PDA

View Full Version : For those on thyroid meds and or SSRI's



WillBrink
03-25-09, 08:01
Some info on interest I hope will be of use to members here on thyroid meds:

A book called "Thyroid Disorders" written by a Dr Gilbert Daniels, listed as Co- Director of the Thyroid Clinic at Mass General Hospital makes for a good reference guide. The book was published in 2006, so I am assuming he's still there. The book is written for physicians, specifically for GPs/family physicians vs. specialists. Most of the information would be basic rehash for the people here that have already done a lot of research on the topic, and most of what he recommends is in line with the standard recommendations.

However, he makes a few salient points regarding optimizing therapy, which seems to be the major issue for most people. Unlike many 'traditional' docs out there, Dr Daniels seems fairly open minded. For those looking for a decent reference guide to tests, diagnoses, etc, it's a good little book. It could also be helpful for when making your case that you are not happy with your current meds/dose, etc and the doc you are working with is resistant. For example, he states:

“Although thyroid function can be precisely, monitored, not all 'optimally treated' patients feel well. For example in one study in which patients were treated with increments of thyroid hormone, those whose T4 dose was increased by 25-50 mcg/d, resulting in a suppressed serum TSH, felt consistently better than those receiving the highest dose at which TSH could be maintained within the normal range. In another community population-based study, patients taking T4 felt psychologically less well than a matched control population.”

Possible explanations for the above findings he lists as:


o Some of these patients may have been subtly under treated. When hypothyroid patients remain symptomatic, the T4 dose should be increased until TSH reaches the lower normal range.

(Note, however, he's clear to point out that an intact hyopthalamo-pituitary axis is necessary for TSH to reflect thyroid status appropriately and other measures such as free hormones and symptoms should be used in that situation in addition to TSH)

o The patients may have remained symptomatic because their symptoms were related to other disorders possibly associated with Hashimoto's thyroiditis, such as depression.

o True physiological replacement of thyroid hormone may require both T4 and T3.

o Clinical deterioration after starting T4 therapy should raise the question of concomitant adrenal insufficiency, known as Schmidt's syndrome.

For a 'traditional' endocrinologist I thought his comments above showed an open minded approach I wish more docs followed.


Additionally, and changing topics a bit here, but germane to the situation of many people, recent studies find that t3 augments the effects of SSRIs, even with treatment resistant MDD, so those on SSRIs not experiencing improvements may want to talk with their physician/therapist about adding a small amount of t3.


Recent t3 and SSRI studies of interest:



1: J Clin Psychiatry. 2005 Aug;66(8):1038-42.

An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder.

* Iosifescu DV,
* Nierenberg AA,
* Mischoulon D,
* Perlis RH,
* Papakostas GI,
* Ryan JL,
* Alpert JE,
* Fava M.

Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. diosifescu@partners.org

OBJECTIVE: In an open trial, we investigated the efficacy of triiodothyronine (T(3)) adjuvant to selective serotonin reuptake inhibitors (SSRIs) in subjects with major depressive disorder (MDD) resistant to SSRI treatment. METHOD: Twenty subjects who met DSM-IV criteria for MDD (mean +/- SD age = 44.3 +/- 10.3 years; 55% [N = 11] women) and had failed to respond to a course of treatment of at least 8 weeks with an SSRI antidepressant were enrolled in a 4-week open-label augmentation treatment with T(3) 50 microg/day. Atypical and melancholic sub-types of MDD were diagnosed using Structured Clinical Interview for DSM-IV Axis I Disorders criteria. We administered the 17-item Hamilton Rating Scale for Depression (HAM-D-17) 4 times during the study (which was conducted between 2001 and 2003). RESULTS: During T(3) augmentation, the severity of depression decreased from an initial mean +/- SD HAM-D-17 score of 20.5 +/- 3.6 to a final HAM-D-17 score of 14.0 +/- 7.1 (p < .001). Seven subjects (35.0%) were treatment responders (HAM-D-17 reduction >or= 50%), and 6 subjects (30.0%) achieved clinical remission (final HAM-D-17 <or= 7). The 5 subjects with atypical depression experienced significantly (p < .01) greater clinical improvement (final HAM-D-17 scores 6.6 +/- 1.8 vs. 16.4 +/- 4.5), and higher rates of treatment response (100% [5/5] vs. 13.3% [2/15]) and remission (80.0% [4/5] vs. 13.3% [2/15]), compared to subjects with nonatypical MDD. The 8 subjects with melancholic MDD experienced significantly (p < .05) greater depression severity at the end of the study compared to nonmelancholic MDD subjects (final HAM-D-17 scores = 18.3 +/- 6.6 vs. 11.1 +/- 6.1). CONCLUSION: Triiodothyronine augmentation of SSRIs may be a promising treatment strategy in SSRI-resistant MDD, particularly in subjects with the atypical MDD subtype.

