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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by twinmom on July 16, 2004, at 16:07:49
Ok - so I got resluts that show my tsh at 3.276 and my pdoc says that's perfectly normal, even though I have tons of signs for hypothyroid - I called to get an appointment with endocrinaolgist and the first avaiable appt is in OCTOBER!!
So - my question to you all - is there something I can do now to help my tsh level come down? Is there an OTC version of the meds?
Any information would be a great help.
BTW I am on zoloft (150mg) wellbutrin (300mg) depakote (1000mg) and risperdal (.5mg) - although the last 2 are new(within the last 6 monts) and for the life of me I cannot think of a manic period in my life - but my pdoc says bi-polar II.
Posted by Larry Hoover on July 18, 2004, at 11:31:21
In reply to TSH Levels and Thyroid Meds?, posted by twinmom on July 16, 2004, at 16:07:49
> Ok - so I got resluts that show my tsh at 3.276 and my pdoc says that's perfectly normal, even though I have tons of signs for hypothyroid - I called to get an appointment with endocrinaolgist and the first avaiable appt is in OCTOBER!!
>
> So - my question to you all - is there something I can do now to help my tsh level come down? Is there an OTC version of the meds?No, but you could try selenium (200 mcg/day). There are enzymatic conversions of the various thyroid hormones (T4 and T3 variants) which depend on selenium-containing enzymes. There's also another process that is inhibited by selenium, so it's rather a crapshoot. More likely to work for you than work against you, though.
> Any information would be a great help.
>
> BTW I am on zoloft (150mg) wellbutrin (300mg) depakote (1000mg) and risperdal (.5mg) - although the last 2 are new(within the last 6 monts) and for the life of me I cannot think of a manic period in my life - but my pdoc says bi-polar II.
>Mania and hypomania are not always pure highs. Irritability, sleep disturbance, certain types of hyperactivity, "noisy brain"....there are different kinds of mania.
Lar
Posted by KaraS on July 18, 2004, at 16:06:45
In reply to Re: TSH Levels and Thyroid Meds? » twinmom, posted by Larry Hoover on July 18, 2004, at 11:31:21
Larry,
What about l-tyrosine? Wouldn't that help to boost thryoid hormone production? (I don't know what other meds, if any, she is taking so I don't know if that would be a good option for her.)-K
Posted by Larry Hoover on July 18, 2004, at 16:26:23
In reply to Re: TSH Levels and Thyroid Meds?, posted by KaraS on July 18, 2004, at 16:06:45
> Larry,
> What about l-tyrosine? Wouldn't that help to boost thryoid hormone production? (I don't know what other meds, if any, she is taking so I don't know if that would be a good option for her.)
>
> -K
Doh! Yes, thank you. Yes, it would. In this instance, I'd target 2 grams/day, first thing in the morning, empty stomach.....and continue for 10 days, at a minimum. If an effect is noticeable, continue indefinitely. It would be synergistic with selenium.Lar
Posted by greenwillow on July 18, 2004, at 18:59:24
In reply to Re: TSH Levels and Thyroid Meds? » twinmom, posted by Larry Hoover on July 18, 2004, at 11:31:21
Lar,
Please explain in more layman's terminology what you are saying about thyroid and selenium. Just curious, as I take 200 mg. selenium daily. Thanks!
Posted by Larry Hoover on July 18, 2004, at 21:11:36
In reply to Re: TSH Levels and Thyroid Meds? » Larry Hoover, posted by greenwillow on July 18, 2004, at 18:59:24
> Lar,
> Please explain in more layman's terminology what you are saying about thyroid and selenium. Just curious, as I take 200 mg. selenium daily. Thanks!I'll do my best, but ask more questions if I miss the mark.
Thyroid hormone is assembled from two tyrosine molecules, and four atoms of iodine. That yields T4 (thyroid hormone, 4 iodine). T4 has few physiological effects, directly. Instead, it is really a pro-hormone (hormone precursor). An enzyme (called deiodinase) pulls off an iodine atom, and you get T3. You may be familiar with T4 (Synthroid, or levo-thyroxine) or T3 (Cytomel, thyroxine) by their drug names. T3 is active thyroid hormone.
