Re: Wife had a Miscarriage-- Only on T4 Med Levoxyl 112 MCGs

[Guest guest]

-,

I actually had a miscarriage w/ my first pregnancy. I didn't know

then that I was hypothyroid back then. I have read enough about it

now to believe that was the cause of the miscarriage. I also have a

friend that will miscarry if her progesterone level drops. She has

to keep a watch on it throughout the pregnancy. She has 8 children

now so there is hope! :-) I went on to have three children after my

first and only miscarriage. Don't give up! I hope your wife has a

good doctor that can help her figure out why this happened. I'm

sorry for your loss. I know how you feel.

Take care,

Molly

-- In NaturalThyroidHormones , " f_kalkattawi "

wrote:

>

> Thank you all for your support....I appreciated everyones

> responses....

>

>

>

> > I am sooo sorry.

> >

> > It is likely that your wife's thyroid problem and the ability to

> bring a healthy baby to term are connected.

> >

> > There are many parents and researchers who have made the

> connections between low iodine, low selenium stores, auto-immunity

> in moms, and autism spectrum disorders in children. These

conditions

> certainly make the infants vastly more susceptible to long-term

> vaccination/mercury damage as well.

> >

> > I lost an early pregnancy the Spring before I got pregnant with

my

> almost 12 y/o DD. She is my only and I am almost 53. I know it can

> feel so hopeless. I hope your wife can recover and take good care

> and that you will be blessed.

> >

> > ...

> >

> >

> >

> > ----- Original Message -----

> > My wife was almost 3 months pregnant. This week she was going

> for

> > her regular checkup and the doctor could not find a heartbeat

> > anymore.

> >

> > I think this happen partly because she is on T4 med only and

not

> > taking any T3 and better yet not taking any Armour. Can this

be

> the

> > problem or part of the problem?

> >

> > Thanks

> >

> >

> >

> >

> >

[Guest guest]

I too am very sorry for your loss. has given you the very best

advice. Both of you need to be as healthy as possible, and then all will go

so much better. The wait will be so worth it.

*********** REPLY SEPARATOR ***********

So sorry to hear this! Hypo kept me from every getting PG when i was

younger and wanted babies, then caused me to need an early hysterectomy, so

it is vital she doesn;t STAY hypo if you want children. She needs to get on

Armour and probably a pretty hefty dose of it. Hypothyroid mother is not

healthy for any baby she might carry and could cause other problems if she

was able to carry it so maybe it is best she gets herself on some good meds

first.

Sheila Bliesath

StarGate Travel

Phone:

For more information on travel or becoming an agent

info@...

[Guest guest]

I too am very sorry for your loss. has given you the very best

advice. Both of you need to be as healthy as possible, and then all will go

so much better. The wait will be so worth it.

*********** REPLY SEPARATOR ***********

So sorry to hear this! Hypo kept me from every getting PG when i was

younger and wanted babies, then caused me to need an early hysterectomy, so

it is vital she doesn;t STAY hypo if you want children. She needs to get on

Armour and probably a pretty hefty dose of it. Hypothyroid mother is not

healthy for any baby she might carry and could cause other problems if she

was able to carry it so maybe it is best she gets herself on some good meds

first.

Sheila Bliesath

StarGate Travel

Phone:

For more information on travel or becoming an agent

info@...

[Guest guest]

-YES, i am so sad for your loss....talk about the baby often to your

wife...help her to feel comfortable grieving ....it is so very

important.....this child was very real to her(and to you I am

certain)---society is quite pathetic,when it comes to the loss of

the " not quite born yet " ---they can say the most hurtful things...I

know it happened to me fout times....I will say a prayer for your

little angel in heaven..jeanne

In NaturalThyroidHormones , Alyce

wrote:

>

>

> Yes. The same thing happened to me. Three times.

>

>

>

> Me too. ~Alyce

>

>

>

> ---------------------------------

> Celebrate Yahoo!'s 10th Birthday!

