thyroid protocol/med adjustment

[munch520]

Hey guys, back with an update for ya after seeing new endo (Dr. Ravi Dhawale) and adjusting thyroid protocol, sorry I didn't post comprehensive labs but iron, ferritin, etc. are all good and in range. Sorry to duplicate, this was in an old thread but I thought it'd be better as a new topic.

PRE-TREATMENT (Sept 2016)
TPO/Thyroid Peroxidase: 220 IU/mL (0-34 IU/mL)
TSH: 7.89ulU/mL (.450-4.5 ulU/mL)
T3 free: 3.6 pg/ml (2.0-4.4 pg/mL)
T4 free: 1.21 ng/ml(0.82-1.77 ng/ml)
rT3: 18.9 ng/dL (9.2-24.1 ng/dL)
TSH index: 8.05 (HAP) [1.3 - 4.1] (PI)


After trying 65mg NDT, then 97.5mg NDT, then 100mcg synthroid
FT4: 1.24 (0.82-1.77 ng/ml) no change
FT3: 3.1 (2.0-4.4 pg/mL) went down?!
TSH: 2.78 (doc also found 2012 labs and my TSH was around 5.57 then, I may have had this issue for a while)


felt awful on meds and QUIT all thyroid support 12/23
Cortisol normal on 1/11/17

labs from 1/20/17:
TPO: 205 IU/mL (0-34 IU/mL)
TSH: 7.89 MIU/mL (.50-6.00 MIU/mL) [note reference ranges changed]
T3 Free: 286 pg/dL(200-490 pg/mL) [note reference ranges changed]
T4 Free: 1.2 ng/ml(0.7-1.8ng/ml)

At this point was feeling pretty good, sleeping well a little tired but back to almost feeling 'great'. The endo thought I was WAY overmedicated before, and started me on only 25mcg of Synthroid. Here's labs after 6 weeks of that

TSH: 3.59 MIU/mL (.50-6.00 MIU/mL)
T4 Free: 1.2 ng/ml(0.7-1.8ng/ml)

I felt great when those labs were taken, a little tired in evenings but who isn't (we have 2 young kids too). So it's curious to me that both doses suppressed the TSH well and pretty quickly, seems that I am both super sensitive to the meds and maybe don't require much or need to be titrated up very slowly to tolerate the meds well.

This hypothesis was contributed to by their suggesting a double dose (50mcg) of Synthroid 1x/week to try to tweak dosage up a bit. Unfortunately 3 days after doing that, I was back to the same side effects (albeit not as bad as when I was on 100mcg) persistent fever, panic, insomnia, etc. Those are still persisting right now, I don't know why such a small adjustment would create these issues!

So I'm now not taking the meds for a couple days then restarting 25mcg and staying there, will retest in late April to see if TSH has been further suppressed/see how I feel.

What do you guys think of this protocol? I've tried both NDT (WP Thyroid) and Synthroid and the Synthroid seems to agree with me best, and at low doses. Am I correct in my assumption that I must need a much lower dose, as I felt better on the 25mcg and my numbers came back almost the exact same (as when I was on 4x that dose)?

 

[munch520]

After thinking more about this, I'm wondering if I have a T4 conversion issue and should be looking into a T3 only regimen? It seems no matter what amount of T4 I'm on, I get sent into a tailspin, resulting in only TSH suppression. T4 never really moves, and in fact FT3 decreases. Shouldn't a successful T4 protocol lower TSH AND increase T3 (through conversion)? The small amount of T3 in the WP Thyroid may have been (trying) to work for me, but was being blocked by the excess T4/rt3 perhaps?

All numbers for conversion look OK, as of last year:
Iron: 111 ug/dL (38-169)
Ferritin maybe was a bit low, 161 ng/mL (30-400).
AST (SGOT): 18 IU/L (0-40)
ALT (SGPT): 19 IU/L (0-44)
GGT: 14 IU/L (0-65)
Insulin: 6.7 uIU/mL (2.6-24.9)

I have not had any of the DIO2 gene testing. Have asked endo about conversion stuff, and have a conf with a friend's dad (Dr. Paul Tai http://www.fcachiro.org/index.php?option=com_content&task=view&id=6619&Itemid=62) to get his input.

 

[Vince Carter]

PM Vetesster Chris he's our resident Thyroid guru, give him a link to this thread.

 

[Vince Carter]

Did you get a diagnosis of Hashi's?

 

[munch520]

PM Vetesster Chris he's our resident Thyroid guru, give him a link to this thread.

will do thanks

Did you get a diagnosis of Hashi's?

yes, thanks to TPOab being habitually in the 200-220 range

 

[Vettester Chris]

Munch, thanks for posting thoroughly!! As you know, you're dealing with TPO enzyme autoimmune, it doesn't sound fun at all!!

One easy avenue to explore (I don't know if we've covered it in other threads/posts with you?) ... Selenium. Especially with TPO, it can have provide amazing results! I read a study where just 200mcg of Selenium dropped antibody levels by 44%. I'll see if I can dig that up ... If selenium deficient, I'm more on board with STTM, suggesting a protocol of 400mcg/daily. Selenium can be a game changer for just about anyone, from Sub Clinical Hypo to full-blown Hashis!!

As for meds, initially they will cause an adverse reaction, inflicting confrontation from your immune system to your thyroid gland, the old anti-TPO Army if you will. It's a bit confusing, but the autoimmune attacks can be mitigated and sometimes eliminated with titrating thryoid meds to an optimal level that can combat the attacks. 1 grain, 1-1/2 grains will just usually create more issues and raise antibodies.

