Treating the Thyroid

[Ema]

My TSH and T4 have been normal every time I've been tested, but my doctor doesn't seem to think testing T3 is necessary. When I talked to her during my last appointment it sounded like she would get T3 tested too, but my results only had TSH and T4. There was a problem drawing blood so only 3 of 6 vials were filled, but it seems like the same batch of blood would have been for all my thyroid tests. I'm hoping it was just a mix-up and my doctor will have my T3 tested during my next visit. If not, my question is how important is it to get my T3 tested? I'm sort of confused about thyroid symptoms, but it seems like something I should rule out. Especially since I have Lyme. My doctor and tests are covered by my insurance so I don't feel like going to another doctor unless absolutely necessary. Overall, my doctor is the best doctor I've ever had, but I am concerned that she doesn't understand a lot of what's going on with chronic illness. My vitamin D 25 hydroxy was low even though I take 6000 iu of vitamin D. I really hope she tests my 1,25 dihydroxy too, but based on her response to my thyroid testing I'm not sure about that either. One last thing about T3. It seems there's free T3, total T3, and reverse T3. Do I need all 3 tests?

It's really important to know your free T3 level because that is the active thyroid hormone.

I don't get total T3 because it measures what is bound and unbound and not what is available for use.

RT3 is good to know but I don't get it every time. It can tell you if you are converting T4 to T3(active) or RT3 (inactive) preferentially. A lot of people with Lyme and chronic illness convert more to RT3 as a way of turning down the metabolism to protect the body from infection. So it is helpful but not necessary every time.

Remember "normal" is not the same as optimal. The thyroid normal ranges are WAY too wide in my opinion and include a lot of people with suboptimal thyroid function.

Ema

 

[invisiblejungle]

My TSH and T4 have been normal every time I've been tested, but my doctor doesn't seem to think testing T3 is necessary. When I talked to her during my last appointment it sounded like she would get T3 tested too, but my results only had TSH and T4. There was a problem drawing blood so only 3 of 6 vials were filled, but it seems like the same batch of blood would have been for all my thyroid tests. I'm hoping it was just a mix-up and my doctor will have my T3 tested during my next visit. If not, my question is how important is it to get my T3 tested? I'm sort of confused about thyroid symptoms, but it seems like something I should rule out. Especially since I have Lyme. My doctor and tests are covered by my insurance so I don't feel like going to another doctor unless absolutely necessary. Overall, my doctor is the best doctor I've ever had, but I am concerned that she doesn't understand a lot of what's going on with chronic illness. My vitamin D 25 hydroxy was low even though I take 6000 iu of vitamin D. I really hope she tests my 1,25 dihydroxy too, but based on her response to my thyroid testing I'm not sure about that either. One last thing about T3. It seems there's free T3, total T3, and reverse T3. Do I need all 3 tests?

TSH is a poor indicator of thyroid status because the pituitary gland can be euthyroid despite peripheral hypothyroidism. T4 shows you how much T4 your thyroid is producing, but reference ranges are too wide, and it doesn't tell you how much is converting to the active hormone T3.

Free T3 is possibly the most valuable thyroid test, along with free T4 and reverse T3.


These are 2 of the best thyroid websites I've found:

http://tiredthyroid.com/

http://nahypothyroidism.org/

 

[Lotus97]

This person is saying that low T3 and (relatively) normal levels of T4 and TSH aren't about the thyroid.
http://chriskresser.com/low-t3-syndrome-i-its-not-about-the-thyroid
Hypothyroidism involves high levels of thyroid stimulating hormone (TSH) and low levels of the thyroid hormones T4 and T3. However, in my clinical practice I frequently see people with low levels of T3 with normal T4 and either low or normal TSH. This condition has been reported on in the medical literature for years but it is rarely acknowledged or discussed in conventional medical settings. Most doctors (even endocrinologists) do not seem to know what causes it, or what to do about it. (I know this because I always ask my patients with this syndrome what their doctors said about it, and my patients’ response is almost always some variation of “not much”).
What’s most important to understand about this condition is that, although it does involve low levels of T3 (the most active form of thyroid hormone), it is not caused by a problem with the thyroid gland. This is a crucial distinction and it’s what distinguishes Low T3 Syndrome from “garden-variety” hypothyroidism.