> Yahoo! Netrospective: 100 Moments of the Web

>

>

[Guest guest]

-YES, i am so sad for your loss....talk about the baby often to your

wife...help her to feel comfortable grieving ....it is so very

important.....this child was very real to her(and to you I am

certain)---society is quite pathetic,when it comes to the loss of

the " not quite born yet " ---they can say the most hurtful things...I

know it happened to me fout times....I will say a prayer for your

little angel in heaven..jeanne

In NaturalThyroidHormones , Alyce

wrote:

>

>

> Yes. The same thing happened to me. Three times.

>

>

>

> Me too. ~Alyce

>

>

>

> ---------------------------------

> Celebrate Yahoo!'s 10th Birthday!

> Yahoo! Netrospective: 100 Moments of the Web

>

>

[Guest guest]

I think the biggest problem was more that her TSH was above 4.0.

This is now considered hypothyroid. The new ranges, which hardly any

US lab seems to have adopted, are 0.5 to 3.0. These new ranges have

been set about two years ago. I think a well adjusted thyroid

patient needs TSH below 1.0 and over the years more astute observers

of TSH find that the heatlhiest people have TSH levels around 1.0.

In pregnancy, women need more thyroid due to the increased hormone

levels, which bind more and increase needs. To be well adjusted on

Levoxyl or Synthroid, you need around 250 to 400 mcg a day, maybe

more, since Synthroid is poorly absorbed. A TSH above 2.0 is

considered impaired thyroid function. This is because studies

indicated that those with TSH levels above 2.0, but under 3.0 have

greater levels of diseases common to hypothyroidism, such as

cardiovascular disease, and heart disease.

http://thyroid.about.com/od/newscontroversies/a/2005issues.htm

Has your wife been measuring her metabolic rate via Temperature,

pulse and breathing rate? If she were to use these methods and

adjust thyroid as needed, this should avoid problems in the future

and make sure her metabolic rate is high enough and can be quickly

adjusted if needed.

http://www.drrind.com/tempgraph.asp

http://www.thyrophoenix.com/self_monitor.htm

http://www.alternate-health.com/thyroid.html

I personally think Armour would be better than Snthroid but, most

importantly, she would need to have her TSH much lower than 4.0 to

be heatlhy and to make shure a child developes properly.

Tish

_________________________

Personal correspondence from DR. Derry to Edna Kyrie of

http://www.thyroidhistory.net

Dear Edna

The statement by C.P. Lalonde in 1948 review: " When thyroxine is

administered to a thyroidectomized or myxedematous patient, it takes

250 -350 micrograms of thyroxine (3.4 grains to 4.7 grains) to

maintain a normal metabolism.

( et al, 1935, Means, 1937) "

C. P. Leblond. Iodine metabolism. Advanc Biol Med Phys 1:353-386,

1948.

It does not say but I believe they gave it intravenously because it

is so badly absorbed orally. But IV thyroxine works well.

_______________________

From " Thyroid Guardian of Health " by G. Young

It is an important guidline in that if individuals are placed on and

excessive dose of thyroid hormone, the temperature should become

elevated within two weeks time. However, if the thyroid feedback

mechanisms are working properly it is impossible to make and

individual hyperthyroid untill they are given more thyroid that the

gland produces--about 4-1/2 grains (333 mcg) for a small individual

and about

5 grains (370 mcg) for the usual adult. Their basal temperature

should rise up

over 98.2 deg F if they are truely hyperthyroid, and thus have too

much thyroid hormone. The pulse is important as well; a slow pulse

is typical of pure low thyroid condition. With low adrenal function,

the pulse speeds up and the rapid pulse may indicate inadequate

adrenal support. The blood pressure is also an important guid line.

A blood pressure with a systolic below one hundred indicates

inadequate adrenal support......

Some authorities believe that if autoantibodies are present, it

renders other thyroid testing invalid.

Clinical symptoms remain the best indicator of adequate dosage.

______________________

Prognosis and treatment of COMMON THYROID DISEASES

Proceedings of a Symposium held in San Francisco,

California, U.S.A. - G March 1970

Editors : HERBERT A. SELENKOW AND FREDRIC HOFFMAN

Thus, in the average patient requiring 280 ug T4 daily (3.7 grains),

190 ug (3 grains) are absorbed. Of this, 90-100 ug replaces the T4

normally secreted daily

and the remainder provides the physiological equivalent of normal T3

secretion.

