Possible to be hypothyroid but have normal tests?

I see an endocrinologist. I did ask about one test in the past for example and he said he didn't think it was a telling test but that others may disagree. I think he's tested me for what he believes is relevant. Still I can ask again.

 

Hi Ema,
I totally agree that having enough cortisol is essential for fighting or beating lyme disease, this is what my lyme doc says. But he has alway been most emphatic that raising cortisol levels artificially is harmful. He says it makes the lyme incurable if you take cortisol supps - in fact one of the first things he asked in my initial apointment was if I had taken steriods, how much, when etc. I have read this quite a few times in the Internet too - I am pretty sure it is in the Burrascano guidelines that cortisol supplementation makes lyme resistant to all cures. So he is very firm that you have to raise it by natural methods.

The thing I have never actually asked him is exactly how/why this is so. I'll ask him in my next appt - I think it would be interesting to know.

As far as anecdotal evidence goes, I started a thread while I was doing my adrenal therapy and and everyone who joined it who takes adrenal hormone supplements seems to have constant trouble getting the dose right. The amount of cortisol and other adrenal hormones the body needs fluctuates drastically and rapidly throughout the day. Maybe the reason is connected with this... just guessing.

 

Anyone know of any articles like that that I could bring in?

 

Have a look here:

http://nahypothyroidism.org/

 

It is very difficult in my experience and of those in my Lyme support group often to get HC dosing right especially at first. It can take many months and unfortunately people give up because they lack proper guidance from their health care professionals. The infection can cause us to burn through cortisol much more quickly than usual which leads to ups and downs.

Further many people start on a dose of HC that is too low and get adrenaline surges which can feel very uncomfortable. This doesn't mean that adrenal support isn't needed but only that the dosing and steroid form needs tweaking. I personally finally got settled on a mixture of dexamethasone at night and HC during the day that feels very stable and my life has changed 180 degrees from last year at this time. Many of us with Lyme need the long acting steroid to act as a base for the HC which can then be dosed in a more natural rhythm.

It would be great if cortisol could be raised by "natural" methods but for many people the adrenals need more than that. Healthy people have physiological levels of cortisol and they are fighting off Lyme and other co-infections. How replacing what healthy people normally produce could somehow make an infection "incurable" defies logic to me. That directly contradicts my experience and those of the many other Lyme patients I know. I would be interested to hear his response because it makes me crazy to see people denied treatment that is needed to heal because of some sort of bizarre fear of low dose steroids.

 

Lots of good information here.

It appears that the most reliable marker is the ratio free T3/reverse T3. It needs to be above 1.8 according to the info on the link provided.

 

The ratio can be tricky to calculate because it depends on the units for FT3 and RT3. There are MANY permutations depending on the lab. If anyone needs help calculating their ratio, please feel free to ask me. Just make sure to post your lab values with ranges and units.

 

The above mentioned document states that "Optimal tissue levels are associated with a free T3/rT3 ratio greater than 1.8. (free T3 is reported in picograms per deciliter and reverse T3 in picograms per deciliter)." This appears to be a screw up. My free T3 is 3.7 pg/mL while my reverse T3 is 233 pg/mL. Both have the same units and both are within the "normal" ranges. There is no way to get a ratio of 1.8 ever if the units for both are the same.

 

OK, found an online calculator that allows one to specify units: STTM FT3/RT3 ratio calculator.

 

Yes, the ratio calculator is a good thing!

I have always used greater than 20 for optimal conversion of T4 to T3. Anything under 20 indicates less than optimal conversion and a possible need for treatment with T3 only at least for a period of time.

With your numbers, I get a ratio of 16 which does indicate less than optimal conversion and a probable RT3 issue (which is very common in those of us with chronic illnesses and methylation problems).

 

What intrigues me more is hypoparathyroidism...where you supplement with vit d and calcium. I read a study showing some crohn's patients are hypoparathyroid simply from the inflammatory cytokines set off in their gut.

 

Wow, and I have just been given levothyroxine (Synthroid) 88mcg. My TSH is 4.76. 88mcg sounds like a fairly high does for someone supposedly with subclinical hypothyroidism.

 

That does sound pretty high. My daughter's TSH was 9.33 before they caught it. She takes 25mcg of levothyroxine. It dropped her TSH from 9.33 to 0.90 in 4 months. Your body is different from hers, of course, so there could be other issues at play.

 

The typical starting dose is 100 mcg of T4. This is reduced slightly for subclinical hypothyroidism.

"Hypothyroidism: 1.7 mcg/kg/day in otherwise healthy adults <50 years old, children in whom growth and puberty are complete,
and older adults who have been recently treated for hyperthyroidism or who have been hypothyroid for only a few months.
Titrate dose every 6 weeks. Average starting dose ~100 mcg; usual doses are </=200 mcg/day; doses >/=300 mcg/day are rare
(consider poor compliance, malabsorption, and/or drug interactions)."

http://www.globalrph.com/thyroid_related.htm

 

But it also says on that package insert not to take thyroid meds with untreated adrenal insufficiency.

 

Hi Roxie, I’m no expert on thyroid meds, but going by Dr Mirza’s recommendations,

“In our experience, a levothyroxine dose of 12.5 mcg a day would reduce TSH
by 2 digits. This simple math will allow you to have a rough estimate of
levothyroxine dose. The goal is to reach a TSH of 1-1.5 mU/L.”

If your TSH is 4.76 then 88mcg would be far too much, like I said in the other tread, I would want a second opinion from a different Endo about your adrenal results, taking thyroid meds when you might have an adrenal problem can have bad consequences.
All the best

 

The only issue I have with this is that it is not the TSH that is most important after starting thyroid replacement but the FT4 and the FT3. This is especially true in cases of subclinical hypothyroidism.

Because of the feedback mechanism, it is very hard (if not impossible) to add to your own thyroid production. This is why most people start feeling hypo again about 4-6 weeks after initiating thyroid replacement and have to raise their dose.

The goal should not be any particular TSH (because it will often be suppressed somewhat when on an appropriate level of meds) but a FT4 of 1.2-1.4 and a FT3 in the top third of the range when on meds.

In my non-medical opinion.

 

as a matter of fact the insert does say that

 

As a matter of fact the insert does say that .


I am desparate to feel better, to have energy. Spent 4-5 hours mid day today laying down again, exhausted and all I did was run to pick up Rx and a little computer time. Unreal. I really don't know what to do.

 

doctor wants me to schedule blood tests again in 8 weeks then see her again in 9 weeks. Of course by then I may not longer have healthcare/ins or a job but they dont really care.....that would be real life intruding into their wrld, cant have that.