The enzyme that converts T4 to T3 (deiodinase) requires selenium in its structure, or it cannot work. There is also another selenium-dependent enzyme that refreshes deiodinase, so it can do its job over and over again.
About 85% of the T3 that circulates in your blood is converted in the liver. Your thyroid gets first crack at selenium supplies, so it might be "unaware" that the liver is running short, and not doing the conversion very well. This is the state where selenium supplementation will have most benefit.
Selenium supplementation also positively affects autoimmune thyroiditis, by reducing anti-thyroid antibody levels. Again, selenium improves thyroid function.
However, selenium also reduces T4 synthesis somewhat. So, that kind of counterbalances some of the possible benefit, but the balance should still be to improve total availability of active thyroid hormone, T3.
Low thyroid could be a sign of iron deficiency. It could be sign of selenium deficiency. It could be a sign of iodine deficiency. It could be a sign of autoimmune thyroiditis. It could be a sign of tyrosine deficiency (most likely due to poor protein digestion, which declines with age). All these are affected by nutrient intake, so supplementation is something that can reasonably and safely be considered.
Iron status should be assessed by blood draw. Selenium status is most likely deficient, based on surveys of food intake. Very few people in the world get optimal selenium from food or water, and fewer still get too much. Iodine can be supplied by seafoods, or kelp tablets. Tyrosine is available as a pure amino.
Selenium does other very essential things in the body, so I'm none too concerned about recommending it.
Well, I'll leave it there, and take questions, if you have any.
Lar
Posted by KaraS on July 18, 2004, at 21:32:36
In reply to Re: TSH Levels and Thyroid Meds? » KaraS, posted by Larry Hoover on July 18, 2004, at 16:26:23
And you thought I was just a pretty face?
-K
Posted by tealady on July 19, 2004, at 4:30:32
In reply to TSH Levels and Thyroid Meds?, posted by twinmom on July 16, 2004, at 16:07:49
Hi Twinmom,
I haven't been reading here lately, so I don't know much about you. Hypo symptoms are the pits.
Few things
Firstly, when did you have these twins?
One can go a bit hypo after childbirth..and it is hopefully temporary.That's a reasonable wait time for an endo appointment.
If it was me, I'd start immediately on the selenium (200mcg for the 2 weeks..taken daily in the morning probably)then reduce to say 100 mcg daily (I'm assuming you live in ths US?)
..retest TSH, FT3, FT4 about 3 months after starting selenium.Next get a blood test for ferritin...this is a part of iron studies usually but can be done alone.
(probably needs to be above 50 for optimal thyroid function..and preferably around 70-80 ..acceptable range perhaps 65-95??)..this is NOT the same as "normal"... Note..rough guideline only..and only mentioned as "normal" is just too broad..(I think normal in Japan is over 50)Iron should not be supplemented without a blood test for ferritin first (unless on doc's advice..as in anemia).. too much iron is bad for you too...
Next..consider zinc..do you have any white spots on your fingernails? That's a telltale sign for me when I am low on zinc.
Latest studies indicate a TSH above a "3" should be treated ..but most endos probably would not do so.
Giving your test result , I'd try selenium first (and zinc if indicated)...as thyroid meds can be "hard" to take and its preferable if you an get your own thyroid to "function" better again.If they do help ..but not enough..try trysoine ..first thing in the morning on an empty stomach...as Lar mentioned I think..but I would say only 500mg per day with some B6 (preferable P5P B6..20-50mg max.) taken at breakfast together with the zinc(about 20mg per day) and selenium(60-100mcg daily) and probably a multiB as well for balance....then iron (if needed) with lunch.
Then calcium/magnesium at bedtime also..just to be sure<grin>.
Yeah, you HAVE to spread them out like this or one stops the other ...Another blood test worth doing is B12..but I think the endo will probably run that one. (and lots more too ..so make sure you get a photocopy or fax of your test results)
There's a few thyroid forums around if you are interested in more detailed info and help.
I think BarabaraCat has thyroid and bipolar?