______________

Author: Dr PBS Fowler

Date Published: 23-May-2001

Publication: Lancet 2001; 357: 619-24. Volume 357,

Number 9273 23 June 2001

Title: Letter in response to Colin Dayan's article '

Interpretation of thyroid function tests'.

Before the days of hormone assays, hypothyroid patients

received about double the average dose of thyroxine

given today, but did not develop osteoporosis or atrial

fibrillation. Doses should be judged clinically rather

than be governed by misinterpreted hormone results.

P B S Fowler

1 Dayan CM. Interpretation of thyroid function tests.

Lancet 2001; 357: 619-24.

________________________

Author: KENNETH STERLING

Date Published: 01-Jan-1975

Publication: CRC PRESS INC CLEVELAND OHIO 1975

Title: DIAGNOSIS AND TREATMENT OF THYROID DISEASES

Category: treating

Keywords: Sterling, diagnosis, treat, thyroid, euthyroid, T4, T3,

dose, sythetic, measure, serum, thyroid, hormone, desiccated, adult,

child, PBI, TSH, heart, normal

Text: 83

REPLACEMENT THERAPY OF HYPOTHYROIDISM

Thus, the ultimate maintenance dose in adult myxedema is usually

between 2 and 5 grains (although sometimes stated to be I to 3

grains in older texts),

____________________

http://thyroid.about.com/library/derry/bl3a.htm

Dr. Derry

The doses a patient gets when monitored by the TSH is currently two

thirds or less of the well established clinically effective doses

established from 83 years of clinical experience before the TSH

arrived. (5-6)

For example, in a sixteen part study of the effects of desiccated

thyroid on healthy prisoners Danowski et al found they tolerated

dosages of 9 grains of desiccated thyroid (540 mgs which equals

about 540 micrograms thyroxine) without ill effects. (9-11). On

studies on obesity and thyroid hormone where the dosages for three

months were between three grains and 25 grains (1500 mg of

desiccated thyroid equals about 1500 micrograms of Eltroxine) (12).

they said: " As in previous studies, these dosages of desiccated

thyroid were well tolerated by the subjects. Occasional nervousness,

increased sweating, and decreased endurance were reported.

Tachycardia and slight increase in the systolic blood pressure and

decreases in the diastolic blood pressure appeared in all.

Electrocardiogram changes were minimal. Body weight decreased by an

average of 26 pounds during the 22 weeks of treatment. " (7).

_________________

http://www.drlowe.com/QandA/askdrlowe/armourthyroid.htm

That optimal dosage range is highly individual, but historically,

the typical patient's therapeutic window has been somewhere between

120 to 240 mg (2 to 4 grains). There's no way to accurately predict

what your therapeutic window is.

(Some people can get by on 2 grains, but not very many.)

_____________________

Dr. Derry, " Breast Cancer and Iodine " :

Before the 1973-1974 change in laboratory diagnosis, the objective

of treatment in all cases was raise the thyroid dose up untill the

patient was in a state of well-being.

Before the 1973-74 change, the normal dose of thyroid was three

times the level seen now (2 -3 grains now) and there were no cases

of fractures or osteoporosis ever reported in the previous 80 years.

________________________

Dr. Barry Peatfield from his book " The Great

Thyroid Scandal " Page 87-88:

The disgraceful fact is that all these measurements (except the

last) may not be worth the paper they are written on; or may be so

flawed that treatment based on them is bound to be wrong. So what

goes wrong? And why are doctors not aware that they may be so badly

off the beam? And why do so many have minds so closed?

The reasons blood tests may be so flawed we need now to examine.

First and foremost these are measures only of the levels of thyroid

hormone in the blood. What we need to know is the level of thyroid

in the tissues, and, of course, this the blood test cannot tell us.