_____________________
: J Affect Disord. 2006 Apr;91(2-3):211-5. Epub 2006 Feb 17.
T3 augmentation of SSRI resistant depression.

* Abraham G,
* Milev R,
* Stuart Lawson J.

Department of Psychiatry, University of Toronto, ON, Canada. gaby_Abraham@camh.net

PURPOSE OF STUDY: To investigate whether the addition of triiodothyronine (T3) helps relieve depressive symptoms in non-hypothyroid major depressive disorder patients who failed to respond to an adequate course of standard SSRI antidepressant treatments. METHODS: Patients who fulfilled the DSM-IV criteria for non-psychotic major depression, able to give informed consent, and failed to show satisfactory antidepressant response after a minimum of six weeks adequate treatment were recruited. To enter the study their Hamilton Depression (17-item HAMD) score had to be 18 or more, thyroid-stimulating hormone (TSH) value within the normal range, and a normal thyrotropin releasing hormone-stimulation test (TRH-ST). All patients continued taking the same SSRI which they had been taking before they entered the study. At the completion of TRH-SH they were all started on 25 microg of T3 and the dose was increased to 50 microg within a week when tolerated; they continued the combination of T3 and the SSRI for a minimum of three weeks. RESULTS: Twelve patients, comprising eight females and four males, entered the study. One female patient withdrew during the first week of side effects, eleven patients completed the trial. The patients ranged from 26 to 77 years of age, with the mean age for males and females being 52.3 and 45.1 years, respectively. Five patients were taking sertraline (mean dose = 130 mg/day) and 4 were taking citalopram (mean dose = 50 mg/day), two were on fluvoxamine (150 mg/day) and one patient was on 40 mg of paroxetine. The women took a mean daily dose of 40.6 microg of T3 for a mean duration of 3.75 weeks, while the men were on a mean daily dose of 43.8 mug of T3 for 3.5 weeks. T3 augmentation was associated with a statistically significant drop (p < .003) in the mean HAMD at end of the three weeks compared to baseline scores. Five patients (42%) showed >or=50% improvement on HAMD scores, with three achieving full remission (HAMD scores<or=7) at the end of the study. There were no reliable differences between responders and non-responders in baseline HAMD scores, number of previous antidepressant trials, gender or Deltamax TSH. CONCLUSION: T3 augmentation resulted in improvement of mood scores. The responders' rate of 42% in our study is comparable to the response rates reported using T3 or lithium to augment tricyclic antidepressants or other combination strategies used to treat resistant depression. Even though one patient withdrew prematurely due to side effects, the remaining 11 patients tolerated the addition of T3 very well. With the availability of T3, a viable, safe, inexpensive and effective augmentation treatment, the recent trend of replacing T3 with other novel strategies appears unwarranted.
___________________________

J Clin Psychiatry. 2001 Mar;62(3):169-73. Links
Triiodothyronine augmentation of selective serotonin reuptake inhibitors in posttraumatic stress disorder.

* Agid O,
* Shalev AY,
* Lerer B.

Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. agid@hadassah.org.il

BACKGROUND: There is considerable comorbidity of major depression and posttraumatic stress disorder (PTSD), and antidepressants have been reported to be effective in treating PTSD. Addition of triiodothyronine (T3) to ongoing antidepressant treatment is considered an effective augmentation strategy in refractory depression. We report the effect of T3 augmentation of antidepressants in patients with PTSD. METHOD: T3 (25 microg/day) was added to treatment with a selective serotonin reuptake inhibitor (SSRI) (paroxetine or fluoxetine, 20 mg/day for at least 4 weeks and 40 mg/day for a further 4 weeks) of 5 patients who fulfilled DSM-IV criteria for PTSD but not for major depressive disorder (although all patients had significant depressive symptoms). The Clinician-Administered PTSD Scale, the 21-item Hamilton Rating Scale for Depression, and the Clinical Global Impressions-Severity of Illness scale were administered every 2 weeks, and self-assessments were performed with a 100 mm visual analog mood scale. RESULTS: In 4 of the 5 patients, partial clinical improvement was observed with SSRI treatment at a daily dose of 20 mg with little further improvement when the dose was raised to 40 mg/day. This improvement was substantially enhanced by the addition of T3. Improvement was most striking on the Hamilton Rating Scale for Depression. CONCLUSION: T3 augmentation of SSRI treatment may be of therapeutic benefit in patients with PTSD, particularly those with depressive symptoms. Larger samples and controlled studies are needed in order to confirm this observation.

____________________

Am J Psychiatry. 2006 Sep;163(9):1519-30;

Comment in:
Am J Psychiatry. 2006 Sep;163(9):1484-6.

A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report.

* Nierenberg AA,
* Fava M,
* Trivedi MH,
* Wisniewski SR,
* Thase ME,
* McGrath PJ,
* Alpert JE,
* Warden D,
* Luther JF,
* Niederehe G,
* Lebowitz B,
* Shores-Wilson K,
* Rush AJ.

Massachusetts General Hospital, 50 Staniford St., Boston, MA 02114, USA. anierenberg@partners.org

OBJECTIVE: More than 40% of patients with major depressive disorder do not achieve remission even after two optimally delivered trials of antidepressant medications. This study compared the effectiveness of lithium versus triiodothyronine (T(3)) augmentation as a third-step treatment for patients with major depressive disorder. METHOD: A total of 142 adult outpatients with nonpsychotic major depressive disorder who had not achieved remission or who were intolerant to an initial prospective treatment with citalopram and a second switch or augmentation trial were randomly assigned to augmentation with lithium (up to 900 mg/day; N=69) or with T(3) (up to 50 mug/day; N=73) for up to 14 weeks. The primary outcome measure was whether participants achieved remission, which was defined as a score < or =7 on the 17-item Hamilton Depression Rating Scale. RESULTS: After a mean of 9.6 weeks (SD=5.2) of treatment, remission rates were 15.9% with lithium augmentation and 24.7% with T(3) augmentation, although the difference between treatments was not statistically significant. Lithium was more frequently associated with side effects (p=0.045), and more participants in the lithium group left treatment because of side effects (23.2% versus 9.6%; p=0.027). CONCLUSIONS: Remission rates with lithium and T(3) augmentation for participants who experienced unsatisfactory results with two prior medication treatments were modest and did not differ significantly. The lower side effect burden and ease of use of T(3) augmentation suggest that it has slight advantages over lithium augmentation for depressed patients who have experienced several failed medication trials.

Barbara
03-25-09, 17:07
When my hypothryoid was diagnosed 4 years ago, my TSH was 137 (on a scale of .3-3.0..seriously.) I was swelled up and sleepy and my hair was falling out, etc. Within a few weeks of being put on the medication, I was a big pile of emotional mush, which to say that least, ain't me. But after another month or so, it regulated itself and I've been (heh..relatively!) ok ever since.

It made me more understanding of depression as I believe there's a physical reason for it. But my levels have fluctuated several times in the past few years, going back up to ~14 TSH at one point, and no depression, although the other symptoms were evident.

WillBrink
03-25-09, 17:10
When my hypothryoid was diagnosed 4 years ago, my TSH was 137 (on a scale of .3-3.0..seriously.) I was swelled up and sleepy and my hair was falling out, etc. Within a few weeks of being put on the medication, I was a big pile of emotional mush, which to say that least, ain't me. But after another month or so, it regulated itself and I've been (heh..relatively!) ok ever since.

It made me more understanding of depression as I believe there's a physical reason for it. But my levels have fluctuated several times in the past few years, going back up to ~14 TSH at one point, and no depression, although the other symptoms were evident.