Posted by tealady on July 19, 2004, at 5:08:43
In reply to Re: TSH Levels and Thyroid Meds? » twinmom, posted by tealady on July 19, 2004, at 4:30:32
Also have a read of this thread.. some old posts of mine in the thread listed below
http://www.dr-bob.org/babble/alter/20031204/msgs/289261.html
http://www.dr-bob.org/babble/alter/20031204/msgs/289577.html
http://www.dr-bob.org/babble/alter/20031204/msgs/290329.html
Posted by Larry Hoover on July 19, 2004, at 10:24:27
In reply to Re: TSH Levels and Thyroid Meds? - Larry, posted by KaraS on July 18, 2004, at 21:32:36
> And you thought I was just a pretty face?
>
> -KNever *just* a pretty face. ;-)
Posted by Cairo on July 19, 2004, at 14:39:58
In reply to Re: TSH Levels and Thyroid Meds? » greenwillow, posted by Larry Hoover on July 18, 2004, at 21:11:36
>
> Low thyroid could be a sign of iron deficiency. It could be sign of selenium deficiency. It could be a sign of iodine deficiency. It could be a sign of autoimmune thyroiditis. It could be a sign of tyrosine deficiency (most likely due to poor protein digestion, which declines with age). All these are affected by nutrient intake, so supplementation is something that can reasonably and safely be considered.
>
> LarA TSH level above 3 is now considered suspect, though some experts start looking at thyroid function above a TSH of 2:
http://www.thyroid-info.com/articles/aacereversal.htm
Also, anemia can be secondary to hypothyroidism, so it's important to see if the chicken or the egg came first.
Hypothyroid-like symptoms can also be due to hypofunctioning of the HPA (hypothalmic-pituitary-adrenal) axis, where you've got enough T3 and T4 and cortisol, but either there is a problem with the receptors or you can't mount enough to deal with stress.
I have discussed this issue at length with both my endocrinologist and Fibromyalgia specialist who say that giving T3 or T4 to someone in these hypofunctioning cases may bring about a short term improvement, but will eventually shut down the thyroid via negative feedback. SAme with giving cortisone to someone who looks Addisonian.
While there are certainly nutritional deficits that can cause these problems, me thinks there is a bigger problem upstream such as dysregulation of the stress sytem:
www.neurotransmitter.net/Gold.pdf
Deficiencies of nutrients may be secondary to stress and disease, rather than primary, though the reverse certainly may be true.
Cairo
Posted by Larry Hoover on July 19, 2004, at 16:45:26
In reply to Re: TSH Levels, posted by Cairo on July 19, 2004, at 14:39:58
> >
> > Low thyroid could be a sign of iron deficiency. It could be sign of selenium deficiency. It could be a sign of iodine deficiency. It could be a sign of autoimmune thyroiditis. It could be a sign of tyrosine deficiency (most likely due to poor protein digestion, which declines with age). All these are affected by nutrient intake, so supplementation is something that can reasonably and safely be considered.
> >
> > Lar
>
> A TSH level above 3 is now considered suspect, though some experts start looking at thyroid function above a TSH of 2:
>
> http://www.thyroid-info.com/articles/aacereversal.htm
>
> Also, anemia can be secondary to hypothyroidism, so it's important to see if the chicken or the egg came first.When you're dealing with systems so tightly under feedback regulation, is it not true that all aspects, and all interventions, are both chicken and egg simultaneously? In other words, isn't it arbitrary to define a point of intervention, when you will ultimately have that intervention feed back to the point of origin?
> Hypothyroid-like symptoms can also be due to hypofunctioning of the HPA (hypothalmic-pituitary-adrenal) axis, where you've got enough T3 and T4 and cortisol, but either there is a problem with the receptors or you can't mount enough to deal with stress.
Enough of what?
> I have discussed this issue at length with both my endocrinologist and Fibromyalgia specialist who say that giving T3 or T4 to someone in these hypofunctioning cases may bring about a short term improvement, but will eventually shut down the thyroid via negative feedback. SAme with giving cortisone to someone who looks Addisonian.Which is exactly why I happen to lean first towards nutrient manipulation. If the system can be stabilized by enhancing the availability of certain key substrates, exogenous hormone treatments might be precluded altogether. I know of no instance of nutrients over-regulating a dysregulated system, short of toxic effects due to ill-advised megadoses. Instead, if the system has the capacity to stabilize, it simply does so.
Of course, I am not meaning that nutrients might compensate for e.g. tumours of the hypothalamus or pituitary. Of course, a thorough work-up is indicated.