 

[Lotus97]

Good news everyone. I was able to convince my doctor to test my free T3 (and vitamin D 1,25 dihydroxy). Even though my doctor is a doctor of integrative medicine and has recommended accupuncture, massage, and various supplements she still does a lot of things "by the book". I don't even think she understood why testing T3 (when TSH and T4 are normal) or vitamin D 1,25 dihydroxy are significant.

 

[invisiblejungle]

If your doctor isn't well-versed on thyroid health, she might think your thyroid is fine as long as your free T3 is "in range." Ideally it should be in the upper 1/3.

 

[Lotus97]

I got my free T3 back. It's 2.8 (range is 2.3 - 4.2) so that's not in the upper 1/3 ... When I got my test results back my doctor wrote "Your tests are in normal range. I don't have any comments." Never mind that my monocytes are 11.0 (not in normal range). And my ferritin is 41 and on the test it says it's within range, but I found this on a thyroid site:
http://nahypothyroidism.org/deiodinases/#iron deficiency

Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present.

Also, on my previous test my iron saturation was 17. I'm at least glad my doctor checked all of these, but it concerns me that she doesn't seem to know how to interpret the test results. It doesn't help that the test's reference ranges aren't accurate (at least according to some sources). I really don't feel like trying to convince her to get my reverse T3 and antibodies tested unless it's really important (?) It's stressful trying to get her to do things.

I also found this on the same site:

The inflammatory cytokines will, however, increase the activity of D2 and suppress the TSH despite reduced peripheral T3 levels; again, making a normal TSH an unreliable indicator of normal tissue thyroid levels

(My TSH was 1.82) I'm not sure what's considered "normal", but 1.82 seems pretty low. I'm mentioning it because I think I am dealing with a high level of inflammatory cytokines right now (even though my C-reactive protein is very low and sedimentation rate is in normal range).

And I do have chronic pain

Chronic pain will significantly suppress D1 and upregulate D2, resulting in a reduction in tissue T3 without a change in TSH. Thus, the significant cellular hypothyroidism is not detected by serum TSH and T4 testing (116-119). This cellular hypothyroidism, which again is undiagnosed by standard blood tests, increases the risk of the associated fatigue and depression seen with chronic pain (116,117,229).

 

[Little Bluestem]

Reverse T3 is important, but only if your doctor knows how to interpret and act on the results.

If your FT4 is high normal and your FT3 is low normal (like mine are), you probably have high RT3 (like I do).

Go to this chart and see where your test results fit in. http:www.drrind.com/forms/ts_ranges.gif
For example, your TSH of 1.82 fits in the +1 range (1.81 - 2.20). You will need to multiply your T3 result by 100.

If your FT4 is in a higher range than your FT3, your RT3 is probably high.

Some good websites on RT3 are:
http://www.thyroid-rt3.com
http://tiredthyroid.com/rt3.html
http://stopthethyroidmadness.com/reverse-t3

 

[Ema]

I got my free T3 back. It's 2.8 (range is 2.3 - 4.2) so that's not in the upper 1/3 ... When I got my test results back my doctor wrote "Your tests are in normal range. I don't have any comments."

A FT3 of 2.8 is pretty low in my opinion but the results really need to all be looked at together along with symptoms to try to get some context.

Your TSH of 1.82 is actually pretty ideal in my opinion. Most people feel best with a TSH between 1-2.

I would like to know what your FT4 is as well as your RT3 to finish having an opinion but my initial thought is wondering why your FT3 is low when your TSH is not elevated. Generally, if you don't have enough thyroid hormone present, the TSH will elevate. Of course there are many reasons why this might not happen (mainly to do with brain dysregulation of the pathways which is common in chronic disease) so TSH is not a good solo marker for thyroid function.

