Re: Wondering if anyone knows anything about this

[Guest guest]

In a message dated 2/22/2005 4:30:33 PM Eastern Standard Time,

vegan1338@... writes:

> My main question that I need feedback on is that now the doctor is saying

> that if my TSH is still low, it must be pituitary and wants to order an MRI of

> the brain and all that. I am suspicious of this, since my T4 and TSH only

> dropped after starting all of the medicines. But she says if my T3 and T4 are

> low and TSH is low at the same time (even though it wasn't before this),

> then it must be pituitary

did you say what your TSH was BEFORE starting everything?

she is suspecting central hypothyroidism which originates from the pituiary -

and is probably wanting to check for a pituitary adenoma. that might be wise

to check that.

cindi

[Guest guest]

In a message dated 2/22/2005 4:30:33 PM Eastern Standard Time,

vegan1338@... writes:

> My main question that I need feedback on is that now the doctor is saying

> that if my TSH is still low, it must be pituitary and wants to order an MRI of

> the brain and all that. I am suspicious of this, since my T4 and TSH only

> dropped after starting all of the medicines. But she says if my T3 and T4 are

> low and TSH is low at the same time (even though it wasn't before this),

> then it must be pituitary

did you say what your TSH was BEFORE starting everything?

she is suspecting central hypothyroidism which originates from the pituiary -

and is probably wanting to check for a pituitary adenoma. that might be wise

to check that.

cindi

[Guest guest]

In a message dated 2/22/2005 4:30:33 PM Eastern Standard Time,

vegan1338@... writes:

> She might stop prescribing the medicine now and I am afraid of having to

> go off of it " cold turkey " and be worse than before, since my body is putting

> out less of it's own hormones now.

>

i don't think she will stop prescribing you medicine....it's obvious you are

hypo - whatever the reason (thyroid or pituitary)....and it is treated the

same.

cindi

[Guest guest]

In a message dated 2/22/2005 4:30:33 PM Eastern Standard Time,

vegan1338@... writes:

> She might stop prescribing the medicine now and I am afraid of having to

> go off of it " cold turkey " and be worse than before, since my body is putting

> out less of it's own hormones now.

>

i don't think she will stop prescribing you medicine....it's obvious you are

hypo - whatever the reason (thyroid or pituitary)....and it is treated the

same.

cindi

[Guest guest]

In a message dated 2/22/2005 4:30:33 PM Eastern Standard Time,

vegan1338@... writes:

> She might stop prescribing the medicine now and I am afraid of having to

> go off of it " cold turkey " and be worse than before, since my body is putting

> out less of it's own hormones now.

>

i don't think she will stop prescribing you medicine....it's obvious you are

hypo - whatever the reason (thyroid or pituitary)....and it is treated the

same.

cindi

[Guest guest]

In a message dated 2/22/2005 8:21:21 PM Eastern Standard Time,

vegan1338@... writes:

> I don't have that exact lab value, but the TSH was " normal " before starting

> Cytomel/thyroid treatment, and only the T3 was low to start with. I think

> the TSH was in

> the low-to-middle part of the " normal " range then.

was that the normal that most docs use...that goes up to about 6....or the

new guideline that goes up to 3? But even within normal....you can be hypo and

it not necessarily be because of your pituitary. My TSH never got over

7...and yet I have seen descriptions of how I was at that time described as

" severe " . I think that the pituitary can just be affected by the hypo (in my

case

caused by hashimoto's) and not rise. There are also other type antibodies that

can affect TSH that no one ever seems to test for either. Although i do think

your doctor is being thorough to check....unless your TSH was in the hyper

range....and you were hypo...I wouldn't think additional testing was necessary.

Cindi

[Guest guest]

In a message dated 2/22/2005 8:21:21 PM Eastern Standard Time,

vegan1338@... writes:

> I don't have that exact lab value, but the TSH was " normal " before starting

> Cytomel/thyroid treatment, and only the T3 was low to start with. I think

> the TSH was in

> the low-to-middle part of the " normal " range then.

was that the normal that most docs use...that goes up to about 6....or the

new guideline that goes up to 3? But even within normal....you can be hypo and

it not necessarily be because of your pituitary. My TSH never got over

7...and yet I have seen descriptions of how I was at that time described as

" severe " . I think that the pituitary can just be affected by the hypo (in my

case

caused by hashimoto's) and not rise. There are also other type antibodies that

can affect TSH that no one ever seems to test for either. Although i do think

your doctor is being thorough to check....unless your TSH was in the hyper

range....and you were hypo...I wouldn't think additional testing was necessary.