> While there are certainly nutritional deficits that can cause these problems, me thinks there is a bigger problem upstream such as dysregulation of the stress sytem:
>
> www.neurotransmitter.net/Gold.pdf
>
> Deficiencies of nutrients may be secondary to stress and disease, rather than primary, though the reverse certainly may be true.
>
> CairoIn either case, is not supplementation warranted? Do you believe it would be ill-advised to consider supplements while awaiting the endo appointment? I'm unclear on that element of your comments.
Lar
Posted by Cairo on July 23, 2004, at 9:10:10
In reply to Re: TSH Levels » Cairo, posted by Larry Hoover on July 19, 2004, at 16:45:26
>>
> > Deficiencies of nutrients may be secondary to stress and disease, rather than primary, though the reverse certainly may be true.
> >
> > Cairo
>
> In either case, is not supplementation warranted? Do you believe it would be ill-advised to consider supplements while awaiting the endo appointment? I'm unclear on that element of your comments.
>
> LarI'm just wondering if vitamins/supplements could skew the results of lab tests that might be necessary for diagnosis or if they could potentially make a situation worse, such as stimulating the thyroid when you already have high cortisol levels.
What do you think?
Cairo
Posted by tealady on July 23, 2004, at 19:21:58
In reply to Re: TSH Levels » Larry Hoover, posted by Cairo on July 23, 2004, at 9:10:10
Hi Cairo.
If they work that's exactly what you want to happen..think about it?
BTW I do agree with all your posts too..
Also have a read thru the links I gave in the posts above..and their links. (especially the ones on the thyroid forum..your quote is actually from the same forum..site home)
More later..have to rush out now
Posted by Larry Hoover on July 24, 2004, at 7:32:32
In reply to Re: TSH Levels » Larry Hoover, posted by Cairo on July 23, 2004, at 9:10:10
> > In either case, is not supplementation warranted? Do you believe it would be ill-advised to consider supplements while awaiting the endo appointment? I'm unclear on that element of your comments.
> >
> > Lar
>
> I'm just wondering if vitamins/supplements could skew the results of lab tests that might be necessary for diagnosisI think it curious that you say skew. Then diagnosis or medication would not be needed? Helping the body work better, with a goal to avoiding hormone supplements, is my hope. There is no hormone supplementation regime which even comes close to matching the pattern and sensitivity of normal hormone release. I would not wish that "treatment" on anyone, if it can be avoided.
> or if they could potentially make a situation worse, such as stimulating the thyroid when you already have high cortisol levels.
>
> What do you think?
>
> CairoWell, if somebody made the situation worse, we wouldn't likely know, as no test series had yet been conducted.....but I again will state that I know of no such cases, except those where extraordinary and toxic intakes of supplements have occurred. (As there are always conditions underlying statements I make, I will say that some people have very "fragile" thyroid function, akin to "brittle" diabetics, and what might be a minor intervention in others might lead to exaggerated disturbance in the "fragile" members....but you only learn that by 'doing the experiment'.)
That's my philosophy, applied to this case.
Lar
Posted by BarbaraCat on July 24, 2004, at 12:24:20
In reply to Re: TSH Levels and Thyroid Meds? » twinmom, posted by tealady on July 19, 2004, at 4:30:32
> I think BarabaraCat has thyroid and bipolar?
>
**What a good memory, TeaLady! I certain do and am. My thyroid has not been helped at all by lithium, as my TSH tends to bounce all over the place. I take 200mcg selenium, 500mg Tyrosine for it, along with all the other nutrients, fish oil, etc. etc. Getting daily aerobic exercise is important too.My recent thyroid test showed TSH at 8.5. No wonder I was feeling like crap. Since increasing my thyroid meds I feel much better. My fibrmyalgia symptoms improve greatly when my thyroid is levels are optimal - for me, TSH around 1.5. I take 1/2 natural thyroid and 1/2 synthetic.
As far as levels within 'normal range', my feeling is that anything over 2.0 is borderline, especially if one has a mood disorder. One has to ask the question, however, if it's wise to supplement a still functioning thyroid gland with an exogenous source of the hormone and risk suppressing the gland's functioning. I would try everything else (besides thyroid hormone) first to try to lower the TSH and, most importantly, start feeling better. That said, in a true hypothyroid condition, there is no substitute for supplementing the hormone and I'm resigned to it being a lifetime commitment.