It can often take up to a year to get the correct doses of thyroid, and often longer if the docs you are working with are not open to different types, doses, etc, and use only lab values to treat, vs symptoms plus lab values, thus why I outline Dr. Daniels book, considering his pay grade in that particular area of expertise.... Good luck.

Barbara
03-25-09, 21:44
I'm fortunate in that I've had the same doctor for 20-odd years and for the most part, I control my own treatment. We're in disagreement right now about my dosage, but I'm at the dose that works for me and she keeps writing me scripts.

Like I said, I think the guys on the right track, at least as far as one potential cause for depression. I've experienced it myself.

ra2bach
03-26-09, 21:48
wow. how timely is this? just this past week I was diagnosed with hypothyroidism. I initially went to the doctor with symptoms of swollen feet and ankles and he immediately suspected heart trouble but that checks out fine.

I am currently taking 50 MCG of Synthroid daily, so I don't relate this to T4, T3, or any of the numbers that you have been quoting here but am motivated to learn as much as I can at this point.

Barbara
03-27-09, 20:51
IME, once you start taking the medication, you may feel worse before you feel better as your body regulates to the correct levels. I took 3-4 months before I felt well and probably a year before I was really better, although it was one of those situations where you don't know you feel bad until you feel better.

Just bear with it..you'll be better soon and it won't generally affect your life at all except for having to take a little pill each morning.

BravoCompanyUSA
04-04-09, 10:14
I am currently taking 50 MCG of Synthroid daily, so I don't relate this to T4, T3, or any of the numbers that you have been quoting here but am motivated to learn as much as I can at this point.

Synthroid - T4.




Thanks Will,
I gotta get this book. My TSH is still too high.

YVK
04-04-09, 12:13
Just noticed this thread. From my personal practice experience, I have only one suggestion: anybody who has been diagnosed with hypothyroidism owes to him/herself to see an endocrinologist at least once, preferably, early in the course. I see way too many folks with euthyroid sick syndrome being put on replacement for no good reason.

Barbara
04-10-09, 15:28
I'm just curious..for those of you who have had hypothyroidism for some years, or have had family members: How often have the levels of your medication been adjusted, past the first year?

vdog
04-29-09, 22:19
Boy does this thread hit home. My family has a history of Thyroid problems. I can remember my Dad having a hyper thyroid when I was a kid he would have bloody noses, drive around in January with the window down in the car. He had part of his thyroid killed now 30 yrs later he has to take synthroid for an underactive thyroid. About 9 years ago I was diagnosed with Hashimoto's. I have been battling the battle of the bulge ever since.

Zhurdan
04-30-09, 10:23
Just got on thyroid medication about 2 months ago. One Doctor kept telling me that I needed to see a psychologist as he thought I was just depressed. That didn't really jive with me as I'm a pretty damn happy person all the time. Went to a different doctor, with the same bloodwork paperwork... two minutes later, she had a prescription for thyroid medicine. Pretty amazine what switching doctors can do. The Doc I switched from had been my Doctor for 15 years, and he pretty much never listened to what I had to say. Glad I switched.

I too went on a rollercoaster of emotional fun when I started taking the meds though. Wife just about put me in the guest room for a month. :D

I feel a crapload better now, and I've lost about 20 lbs.

Zhur

CarlosDJackal
06-22-09, 16:09
I received my second attempt of RIT New Year's Eve (the first one was in July 2007 and only resulted in normalcy for about 6-months) and was officially diagnosed as being hypothyroid the day after Thanksgiving (when I felt like I was hit by a bus). I was originally diagnosed as having Hypothyroidism due to Grave's disease back in late 1999 and have been fighting it with varying doses of PTU (I had an allergic reaction to 'Tapazole' - the first medicine they prescribed).

In February my TSH level was 93 so I was given 75mcg/day of Senthroid for 6-weeks. My Endocrinologist wanted to prescribe a stronger dosage but I pointed out that I am normally very sensitive to medication and I may go extreme hypo if we did that.

Six weeks later my TSH level was down to 43 but was still too high so we went to 125mcg/day. Six weeks after that it was down to 18 which still necessitated a bit of an increase to 150mcg/day.