The nearest we can go is the Basal Temperature Test, or the Basal

Metabolic Rate. The first we have discussed; the second is now of

historical value. The patient is connected up to an oxygen uptake,

carbon dioxide excretion, measuring device, and the rate of usage

determines the metabolic rate. This is also subject to various

errors. The amount of thyroid hormones being carried by the

bloodstream varies in a highly dynamic way, and may be up at one

point and down the next. The blood test is simply a two-dimensional

snapshot of the situation at that moment. The slowed circulation may

cause haemo-concentration from fluid loss, so that the thyroid

levels are higher than they should be. (A simple way to explain this

is to think of a spoonful of sugar in your cup of tea. If it is only

half a cup of tea but you still put in your teaspoon of sugar, then

although the amount of sugar is the same, the tea will be twice as

sweet.)

But the blood levels depend mostly on what's happening to the

thyroid hormones. If the cellular receptors are sluggish, or

resistant, or there is extra tissue fluid, together with

mucopolysaccharides, the thyroid won't enter the cells as it should;

so that part of the hormone is unused and left behind, giving a

falsely higher reading to the blood test. It is simply building up

unused hormone. This may apply to both T3 and T4. Further

complications exist if the T4 + T3 conversion is not working

properly, with a 5'-diodinase enzyme deficiency. There will be too

much T4, and too little T3. If there is a conversion block, and a T3

receptor uptake deficiency, both T3 and T4 may be normal or even

raised. The patient will be diagnosed as normal or even over-active;

in spite of all other evidence to the contrary. It grieves me to

report that I have intervened several times to prevent patients,

diagnosed as hyperthyroid, having an under-active thyroid removed

when the only evidence was the high T4 level (due to receptor

resistance) and the patient was clinically obviously hypothyroid.

The patients thanked me, but not the consultants.

Adrenal insufficiency adds another dimension for error to the T4 and

T3 tests. Adrenal insufficiency, of which more anon, will adversely

affect thyroid production, conversion, tissue uptake and thyroid

response. It may make a complete nonsense of the blood tests.

The most commonly used test of all is the TSH. I have sadly come

across very few doctors who can accept the fact that a normal, or

low TSH may still occur with a low thyroid. The doctrine is high TSH

= low thyroid. Normal TSH = normal thyroid. But the pituitary may

not be working properly (secondary or tertiary hypothyroidism). It

may not be responding to the Thyrotrophin Release Hormone(TRH)

produced by the hypothalamus, which itself may not be producing

enough TRH for reasons we saw earlier. The pituitary may be damaged

by the low thyroid state anyway, and be sluggish in its TSH output.

______________________________

http://www.drlowe.com/frf/t4replacement/intro.htm

The most effective of these therapies involves adjusting patients'

dosages of combined T4/T3 or T3 alone according to several indices

other than TSH and thyroid hormone levels. Those indices are signs,

symptoms, and various objective measures of tissue response to

particular dosages. When patients' dosages are titrated according to

these indices, dosages that prove safe and effective are typically

TSH-suppressive.[44] Evidence is available that this therapeutic

approach relieves patients' signs, symptoms, and measurable tissue

abnormalities such as low resting metabolic rates (RMR) according to

indirect calorimetry.

This observation suggests that dosages higher than those dictated by

the replacement concept more effectively relieve patients'

hypothyroid symptoms. Other research has shown that patients report

feeling better with TSH-suppressive dosages of thyroid hormone.[23]

[24][25] Moreover, psychiatrists report that dosages of T3 higher

than replacement dosages augment the depression-relieving effects of

antidepressants.[9][28][29][30][31][34] In addition, in a study of

patients made hypothyroid by therapeutic destruction of the thyroid

gland, some used TSH-suppressive dosages of thyroid hormone and

others used T4-replacement. Those on TSH-suppressive dosages didn't

gain excess weight; those on T4-replacement did. The researchers

concluded that T4-replacement was the cause of the excess weight

gain.[55] These published reports are consistent with thousands of

cases in which hypothyroid patients recovered from their symptoms

and other health problems with TSH-suppressive dosages of thyroid

hormone after T4-replacement failed to help them.