**Also, interesting you mention high iron levels. My recent lab work showed that my iron is high. Not many people are aware of the very serious dangers of this condition and how prevalent it is. One of the symptoms is 'psychological disturbances', as the iron can deposit in the brain, as well as other organs (the liver is a favorite). Hah! yet another addition to my long list of possible culprits. Men and post-menopausal women are at risk. Frequent blood giving is the only way to reduce these levels.
I strongly encourage you all to do a search on 'excess iron' or 'hemochromatosis', which is the more serious genetic disease form of it. Don't assume you have 'iron poor blood' or need iron in your multi-vites, and have your doctor run a ferritin test, especially if you're in the at risk population. - BarbaraCat
Posted by Cairo on July 24, 2004, at 19:18:49
In reply to Re: TSH Levels and Thyroid Meds? » tealady, posted by BarbaraCat on July 24, 2004, at 12:24:20
> **Also, interesting you mention high iron levels. My recent lab work showed that my iron is high. Not many people are aware of the very serious dangers of this condition and how prevalent it is. One of the symptoms is 'psychological disturbances', as the iron can deposit in the brain, as well as other organs (the liver is a favorite). Hah! yet another addition to my long list of possible culprits. Men and post-menopausal women are at risk. Frequent blood giving is the only way to reduce these levels.
>
> I strongly encourage you all to do a search on 'excess iron' or 'hemochromatosis', which is the more serious genetic disease form of it. Don't assume you have 'iron poor blood' or need iron in your multi-vites, and have your doctor run a ferritin test, especially if you're in the at risk population. - BarbaraCat
BC,Do you have hemachromatosis, which is inherited? And you are correct in saying that a TSH above 2 is suspect, as the American College of Endocrinologist finally acknowledged formally (above 3). I only wish that bringing my TSH down to helped my FMS. I don't feel any different on Unithroid.
I think FMS is a catch-all diagnosis, presenting differently in different people. Just as cancer therapy is getting away from labels such as breast cancer and liver cancer to the actual cell types (which can be found in any part of the body), there are subtypes in FMS too!
BTW, how's your growth hormone level?
Cairo
Cairo
Posted by Cairo on July 25, 2004, at 8:50:50
In reply to Re: TSH Levels and Thyroid Meds? » tealady, posted by BarbaraCat on July 24, 2004, at 12:24:20
BC,
Anemias and excess ingestion can cause iron overload:
http://www.cdc.gov/hemochromatosis/training/pathophysiology/iron_overload.htmhttp://www.irondisorders.org/disorders/sba/
"Acquired sideroblastic anemia is due to prolonged exposure to toxins like alcohol, lead, drugs or nutritional imbalances such as deficiency in folic acid, deficiency in copper or excess zinc. Other causes are due to disease such as inflammatory conditions like rheumatoid arthritis, cancerous conditions such as leukemia, lymphoma; kidney disorders causing uremia; endocrine disorders such as hyperthyroidism; metabolic disorders such as porphyria cutanea tarda. Acquired SA is usually seen in patients over 65 year of age but it can be present as early as mid to late fifties."Cairo
Posted by BarbaraCat on July 25, 2004, at 14:01:41
In reply to Re: TSH Levels and Thyroid Meds? » BarbaraCat, posted by Cairo on July 24, 2004, at 19:18:49
>
> >> BC,
>
> Do you have hemachromatosis, which is inherited?**I haven't had the genetic sequencing test. HMO is too cheap. It's a watch and see thing for them. I am going to donate blood in the meantime.
>>And you are correct in saying that a TSH above 2 is suspect, as the American College of Endocrinologist finally acknowledged formally (above 3). I only wish that bringing my TSH down to helped my FMS. I don't feel any different on Unithroid.
**Yes, 2 and below are considered optimal. It was a huge admission for them to admit 3. You may need to add the T3/natural for a while if you're not getting a good response. Seems to kick start things. Also depends also on how long you've been on it. It effects deep change very slowly. Try taking 500mg L-Tyrosine. And DON'T take any meds with grapefruit juice! It interferes with the Cytochrome P450 enzyme, causing unpredictable results. But you probably know all this.