I would also be curious to know if you've ever taken temps regularly to know if they run low or not?

Never mind that my monocytes are 11.0 (not in normal range). And my ferritin is 41 and on the test it says it's within range, but I found this on a thyroid site:
http://nahypothyroidism.org/deiodinases/#iron deficiency

Also, on my previous test my iron saturation was 17. I'm at least glad my doctor checked all of these, but it concerns me that she doesn't seem to know how to interpret the test results. It doesn't help that the test's reference ranges aren't accurate (at least according to some sources).

That's the same issue I had with my former doctor - she was actually pretty good at ordering the "right" tests but had crap-all intelligent to say about the results.

Reference ranges are just statistical constructs that represent 95% of the population under the "normal" range. To be out of range, you have to be in the top 2.5% or the bottom 2.5%. Obviously that makes zero sense...that's why the more forward thinking doctors talk in terms of "optimal" and not "normal".

It sounds like you are iron deficient with a ferritin of 41 and an iron sat of 17%. In terms of optimally using thyroid hormones, many suggest a ferritin of at least 70 and a serum iron level of 100-110 which generally works out to be a %sat of around 35-45%.

It's really important to know your binding capacity though before starting to supplement iron. Those of us with chronic diseases often have low binding capacity which means little ability to safely supplement iron. This is called TIBC or UIBC on the lab order and is a part of the $25 iron panel that you can order yourself online in most states.

I really don't feel like trying to convince her to get my reverse T3 and antibodies tested unless it's really important (?) It's stressful trying to get her to do things.

In your position, I think I would order the labs myself if you live in a state where that is possible. You order online and then go to Labcorp for the draw and the results turn up in your email usually the next day. It is not reimbursable by insurance usually but the pricing is not too bad for most things and it is a LOT less stressful in some cases. I like Walk in Labs and PrivateMD Labs the best in terms of pricing though it is very wise to shop around as there is a lot of variation.

And I do have chronic pain

Did I suggest DPA to you before for chronic pain? I know I've been talking about it a lot lately but can't remember what thread!

Ema

 

[Lynn]

I recently doubled my low dosage of armour thyroid on the advice of my physician due to a barely in the norm thyroid test. It cause huge night sweating which impacted my sleep. After a couple of weeks I decided to go back to the normal dose and the sweating has reduced considerable.

I wonder if my body just doesn't want that much thyroid.

Lynn

 

[Ema]

I recently doubled my low dosage of armour thyroid on the advice of my physician due to a barely in the norm thyroid test. It cause huge night sweating which impacted my sleep. After a couple of weeks I decided to go back to the normal dose and the sweating has reduced considerable.

I wonder if my body just doesn't want that much thyroid.

Lynn

Low iron and low cortisol will cause intolerance symptoms to thyroid hormone which many people mistake as a reaction to the thyroid hormone itself when it is actually a separate issue. It's possible that could have been an issue for you as well.

Doubling thyroid overnight in that situation is probably also not wise (depending on how much you were taking). Generally it works best to raise by 1/4 to 1/2 grain every 2-4 weeks depending on if your TSH is suppressed. But if you were on a really low dose, it may have worked out to that anyway.

It's also possible that your body has turned down your metabolism for a reason (pathogens are a usual culprit) and doesn't want more thyroid hormone. I found that to be the case in that I could never raise past 3 grains even after I got my iron and cortisol sorted. But 3 grains gave me reasonably normal thyroid levels while I worked on eradicating pathogens through antibiotics/antivirals/immunoglobulins.

Ema

 

[sianrecovery]

My thyroid labs were in low normal range, but my ME doc suggested trying thyroid hormones after years of everything else, treating adrenals, getting cortisol up etc etc. She thinks long term infection can knock out normal thyroid function. She suggested T4, but I'd read Paul Robinson's book on circardian dosing with T3, and went for that. It's been interesting. It's allowed me to function again, and given me a life back, but it hasn't cured the underlying disease, and I haven't found it an easy med to take. I was going to shift over to NDT, but events intervened, and I haven't yet been able to. thyroidpatientadvocacy is a good forum to post results on, and their website has some excellent resources.

