733 Thyroid Disease Update

I have dry skin, dry hair, nails that break easy, toe nails are brittle and I stay tired most all the time. I take vitamins every day, fish oil, flaxseed oil, (dr's recommendation) daily vitamin, presser vision, coq10, B12, red yeast rice (for cholesterol).

The doctor has taken thyroid test but she says it is OK (blood test only). Should I be concerned? I am also a diabetic on daily med. 1 daily. She says I am on the border line but I have my doubts. It is very much under control.

Can you please comment on Statins interfering with the TSH test? I read this in a book and it seemed to be true for my husband. When he was taking statins his TSH was lower. But the book said the test is not reliable when you are taking statins. Isn't this something that doctor's should be aware of?

Are there reliable studies showing that treatment of Hashimoto's with Thyroid hormone even at lower TSHs (3-4) can reduce antibodies and symptoms? My daughter's endocrinologist wouldn't even discuss this possibility. I am concerned about damage to her arteries over time. The doctor just said she has hashimoto's but nothing will be done until she is hypothyroid (which he defines as TSH>5). And that this will not 'damage her heart'.

It is so frustrating. Doctor's are not particularly fond of being interviewed about which TSH they consider normal before you make an appointment. This is all so frustrating.

A friend of mine suffering from Bipolar Disorder (more depression) has finally become stable in the last year due to a prescription of Cytomel. There is a website which corroborates this helpful link. This was after many years of suicide attempts, heavy costly medications and much suffering.

My experience is my friend's, although I have been treated with armour thyroid for years. A good friend of mine has suffered with bipolar disorder for many years. I had always urged her to have her thyroid tested, but it wasn't until her psychiatrist prescribed cytomel that she has become stable.

This past stable year came after so many costly medications, electro convulsive shock therapy, suicide attempts and general suffering. There is a website that corroborates there is a subset in the bipolar community that benefits from thyroid treatment.

The show this morning was fascinating. Because, however, I had my thyroid removed last January I am wondering how this will affect me physically. In addition, I have hyperparathyroidism. When I was in my 30's I also had it but the offending parathyroid was removed. Now, the other parathyroid's are hiding and my surgeon in Pittsburg has recommended that I have a preoperative combined SPECT/CT scan to localize the other parathyroid adenomas.

What I am wondering is, is anyone in the North Carolina doing these tests or even South Carolina? This would be very helpful as it would mean that I would not have to make 2 trips to Pittsburg, 1 for the test and 1 for the additional surgery. Any information or suggestions you can give me would be very much appreciated. Thank you.

I am taking Armour Thyroid, 60 grains daily. I continue to gain weight, have little energy, no interest in sex and my ankles swell. Where can valid information be gotten that will tell me what my TSH numbers should be, if there are other tests beside blood work and how long one should be on medication before a difference is noticed? My Dr. said once a year testing is sufficient. I'm ready to try alternative medicine at this point. Thank you.

I was probably hypothyroid my whole life with many symptoms of tiredness, insomnia, hair loss, heart palpitations etc. Not one doctor I ever saw treated my symptoms because the blood tests were always, "normal". Finally I went to a physician who believed that a normal value of TSH ended at 2. Anything above 2 was abnormal to him and he would treat the patient as hypothyroid. He also had me take my temperature every morning before jumping out of bed, and my pulse rate, both of which were abnormally low and slow.

I am so glad I went to someone who finally thinks outside the box and prescribed some medication to help me after all these years. Joan M

Ann -- when you've had a thyroid test and been told it is "ok" you need to get a great deal more information. First, if it was the TSH (thyroid stimulating hormone) test that your doctor did, what was the actual result. Because labs in the U.S. use a range of approximately 0.5 - 5.0 as the "normal" range -- but 7 years ago, thyroid experts recommended that the range be narrowed significantly, to 0.3 to 3.0 -- and MILLIONS of people are now stuck in that limbo between 3.0 and 5.0 and they are told their thyroid is "normal" -- but another doctor would disagree and provide thyroid treatment.