Kaplan's observation also suggests another point: that T4-

replacement keeps many hypothyroid patients' dosages too low to

relieve their symptoms is an indictment of the concept of

replacement. As the cause of

(1) the continued suffering and debility of patients,

(2) an increased incidence of potentially life-threatening diseases,

and

(3) the need for the chronic use of medications,

___________________________

Dr. Derry article:

http://thyroid.about.com/library/derry/bl11.htm

The effective dose physicians used by clinical judgment and

experience before 1975 was around 2-3 times higher than the dose

used by TSH blood test monitoring. So everyone's dose of thyroid

after 1975 was decreased by about two thirds of well established

clinically effective doses.

__________________________

Another Derry article:

http://thyroid.about.com/library/derry/bl4a.htm

In the 1960s it was textbook material after 70 years of experience

using thyroid that a dose below 180 mg of desiccated thyroid (3

grains) could not be measured clinically or in the laboratory. In

other words it was without effect.(2) The approximate equivalent

dose of synthroid or thyroxine (T4) would be about 180 micrograms.

(3)

So unless your dose is above 180 there is little chance of regaining

your hair back and the problem likely continue and get worse. You

can tell when you are approaching the right dose personally when the

itching starts to go away permanently. Depending on how old you are

and other medical history it is likely though you would get complete

relief with a dosage up around 200 micrograms of Synthroid or

higher. We know that there are no side effects at those dosages.

Dosages of thyroxine (Synthroid, T4) of up to 300 micrograms are

without morbidity or mortality. (no sickness or deaths) (4)

_____________________________

Dr. Lowe's wife:

http://www.drlowe.com/emailnewsletter/2003archive.htm

Instead, they adjust dosages according to how patients respond to a

particular dose. As studies have shown, this approach produces far

superior treatment results than does adjusting dosages according to

thyroid test results.[1][2]

___________________________

Dr. Lowe uses this guide:

http://www.drlowe.com/clincare/clinicalforms/areyouoverstimulated.pdf

to determine if the patient is on too high a dose. In other words,

they raise thyroid dose up untill the patient feels best and use

this form as a way to make sure they haven't gone too high. Dose is

determined purely by how the patient feels and no tests are used

_____________________

Dr. Guberman

http://drguberman.com/news.cfm?date_range=8/01/04

7051 West Commercial Blvd., Suite 3-C

Tamarac, FL 33319

e-mail: drguberman@d...

That optimal dosage range is highly individual, but historically,

the typical patient's therapeutic window has been somewhere between

120 to 240 mg (2 to 4 grains). There's no way to accurately predict

what your therapeutic window is. Until you find it, you may not

improve much from the Armour. But once you do, you're likely to feel

that the wait was well worth it.

_________________________

Author: P. B. S. Fowler

Date Published: 11-Aug-1973

Publication: BMJ 11 August 1973 Vol. III p 352 - 353

Title: LETTER: Treatment of Hypothyroidism

this infrequent phenomenon lies in the

fact that exogenous thyroid hormone in moderate

doses administered to normal subjects rarely has

appreciable effects, owing to compensatory suppression

of the subject's own thyroid gland through diminished

secretion by the pituitary of thyroid-stimulating

hormone (TSH). TIns feedback inhibition tends to

maintain a constant level of circulating thyroid hormone.

There are, in fact, instances of normal subjects

who have taken quite appreciably excessive doses of

thyroid with minimal or no manifestations of toxicity,

probably due to enhanced ability for degradation of

excessive

84

amounts of hormone in some individual

_______________________

http://www.thyroid-info.com/articles/dommisse.htm

An Interview with Dommisse, MD

Unique Theories About Hypothyroidism Treatment

I ran into too many patients who had classic hypothyroid symptoms,

which cleared completely on appropriate thyroid treatment, and whose

TSH was below 2.0 (but above 1.5) and with FT4 and FT3 levels in the

low ends of their 'normal ranges'….Finally, I found some patients

with several symptoms and signs of hypothyroidism whose TSH was

between 1.0-1.5; so I lowered my range, for the last time, to 0.1-

1.0; I now treat primary hypothyroidism with a TSH of >1.0 (if the

FT4 and FT3 are low-normal, not above the middle of their 'normal

ranges').