 

[sianrecovery]

ps I have recently discovered I have oestrogen that is breaking down into unhelpful metabolites, keep meaning to post results, and suspect there may be a T3/oestrogen connection - I understand they use the same transporter proteins. Does anyone know more?

 

[Ema]

ps I have recently discovered I have oestrogen that is breaking down into unhelpful metabolites, keep meaning to post results, and suspect there may be a T3/oestrogen connection - I understand they use the same transporter proteins. Does anyone know more?

Do you mean SHBG? Thyroid hormone increases SHBG which can also cause more of your estrogen to be bound instead of free and available.

 

[Lotus97]

A FT3 of 2.8 is pretty low in my opinion but the results really need to all be looked at together along with symptoms to try to get some context.

Your TSH of 1.82 is actually pretty ideal in my opinion. Most people feel best with a TSH between 1-2.

I would like to know what your FT4 is as well as your RT3 to finish having an opinion but my initial thought is wondering why your FT3 is low when your TSH is not elevated. Generally, if you don't have enough thyroid hormone present, the TSH will elevate. Of course there are many reasons why this might not happen (mainly to do with brain dysregulation of the pathways which is common in chronic disease) so TSH is not a good solo marker for thyroid function.

I would also be curious to know if you've ever taken temps regularly to know if they run low or not?

That's the same issue I had with my former doctor - she was actually pretty good at ordering the "right" tests but had crap-all intelligent to say about the results.

Reference ranges are just statistical constructs that represent 95% of the population under the "normal" range. To be out of range, you have to be in the top 2.5% or the bottom 2.5%. Obviously that makes zero sense...that's why the more forward thinking doctors talk in terms of "optimal" and not "normal".

It sounds like you are iron deficient with a ferritin of 41 and an iron sat of 17%. In terms of optimally using thyroid hormones, many suggest a ferritin of at least 70 and a serum iron level of 100-110 which generally works out to be a %sat of around 35-45%.

It's really important to know your binding capacity though before starting to supplement iron. Those of us with chronic diseases often have low binding capacity which means little ability to safely supplement iron. This is called TIBC or UIBC on the lab order and is a part of the $25 iron panel that you can order yourself online in most states.

Here's all my iron and thyroid scores:
TSH - 1.8 (it was the same in 2011, but in 2010 it was 1.1)
Free T4 - 1.2
Free T3 - 2.8
Reverse T3 - Unknown
MCV - 83.0
Ferritin - 41
Iron - 65
Transferrin - 259
Iron saturation - 17
Iron binding - 386
I've been taking carnitine for the past couple months. I'm not sure if it's affected my scores or not. I lowered my dose after finding out my free T3 might be a little low. I've also been taking milk thistle, but I stopped after finding out that it chelates iron. Apparently curcumin also chelates iron. Right now I'm taking lactoferrin with spirulina and other high iron foods. According to this study it seems that that's just as good as taking iron supplements: http://www.ncbi.nlm.nih.gov/pubmed/19639462#

In your position, I think I would order the labs myself if you live in a state where that is possible. You order online and then go to Labcorp for the draw and the results turn up in your email usually the next day. It is not reimbursable by insurance usually but the pricing is not too bad for most things and it is a LOT less stressful in some cases. I like Walk in Labs and PrivateMD Labs the best in terms of pricing though it is very wise to shop around as there is a lot of variation.

My doctor and all the tests she runs are covered by my insurance so I don't really have much of a choice. I've been spending a lot of my money on supplements and if I used my money for something else seeing a Lyme doctor would be at the top of my list.

Did I suggest DPA to you before for chronic pain? I know I've been talking about it a lot lately but can't remember what thread!

That was someone else. What's DPA?