I had my blood drawn for the test this morning and we shall see where I am. But what I am finding is for each day of effort (ie: a Tactical Rifle course) results in at least 1-day of complete inactivity due to the resulting "crash". Plus, I am still experiencing heart palpitations which necessitated me taking 25mg of Beta Blockers a day.

Why my Hypo active self is experiencing a resting heart rate of 120-bpm has puzzled my doctors. When I do something strenuous, I experience heart rates up to 146-bpm. This may indicate that I may once again be hyperactive, but I doubt it since all the other symptoms (crusty hair, low tolerance to cold, malaise, etc) indicate otherwise. I've already had a stress test and wore a 24-hour Holter monitor neither of which resulted in anything that indicates heart issues.

I may have to buy this book to get a better idea of what I am going through.

BrentPete
06-23-09, 18:17
I'm just curious..for those of you who have had hypothyroidism for some years, or have had family members: How often have the levels of your medication been adjusted, past the first year?

My wife has had her dosage changed about six times during the last year. However, she went through a pregnancy during the last year so the doctor kept a close watch on the dosage. She met with her endoc. about two times, but she has had her levels monitored regularly and the endoc. and OB/GYN monitored the levels and made changes.
From here on I don't know if they will change much or not. Our situation probably isn't a good comparison since we have had two children in three years. But I would definately recommend finding a Dr. who is proactive. It has surely made a difference for her.

WillBrink
06-23-09, 18:28
Synthroid - T4.




Thanks Will,
I gotta get this book. My TSH is still too high.

The book is not light reading. It's a medical text for other docs to follow. The important "take home" stuff is in my thread. What I have had people do however is print out my post, and give that to their doc along with a copy of the book to convince their doc realize they may not be correctly treating/dosing. It's a small book and they can't say something like "it's written by a quack" or something like that. The doc who wrote that is a 4 star general if you were to compare in military terms.

tmckay2
08-31-09, 22:35
unfortunately this type of stuff is the norm in medical practice, not that you can really blame doctors. medication and medical knowledge is ever changing and often times doctors just aren't aware of these types of mistakes. this is actually an issue we have talked about in pharmacy school though and should certainly be brought up with your doctors

baburgerflipper
09-10-09, 11:04
Well, this certainly is an interesting post to stumble upon.

What are the professional (LE) consequences of thyroid disfunction, is it something that affects local or federal folks?

Thank you.

WillBrink
09-10-09, 12:16
Well, this certainly is an interesting post to stumble upon.

What are the professional (LE) consequences of thyroid disfunction, is it something that affects local or federal folks?

Thank you.

Depends on the disunction, but the above assumes hypo. The role of thyroid hormones are many and extensive and essential to human health, so it's a human consequence vs a job specific/LE issue per se. If your health is all fu%$ed up due to hypo thyroidism, no doubt, job performance will suffer. ;)

Here is the Mayo Clinic write up on th condition if interested:

http://www.mayoclinic.com/health/hypothyroidism/DS00353

baburgerflipper
09-11-09, 11:43
Assuming simple hypothyroidism, under control through synthetic thyroid supplementation, is there a general disqualification within LE that you have seen? I'm assuming not, as long as there are already
populations on statins and synthroid who can pass PT tests and stand duty, etc.

Is this a symptom agencies examine to screen for anabolic steroid use?

Looking at military medical accession standards, there is little/no room for endocrine problems, but LE seems to be more flexible or at least less strenuous in its requirements.

Thanks again for your time and expertise. This is an interesting topic to encounter here.

WillBrink
09-11-09, 11:53
Assuming simple hypothyroidism, under control through synthetic thyroid supplementation, is there a general disqualification within LE that you have seen? I'm assuming not, as long as there are already
populations on statins and synthroid who can pass PT tests and stand duty, etc.

Is this a symptom agencies examine to screen for anabolic steroid use?

Looking at military medical accession standards, there is little/no room for endocrine problems, but LE seems to be more flexible or at least less strenuous in its requirements.

Thanks again for your time and expertise. This is an interesting topic to encounter here.