Second, as discussed in the radio interview, you want Free T4, Free T3, thyroid antibodies and sometimes Reverse T3 also checked. You may need to see an integrative or holistic physician who looks at the more complete thyroid picture -- blood tests, symptoms, clinical signs -- for proper diagnosis and treatment.

MF -- there are reliable studies showing that treatment of Hashimoto's with "normal" TSH levels can reduce antibodies and symptoms?

Here are some studies to look at:

En-Ting Chang, Du-An Wu, Dee Pei, Shi-Wen Kuo, Ming-Chen Hsieh. [P2-552] Influence of L-Thyroxine Administration in Patients with Euthyroid Hashimoto's Thyroiditis. Endocrine Society Endo 2005 Abstracts

Thyroid, 2001 Mar;11(3):249-55, "One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit?"

Duygu Yazgan Aksoy, et. al. "Effects of Prophylactic Thyroid Hormone Replacement in Euthyroid Hashimoto's Thyroiditis" Endocr J (Japan) Vol. 52: 337-343, (2005).

I've discussed these in an article I wrote about Do You Need Preventative Thyroid Treatment, regarding treating antibodies when TSH is normal.

Thanks for sharing this, Elizabeth. There is definitely a subset of people with bipolar disease who seem to benefit from thyroid treatment. Some people with treatment-resistant depression also seem to benefit from the addition to T3 thyroid hormone to their antidepressant treatment.

And it's also important to note that for patients who suffer from bipolar disease who are taking lithium, a side effect of lithium can be hypothyroidism, so someone who is taking lithium so periodically be evaluated for hypothyroidism that can develop as a result of the use of lithium.

Parathyroid issues are very different than thyroid. You can usually find doctors in your area who are knowledgeable about treating thyroid issues.

If I were to need parathyroid evaluation or surgery, I'd likely go to Dr. James Norman in Florida, http://www.parathyroid.com -- he has built up an national reputation in parathyroid assessment and surgery.

Hi Dee.

You'll want to really work with your doctor -- possibly a new, integrative physician? -- to optimize your thyroid treatment. That may mean:

• A different dosage of Armour, or a switch to a different medication
  
• Evaluation of Free T4/Free T3/Reverse T3 and addition of T3 medication if deemed necessary
  
• Evaluation of other endocrine hormones, i.e., adrenal/stress hormones, and reproductive hormones like progesterone/estrogen
  
• Other lifestyle and dietary changes.
  

The Graedon's have some very valuable information here at their site regarding thyroid and hormones. I've also discussed the whole process of optimizing treatment for hypothyroidism at length in my book "Living Well With Hypothyroidism," which might be a useful starting point for your investigations.

Joan, I'm thrilled to hear that you have a forward-thinking doctor to help you manage your thyroid. There are doctors out there who do not treat patients like lab values. They look at the complete picture, and recognize that there are many factors to consider in making a diagnosis. Sounds like you've found a winning doctor -- and that you're feeling better and living well!

Is there a formula for converting levoxyl and cytomel dosages to armour? My endo says it is so complicated that it is best to stay with what I'm on.

I was diagnosed with Graves Disease about 10 years ago. I took the radioactive iodine to kill my thyroid. It took about 2 years to stabilize my TSH. In the last couple of years my TSH is really unstable. I've change my dose a couple of times. I take 2.75MCG, at one point I was on 3.25MCG. I'm post menapausal. I am depressed, overweight, and have no lust for life anymore. I keep bringing it up to my doctor. He tried to throw another pill at me for depression. I don't want another pill. I do want solutions.

Sometimes doctor's go by the "numbers" on a thyroid lab scale, not by how a person feels. I've been through four doctors until I finally found one that will listen to me and how I feel. We have to be pro-active concerning our health, do a lot of research about your thyroid problem. I visit a thyroid forum and have learned so much, things the doc didn't tell me.

I have been on Armour thyroid for a few years now; 6 or 7 yrs. It was hard getting my NP to Rx it; even harder to get my MD to Rx it; HE will ONLY do a TSH test; he says the tests out there now are very SENSITIVE; the last test showed a little bit on the low end of the test scale; yet, I am having a harder time as though my thyroid is just not putting out well.