 

[Ema]

Here's all my iron and thyroid scores:
TSH - 1.8 (it was the same in 2011, but in 2010 it was 1.1)
Free T4 - 1.2
Free T3 - 2.8
Reverse T3 - Unknown
MCV - 83.0
Ferritin - 41
Iron - 65
Transferrin - 259
Iron saturation - 17
Iron binding - 386
I've been taking carnitine for the past couple months. I'm not sure if it's affected my scores or not. I lowered my dose after finding out my free T3 might be a little low. I've also been taking milk thistle, but I stopped after finding out that it chelates iron. Apparently curcumin also chelates iron. Right now I'm taking lactoferrin with spirulina and other high iron foods. According to this study it seems that that's just as good as taking iron supplements: http://www.ncbi.nlm.nih.gov/pubmed/19639462#

My doctor and all the tests she runs are covered by my insurance so I don't really have much of a choice. I've been spending a lot of my money on supplements and if I used my money for something else seeing a Lyme doctor would be at the top of my list.


That was someone else. What's DPA?

Can you post the ranges too please?

 

[Lotus97]

TSH - 1.8 (it was the same in 2011, but in 2010 it was 1.1)
Free T4 - 1.2 (0.89-1.76)
Free T3 - 2.8 (2.3-4.2)
Reverse T3 - Unknown
MCV - 83 (88-99)
Ferritin - 41 (22-322)
Iron - 65 (65-175)
Transferrin - 259 (200-400)
Iron saturation - 17 (20-55)
Iron binding - 386 (298-596)
Hemoglobin (HGB) 13.4 (13.2-17.3)
Hemocrit (Hct) 40.8 (39-49)

This site lists some diagnostics for anemia
http://www.hematology.org/patients/blood-disorders/anemia/5263.aspx

How Is Iron-Deficiency Anemia Diagnosed?
Iron-deficiency anemia is diagnosed by blood tests that should include acomplete blood count (CBC). Additional tests may be ordered to evaluate the levels of serum ferritin, iron, total iron-binding capacity, and/or transferrin. In an individual who is anemic from iron deficiency, these tests usually show the following results:

• Low hemoglobin (Hg) and hematocrit (Hct)
• Low mean cellular volume (MCV)
• Low ferritin
• Low serum iron (FE)
• High transferrin or total iron-binding capacity (TIBC)
• Low iron saturation

The peripheral smear or blood slide may show small, oval-shaped cells with pale centers. In severe iron deficiency, the white blood count (WBC) may be low and the platelet count may be high or low.

 

[Ema]

TSH - 1.8 (it was the same in 2011, but in 2010 it was 1.1)
Free T4 - 1.2 (0.89-1.76)
Free T3 - 2.8 (2.3-4.2)
Reverse T3 - Unknown
MCV - 83 (88-99)
Ferritin - 41 (22-322)
Iron - 65 (65-175)
Transferrin - 259 (200-400)
Iron saturation - 17 (20-55)
Iron binding - 386 (298-596)
Hemoglobin (HGB) 13.4 (13.2-17.3)
Hemocrit (Hct) 40.8 (39-49)

This site lists some diagnostics for anemia
http://www.hematology.org/patients/blood-disorders/anemia/5263.aspx

Your FT4 is a little bit low as is your FT3. Most women feel best with a FT4 of about 1.3, men slightly higher. Your FT3, unmedicated, may be OK for you or it may be too low.

I can't say if RT3 is an issue obviously or whether or not your have Hashi's without seeing antibody testing. At this point, I would say that your metabolism is sluggish due to chronic illness rather than overt hypothyroidism. Of course, you could always do a trial on thyroid meds to see if you felt better but I feel doubtful that it will address the underlying causes unfortunately.

I would say the same things probably about your iron levels...they are WAY too low in my non-medical opinion. But it could very easily be the anemia of chronic disease which is caused by a cytokine response in an attempt to keep the bacterial or other pathogens from one of their favorite meals.