As far as the application to LE and mil, in terms of any grounds for disqualification, that's a bit out of my lane. I do not believe hypo thyroid is grounds for disqualification in mil or LE, and I have never heard of anyone being discharged due to that. No relation to anabolics, so it's not a test that's run in relation to use of anabolics. I don't think LE or Mil screen for thyroid one way or another, but a mil doc, etc would need to jump in there for answers. It might be part of the general physical blood tests as it generally is for say a general physical one takes, where they test BP, cholesterol, etc. TSH (a hormones that gives an idea of thyroid function status) is a common blood tests given either due to some complaints/symptoms or run as a general screening.

wild_wild_wes
02-07-12, 18:55
Thanks for the info! If our Will Brink can live without this gland and still be an amazing physical specimen, so can I!!

WillBrink
02-07-12, 19:11
Thanks for the info! If our Will Brink can live without this gland and still be an amazing physical specimen, so can I!!

I do OK considering all that I have dealt with in my life so I'll take the compliment, but I will say, keep the above very much in mind, as I promise you, can go easy or hard depending on the doc you're dealing with. Doc who wrote the above is not some small town "alternative" doc but a big time mucky muck at one of the best known hospitals in the world, and head of the department no less.

Thus, if doc gives you flack, the above tends to help them see right. It's helped a lot of people I know who had their thyroid removed when they were having serious problems, and at their whits end thinking they'd never feel "normal" again.

You can and you will, but make sure to be clear on your needs as you begin this particular life phase. I had a tough year of it, and this is what I do for a living.

wild_wild_wes
02-07-12, 19:18
My endrocinologist has 37 years in the field, and I've discussed my active lifestyle with her. She forsaw no problems, and complimented me on my "athlete's heart" when she examined me :D

She also said I would live to be a "very old man", so I've got that going for me!

WillBrink
02-07-12, 19:25
My endrocinologist has 37 years in the field, and I've discussed my active lifestyle with her. She forsaw no problems, and complimented me on my "athlete's heart" when she examined me :D

She also said I would live to be a "very old man", so I've got that going for me!

It's all good, just keep what I told you in mind. Endo I dealt with, top guy, refused to up my dose until I brought his boss (eg, the very same guy who wrote what I posted above) into the discussion and waved his bosses own damn book in front of him.

He's good guy and good doc, but was set in his ways in terms of how he went about it, and how he went about it left me feeling like dirt.

And remember, I know the lingo, can read all the blood work, etc, and still had some problems, so assume nothing. I can't give you better advice then that my friend.

Vic303
08-20-14, 07:42
Just bumping this old thread back up. Timely info in here folks, as Hashimoto's Disease is possibly hte world's most underdiagnosed illness.

I was recently confirmed with Hashimoto's, and it appears to run in my family, along with LADA diabetes. Fortunately I am not diabetic at this point. I also have a great endocrinologist who is willing to work with me based on how I feel/symptoms and not just bloodwork. We are starting out slow on the Synthroid, initially 25mcg 2x/week, then bumped to 4x/week. Recently requested she bump me up to 25mcg/daily, and she agreed. I do feel better at this level, though I know with HD, I will likely get bumped up again and again over time. I will talk with her in Sept about possible T3 supplementation also. That, after a rescreen of the nodules in the thyroid (ultrasound, not biopsy (never again!)).

WillBrink
08-20-14, 08:18
Just bumping this old thread back up. Timely info in here folks, as Hashimoto's Disease is possibly hte world's most underdiagnosed illness.

I was recently confirmed with Hashimoto's, and it appears to run in my family, along with LADA diabetes. Fortunately I am not diabetic at this point. I also have a great endocrinologist who is willing to work with me based on how I feel/symptoms and not just bloodwork. We are starting out slow on the Synthroid, initially 25mcg 2x/week, then bumped to 4x/week. Recently requested she bump me up to 25mcg/daily, and she agreed. I do feel better at this level, though I know with HD, I will likely get bumped up again and again over time. I will talk with her in Sept about possible T3 supplementation also. That, after a rescreen of the nodules in the thyroid (ultrasound, not biopsy (never again!)).

What do those doses get your TSH levels and t3/t4 levels to?

