Will Brink
Member
Important Information For Those on Thryoid meds and or SSRI’s
Considering how many people are on thyroid meds and or SSRI’s, it’s surprising – especially in the case of thyroid medications – how much confusion exists in the medical community on how best to treat people with hypothyroid.
I find many people feel they are often in some sort of battle between themselves and their doctor as to what doses, types, etc of thyroid meds they need.
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. Some of Dr. Daniels comments below on T4/T3 combination therapy was supported by recent studies that found people on a combo therapy much prefer it over a T4 mono therapy.
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 follow for those who enjoy reading study abstracts. Obviously, optimal thyroid levels are essential for weight management and general health.
Considering how many people are on thyroid meds and or SSRI’s, it’s surprising – especially in the case of thyroid medications – how much confusion exists in the medical community on how best to treat people with hypothyroid.
I find many people feel they are often in some sort of battle between themselves and their doctor as to what doses, types, etc of thyroid meds they need.
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. Some of Dr. Daniels comments below on T4/T3 combination therapy was supported by recent studies that found people on a combo therapy much prefer it over a T4 mono therapy.
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 follow for those who enjoy reading study abstracts. Obviously, optimal thyroid levels are essential for weight management and general health.