So many people nowadays do not use much table salt with added iodine of any kind; 30 years ago a nuclear test showed my thyroid was not "absorbing" iodine at all.....

I saw a chart a few years ago showing the areas of the USA that were covered by drifting fallout from nuclear testing years ago; Missouri and a few other states were in the "drift area"; the report stated that in those areas, thyroid disease was much higher.

Elaine,

It might be time for a new doctor, if your endo really thinks it's that complicated.

Because it's actually rather simple math.

I have a thyroid medication conversion chart online, and Armour Thyroid has one online as well.

clc -- If you're telling the doctor that you're depressed, overweight, and don't feel well, and he just keeps prescribing antidepressants, it's time for a new doctor. One starting place might be the thyroid doctors recommended by other thyroid patients at the Thyroid Top Doctors Directory.

But in general, when you're hypothyroid (which is what happens after radioactive iodine to kill off/ablate the thyroid) you want to make sure that:

1. You're on the right dosage of medication for you -- many women say they feel best with TSH between 1-2, and Free T3 and Free T4 in the top half of the normal range. High TSH and lower/low-normal Free T3 and Free T4 is a recipe for feeling pretty draggy.
   
2. You're on the best medication for you -- some people feel best when adding some T3 (i.e., Cytomel, or time-released compounded T3) to their levothyroxine. Others do better on prescription natural thyroid, like Nature-Throid or Armour.
   
3. You're optimizing your nutritional status for maximum conversion -- so you're getting a good multi vitamin, enough B vitamins, proper amounts of selenium, tyrosine, and other building blocks for thyroid hormone and function
   
4. You don't also have an underlying adrenal fatigue or adrenal dysfunction that is contributing to fatigue and depression
   

You may also want to check out my new book, The Menopause Thyroid Solution, which may help sort out some of the hormonal imbalances.

Willa --

You're absolutely right. And the rallying cry for thyroid patients is "We're patients -- NOT lab values." Lab tests can be part of diagnosis and management of our thyroid treatment, but it can't be the only factor, and especially not to the exclusion of symptoms, history, and clinical signs.

When did some doctors decide that actually looking at and listening to patients should be totally ignored in favor of lab results?

It's perplexing when I hear stories of women in particular, who have a enlarged thyroid (goiter), a family history of thyroid disease, numerous hypothyroidism symptoms, they're losing the outside edges of eyebrows (classic hypothyroidism sign), they have blunted/slow reflexes (another classic hypothyroidism sign), but because their test comes back right on the "border" of what is considered normal, there are some doctors who seriously will look at these women and tell them that their problem has "Nothing to do with the thyroid." Meanwhile, if their TSH blood test goes from a 5.1 to a 4.9, all of a sudden, that same doctor would say "You're hypothyroid." This "tyranny of the TSH" does not make sense, and it's not good medicine.

Question: I am 48 yr's old and have multiple thyroid nodules, I believe 7. The last time I had a ultrasound was one month ago, they said there were no changes. I haven't had them aspirated in about 7 yr's, is this something I should do more frequently? I developed these after my second child was born about 14 yr's ago. I have a very hard time losing weight and get depressed easily. I take no medication, am active but slightly over weight, normal vital signs. When ever I get my lab work checked they say it is fine. What lab work should I ask for and what are the ranges I should be in?
Thank you.

I have taken thyroid medication for over 50 yrs. In the past I have taken Armours but for many years now my current internist has me taking synthroid which doesn't seem to be working as well but tests are "normal". I take my thyroid pill in the AM with all of my other pills including a multi-vitamin. A friend told me that her endo told her not to take thyroid with other pills, especially vitamin pills. Is this so?? My dr. has never said anything about when I should take it & she is aware of all of my other meds.

PEOPLE'S PHARMACY RESPONSE: "VITAMINS" MAY BE OK BUT SOME MINERALS SUCH AS IRON, CALCIUM AND ZINC CAN INTERFERE WITH SYNTHROID ABSORPTION. YOU'LL GET MORE FROM YOUR SYNTHROID IF YOU TAKE IT ON AN EMPTY STOMACH WITHOUT OTHER PILLS.