Vic303
08-20-14, 09:52
Won't get new blood work until September. TSH should be down some.

wild_wild_wes
08-21-14, 20:40
What is the benefit to T3 supplementation? I asked my doctor about it, but she said if I wanted the T3, she'd bump my Synthroid doseage way down.

WillBrink
08-21-14, 20:57
What is the benefit to T3 supplementation? I asked my doctor about it, but she said if I wanted the T3, she'd bump my Synthroid doseage way down.

The OP touches on some of that BTW.

Vic303
08-21-14, 21:22
http://www.livestrong.com/article/240969-how-does-thyroid-t3-supplement-work/

Quick summary of T3 supplementation and actions in the body.

WillBrink
08-22-14, 08:11
http://www.livestrong.com/article/240969-how-does-thyroid-t3-supplement-work/

Quick summary of T3 supplementation and actions in the body.

Not a bad write up, but LS not generally a reliable source for accurate objective based info.

Vic303
08-22-14, 08:26
Best I could dig up on a quick search last night...

wild_wild_wes
09-07-14, 01:00
Some very interesting info here: http://suppversity.blogspot.de/2012/08/hypothyroid-cold-tired-depressed-try.html

"T4 + T3 therapy makes subjects feel better, 20/32 don't want to go back on monotherapy"

Vic303
09-07-14, 08:46
Thanks Wes, for posting that link. Interesting article. Just had my thyroid ultrasound. Classic Hashi's thyroid on appearance with a single large(in my opinion) nodule.

Vic303
10-01-14, 12:27
Started dual therapy, adding 2.5mcg T3 to my daily 25mcg T4. No jitters, no palpitations, no problems.

Way more alert-energetic with the T3, throughout the day. I get a lot more done it seems too.

Doc is also going to run another test to see if I am having an issue converting T4 into free T3...I think!

WillBrink
10-01-14, 14:07
Started dual therapy, adding 2.5mcg T3 to my daily 25mcg T4. No jitters, no palpitations, no problems.

Way more alert-energetic with the T3, throughout the day. I get a lot more done it seems too.

Doc is also going to run another test to see if I am having an issue converting T4 into free T3...I think!

Those are very conservative doses so I wouldn't expect and issues. Many report much better responses with the t3/t4 combination therapy.

Vic303
10-01-14, 18:51
Yep. Starting out slowly, since my thyroid isn't totally Hash'd yet. But fortunately, my doc is VERY willing to listen to patients.

Also there is some evidence that early intervention with thyro supplements can significantly lower your risk of developing a secondary auto immune disorder.

kln5
10-13-14, 01:10
As far as the application to LE and mil, in terms of any grounds for disqualification, that's a bit out of my lane. I do not believe hypo thyroid is grounds for disqualification in mil or LE, and I have never heard of anyone being discharged due to that. No relation to anabolics, so it's not a test that's run in relation to use of anabolics. I don't think LE or Mil screen for thyroid one way or another, but a mil doc, etc would need to jump in there for answers. It might be part of the general physical blood tests as it generally is for say a general physical one takes, where they test BP, cholesterol, etc. TSH (a hormones that gives an idea of thyroid function status) is a common blood tests given either due to some complaints/symptoms or run as a general screening.

I was disqualified in the army recruiters office for hypothyroid. A little history about my diagnosis: I ironically was diagnosed by my orthodontist. I had brace two Seperate times and both times my teeth and jaw were extremely slow to respond to treatment. I was about 10 to 12 years old at the time. After blood work was done I found out my thyroid gland is there but does not function. I have been on the same dosage for many years now and can't remember the last time my medication was changed. Currently taking 176mcg of levothyroxine. I can't remember if I ever have seen an endocrinologist.
Still reading through the thread but glad I found it.

afff_667
10-13-14, 07:51
I'm looking for recommendations for an endocrinologist in the Dallas area who might actually listen to a patient. I've been hypothyroid for well over 25 years and taking Synthroid for that entire period of time. My initial diagnosis was made by "accident" while tracking down another issue. My Synthroid dosage has fluctuated very little based on biannual blood work, but I cannot get across to my current endocrinologist that I feel like shit in general (lethargy/ongoing fatigue, inability to concentrate, dry skin, etc) all of the time. I enjoy working out, but it's getting to be so much of a slog fest through knee-deep mud that motivation is getting much, much more difficult. I could be crazy or suffering from some other condition, but the more I read the more I am convinced that hypothyroidism is involved in the way I feel. My last round of blood work indicated that I was on the correct dosage of Synthroid and all other bodily functions checked were right where they needed to be.