_______________________

.. " Optimum Diagnosis and Treatment of Hypothyroidism With Free T3

and Free T4 Levels " by Dr. ph Mercola (US), DO

http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Most patients continue to have classic hypothyroid symptoms because

excessive reliance is placed on the TSH. This test is a highly

accurate measure of TSH but not of the height of thyroid hormone

levels.

The basic problem that traditional medicine has with diagnosing

hypothyroidism is the so called " normal range " of TSH is far too

high: Many patients with TSH's of greater than 1.5 (not 4.5) have

classic symptoms and signs of hypothyroidism.

___________________

Dr. Derry http://www.bites-medical.org/hypo/hist.html (Site

now gone)

There were

no problems with desiccated thyroid even at high

doses, and it was known as one of the safest drugs

available. Synthetic T4, on the other hand, has had a

long history of manufacturing and reliability problems.

_____________________

(This paper points out that some patients need suppressive doses of

thyroid to feel good.)

MINI REVIEW

Intrinsic imperfections of endocrine replacement therapy

J A Romijn, J WA Smit and S W J Lamberts

Department of Endocrinology, Leiden University Medical Center,

Leiden and Department of Internal Medicine, Erasmus Medical Center,

Rotterdam University, Rotterdam, The Netherlands

(Correspondence should be addressed to J A Romijn; Email:

j.a.romijn@l...)

However, many patients

treated for endocrine insufficiencies still suffer from more or less

vague complaints and a decreased

quality of life. It is likely that these complaints are, at least in

part, caused by intrinsic imperfections

of hormone replacement strategies in mimicking normal hormone

secretion.

......effects of

hormones in general, and thus of hormone replacement strategies in

particular, are difficult to

quantify at the tissue level. Therefore, in clinical practice we

rely mostly on plasma variables –

`plasma endocrinology' – which are a poor reflection of hormone

action at the tissue level.

Complaints of thyroid patients....They range from

musculoskeletal complaints, to vague feelings of being

unwell, and to depression. Two approaches have been

used to decrease the complaints experienced by these

patients: an increase in the dose of L-thyroxine, and

combination treatment of thyroxine with tri-iodothyronine.

In some of the patients, a decrease in complaints

can be achieved by increasing the dose of thyroxine

above that required to restore TSH concentrations to

normal (1). For this reason, such patients are often

allowed to take a dose of thyroxine that would be

judged as overtreatment with respect to TSH concentrations.

The second approach was evaluated by

Bunevicius et al. (2), who performed a randomised controlled

trial to compare the effects of thyroxine alone

with those of thyroxine plus tri-iodothyronine. Patients

with hypothyroidism benefitted when 12.5 mg triiodothyronine

was substituted for 50 mg thyroxine in

their treatment regimens. This resulted in improved

neuropsychological functioning. Pulse rates and

serum sex hormone-binding globulin concentrations

were greater after treatment with thyroxine plus

tri-iodothyronine, indicating a slightly greater effect

on the heart and liver. Serum thyroxine concentrations

were lower and tri-iodothyronine concentrations

were greater after treatment with thyroxine plus

tri-iodothyronine, but serum TSH concentrations, a

sensitive measure of thyroid hormone action, were

similar after the two treatments. It should be noted

that not all patients benefitted from this approach

because, even in the group with combination therapy,

patients continued to report complaints of depression.

Thyroxine:

The thyroid secretes tri-iodothyronine (T3) (,20%) in addition to

thyroxine (T4) (,80%). In the absence of

thyroid function, exogenous thyroxine is not able to normalise the

concentrations of T4 and T3 in all tissues in rodents, even in the

presence of normal TSH concentrations. Despite this knowledge,

currently available preparations of T3 have unfavourable

pharmacological profiles and adequate markers of biological effect

are lacking. Additional evidence is required before combination

therapy can be advised.

