RE:Wondering if anyone knows anything about this

February 22, 2005

Hi ,

Okay, here's the way it works. The hypothalamus puts out something

called TRH, which causes the pituitary to put out TSH, which stimulates

the thyroid to put out T4, T3, and some other goodies. The T4 and T3,

when they get back to the hypothalamus, tell it to lower the TRH, which

tells the pituitary to lower the TSH, which tells the thyroid to lower

T4 etc. It's a big feedback loop. Make sense? No? Good!

So, the reason your tsh went down after starting the cytomel is because

your hypothalamus/pituitary sensed the increased thyroid hormone and

lowered your tsh, which in turn caused your t4 to go down. For example,

my sister-in-law is on Cytomel only, and her tsh and t4 values are 0.

Of course, she takes 125mcg of Cytomel per day.

Anyhow, it's perfectly normal that your tsh and t4 went down on Cytomel.

Rather than add synthroid to make up for that, though, you'd probably be

happier on Armour, which gives you both t3 and t4 and those other

goodies that your thyroid makes, but doctors think are unimportant, much

like they used to think adenoids and tonsils were unimportant. Be

prepared to have doctors laugh at you if you ask for Armour. They

consider it old-fashioned. Of course, old-fashioned thyroid treatment

left people feeling good and living full lives, so we don't consider

old-fashioned a bad thing.

The MRI is not necessarily a bad idea, because you could have a problem

with your hypothalamus or pituitary. If you have to pay for the mri out

of pocket, though, that might not be possible, practically speaking.

Perhaps some of the people here with pituitary problems will know better

about this.

If you have ANA antibodies, you may have thyroid auto-antibodies also

(didn't someone say they go together?). See if your doctor will run the

anti-TPO and anti-thyroglobulin tests. If either of those are positive,

you have Hashimoto's (antibodies to your own thyroid), and all thyroid

blood tests instantly become mostly useless (especially the TSH, which

was already useless).

In the end, finding a good doctor will be the hardest thing you'll. I'm

scheduled for doctor #7 next month, hoping he'll be the last. If the

" top docs " list you are referring to is from Shoman's site at

about.com, I have to tell you that I've been to two from that list, and

I've had terrible results from them. Many people here have given up on

doctors and buy medicine on the internet. That is somewhat risky, but

so is letting the average doctor kill you slowly with poor treatment.

The " good docs " list on this group is much smaller, but if one is near

you they're much more likely to be, well, good. Many of us drive hours

to go to a good doctor, because if they really are good, you won't have

to go that often.

If you've been lurking for a while, you've probably seen Janie's post of

Natural Thyroid 101. That's a good starting point. Keep posting your

progress, or if you just feel like venting. Maybe we can send you some

girl scout cookies. :-)

Hang in there... -- prr

vegan1338@...> wrote:

Hi Everyone,

I was wondering if anyone can give me any feedback on this. I apologize

for this long post, but don't know how to give the background in a

shorter way!

I have been lurking on the list, not posting mostly due to a lack of

energy, but have been learning a lot when able to read messages, and am

impressed with everyone's knowledge.

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.

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. 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)

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. I don't have insurance, which is part of the reason

I haven't switched doctors yet, and I just found out today that I have

been accepted into a low-priced clinic, but I don't know if they will

treat this condition properly either.

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. But I am

unsure, since my TSH was never high to begin with. I was wondering if

anyone knows about this. 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.

Thank you SO MUCH if you got this far reading this and taking the time;

I really appreciate it. I am just not going to change anything for now

and am going to try the low-priced clinic this coming week and see what

they say. Then, if that doesn't work, I may have to try one of the " top

thyroid docs " on a website, but that is hard since I don't have

insurance. I have enough medicine to last me a couple of weeks or more.

Thanks again,

February 22, 2005