I too had a parathyroid tumor and was blessed to find Dr. Jim Norman in Tampa, FL. I would recommend you check his website www.parathyroid.com. I had surgery three and a half years ago. Dr. Norman is an expert in parathyroid disease.

I've been on thyroid medication for over 30 years and finally my doctor agreed to put me on Armour which I've taken for three years and feel great.
Now Walmart pharmacy has discontinued it and Walgreen's is having a hard time getting it, especially certain doses. What is the problem? Can it be ordered directly from the drug company?

I am a 26 year old newly wed. My husband and I wanted to get pregnant soon after we got married. I stopped taking my birth control almost a year ago. Since that time, I feel like my body is a total stranger to me now- I have had no periods- (not even when they put me on 2 rounds of hormones)- excessive sweating, depression, facial hair growth, constant fatigue,followed by bouts of insomnia,rapid and extreme weight gain (60 lbs in 7 months)and night sweats. I have been in and out of the doctors office for months now.

They have checked my thyroid and said it came back borderline but normal. I was recently told that I have bilateral carpal tunnel (about to have my 2nd wrist surgery in the next few months)and the doctor told me that I should seriously look at getting my thyroid checked because it can contribute to my bad wrists- I have never heard of that. They also checked my cortisol levels which also came back normal. I am so frustrated- What else can I do?

Joan,

I am glad that you are feeling much better; you must be relieved.

May I ask what your Dr. prescribed for you?

Thank you.

My physician prescribed Cytomel for my hypothyroidism. He started off with a dose of 5 micrograms twice daily and monitored my heart rate.

He then kept upping the dose until I reached my maintenance level and my heart rate was around 84 bpm. He did not want my heart rate at 88 bpm or above. That dosage for me is now 50 mcg per day.

I recently tried to switch to a cheaper, generic cytomel but was not satisfied with the results, so am back to the original. JM

Joan, were you prescribed a natural remedy or homeopathic one? I'm having the same problems.

Thank you

I think that cytomel is a natural medication. I don't think it's homeopathic but I know it's been around awhile, since I've heard of others who have had it prescribed for them. Maybe the Graedons can help me out with this one. They probably know more about its make up than I do. JM

PEOPLE'S PHARMACY RESPONSE: CYTOMEL IS A SYNTHETIC T3 HORMONE ANALOG.

What would you say are the 'normal' ranges for the recommended thyroid tests? My teenage brother has recently had some problems and getting tested soon for these levels (Free T3, TSH, Free T4, and reverse T3).

I have the same problem...Doctor increased frm 88MCG to 100MCD I have been on this for a month. Energy level has increased somewhat. Still not sleeping well, fatigue, having a difficult time keeping weigh down have put on about 10pds within the last 6mos and still fighting with the diet. I am sure I would have put on more.. yes loss of hair too.

My internist has been treating me for hypothyroidism but he says he goes strictly by lab results. I don't have much faith in him and will see a Dr. in Feb. from the 'Top Dr.'s List' mentioned on this page. When on 100 mmg of Lyvoxel, my TSH was 1.9 (up from .9) but my T3 and T4 stayed the same as when I was on 80mmg (which was .9). Dr. upped me to 150mmg and I still don't notice much of a change. Dr. is confused and said he never saw that before. I have all of the symptoms to a great degree. What do these lab results indicate? Thank you.

I've suffered poor health for some time now and can't find an "integrative" or "holistic" physician because my coverage is Medicaid. I'm in the Chicago area, have contacted Broda Barnes Foundation, for instance, and nothing so far. All the doctors I'm relegated to are too "conventional"-tests, like CBC that say nothing helpful. Anyone know any clinic/doctor who could help me?

My doctor ran me some tests and I was diagnosed with hypothyroidism. My doctor gave some dietary supplements like desiccated bovine thyroid. A couple of weeks later, I felt like I had my life back.