First, it is remarkable that the normal values

of TSH show a more than tenfold variation, between

0.4 and 4.5mU/l. Because, in clinical practice, the optimal

TSH concentration for individual patients within

this range is unknown, titration of the substitution

dose of thyroxine within this tenfold variation is

relatively crude. Secondly, the intrinsic assumption of

many doctors in this approach is that normal TSH

concentrations reflect adequate thyroid hormone

concentrations, not only at the tissue level of the

hypothalamus and the pituitary, but also in the other

tissues. However, it is likely that this assumption is

erroneous, because TSH is produced only by the

pituitary gland and therefore may not reflect thyroid

hormone status in tissues outside the hypothalamo–

pituitary axis. This notion is supported by data obtained

from animal experiments.

Thyroxine is considered to be an

inactive hormone, because a thyroxine-specific receptor

has not been identified. Rather, thyroxine serves as a

prohormone, because it is the precursor of tri-iodothyronine.

Some tissues, such as muscle, have a relatively low

deiodinase activity and are dependent, to a great

extent, on tri-iodothyronine derived from the thyroid

and the liver.

In rodents, it has been clearly demonstrated that

there is no single dose of thyroxine or tri-iodothyronine

that normalises thyroid hormone concentrations in all

tissues simultaneously in hypothyroid animals (3).

Therefore, it is highly likely that, in patients treated

with L-thyroxine, subtle derangements at the tissue

level are present with respect to thyroid hormone availability,

and probably also thyroid hormone action.

_______________________

Changes in serum triiodothyronine, thyroxine, and

thyrotropin during treatment with thyroxine in severe

primary hypothyroidism

M Maeda, N Kuzuya, Y Masuyama, Y Imai and H

Ikeda

J. Clin. Endocrinol. Metab., Jul 1976; 43: 10 - 17.

It is difficult to assess what is the

optimal dose for any one subject, for at present we

have no objective, easily quantifiable parameter to

assess response of body tissues to thyroid hormone

replacement. Measurements of serum TSH, kinetics of

reflex time, and oxygen consumption are helpful, but

not entirely reliable for this purpose.

Individuals on physiological replacement

replacement

doses of pure sodium levothyroxine have elevated

levels (high normal to hyperthyroid range) of serum

thyroxine (-Pattee). The resin uptake tests in

these persons are also elevated above normal, so that in

patients on 300 or 400 pg of sodium levothyroxine

(4.0 to 5.5 grains) a

day, the PBI or serum thyroxine level will

be in the high range and so will the free thyroxine

index.

(Note the very high doses of Synthroid needed to make the patient

feel well. This was before over reliance on the TSH test.)

_______________________

(This paper points out that healthy people have little responxe to

being given thyroid.)

Author: WILLIAM H. BEIERWALTES, M.D.

Date Published: 01-Jan-1955

Publication: Michigan Journal Clinical Endocrinology Vol. 15, 1955

p148 - 150 (Editorial)

Title: RESPONSE TO THYROID

Category: diagnosing

Keywords: thyroid, BEIERWALTES, desiccated, oral, research,

myxedqamatous, myxoedema, euthyroid , diagnose, basal, pulse rate,

iodine

Text: 1955 Editorial WILLIAM H. BEIERWALTES, M.D. University

Hospital, Ann Arbor, Michigan Journal Clinical Endocrinology Vol.

15, 1955 p148 - 150

p148

RESPONSE TO THYROID

WHEN desiccated thyroid is administered orally to myxedematous

humans, the resultant metabolic changes are quite different from

those observed in the euthyroid subject. The clinician can diagnose

or treat hypothyroid patients much more intelligently if he is aware

of these difference in response to thyroid. In addition, an unworked

field for clinical research becomes evident when one reviews the

known major differences between the myxedematous patient and the

euthyroid subject in response to desiccated thyroid administration.

The most striking difference observed may be summarized by the

statement that the patient who is truly deficient in circulating

thyroid hormone responds dramatically and with predictable

regularity to the administration of small doses of desiccated

thyroid. The euthyroid subject, on the other hand, shows no obvious

clinical response to small doses of thyroid. A simple and readily

available diagnostic test for borderline hypothyroidism, therefore,

is the administration of 1 grain of desiccated thyroid per day for a

period of six weeks after a careful history and physical examination

have been made and basal metabolic rate and serum cholesterol

determinations have been performed. The patient who is truly

deficient in thyroid hormone will generally respond to the

administration of 1 grain of desiccated thyroid per day for six

weeks with an increase in basal pulse rate and metabolic rate and a

fall in the serum cholesterol level. The patient not truly deficient

in thyroid hormone will show no significant change in these indices

of thyroid hormone effect.