Cindi

[Guest guest]

>>> In July of last year, I became sick with terrible fatigue. I

also had mild joint swelling, constipation, postural hypotension,

mild edema, general congestion, feeling of being " unbalanced " or

unsteady much of the time. Went to general doctor -- had not been

to the doctor for years prior to that. She eventually did lab

tests. I was not anemic, TSH was normal (actually in low-to-middle

range), folic acid and B12 normal, serum cortisol a little high,

white blood cell count a little low. Also had that lupus test -- I

think it's called " ANA with muscle reflex " or something like that,

and the antibodies came back positive, but muscle reflex negative,

so she didn't think that meant anything.

, ANA is often tested when RA (rheumatoid arthritis) is

suspected. Did they do an RA factor as well?

>>>The doctor chalked everything up to chronic depression/anxiety

that I've had for years, even though I told her that I have never

experienced ANYTHING like this. FINALLY, she ran a " free T3 " test

and it was low.... I believe it was 1.6 and the lowest normal value

was about 2.3 or something like that. I started on 25 mcg Cytomel.

T3 was still low, so eventually got up to 50 mcg Cytomel now. My T4

was normal before I started taking Cytomel, but then that dropped

also (to 0.5), so I was started on 25 mcg Synthroid too.

T3 can drive down your T4, I've seen it happen often. You were on a

high dose of Cytomel, so it's not a surprise your T4 tanked. It's

likely you need more than 25mcgs of synthroid to bring it back up.

Your highish cortisol coupled with the low T3 screams adrenals to

me; but I'm not confident when it comes to adrenals, so I'll leave

that to someone else

>>>I have been taking the 50 mcg Cytomel and the 25 mcg Synthroid

for 7 weeks or more. I still have terrible fatigue. A lot of the

physical symptoms are better, but the fatigue and brain fog are

still very bad, so much so that I still cannot work much and get

scared when I have to run a lot of errands, because I'm so tired and

still have the difficulty thinking as clearly as I used to be able

to. My last test results on this combo of meds were:

>

> Free T3: 1.9 (Normal Range 2.3 - 4.2)

> Free T4: 0.7 (Normal Range 0.8 - 1.8)

> TSH: 0.168 (Normal Range 0.35 - 5.50)

>

Your symptoms make sense looking at those numbers. Your FTs are

super super low and I bet your doctor is only looking at your TSH.

I don't know how progressive she is, or if she'll listen to you but

I have an article written by dr. Domisse that discusses this

very problem - dosing based on TSH and NOT ft4 / ft3. I'll find out

about posting it in the links / files area.

>

>>> My TSH has dropped to 0.168 when taking the Cytomel and

Synthroid together (it was 0.5 when taking the Cytomel only and

in " normal " range). So I started out with normal T4 and normal TSH,

with just a low T3, and now all 3 are low. The T3 is almost just as

low as it was on the 25 mcg Cytomel by itself. The T4 went up a

couple of points after adding the Synthroid. She is having me

repeat the TSH over and over, to rule out lab error.

TSH seems to respond most strongly to FT4 levels, so it would make

sense that your TSH was not sky high when you started out.

The issue could be pituitary, but the end product is the same - if

your pituitary is not telling your thyroid to make more FTs then you

need thyroid hormones. You can't 'fix' the pituitary, you have to

supply the hormones it's ultimately responsible for.

>>>> My main question that I need feedback on is that now the doctor

is saying that if my TSH is still low, it must be pituitary and

wants to order an MRI of the brain and all that. I am suspicious of

this, since my T4 and TSH only dropped after starting all of the

medicines. But she says if my T3 and T4 are low and TSH is low at

the same time (even though it wasn't before this), then it must be

pituitary.

I would disagree - your TSH is low because you're taking such a

large dose of cytomel. the fact that she doesn't recognize this is

cause for concern.

