, or even an A1c.

With a few notable exceptions, few of the better thyroid docs are endocrinologists. Most of the better thyroid docs are in primary care. The very best ones are hypothyroid themselves along with family members and even pets(!).

While there is no one thyroid med which is optimal for everyone, many of us do better on Armour, an extract of desiccated porcine thyroid glands. One of my favorite docs switched all of his thyroid patients to Armour, and not one has asked to go back to their $ynthroid.

>> I'm a 51-year-old man. I am currently 5' 8" tall and weigh 230 lbs. I> gained the last 50 lbs fairly quickly in 2003 and 2004 while taking an> anti-depressant.> > In January 2008 I was diagnosed as hypothyroid. My TSH was 7.18.> Although I had physical exams every 3-4 years prior to this, there had> never been a prior diagnosis of thyroid issues.> > I was also diagnosed at that time with high cholesterol. My total> cholesterol was 235, triglycerides were 143, LDL of 159, and HDL of> 47. Prior to this my total cholesterol had been in the 160s to 180s.> > My doctor prescribed Synthroid 125 mcg / day. > > In March 2008, my TSH was 2.18, cholesterol was 219, triglycerides> were 138, LDL of 144, and HDL of 47. Total T4 was 10.9, FTI was 3.7,> total T3 was 150, T3 uptake was 34. As you can see, my TSH was now in> the normal range and blood lipids were all improving.> > My doctor upped my Synthroid to 150 mcg / day.> > In May 2008, my TSH was 1.94, cholesterol was 202, triglycerides were> 159, LDL of 130, and HDL of 40. Total T4 was 11.0, FTI was 3.6, total> T3 wasn't reported, T3 uptake was 33. Except for triglycerides, all> blood lipids improved.> > In July 2008, my TSH was 1.48, cholesterol was 251, triglycerides were> 200, LDL of 166, and HDL of 45. Total T4 was 12.1, FTI was 3.9, total> T3 was 149, T3 uptake was 32. All of my blood lipids had reversed> direction and increased by 25 - 27%. They were worse than when I began> treatment.> > In October 2008, my TSH was 1.40, cholesterol was 240, triglycerides> were 184, LDL of 163, and HDL of 40. Total T4 was 12.2, FTI was 4.3,> total T3 was 168, T3 uptake was 35. My blood lipids were starting to> trend back down, but my T4 and FTI were at or over the top of the> "normal" range. Same for T3 uptake.> > My doctor has since added Vanachol in an effort to get my cholesterol> under control.> > Does anyone have ideas as to what is going on with my thyroid and> blood lipids?> > I have an appointment with my doctor in late January. I'm going to ask> him to reconsider my thyroid meds and/or refer me to an> endocrinologist who specializes in thyroid disorders.> > Bill>

[Guest guest]

Changing my thyroid medicine to Armour from Synthroid did more to bring

down my cholesterol that 80 mg of Lipitor ever did...

Marti

> I'm a 51-year-old man. I am currently 5' 8 " tall and weigh 230 lbs. I

> gained the last 50 lbs fairly quickly in 2003 and 2004 while taking an

> anti-depressant.

>

> In January 2008 I was diagnosed as hypothyroid. My TSH was 7.18.

> Although I had physical exams every 3-4 years prior to this, there had

> never been a prior diagnosis of thyroid issues.

>

> I was also diagnosed at that time with high cholesterol. My total

> cholesterol was 235, triglycerides were 143, LDL of 159, and HDL of

> 47. Prior to this my total cholesterol had been in the 160s to 180s.

>

> My doctor prescribed Synthroid 125 mcg / day.

>

> In March 2008, my TSH was 2.18, cholesterol was 219, triglycerides

> were 138, LDL of 144, and HDL of 47. Total T4 was 10.9, FTI was 3.7,

> total T3 was 150, T3 uptake was 34. As you can see, my TSH was now in

> the normal range and blood lipids were all improving.

>

> My doctor upped my Synthroid to 150 mcg / day.

>

> In May 2008, my TSH was 1.94, cholesterol was 202, triglycerides were

> 159, LDL of 130, and HDL of 40. Total T4 was 11.0, FTI was 3.6, total

> T3 wasn't reported, T3 uptake was 33. Except for triglycerides, all

> blood lipids improved.

>

> In July 2008, my TSH was 1.48, cholesterol was 251, triglycerides were

> 200, LDL of 166, and HDL of 45. Total T4 was 12.1, FTI was 3.9, total

> T3 was 149, T3 uptake was 32. All of my blood lipids had reversed

> direction and increased by 25 - 27%. They were worse than when I began

> treatment.

>

> In October 2008, my TSH was 1.40, cholesterol was 240, triglycerides

> were 184, LDL of 163, and HDL of 40. Total T4 was 12.2, FTI was 4.3,

> total T3 was 168, T3 uptake was 35. My blood lipids were starting to

> trend back down, but my T4 and FTI were at or over the top of the

> " normal " range. Same for T3 uptake.

>

> My doctor has since added Vanachol in an effort to get my cholesterol

> under control.

>

> Does anyone have ideas as to what is going on with my thyroid and

> blood lipids?

>

> I have an appointment with my doctor in late January. I'm going to ask

> him to reconsider my thyroid meds and/or refer me to an

> endocrinologist who specializes in thyroid disorders.

>

> Bill

[Guest guest]

Thank you all for your insights.

Yes, all of my blood work was based on fasting 12 hours prior to the

blood draw. However, I took my Synthroid two or three hours prior to

the blood draws.

Normal ranges were:

TSH 0.40 - 4.50 mIU/L

Total T3 97 - 219 ng/dL

T3 uptake 22 - 35%

Free T4 0.8 - 1.9 ng/dL

Total T4 4.5 - 12.5 mcg/dL

FTI 1.4 - 3.8

I will ask my doc for a Free T3, Free T4, and antibodies test before I

see him in January.

Bill

[Guest guest]

T3 and T4 numbers at 2-5 hours will represent a spike in your levels. TSH is not affected. So, you are probably still undermedicated.

>> Thank you all for your insights.> > Yes, all of my blood work was based on fasting 12 hours prior to the> blood draw. However, I took my Synthroid two or three hours prior to> the blood draws.> > Normal ranges were:> > TSH 0.40 - 4.50 mIU/L> > Total T3 97 - 219 ng/dL> > T3 uptake 22 - 35%> > Free T4 0.8 - 1.9 ng/dL> > Total T4 4.5 - 12.5 mcg/dL> > FTI 1.4 - 3.8> > I will ask my doc for a Free T3, Free T4, and antibodies test before I> see him in January.> > Bill>