p149

.....The myxedematous patient and the euthyroid subject also show a

different response to sudden cessation of desiccated thyroid

medication. The myxedematous patient at first shows a rapid drop in

his serum precipitable-iodine level and basal metabolic rate, then a

slower fall to pre-treatment levels over a period of six to eight

weeks (3). On the other hand, when the thyroid medication of a

euthyroid person is suddenly stopped, the serum precipitable-iodine

value falls to myxedematous levels in three to four weeks, but the

basal metabolic rate may take as long as nine to fifteen weeks to

reach its lowest level (3). These values then rise to pre-treatment

levels. The radioiodine uptake is also falsely depressed by thyroid

administration and has taken as long as eleven weeks to recover (4).

Furthermore, when the thyroid does recover its ability to

concentrate I131, the I131 pickup rate may rebound temporarily to

hyperthyroid levels. Obviously, if a physician were to stop the

desiccated thyroid medication of a euthyroid patient in an attempt

to evaluate the patient's underlying thyroid status, these ensuing

changes in indices of thyroid function, when sampled, might prove

very misleading and confusing.

The daily output of thyroid hormone by the normal thyroid gland is

thought to be equivalent to not more than 3 grains of desiccated

thyroid per day. Consequently, when the daily dosage of desiccated

thyroid is raised to 4 grains or more per day, any differences

observed between athyreotic and euthyroid subjects can not be

explained on the basis of further suppression of normal thyroid

function. Most practicing physicians have probably observed a

euthyroid patient who was comfortable while voluntarily taking 5 to

20 grains of desiccated thyroid a day, in an attempt to reduce

p149

his weight and rid himself of fatigue. Rarely, if ever, does one see

an athyreotic patient voluntarily take more than 3 grains of

desiccated thyroid per day. This situation suggests that the

athyreotic patient is more sensitive to thyroid substance than is

the euthyroid person, even after his myxedema has been controlled

with medication.

.....WILLIAM H. BEIERWALTES, M.D.

University Hospital, Ann Arbor, Michigan

REFERENCES

1. MEANS, J. H,: The Thyroid and Its Disease, ed. 2. Philadelphia,

J. B. Lippincott Co., 1948, p 249

2. WINKLER, A. W.; RIGGS, D. S., and MAN, E. B.: Serum iodine in

hypothyroidism before and during thyroid therapy, J. Clin. Invest.

24: 732, 1945

3. RIGGS, D. S.; MAN, E. B., and WINKLER, A. W.: Serum iodine of

euthyroid subjects treated with desiccated thyroid, J. Clin. Invest.

24: 722, 1945

4. GREER, M. A.: The effect on endogenous thyroid activity of

feeding desiccated thyroid to normal human subjects, New England J.

Med. 244: 385, 1951

5. JOHNSTON, M. W.; SQUIRES, A. H., and FARQHARSON, R. F.: The

effect of prolonged administration of thyroid, Ann. Int. Med. 35:

1008, 1951

6. THOMPSON, W. O.; THOMPSON, P. K.; TAYLOR, S. G., and DICKIE, L.

F. N.: Calorigenic action of single large doses of desiccated hog

thyroid: comparison with the action of thyroxine given orally and

intravenously, Arch. Int. Med. 54: 888, 1934

[Guest guest]

A DNC is done to make sure that all possible tissue is

gone after a miscarriage. If any is left there is

possibility of infection that is quite serious.

Kerry

__________________________________

Celebrate Yahoo!'s 10th Birthday!

Yahoo! Netrospective: 100 Moments of the Web

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[Guest guest]

A DNC is done to make sure that all possible tissue is

gone after a miscarriage. If any is left there is

possibility of infection that is quite serious.

Kerry

__________________________________

Celebrate Yahoo!'s 10th Birthday!

Yahoo! Netrospective: 100 Moments of the Web

http://birthday.yahoo.com/netrospective/