Generally serum iron should be 100-110, TIBC needs to be well above the bottom of the range to indicate the ability to safely bind supplemental iron and %sat is considered optimal between 35-45%. Ferritin at least 70-90.

But in this case, with those results, I would cautiously supplement iron. I use a form called iron bis-glycinate and it does not cause constipation or other digestive upsets. I take 75-100 mg/day to keep my serum iron up near 100. Better iron levels may also improve your thyroid function. You might also look into lactoferrin which may also help to keep iron from pathogens.

Do you get any iodine? Not the mega amounts recommended by some sites, but just the RDA?

Have you been tested for pathogens?

Had a saliva cortisol test?

I think those would be my next steps if I was in your shoes.

Ema

 

[Ema]

I've been taking carnitine for the past couple months. I'm not sure if it's affected my scores or not. I lowered my dose after finding out my free T3 might be a little low. I've also been taking milk thistle, but I stopped after finding out that it chelates iron. Apparently curcumin also chelates iron. Right now I'm taking lactoferrin with spirulina and other high iron foods. According to this study it seems that that's just as good as taking iron supplements: http://www.ncbi.nlm.nih.gov/pubmed/19639462#

My doctor and all the tests she runs are covered by my insurance so I don't really have much of a choice. I've been spending a lot of my money on supplements and if I used my money for something else seeing a Lyme doctor would be at the top of my list.


That was someone else. What's DPA?

Good! You already found lactoferrin. I need to go back to that study and see which form that it refers to...there are two forms apo and halo and one contains iron and the other doesn't if I recall correctly. They both have benefit in my opinion beyond iron metabolism but I'm not sure you can actually raise iron levels without ingesting some actual iron. I always used the lactoferrin along with iron supplements and found that to be quite effective. I should look back at this though as I've forgotten some of what I had originally read.

FWIW, I've take milk thistle twice a day for a long time. I haven't noticed any effects on my iron levels one way or another. And it seems to be good for my liver considering I'm taking a lot of crap and my liver enzymes are still low. Improving liver function might go a long way towards improving your thyroid levels as well. Liv52 is another good option for liver support though it is herbal too.

A Lyme doctor will probably want a lot of this testing which would be good especially in terms of pathogens. Maybe that would be a good next step too. I've nothing against driving your own health care but I would want to have some good solid testing before spending too much time, energy and money on supplements when you're not sure exactly what it is you're trying to treat at this point. Not that we ever really do...LOL.

DPA is d-phenylalanine and I find it extremely useful in boosting endorphins and reducing pain.

http://www.moodcure.com/restoring-natural-opioid-system.html

Ema

 

[Sushi]

Lotus97

Also note that improvement in methylation can improve thyroid function--as I just learned the hard way. So it might be good to recheck fairly often while taking methylation supplements.

Sushi

 

[Lotus97]

Lotus97

Also note that improvement in methylation can improve thyroid function--as I just learned the hard way. So it might be good to recheck fairly often while taking methylation supplements.

Sushi

This is from the methylation study using Rich's protocol (I'm not sure if the changes are significant or not)
http://www.mecfs-vic.org.au/sites/w...Article-2009VanKonynenburg-TrtMethylStudy.pdf

With regard to the thyroid testing, 10 of the 21 patients were on thyroid hormone
supplementation at the beginning of the study, and remained on it during the study. The initial
total T3 levels were found to converge toward the mean reference value at 3 months, as seen in a
shift in the mean and a decrease in the standard deviation. The initial and final mean and
standard deviation values were 156.9 (48.9) and 136.1 (29.9) ng/dL, compared to the reference
mean and standard deviation of 120.5 (30.2) ng/dL. This shift barely missed achieving the
p<0.05 criterion of significance, but in 19 out of the 21 patients, the shift in total T3 was in the
direction toward the reference mean. Two out of the 21 patients had elevated thyroid peroxidase
antibodies initially. In one of them the level decreased significantly after 6 months of treatment,
while the level in the other remained nearly the same.