>
> I think FMS is a catch-all diagnosis, presenting differently in different people. Just as cancer therapy is getting away from labels such as breast cancer and liver cancer to the actual cell types (which can be found in any part of the body), there are subtypes in FMS too!**I'm seeing that although symptoms may present differently based on in heritance and culture, when you get right down to the nut of it, it's all very similar. Body aches, stiffness, anxiety, insomia, fatigue, dropsies, clumsy, ouch, hurts! Super sensitive pain perception.
My personal feeling is that it's a faulty mixture primarily of a circadian disorder that results in disordered sleep phases. This may be the result of damaged hypthalamus and hippocampal structures, the damage caused by too much stress hormone (proably glutamate). Whatever stories or reasons we got there, we struggle from the outcome of dysfunctional brain and hormonal systems that ain't working right. I don't know how Substance P plays into this except it's a confirmation of the hypersensitive condition. I'm convinced our alarm systems, our amygdalas, are hardwired for alarm and hypervigilance. This can make you very tired. All the hormones get out of whack. The pituitary loses its ability to direct the show. That's why Dr. John Lowe talks about thyroid being the culprit. It is only one of many and he has to look farther upstream for the source.
My IG-1 levels were nill. I've been taking HGH shots each morning for about a year. I'm doing a test right now and have stopped taking them 'just to see'. There was nothing I could put my finger on and say 'Hey, this stuff is working'. At $200 bucks a month I was hoping to be able to say that with conviction. Time will tell. If my mirror starts looking like the piture of Dorian Gray, I'll probably start taking puncturing myself again. - BarbaraCat
> BTW, how's your growth hormone level?
>
> Cairo
>
> Cairo
>
>
Posted by Cairo on July 25, 2004, at 21:35:55
In reply to Re: TSH Levels and Thyroid Meds? » Cairo, posted by BarbaraCat on July 25, 2004, at 14:01:41
> My personal feeling is that it's a faulty mixture primarily of a circadian disorder that results in disordered sleep phases. This may be the result of damaged hypthalamus and hippocampal structures, the damage caused by too much stress hormone (proably glutamate). Whatever stories or reasons we got there, we struggle from the outcome of dysfunctional brain and hormonal systems that ain't working right. I don't know how Substance P plays into this except it's a confirmation of the hypersensitive condition. I'm convinced our alarm systems, our amygdalas, are hardwired for alarm and hypervigilance. This can make you very tired. All the hormones get out of whack. The pituitary loses its ability to direct the show. That's why Dr. John Lowe talks about thyroid being the culprit. It is only one of many and he has to look farther upstream for the source.
- BarbaraCat
Sleep disorder in FMS is probably due to HPA axis dysfunction:http://www.endotext.org/adrenal/adrenal31/adrenalframe31.htm
Inhibition of substance P may help as an adjunct for pain in some cases. It's too bad that
aprepitant was not approved for depression, as that would probably have lowered the price since it would have been used chronically and they couldn't justify charging $80 per tablet as they do for Emend (approved for chemotherapy induced nausea).As I get some relief from Neurontin, though I need drug holidays from it, I'll be eager to try Pregabalin which I understand will be available later this year.
Meanwhile, I'm using our heated pool every day and it helps with stiffness. My recent MRI just came back with disc bulging at C4-5, so I'll need to take care of that as it's feeding the pain cycle. But I surmise that HPA axis dysfunction has contributed to that also via inflammation and mechanically.
Cairo
Posted by BarbaraCat on July 27, 2004, at 22:27:24
In reply to Re: TSH Levels and Thyroid Meds? » BarbaraCat, posted by Cairo on July 25, 2004, at 21:35:55
Thanks for the link, Cairo. Looks very interesting. I'm recently trying low dose naltrexone. You can check it out at http://www.lowdosenaltrexone.org. The short theory is that suppressing the opiod pathway by a low dose opiod antagonist creates a spike, revs up, kicks in the seat of the pants, the old endorphins. So far, after 3 nights at 4.5mg I can definitely sense a lessening in my pain symptoms.
Not so much in the depression arena, however. Of course, that may be due to the fact that we're having to put down one of our beloved cats tomorrow cause he's so sick. Sigh. I do wish this life made more sense. - Barbara
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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