I've brought up with her material similar to this in the past, and she simply says that my blood work indicates that I'm on the correct dosage of Synthroid...I'm not physician and can't hold up a technical discussion with her very long, but I'd appreciate seeing a doc that seems to really be interested in listening and helping me.

PM any recommendations if that's appropriate. Any other suggestions are welcome.

WillBrink
10-13-14, 08:01
I'm looking for recommendations for an endocrinologist in the Dallas area who might actually listen to a patient. I've been hypothyroid for well over 25 years and taking Synthroid for that entire period of time. My initial diagnosis was made by "accident" while tracking down another issue. My Synthroid dosage has fluctuated very little based on biannual blood work, but I cannot get across to my current endocrinologist that I feel like shit in general (lethargy/ongoing fatigue, inability to concentrate, dry skin, etc) all of the time. I enjoy working out, but it's getting to be so much of a slog fest through knee-deep mud that motivation is getting much, much more difficult. I could be crazy or suffering from some other condition, but the more I read the more I am convinced that hypothyroidism is involved in the way I feel. My last round of blood work indicated that I was on the correct dosage of Synthroid and all other bodily functions checked were right where they needed to be.

I've brought up with her material similar to this in the past, and she simply says that my blood work indicates that I'm on the correct dosage of Synthroid...I'm not physician and can't hold up a technical discussion with her very long, but I'd appreciate seeing a doc that seems to really be interested in listening and helping me.

PM any recommendations if that's appropriate. Any other suggestions are welcome.

I don't have a name for you, but perhaps send her this specific info from the OP, and or find another doc. Does not need to be an endocrinologist per se either.

afff_667
10-13-14, 10:43
I don't have a name for you, but perhaps send her this specific info from the OP, and or find another doc. Does not need to be an endocrinologist per se either.

Thanks. That's a great start, and I sincerely appreciate it.

Vic303
10-14-14, 22:10
Pm sent to afff667 with a name.

WillBrink
10-19-14, 17:31
For those of you on thyroid having trouble convincing your doc t4/t3 therapy possibly superior to mono therapy with t4, this review paper may be helpful:


Defending plasma T3 is a biological priority
(http://onlinelibrary.wiley.com/doi/10.1111/cen.12538/full)

This is not a smoking gun paper "proving" combo therapy is superior to mono therapy, but is an excellent current summary of the evidence that you can direct your doc(s) to read that may make them more open to at least trying t4/t3 therapy. It's full paper free access BTW.

Vic303
10-20-14, 10:24
Interesting if somewhat hard to follow the intricacies of the science behind it all. What I get from it is that combo therapy may be superior, and many pts on it report feeling better, but meta studies show little to no difference in pt outcomes. However, that may be due to the method of administering t3 and that a slow-release, or an increased dosage of t3.

I'm just happy my endo is willing to let me try the combo therapy.


For those of you on thyroid having trouble convincing your doc t4/t3 therapy possibly superior to mono therapy with t4, this review paper may be helpful:


Defending plasma T3 is a biological priority
(http://onlinelibrary.wiley.com/doi/10.1111/cen.12538/full)

This is not a smoking gun paper "proving" combo therapy is superior to mono therapy, but is an excellent current summary of the evidence that you can direct your doc(s) to read that may make them more open to at least trying t4/t3 therapy. It's full paper free access BTW.

WillBrink
10-20-14, 10:45
Interesting if somewhat hard to follow the intricacies of the science behind it all. What I get from it is that combo therapy may be superior, and many pts on it report feeling better, but meta studies show little to no difference in pt outcomes. However, that may be due to the method of administering t3 and that a slow-release, or an increased dosage of t3.

I'm just happy my endo is willing to let me try the combo therapy.

Your summary is spot on I'd say in terms of the essential "take home"