STTM suggests 2 to 5 grains, and I've even read in other thyroid communities that no less than 3.5 grains is the ticket! FYI, 100mcg of Synthroid or Levo is = to 1 grain of NDT. You could even explore Cytomel (T3 only), which 25mcg would essentially equate to 1 grain NDT, or 100mcg of T4 synthetic.

With that said, I urge you not to just ramp up your NDT's, because you read it here, and then see how it goes. Research it a bit, talk with your doctor, research it more, make your decisions. However, with the elevated anti-TPO, just know it will have it's way if you do nothing! The attacks will come and go, and will likely get worse as you get older. I think the selenium thought can be implemented pretty easily if you haven't tried it?, but work tightly with a doctor that understands a thyroid treatment protocol to combat Hashis (or at least put it in the corner!)!!

Also, avoid the gluten ... That seems to aggravate the attacks even more! Keep us posted. Hope some of this helps

 

[ratbag]

STTM suggests 2 to 5 grains, and I've even read in other thyroid communities that no less than 3.5 grains is the ticket! FYI, 100mcg of Synthroid or Levo is = to 1 grain of NDT. You could even explore Cytomel (T3 only), which 25mcg would essentially equate to 1 grain NDT, or 100mcg of T4 synthetic.

Hi Chris,

Not questioning you but how do you arrive at that data? Are you assuming conversion in those numbers? Because NDT is usually 35mcg T4 and 8-9mcg of T3 per grain or per 60-65mg NDT tablets. The problem as I understand it is that no one converts the same. I too don't appear to convert T4 into T3. So I've always made the assumption that many people do not convert well and thats why NDT works so well because it has T3 in it. Now I take 25 cytomel and 200 synthroid and feel pretty good once I can get my iron into range.

 

[munch520]

Munch, thanks for posting thoroughly!! As you know, you're dealing with TPO enzyme autoimmune, it doesn't sound fun at all!!

One easy avenue to explore (I don't know if we've covered it in other threads/posts with you?) ... Selenium. Especially with TPO, it can have provide amazing results! I read a study where just 200mcg of Selenium dropped antibody levels by 44%. I'll see if I can dig that up ... If selenium deficient, I'm more on board with STTM, suggesting a protocol of 400mcg/daily. Selenium can be a game changer for just about anyone, from Sub Clinical Hypo to full-blown Hashis!!

As for meds, initially they will cause an adverse reaction, inflicting confrontation from your immune system to your thyroid gland, the old anti-TPO Army if you will. It's a bit confusing, but the autoimmune attacks can be mitigated and sometimes eliminated with titrating thryoid meds to an optimal level that can combat the attacks. 1 grain, 1-1/2 grains will just usually create more issues and raise antibodies.

STTM suggests 2 to 5 grains, and I've even read in other thyroid communities that no less than 3.5 grains is the ticket! FYI, 100mcg of Synthroid or Levo is = to 1 grain of NDT. You could even explore Cytomel (T3 only), which 25mcg would essentially equate to 1 grain NDT, or 100mcg of T4 synthetic.

With that said, I urge you not to just ramp up your NDT's, because you read it here, and then see how it goes. Research it a bit, talk with your doctor, research it more, make your decisions. However, with the elevated anti-TPO, just know it will have it's way if you do nothing! The attacks will come and go, and will likely get worse as you get older. I think the selenium thought can be implemented pretty easily if you haven't tried it?, but work tightly with a doctor that understands a thyroid treatment protocol to combat Hashis (or at least put it in the corner!)!!

Also, avoid the gluten ... That seems to aggravate the attacks even more! Keep us posted. Hope some of this helps

Hi Chris, thanks so much for the response.

I honestly have been lenient to go that high with any mess as my ft3/ft4 hormones have never been low and unmedicated were in the upper third of range...

I only take 70mcg of selenium now as part of a multi. I will ratchet that up to 400 and see what happens! You're spot on, I would like to address antibodies first as those are the beginning of this whole chain reaction, and with your help regarding this maybe I can do that, thereby lowering TSH.

I was recently also diagnosed with chronic sinusitis, and am going in for surgery to clean out sinuses and widen passages to promote draining. I get sinus infections monthly sometimes and I wonder how ouch of this chronic infection has juiced up my immune system.

I'm also lucky to have "Konodia MD" here in Columbus, and I'll be seeing him by the summertime to comprehensively go through diet and hopefully identify triggers I'm not even aware of.

Lots to consider! Thanks again for the help

 

[Vettester Chris]

Hi Chris,

Not questioning you but how do you arrive at that data? Are you assuming conversion in those numbers? Because NDT is usually 35mcg T4 and 8-9mcg of T3 per grain or per 60-65mg NDT tablets. The problem as I understand it is that no one converts the same. I too don't appear to convert T4 into T3. So I've always made the assumption that many people do not convert well and thats why NDT works so well because it has T3 in it. Now I take 25 cytomel and 200 synthroid and feel pretty good once I can get my iron into range.

No worries, it's kind-a confusing as you start getting into potency factors, as this will figure T3 to be 4x more potent than T4 (So an easy example on this method is taking Cytomel T3 at 25mcg x 4 is = 100mcg of Levo or Synthroid T4). NDT's can vary by manufacture a little, but Armour is at 38mcg of T4, 9mcg of T3 (x4 again) ... So that puts it around 74mcg, but I believe they also factor T2 and T1 into the mix ... Calcitonin is also in the breakdown, but not sure if that's attributed in the calculation? It's all approximations when it all settles out.

Here's a chart from a local compounding pharmacy in the LA area that gives you a snap-shot on some of the different meds ...

 

[sportsfan8724]

Chris do you think nature thyroid is better then armour thyroid? I've been hearing some top docs switching their patients over.