Re: Elaine -- confused, please comment

[Guest guest]

Hi ,

I think you're finding out that many doctors don't take suggestions very well.

The TSH dilemma has to do with labs disseminating incorrect info in the past.

When we first developed tests to measure TSH we had no idea that most thyroid

disorders were autoimmune. What we did know is that normally TSH will fall

before thyroid hormone levels get too high and that TSH is a sensitive marker of

thyroid function. This works well in normal people and in your case it worked

well when your TSH rose to >5.0 before your thyroid hormone levels fell

dangerously low.

So up until a few years ago endos were trained to rely on TSH as the best

marker for thyroid function. And in the majority of the population, it is the

best marker. However, in autoimmune thyroid disease the normal

pituitary/hypothalamic/thyroid axis is off-kilter and TSH is influenced by TSH

receptor

antibodies. This is where TSH gets misleading. And that's why if your doctor

were to

consult Werner & Ingbar's The Thyroid, 7th Edition, he'd say that the TSH test

is not recommended for monitoring ATDs. Dr. Utiger also has an article

on the ATA web site discussing how TSI can interfere with TSH levels. But many

endos do not know this. And they're not about to change their way of

monitoring ATDs or admit they might be wrong because you suggested it. There is

a

great deal of info out there on this but it's hard for doctors to keep up with

all

the changes in both endo and laboratory medicine.

You should be able to achieve remission easiest on the dose that's best for

you. That would be a dose that prevents you from becoming hypothyroid. If your

thyroid gland is not slowed down enough (evidenced by adequate thryoid hormone

production) antibody production will continue. Hopefully at least your

doctor realizes the TSH range changed last year and is now 0.3-3.04 mu/L. Best,

Elaine

[Guest guest]

Hi Elaine,

Thanks for steadying me, and for the reference. I am unclear about one

thing you said: " If your

thyroid gland is not slowed down enough (evidenced by adequate thyroid

hormone production) antibody production will continue. "

Please clarify.

Thank you,

At 02:05 PM 10/7/2003, you wrote:

>You should be able to achieve remission easiest on the dose that's best for

>you. That would be a dose that prevents you from becoming hypothyroid. If

>your

>thyroid gland is not slowed down enough (evidenced by adequate thryoid

>hormone

>production) antibody production will continue.

[Guest guest]

Hi ,

If you're producing adequate thyroid hormone, usually at least midrange, your

thyroid gland doesn't try to compensate. There are lots of natural mechanisms

that try to correct thryoid imbalances. For instance, TSH stimulates thyroid

cell growth and activity. When TSH is suppressed or low and thyroid hormone

levels are adequate, your thyroid gland stays at rest. Some sources equate this

to putting the gland to sleep. An example is when people who don't need

thyroid hormone begin taking it. Over time, their gland slows down and produces

less

hormone causing a dependence on thyroid replacement hormone. When your gland

is at rest and doesn't have to work to correct low thryoid hormone

production, cellular activity including antibody production slows down. This is

one of

the reasons experts caution against allowing hypothryoidism to develop while on

ATDs. Take care, Elaine

[Guest guest]

Hi Elaine,

Thank you so much for the clear explanation! I know you always say it is

best to keep thyroid levels midrange to high normal, now I know why. If I

understand you correctly, it is best for this to be done on the lowest dose

of ATD possible.

This is complex stuff. From what you say about creating a dependence on

thyroid hormone replacement, it makes me think that it is better to take

just a low dose of ATD rather than a higher dose of ATD and supplement with

synthroid, as long as one is doing well on that. I'm beginning to wonder if

the better results found with the Japanese studies is a function of the

length of treatment, more so than the BRT.

At 12:42 PM 10/8/2003, you wrote:

>Hi ,

>If you're producing adequate thyroid hormone, usually at least midrange, your

>thyroid gland doesn't try to compensate. There are lots of natural mechanisms

>that try to correct thryoid imbalances. For instance, TSH stimulates thyroid

>cell growth and activity. When TSH is suppressed or low and thyroid hormone

>levels are adequate, your thyroid gland stays at rest. Some sources equate

>this

>to putting the gland to sleep. An example is when people who don't need

>thyroid hormone begin taking it. Over time, their gland slows down and

>produces less

>hormone causing a dependence on thyroid replacement hormone. When your gland

>is at rest and doesn't have to work to correct low thryoid hormone

>production, cellular activity including antibody production slows down.

>This is one of

>the reasons experts caution against allowing hypothryoidism to develop

>while on

>ATDs. Take care, Elaine

[Guest guest]

Hi ,

You understand correctly. I think the BRT works well if people are kept on a

low enough ATD dose to balance the Synthroid, keeping levels high. Often,

doctors feel uneasy about adding the thryoid hormone and end up keeping the

levels

too low. With the original BRT studies, they monitored labs closely to

prevent hypothyroidism from developing. But I'm sure the length of time

contributed.

In these early studies, most people achieved remission within a year, but

some people took as long as 4 years. Of the people who took 4 years, or stayed

on

meds 4 years, to achieve remission, not one had a relapse, whereas some

relapses occurred in the group who achieved remission quickly. Take care, Elaine

[Guest guest]

When I said " keeping levels high, " I meant keeping them in the high end of

the normal range.