[Guest guest]

>>> In July of last year, I became sick with terrible fatigue. I

also had mild joint swelling, constipation, postural hypotension,

mild edema, general congestion, feeling of being " unbalanced " or

unsteady much of the time. Went to general doctor -- had not been

to the doctor for years prior to that. She eventually did lab

tests. I was not anemic, TSH was normal (actually in low-to-middle

range), folic acid and B12 normal, serum cortisol a little high,

white blood cell count a little low. Also had that lupus test -- I

think it's called " ANA with muscle reflex " or something like that,

and the antibodies came back positive, but muscle reflex negative,

so she didn't think that meant anything.

, ANA is often tested when RA (rheumatoid arthritis) is

suspected. Did they do an RA factor as well?

>>>The doctor chalked everything up to chronic depression/anxiety

that I've had for years, even though I told her that I have never

experienced ANYTHING like this. FINALLY, she ran a " free T3 " test

and it was low.... I believe it was 1.6 and the lowest normal value

was about 2.3 or something like that. I started on 25 mcg Cytomel.

T3 was still low, so eventually got up to 50 mcg Cytomel now. My T4

was normal before I started taking Cytomel, but then that dropped

also (to 0.5), so I was started on 25 mcg Synthroid too.

T3 can drive down your T4, I've seen it happen often. You were on a

high dose of Cytomel, so it's not a surprise your T4 tanked. It's

likely you need more than 25mcgs of synthroid to bring it back up.

Your highish cortisol coupled with the low T3 screams adrenals to

me; but I'm not confident when it comes to adrenals, so I'll leave

that to someone else

>>>I have been taking the 50 mcg Cytomel and the 25 mcg Synthroid

for 7 weeks or more. I still have terrible fatigue. A lot of the

physical symptoms are better, but the fatigue and brain fog are

still very bad, so much so that I still cannot work much and get

scared when I have to run a lot of errands, because I'm so tired and

still have the difficulty thinking as clearly as I used to be able

to. My last test results on this combo of meds were:

>

> Free T3: 1.9 (Normal Range 2.3 - 4.2)

> Free T4: 0.7 (Normal Range 0.8 - 1.8)

> TSH: 0.168 (Normal Range 0.35 - 5.50)

>

Your symptoms make sense looking at those numbers. Your FTs are

super super low and I bet your doctor is only looking at your TSH.

I don't know how progressive she is, or if she'll listen to you but

I have an article written by dr. Domisse that discusses this

very problem - dosing based on TSH and NOT ft4 / ft3. I'll find out

about posting it in the links / files area.

>

>>> My TSH has dropped to 0.168 when taking the Cytomel and

Synthroid together (it was 0.5 when taking the Cytomel only and

in " normal " range). So I started out with normal T4 and normal TSH,

with just a low T3, and now all 3 are low. The T3 is almost just as

low as it was on the 25 mcg Cytomel by itself. The T4 went up a

couple of points after adding the Synthroid. She is having me

repeat the TSH over and over, to rule out lab error.

TSH seems to respond most strongly to FT4 levels, so it would make

sense that your TSH was not sky high when you started out.

The issue could be pituitary, but the end product is the same - if

your pituitary is not telling your thyroid to make more FTs then you

need thyroid hormones. You can't 'fix' the pituitary, you have to

supply the hormones it's ultimately responsible for.

>>>> My main question that I need feedback on is that now the doctor

is saying that if my TSH is still low, it must be pituitary and

wants to order an MRI of the brain and all that. I am suspicious of

this, since my T4 and TSH only dropped after starting all of the

medicines. But she says if my T3 and T4 are low and TSH is low at

the same time (even though it wasn't before this), then it must be

pituitary.

I would disagree - your TSH is low because you're taking such a

large dose of cytomel. the fact that she doesn't recognize this is

cause for concern.

[Guest guest]

Dear Cindi,

You wrote:

> did you say what your TSH was BEFORE starting everything?

> she is suspecting central hypothyroidism which originates from the pituiary -

> and is probably wanting to check for a pituitary adenoma. that might be wise

> to check that.

I don't have that exact lab value, but the TSH was " normal " before starting

Cytomel/thyroid treatment, and only the T3 was low to start with. I think the

TSH was in

the low-to-middle part of the " normal " range then. Then it dropped to a

low-normal (0.5)

after taking Cytomel only, and now after taking both Cytomel and Synthroid, it

has dropped

below

normal (0.168).

Thanks for the feedback, I appreciate it!